Jean McMillan

So, what is your question? Are you asking if your band's increased tightness is related to eating under 1000 calories a day? If so, I doubt it. There are lots of things that can cause variations in your experience of restriction. Time of day, time of month, hydration, seasonal allergies, illness, medications, Fluid retention, stress, etc. etc. If the only consequence of this increased tightness is that you get full faster, that's great, but if you find you're unable to meet your nutritional goals each day and/or are unable to drink liquids, give your surgeon a call.

Could be esophageal spasms, but since chest pain can also be a cardiac symptom, call your surgeon and go to the ER.

Been there, done that, and didn't even get a tee-shirt. Like you, I found that my experience of restriction was different after a complete unfill, and a lot of people find the last 20 or so pounds hard to lose. IMO, the most important thing to address is not your weight gain but the reflux. I recently learned how severely reflux can damage the esophagus and wouldn't want you to lose your band because of tolerating reflux for an extended period of time. Have you tried taking omeprazole for it? Do you avoid eating a few hours before bedtime? As for the weight loss puzzle - I just wrote an article about breaking a weight loss plateau. Check it out here: http://www.lapbandtalk.com/page/index.html/_/plateaus-and-regain/breaking-a-weight-loss-plateau-r67

Why do plateaus happen even when we’re doing all the right things? The human body wants to preserve itself. It fights weight loss by adapting the metabolism to accommodate decreased calorie intake and/or increased calorie output. The body's new plan of attack is multi-pronged: increase calorie intake by making you hungrier (so you eat more), use less energy to accomplish physical activity (so you burn fewer calories) and hold on to stored fat (so it can use it for energy). I think plateaus often happen because we're in a rut. So even if you believe you're doing all the right things in terms of diet, exercise, and mental or emotional effort - try changing them. If nothing else, it will prevent boredom and help you feel that you're taking positive action instead of being a victim of fate. Here are some things you can try to shake up your routine. Change the intensity, duration, frequency and type of exercise you're doing, so your body doesn't become too efficient at burning calories when you work out. Don't neglect strength training - muscle burns far more calories than fat does. Don't over-train - take one day off exercise a week. Plan all your meals (the "how much" as well as the "what"). Weigh and measure your food before you put it on your plate. Log your food intake - you might be surprised to see what and how much you're really eating. Try calorie shifting: vary your calories - eat 1200 one day, 900 the next, and so on, to keep your body guessing. Eat 3 small meals and 3 healthy snacks a day instead of 3 meals a day. Increase your water intake. Decrease your sodium intake. Don't weigh yourself every day - switch to once a week. Don't skip breakfast. By the way, if you weigh yourself every day and think that no weight loss for three days running is a plateau, you're going to have a long journey ahead of you. Get off that scale, now! I have one more suggestion that you probably won't want to hear: CULTIVATE PATIENCE. No, it's not one of my virtues, either. Give it a try anyway.

I know that delayed restriction and slow weight loss are frustrating, but I don't think it's fair to say that they mean your surgery was a waste of time. You're young (compared to me!) and have a long lifetime ahead of you (God willing). If you could lose your excess weight and keep it off for the rest of your life without surgery, then maybe surgery would be wasted time & effort, but if you could do that, wouldn't you have already done it by now? The band is a tool for lifetime weight management.

Welcome, Gregg, and congrats on being banded. Everybody's pain tolerance varies. I've been told that bandsters who had a hiatal hernia repaired during their surgery experience a bit more pain because of the work done on the diaphragm. That work on the diaphragm, plus the gas used to inflate the abdominal cavity during surgery, can cause quite a bit of pain in addition to any discomfort from incisions. Some of that pain can be "referred" to the left shoulder due to quirks in the nerves in the upper GI tract. I found that moving around a lot (which also helps prevent blood clots) was the ony thing that helped the gas, but some people have found that Gas-X helps with that. I did OK sleeping in my own bed, propped up with LOTS of pillows, but if you're more comfortable sleeping in a recliner, you won't be alone. Lots of folks sleep that way when recovering from surgery. When you're sleeping in your own bed, what body position do you favor? I'm a side-sleeper so I clutched a big bed pillow to my tummy and leaned on it a bit to find a comfortable position. If you're a tummy sleeper, you may be out of luck for the moment. If you sleep on your back, you should be OK except when trying to get in and out of bed. My technique for that is: GETTING INTO BED: 1. sit on the edge of the bed at the approximate point where your butt would be if you were asleep in it, turned slightly so that you're looking at the foot of the bed. 2. using your arms to brace yourself, fall as gently as possible onto your back, then wiggle as necessary, holding a pillow against your abdomen if need be, until you're more or less in your desired sleeping position. GETTING OUT OF BED: 1. Holding a pillow against your abdomen, roll onto your side so that you're facing the edge of the bed. 2. Bend your legs so they're right at the edge of the mattress. 3. Use your body weight to lean forward so you "roll" off the bed onto your slightly-bent legs, and slowly stand up when your feet hit the floor. I think I need to make a video of that method because words don't seem to do it justice! Finally, about the pain medication. Narcotics are wonderful, but the limitations are that it's constipating and it's depressing. It depresses your respiration and your nervous system. For me, that results in low energy and a depressed mood. So at some point pretty soon you'll want to start cutting back on the pain meds. Your doctor's the best one to tell you how to do that. What I did was start spacing the doses out further apart, then took half the dose each time, then took a dose only once a day, then none at all. You shouldn't be driving a vehicle while on pain meds so that might be an additional incentive for you to taper off them. Hope you feel better soon!

Helen, You may be able to avoid (or at least minimize) future brou-ha-has about your articles by including a disclaimer before or after the article text. Here in the litigious USA, even highly qualified medical experts find it necessary to use the language shown below when publishing material aimed at end-users, patients, or consumers: The information contained herein is intended solely for the general information of the reader. It is not to be used for treatment purposes, but rather for discussion with the reader’s own physician. The information presented is not intended to diagnose health problems or to take the place of professional medical care. It is neither intended to dictate what constitutes reasonable, appropriate or best care for any given health issue, nor is it intended to be used as a substitute for the independent judgment of a physician for any given health issue.

Helen's beliefs about drinking while eating are shared by Terry Simpson, MD, an American gastric band expert. http://azlapband.com/blog/what-we-know-from-successful-band-patients/ If you read through his article, you'll find this statement: Drinking and eating Successful patients eat and drink at the same time. We use to think this wasn’t a good idea, and some patients from those days don’t eat and drink at the same time- and tell us it makes a difference.

Helen didn't post it as a separate thread. The LBT system does that automatically.

I haven't heard of taking calcium to prevent hair loss. Calcium supplements are important for bone health (especially for women), but it's Biotin that's most commonly recommended for hair loss.

I also wish I had known how long it would take to feel some restriction. My (unbanded) nutritionist had told me I wouldn't be hungry after surgery, but I was very hungry, and it took several fills for me to start feeling like my band was really working.

By all means, read Helen's excellent PDF, but the short version is that the presence of the band against the upper stomach, and the action of the stomach as it contracts and expands to break down solid food and move it south, triggers the vagus nerves in the upper stomach to send satiety signals to your brain.

Helen, Thanks for sharing that PDF. While I still have concerns about drinking while eating, I had to laugh when I saw your funnel diagram because it's so similar to the diagram I created for the chapter in Bandwagon on how the band works. Surely this proves that agreement and disagreement can co-exist without obliterating a common truth!

Here's another week's worth of dinner menus. Some of the recipes used come from my cookbook, Bandwagon Cookery, so the page numbers are included. Bon appetit! SUNDAY Butternut, barley & sausage stew (p.173) Leafy green salad (try the creamy raspberry salad dressing on page 184) MONDAY Tasty chicken tenders with ranch dipping sauce (p.253) Broccoli & Apple slaw (p.192) TUESDAY Oriental pork chops (p.267) with tahini yogurt sauce (p.144) Mashed plantain with onions (p.333) Mango-avocado-cherry salad (p. 198) WEDNESDAY Easy seafood Newburg (P.281) Brown rice Herbed mushroom salad (p.196) THURSDAY Broccoli crust pizza (p.232) Jicama & cucumber salad (p.197) FRIDAY Chicken & Fruit Sate with peanut dipping sauce (p.162) Roasted chickpeas (p.151) SATURDAY Ham & sweet potato patties (p.263) w/ the Devil & Miss Dole sauce (p.142) Hot Coleslaw (p.304)

I'm so glad you liked it!

Although I disagree with Helen's suggestion that it's OK to drink while eating, I want to mention something that isn't part of her article. Usually each magazine article is followed by an author info blurb, in which the author's credentials and/or position are described. But because of site updates that are now underway, this info isn't being included and as a result, members reading Helen's article may be unaware that she is a dietitian, presumably qualified to talk about bariatric nutrition, and she's located in Australia, where the adjustable gastric band has been in use a lot longer than in the USA.

This is a big topic with a zillion possible answers. First of all, what do you mean by "upper stomach"? Do you mean your upper abdomen (under your breasts) or your upper stomach (between your breasts)? Getting sick (or what we call a PB - productive burp or regurgitation) can be the result of many things. The food might not agree with you, or may need to be cooked differently (moist is always better). Maybe you took bites that were too big, ate too fast, didn't chew well enough? I wouldn't ditch a food altogether based on an early experience of an eating problem with it, but the next time you eat that food, pay very, very close attention to your eating skills. If you still have a problem, then you'll need to set that food aside, at least for a while. Different bandsters can tolerate different foods at many different stages (and times of day, and times of month) of the WLS journey. You might be able to eat a piece of toasted bread tonight, but not tomorrow morning. So, proceed with caution!

Very interesting, and completely opposite to what I heard at seminars at the Obesity Help conference in Seattle last July. Several bariatric professionals, including Ross McMahon, MD, medical director of Swedish Weight Loss Services, stated that failure to separate intake liquids and solids (in other words, drinking while you eat) is one of the most common causes of failure to lose weight in all types of bariatric patients (band, bypass, sleeve, DS).

Again, I'm sorry that you've had to go through this, but it sounds to me like you have your head on straight and I have the feeling that you're going to beat this. And I agree, doing something is better than doing nothing at all. I'd rather make a bad decision than no decision.

It'd be hard to match a saga like yours. I haven't heard many like it. It's ridiculous that your troubles were allowed to go on so long without appropriate treatment, but right now I think getting that band out of you is priority #1. I had my band removed recently because of damage that my band and/or reflux had caused my esophagus. Like you, I was told that aspiration of stomach contents into the lungs was a serious risk for pneumonia. Like you, I wanted to revise to the sleeve in the same procedure as my band removal, but it didn't happen because of a stricture at the base of my esophagus. When I went for my 2-week post-op visit, my surgeon said that I can have the sleeve revision eventually, when the stricture is fixed, but that the scar tissue I have from my band and other abdominal surgeries will make it a challenge (but not impossible). In your case, I think that waiting a while and letting your poor innards heal and rest would be the best course of action. Good luck!

I think trying to peel a cherry or grape tomato would be a good punishment for someone who had wronged me. I suggest that you try eating one, unpeeled. If it doesn't give you any problems, eat another one. Also, at times I've had to cut cherry or grape tomatoes in half in order to eat them. so you could try that. I started out doing weight training and cardio. About a year ago I added PIlates to the mix and I think it's given me better muscle definition. Since some Pilates moves (and Stott Pilates machines) use the weight and resistance of your own body, I imagine it can build muscle the same as weight training, but I don't know which is better at it. Maybe a personal trainer or other fitness professional could tell you that.

I wonder if you're body is still adjusting to the big weight loss during your pre-op diet. What do your surgeon and nutritionist have to say about it? Has your thyroid function been checked lately?

Your surgery is tomorrow! Are you ready? Do you have a list of last-minute things to do before you leave for the hospital or surgery center? Have you packed your bag yet? What to Take to the Hospital or Surgery Center This isn't like packing for a two-week vacation. Most hospitals prefer that you bring a minimum of belongings with you and don't want to be responsible for keeping track of them. You'll need less than you'd think. The hospital will want you to wear their gown instead of your own nightgown or pajamas, and you can wear an extra hospital gown backwards to use as a robe so you won't moon anyone when you're roaming the hallways. If you're allowed to shower while you're there (you may not be), they'll provide soap and shampoo. If your feet get cold, the nurses will give you very attractive one-size-fits-few socks with non-slip soles. Here's what I suggest you bring: Insurance ID card Photo ID A copy of your advance health care directive CPAP machine (if you use one) A list of your medications (you may be instructed to bring the actual meds with you) Lip gloss (your mouth & lips will be very dry) Toothbrush, toothpaste and essential toiletries Cosmetics (if you must) IPod or MP3 player Laptop computer (if you must) Something to read (magazines, books, Bible) Loose-fitting clothing (elastic waist) A change of underwear Slip-on shoes or sandals Pillow(s) for the ride home A water bottle for the ride home Bring your cell phone if you like, but some hospitals don't allow use of cell phones on the premises because of possible interference with patient monitoring equipment. Do not bring cash or valuables. The medical staff is there to take care of you, not your engagement ring. Last Minute Things to Do 1. Have someone take Before photos of you (front, back, and side views). 2. Take your body measurements (neck, bust, waist, abdomen, thighs, calves, ankles, upper arms, wrists). 3. Set aside a pre-op outfit of fat clothes to preserve for posterity. 4. Put clean sheets on your bed. 5. Do laundry. 6. Clean your house. 7. Arrange for transportation to and from the hospital. 8. Arrange for child care. 9. Arrange for pet care. 10. Pay your bills. 11. Fill your prescriptions (your usual meds, plus pain-killers, anti-nausea meds and/or blood thinners for after surgery if your surgeon’s willing to prescribe them in advance). 12. Pack your bag for the hospital. 13. Complete & submit any forms your employer requires for your time off from work. 14. Pick up books to read and videos to watch while you recover. 15. Make sure there's easy-to-prepare food in the house for your family to eat. 16. Do your bowel prep if required (laxatives or enema). 17. Check your supplies: § The liquids you'll be allowed to drink in the first week § A blender or Magic Bullet® § Liquid Tylenol § Thermometer § Gas-X® § A heating pad § An ice pack (or a bag of frozen vegetables) § Witch hazel or anti-itch gel (to put on the skin around your itchy incisions, but not directly on the incisions) § Reading material, puzzles, games 18. Remove nail polish (if you wear it) from fingers and toes. 19. Remove all jewelry (including piercings) and put it in a safe place[1]. 20. Bathe with Hibiclens (or other antibacterial cleanser) as instructed by your surgeon. Almost without exception, bandsters’ response to this is that every item on the list is a good idea except items 1 and 2. Some also whine about items 17 and 18, but I’m not interested in hearing what dreadful thing will happen to you if you must undergo surgery while completely unconscious and denuded of your nose stud and blue fingernail polish. Save it for the pre-op nursing staff. I just want to reinforce items 1, 2 and 3. You may hate the camera and the measuring tape with a passion, but some day you’re going to be glad you have those pre-op photos and measurements. Similarly, you may plan to burn that fat outfit in a celebratory bonfire soon, but one day you’ll be glad you saved it. When your bathroom scale is stuck at on a number you hate, comparing your “now” photos, measurements, and clothing to those awful “befores” will remind you of just how far you’ve come, and give you a little push forward on the bandwagon trail. [1] This is not negotiable. I once had my wedding ring cut off by a nurse before she would transport me to the operating room.

Remember this? “I’m strong to the finish ‘cause I eats me spinach. I’m Popeye the sailor man!” Growing up, I watched Popeye guzzle cans of spinach to instantly restore and increase his legendary strength as he battled his enemies and courted the thin, homely Olive Oyl. I didn’t identify much with Popeye or Olive Oyl – I was more like the portly J. Wellington Wimpy, who would gladly pay you Thursday for a hamburger today. But like millions of other children, I did get the message that spinach was good for me. Magically good! And if eating spinach could help me prevail in the endless fights I had with my brother, it was worth a try. I never did win a battle with my brother, but I ate my spinach and actually liked it. Not canned spinach like Popeye’s (the very sight of canned spinach is revolting), but frozen chopped spinach, boiled, drained, and covered with melted Velveeta cheese. When asked if he liked spinach, Popeye replied, “I hates it.” He might have liked my favorite cheesy spinach better, but clearly he was taking his spinach like medicine at a time in history when medicine always tasted terrible. The worse the taste, the more potent it was. Spinach didn’t give me bulging Popeye muscles (or, thankfully, his speech impediment), and since I hated gym class and avoided exercise as much as possible, I didn’t develop any more than minimal strength and endurance. When I reached puberty in the 1960’s, women’s liberation and the concept of a strong, independent woman were still quite new. My macho first boyfriend thought women shouldn’t be allowed to drive a car, never mind lift something heavy. As I wrote in Bandwagon, my parents scorned President Kennedy’s physical fitness advocacy and encouraged intellectual rather than physical strength. The exercise programs and studios I tried in the 1970’s and 80’s prescribed exercise for weight loss and toning; the dance classes I took taught me about form, agility and flexibility; but never did I hear any messages about strength. Perhaps I wasn’t listening very well. I thought that weight lifting would turn me into a muscle-bound freak like the ones I occasionally saw on television. As an adult married woman, I’ve had a tall, strong husband to open jars, change flat tires, take out the garbage, and reach things stored on high shelves (he claims that’s why I married him, when in fact it was his dog, not his brawn that captured my heart). That allowed me to reserve all my meager strength for the herculean task of moving my obese body from my arm chair to the kitchen and back. It wasn’t until I had weight loss surgery at age 54 that I learned about the value of muscle during weight loss. That was the first time ever that I heard that muscle burns calories faster, and takes up less room, than fat. The theory sounded good, but for my first post-op year I focused on cardio exercise because an online calculator showed that I could burn almost three times more calories doing an aerobic dance class than the same time spent weight training. I worked out faithfully, walking and doing a variety of cardio classes, and reached my weight goal, but I was still a weakling… a scrawny weakling instead of an obese one, a weakling who could wear a size 10 but struggled to pick up a 10-pound bag of dog kibble. Here at the 9 Dogs Howling ranch, that’s a serious deficit indeed! Eventually I got bored with my workout routine. To add more variety and challenge to my exercise, I began working with a personal trainer when I was 20 months post-op. My trainer taught me lots of moves with free weights and weight machines, some of which I grew to hate, but after about three months of our weekly sessions, I began to notice some muscle definition in my flabby arms. Nothing like Popeye, but there before me was proof, visible to the naked eye, that I actually had some muscles underneath that sagging skin. Even after I stopped working with my personal trainer, I kept working at strength training, hoping to see more and more muscles. All that effort was in the service of my vanity, you understand. I just wanted to look “ripped” and it didn’t occur to me that strongly-defined muscles could be pressed into service at home (lifting dogs as well as dog food bags) and at work (lifting boxes, shifting heavy display fixtures, climbing stock room ladders). Gradually I came to realize that I was getting physically stronger. I could no longer claim to be a “delicate flower of womanhood” like Scarlett O’Hara. That turned out to be no terrible loss. It turned out that being strong(er) was as good for my insides as my outsides. Not only was strength training helping make my bones and muscles stronger, it was making my mind and heart stronger. Instead of being afraid to try something new, I just went ahead and did it, and even if I brought absolutely no skill to the task, I had enough strength of mind and body to tough it out. Early in 2010 I joined a new fitness studio, one with Stott Pilates machines instead of weight machines. At first I worried that I would lose muscle definition without weight machines as part of my workouts, but in fact my muscle definition improved all over my body and especially in my legs. In late summer 2010, I did some personal training with the owner of the studio. Her first step was to give me a fitness evaluation. I had to do push ups, step ups, toe touches, and other moves to evaluate my strength, agility, flexibility and cardio fitness. Much to my (happy) surprise, I scored above average for my age in most of those areas. Just the process of being tested was a revelation, because each time Caroline instructed me to do a new move, I did it without any anxiety or hesitation about whether or not I’d be able to do it. Since then, I’ve thought many times about the importance of fitness and strength to an average, everyday woman like me. Not an Olympic athlete, not a dancer, not a ditch digger, not a materials handler, just Mrs. Middle Aged American. Although I admire my late mother and aspire to be like her in many ways, I don’t want to end up the way she did after a lifetime of avoiding exercise. She was only in her early 70’s when she began to struggle with little tasks that most of us take for granted. Dressing herself, picking a pen off the floor, getting out of a chair, walking from her apartment to the elevator, opening a door, all of that was too hard for her. She had never claimed to be a delicate flower of womanhood, either. She was one of the most capable and energetic people I’ve ever known, but she never took care of her body and in the end, her body failed her. I’ve vowed that I won’t let that happen to me. I’m going to keep this body moving, or die trying, and that’s got to be a better way to go than lying helpless in bed while an attendant maneuvers a straw into my mouth. I hope that in 20 years when I’m 78, I’ll enjoy sitting in a rocking chair beside my husband for a while, and then getting up to kick ass in an exercise class.

Yes, that's normal. The anesthesia is still working its way out of your system, you've got some incisions, and in a sense your body's been through a trauma during surgery. Please stay as active as you can, even if you can only walk for 5-10 minutes at a time, in order to prevent blood clots.