BetsyB

So the alternative is staying fat, and remaining exposed to the attendant health risks? Sagging skin isn't the prettiest thing in the world. It looks a heck of a lot better than skin stretched beyond capacity with fat. Obese boobs and bellies sag, too. But obese bellies pose a huge health risk. Losing weight by any means can result in sagging or loose skin. It's not a given, however. It's dependent on genetics, age, smoking status, how long you've been overweight, how many times you've gained and lost, past pregnancies, and so on. It is NOT affected by rate of loss (not that banding provides ultra-rapid loss, anyway) or by anything you apply to the skin. Staying fat to avoid skin issues is like continuing to smoke so you don't gain weight--it doesn't make sense. Tell your friend to have her doctor document all health issues relating to her hanging skin (skin rashes, and so on). Her insurance may not cover abdominoplasty (tummy tuck), but it is likely to cover panniculectomy (removal of the hanging skin). No rose-colored glasses here--just almost 100 pounds down from my highest weight. At 48, after 3 pregnancies and plenty of yo-yoing, I look pretty damn good. Will I have surgery? Maybe. I am not sure how I will look when I hit my goal, but the way things are going, I might (and in fact have a consult scheduled for May, when I will be in the surgeon's city, anyway)---but it looks like I will need far less than I originally had feared.

When the band is installed, the ring that surrounds the stomach (forming the pouch) is not full. (Some doctors do put a bit of saline in at the time of installation.) Over time, saline is added to the band, via a port that lies under the skin of your abdomen. This adjustment is what we are referring to when we say "fills." Over a period of time--often several months, the band is adjusted until you achieve the appropriate level of restriction. A very, very important consideration, when choosing your surgeon, is preop preparation and aftercare. Some doctors do provide really good preop seminars, nutrition classes, exercise support, and support groups, and so on. Others do not--many patients end up feeling kind of abandoned. My doctor is in the former group--and nutrition courses continue for the first year postop. (I am sure you could attend longer, if you wanted.) It helps a lot. In addition, patients are given a pretty comprehensive "manual" of what to expect, how to advance diet and exercise, the changes to make during maintenance, and so on. When you're choosing your doctor, do ask about the support you'll receive. I never really am aware of the band, unless I've taken one bite too many. I just don't feel it at all. I can, however, feel my port. It doesn't really interfere with exercise, though I am aware of it more when using certain equipment.

Once you achieve restriction, which can take a period of months, you will be left with a pouch (with limited capacity) that slowly empties. This means that hunger is pretty much removed from the equation, making it far easier to sustain the lifestyle needed to lose weight and maintain loss. It depends on your doctor. Many recommend a higher-protein, lower-carb regimen. There is limited pouch space once you achieve restriction, so the most important thing, really, is to choose foods that benefit your body and meet its needs. Well, most of the time; there is room for indulgences and treats. See above; hunger is removed from the equation. If you are a compulsive eater, you will still have to learn new behaviors and coping techniques; the band will not miraculously remove the impulse to eat. But it does provide pretty good negative reinforcement for overeating. This is dependent on your specific policy. Mine does cover band-related complications. I have not heard of any large-scale manufacturing defects. In general, when there are medical device issues, patients (or their insurers) are generally responsible for repairs unless the company is found liable. Your doctor will inform you pretty fully of the potential risks associated with banding, and when you consent to surgery, you accept those risks. It is temporary (and related to anesthesia and surgery itself); most doctors give medication that prevents these from occurring. It depends on your doctor. Most do not recommend drinking alcohol for a period of time after surgery. Mine vetoes it for about a year; the idea is to promote the adoption of new health habits (while maximizing weight loss). Alcohol = liquid calories that are used, by the body, very efficiently (as in, converted to fat very easily). It is also a disinhibitor--making it more likely that you will make inappropriate food choices. That said, occasional drinking usually is not an issue (if you don't have medical issues that preclude it)--you just have to be aware that it can affect the rate of weight loss.

Her surgeon MUST know of her alcoholism prior to surgery. This is potentially a matter of life and death. My mother was not honest with her doctor prior to a surgery near the end of her life. I pulled the anesthesiologist aside and told him---it was imperative. She still experienced delirium tremens--a minor surgery landed her in ICU because of complications due to alcohol withdrawal. Had they not known in advance, they would not have been prepared, would have wasted time trying to determine what was wrong. Alcohol withdrawal is very dangerous--very. It needs to be carefully medically managed. It's utterly immoral to subject a surgeon to her risks without informing him. He puts his license on the line every time he performs a procedure. Knowingly jeopardizing HIM with her actions is pretty heinous. Legal liability aside, living with the knowledge that a patient came to harm on your watch is HORRENDOUS. What a horrible, ill-thought plan.

Yep, we take care of everyone except ourselves.

I don't know agents, but I am a writer/editor (the nature of my writing doesn't require that I be agented); if you find that you need another set of eyes to prepare the manuscript (or receive feedback that this is necessary) let me know--I'll be glad to help you out. Editors can be expensive, and I'd be glad to spare you that expense.

There really is a period of mourning for food. It occurs at a time when we are very vulnerable--our bodies and minds are in upheaval from anesthesia, meds, the trauma of surgery, hormone fluctuations. Throw in the I-can't-have-that line of thinking and genuine hunger, and it's a recipe for meltdown. It gets so so so much better. First, you'll just get on a more even keel as you recover from surgery. You'll feel better, both physically and emotionally, as you heal. The grief for the old friend, food, can be helped, I found, by adopting a slightly different was of thinking about the restrictions the band (or your doctor's prescribed eating regimen) place on you. Just reframing the way you think about the I-can'ts can help tremendously. Instead of saying, "I can't have that," focus on what you can have. Try to reframe your thinking so that you don't tell yourself, "I'm not allowed..." but instead think, "I choose...." Honestly, making it about choice is very empowering; it effects a shift in thinking that results in far less of a sense of deprivation than occurs when you feel as though your actions are driven by rules imposed by others. (I hope that made sense!)

Isn't it interesting how many of us have nursing backgrounds? My therapist has pointed out more than once that those of us who are caretakers often care for others at our own expense....I know that definitely factored into my own obesity.

My first recommendation would have been to focus on Protein and nonstarchy veggies--but you're already doing that! Is it possible, do you think, that your rate has simply slowed because you are now at the point where you need to lose less? A pound a week after an 87-pound loss--when you are so close to your goal--may be a realistic expectation. That said, are you exercising regularly? For me, exercise is absolutely critical. I'm at 83 pounds down, and was slowing down a lot---and bumping up my exercise just a bit got things rolling a little faster for me again.

I never have in the past. When I worked in neuro, I had a patient who experienced Guillain-Barre syndrome after a flu shot. The first time, it was chalked up to unlikely coincidence. The second time it became pretty darn evident that it was a response to the vax. Since then, I've read about quite a few cases of GBS related to flu vaccination. Ordinarily I am VERY pro-vaccination. But because I was a young, robust woman who bounced back easily from illnesses, I chose not to take the risk. (My husband, OTOH, is in a high-risk group, and has always been vaccinated; for him, the risk of flu has always outweighed the risk of the shot.) This year, I will be vaccinated. I got pneumonia the last time I got flu--and while I'm still relatively young and resilient, I am for the first time facing being a single parent---and want to reduce the chances of becoming ill. I have a child who relies on me, and as I stare down the barrel of having no one to help me pick up the slack if I'm ill, I need to protect myself as much as possible so that I can be the best parent possible. But I will cringe as I get the shot, and worry that I will end up like Mr. B--on a ventilator for months due to vaccination-induced Guillain-Barre syndrome (fully realizing that the odds are very, very, very slight that I will be adversely affected). ETA: And thank you for the reminder; I will make an appointment today.

What about it makes you nervous, do you think? There are certain milestones that are prominent in our minds, but really, it's not the number that carries great meaning. It's the big changes going on in our bodies and minds. I remember getting on and off the scale several times when I went below 200. I wanted to make sure that 199.4 was real--and then I took a picture of the number (and my ugly winter feet). It was a milestone. But it was also anticlimactic. There wasn't a huge change from the day before---I was the same person who needed to do the same things to stay healthy. I guess I'm saying that it's not something to fear. It is a milestone, but it doesn't create changes that are daunting. If you're stalled because your body is simply regrouping after losing a lot, the loss will resume, and you'll just slide into the 190s. If you're stalled because you are subconsciously self-sabotaging a little bit, you'll reach the point where you are comfortable moving on in your weight loss journey. There is nothing wrong with you. You are just engaged in a process that involves a great deal of emotional letting go. You will do it when you are ready. Just know that there's no need for fear.

I'm in a suburb of Chicago, and am an RN turned science/health writer. I am working toward certification as a nutrition and wellness counselor.

It is completely out of a nutritionist's scope of practice to form a professional opinion regarding the suitability of a particular procedure. What you are receiving from her is purely a personal opinion---and you will get many of those from people who are equally as unqualified to give them. Put it in perspective. She has a personal bias; she does not have the professional expertise to form a professional opinion regarding whether surgery is appropriate. Her role is to impart the information you will require in order to be successful with loss once your banded. That's it. Ideally, she should be on the same page as the physician who referred you to her. She should provide information that supports the stated goal--which is eating/weight loss success with an adjustable gastric band. It sounds as though you just got a vibe from her. Even if she didn't actively discourage surgery, I think this is worth mentioning to the surgeon who referred you.

I tell myself, "Self, you're playing mind games that drive you nuts. Knock it off." Seriously, I've been working on my internal narrative, and it has helped a lot. I experience very little head hunger now--and what I do experience, I can now get past by telling myself, "I can choose to eat that. But--nah, I choose not to." (There's something about it being a conscious choice, rather than a rule imposed by a doctor or diet, that makes a difference for me, in terms of emotional response.)

The immediate postop period is so hard---it's when the, "Oh crap! This is real!" realization hits. You realize that Oreos are not an option---and that's a hard pill to swallow. Throw in that you're all out of whack, physiologically, due to anesthesia, meds, the trauma of surgery, hormone fluctuations----and it's a very difficult, very emotional time. It gets SO much easier. The blues will dissipate as you recover. The hunger will become manageable as you move through the phases of eating and work toward restriction. But I know it seems, some days early on, like there's no light at the end of the tunnel. Until then, every sandwich not eaten and every Oreo not snatched is a victory. You're doing great :thumbup:

It's okay to focus on fluids for the first few postop days; that is what your body needs the most. Yes, ultimately, you will need to get your protein and other nutrients in. But a clear liquid diet is NOT designed to do much more than hydrate you---and water does that just fine.

I agree with Jacqui; we need adult Vitamins, preferably bariatric ones designed for bandsters. (Jacqui, I hope you're feeling as well as can be expected; you are often in my thoughts and prayers.)

Congratulations on your great loss so far! When I'm stalled, I look over my journals. (I journal on fitday.com, and also use a BodyBugg.) If I am eating the way I need to eat to support weight loss, getting enough Fluid, and exercising, I power through---sometimes, the body just needs to regroup after losing a significant amount, and time is all it takes. I've just had a couple of weeks of stall, though, and decided to add distance/time to my walks. I've lost enough that my body really did need this change in order to spur loss again. Sometimes, it's trial-and-error: you give it some time doing what you know has been effective in the past. Then, if that doesn't do the trick, you tweak something to see if that helps. (I'll bet, though, that after a pretty rapid loss of 30 pounds, your body's just saying, "Hey! What's going on here?!" and will resume losing after a bit of time.)

Well, adding solids back in does slow loss--but only temporarily, and only because it lingers in your colon. So try not to worry about that too much. That said, it might be time to play around with calories. I know there are lots of "shoulds," but I had to toss mine by the wayside. After years of (preband) journaling on fitday.com, it became undeniable to me and my doctors that my calorie needs, despite my weight, were much, much lower than any recommended level. That's why I got banded. Give your body a little time to get used to the solids---it's been through quite an ordeal. In the meantime, it might be a good idea to start journaling someplace like fitday.com---just for a baseline. If you don't start losing again---which you probably will, once your body figures things out---then you can experiment a little. You can see if bumping up your Protein helps, or if paring down on refined carbs helps, or if upping your exercise helps, or if knocking down your caloric intake helps.... It's too soon to freak out, but not too soon to think about logical ways to tackle things if it does evolve into a problem. With luck, the scale will start moving soon, and it will all be moot.

Yes, I am tighter just before and at the beginning of my period. I think this is a fairly common phenomenon.

Awesome progress!

this is a very old post, but since it's been revived, I think it's important to note that dehydration causes the same symptoms--and is a far more likely culprit, especially so close to surgery.

I second all the recommendations so far. I'd add journaling your food intake someplace like fitday.com to make sure you're meeting your nutrient needs. I'd also discuss, with the prescribing MD, antidepressants--because your dosage or med might require adjustment. I'd also be sure to take a good-quality bariatric Multivitamin. Finally, Co Q-10 supplements have made a HUGE difference in how I feel. When I run out, I really notice.

I was told not to use anything like Mederma for six MONTHS postop. By then, my scars had faded so much I didn't bother---I haven't done anything other than use my regular body lotion (and even that, I'm pretty unreliable about doing).

It's so, so hard at the beginning. When you are genuinely hungry--and I know you are!--it's very difficult to make wise food choices. First, stop beating yourself up. It perpetuates the same cycle you had preoperatively. The "I can't do this" mentality is, as you've already noted, self-sabotaging. What you can do is identify ways you can bolster your odds of success. That might mean stocking up on "approved" foods. It might mean ridding the pantry of things that you choose (note that I said "choose," because when you start to think of it this way, things start changing emotionally) to avoid. Yes, this may inconvenience others in your family temporarily. They may have to prepare their own meals, or have their ice cream outside the home instead of in the family room every evening. (In the long run, it will benefit them--no one requires junk, and if they have to make a conscious effort to acquire it, they may find it's not worth it to them.) It's all about choices. And you DO have the strength to make them. Start by feeding your body what it needs. Make sure you are getting enough Fluid. Make sure you are getting enough rest (this is really important). And make sure you exercise, in some form, each day. (It doesn't have to be elaborate; taking a walk is fine.) If you focus on the basics, and gain a sense of control and mastery, then it becomes easier to resist the siren song of the pantry. It really does. Will you be hungry? Maybe. Maybe eating the right stuff in the right amounts will still leave you feeling as though you're on a starvation diet. But know this: this is the last time you will be hungry in the name of weight loss. As you gain restriction, that overwhelming hunger will disappear. For now, you can work to acquire the good habits that will serve you well when you do have restriction. You can start conquering the head hunger monster. You can make HUGE progress, even during this period when you are struggling. But it starts with being kind to yourself. Recognizing that your body and mind are still hugely affected by a pretty significant trauma to the system. That you're naturally all over the place, emotionally, because not only have you introduced something that requires enormous change from you, but that the situation is compounded by the insult of anesthesia, surgery, and medications, by hormone fluctuations, by things that you just have to ride out. The rollercoaster ride will end. But you can make it easier for yourself if you gently guide yourself to the right choices. ETA: I agree with Elfie about Protein and low-carbing; my doctor's eating regimen is posted in the visitor message section of my profile. Was I hungry before I had restriction? Yes. But this really helped manage it for me.