Jean McMillan

Have you ever read something posted by Tom, d**k, Harriet (or even - gulp - Jean McMillan) and wondered, "Why is she being so mean?" Although I've felt that way myself, I have to admit I've offended others by being so outspoken (not just in the world of WLS, but in my "real" life too). Sometimes that kind of behavior is coming from a troll or a mentally imbalanced person (I've run across a few of those in 5 years on LBT and 5-1/2 years on another WLS site), and the best course of action then is to follow the simple (if difficult) advice my mom used to give me when my brother was picking on me: "If you'll just ignore him, he'll stop." Sometimes that kind of behavior is coming from an otherwise normal person. I won't claim to be normal (whatever that is), but now that I'm out of the hospital, taking my medication as prescribed, and have been freed from my strait jacket, I'll give you some thoughts about what's really going on when someone's being mean and why it can be so hard to hear. > Sometimes we need to hear things that make us uncomfortable. If no parent, teacher, boss, doctor, or other authority figure had ever corrected my errant behavior - if they had instead said, "It's OK, Jeannie, we understand why you hit your brother upside the head, and here's a baseball bat to use the next time" - I would never have learned the lessons I needed about getting along with other people. I might even be in jail by now. Or back at the funny farm for a forced vacation. The firm-but-caring approach is commonly known as tuff luv, and it's not meant to go down as smoothly and deliciously as a chocolate milkshake. It's meant to be astringent, sour or strong enough to get your attention fast and force you to pay attention to something you hadn't noticed before. Which can be something that's putting you, your band, your health, or your life in danger. > Sometimes the "mean" person is reacting so strongly because the other person has said something that pushes their buttons. The underlying message (even if the mean one isn't conscious of it) is that inside, we share some tough stuff about our eating and weight. One of my hot buttons, for example, is the issue of personal responsibility, so when I see someone blaming their band for everything that's wrong in their life as well as the world's famines, wars, and plagues, my eyes start to bulge out of my head from the increased pressure of my brain, which is swellilng fiercely because I have to hold on so tight to my own reins of personal responsibility. I'm reacting this way because I see myself in the other person, and I don't like what I see. Should I act mean because of that? Of course not. Am I human for acting that way? Absolutely. > Sometimes the "mean" person has the best intentions in the world, but his or her advice comes across too loudly or too harshly because of what I call the New Convert Syndrome. A friend of mine who's a smoker once told me that people who have just quit smoking are now on fire with the conviction that no one should smoke and complain the loudest when someone else smokes in their presence. This also can happen with people who've undergone a sudden or very recent religious conversion. That kind of life change tends to be surrounded by very strong emotions, and those emotions compel the convert to speak at length and with a great deal of single-minded enthusiasm about their new religion. I started going through that about 3-4 months after my band surgery and it lasted about 18 months after that. Then my inner fire changed from leaping flames to warm embers, and I was probably a lot easier to get along with then. None of the above may apply to you. If that's the case, I suggest that you follow some classic 12-step advice after reading this or any other post on LBT: take what you need, and leave the rest. Thank you all for your attention. I must now return to the regularly scheduled program, which consists of me letting our 9 dogs in and out, in and out, in and out, all day long. Jean

Yup. Nine dogs. Or rather, nine who come into the house, and three who are outside dogs (who have comfy condos in our garage), for a total of twelve. And three cats. All of those critters are rescues. We live out in the country where people discard puppies and kittens like so much garbage, and we don't have the heart to let them starve.

For most of us starting a WLS journey, bariatric surgery is vast, uncharted territory, full of unknowns. We long for a happy outcome – maximum weight loss with minimum problems. We listen to stories told by other patients with a combination of hope (to be as successful as they’ve been) and fear (that we won’t experience the side effects or complications they talk about). No one wants to be haunted by the specter of anxiety and dread, but I think a little bit of fear is a good thing. I don’t want fear to dominate my life, but without it, I’m likely to become complacent about my weight loss success and/or revert to the old, all-too-comfortable ways that made me obese in the first place. In small doses, fear keeps me on my toes. Like pain tolerance, fear tolerance varies from one person to the next. Perhaps I’m able to tolerate and use fear because my childhood and adolescence were so full of fear-provoking experiences. By the time I was in my late 20’s, I actually got a little thrill out of fear, possibly because it stimulates adrenalin production. There’s nothing quite like a knife coming at you to activate your fight-or-flight system, causing a perverse fear “rush”. At the same time, prolonged exposure to fear has also taught me to respect it. I don’t play with fear the way daredevils like Evel Knievel did, risking life and limb for the brief thrill of jumping 14 buses at a time with his motorcycle. But I do like the way fear can clear my mental field, forcing me to draw a line between important and unimportant. When the choice is survival or surrender, I’d rather choose survival. I’m not a quitter. When challenged, I’m going to fight back, especially if something precious like my health is at stake. If fear tends to paralyze rather than mobilize you, you may have to use your own compass to navigate a problem, or play follow-the-leader (provided you have a trustworthy leader) instead. Whatever you do, don’t give in. Giving in turns you into a victim (click here to read an article about victim mentality: http://www.lapbandta...-of-obesity-r79), which is not a position of strength in any battle worth fighting. And your health is worth fighting for, isn’t it? So, how can you make fear a working partner in your WLS journey? Let’s take a closer look at two of the more common faces of fear. FEAR OF FAILURE Somewhere between my first, mandatory pre-op educational seminar and my pre-op liver shrink diet, I became uncomfortably aware of a shadow that followed me everywhere. It was dark and scary, and even bigger than I was. It was my fear of failure. After decades of struggle – diets, weight loss, weight gain – I felt that WLS was my absolute last chance to be healthy. And after slogging through all those pre-op tests, evaluations, consults and procedures, I danged well was not going to fail this time. Since I had to admit that my weight management skills were sadly lacking back then (as amply proven by the number on the scale and the numbers in my medical files), the only option available to me was to become the most compliant patient my surgeon ever had (click here to read an article about patient compliance: http://www.lapbandta...g-deal-abo-r112). I had to believe that he and his staff knew what they were doing and would guide me well. I’m a very curious and often mouthy person, so I asked a lot of questions and did my best to understand what was going on in me and around me, but I spent very little time trying to second-guess the instructions I was given. That approach freed up a lot of time and energy that I was then able to devote to changing my eating and other behaviors in ways that helped my weight loss. FEAR OF COMPLICATIONS Compliance served me well I this area also. I can’t claim that I was never tempted to cheat on my pre or post-op diets or to test my band’s limits. I can’t claim that I believed I’d be forever exempt from the side effects and complications I heard about from other WLS patients. But when my dietitian told me (for example) that I’d be mighty sorry if I accidentally swallowed a wad of chewing gum and had to have it scraped out of my stoma, I quickly lost my interest in chewing gum. When I observed that many bandsters experienced certain types of side effects and complications after engaging in certain types of risky behaviors, I resolved not to follow them down the road of no return. Eventually I discovered that life after WLS can deliver some unpleasant surprises, just as in every other aspect of life. I had to learn some things the hard way, like: If you swallow a large antibiotic capsule that can’t pass through your stoma and slowly dissolves into a corrosive mess, you will end up in the ER thinking you’re having a heart attack (and end up with a big unfill). And no, liquid antibiotics don’t taste good, but they taste a lot better than the weight I regained after that unfill. Most of the mistakes I made were the result of impatience or carelessness, but I did my best to learn from those mistakes and keep moving on. A handful of mistakes was about all it took for me to decide not to challenge the validity of my surgeon’s and dietitian’s instructions, and that kept me trudging along the bandwagon trail, getting ever closer to my weight goal. And once I reached that wonderful place, I was determined to stay there!

WATCH OUT! The Food Police are watching you, and if they catch you misbehaving, you’ll be dragged off to prison, where you’ll have to subsist on stale melba toast and lukewarm water. The Food Police are every dieter’s nemesis. They’re relentless and sometimes cruel, and they surround us. You know them. They're the friends, relatives, and coworkers who watch as you eat a meal and say things like, "Should you be eating that?" I actually enjoy dealing with that kind of comment. Depending on my mood and the circumstances, I might give a mind-your-own-business answer ("What's it to you?") or I might say, "So, where did you get your degree in nutrition science?" The existence of Food Police implies that there are some hard-and-fast Food Laws that the Food Police enforce as they prowl the weight loss community, maintaining order and detecting crime. Although I wouldn't want the job of a police officer, I know the police are necessary, and I believe that without them, chaos and anarchy would probably ensue. But in the world of weight loss, there are at least a thousand sets of Food Laws, and they change by the moment according to whatever new scientific discovery or not-so-scientific fad is being publicized. If you listened to every member of the Food Police, you'd probably end up feeling like a citizen of a Police State, where the police not only enforce the law but create it. That's truly a scary thought. I can snap out smart-aleck responses to Food Police interrogations all day long, but I'm not always so clever at dealing with the special squad of Food Police who live inside my brain, monitoring every bite of food, every minute of exercise, every food choice, every ounce on the scale. They've been there a long, long time. The summer I turned 14, when wearing a cute bikini was the most important goal in my mind, I kept a food log and graded every bite of food I took. I knew that a chocolate donut had 310 calories, and since that was one-fourth of the total calories I had allotted for each day, that donut got a low grade. I knew it was a "bad" food choice, so I decided to eat only a quarter of a donut (77.5 calories) for breakfast at 8:00 each morning, but since I'm a notorious Food Criminal, I'd end up eating another donut quarter at 8:30, and another at 8:45, and the last at 9:00, at which point I would view the empty donut box with deep regret and the three empty hours until lunch time with deep dread. That was not a happy summer for me and the cute bikini I sewed for myself would have caused the Fashion Police to arrest me if they'd been out cruising our neighborhood. FOOD CHOICES: GOOD, BAD & INDIFFERENT The Food Police can make us miserable, it's true, but can we live entirely without them? One of the lifestyle changes I committed to when I had bariatric surgery was to make a sincere effort at making good food choices from now on. Since I don't have a degree in nutrition science, I decided to follow my bariatric nutritionist's Food Laws. I think highly of Susan but as the months went by, I realized that succeeding with the band actually involved several types of "good" food choices. The two most important categories for me are: 1. Food that's nutritious. 2. Food with high satiety value. The pre- and post-op nutrition classes Susan conducted emphasized food choices and behaviors that would support good health ("nutritious") and prevent eating problems (like stuck episodes, PB's, sliming), but I don't recall any mention of eating for satiety. Susan is a smart lady but she's not a bariatric patient, and I learned gradually, through trial and error, that food consistency could turn a "good" food into a "bad" one in the satiety sense. For example: 1. An apple is "good" while applesauce is "bad". 2. Baked chicken is "good" while chicken salad is "bad". 3. A bowl of chickpeas is "good" while a bowl of hummus is "bad". 4. Hard cheese is "good" while cottage cheese is "bad". 5. A granola bar is "good" while a bowl of cooked oatmeal is "bad". Provided that all of the foods mentioned in the examples above are prepared in a low-fat, low-sugar manner, all ten of them are nutritious, but only five are good food choices in terms of satiety. How so? Solid food has the greatest chance of triggering the nerves in your upper stomach to register satiety and send a "had enough" message to your brain via the hormone called leptin. Soft and slippery foods, no matter how "healthy", can't be relied on to do that job. FOOD LAW AMENDMENTS I've also learned that appropriate enforcement of band food rules needs to be adjusted on almost a daily basis, because on Tuesday morning I can eat 2 cups of cottage cheese while on Wednesday afternoon I can eat only 2 tablespoons of it. As a result, I not only have to constantly monitor my body and my eating (which is not such a bad thing), I have to continually amend my Food Laws. The variability of restriction is one of the most perplexing things about living with the adjustable gastric band. It can be downright infuriating. But consider the alternative. The alternative is the way I ate and lived pre-op. I could and did eat anything I wanted, in any quantity, at any time of day. Three chocolate donuts every morning, three pounds of shrimp every afternoon, a gallon of ice cream every night. The price I paid for those food choices was obesity and all the painful, humiliating, and frustrating side effects and limitations caused by 90+ extra pounds on my short body. YOUR ASSIGNMENT, SHOULD YOU CHOOSE TO ACCEPT IT Do you have Food Police in your life? Who's wearing that uniform? A spouse, parent, coworker, friend or neighbor? Are they truly qualified to judge your food choices? How do you respond when they try to force a food law on you? And what about the Food Police inside you? What are they telling you every time you take a bite of food? Do they chastise you, or do they sometimes give you a good citizen award? Do you listen to them, heed them, ignore them, defy them? Make a list of 3-5 Food Laws that structure your post-op life. Are they serving your health and weight loss needs? Or do they need amending? Can you do that by yourself, or do you need the help of a professional, like a nutritionist or a counselor? At almost 5 years post-op, I still have my own in-house (so to speak) Food Police, but they're not as strict and punitive as they used to be. I keep them on the job because I'm so good at justifying the worst eating behavior and I sometimes need them to say, "Hey, hey, hey, little lady! What do you think you're doing? You know better than that!" The Food Laws that structure my life are: 1. Eat for good health. 2. Eat for good satiety. 3. Eat for pleasure. Did I really say "eat for pleasure"? I sure did. But that's a topic for another article!

THINK THIN, BE THIN I think I’m well qualified to speak on this subject, since once upon a time my schoolmates chanted, “Fatty, Fatty, two by four, can’t fit through the kitchen door!” when I walked into the gymnasium for a physical education class with a teacher who, after weighing and measuring each kid, announced to her captive audience that Jean was the shortest and heaviest girl in the class. After which I was the last kid (once again) to be chosen for a volleyball team. I believe that in order to become a thin person, we must learn to think like one. It’s a tall order, I know. You might as well ask my dogs to learn to think like cats (I’m pretty sure my cats can think like dogs, but it doesn’t seem to work the other way around, to the everlasting detriment of the dogs). At the same time, I believe that we must never forget our inner fat person. If we do forget, the fat folks may burst out of us and take over again. I know mine did last year, for six months and 30 pounds of regain. She was aided and abetted by the loss of my beloved Lap-Band®, but once she was out of her cage, she took charge so fast it made my dizzy blonde head spin. That’s not a pretty sight when that head is busy gobbling all the food in the western hemisphere and the body attached to it is rejoicing, “Starvation has ended at last! It’s party time!” (which is what my gastroenterologist said my metabolism was doing, although not in those exact words). I lost the weight I had regained, plus another 10 pounds. I know (or I hope) I don’t look like a fatty any more, but a fatty still lurks inside me somewhere. My fat demon is hidden from view, but she’s still my demon. Exactly what every girl needs, along with a good bra and a good hairdresser. Seriously, though, my fat potential lives on, mainly because obesity is an incurable, chronic disease that no surgery today can cure. As long as my inner fatty threatens to take over, it’s hard for me to think and act like a thin person. But I refuse to give up the quest for Thin Jean, and I strive every day to emulate her. I believe that practicing thin behavior will eventually teach me thin thinking, and I believe that practicing thin thinking will keep my body thin. FAKE IT UNTIL YOU MAKE IT We have now arrived at the bad-tasting course in this home-cooked meal of advice. In order to practice thin thinking, we need to do things that we’ve done over and over again in the past without long lasting results, like making good food choices, practicing portion control, and exercising. I know that this concept frustrates many of us and infuriates some of us. Some people scorn the practicing part of the WLS journey. They say, “It’s just another diet.” A friend of mine declared a week before her band surgery, “I refuse to diet.” Perhaps it’s a matter of semantics or personal preference, but I persist in believing in the importance of practice because thin thinking and thin acting don’t come naturally to me. I wasn’t born with piano-playing skills. I had to take lessons and practice every day just to be able to play “Chopsticks”. Even famous concert pianists must practice every day. The same is true of being thin. This reminds me of the “fake it until you make it” slogan repeated in 12-step groups. The 12-step tradition recognizes that sobriety or abstinence doesn’t come naturally to people with addictive tendencies. It doesn’t expect its members to leap from the first to the 12th step in one week, one month, or even one year. All it asks is that we practice desirable behaviors every day, day after day, while the struggle to do that gradually lessens and we gain some control over the undesirable behaviors. Eventually we discover that we don’t have to “white knuckle” it anymore because the desirable behaviors have become habits. Assuming that you had WLS because you don’t want to be a fatty any more, I’d like to suggest that you begin by not eating like a fatty any more. You don’t have to do it perfectly, because you’re just practicing, right? As far as I’m concerned, you can leave the perfection stuff to God. All you need to do is do your best, day by day, to work with your strengths and work around your weaknesses. Even if practice doesn’t always make perfect, it’s got to help you with the fake it part until you get to the make it part. Yes, it’s a lot of work, but you can do it!

Did you know that obesity can be fatal? Yes, it’s depressing and inconvenient and unlovely, but the worst part is that it can kill you. So listen up! Anyone who’s known me for more than 10 or 15 minutes knows that I love to laugh. I even laugh about my obesity, when otherwise I might cry. But obesity is not a laughing matter. Obesity is serious. Dead serious. As serious, in fact, as a heart attack. And that’s why we all need to take it seriously. We need to keep the Grim Reaper in mind even as we journey to a new life free of excess weight. Yesterday I showed a friend (who never knew the obese Jean) a photo of me taken 95 pounds ago. She said, “Wow. Talk about reinventing yourself!” Bariatric surgery, and the weight it helped me lose, didn’t just help me reinvent myself. It saved my life, and I’ve heard many other people say the same, using the exact same words: “It saved my life.” So it puzzles me to see other people acting as if weight loss is a hobby rather than a career, a hobby they’ll discard once they arrive at their goal weight and go on to something fun and easy, like a party or a vacation. They’re not stupid people, so why don’t they recognize the gravity of their situation and the life-changing importance of weight loss surgery? Do they not know what “morbid obesity” really means? I know what it means to me. I know that it’s a matter of life and death, but I freely admit that sometimes I want to forget it altogether. I’m a new woman, enjoying a new life, making up for lost time. I’m tired of worrying about food and eating and the numbers on my bathroom scale. I don’t want to think about the Grim Reaper any more, but I can’t afford to forget him, because he follows me everywhere. That’s because weight loss surgery doesn’t cure obesity. All it does is treat it. It merely helps us manage the chronic disease of obesity. That management is a lifetime job. We all know what obesity is – it’s the excess weight that drove us to bariatric surgery in the first place. We know how miserable obesity makes us look and feel, but none of us can afford to ignore the morbid part, because that’s the part that drives us to the grave. It’s the part that increases the risk of heart disease, diabetes, cancer, and other potentially fatal conditions. Morbid obesity may not be listed as the cause of death on your death certificate, but it’s the cause that’s lurking around the corner. Your friends and family aren’t going to pay much attention to that, because all they’ll care about is that you’re gone long before they ever dreamed they’d have to say goodbye to you. Wearing plus-size or big-and-tall clothing while we watch our kids enjoy carnival rides that we’re too fat to fit on is lousy today, but morbid is lousy forever. Even if you have no or mild co-morbidities (conditions caused or aggravated by obesity) today, chances are you’ll develop them in a day or a year or in 10 years. Morbid obesity is morbid because it’s been proven to shorten our lives. Even if you can overcome the heartache and shame of being excluded from life’s joys, you can’t overcome death. That’s forever. And I can’t ignore Forever. Can you? So this is your wake-up call. Obesity can be fatal. It’s serious. Dead serious. It’s time to buckle down and do something about it…right this minute, before the Grim Reaper gets an inch closer…Hey! Get moving, now. Here he comes!

Naomi, I know you mean well, but I think you've missed a few important pieces of data here. 1. The chief finding of the study you mentioned was that successful bandsters in Australia do drink (but not guzzle) while eating. Those findings did not explain why that's so. The "why" part is conjecture on the part of the study's authors. Also, I question their claim that "There is no pouch or small stomach above the band. There should never be food sitting there waiting." I agree with the last part of that ("There should never be food sitting there waiting") but I disagree with the first part and have no idea where they came up with the idea that there's no pouch or small stomach above the band. Yes, the band has been used in Australia a lot longer in the USA, but that statement completely contradicts everything I've read in Allergan and J&J literature and surgeon resource sites. And I have watched my own upper GI tract during several upper GI studies, and there was indeed a small stomach pouch above my band every single time, no matter what else was going on in there (or not) at the same time. The radiologist pointed it out to me on every occasion, so I wasn't misreading the images. And by the way, that pouch was a normal finding, not an anomaly. 2. According to American bariatric surgeons I've talked to or whose seminars I've attended or whose articles I've read, NO bariatric surgery patient should drink while eating. In fact, at a bariatric conference 2 years ago, I heard that stated by 3 different surgeons who were giving 3 speeches. All of them stated that failure to separate consumption of solids and liquids is the most common cause of WLS "failure" (that is, no or disappointing weight loss, or weight regain). Since many LBT/Bariatric Pal members live in the USA and have surgeons in the USA, I think it behooves us to follow the instructions of our American doctors. Or, go to Australia for surgery and every fill and unfill and all aftercare. Hey, if I had the money to do that, it might even be fun to travel there, but it would sure disrupt the rest of my life. But hey, a mere $8,000 per trip (not counting hotels, meals, taxis, surgeon's fees, etc.) would be nothing for us rich Americans, right? 3. Every bariatric surgeon I've encountered (in person, on the telephone, online) has stated that the band does not and should not control the movement of food and liquids from the esophagus into the stomach. If the band is far enough up to do that, it has slipped or the surgeon who placed it was incompetent. What controls the movement of food and liquid from the esophagus into the upper stomach (the fundus) is a sphincter at the base of the esophagus where it joins to the stomach. Continually eating in a way that causes food to be stored in the esophagus is asking for trouble. It can cause serious and permanent damage to the esophagus and the esophageal sphincter. 3. No bandster should ever, ever eat in a way, with or without liquids, that allows food to sit in the esophagus for more than maybe 30 seconds. The esophagus is not meant to store food for any period of time. It's designed to move food up or down (preferably down) only. If food is sitting in the esophagus, any liquid consumed after that is probably going to come back up rather than flushing through the stoma, because at that point the upper stomach pouch and the stoma created by the band are probably already jammed up with food. PB's (or regurgitation of food) usually come from the esophagus, not from the upper stomach pouch, for the very reason I mentioned above. The stomach is designed to stretch to accommodate food, while the esophagus will resist stretching until the food has to come back up or (over time) the esophagus becomes dilated - something we all want to avoid, because even if the band is unfilled and the upper GI tract given a good long rest, there's no guarantee that the esophagus will ever go back to its normal state. And no one should have to live the rest of their life with a malfunctioning esophagus or sphincter. Esophageal dysmotility problems caused by careless eating can become a serious health issue, with the patient eventually having to live on liquids, live with a a feeding tube, and/or hope that an attempt at surgical repair will help. Surgery in that part of the upper GI tract is not something to take lightly, because the scar tissue that develops after surgery can also interfere with esophageal function. I speak from personal experience here. I had an esophageal stricture (from reflux damage). I lived on liquids for months, was unable to revise to the sleeve at the first try because my surgeon couldn't get the small (about the size and shape of a Sharpie marker) bougie calibration instrument through the stricture, and eventually had to have the stricture dilated enough to make eating possible, but not enough to make the stricture disappear forever (it was still there when I had an EGD 6 months later). I think esophageal dysmotility has also been a problem for an LBT member known as MsMaui, and last I heard, even an unfill, months of upper GI rest, and band removal have not resolved her problem. 4. So in my opinion, the best way to avoid these unhappy events and their consequences is not to drink while you eat but to avoid keeping too much fill in the band; to practice good band eating skills: take tiny bites, chew very well, eat slowly, don't drink while you eat, avoid problem foods, learn and heed your unique satiety or "stop eating" signals, and give your body the respect it deserves. But what do I know? Jean

Oh, and another thing...how fast you lose weight depends on more than just your fill level. Men usually lose weight faster because they have greater muscle mass than women (but we women compensate with greater wisdom). Heavier people of either gender usually lose faster than lighter people because their bodies need more calories just to stay alive. And weight loss slows down for most of us as we get lighter, because we have less to lose and because our bodies are trying to fight the weight loss. Hang in there!

I know this is hard advice to follow, but try not to compare yourself to others unless the comparison inspires you. Human beings are so unique - their anatomy, the band's effects on them, the band's effects in the same person over time (or even by the time of the day). Sounds to me like you're doing what you should be doing. It would be nice to cross the finish line first, but you'll cross it eventually!

We need to answer a lot of questions to properly address this issue, which is a common one, by the way. When was your surgery? What is the capacity of your band? How much fill do you have in it now? When was your last fill? Are you losing weight? Are you experiencing physical hunger? Do your meals keep you satisfied (i.e., no physical hunger) for at least 3-4 hours? Are you having any eating problems (PB's, stuck episodes, sliming)? Are you emphasizing solid food and avoiding liquid calories? Have you discussed this with your surgeon and/or dietitian? Jean

I'd like to see that article and learn more about that study and whoever published the findings you mention.Lightheadedness, puking, nausea and diaphoresis may indeed be signs of something serious...such as not having consumed any nourishment prior to the workout, no matter how fit you are, or how highly aggrandized your mental condition.

Bless your heart. I tried a HIT class a few times and had to call it quits. I'm not surprised that you puked after some of that inhuman torture. I agree that you need some food before any workout, and especially before an extreme workout. When my band was extra tight in the morning, I would do a Protein shake before my workout. Everything I've read on this subject agrees that carbs (for energy) and protein (for endurance) are important pre-workout, and that protein (for muscle repair) is important post-workout. If your band still feels tight after your workout, I'd do another protein shake. Otherwise I'd have a Protein Bar. Good for you for taking on workout challenge like that and sticking to it!

You should puree all animal/fish protein, fruits or veggies that aren't already of smooth, moist consistency. You don't need to puree stuff like yogurt and cream of wheat - they're already of puree or mushy consistency. But you really need to check in with your nutritionist and/or surgeon to find out what foods they consider to be puree/mushy. Some bariatric clinics have different rules (wondering why that's so is basically a waste of time, but I can give you a Cliff Notes version if you like). For example, one clinic might allow small-curd cottage cheese in the puree phase, but the clinic across the street might tell you to puree the cottage cheese. (Cottage cheese pureed with sugar free pudding mix and/or pureed fruit and your sweetener of choice is pretty good, or you can use ricotta cheese instead of cottage cheese).

The first thing I ate after I got through the liquid stage was a scrambled egg. It was divine! Michelle, a WLS patient (she had RNY)has a wonderful blog with lots of great meal and snack ideas. Here's a link to the section on pureed/mushy foods: http://theworldaccordingtoeggface.blogspot.com/2007/08/pureed-foods.html

I just had another thought...one way you could deal with physical hunger while eating only 60 grams of protein a day is to eat smaller amounts more frequently during the day. When I was banded, I ate 6 small meals/snacks a day. I tried to always combine protein and carbs in each meal or snack. That worked well for me. Now I have to eat 8-10 times a day (thanks to you know what), and when I manage to combine protein and carbs each of those times, I have less hunger and more energy throughout the day.

That sounds like a fairly low Protein goal, for the very reason you mention - dealing with physical hunger. Have you discussed your concerns with her? Does she have any suggestions for other ways to manage physical hunger? My own and most other bariatric surgeons I've encountered recommend at least 70 grams of protein a day for women. My current surgeon recently told me that I should consume at least 90 grams of protein a day for several reasons: my physical hunger is ferocious (thanks to my sleeve), I work out a lot, and I've been experiencing unintentional weight loss (I'm 18 lbs below my goal weight). Appropriate macro-nutrient (protein, carb, fat) intake also depends on the patient's height, weight, age, gender, activity level, and health problems. I'm 5'2" tall, 114 lbs, 60 years old, female, very active, anemic (thanks to my sleeve) and diabetic. If you're still in the early stages of your weight loss journey, probably heavier than I am, and surely younger than I am, I would expect that your basal metabolic rate (the number of calories you need to consume just to stay alive) would be quite a bit higher than mine, which is another reason I think that 60 grams of protein a day is too little. But... I'm not a dietitian or any other kind of medical professional, so I hope you'll be able to discuss this further with your dietitian and/or surgeon and come up with a workable compromise. Jean P.S. - When I was first diagnosed with type 2 diabetes, several years before my band surgery, the dietitian I saw at that time told me that most Americans eat far more protein than they need, and that I should consume no more than 60 grams a day. Since then I've heard bariatric dietitians and surgeons say that the maximum 60 grams of protein recommendation is outdated and that all bariatric patients need more than that to help with healing and to maintain good health.

Just because you CAN eat anything doesn't mean you SHOULD. Your stomach is still healing...your band is still settling into place against your stomach...and failure to follow the post-op diet progression is a common cause of band slips. So unless your surgeon has told you it's OK to eat solid protein, veggies, and fruits at only 3 weeks post-op, I think you may be eating solids prematurely.

Do you know when to call it quits? To quit a meal, that is? It’s 12:15 pm. Sad to say, your meal is over now. I used to work with a recovering food addict (I'll call her Wendy) whose work station was about four feet away from mine. We both went to lunch in the company break room at noon every day. Wendy had lost over 100 pounds in a 12-step program, but food was still of paramount importance to her. At 11:45 every morning, she would announce hopefully, "It's getting close to lunch." At 11:55, she would announce ominously, "It's getting dangerously close to lunch." At 12:00, she would announce triumphantly, "It's time for lunch!", spring out of her chair, and head for the break room. At 12:15, came the final, regretful announcement, "Lunch is over." Our coworkers found this daily ritual both amusing and annoying. Only another food addict (like me) could understand what was going on in Wendy's head as she looked forward to her noon meal and then mourned its passing. What's the take-home message from this story? Lunch is over. It has to be over. You must put down your fork and stop eating when your planned portion is gone or the instant you get a stop message. But what if there's still food left on your plate? What about the children in Armenia (all starving, according to my mother)? What about that leftover food? 1. Get up from the table (say, "Excuse me" if it seems indicated). 2. Put the food in a storage container, and put the container in the refrigerator, or throw the food away (down the garbage disposal, where you can't get at it, is best). 3. Take your plate to the sink and rinse or wash it. Did I say "throw the food away"? In spite of the starving Armenian children? I sure did. I'm not going to tell the World Health Organization that you threw out the extra food. You can donate money to a food charity to help feeding starving children (you'll be able to afford a few bucks for charity because you won't be spending $50 a month on soda). God will not strike you dead for this, I promise. Remember what Rhoda Morgenstern said to Mary Tyler Moore as she tore into a chocolate bar back in 1973 (or thereabouts)? "I don't know why I'm eating this. I should just rub it directly on my hips." So look at that plate of leftover food and ask yourself, "Should I roll in it, or throw it away?" Lunch is over!

How can you socialize and stick to your food plan? Sooner or later you'll find yourself in a situation where you have little or no control over the food served. That doesn't mean you have to abandon all your band eating skills or go hungry. The key is to have plans, even for unpredictable situations. Social eating poses all kinds of challenges to the bariatric post-op. How to resist the dessert cart? How to refuse an extra helping of potatoes that Mom mashed especially for you (with just a little gravy)? How to chat with nine people and still concentrate on taking tiny bites? One recommendation applies to all social eating situations: do not experiment with new foods. You don't know how well they'll go down and you don't want to disgrace yourself in public. This has been a challenge for me because I love to try new foods, especially when I travel, but taking food risks in public is just not worth the potential pain and embarrassment. How easily you can pull off social eating will depend in part on whether your hosts or fellow guests know about your weight loss surgery (a topic worthy of an article of its own, so stay tuned). Sometimes I think my new eating habits are harder on my friends than they are on me. For example, a few months ago I went out to lunch with a group of women, including a friend (we'll call her Kathy) who knew me when I was fat and knows I had weight loss surgery. This was not the first time I had dined with Kathy since my surgery, so I was a bit surprised to realize that she was studying me as I ate. "Is there a problem?" I said. "I'm sorry, I shouldn't stare," she answered, "But I just can't get over the way you eat now." "Isn't it great?" I said with hearty enthusiasm. "Um, yeah, I guess so." There was an awkward pause. Then she rallied and said, "So how many dogs did you say you have now?" I have survived many post-op social eating occasions with acquaintances who don't know about my weight loss surgery (and I'd rather keep it that way). Most of them keep their opinions about my eating (if they even notice it) to themselves. Sometimes they ask, "Don't you like the food?" (I answer honestly, yes or no), or "Are you diabetic?" (yes), or "Are you allergic to nuts? (no). Sometimes I have to use Kathy's change-the-subject method of getting out of an awkward moment (asking the hostess for the recipe, or a portion of dessert to take home, works well as both a compliment and a distraction). Advance planning is crucial for successful social eating. Try to find out what will be served and decide what you'll eat. Eat something before you leave home, because the old advice to save your calories for the party is risky business for a post-op. Imagine how irresistible the buffet table is going to look if you haven't eaten for 10 hours. You're not just risking extra calories at that point - you're risking a stuck episode, a productive burp (regurgitation), or sliming - because you're too hungry to eat carefully. If at all possible, bring some food that you can eat and share with the other guests (tell the host or hostess you're going to do this or it might get whisked away and stashed in the refrigerator). If you know alcohol is going to be served, bring a pitcher of a non-alcoholic beverage you like and announce that you thought everybody might like to try your special punch or fruit tea or whatever it is. Stand-up can be easier than sit-down affairs because everyone is busy balancing a plate, cutlery, beverage and conversation and it's easier to sneak off and ditch the food without being seen. At sit-down meals, I'll grab my plate and a neighbor's (making sure it's empty first, of course) and head for the kitchen saying, "Do let me help clear the table" or "Can I get you anything while I'm up?" (that's hard to pull off in a restaurant, though). Speaking of stand-up affairs, finger food is a terrible idea for bandsters. Human teeth are just not designed to take a small enough bite of anything solid enough to be held in the fingers, so proceed with caution. Whether you're standing up or sitting down, cutting up your food into tiny pieces and occasionally moving it around your plate with your fork are good ways to camouflage your spare post-op eating style. And one last piece of advice: please do not give your uneaten food to your host's dog (or cat, or potted plant), no matter how hungry the dog claims he is. You have no way of knowing if the food is even safe for the dog. My dogs are four-legged garbage cans, and they have even worse judgment about food than I do!

Oh, one more comment (for now). The sleeve is the new darling of the bariatric surgery community. If I were a surgeon, it would probably appeal to me too. I wouldn't have to pay a penny to a band manufacturer for gastric bands, wouldn't have to bother with fills or much patient education or aftercare (which tend to be things that don't interest surgeons who'd rather spend all their time in the operating room). It would be an interesting new procedure to try and perfect, until the next new thing came along. In my opinion, the band is a high-maintenance deal for both the surgeon and the patient. That doesn't make it a bad procedure, nor does it make the sleeve a good procedure. OK, I'll get down off my soap box now and go figure out something else to eat to keep that hunger down for another 40-60 minutes. Eating 16 times a day sure keeps a girl busy doing the one thing she had hoped to set aside when she had WLS.

Oh, one more comment (for now). The sleeve is the new darling of the bariatric surgery community. If I were a surgeon, it would probably appeal to me too. I wouldn't have to pay a penny to a band manufacturer for gastric bands, wouldn't have to bother with fills or much patient education or aftercare (which tend to be things that don't interest surgeons who'd rather spend all their time in the operating room). It would be an interesting new procedure to try and perfect, until the next new thing came along. In my opinion, the band is a high-maintenance deal for both the surgeon and the patient. That doesn't make it a bad procedure, nor does it make the sleeve a good procedure. OK, I'll get down off my soap box now and go figure out something else to eat to keep that hunger down for another 40-60 minutes. Eating 16 times a day sure keeps a girl busy doing the one thing she had hoped to set aside when she had WLS.

I'm sorry to hear about your problems. It can be very frustrating to try to find a tolerable fill level. I think you're wise to at least consider a revision, because no one should tolerate reflux. It's not just an unpleasant inconvenience. It can cause some serious and permanent damage to your upper GI tract. Speaking as someone who (not entirely by choice) revised from the band to the sleeve because of damage from reflux, the sleeve is not a great choice for someone who's had problems with reflux. I managed to ignore that when making my revision decision. Most sleeve patients experience reflux after surgery even if they never had it before. If you've already had reflux, removing the band will probably help reduce or eliminate it (though RNY is the only WLS procedure that can "cure" reflux), but until (and if) your body realizes it doesn't have to produce much stomach acid any more, it will go on producing enough for a full-size stomach. And there's no guarantee that it'll resolve. My sleeve surgery was in August 2012 and I'm still dealing with reflux. It's not as bad, thanks to omeprazole twice a day, but it's still there. Nor has my tiny sleeve reduced the production of ghrelin, the hunger hormone that the sleeve is famous for banishing. So thanks to my sleeve, I am now constantly hungry (probably heightened by all that acid) no matter how much or what or when I eat. My sleeve has given me a bunch of other health problems that I'd be happy to tell you about. I know plenty of ex-bandsters who love their sleeves, but that love may be related to the relief they feel at the absence of problems their bands were causing or aggravating. Kind of like the happiness you feel when you stop banging your head against the wall. But at this point in my life, having lost 75% of my stomach forever, the best I can say of the sleeve as compared to the band is that it doesn't require fills. It is what it is, like it or not.

I'm sorry to hear about your problems. It can be very frustrating to try to find a tolerable fill level. I think you're wise to at least consider a revision, because no one should tolerate reflux. It's not just an unpleasant inconvenience. It can cause some serious and permanent damage to your upper GI tract. Speaking as someone who (not entirely by choice) revised from the band to the sleeve because of damage from reflux, the sleeve is not a great choice for someone who's had problems with reflux. I managed to ignore that when making my revision decision. Most sleeve patients experience reflux after surgery even if they never had it before. If you've already had reflux, removing the band will probably help reduce or eliminate it (though RNY is the only WLS procedure that can "cure" reflux), but until (and if) your body realizes it doesn't have to produce much stomach acid any more, it will go on producing enough for a full-size stomach. And there's no guarantee that it'll resolve. My sleeve surgery was in August 2012 and I'm still dealing with reflux. It's not as bad, thanks to omeprazole twice a day, but it's still there. Nor has my tiny sleeve reduced the production of ghrelin, the hunger hormone that the sleeve is famous for banishing. So thanks to my sleeve, I am now constantly hungry (probably heightened by all that acid) no matter how much or what or when I eat. My sleeve has given me a bunch of other health problems that I'd be happy to tell you about. I know plenty of ex-bandsters who love their sleeves, but that love may be related to the relief they feel at the absence of problems their bands were causing or aggravating. Kind of like the happiness you feel when you stop banging your head against the wall. But at this point in my life, having lost 75% of my stomach forever, the best I can say of the sleeve as compared to the band is that it doesn't require fills. It is what it is, like it or not.

Bandwagon Cookery is fabulous. Easy for me to say, since I'm the author. Two other books come to mind: Eating Well After Weight Loss Surgery and recipes for Life After Weight Loss Surgery. I prefer Eating Well, but it doesn't say how much is in a serving, so it's hard to judge portion sizes. Recipes for Life does specify serving sizes (such as 1/2 cup, 3 ounces, etc.). Bandwagon Cookery does (of course) specify serving sizes & nutritional info for each recipe, includes modifications for each post-op diet phase, and has a lot of tips for meal-planning, food shopping, cooking for a family, strategies for problem foods, and some hilarious (of course) stories about food and cooking. I also subscribe to Cooking Light and Eating Well magazines. I get lots of ideas from them. I also like Ellie Krieger's cookbooks. Not targeted to WLS, but delicious, healthy, and easy recipes. I don't think it's essential to use only WLS cookbooks. Like you, I get food boredom very easily, so the more recipe sources, the better. If you can only buy one cookbook, please do buy Bandwagon Cookery, whose very modest profits are used for food and veterinary care for the 12 dogs and 3 cats here at the 9 Dogs Howling ranch. Speaking of which, the dogs just sounded an alarm. I'd better go see if there really is an army of fire-breathing dragons in the yard.

Bandwagon Cookery is fabulous. Easy for me to say, since I'm the author. Two other books come to mind: Eating Well After Weight Loss Surgery and recipes for Life After Weight Loss Surgery. I prefer Eating Well, but it doesn't say how much is in a serving, so it's hard to judge portion sizes. Recipes for Life does specify serving sizes (such as 1/2 cup, 3 ounces, etc.). Bandwagon Cookery does (of course) specify serving sizes & nutritional info for each recipe, includes modifications for each post-op diet phase, and has a lot of tips for meal-planning, food shopping, cooking for a family, strategies for problem foods, and some hilarious (of course) stories about food and cooking. I also subscribe to Cooking Light and Eating Well magazines. I get lots of ideas from them. I also like Ellie Krieger's cookbooks. Not targeted to WLS, but delicious, healthy, and easy recipes. I don't think it's essential to use only WLS cookbooks. Like you, I get food boredom very easily, so the more recipe sources, the better. If you can only buy one cookbook, please do buy Bandwagon Cookery, whose very modest profits are used for food and veterinary care for the 12 dogs and 3 cats here at the 9 Dogs Howling ranch. Speaking of which, the dogs just sounded an alarm. I'd better go see if there really is an army of fire-breathing dragons in the yard.