kbattal

The first 40 pounds were very easy, the next 20 pounds were difficult, the last 20 pounds are extremely difficult.

This explains it. The bottom part of the syringe was blue, then I believed mistakingly the color of the contrast agent was also blue. Anwyay, it was clearly visible under the fluoro.

Dr C, I was also worried of a possible leak a month ago. The doc injected 1cc contrast agent omnipaque (blue color) and 1cc saline, to make it total of 7.0cc in the band. Then I went to another fill doctor two weeks ago, he draw the saline 6cc but no omnipaque, the Fluid was clear, 1cc less, and there was no blue color mixed up. I assume the omnipaque was still in the band, he got misreading. Since it is thicker, omnipaque does not mix with saline, and can not be drawn. This is my conclusion. Is that right. I really had 7cc in the band not 6cc. Under fluoro, I was able to monitor how the blue stuff (contrast agent) went through the tube up to the band. The other doctor could not draw it up. Is this normal? Thanks Dorin

Your body and your eating habits may need time for a good restriction. You just need to learn to eat small bites and chew well, it takes time. At my 4th fill I am still strugling to chew well. I feel quite restricted, that means, if I eat half a cup of solid food, chewed well, I feel satisfied, and it lasts minimum 3-4 hours.

As far as I remember, I never saw any referencess to different tube sizes, and how much a tube holds. There are two different ports, one for the vanguard, and the other for the 4ccs.

Dear Bawillims1, It souds like 1- you have a larger band, or 2- your port or tube is leaking, 3- I also read in the past threads that rebanded bandsters need more saline to fill good restriction. Maybe you need to max it out. I have a very agressive and good fill doctor now. The last time I asked him to draw all the saline to see how much was in there. There was about 6cc saline, then he put back in there. The needle back in the place, he max out my band, I asked him to do this, he could only fill in an extra 6cc. No more. I think I had total 12cc in that time. I was out the same day for about 4 hours, to feel how it felt like. I felt miserable, I could not even drink Water, so the same day he took 4cc out, I could hardly drink water, but no Soups. The next day My swelling went away, and I could only drink Soup. The third day I could eat mushy stuff, and after two weeks, now, I feel quite restricted. As long as I chew well, I can tolerate most solid foods. So in your case, I would ask him to draw the saline first to see how much was there, and then try with a larger dose, like an extra 4cc to fill in, maybe you have a larger band. This way you could be sure, if there were any leaks or you have a larger or smaller band. 4cc bands are high pressure bands, once the needle is in, some saline comes up to syringe, you could see it. 10cc bands are low pressure, usually no saline comes up at 4cc. I bet you did not look at the syringe anyway.

The Health and Nutrition Editor from the Associated Press, Marilynn Marchione, wrote a clever article about some of the ideas in Mindless Eating. If you missed it, here it is: 12 Ideas to Keep Off Holiday Pounds By Marilynn Marchione, Associated Press Medical Writer Three French pastries ... two turtle cheesecakes ... and a partridge in a pear sauce. The Twelve Days of Christmas bring holiday foods meant to be enjoyed, but no one wants a weight problem when the merriment ends. food psychologist Brian Wansink has spent many of his own days researching how these problems occur. His new book, "Mindless Eating: Why We Eat More Than We Think" explores the unconscious cues that make us feast as we do, and how we can keep them from manipulating us. Nearly all of his suggestions are based on published results of scientific studies he has conducted as director of Cornell University's Food and Brand Lab. Here are 12 of his tips, one for each day of the season: _ Put high-calorie foods on plates in the kitchen and leave leftovers there. You'll eat 15 percent to 20 percent less. Do not serve "fat-family" style (from a big platter or bowl that is passed) unless it's veggies or salad. _ See it before you eat it. Dishing out Chex Mix led one group to consume 134 fewer calories than others who ate straight from the bag. _ Keep the evidence on the table _ turkey bones, muffin papers, candy wrappers. Diners in one study ate 30 percent more chicken wings when the bones were periodically cleared away than others whose bones stayed in front of them. _ Bank calories. Skip the appetizers if you know you want dessert. You also will be more accurate at estimating how many calories you consume. _ Sit next to the slowest eater at the table and use that person to pace yourself. Always be the last one to start eating, and set your fork down after every bite. _ Embrace comfort food. Don't avoid the food you really want, but have it in a smaller portion. _ Avoid having too many foods on the table. The more variety, the more people will eat. People ate 85 percent more M&Ms when they were offered in nine colors rather than seven. _ Keep your distance. To reduce the mindless snatch and grab, move more than arms length away from the buffet tables and snack bowls. _ For foods that are not good for you, think "back." Put them in the back of the cupboard, the back of the refrigerator, the back of the freezer. Keep them wrapped in aluminum foil. Office workers ate 23 percent less candy when it was in a white, covered candy dish than in a see-through one. _ Use small bowls. A study found that people serving themselves from smaller bowls ate 59 percent less. _ Use tall, narrow glasses for drinks. Even experienced bartenders poured more into short, squat glasses than into skinny ones. _ Don't multitask. People tend to unconsciously consume more when distracted by conversation or a game on TV. Setting your fork down and giving the conversation your full attention will prevent overeating. "We don't know exactly how many calories, but chances are you'll enjoy it more," Wansink said. "And people will enjoy you more."

I am no longer bringing it up. After my third fill, the doc did under fluoro, I am properly restricted now. I just feel like I do not need another fill at least another 3 months. But I can tolerate many foods as long as I can chew well, and eat slowly, and can not eat food more than the size of one half of an apple, and then my hunger goes away. I have 45 pounds more to lose the get below 25 BMI, so really I am done with fills, at least I hope so.

Well, first of all I am very happy that I am banded, and lost 40 pounds in three months. I recommend it everyone, there are risks, hepatisitis etc, in everyday life, but people seem to keep up with these things, conditions are improving rapidly. I still like my doctor, he is at least better than most of the rest. This is part of the life. Dorin

I am just angry because most of you believe that health care standards are same in other countries. Doctors and health personel are well educated, courteous, helpfull. Just no. Here in Romania, Health care system is under state control, and free, but docs are just like ordinary government employees. Just like a post office clerk. They do not get post education. State health care is free, but you have to wait in lines to get basic care. Basically, state health care system is in ruins. Staff and doctors are in general undereducated, old , underpaid, the hospitals and equipments are old, and dirty.Corruption is going everywhere. Good doctors and health care personel move to other european countries. My doc is the chief of the surgery unit, but he does not have an office of his own. We always talk in corridors,there are maybe 10 doctors packed up in one single room. They are like an ordinary government employee. How can you expect good health care from them. I have done the surgery there, because the doc is the most experienced in this field in Romania.He has done over200 lapbands. but his staff is terrible, and unprofessional. No pre-post information. You are mostly on your own. He gets his big money from patients (he is a public employee) after the surgery, five hundred dollars in packet, never wants to get bothered after that. So I had to keep up with his ego. He just doent like too many fills. He told me I should come after 6 months, how can I argue with him. I should wait another 6 months for the next fill, for a super sized VG band. This is unethical, unprofessional, and irresponsible behaviour on his part. I am pretty sure he use the same needle for many fills, because the state doesnt pay for the huber needle, they do not have a budget for that. He just asked extra money for that. I know there are some private clinics doing the same procedure, but I do not believe the docs are as well experienced. The hospital had the fluoro unit,thanks god, I could check the health of the system. I have seen the contrast agent (omnipaque) flowing, through the tube to the band. I was really happy because I was also worried that when I did my own fill, I could puncture my port because I used some force to inject that I needn't to, and used a core needle. Anyway, next time I will bother him a lot so that he will accept another fill, I hope so. Money might talk.:mad: Dorin

There is a good article below, looks like if someone does not lose weight, it is not her or his fault totally. Why Did They Lose More Weight Than Me?” - by Cynthia K. Buffington, Ph.D. During a recent support group meeting, five patients whose surgical procedures were identical and performed on the same day asked why they were losing weight at different rates. Three months following laparoscopic adjustable gastric banding, the only male patient, Charles, had lost 71 pounds. Sarah, on the other hand, had lost 57 pounds, Sally had lost 40 pounds, Sue was 29 pounds lighter, and Jennifer had lost only 19 pounds. Why had Charles lost more weight than the female patients? Why had Sue and Jennifer experienced less weight loss than the other patients? Were Jennifer and Sue not adhering to the recommended postoperative dietary protocol? Were they consuming calorie-dense beverages or foods, such as milkshakes, colas, cake, ice cream? Did Charles and Sarah, who lost the greatest amounts of weight, exercise more regularly than Sally, Sue, and Jennifer? In order to determine why there were such large differences in weight loss between patients, we examined the lab results, nutritional profiles, and clinical reports of their most recent follow-up appointments, which had taken place only 3 and 4 days earlier. To attempt to understand why some individuals lost more weight than others, we first examined body size measurements before and after surgery. All patients had a somewhat similar body mass index (BMI) prior to surgery, i.e. range 43 to 47, but patients differed as to where on their bodies fat was distributed. Body fat distribution is determined by measuring the circumference (distance around) the waist and the circumference of the hips and then dividing the waist circumference by that of the hips to derive the waist-to-hip ratio (WHR). A male with a WHR greater than 0.95 stores much of his body fat around the waist (abdominal fat). Premenopausal females store fat in their hips and buttocks and generally have a WHR less than 0.80, but females with a WHR greater than 0.80 tend to store fat in abdominal regions, as well. Deep abdominal or visceral fat has a much faster rate of turnover than fat that is deposited on the hips and thighs. For this reason, larger amounts of abdominal visceral fat are lost with calorie restriction than are fat deposits on the hips and thighs. A person with abdominal obesity, therefore, is likely to lose weight more rapidly on a diet or after surgery than would someone with fat on the hips and thighs. Men tend to store much larger amounts of fat in abdominal visceral adipose depots than females and, for this reason, men are generally able to lose weight more rapidly than females. Charles had a pre-surgery WHR of 1.2 and at 3 months had lost most of his weight from around his waist. The greater rate of turnover of Charles’ abdominal fat is likely to be one of the primary reasons he was capable of losing more weight than the female patients. Sarah, Sally and Sue all had similar WHR, i.e. 0.85, 0.84, and 0.83, respectively. Changes in waist and hip circumferences at 3 months after surgery were also similar, with all patients having a proportionately greater loss of inches from the waist than from the hips and thighs. Jennifer who had lost the least amount of weight of any of the patients (only 19 pounds) had very large hips and thighs and a relatively small waistline and upper torso. Her WHR before surgery was 0.68. Fat on the hips and thighs is broken down at a far slower rate than fat in abdominal regions. Women who have large hips and thighs and small waists generally have the greatest difficulty losing weight following surgery or with any other anti-obesity procedure. Jennifer may, therefore, have lost the least amount of weight post-surgery because most of her fat was stored on her hips and thighs where fat turnover is slow. Differences in fat distribution could not explain why Sarah, Sally and Sue’s weight losses differed, as all three had a similar WHR. (Remember: Sarah had lost 57 pounds, Sally 40 pounds, and Sue only 29 pounds.) The three females also had similar starting weights. Furthermore, exercise habits could not account for differences in these patient’s postoperative weight losses, as all three patients were participants of the same postoperative exercise program. Nutritional profiles, however, did provide a clue as to why Sue’s weight loss post-surgery differed from Sarah and Sally. At our clinic, nutritional profiles are obtained from patients’ food diaries at each of their follow-up visits. Nutritional information obtained from these profiles include total calorie intake, the percentage of diet that is Protein, carbohydrate and fat, the types of protein, carbohydrate and fat consumed, and dietary Vitamins and minerals. We found that Sarah and Sally’s nutritional profiles were similar with regard to daily calorie intake and dietary composition. Sue’s diet, however, significantly differed. Sue was eating an average of 250 calories more per day than Sarah and Sally. In addition, Sue was consuming fewer calories as protein and more calories high in sugar-containing carbohydrate. Sue’s greater intake of sugar-containing carbohydrate, coupled with the slightly greater number of calories she was consuming each day, could have contributed to the lower weight loss she experienced when compared to the weight losses of Sarah and Sally. Sugar-containing carbohydrate and processed grains increase insulin to levels higher than would occur if fiber-rich carbohydrates were consumed, such as fruits, whole grains, nuts, legumes, vegetables. Insulin, in turn, drives fat into fat storage depots and reduces the breakdown of fat, thereby adversely affecting weight loss success. Sue’s diet was not only higher in simple carbohydrates but was also lower in protein than the diets of Sarah and Sally. Eating sufficient amounts of protein helps prevent the breakdown of muscle and other lean body tissue that may occur post-surgery or with low calorie diets. Muscle has high metabolic activity and oxidizes (burns) fat. A loss of muscle or other lean body tissue, therefore, would reduce metabolic activity and fat metabolism. Over the 3-month postoperative period, Sue lost proportionately more muscle and other lean body tissue and proportionately less fat than did Sarah or Sally. (Note: body composition was measured by bioelectric impedance). Sue also had a greater reduction in basal metabolic activity (measured by indirect calorimetry) in association with her loss of muscle and lean body tissue. Basal (resting) metabolic activity accounts for up to 70% of all calories burned during the course of the day. Sue’s failure to lose weight as effectively as Sarah and Sally, therefore, could have resulted, in part, from her postoperative loss of lean body tissue and decreased basal metabolic rate. Sue’s poor nutritional profile, her greater muscle and lean body tissue loss with surgery and reduced basal metabolic activity could explain why she lost less weight than did Sarah or Sally. However, differences in nutritional profiles, body composition, and basal metabolic activity, as well as fat distribution, initial body size, and levels of physical activity do not explain why Sally lost less weight with surgery (17 pounds less) than did Sarah, since all of these measures were similar. Why, then, would Sally have lost less weight than Sarah? According to Sally’s 3-month postoperative clinical records, she was still taking diabetes medication (a sulfonylurea) to control her blood sugar, albeit at a lesser dosage than before surgery. She was also taking a beta-blocker for hypertension. Sarah, on the other hand, was on no medication. Ironically, many medications used to treat diseases caused or worsened by obesity increase body weight. Most diabetes medications (except metformin) cause fat accumulation and weight gain, including insulin, sulfonylureas and the thiazolidinediones. Many anti-depression medications or mood stabilizers also cause weight gain, especially lithium and the tricyclic antidepressants. In addition, steroids used to treat osteoarthritis or autoimmume disorders increase body weight and fat accumulation, as do beta-blockers and Calcium channel blockers for hypertension. It is likely that Sally’s diabetes and hypertension medications were responsible for her inability to lose as much weight as Sarah. However, there could have been factors other than medication, diet, exercise, metabolic rates, or fat turnover that caused post-operative differences between Sally’s or Sarah’s weight losses or those of other patients in the group. One patient may have lost less weight than another because their growth hormone levels were low, sex hormone production was altered, or cortisol levels were high. Defects in hormones, gut factors or neurochemicals that regulate food intake, satiety and energy expenditure may also have caused variability in patient post-surgical weight loss. Altered activities of enzymes regulating fat metabolism or energy utilization may have influenced rates of post-surgical weight loss. Genetics could have contributed to weight changes, as could numerous other conditions that influence energy intake or expenditure. Why, then, does one patient lose more weight than another with surgery? For numerous reasons, including differences in calorie intake, energy expenditure, body habitus and body composition, basal metabolic activity, hormone profiles, genetics and much more. Because weight loss is regulated by such a myriad of factors, it would be highly unlikely that any two individuals would lose identical amounts of weight post-surgery, even if they were consuming the same amount of calories and performing similar amounts of physical activity. Therefore, it is important that healthcare professionals realize that identical surgical procedures do not result in identical weight loss patterns and that weight reduction is regulated by far more than calories in and calories out. Furthermore, patients should not despair or feel unsuccessful if they have lost less weight than others, particularly if they have been honest in adhering to their postoperative dietary and exercise regimens. Cynthia Buffington is the Director of Research, U.S. Bariatric, Fort Lauderdale, Miami, Orlando Originally Published in Beyond Change - 2004

I hope this is a right place to ask. I am banded 3 months ago, and lost 40 pounds,for about two weeks I am experiencing an increase in libido, and sexual activity, almost every morning, my wife is quite happy about it. I am 44, definetily I see an improvement in our sexual relationship, my wife is much younger than me, this has been a good suprise for me, If anybody have similar opinions, please let us know. Dorin