NaNa

Your post was very educational. I am so glad your health is back and you are doing well! Thank you for your support, I am glad am on the mend to recovery, I still have a long way to go to get back 100 percent, but I'll take what I can get, but I am thankful and blessed of what I've got back so far..I am glad you enjoyed reading my post.

Today marks one year after the car accident that caused my brain to bleed and caused a hemorrhagic stroke. I was on my way to the dentist early that beautiful cool crisp September morning, and out of the blue, this car ran into me from the passenger side and totaled my brand new SUV, I had only had it for one month, I was in a rush because I was late for my dental appointment and I forgot to put on my seat belt, that why I believe I I was shook up so badly . I was able to get out of my SUV to look at the damages, I then called my husband to come up because I was feeling nervous and confused, the lady who ran into me got out her car too and examined her car, a police was riding by and got out his car to help out, the paramedics was called, although I did not suffer any body injuries I felt very funny almost numb like. The police asked me for my registration, and gave me a ticket, because the lady who hit me had the ride away, it is a dangerous intersection you have to look both ways after you stop at the stop sign, and I pulled out and did not see the woman coming down the road and she ran into me on the passenger side. I was still feeling confused and I kept fumbling around my dashboard, then my husband came quickly because I had just left the house and we lived right around the corner where the accident happened. The paramedics arrived and I continued to feel confused, the paramedics asked if I was okay and then suddenly; I remember losing the ability to say anything it scared me to death, I felt no pain I just could not communicate and I was standing up leaning on the driver side of my SUV and then I started to slide down from the driver seat. That is when the paramedics started to ask me over and over if I was okay, and I could not answer that’s when they realized that something was dreadfully wrong. My whole body was going limp and I did not have a clue what was happening to me. They rushed me to the nearest hospital and when I arrived in the ER and took my blood pressure it was 200/178, they rushed me to do a CT scan because I was having stroke symptoms and the doctor at the ER found I had bleeding on my brain I was hemorrhaging, and then they called a hospital that specializes in strokes (Hershey Medical center) at Penn state and I was life-lined by helicopter to Hershey Medical center in the event they had to operate on my brain to get the bleeding to stop. I never lost consciousness during my ride in the helicopter all I can remember was the men who were in the helicopter was rubbing my head and telling me to hang in there and everything was going to be okay. When I arrived at the hospital Hershey Medical center, it started going downhill from there, I started to get weaker and weaker but my vitals were stable but I felt miserable. I could not move my body or talk it was a very scary feeling. I stayed in ICU for a week with all kinds of wires hooked to me and compression cuffs on my legs to prevent blood clots, my brain stopped bleeding on its own, they gave me a salt solution with a saline drip and that seemed to stop the bleeding and I did not require brain surgery to stop the bleeding. I could not control my urine or bowels because my entire body weak, I could only move my left side of my body a little I was in a miserable situation, having to wear diapers and depending on nurses to change your diaper because I was too weak to sit up at this point a bit humiliating to say the least. Once I was stabilized they transferred me out ICU, on a step down floor, this was one week later, and then the doctors said that I needed to start rehab as soon as possible. My husband quit his job to care for me and I will always be ever be grateful to him, I would have been put in a nursing home if my husband went back to work because early in my recovery I needed around the clock care, and I know some people are not as lucky as me, that's why I''ll always be grateful for my husband and we actually are still newlyweds we've only been married for 4 years when I had the accident, we met online on match.com, he is definitely a keeper, it has not always been easy,... I was transferred to another rehab closer to home and that was a mistake because my husband had to learn the hard way the rehab center was not the best for my condition, and I could make decisions for my self at the time. My stay at the inpatient Rehab facility was not a pleasant one, the stroke deficits started to kick in full gear, my whole body was weak, I would get so tired quickly, and I could barely hold my head up, I needed help sitting up, I was so weak I could not even sit up on my own. My sister flew up to be by my side from Atlanta, she stayed with me through my hospital stay and made sure I was treated good because I could not verbally communicate with the hospital staff, I had to communicate through sign language, thumbs up for yes and and thumbs down for no. But I never lost my cognitive abilities I still could think clearly but could not speak, it's your worst nightmare of being trapped inside your body where you can't move and can't talk but you are aware of everything around you and understand people but can't move or respond. About 1 month after my inpatient stay at Rehab, I was in speech therapy one day and my speech therapist told me to try to say the alphabet and I attempted as hard as I could and a sound came out and tears of joy came down my face, I started repeating A,B,C...and so on until I repeated the entire alphabet, and then she wanted me to start counting to one through ten... Finally was I able to get my speech back and now I talk normally thank god I prayed every night to recover every thing I lost. I did not know a stroke could be so painful, I was in so much pain at this time I had be given Percocet around the clock, I also had a brief bout of muscle spasms and it would hurt so bad I would scream out in pain they gave me balcofen for the spasms for the pain and I had to wear a pain patch on my right side to help ease the pain, it was mostly in my right shoulder my affected side, although when I was having the stroke I felt no pain, it’s just the after effects of stroke I felt pain, I guess the pain was coming from being paralyzed on my right side. I went through this misery for several months, I was released from inpatient Rehab in a wheelchair at the time of my release I could barely stand up, I was walking with a quad cane with 4 prongs. My husband had to order me a hospital bed at home because I could not lay flat in a regular bed it was too painful. I hear stroke recovery is very slow and the kind of stroke I had is the most deadly most people do not survive a brain hemorrhage, I was very lucky that the paramedics and my husband was right there when I was having the stroke. But I was told if you are able to survive a brain bleed your chances of recovery is good and your chances of getting back all you lost are very good, I was told that people who have brain bleeds respond to therapy better. I am no longer on blood pressure medication my blood pressure has stabilized it has consistently been running low 96/80, 91/70 and my primary care physician decided to take me off all together, and a low blood pressure can cause problems as a high blood pressure. I only take one prescription drug now and my Vitamins, so overall I am in good health and through out my ordeal my lap band stayed intact in fact I lost more weight, now I am at a healthy weight. . So the neurologist summed it up to the reason I had a brain bleed was because of the trauma and impact of the car accident and not wearing a seat belt caused a blood vessel to bust in my brain causing a hemorrhagic stroke. Things I have accomplished: Being able to put my shoes on, initially I was too weak to do this, but I still cannot tie my shoes, I wear sandals in the summer and wear tennis shoes when I am going to therapy. Being able to dress myself, Initially I could not even put my clothes on, the only thing I cannot do now is put my bra on or shave myself or cut my finger nails, my husband now has to help with those tasks. Being able to bath myself and stand up in the shower without using a shower chair, I use to be only able to stand no longer than 5 minutes at a time. Initially when I had my stroke I could not move nothing on my right side, my stroke affected my left side of my brain , including my feet, ankle, I could not wiggle my toes on the right side, I could not move my right arm I could not even slide myself over in the bed, I had no movement in my feet, my entire right side was paralyzed, I could not even turn my head on the right side. Also my face was crooked. The face droop cleared up in about 2 weeks after I had my stroke and It took about a month after I had my stroke to get movement back in my right leg and feet, now I can move my feet freely and wiggle all my toes after intense physical therapy. Now I am able to move my head to right and left, little things keep improving. Being able to cook for myself, I can cook most foods and I prepare my own my Breakfast every morning. I can wash my hair, brush my teeth and put on my makeup with one hand actually I have got very good at it. I can help around the house now I can clean the bathrooms now and vacuum with one arm, sometimes I will use my weak arm to help sweep the floor. I could not do, especially in the first few months. I use to have a hard time getting out of chairs, now I am even able to get out of low chairs. I am able to walk up and down stairs. I can talk more clearly now, before I use to talk with a delay between my sentences, now I talk normal. I can slowly open and close my hand on my affected side I can raise my arm only to my waist level. I can sleep in a regular bed now, before my hip, and lower back on my affected weak side made it impossible for me to lie flat without severe pain, and my doctor ordered a hospital bed at home where I could adjust the head of the bed and sleep sitting up. I can now use my arm bike that my husband bought for me last Christmas, I was not strong enough and could not grip the peddles, now I am able to peddle my weak arm without pain, and that is a very big accomplishment because it use to very painful when I tried to use the arm bike and also I was not strong enough to grip the handle, now I can grip the peddle with no problem. The only deficit I have now after a year is my right arm/hand is still weak, I have some movement in hand/fingers and I am not going to give up on my right arm yet, the next goal will be driving again. I notice very small changes every day of things I can do, I use to take simple things like putting on my clothes and taking a bath or shower, driving my car for granted, being able to talk and think. It reminds me that our bodies is nothing but a machine controlled by our brain and the brain send signals to our arms and legs to function and move and when you lose the capability to move your body and talk you are considered brain dead and I have literally came back from the dead. It was just not my time to go. I have recovered enough that my husband is taking me with him on a vacation to Monterrey, California next week he inherited some money from his aunt enough to buy a restaurant, we will be moving to the Atlanta area in October where the weather is warmer the cold weather makes my joints very stiff. I had my last MRI and my neurologist said that I did not show any signs of a hematoma from the bleeding and I should not have to worry about another stroke ever again--- at least a brain bleed.

Thank you for your support, it has been a life changing event for sure, I am happy I am still here to be able to share my story.

Hello... I thought I would post this must read article by the surgeon who invented the "Green Zone" and how the band should "ideally work".... http://bariatrictime...1/#comment-2133 Gastric Banding and the Fine Art of Eating BT Online Editor | September 22, 2011 by Paul O’Brien, MD Dr. O’Brien is from the Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Australia. Bariatric Times. 2011;8(9):18–21 Funding: No funding was received for the preparation of this article. Financial Disclosure: Dr. Paul O’Brien is the Emeritus Director of the Centre for Obesity Research and Education (CORE) at Monash University, which receives a grant from Allergan for research support. The grant is not tied to any specified research projects and Allergan has no control of the protocol, analysis and reporting of any studies. CORE also receives a grant from Applied Medical toward educational programs. Dr. O’Brien has written a patient information book entitled The Lap-Band Solution: A Partnership for Weight Loss, which is given to patients without charge, but some are sold to surgeons and others for which he receives a royalty. Dr. O’Brien is employed as the National Medical Director for the American Institute of Gastric Banding, a multicenter facility, based in Dallas, Texas, that treats obesity predominantly by gastric banding. Abstract The author reviews the physiology of eating and what the adjustable gastric band does to the function of the distal esophagus and upper stomach of the patient. The author also provides the “Eight Golden Rules” on proper eating habits for patients of laparoscopic adjustable gastric banding, including what, when, and how they should eat, in order to achieve optimal weight loss results. Introduction Laparoscopic adjustable gastric banding (LAGB) has been shown to enable patients with obesity to achieve substantial, durable, and safe weight loss,[1,2] which can help reduce or resolve multiple diseases,[3] improve quality of life, and prolong survival in patients with obesity.[4] LAGB is a weight loss surgical procedure performed solely for the purpose of affecting a key physiological function in weight loss, appetite control. In 2005, we conducted a randomized, blinded, crossover trial that showed that the LAGB controls the appetite.[5] However, if the LAGB is not placed properly or if the patient does not eat properly, it will not perform at an optimal level. For example, if the band is placed too loosely, then it will not provide the proper level of reduced satiety and appetite, and likely will have little effect on the patient’s weight and health. If the band is placed too tightly or if patient eats too fast or takes large bites of food, slips and enlargements can occur, leading to reflux, heartburn, vomiting, and sometimes the need for revision. Optimally, the band should be adjusted so that it squeezes the stomach at just the right pressure. If the patient eats correctly and the band is placed correctly, the LAGB should adequately control the patient’s appetite, resulting in optimal weight loss. The Physiology of LAGB Dr. Paul Burton, a bariatric surgeon at the Centre for Obesity Research and Education, Melbourne Australia, has studied the physiology and the pathophysiology of the LAGB closely. He used high-resolution video manometry, isotope transit studies, endoscopy, and contrast imaging to understand what happens during eating in normal controls, eating in patients who are doing well after LAGB, and eating in patients who have symptoms of reflux, heartburn, and/or vomiting after LAGB.[7–15] In Burton’s series of articles, he concluded that in LAGB, it is not the band that fails, but rather the patients who receive the band and, more importantly, the doctors who care for them. Many years ago at the Centre for Obesity Research and Education (CORE), my colleagues and I developed the Green Zone chart, a conceptual way of identifying the optimal level of band restriction (Figure 1). When a patient is in the yellow zone, it is an indication that the band is too loose. When in the yellow zone, a patient may be eating too easily, feeling hungry, and not losing weight. When a patient is in the green zone, he or she does not feel hungry, is satisfied with small amounts of food, and is achieving weight loss or maintaining a satisfactory level of reduced weight. When a patient is in the the red zone, it is an indication that the band is too tight. The patient experiences reflux, heartburn, and vomiting. The range of food the patient in the red zone can eat after undergoing LAGB is limited and he or she may start to eat abnormally (so-called maladaptive eating), favoring softer, smoother foods like ice cream and chocolate. While in the red zone, patients will not lose weight as effectively and they may even gain weight. Burton measured the pressure within the upper stomach beneath the band in numerous patients when they were in the green zone. He found the optimal pressure was typically 25 to 30mmHg. The art of adjustment is to find the level of Fluid in the band that achieves that pressure range. That level of pressure generates a background sense of satiety that persists throughout the day. The patient, when correctly adjusted, normally will not feel hungry upon waking in the morning, and throughout the day should feel much less hungry than he or she did before band placement. In my experience, it is common for LAGB patients to have no feeling of hunger in the morning. Then, during the day, a modest level of hunger will develop, which a small meal should satisfy. One of the key lessons learned from Burton’s studies was that each bite of food should pass across the band completely before another bite is swallowed. There is no pouch or small stomach above the band and there should never be food sitting there waiting. The esophagus is a powerful muscular organ that typically generates pressures of 100 to 150mmHg, but it is capable of generating pressures above 200mmHg. Esophageal peristalsis squeezes the bite of food down toward the band and then progressively squeezes that bite across the band. Each bite must be squeezed across the band before the next bite starts to arrive. Figure 2 shows a bite in transit across the band. A single bite of food, chewed well until it is mush, will move down the esophagus by peristalsis. At the level of the band, the esophageal peristalsis will squeeze that bolus of food across the band. It takes multiple squeezes (usually 2–6 squeezes or peristaltic waves) to get that bite of food across in a patient with a well-adjusted band (Figure 2). Those squeezes generate a feeling of not being hungry and stimulate a message that passes to the hypothalamus to indicate that no more food is needed. If a single bite of food is able to generate between two and six waves of signal, a meal of 20 bites may generate 100 or more signals. This is enough to satisfy a person and is enough to signal him or her to stop eating. We recognize two terms for appetite control, satiety and satiation. Satiety refers to the background control of hunger that is present throughout the day regardless of eating. In the LAGB patient, satiety is generated by the band exerting a constant compression on the cardia. Satiation is the early control of hunger that comes with eating. In the LAGB patient, satiation is generated by the squeezing of the bolus of food across the band during a meal. Each squeeze adds to the satiation signal. There are sensors in the cardia of the stomach that detect this squeezing. The exact nature of these sensors is still to be confirmed but they must be either hormonal or neural. We know that satiety and satiation are not mediated by one of the hormones currently known to arise from the upper stomach.[16] Ghrelin is a hormone that stimulates appetite. A number of hormones that can be derived from the cardia of the stomach are known to reduce appetite. None of these hormones are found to be raised in the basal state after gastric banding and none can be shown to rise significantly after each meal.[16] Vagal afferents are plentiful in the cardia, and one group of afferents has a particular structure that lends itself to recognizing the compression of the gastric wall associated with squeezing of the bite of food across the band. In my opinion, the intraganglionic laminar endings, better known as IGLEs, are the most likely candidate as mediator of the background of satiety throughout the day and the early satiation after a meal. The IGLEs lie attached to the sheath of the myenteric ganglia and are known to detect tension within the wall of the stomach. They are low-threshold and slowly adapting sensors and therefore are optimal for detecting continued compression of cardia of the stomach over a 24-hour period. The several squeezes that go with the transit of each bite stimulate the IGLEs further. The signal passes to the arcuate nucleus of the hypothalamus and the drive to eat is reduced. The lower esophageal contractile segment. Burton developed the concept of the lower esophageal contractile segment (LECS). It is made up of four parts: the esophagus, the lower esophageal sphincter, the proximal stomach (including the 1cm or so above the band and the 2cm of stomach behind the band), and the band itself (Figure 3). As the esophagus squeezes the bolus of food down toward the band, the lower esophageal sphincter relaxes as this peristaltic wave approaches. It then generates an after-contraction, which can maintain some of the pressure of the peristaltic wave as a part of the food bolus is squeezed into that small segment of upper stomach. The upper stomach, including the area under the band, is sensitive to these pressures. It generates signals to the hypothalamus. These signals may be hormonal but are more likely to be neural. A correctly adjusted band will generate a basal intraluminal pressure of 25 to 30mmHg, providing a resistance to flow. The segment of the bolus that is squeezed through generates more signals from that area. Keeping the LECS intact is a key requirement for success with the gastric band. Bad eating habits (e.g., insufficient chewing, eating too quickly, taking bites that are too large) hurt the LECS. If those bad habits go on for long enough, stretching occurs and the power of peristalsis is lost, leading to the return of hunger (Figure 4).[11,12] The Fine Art of Eating A quality aftercare program is essential to successful weight loss in patients after LAGB. Before making the decision to proceed with LAGB in patients, I promise my patients three things: 1) to place the band in the optimal position safely and securely, 2) that they will have permanent access to a skilled aftercare program, and 3) that I will give them the information they need to obtain the best possible weight loss from the band. In return, I ask for three commitments from my patients: 1) that they follow the rules regarding eating after undergoing the procedure, 2) that they follow the rules regarding exercise and activity, and 3) that they always come back for follow up no matter how many years have passed.[6] The “Eight Golden Rules.” At my facility, we summarized guidelines for eating after LAGB into what we call the “Eight Golden Rules” (Table 1). These rules are included in a book and DVD given to every patient who undergoes LAGB at the facility.[6] The rules are also posted on www.lapbandaustralia.com.au and are reinforced at most aftercare visits. These eight golden rules must become part of each patient’s life. The effect of the LAGB procedure on hunger facilitates a patient’s adherence to the rules, making it more likely that he or she will follow them. However, achieving positive results with LAGB requires a working partnership between the physician and patient. Adhering to these rules is the patient’s part of the partnership, and he or she ultimately is responsible for the success or failure of weight loss following LAGB. What to eat. After undergoing LAGB, patients should eat small amounts of “good food,” meaning food that is Protein rich, of high quality, and in solid form. Each meal should consist of 125mL or 125g (i.e., about half of a cup of food). This measure of “half a cup” is a concept rather than a real measure of food, as some foods, such as vegetables and fruit, are composed largely of Water and this has to be allowed for in some way. Thus, I allow exceeding the “half a cup” limit a little for vegetables and fruit. We instruct patients to put each meal on a small plate and to use a small fork or spoon. The patient should not expect to finish all of the food on the plate, but rather he or she should plan to stop when he or she is no longer hungry. Any food left on the plate should be discarded. Protein-rich foods. Protein is the most important macronutrient in the food a LAGB patient eats. At our clinic, we recommend that our patients consume approximately 50g of protein per day. We have measured protein intake of our patients (Table 2) and have monitored their blood levels. We have not seen any protein malnutrition after LAGB, indicating that a daily intake of about 50g a day is sufficient. Table 2 shows the energy and macronutrient intake of 129 consecutive patients measured before and at one year after LAGB. Note the mean energy intake is reduced by approximately 1500kcals.[17] The best source of protein is meat; however, red meats, such as beef and lamb, tend to be difficult to break up with chewing in order to be sufficiently turned into mush. It is much easier to break up fish with chewing, and many fish are high in protein, including shellfish. chicken, duck, quail, and other birds can also be cooked to be easily chewed to mush before being swallowed. eggs and dairy, including cheese and yogurt, are also excellent protein sources. For nonanimal sources of protein, a patient should consider lentils, chickpeas, and Beans. Half of the “half a cup” allotment per meal should comprise protein-rich food. The other half should be made up of vegetables and/or fruits. I recommend to my patients that they eat more vegetables than fruit because vegetables have less sugar. Any space left in the “half a cup” can be used for the starches, (e.g., bread, Pasta, rice, cereals, potatoes), though I recommend to my patients that they eat a minimal amount from this group of foods as they tend to provide no important nutritional benefit. High-quality foods. High-quality food are foods that are minimally processed, natural, and whole. We encourage our patients to look for quality over quantity—for example, they might try sashimi-grade tuna, smoked salmon, duck breast, lobster, or even a simple poached egg. It is also important to remind your patients that there is no limit to the amount of herbs and spices that can be used to enhance the flavors of their foods. Solid foods. The patient should choose solid foods over liquids whenever possible. Liquids pass too quickly across the palate and, more importantly, too quickly across the band. There is no need for the esophagus to squeeze liquid, and without the squeeze, there is no stimulation of the IGLEs and no induction of satiety; therefore, eating calorie-containing liquids may negatively impact a patient’s weight loss. When to eat. After undergoing LAGB, a patient should eat three or less times per day. If the patient is in the green zone, meaning that the band is adjusted correctly, there should be no need for him or her to eat between meals. In fact, even three meals a day may be more than needed for satiety. In my experience, patients have little interest in eating in the morning. By late morning or early afternoon, patients may start to notice some hunger, which indicates that it is time to have a first small meal. In the evening, patients may have another meal. Most importantly, patients should be instructed that a meal missed is not to be replaced later on. The typical human body is satisfied with a maximum of three meals per day but often is happy to accept two or even one meal per day. Patients should be reminded that there should be no snacking between meals. If a patient finds that he or she is hungry by late afternoon, encourage him or her to eat something small and of high quality, such as a piece of fruit or some vegetables, just to tide him or her over until the evening meal. The patient should then visit the clinic to check whether or not he or she is in the Green Zone. It is important that the patient adhere to the aftercare program to monitor whether or not he or she is in the green zone. If not in the green zone, the patient will need to have fluid in the band increased or decreased. How to eat. Take a small bite and chew well. The “half a cup” of food should be placed on a small plate. The patient should use a small fork or a small spoon to eat. A single bite of food should be chewed carefully for 20 seconds. This provides the opportunity to reduce that bite of food to mush. It also provides the important opportunity for the patient to actually enjoy the taste, the texture, and the flavor of the food. Encourage your patients to enjoy eating more than they ever have. After chewing the food until it is mush, the patient should swallow that bite. Swallow, then wait a minute. The patient must wait for that bite to go completely across the band before swallowing another bite. Normally, it will take between two and six peristaltic waves passing down the esophagus, which can take up to one minute. This is probably the biggest challenge of educating the patient who has undergone LAGB. You must instruct the patient to eat slowly—chew well, swallow, and then wait one minute. A meal should not go on for more than 20 minutes. At one bite per minute, that is just 20 small bites. The patient probably will not finish the “half a cup” of food in this time. In this case, the patient should throw away the rest of the food. After undergoing LAGB, the patient should always expect to throw away food and to never eat everything on the plate. If it takes between two and six squeezes to get a single bite of food across the band and each squeeze generates satiety signals, then 20 bites should be generating 40 to 120 signals. The actual number will depend on the consistency of the food, the tightness of the band, and the power of the esophagus. With good eating practices and optimal band adjustments, the patient should not be hungry after 20 bites or less. As soon as the patient is no longer hungry, he or she should stop eating. After undergoing LAGB, the patient should never expect to feel full. Feeling full means stasis of food above the band and distension of that important part of the LECS above the band. This destroys the LECS, the mechanism that enables optimal eating behavior and appetite control. A patient should always keep this process in mind. If the patient finds that after eating the “half a cup” of food he or she is still hungry, he or she should review his or her eating practices, correct the errors, and consider the need for further adjustment of the band. If this is occurring, it is usually an indication that the patient is not in the green zone. Eat a small amount of good food slowly. These eight words are the key to success. Small amount refers to small bites, the small fork (e.g., oyster fork), and a total meal size of half a cup. Good food refers to protein-rich, high-quality, and solid food. Slowly refers to chewing well, swallowing, and waiting a minute. Try to repeat these eight words to every patient every time you see them. Get them to repeat it at every meal. The failure of the gastric band can almost always be traced to failure of this process. Addressing the Challenges The two principal challenges after LAGB are weight loss failure and the need for revisional surgery due to proximal enlargements above the band. Weight loss failure will occur if the band is not placed or adjusted correctly or if the patient does not adhere to the guidelines of proper eating and exercise. When a patient is not achieving results after his or her LAGB operation, the doctor should check to ensure that the band is correctly and safely placed. The most common reason for weight loss failure is poor eating behavior, which leads to enlargement above the band. There are three common eating errors: 1. The patient is not chewing the food adequately. Food must be reduced to mush before swallowing. If it cannot be reduced to mush, it is better for the patient to spit it out (discreetly) than to swallow it. 2. The patient is eating too quickly. Each bite of food should be completely squeezed across the band before the second bite arrives. 3. The patient is taking bites that are too big to pass through the band. Each of these errors leads to a build up of food above the band where there is no existing space to accommodate it (Figure 4). Space is then created by enlargement of the small section of stomach or by enlargement of the distal esophagus, both of which can compromise the elegant structure of the LECS. If the LECS is stretched, it cannot squeeze. Without the squeezing, satiation is not induced. When satiation is not induced, hunger persists, more eating occurs, and stretching continues. If our patient continues this each day for a year, it is inevitable that chronic enlargement will occur, the physiological basis for satiety and satiation is harmed, and stasis, reflux, heartburn, and vomiting supervene. The doctor should continually review the Eight Golden Rules for proper eating and exercise with each patient. For optimal weight loss following LAGB, the patient should have access to a comprehensive long-term aftercare program for clinical support and optimal band adjustments and he or she must follow the guidelines regarding eating and exercising for the rest of his or her life. “Eat a small amount of good food slowly” is the key to optimizing the gastric band.

It's like a love/hate relationship I have with my band -- UGH! Damn if I do (with restriction) and Damn if I don't (a looser band). I will tell you, after having a restrictive band year in and year out...sometimes it get OLD...at least for me. With my old band, I had kiss a@@ restriction and lived with that for years, until I had saline removed and I honestly (welcomed it) because I was sick and tired of getting food stuck, slimming, etc. chewing, etc. When my surgeon removed some saline back in 2012 due to a hiatal hernia and back pain when it was filled optimally-- I felt FREE.. a release from (lap band jail)...LOL.... I felt so free, I went wild....I ate a Five Guys burger, with melted cheese and fries without getting that ( Deer in the Headlights) Look...you know what I am talking about . Then I had a delicious philly cheese steak sandwich with toasted bun, onions the whole nine yards....I was on a roll.... I continued my FREEDOM...Until my pants started to get tight...and then I had to go shopping again for a new size.... At this time, my band was still pretty empty, I could not fill it properly because I had back and chest pains from my hernia, so I continued on a downward spiral of FREEDOM....forget about ice cream and candy...you know the sliders we sneak and eat with a very tight band....I wanted REAL food...and I got it... Well...50 pounds later and finding myself in a size tight 16-18 pants...something that I NEVER THOUGHT WOULD HAPPEN WITH A LAP BAND INSTALLED....HAPPENED TO ME...ME? I was the person that was obsessed with the scale, someone who walked at 5 each morning, in 20-30 degree temperatures for 6 straight years...because I HAD CHANGED MY LIFESTYLE FOREVER? EVER ...EVER? Once I found a surgeon to HELP me repair my hernia, give me a second chance to get my "grove back" I was humbled and grateful.. THE MORAL OF MY POST IS...NEVER THINK YOU GOT THIS WEIGHT LOSS SURGERY IN THE PALM OF YOUR HANDS....BECAUSE ANYTHING CAN COME AND TAKE IT AWAY FROM YOU .... When the lap band is UNFILLED AFTER YEARS OF EATING HARDLY NOTHING...your metabolism gets SHOT...and if you EVER have to get unfilled....THE WEIGHT CAN COME BACK QUICKLY...I GAINED 20 pounds in ONE month.... And oh yea....after I had ..had my feel of Burgers and Cheese Steaks....it was too late to eat Broccoli and baked chicken....no matter what I'd done with a LOOSE band...I could NOT get the weight off UNTIL I got my lap band properly restricted again..... It took over 14 months JUST TO LOSE the 50 pound weight gain, I was FINALLY BACK to my old lap band fighting weight ...it sure was not easy like it was when I was first banded... So while my lap band (SuzieQ) is working NOW in full over load.....I still want to stuff my face and I can't, I just can't do it.....and you know what? I glad.... ... Please respect your band and cherish with love, because one day...you may find yourself IN FREEDOM with an unfilled band and that is a very SCARY place to be!

I don't get on here as much as I use to since I have a very busy life, glad I logged on this morning. Congrats on your awesome success!! You look great!! This is one of the most honest and TRUTHFUL stories I've read here. Keep on working that band and much success to you.

This year will be reflection on my long journey, I've had many ups and downs, weight loss surgery IS a journey. I will be 9 years post op this year, and this great little tool is still keeping my weight down. I am still happy and healthy, I don't have to take a boat load of supplements, or kill myself exercising, just an hour walk daily on my treadmill or outdoors helps keep my weight down. I started in a size 26, and my lowest size was a 8, I hover around a size 10/12 at 5'7 inches tall now, I don't have to kill myself at this size -- and still eat what I want, I am grateful to be healthy at 9 years post op and most importantly -- still wearing a size 10...

You said... I thought green means going 4 or 5 hrs without getting hungry between meals. Not "no hunger at all". ? It does, green does not mean starvation and malnutrition, it means having a DIMMED appetite under control about 4-5 hours between meals.

Thanks Alex for the tip! I've been looking for great alternatives to bread when making a sandwich since bread tends to plug me up. Great sandwich ideas especially for me almost 9 years post op.

Good post! And you make a good point, I wish my obesity was that simple! Because I used to eat healthy and eat some junk too, I was never a total horrible food eater, I was not a burger and fries,fried foods, ice cream, fattening Cereal, chips loads of Pasta, mac and cheese, and junk type of obese person. I just ate too much combined with lack of exercise, and I was a stress eater too, I love healthy food, spinach, collards, cabbage, salads, baked chicken etc, I am also a good cook...I write computer code and I will tell ya...I could go through a whole bag of chocolate kisses if I had a difficult problem to solve....so the reason I was fat was a bit more complex...LOL and genetics play a role for me too...I can just look at food and gain 10 pounds... I've always wondered how some skinny women could sit all day and never enter a gym and stay skinny!!

Congrats on your success!!! You look great, may you have many more blissful years with your band!!!

Hello... Band slippage does not work that way....in fact the symptoms of band slippage is when you can't hardly get solids down and experiencing daily "productive burps" you do NOT want to achieve that. Also pouch dilation can happen two ways, it can happen when you are TOO TIGHT (red zone) and eating any food on a too tight band will eventually dilate your pouch to compensate for the food you are eating... Pouch dilation can also happen when you are in the green zone and constantly eat past 4oz per meal and vomit and purge your food daily...it takes a while for this to happen, sometimes a few months and sometimes a few years. Also you can't stretch your pouch on a "loose" band, when the band is tighten to the green zone or red zone this is when pouch dilation can occur because there is more pressure on the pouch and you have to be more careful with eating and productive burps at this level. You probably have not achieved optimal restriction at this point sometimes it takes some people 3-6 fills before they reach the green zone. Having the lap band requires patience.

Sorry to hear about your slip, but why can't your surgeon reposition or replace your band? Is there too much damage? I know some people are not candidates for rebanding, but many are.

I am so sorry to hear this! If you have pouch dilation it does not take that long for it to heal, usually the treatment is to empty the band and let it rest for about 6 weeks and then slowly restart filling, some people can get back to the green zone with no issues, but after a pouch dilation you have to be more careful with portion sizes and measure and careful with Pbing and sliming. You may want to seek another opinion with another surgeon and see if they can replace your band, if you have the older 4cc bands they were more prone to issues than with the newer bands, but all bands can have the same issues but the older bands were higher pressure which caused more issues. Hope you can find answers. Thanks. What is pouch dilation? I have a 10 CC Vanguard Band placed in 9/8/06. I have never ever wanted it removed. And I really don't know about replacing it. . . . it was working fine before my breast cancer surgery. Hi Joanne, Ok, you have the older type model band, the 10cc Vanguard bands are no longer used in the US just like the 4cc bands, they were all higher pressured bands that were hard on the body, but many loved their bands, I loved my old 4cc band too, however the 10cc VG band were bigger than the 4cc bands, but they were still higher pressure. Pouch dilation is actually a mild complication of banding, many people do not know if their pouch is dilated, some think after a while they can eat more food, they will go and get a fill, this can be dangerous because if the pouch is dilated, it needs to be treated and the usual treatment is removing saline to remove pressure off the pouch...and wait about 6 weeks and start refilling the band... The classic signs of pouch dilation is reflux at night after a too tight adjustment and then after being too tight too long the pouch will dilate. This is why many people suffer complications and don't know why...this is why those who have been banded a long time greater than 2 years need to have their bands checked yearly to check the pouch size before adding more saline....many surgeons don't check they will just blindly fill the band and they have no clue if the pouch is dilated....mild dilation is not harmless... But if the pouch gets huge...it will prolapse and cause band slippage...and this will require surgery to fix or remove the band... Someone can have mild pouch dilation and pouch dilation can get severe with slippage...mild pouch dilation can be treated with unfilling the band and watching portion size, but slippage must be treated with surgery removing the band or re positioning or replacing depending on the damage... Here is some more info on pouch dilation and symptoms and prevention.... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874894/ In summary, pouch dilatation with or without slippage is a long term complication in LAGB patients; the percentage observed in our three-year study was 11.1%. Except for posterior slippage, these complications show an association with postoperative management, such as over tightening of the band or poor compliance among patients. Gradual band adjustment with strict follow-up and continued dietary consultation will prevent or minimize occurrence of these complications. From a technical point of view with consideration of accurate pars flaccida techniques, accurate seromuscular bites are very important because inaccurate gastrogastric fixation can be loosened with time (stitch burst), and eventually make the portion of the fundus redundant below the band. Removal of the fat pad on the cardia with coagulation greatly facilitates the accurate seromuscular bites. In addition, adequate wrapping also stabilizes the gastric band and minimizes the fundal prolapse, thus avoiding slippage.

Sorry you've had such a horrible time with your band, it happens to a lot people. I hope the Sleeve brings you everything you hoped the band would. Many love their Sleeves, but some report reflux issues too, so hopefully you have done your research on the possibility of developing GERD with Sleeve which can involve throwing up in your sleep as well, but hopefully you know the risks. Many lose more weight overall with Sleeve than Band, and you no longer have to worry about fills adjustments.

I am so sorry to hear this! If you have pouch dilation it does not take that long for it to heal, usually the treatment is to empty the band and let it rest for about 6 weeks and then slowly restart filling, some people can get back to the green zone with no issues, but after a pouch dilation you have to be more careful with portion sizes and measure and careful with Pbing and sliming. You may want to seek another opinion with another surgeon and see if they can replace your band, if you have the older 4cc bands they were more prone to issues than with the newer bands, but all bands can have the same issues but the older bands were higher pressure which caused more issues. Hope you can find answers. Well...the thing is that for some people sliming can lead to PBing....and we have to be very careful with putting too much pressure on the band, this can also dilate and swell the pouch.... Sliming is not that harmful since you are only spitting out slime and not causing pressure..but they should be avoided....everyone who gets a lap band and get to the green zone WILL at SOME point slime and PB it comes with the territory, we are not all perfect, however it should not be several times a day or even daily, you should keep them very rare...this is why we should always focus on eating taking tiny bites and chewing to mush, and not be distracted to minimize sliming... I slime about 2 times per week,...it's just a way a life for me, but I don't do it daily.

I am so sorry to hear this! If you have pouch dilation it does not take that long for it to heal, usually the treatment is to empty the band and let it rest for about 6 weeks and then slowly restart filling, some people can get back to the green zone with no issues, but after a pouch dilation you have to be more careful with portion sizes and measure and careful with Pbing and sliming. You may want to seek another opinion with another surgeon and see if they can replace your band, if you have the older 4cc bands they were more prone to issues than with the newer bands, but all bands can have the same issues but the older bands were higher pressure which caused more issues. Hope you can find answers.

You mentioned: I know that the lapband is not magic, and it does not prevent me from gaining weight. But it sure does level the playing field, giving me a much-stronger shot at not only getting to goal, but staying there. Exactly: This holds true with the fact that the band IS ONLY A TOOL...it does NOT work properly until we work it and use it wisely. My lap band DOES NOT STOP me from eating, IT DOES NOT STOP me from eating junk and sweets, even in the green zone I can eat a whole bag of chips if I choose to do so, I can eat unlimited amounts of JUNK...but SO can my friends WHO HAVE A SLEEVE....ALL these surgeries are TOOLS.....not magic wands.. BUT --- what my band does help me with is portion control (with solid food) and it keeps my hunger level under control and to ME that is A LOT OF HELP...lol... I got cocky in my 6th year and assumed I could KEEP my weight down WITHOUT being in the green zone, well -- that did not work well at all, my hunger returned and my portion sizes got bigger (pre op size) and I had gained 50 pounds back in no time.... This is why I will cherish my band in the green zone and I will never push the limits because I know I will gain every pound back WITHOUT the help of my lap band...been there and done that....and I will respect this wonderful tool as long as I have it and hopefully can keep it functioning properly.

I guess it depends on tight your band is...if you are in the green zone here are some suggestions: 1. Tuna salad/egg salad/chicken salad 2. Deli turkey slices -- I love those only about 30 calories per slice I add slice of cheese and melt it - YUM, lots of Protein. 3. Saute spinach with onions , grilled turkey burger 4. Moist baked chicken, raw carrots Sometimes it helps to cook in advance since we eat so little and eat off left overs for a week.

I agree its' personal....It's NOT my business how tight someone keeps their bands, how often or how little they eat, or how many times someone PB's and slime....THAT's IS THEIR business. If someone keeps their bands too tight, that is OK, I will still like them and give them congrats on their weight loss...LOL..that is NOT my business how they rock their bands, or lose their weight, but they need to know to don't be surprised if they suffer complications, and even when people suffer complications I will still help them any way I can.-- what I don't like is band bashing...after someone has abused their bands. I use to just concentrate on giving people congrats on their weight loss and looking at before and after pics.....UNTIL....everyone started to disappear after being banded 5 years...lol....they were losing their band in droves.... Then SURGEONS STOP doing bands for MANY people because the re-op rate was SO high....if you have not heard about the downfall of the lap band you must have been under a rock for the last few years....The lap band is about satiety AND NOT TIGHT RESTRICTION....anyone CAN choose to use their band how they want, they can keep it too tight, etc, but when problems crop up down the wrong, please don't act surprised or start bashing the band..LOL You have to REALLY know how to use the band for it to be effective and not cause complications, this is why MANY surgeons stop doing bands and started recommending the Sleeve and the Bypass for those WHO NEED MORE help with losing weight, the band IS NOT RESTRICTIVE, it is not designed that way it is NOT designed to stop us from eating it is designed to help us stop....and YES, it is still dieting for many of us...with just a little help, unfortunately. Anyone can choose to use the band however they like, they can tighten the band to the point of drinking Protein shakes, but what is the point of following the green zone if someone KEEPS their band adjusted in the RED zone? Adequate fill levels in the band researchers in Australia developed the Green Zone Chart: Then Dr Simpson and others who follow Dr. O'Brien golden rules went to Allergan and said we need to do something and quick....so many are losing their bands...and MANY started to revise to the Sleeve because MANY were NOT following the Green Zone chart of safety....some people think a too tight band is when you can't swallow your spit...NOT....you can STILL be too tight if you can't eat MOST solids. Please read here the downfall of the lap band: I watched it all happen..... Wrong Information The original model for the Lap-Band was it made a person “feel full with less.” This was preached by the sales force at Allergan to the surgeons who were placing the band. If you were not feeling “full” eating less, then they need to have their band tighter. Out of Australia the research was showing something different. The band was not making people feel full with less. In fact, the band worked best when it was a bit loose and food went past the band. As much as John Dixon preached this, the only ones who kept up with that data were those surgeons whose main interest was the Lap-Band, but not the entire bariatric community. As a result, patients were getting heart burn, band slips, not losing weight, and feeling miserable. Especially among surgeons who didn’t learn how the band worked. As these patients got into trouble, their bands were removed, or ex-planted. Now the group of surgeons who used the band a bit, were getting a bad feeling about the band. Those surgeons who used the band as the major focus for their practice, took the new information to their patients, and continued to have good results. http://www.yourdoctorsorders.com/2013/05/lap-bands-perfect-storm-and-turn-around/

Haha...I got flamed big time for posting about this...and created many enemies and hate mail..... Actually O'Brien the creator of the "Green Zone" suggest that Lap banders do not have to wait 30 minutes or longer to drink after eating, he has done much research and studies and observation on this regarding the Pros and Cons....our food slowly empties from the esophagus into upper the (upper stomach made by the lap band which is near the lower esophagus) and there is no benefit to wait a long period of time after eating. Now he suggest that we can take a sip of liquids between bites of food since we lap banders do not technically have a pouch like Bypass people do (this IS the rule for both Sleeve and Bypass people to wait 30 minutes or longer to drink after eating) since their food empties different than us lap banders. The old rule for many was 30/30 meaning drink up to 30 minutes prior to a meal and 30 minutes after we eat to keep from washing the food down too quickly which was supposed to keep us full longer, if that was the case, we would not be hungry before we reach the green zone. Dr. O'Brien has a video detailing that it is OK to drink between bites while eating. Here is Dr' O'Brien explaining how when you are in the green zone, it is the esophagus squeezes that gives up that feeling of satiety and fullness...NOT the stomach, our food slowly empties from the esophagus creating that "full feeling" For ME, I have tested both, I still get satisfied for hours even if I take a sip of liquid or wine between meals...the MAIN thing for me is to have my lap band adjusted in the green zone, this way I don't worry about pushing food through, I stay satiated for hours even if I drink with my meals..... Here is more interesting info on this topic: http://coloradobariatric.com/2012/01/how-to-eat-appropriately-for-weight-loss-after-lap-band-surgery/ Adequate fill levels in the band researchers in Australia developed the Green Zone Chart: Dr. Paul Burton, a bariatric surgeon in Australia has done studies on the pressure provided by the band while patients were in the green zone. It was found that each bite of food should completely cross the band before another bite is swallowed. Food passes the band through esophageal peristalsis (contractions or waves of the muscles in the esophagus which force food to move). The goal is that a small, single bite of food is chewed until it is mush. Then through peristalsis it will move across the band, taking multiple squeezes (usually 2-6), in green zone adjusted patients. In patients who are underfilled or overfilled it will take less or more waves to push the food past the band. It was found that the squeezes of the esophagus are what cause the sensation of no longer being hungry and that each squeeze adds to the satiation signal.

Looks Yummy! Unfortunately I can eat EVERY thing there including cupcakes, I probably can eat 3 cup cakes in 1 sitting! I don't keep my band dangerously too tight to not eat junk food...LOL...they will slide right down... I have to have discipline to stay away from too many sweets, but every now and then I will have my chocolate fix.

Jenny, I've watched your journey and I am so proud of you! You've come along way baby! Congrats on onederland and I am positive you will make your goal in no time!!! Keep on working your band and it will take care of you.

Anyone who is over 2 years post op, and can 'suddenly' eat too much should see their surgeon, it is recommended everyone who has a band to get a yearly fluoroscopy or Upper Gi to check the band.... It could be you need a fill, it also could be erosion, pouch dilation or leak.

I loved rewarding myself with cute clothes, shoes, nice jewelry...pedi/mani;s new hairdo....new fragrance...things that made me feel and look good