BetsyB

One thing that leaps to mind (because I actually have a husband for whom this is currently a very real problem) is your hydration status. I am going to give advice that sounds counterintuitive. If you are drinking 10 glasses of Water in addition to other fluids and Protein drinks, you might want to pare back a little. (Post-op, you'll likely have to pay attention to getting ENOUGH liquid, so this is not a long-term suggestion; just something you might want to consider as you endure the preop agony.) Everyone always says to drink, drink, drink. But once you're well-hydrated, there's no such thing as "better hydrated." Our kidneys do an exquisite job of ridding our bodies of excess fluid---but when they are flooded with too much Fluid, their ability to finely regulate electrolytes is compromised. This can wreak havoc with electrolytes (sodium in particular) and cause weakness, headache, and other (sometimes very serious) problems. The easiest way to gauge hydration is urine color. If it's very dark, you need more fluid. If it's pale yellow, you're a-okay. If it's clear, you can ease off on fluid a bit.

At two weeks out, I would not be terribly concerned about damaging anything. I"m sorry you experienced discomfort---rice can be problematic for many. But just hop back on the wagon. You'll be fine :thumbdown:

When you get stomach flu, quite often, you have diarrhea instead of vomiting. If you do heave/retch, doctors often ask that you notify them so that they can prescribe antiemetic (antinausea/vomiting) meds so that you don't risk band slippage. The anatomy is such that stuff from the lower portion of the stomach can't really get back up--so the heaving is dry (unless you have a little bit in your pouch at the beginning). So, the idea is to stop that heaving so that your band stays right where it belongs.

That I can exercise complete control over what I put into my body---and that it feels great. Eating a low-carb diet and exercising routinely Believe in yourself. Set yourself up for success. Have high expectations, but realize that you are human, and are "allowed" to make mistakes. You will learn from them Exercise. Exercise. Exercise. I think it's the most crucial part of the lifestyle change. Don't be discouraged when, at the beginning, you do not feel "different." It's typical to experience a period of time when the band isn't yet doing its "trick." You may be hungry--but it will be the last time you'll be hungry in the name of weight loss. DON"T LISTEN TO PEOPLE WHO TELL YOU THIS IS NOT A TIME FOR LOSING WEIGHT--you can lose weight during bandster hell; follow your doctor's rules--and you will lose. If you do feel discouraged, know that it gets so, so much better as you approach and achieve restriction. Don't be afraid to take pain meds if you need them. We all emphasize what a breeze the surgery is--and compared to many things, it is an easy procedure. But it hurts, and if you need pain relief, use it--it will help you get moving, and that is so important. Walk as much as you can after surgery--it will help you feel better much faster. But also be sure to get enough rest. Don't break the rules--at least not at first. Learn how to maximize your loss by using your band the way your doctor intends. You will have a lifetime to tweak things to fit your lifestyle; commit to spending the first year or so adopting new habits.

When you talk to the surgeon, spend some time with him discussing how and what you eat. If you were to journal your food intake for a period of time before your appointment (fitday.com is a good site, but there are many), it will help him get a really good idea of what "kind" of eater you are. BMI isn't the only criterion that should be used to decide what surgery to have. The long-range results for both gastric banding and gastric bypass are about the same. (Yes, you lose more rapidly with bypass---but overall, the outcomes are similar.) It is more important to identify which surgery with which your eating style is best aligned. My doctor paid a lot of attention to my eating history. I did have food journals for him to look over---and in the end, he told me he thought I was a much better candidate for banding. Your doctor may reach a different conclusion---but you can help him reach the right conclusion with you if you give him as much information as possible.

Without even getting into the starvation mode debate, there's really no way to ascertain whether Amanda needs more or fewer calories based on the information given. Journalling both food and exercise on a site such as fitday.com will give a far better idea of energy input/output. The "day off" this week, as well as very loose adherence to an eating program ...well, maybe Amanda needs more calories, or maybe she's grossly underestimating her caloric intake. Amanda, in order to make wise decisions about the course of action to take, you need to have good baseline data. All the advice from others in the world doesn't amount to anything if it's not the right advice for you. To figure out what's right for you, you have to assess your situation clearly and honestly, then systematically make changes to find what works (and what does not). So, start by recording what you're currently eating. Assess what it's giving your body. THEN make changes. Maybe, for a two weeks, you would want to try adding 100 calories/day. Assess how that change affects your body. If it works, keep it up (or even see if another 100 calories keeps you going at the same, or better, rate). If not, try something else (bumping up or changing exercise, eating a few fewer calories---depending on what you determine your baseline to be---bumping up Protein, paring down on carbs, whatever.) Getting a baseline idea of what isn't working can help get you on track to a routine that will work. And like Denise noted, it may just be that you've hit a rate of loss that will be typical for you. The results really, really do add up over time.

Congratulations!

I'm starting to get this--and it's so silly! I'm a little more than 10 pounds from a normal BMI--and plan to go lower. I think some people are just so used to having me a certain way that they don't *get* me now. They'll get over it

I'm sorry you're feeling so cruddy. coffee (even decaf) really stimulates stomach acid production; if you are experiencing indigestion, it probably is not a good choice, at least right now. For me, warm liquids are soothing, so many you can find an alternative.

What you're doing wrong is making up your own rules and assuming they will work better than what your doctor told you to do. In short, you're sabotaging your success. I'd recommend tracking your eating and exercise on Fitday.com. It will let you enter the nutritional information for your Lean Cuisines. After a few days, look at the pattern. You will likely see that you're getting inadequate Protein, and a whole lot of ...well, nothing. Throw in a day off every week---and you're setting yourself up for failure. I am not in the "you're eating too little" camp. I think rather than focusing on the often-given "eat more" advice, it would be a FAR better idea to reconsider the nutrition advice given by the surgeon/dietitian whose expertise you (or your insurance) paid good money. You may or may not need more calories. There's no way to really know, because you're using free days, etc. Track what you're doing so you have a realistic view of what you are giving your body. You don't have to track forever--just long enough to get an honest view. Sluggish weight loss aside, you are not giving your body what it needs to be healthy.

My favorite is tuna tartare or tuna sashimi from my favorite sushi place. But it's not something I rely on routinely--I can't afford it as often as I'd like! On a routine basis, I rely on the basics: chicken, fish, turkey, lean beef, lean pork. LOTS of Beans (chilis, soups--and yes, I know some doctors say no to Soup because it's supposed to be a slider, but for me it isn't, so I eat it). I use Protein supplements pretty routinely to bump up my protein because I feel and lose better when I aim for 80-100g/day. My favorites are the Inspire powders (Dutch chocolate, especially) and PURE unflavored whey protein isolate from bariatriceating.com.

I know it's hard to hear, but the first fill often does not effect the change that bandsters so badly want. Band adjustment is a process. For some of us, it takes several fills to experience any restriction--and often more to fine-tune adjustment. As frustrating as it is, try to remember that this is the last time you will be hungry in the name of weight loss. Stick to your doctor's recommended eating plan--so that you get a leg up on loss---and know that it will get better. Your first fill may or may not give you some relief. It's not unusual for there to be some restriction at first (due to swelling), and for that to subside. No matter what your experience, it will take you a step closer to where you want to be. I didn't feel much difference at all until my third fill. I was lucky that my doctor was willing to accelerate timing for me a little bit; I had my first fill at 4 weeks, and my second and third fills at 3-week intervals after. (Usually he waits 6 weeks.) But even after that point, I've had a lot of fine-tuning; I've since had 4 fills, and only now have what seems to be lasting restriction. Don't get discouraged. It does get easier each step of the way....but it's a process.

Hboyd is correct. The first place to start is with your insurance policy. It will spell out the conditions that must be met in order for bariatric surgery to be approved. Depending on those conditions, you may have to have a referral from your PCP to a surgeon---or you may be able to initiate the process yourself. My insurance covers the procedure for those who are 18 and older. (Don't be discouraged--the preop process is lengthy, and starting it now may be just right.) It does not require my PCP to be involved, so my next step was researching surgeons in my area. My insurance specified that I use a Bariatric Center of Excellence, so that narrowed choices in my area. An acquaintance had used a certain surgical group, so I started (and stuck with them). From there, it was a matter of following the surgeon's path: I started with their informational seminar. At that time, I provided insurance and other basic information. Within a day or two, the surgeon's insurance specialist verified that I was preapproved, and scheduled me for an appointment. From there, it was a matter of following the surgeon's procedures (also guided by insurance requirements, to a certain degree): seeing various specialists for surgical clearance. My insurance did require a 3-month supervised diet. My surgeon did not specify a plan; I was permitted to use any method that had been previously successful for me, but was required to lose 6 pounds within that time frame. (The amount was dictated by insurance; though they require a BMI of 40 without comorbidity, they used my STARTING weight---which is good, because the 6 pounds pushed me below 40). Once all the criteria (surgeon and insurance requirements) were met, then the paperwork was submitted to insurance for final approval. So...start with your policy. It will tell you what is required. Depending on its requirements, you will either see your family doctor or attend a surgeon's informational seminar. If you are not relying on insurance, then you can start with the seminar. Good luck! I think it's great that you're choosing to conquer this problem now, when you have your whole life ahead of you.

Yes, it does get better--I promise. I withdrew gradually, over the month or so before my preop diet, though it overlapped the diet a little. I was HARDCORE--drank an amount that now embarrasses me, and had since I was a kid. But now I live very happily without it. I am amazed at how much money it saves, too. Between giving up diet soda and giving up Starbucks, it's made a huge difference for me. Good luck--you can do it!

It used to be that nausea and vomiting were an expected part of the immediate postop experience. Now, most surgeons administer meds preoperatively that remove this problem. I experienced NONE after my surgery. If you're worried more about the stories you hear about stuck incidents, or throwing up when you eat too much---again, probably not something that should deter you from surgery. Vomiting postop is NOTHING like vomiting now. It doesn't involve heaving/retching. It doesn't involve gross partially-digested food and bile/stomach acids. It's simple regurgitation of a clump of food, enveloped in mucus. It isn't preceded by nausea. Instead, it's preceded by the discomfort of being stuck (or having taken one bite too many), and it is a HUGE RELIEF. No retching, no heaving---just relief. It's hard to describe this to someone whose sole experience with vomiting is the preop kind...but it really is very, very different---and while I know it's daunting to think of (especially because you read so, so much about how much it happens), you have to realize that it isn't a regular occurrence. Once you master taking small bites, eating slowly, chewing....well, yeah--you'll still have an occasional stealth food that causes you trouble. But by and large, you will live your life without complication.

Well, vomiting's different after banding. The throwing up that occurs after a stuck incident, or eating too much, involved mucus-encased food that is simply regurgitated---no stomach acids, no bile, just removal of the "offending" food. With stomach viruses, people often find they are more prone to experience diarrhea. Vomiting again is "different"--the lower stomach may heave, and you may retch--but if there's nothing in the pouch, then vomiting does not occur. That said, violent heaving/retching can pose a risk of band slippage; most surgeons ask their patients to contact them if they develop such an illness so that they can prescribe antiemetic (anti-nausea/vomiting) meds to reduce this risk.

In general, I think most surgeons do a competent job of installing the band. Slips and erosions do sometimes happen--but they are not generally related to surgical skill. The rates of slip and port flip you describe for the Seattle doctor are perfectly acceptable. Again, they are not generally related to surgical skill--they're complications that just sometimes happen. Particular patients have vulnerabilities that cannot always be predicted. I would NOT make single-incision surgery a priority; the scarring from traditional laparoscopic procedures is minimal, and I would pick the doctor (a) with the best preop patient education, and ( the best AFTERCARE. Because unlike most surgeries, when you see the surgeon once, and maybe during a single follow-up visit before you are discharged from care, banding requires an ongoing relationship. While I'm perfectly comfortable traveling to another state to have plastic surgery---knowing that I will have a time-limited relationship with the surgeon that will terminate when I leave the city several weeks later (and resume when I return for another procedure), I would be very uncomfortable having surgery with a doctor I did not meet before making the surgery. (I will meet my plastic surgeon during the decision-making process; if we don't click, then I will find another.) I would also be very wary of choosing a faraway surgeon---I don't believe banding is just a matter of finding the right guy to install the band, then worrying about aftercare as an afterthought. With this surgery, preoperative patient education and aftercare are key to success with weight loss and maintenance of that loss. I'd go with the guy in Seattle, ask him how comfortable he is with the single-incision, defer to his judgment regarding the approach (though 15 procedures is probably reasonable---especially if he operates like mine does: no matter what the procedure, my surgeon and his partner are ALWAYS together in the OR. ALWAYS---two experts for the price of one.) It's a tricky decision, with lots of things to consider---make sure the ones you're focusing on are the ones that will make the most difference in terms of your long-term success. (And remember, the stats you read regarding complications attributable to each doctor (a) may not be accurate, and (:tongue2: may not reflect anything actually attributable to the surgeon; slippage, for example, is often due to user error---or something random, like a patient who becomes ill with a virus that causes violent vomiting or coughing.) Good luck!

The bowel prep represents a new stage, so no--no Optifast. It should be clear liquid, and some doctors specify certain of those to avoid (ones that are red in color, for example).

How frustrating! It sounds like Honk's ideas are really helpful. I hope you are able to get good reassurance.

Chances are, it's just Fluid retention. Weight can fluctuate by a few pounds normally--so it's probably pretty meaningless. Your loss so far is great! It gets much better as you work toward restriction

Totally normal---as long as you're not uncomfortable, you don't have to worry. There's just not that much moving through the bowel right now. Plus, meds and anesthesia slow things down a bit, temporarily.

Adding some flexibility work (even simple stretches) then rounds things out really nicely. Cardio, weights, and flexibility---the triad

The degree of excess skin you experience is related to age, genetics, how much/how long you were overweight, how many times you've lost/gained, how many pregnancies you've had, and other factors--none of which you really can control. It's not affected by rate of loss (though it can seem to be--if you lose quickly, it just becomes apparent more rapidly) or exercise or topical creams, etc. (There are some lotions that temporarily tighten things up, though; I like C. Booth's 4-in-1 Multi-Action body lotion--it's inexpensive and great.) Exercising is really important. Building and maintaining lean muscle mass is crucial for a number of reasons. And it does produce a nice "scaffolding" for your skin to cover. But you may, in fact, be left with excess skin. If you look at plastic surgeons' before and after galleries, you often will see people who have not achieved a good BMI prior to surgery; if they lost more, some of the areas upon which they had surgery might have retracted further. Or they might not have. Skin elasticity is not infinite. Think of a balloon that you inflate and deflate. For a few times, it does just fine. But after a few more tries, the latex gets ripply and less elastic. Eventually, it breaks. Skin is kind of the same. It can only stretch and retract so much. Same with the connective tissue beneath the skin. (Stretch marks are actually scars in this connective tissue.) All you can do is stay well-nourished, well-hydrated, well-exercised (and well-rested)---and hope for the best. I'm 48, have gained and lost a few times (but have not been obese my whole life). I've had 3 pregnancies, quit smoking a dozen years ago, and have found that my skin is doing MUCH better than I expect in some areas, and not as well in others. But I'll tell you this much: every single part of my body, whether saggy or not, looks a hell of a lot better than it did when inflated with 99 more pounds of fat!

The physical and emotional benefits of regular exercise are just so great that I can't imagine ever giving it up. For me, it's as critical to my weight loss as eating the right foods in the right amounts; I simply cannot lose well without it. But even if that were not the case, it makes me feel so much better. It has been crucial, psychologically--it has taught me to trust and love my body (and this actually happened before my decision to be banded, and helped me determine I was worth the effort to get to a healthy body weight). It helped get me in touch with a body I'd learned to ignore.

I have to focus on Protein, or it sets me up for being hungry all day. When I first get up (very early), I have a warm Protein Drink. I postpone eating until after I exercise--which often means it's more of a brunch than breakfast. I tend to have savory things, things that aren't typical breakfast foods. (eggs don't generally work well for me.) Often, it's something like chicken black bean chili, or something else with Beans. I eat low-carb in general, but the carbs from beans work very well for me post-exercise.