Jean McMillan

Oh yes, highly recommended!

As Elcee said, full with the band is qutie different than without it, and if you keep eating because you're looking for your old "full" feeling, you'll get into trouble. You'll need to focus on satiety instead of fullness. Satiety is the feeling of having eaten enough food for now. Mentally you may be thinking that you need or want more than a small portion, but if you pay attention to how your body feels, eventually you'll notice new satiety signals - a hiccup, sigh, burp (or need to burp), sneeze, runny nose, fullness in the back of the throat, the urge to cough or clear your throat.

I'm hoping you feel better by the time you see this. There isn't much you can do when something like that happens except wait for everything to calm down. If it doesn't calm down within a day or so, or you can't drink clear liquids, call your surgeon. In the meantime, plan for the future. Do not eat solid food the same day as you have a fill. Most surgeons instruct patients to follow a liquid diet for at least 24 hours after a fill, then transition gradually to purees, then soft, then solid food.

I'm glad you didn't beat yourself up for that, because you've got to live a full life. A grown-up night out is great when it doesn't lead to a permanent vacation from healthy living. I don't think weight loss needs to be like walking across a bed of nails. That's what "dieting" felt like to me. Hopefully, banded life is for the rest of your life, complete with celebrations, missed meals, the occasional treat, etc.

Crumb snatchers?! LOL!

That's exciting! June 8th is just around the corner!

Yeah, I wonder that exact same thing!

That's really up to your surgeon. Time off averages 1-2 weeks. You won't be allowed to lift anything heavy (your doc should give you a weight limit, like 10 lbs), and you won't want to do much twisting, bending, reaching up or reaching down because your incisions will complain.

High cholesterol is considered a co-morbidity of obesity so that could increase your chance of getting approved. Diabetes is also a co-morbidity. An enlarged, fatty liver is extremely common in obese patients. It wouldn't hurt to see a specialist about it, just to be safe. Many surgeons have their patients do a pre-op "liver shrink" diet to make surgery safer (part of the liver lies on top of the stomach, so the surgeon has to be able to safely manuever it out of the way to place the band). Pre-op tests and evaluations are done to make sure you're healthy enough to have surgery, but your surgeon's list of tests sure is a long one. This is the first time I've heard of a bariatric patient needing a colonoscopy, PAP, and mammogram before their surgery. I can't imagine why an insurance company would want need to see the results of those tests in order to approve surgery that takes place in the upper GI tract. Nothing wrong with doing those tests, but I would ask your surgeon's office to clarify which of those are needed for your insurance company and which are for your surgeon's benefit (and probably not necessary to prepare you for bariatric surgery).

I was 54 when I was banded (age 58 now)and have several banded friends who are in their late 50's - early 60's. We older folks have a slight advantage in being better able to follow instructions, and a disadvantage in having so many decades of bad habits. You'll do fine!

You might want to give your surgeon a call. An upper GI study could verify that everything's OK in there. Be careful of "super restriction". It can lead to complications like a band slip, band erosion, esophageal or pouch dilation.

When surgeons quote 50% as the expected weight loss with the band, that's an average. The average is based on people who lost 100+% of their excess weight, and people who lost none. So it's entirely possible for you to lose 100% of your excess weight with the band. I did.

Did you vomit when you had that stomach bug? Vomiting can alter the position of the band. Not necessarily a band slip, but enough to "feel" different.

I had my husband take monthly progress photos of me (front & side - wish I'd done the back, too). I also logged my body measurements (bust, waist, abdomen, hips, etc.) so I could add up how many inches I was losing and see progress even when the scale didn't show it. And, I kept one fat outfit. When I'm feeling fat, I put it on and laugh because the jeans fall off me.

Obesity bias. We all hear about, and some of us experience it, in the workplace and in social situations. But obesity bias lurks elsewhere, in places where you’d least expect it because the people involved are so well-educated. It lurks in what I call the “helping professions”. Teachers, ministers, people who ought to know better. Because of that, I addressed the last chapter of Bandwagon to medical professionals. Telling them how I feel about obesity bias is important to me personally, and awareness of the issue is important to us all, fat or thin, young or old. Politicians, educators, and the media can help (if they can just get their heads screwed on straight), but those of us who suffer from obesity can help by refusing to tolerate it. That’s why I’m reprinting my obesity bias chapter here: I want to put the fire in your belly. Curious? Read on. AN OPEN LETTER TO MEDICAL PROFESSIONALS You wouldn’t guess it to look at me now, but I was once obese enough to qualify for and have bariatric surgery. I was so fat that I got stuck in turnstiles, had to use handicapped stalls in public restrooms, and dressed in drab garments that looked like they were made by Omar the Tentmaker. I was so fat that children would point at me and giggle. So fat that I couldn’t fit in a booth in nice restaurants. So fat that fellow airline passengers groaned when I sat down in the seat beside them. Despite all that, I think I've been pretty lucky. I haven't suffered as much of the obesity prejudice that others like me have faced. My career might have been more successful if I was thin, but I was never aware of obesity bias in a workplace and I advanced further in my career than I ever could have dreamed possible. But I have experienced obesity prejudice, and some of that has come from you: the health care professionals with whom I've entrusted my physical and mental health, and that's a special kind of betrayal. I’m not a doctor; nurse; nutritionist; dietician; surgeon; exercise physiologist; physical or occupational therapist; medical, laboratory, radiology or surgical technician; or psychiatrist, psychologist or social worker, so I can only make assumptions about what motivates you in the practice of your profession. It’s probably a mix of things: the need for a paycheck; love of science; the expectations of your families, teachers and employers; laws and ethics (both written and unwritten); the desire to relieve suffering; and compassion for your patients. In reality, compassion seems to be undervalued in both the medical community and society at large. I'm told that medical students undergo training so grueling that it would be considered inhumane in any other environment. Then they leap into a practice that requires them to balance patient care with business, financial, insurance, legal and ethical issues that their formal education did not fully address (if at all). Americans of any profession live in a paradoxical society. We praise the athlete who finishes out a game despite a serious injury while we pop pain pills for the aches in our own inactive bodies. We give our children television sets, video games, cell phones and junk food, but don't have time to play with them or encourage them to exercise. Our government mandates the publication of nutrition information on food packages that we are unable or unwilling to understand. We admire the underweight women pictured in celebrity magazines while we wait in line at the supermarket to purchase a cartful of super-processed, calorie-rich, nutrition-poor food. During our daily trip to McDonald's, we recoil when we see an obese person enjoying the same meal that's on our own tray. We think, "What a pig! I would never let myself get that fat. Why doesn't she go on a diet? She must be too lazy or too stupid." Then we stuff another fistful of French fries in our mouths, take a big swig of Coke, and secretly loosen the button on our own straining waistband. The meal we have just eaten could feed a third-world family for a week, but neither our greediness nor their neediness concerns us. Somehow the careless eating habits of a normal weight person, the anorexic eating of an underweight actress, and the starvation of an impoverished child are all okay, but the overeating of an obese person is reviled. Despite the societal stigma associated with it, obesity isn't the shameful plight of "other" people — lazy, unlucky, immoral people. It can happen to anyone. It happened to me, and it can happen even to well-educated medical professionals like you. I am by no means lazy. God has given me many blessings, and I do my best to live in a moral fashion, but through a mysterious combination of nature and nurture, I suffer from the chronic disease of obesity. It is no easier for me to cure myself of this disease than it is for someone to cure herself of asthma, epilepsy or diabetes. I find it ironic that the only current "cure" for diabetes - gastric bypass surgery - is so often considered to be unnecessary “cosmetic” surgery when an obese person seeks it as treatment for their disease. When I asked him for a referral to a bariatric surgeon, the physician who diagnosed my Type 2 diabetes (who happens to be morbidly obese himself) told me, "You don't need something that drastic. You just need to try harder." Telling me that was as helpful as telling a patient with a broken leg, "Let's just wait and see if this gets better on its own. If you concentrate hard enough, that bone will mend itself." That same doctor told me many times to exercise more and eat less. We live in a small town and I see him and his family in local restaurants and stores, but never at the health club owned by the hospital with which he is affiliated. The most strenuous exercise I've seen him do is to repeatedly lift a fork to his face as he plows through a plate of Mexican food. Do I sound bitter? I suppose I am, and you would be too if you had been treated by your fellow human beings, including medical professionals, the way I have been treated. To hear me talk, you might think I'm nursing a grudge against my doc, but I'm not. My obese doctor is a really nice guy, and I have genuine respect for the talented, hard-working people who practice the "helping professions". But not for one minute do I believe that any of them are qualified to judge me. That privilege is reserved for God. Sometimes it's the most kind and well-intentioned people who inflict the most hurt and humiliation on an obese person. To suffer that at the hands of professionals who ought to know better has been especially hurtful and disappointing. When I first moved to Tennessee, I went to see Dr. X, the family physician recommended to me by a local friend. He gave me a prescription for my high cholesterol (essential, he said), refused me medication for depression (not necessary, he claimed), and told me I must lose weight (also essential). I asked him how I should do that. His response was, "It's simple. Put the fork down. Eat less and exercise more." When I said, "That's easier said than done," he answered, "You don't need to talk about it. Just do it." (He also inexplicably refused to give me a referral to a nutritionist, psychotherapist or weight loss support group.) From this experience I could only conclude that my obesity was due to a fatal lack of willpower. I reported that conversation to my friend, who said, "That's probably because Dr. X used to be very heavy himself, and he thinks if he can lose weight, anybody can." The fascinating thing about that factoid was that although Dr. X was specially equipped by his own experience with obesity to give advice, support, and compassion to an obese patient, he was unable or unwilling to offer me any of those things. I don't know what his problem was, because I never got to know him better. I found another family doctor (the obese one) and never returned to Dr. X for medical care. I've also experienced obesity prejudice in a mental health setting. For a year or so I attended a support group meeting for behavioral health patients at our local hospital. The woman who facilitated the group was an addiction specialist - entirely appropriate considering the high proportion of drug and alcohol addicts in the group, but even she laughed when I told the group, "It's all very well for you to talk about abstinence. You can completely give up drugs or alcohol and survive just fine, but if I completely give up food, I'll die." I'll admit I often say funny things with a serious expression on my face, but how was that statement funny when tears were running down my face? I've even experienced a subtle form of obesity prejudice in a bariatric medical practice. In the past five years, I've used the services of two different hospitals with well-established, well-respected bariatric surgery programs. I won't name them because medically I have no bone to pick with them, but I will describe them because they reveal a lot about themselves in their bariatric facilities' design. One facility is supplied with plus-size patient gowns; wide benches and chairs; wide hallways and doorways; big exam tables with sturdy step stools beside them; large, easy-access restrooms; specially-equipped operating rooms; large-size blood-pressure cuffs; and many other accommodations for large-sized patients. The other facility has none of that, and if a patient is too large to fit through the door that leads to the exam rooms, his or her consult may take place in the waiting room, in the sight and hearing of other patients. So much for patient confidentiality, huh? Both of these facilities have given me excellent and considerate care, but only one of them gives the impression of having thought deeply about what its patients really need. And speaking of what bariatric patients really need, I also have a word for the general surgeons who are jumping onto the bariatric bandwagon in hopes of increasing revenue: please, please don't lift that scalpel until you've established a complete patient education and aftercare program, employing the services of the experienced nurses, nutritionists, psychologists, exercise physiologists and other bariatric professionals who can make or break your patients' success. When you have your team assembled, please make sure they're all singing from the same sheet of music. One of the most common complaints I hear is that staff members in a single bariatric practice issue conflicting instructions - for example, the surgeon says you should eat 1/2 cup of food per meal, but the nutritionist says you should eat 1 cup. My response to this is always: follow the surgeon's advice until you're able to clarify the issue. But bariatric surgery patients, especially new ones who are trying to learn dozens of new facts and behaviors, do not need their bariatric team adding to their confusion. Just as you should not underestimate your patients' need for education and support, nor should you underestimate their intelligence. Surely as a scientist you can acknowledge that human intelligence is not inversely proportionate to body size, any more than it's related to skin color, ethnicity or religious belief, but I must remind you that mental faculties do not decrease as body size increases. While I appreciate any efforts you make to communicate clearly, it is not necessary to talk down to me. And baby talk is out of the question. I will never forget the doctor (about 15 years my junior) who explained to me that while I (age 50) was catheterized for surgery, I would "go pee pee" into a bag. I am not a child, and I will thank you to treat me as an adult. If you want me to call you "Doctor Smith", please address me as "Ms. McMillan" (or, if you are of a southern persuasion, "Miss Jean"). By now you may be thinking, "I don't have time for any more of this nit-picking," or, as a nurse practitioner once said to me, "I don't have any more time for you today. I have sick people to see." But before you run off, I also want to say this: Thank you for all that you do, for your arduous studies, hard work, and long hours; for the risks you take, your research, your continuing education; for being willing to treat a complicated and chronic disease like obesity with an expensive medical gadget that's being refined and improved even as I write this, even as you walk through the operating room doors to perform weight loss surgery on another patient. Keep up the good work, partner. None of us would get very far on the bariatric bandwagon without you!

I know just how you feel. When I was obese, I just did not see anything below my chin when I looked in the mirror. I could only see how big I was in photographs....and I avoided that as much as possible. But one day you'll be glad you have those before photos, to show you how far you've come.

I'm not a low carb gal, but I want to share a great website for low carb recipes: http://www.ibreatheimhungry.com/ This blogger is an inspired cook and a great photographer. You will drool when you see her dishes!

"Soft stops" can be subtle and may not happen consistently. Watch for a sigh, a sniffle, , a hiccup, a burp (or the need to burp), fullness in the back of the throat, the urge to take a deep breath, watering eyes, runny nose, excess saliva, the urge to cough or clear the throat.

The fact that you can recognize already that weight loss surgery is just a tool, and not magic, means you're already on your way to success. I like #3 on your list. I'll carry your bags for you, if you want.

When did the feeling start? During a meal? After a meal? Out of the blue? For me, a sense of fullness or pressure at the back of my throat could be a satiety signal (that I've had enough to eat and should stop). When it feels bigger, like a lump, that's a sign that I've overeaten. As I understand it, the sensation comes from your esophagus. It means that food is sitting in your esophagus (which is designed to transport food, not store it) and your esophagus is unhappy about it and possibly spasming to get rid of it.. Are you able to drink Water? You could try taking a few sips of a hot liquid, but stop if that makes the lump feel worse. If it gets worse and/or you can't drink Clear Liquids, call your surgeon's office.

Nicole, I'm so sorry you had to go through that. Please don't beat yourself up over regaining weight. I had to say goodbye to my band 3 weeks ago and I've regained also. My band was removed because of a congenital problem with my esophagus that contraindicates the gastric band, so eventually (when my esophagus is sorted out) I hope to revise to the sleeve. People often say that the band is the least invasive of bariatric surgeries, but let's face it. Any surgery that requires the patient to be anesthetized while a surgeon cuts holes in their abdomen, pokes instruments into those holes, and implants a medical device, is pretty invasive. People also say that the band is good because it's removable. Well, that's true, but it doesn't mean that removing it is easy and safe. RNY is reversible, if need be, but that doesn't mean it's easy or safe. So I guess you have to choose the lesser of the evils. I think we'd all like to say we can lose and maintain our weight on our own, but if we had a big enough problem that we qualified for weight loss surgery, it's not likely that another attempt to do it "on your own" is going to work longterm. On the other hand, presumably you've acquired some healthier habits since being banded, and can rely on those now, at least until you're healed and ready to consider a different surgery. Good luck!

RUN, SPOT, RUN! The phrase "sweet spot" pushes me into my swirling stream of consciousness, where I hear: Sore spot, hot spot, weak spot, sweet spot. Spot the dog. Run, Spot, run! That's what the bandster sweet spot does. It runs ahead of us, wagging its tail, taunting us, "When you catch me, you're gonna lose weight like never before! But first you gotta catch me!" And off it goes again, dangling that precious weight loss carrot just out of reach while we follow, huffing and puffing and worrying that we may never catch our errant Sweet Spot. What if we don't? Will our weight loss surgery be a waste of time and money? Sweet spot. Just two words. Short words, endearing words, simple words, but loaded words. For such a little phrase, the sweet spot is a very big deal. But is it real? Is it even possible? I can think of other little phrases that are also big deals, and after several decades as a voting citizen of the United States of America, I have to wonder if they're just a dream. World peace. Cancer cure. Justice for all. Sweet spot. THE ELUSIVE SWEET SPOT The concept of a sweet spot was unknown to me until I shortly after my Lap-Band® surgery. It's not a term exclusive to bandsters. In tennis, baseball, or cricket, a swing will result in a more powerful hit if the ball strikes the racquet or bat on its "sweet spot". In the world of music recording, the sweet spot is the focal point between two speakers, where a listener is fully capable of hearing the stereo audio mix the way it was intended to be heard by the mixer. In general terms (that might make more sense to those of us who are athletically or musically challenged), a sweet spot is a place where a combination of factors results in a maximum response for a given amount of effort. That's exactly what we're hoping for when we have weight loss surgery, isn't it? After years of useless struggle and unsuccessful dieting, we want to expend the least possible effort for maximum weight loss results. Unfortunately, there's a trick phrase hidden in the paragraph above: a given amount of effort. It's not “no effort”. A given amount of effort…but an undefined amount. How much effort? How long, how often? Does making the sweet spot work for us take an hour a month, a week, a day? In Bandwagon, I wrote that the sweet spot is a myth that does bandsters a great disservice because it's a mistake to think of restriction as a single point (or sweet spot) on a line. Let's pretend that you've found your sweet spot. It looks like the diagram above. Can you balance on it indefinitely, like the green triangle poised on one precarious corner? I couldn't. All it would take to knock me off that little spot is a strong breeze, and if I had to devote all my attention to keeping my balance, I wouldn’t be able to make good use of the imperfect but quite useful areas to the left and right of my sweet spot. It’s more useful (and balanced) to think of restriction as a range, not a single point, with the sub-optimal yellow zone (not enough restriction) to the left and the sub-optimal red zone (too much restriction) to the right. According to Allergan, the band's optimal performance is in the middle “green zone,” where to greater or lesser degrees you experience early and prolonged satiety and reduced appetite and hunger. Now let’s try thinking of restriction as a river or stream that flows along, sometimes slowly, sometimes fast, and sometimes it's quite still. If you try to catch that river water in your hands, crying, "This is it! My sweet spot!" the water will run through your fingers. If you step into the stream, your restriction is with you all the time, sometimes optimal, sometimes sub-optimal, but always there. DOWNSTREAM WITH JEAN Does my stream analogy sound too much like something Yoda would tell Luke Skywalker? I'll climb out of the stream now, shake off the water, and tell you about my own "sweet spot" experience. The #1 thing I want you to know is that you can lose weight without ever catching hold of your sweet spot. I lost 100% of my excess weight (90 pounds) in my first year post-op, with far less restriction than I had later on. Except at the very beginning, when everything about banded life was a mystery to me (including the Green Zone poster at my surgeon's office), I didn't have a lot of anxiety about whether or not I'd found my sweet spot because I was losing weight without even knowing what my sweet spot looked like. I didn't have to starve myself or take diet pills or any of my rarely effective pre-op weight loss techniques. My band was most definitely helping me even though sometimes I felt as if I didn't have a band at all. As time went on, I sometimes took my band for granted, and only when I had to have unfills to treat symptoms of careless eating or overeating did I realize how much my band had in fact been doing for me. After each unfill, my appetite and my physical hunger immediately increased, which both scared and pleased me. As in many things, it was a matter of perspective. One day I whined about getting hungry 3 hours after eating and being able to eat 1 cup of food. The next day (after the unfill) I whined because I got hungry 1 hour after eating and was able to eat 2 cups of food. There's a popular saying that claims you never appreciate what you have until it's gone, and that's certainly true for me. Hearing my story, you might want to argue that before those unfills, I had reached my sweet spot and just didn't know it. That's entirely possible. After all, how would I know what the weight loss sweet spot looked or felt like? I'd never been there, never held it in my hot little hands - I probably wouldn't recognize it any more than I'd recognize the mayor of Kansas City or the invisible line where the Eastern time zone ends and the Central time zone begins. Of course, one of the reasons we choose WLS is to make losing weight easier. When people criticize WLS patients for "taking the easy way out", I want to laugh and then scream. Of course I chose the easier way, that's the whole danged point! But at the same time, it's not as easy as you might imagine. It's not magic! Losing weight "the hard way" hadn't worked for me, so it wasn't unreasonable of me to want my band to work perfectly right from the start. If it didn't work that way, I really can't complain (much). After all, I didn't learn how to ride a bike, multiply 9 x 7, or play the piano on my first try either. And if I'm completely honest, I'm not sure I would have been able to handle it if I arrived at my so-called sweet spot the day after my surgery or even after my first fill. One of the reasons most surgeons administer fills in small amounts over a period of weeks or months is so the patient can gradually become accustomed to the change in their body and eating, and thereby avoid unpleasant side effects and complications. If I had walked out of the hospital on September 20, 2007 with as much restriction as I had 3 years later, and with virtually no practice of band eating skills, I would've been calling my surgeon the next day, crying, "Take this thing out of me!" Since I'm an extremely stubborn person, I needed plenty of time to adjust to everything going on in my life after surgery. In the year it took me to reach my weight goal, I learned perhaps 50% of what I needed to know to manage my weight for the rest of my life. I hadn't once heard the Sweet Spot bells chiming, but I was mighty happy with myself and my band. I had changed a lot, in my mind, heart and body. Just standing in that river of restriction, going with the flow, was such an enormous improvement over my pre-op life, all I could feel was gratitude.

Here's another week of dinner menus to inspire you, including the page numbers for the recipes in my cookbook, Bandwagon Cookery. Enjoy! SUNDAY Mini meatloaf Italiano (p. 260) Cheesy potato & veggy mash (p. 321) Cooked green veg of your choice MONDAY Chicken & white bean stew (p. 170) Leafy green salad TUESDAY Deviled halibut (p. 272) Carrot & craisin salad (p.193) Orange bulgur pilaf (p. 208) or bulgur cooked in broth WEDNESDAY Meaty ricotta casserole (p. 235) Marinated zucchini Italiano (p. 323) Pasta (optional) THURSDAY Roasted veggy & cheese thin crust pizza (p.237) Leafy green salad FRIDAY Cioppino fish & shellfish stew (p. 176) Crusty bread (optional) or baked pita chips (p.156) SATURDAY Tofu & veggy cannelloni (p. 294) Roasted green beans (p. 312)