Jean McMillan

The title of this article (lightly) rapped a ruler over my knuckles, because I've been dealing with "you're getting too thin" remarks from friends and coworkers while I still struggle to get used to seeing a skinny body in the mirror. My surgeon assures me that I'm not too thin. I don't have any symptoms of malnutrition and am enjoying dozens of benefits of better health, but skinny still doesn't feel right to me. At the same time, I'm terrified that Fat Jean will take over again sooner or later. Mary Jo, do you think that the longer we live with a distorted body image and the shame of obesity, the longer it takes us to recover? Do you have any tips for how I can achieve a better balance with being too skinny and with finding and accepting my "happy weight"?

When I was obese, a friend of mine once told me "I know you're a touch-me-not" every time she hugged me. Like you, I enjoy casual affection more now. Liking intimacy, though, is an uphill battle.

As we say in 12-step groups (on this side of the pond, anyway), take what you need and leave the rest.

This is an interesting article, Mary Jo. Choosing sex instead of food is hard advice for me to take, and I've encountered a lot of obese women who have a personal history like mine - survivors of emotional, physical, and sexual abuse, with years of promiscuity and other dangerous acting-out behaviors. Even obese people with picture-perfect childhoods are likely to experience years of self-loathing that's intensified by interpersonal and societal messages about body size. Like mistysj, I also worry about transfer addiction. I'm in a long and stable married relationship, but I have a single WLS friend whose post-op sexual escapades have been disastrous and include one date-rape. This is just another example of how complicated obesity is - a dense tangle of mind-body issues that weight loss (however achieved) is not going to cure or even treat without a lot of work on the part of the patient and her/his support team. Just putting together a support team is hard!

Officially, average weight loss with the band is 1-2 lbs/week, so you're doing fine. But...I do feel your pain and frustration over your rate of weight loss. In our heart of hearts, don't we all wish we could wake up in the recovery room after surgery at our goal weight? Unfortunately, only limb amputation could accomplish that. Generally speaking, men tend to lose weight faster than women because of their greater muscle mass. People who start out at a higher weight usually lose weight more quickly at the start because their basal metabolic rate is higher (they need more calories just to stay alive). I've encountered post-ops of all surgery types who lost weight at a stupendous rate for a month or 3 months or longer, and eventually they (and their very confused bodies) slammed into the brick wall of a plateau. The calorie restriction that comes along with almost any kind of weight loss effort (with or without surgery) is a big challenge for the human body. We're programmed to eat to stay alive, and when we eat less day after day, week after week, month after month, eventually our bodies ratchet down our metabolism just to deal with that perceived starvation threat. Then you throw in other health problems, exercise, medications, hydration, hormones, etc. etc..... Of course, nothing I said in the paragraph above is going to make patience any easier for you to practice. It's certainly not one of my strong points. So my final words (for now) are as follows: HANG IN THERE!

As a band-to-sleeve revision patient, it's interesting for me to compare the speed and amount of weight loss between different surgeries even though that knowledge has little effect on my quality of life (which is not as good now as it was when I was banded, but better than when I was obese). @B-52 Interesting...wonder why bypass and sleeve patients loose more weight per month.... Gastric patients only absorb half of the calories eaten because the part of the intestine that absorb calories have been cut out along with the egg sized pouch. So they've got a double bonus! Sleeve patients entire stomachs (not just the top portion like lap band) are cut into the shape of a long tube, much like a paper towel roll all the way down thru to the intestines Lap Band on the other hand, all we have is the egg sized pouch, we still absorb 100% of the calories eaten. It's not actually correct to say that RNY patients absorb half of the calories eaten because different surgeons doing surgery on different people create different-sized pouches and do the intestinal re-routing (distal vs proximal) differently. Similarly, different surgeons doing VSG on different people create different sleeve sizes using bougies (the calibration tool) of different diameters. And we musn't forget that each human being is unique - even identical twins may lose weight differently (and one may be obese while the other is a normal weight). Also, our bodies undergo vital changes as we respond to daily environmental and other factors - changes that alter the way our genes express themselves in our bodily functions. It's very, very complicated. Too complicated to make any generalizations at all, but I have seen very broad trends in the way WLS patients react to each procedure. Some of those trends can eventually shake up what we all once thought were basic truths about each procedure. For example, as aI pre-op, I was told that the band and the sleeve were purely "restrictive" procedures with no nutrient malabsorption, but there's some evidence now that sleeve patients may have macro- as well as micro-nutrient malabsorption. I definitely have micro-nutrient absorption problems now (especially Iron, B12, and zinc) and I'm beginning to think that macro-nutrient malabsorption explains why I'm 18 lbs below my goal weight at 17 months post-sleeve. Since I'm constantly hungry, I'm constantly eating. Not a lot at one time, but a steady intake. When I study my food log, I'm always surprised to see that I'm taking in the same or more calories each day than when I was a bandster in the weight maintenance phase, and I'm exercising about the same. So why have I gone on losing weight? In an effort to halt my weight loss (a bizarre situation for a former fat girl), I started using full-fat dairy and consuming more Protein (especially protein drinks) in September 2013 and despite the additional calories, have continued to lose about 1/2 lb per week.

I can't imagine how Pepto would hurt you or your band, but it's not what I'd use for gas pains. I've tried Gas-X and it didn't help. Mostly you need patience. Depending on how long it's been since your surgery and whether you still have freshly healing incisions, you could try this advice that a nurse gave me years ago. Drape yourself across an armless chair, with your abdomen on the seat of the chair, and rock gently back and forth and side to side. About 75% of the time, that helps get the gas moving in the right direction (though you might not want to do this in polite company).

I'm glad everything came out all right. So to speak...

Have you been taking pain meds? I find that they're very constipating. If you're not able to get down liquids at this point, you might want to give your surgeon a call. We can live without food for quite a long time, but we can't live without fluids, and dehydration can lead to some very unpleasant problems. My surgeon's instructions were to drink 1 ounce of liquid (Water, broth, Protein drink) every 15 minutes. The hospital discharged me with a small supply of plastic 1-ounce cups. They're about the same as the dose cups that come with Nyquil and Dayquil. I probably could've swallowed more than that at one time, but I think that taking it slow and easy is a better approach.

During my morning workout today (cardio blast), my former port site started to complain. That port's been gone for 21 months! All I can figure is that there are some adhesions/scar tissue in that area - probably always be there. And, I wasn't doing crunches or anything else you'd think would work my abs. The human body is a strange and wonderful thing...

Ridiculous!

I'm sorry to hear of your struggles and hope things go better with your sleeve. I revised from the band to the sleeve, a choice made with more haste and panic than wisdom. As NaNa pointed out, reflux is extremely common after sleeve surgery. Chronic reflux can cause a pre-cancerous condition called Barrett's Esophagus. Regurgitation of acid while you're asleep poses a risk of aspiration (inhaling the acid) and then pneumonia. I'm diligent about taking the omeprazole my surgeon prescribed for me, but even at 17 months post-op, still have breakthrough reflux from time to time. Good luck with your sleeve.

Tell me why you don’t weigh and measure you food before putting it on your plate. Is it painful? Surely not. Is it impossibly difficult? No, I can’t believe that either. Or do your cups, spoons, and scale gather dust simply because they remind you too much of…gasp!!...dieting? Dieting…one of the most hated words in the vocabulary of every obese person who hated dieting, and failed at it so often, that she or he finally got fat enough to qualify for weight loss surgery. I completely understand. I’ve been there, done that, and got the size 3X tee-shirt. Yet still I’m going to insist that you give the practice of weighing and measuring food a try, because it’s one of the things that has made me a WLS success and because I can think of 9 (count 'em - NINE) excellent reasons for you to do it too. 1. It will prevent you from consuming more calories than you can burn each day, thereby helping you lose weight. Me, I’m terrible at eye-balling food amounts, even after years of practice. I cut myself a piece of chicken that I think weighs 2 ounces, and find to my surprise that it weighs 4 ounces. I spoon myself a modest mound of veggies that I think measures ¼ cup, and discover that it actually measures ½ cup. 2. It will make the data you enter in your food log more accurate so you’ll know how much you’re really consuming and whether you’re eating appropriate amounts of proteins, carbs, and fats each day, not just for weight loss but for good nutrition. You do keep a food log, don’t you? Did you know that scientific studies have shown that people who keep a food log lose more weight than people who don’t? 3. It will help give you a sense of control and mastery over food and eating, which will be very welcome and empowering after years of feeling that food and eating controlled you. 4. Weighing, measuring, or counting out 10 potato chips or 14 M&M’s will give you a chance to think one last time about whether that stuff will meet your nutritional and health goals as well as temporarily scratching the itch of a food craving. 5. It will slow your progress from stove to table, thereby reducing your risk of inhaling your food without even tasting it. You do sit at the table to eat, don’t you? It’s not true that calories eaten while standing up at the counter (or in your car or at your desk) don’t count! 6. The ceremony of weighing and measuring will help you appreciate the sensual delight of food, and that will increase your satiety (the sensation of having eaten enough food, which by the way is quite different from feeling “full”). 7. Until you learn what your satiety or “stop eating” signals are, you’ll have no way of knowing if you’ve eaten too much until it’s too late. And stopping eating too late can translate not only into disappointing weight loss but into unpleasant side effects like PB’s (regurgitation), sliming, foaming, and stuck episodes. 8. It will prevent you from consistently overeating, thereby preventing you from experiencing not just the side effects mentioned above but also some unwanted and potentially irreversible medical complications, like a band slip, a dilated esophagus, and/or a dilated stomach pouch. 9. If you give it an honest try for at least one week – just 7 days – and it doesn’t help, you’ll have the pleasure of saying that you proved me wrong. That’s highly unlikely, but hey, give it a shot! Oh, one last thing (for now). I know some highly successful bandsters who never weighed and measured a single morsel of food. They ate small amounts of foods they liked, lost weight, and maintained that weight loss. But they’re in the minority. And I, the World’s Greatest Living Expert on Everything, who slacked off on food vigilance after I reached my goal weight, have found that one of the quickest and easiest ways to get my eating back on track and nip weight regain in the bud is to go back to weighing and measuring. At the same time, I’m able to eat small amounts of foods that I like – just like the ones who don’t weigh and measure. The fact that my food has been weighed and measured doesn't make it any less delicious! If it makes the practice easier for you to bend your stubborn mind around, tell yourself you’ll just do it just for this one week, or one day, or one meal. Sometimes the WLS journey has to be taken one tiny baby step at a time. And that’s perfectly okay, because hundreds of baby steps can add up to hundreds of pounds and inches lost, and a lifetime of weight maintenance. Isn’t that what you want, in the end? Yeah, me too.

Yes, that has happened to me, more times than I'd like to admit. If your port isn't red or hot to touch (signs of infection), you're probably OK, but the only expert who can determine that is your doctor. So you might want to back off the crunches until you can talk to your surgeon about it. My surgeon once said that port pain is not a good excuse for avoiding ab crunches. Your port is stitched into the fascia (the tough sheath) surrounding your abdominal muscles, and anything that puts stress on those muscles can irritate that area. My port flipped, and I had absolutely no idea until my surgeon and her NP had problems accessing it for fills. I think that a GI x-ray would tell the story about what's going on with your port, so I'd insist on that at a minimum.

Good topic. I've made a lot of changes in my life in the past 6-1/2 years. Eating and exercising are the big ones, but there are lots of little ones too. I have more body confidence and am more willing to try doing physical activities that I never would have considered before. Not necessarily related to purposeful exercise. More along the lines of climbing a ladder. I take more fashion risks now that I'm not trying to be invisible. I'm not as painfully shy and I socialize more. I've made a conscious commitment to using my remaining years with as much wisdom, care, purpose, and fun as I can muster. I've attended several WLS conferences and was on an ask-the-experts panel at one of them. I've done some public speaking. I've published 3 books and many magazine articles, helped to start and now am VP of a non-profit organization, changed jobs, and acquired a ridiculous number of stray cats and dogs. Most of the time, I think I'm a better, more attentive, and less defensive wife. I've made a lot of new friends, both inside and outside the WLS community. Now that I don't have excess weight to blame for every problem or unhappy event, I'm having to face up to some unlovely things about myself, such as my quick temper and sarcastic tongue. That part isn't much fun, but I'd rather learn about that kind of thing and deal with it now rather than weight until I get to the gates of heaven and hear St. Peter say, "Jean McMillan? What are you doing here? Don't even dream of touching that gate. Turn around and get your skinny butt outta here." Or something like that.

You ought to give your doctor a call. I suppose it's possible that there's still gas moving around in there. Irritation of organs/tissues in the vicinity of the upper GI tract tend to not be felt at the site of the irritation, so the pain (or whatever response) gets "referred" to somewhere else. That's why the gas introduced into the body during surgery can cause left shoulder pain. Have you had any eating problems or other issues that might be related to your band? Where is this pain in relation to your port? Does a change in body position ever trigger the pain? Did you by any chance have a hiatal hernia repaired at the same time as your band surgery? I ask because I have one (that my original surgeon was supposed to fix but didn't) that occasionally causes me pain in the same location. It doesn't bother me often since I've lost weight, and I don't know why it comes and goes. Sometimes it comes out of nowhere and other times it shows up, or worsens, when I bend at the waist. Edited to add: It's possible to develop a hiatal hernia even after bariatric surgery (I've heard several tales of that), so I suppose it's also possible for a repaired hernia to give way again. If that's the case, it's extremely unlikely to endanger your band.

1. Patience and deep breathing. 2. Resolve to avoid future stuck episodes. Prevention is crucial. I know you already mentioned these things, but they bear repeating: careful food choices, slower eating, smaller bites, chewing each bite more thoroughly. 3. Some people say that chewing a few papaya enzyme tablets helps, but that never worked for me. 4. Some people say that drinking a hot liquid helps, but that not only didn't help me, it also made me power-PB. 5. Some people say that drinking warm pineapple juice helps, but my reaction was the same as #4. 6. Ask your surgeon.

We need to know a lot more about you and your band experience to give you helpful responses. How long has this stand still lasted? What is your fill history? How big is your band and how much fill do you have in it? Do you have any eating problems? Are you eating mostly solid foods? Do you feel you're making good food choices? How are your portion sizes? How long after a meal or snack do you get physically hungry? Are you eating out of boredom, stress, or other cues unrelated to physical hunger? Have you discussed your concerns with your bariatric surgeon and/or dietitian? Do you have any medical conditions, or take any medications, that could affect your weight? Do you exercise on a regular basis? Jean

I don't mean to sound harsh, and I'm very sorry you've had all that trouble, but none of my doctors would ever agree to give medical advice to the online acquaintance of a person who's asking the question. Not only is doing that irresponsible, it's in violation of HIPAA regulations. My doctors won't even tell my medical information to my husband without having me sign a waiver authorizing them to do that. So, me best advice to you is to talk to your own surgeon about this again - over and over again until your questions are answered. If you're still worried after that, you could try seeing another surgeon to get a second opinion.

Congratulations, and welcome to the losers' bench!

OK, thanks, Alex. I'll phrase my response to Linda accordingly. Jean P.S. - Most of my friends know I had WLS, and some acquaintances probably wouldn't care, but there are a few, like my boss (who admits to trolling on FB for the scoop on current and potential employees), who don't deserve to know and can't be trusted with the knowledge. Why do I work for someone like that? That's a long story that could be answered if you'd like to come visit the county in TN with the highest unemployment rate in the state, plus listen to a very long tale of my own business career! And the pluses and minuses of living in a small town where gossip is king.

Alex, I'm not very FB savvy. When/if I respond to Linda's FB post, will my comments show up in the feed or whatever it is on the FB pages of everyone in the universe? If so, I'll need to phrase my response carefully in order to protect both my and Linda's medical privacy. Thanks, Jean

You're very welcome!

I think it's probably lindora.com. If you're interested in low-carb recipes, you might also want to check out ibreathei'mhungry.com. Jean

Amen, sister! I am very thin now, but I also have a lot of health problems now, including some that are supposed to be relieved or eliminated by weight loss. For example, fibromyalgia. More than one doctor I've seen, and several that I interviewed for a magazine article, told me that obesity causes fibromyalgia and that weight loss would relieve the symptoms. That angered me at the time, but now I look back and wish I had laughed in their faces. "Doctor, doctor! Surely you jest! I'm thin! I was thin when my fibro symptoms began! How much more weight do I need to lose? What is the magic number that will make this pain go away?"