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GET INTO THE GREEN ZONE Bandsters tend to obsess about finding their sweet spot** or perfect restriction, and in the process torturing themselves with the idea that weight loss won’t start until they reach that magic place. That’s kind of like trying to balance yourself on the pointy peak of a pyramid, where you’re all too likely to fall off and crash into the ground. Focusing on finding that one special spot (instead of appreciating what our bands are doing for us right now) is short-changing yourself. It’s kind of like sex: if you don’t pay close enough attention to how you feel now, you’re not going to appreciate the many small, pretty-good moments that lead up to and follow the one great moment. To my mind, it’s more helpful to use the term Green Zone. Allergan, the manufacturer of the Lap-Band®, developed the Green Zone chart as a simple, visual way to explain the band’s performance without using the terms sweet spot or restriction. I agree with that approach. In my personal experience, it’s far better to think of restriction as a range of experience rather than a single point on a line. I’d really like to drop the term restriction altogether because it’s an outdated term from the olden days when adjustable gastric band was labeled a “restrictive” device that automatically limits how much the patient can eat. I prefer the term “optimization” - a band system functioning at its best. That system consists of the band and the patient who is taking responsibility for good food choices (both for satiety and for health) and portion control, plus fighting the good fight against emotional and addictive eating. But having said all that, I’m going to go on using the term restriction because it’s more easily recognized by bandsters than the term optimization. Just keep in mind that when I mention restriction, I'm referring only to the signals the band system uses to communicate its status and/or need for adjustment. Let’s take a look at some of those indicators. They are signposts that can be hard to read until you’ve learned your band’s and your body’s idiosyncrasies. ** To read more about the sweet spot, click here: http://www.lapbandtalk.com/page/index.html/_/support/post-op-support/the-elusive-sweet-spot-r59 YELLOW ZONE - hungry; eating big meals; looking for food Ü add fluid This is territory that new bandsters often find themselves in – also known as “bandster hell.” We don’t have enough fluid in our bands yet, and at this point, the patient has to work harder at weight loss. The yellow zone is very frustrating, but it doesn’t mean that your band is broken. It just means that your band system needs some tweaking. GREEN ZONE - early & prolonged satiety; satisfactory weight loss or maintenance J no fluid adjustment needed The Green Zone is the bandster’s Promised Land, where the patient and his/her band work in tandem to achieve weight loss or weight maintenance. It isn’t a worry-free or work-free zone – like many other good things, it needs attention, consistency, and plenty of work – but it’s a wonderful place to live. RED ZONE - difficulty swallowing; reflux-heartburn; night cough; regurgitation; poor eating behavior Ü remove fluid. You may find yourself in the red zone when your band is too tight. That can happen even when you haven’t recently had a fill, and for a variety of reasons, many of them benign if frustrating. BE YOUR OWN TRAVEL GUIDE I can’t over-emphasize how important it is for you, the patient, to participate in reaching the Green Zone and staying there. Being your own travel guide during your WLS journey is well worth the effort, because if all goes well, you’re going to be traveling with your band for the rest of your life. You need to be able to recognize your restriction signals and make good decisions for your weight, nutrition, and general health***. I told you that the Green Zone is a wonderful place to live, but no one can guarantee that your residence there is or will be permanent. Even when you believe you have the “right” amount of fluid in your band, you can find yourself in the Yellow Zone again for several reasons: 1. You’ve lost enough weight for the visceral (internal) fat clinging to your stomach to shrink, so the band puts less pressure on the stomach and feels too loose. 2. You’ve been making poor food choices – that is, eating foods that are too soft to give you early and prolonged satiety. This can be sign of what I call Soft Calorie Syndrome. To read more about it, click here: http://www.lapbandtalk.com/page/index.html/_/support/post-op-support/tighter-isnt-always-better-r118) Or perhaps you’ve been eating foods that by their very nature are not conducive to weight loss, (like fast food), or you’ve been overeating or snacking because of neglected emotional issues (often called self-medication). Likewise, you can find yourself in the Red Zone even when you’ve been doing every little thing “right.” Your band can start feeling too tight when seasonal allergies are flooding your upper GI tract with excess mucus, illness has been making you cough or vomit a lot, you’ve been dealing with a lot of stress, you started taking a new medication, you haven’t been drinking enough clear liquids, and so on. Whatever the reason, the best course of action is to remove some or all of the fluid to allow inflammation of the esophagus and stomach to calm down, then gradually start adding fluid again until the patient moves back into the Green Zone. Does all this sound like an awful lot of work? It is hard work. Bariatric surgery of any description is meant to make weight easier, but no WLS procedure makes it automatic. For me, there’s nothing quite as satisfying as achieving a goal I worked hard for. And once I have the prize in my grubby little hands, I’m going to hold onto it for dear life, because my life and my health are both very dear to me. ***Note: Jessie Ahroni’s book, Laparascopic Adjustable Banding, includes an excellent guide to determining if you and your band are properly adjusted, with questions to help you understand that adding or removing fluid is not the only way to adjust the band system: you may also need eating, behavior, activity, attitude adjustments.

I attended Dr. Titus Duncan (Atlanta Bariatric) seminar on wls three weeks ago. The only call I have received from his office is to verify my insurance member number. I know my insurance cover wls because I called and checked myself before pursuing this journey. The only thing left to say is either Dr. Titus Duncan staff is not doing what they suppose to, Dr. Duncan is just too busy or he is not interested in treating me. Either way I am not going to let this discourage me because I am on a journey to better my health and life. I am now looking for other surgeons to research and get you all opinions on in the Georgia. I feel I have wasted enough time waiting on Dr. Titus Duncan and his staff to get in touch with me. Please share your surgeon and experience in the Georgia area with me if you don't mind. Thanks

She is incorrect that either ibuprofen or diphenhydramine (Benadryl) are appetite stimulants. Some people retain modest amounts of Fluid in association with ibuprofen use. Neither drug is commonly associated with constipation, though Benadryl, being an antihistamine, theoretically might contribute to it. (As an antihistamine, it also tends to be appetite suppressant.) I know you're looking for answers. Trainers are not, in general, a reliable source of information about medications. Or, diet---particularly bariatric diet--unless they have additional certification. ETA: Suppose she were right, though. How could using Benadryl possibly have sabotaged your weight loss efforts? Water retention is temporary; fat loss occurs even if you retain fluid.

TKE I forwarded your post to a bariatric doctor here and she said that your trainer is pretty much dead on! Thanks for posting this!

Yes true all Dr's have their own rules I just had my surgery at Cedar Sinaid hospital last Friday the 16th in LA and I can have sugar-free Jell-O sugar-free popsicles, sugar free Italian ice, I can have propel, vita water, sugar free crystal light and that will count towards my liquids intake, but my protein shake are not part of my liquid intake, that counts as my protein intake. Otherwise you won't get enough water during the day. I can send you a copy of that page from my bariatric hand out book that they have provided for my guidance, if you like.

Do you have a local Bariatric program you could consult with? I know our bariatric program welcomes people who had surgery in other places but live locally to the plan. Maybe see if there is a support group you can attend and see if a NUT or local Surgeon can look at your medical records and suggest a plan for you to eat after surgery.

Before my surgery, I had to get an exam done by a bariatric counselor. They talked to me about how I felt about giving things up, or how I plan to succeed. I am a mental health professional so I told them what I knew they wanted to hear bc I wanted the surgery (I know.. I know.) But after surgery, I felt like there was some unresolved issues with food, much like yourself, and so I'm doing the process to go back to the counseling center. Honestly, looking for eating disorder counselors might be a good first step for you.. because overeating is a disorder.. I imagine most people think "eating disorder" and imagine anorexia or bulimia. Which isn't 100% the case. Mood disorders is something completely different. When you talk to a therapist, you get to interview them first. You have to make sure that THEY are a good fit for YOU. Even if it's just to go 1x a month, I bet it'll be helpful. If you don't feel comfortable with them, then ask for a change. You can request a specific gender if you'd like. Look at their credentials and see how long they've been in practice. healthgrades.com is also a good place to get some reviews. Making a call will also help you establish how they'll treat you. Trust your gut with it. I know you've had a bad experience in the past, but that doesn't mean that all experiences will be bad. I had a horrible exp in college with a therapist and swore I'd never go back. Now I've been in therapy for 3 years now and it's changed my life. Good luck!

I live in Georgia as well. There are a lot of bariatric centers. We have several here in Augusta. Have you tried other places? Did your cardiologist reccomend any other bariatric surgeries or only lap band? If you live anywhere near Augusta, try this link WWW.AUGUSTASURGERY.COMAlso, go to www.lapband.com and they have a surgeon locator. Wellcare is a Georgia program so it shouldn't matter if you use a local surgeon or not as long as they are in the state. Best of luck to you.

Hey, Terry, no fair quoting me in your signature line without attribution! How about this? Bariatric surgery of any description is meant to make weight easier, but no WLS procedure makes it automatic. (c.2013 by Jean McMillan).

"THOU SHALT NOT?" Somewhere in the dark mists of my distance past, the term “reverse psychology” entered my awareness, especially as applied to child-rearing. The idea was that if you told your child “Please slam the door when you leave the house,” the defiant devil in that child would shut the door quietly in opposition to your instruction. I don’t have human children and never observed reverse psychology work magic in my childhood home. No matter how firmly you told my brother not to brush his teeth, his teeth went unbrushed. Telling him to jump on the bed would trigger a marathon jumping session (causing the box spring to violently part company with the bed frame) instead of a peaceful bedtime story. And I was no angel – I rewarded my mom’s laissez-faire attitude towards teen dating by involving myself with the worst losers I could find. Despite all that, I know there’s a kernel of truth in the concept of reverse psychology. If you told me I must never, ever eat chocolate again, I’d get started on a chocolate binge before you even finished your sentence. And if you told me, “Thou shalt not even think about potato chips,” my every waking and dreaming moment would be filled with potato chips. Unfortunately, this principle doesn’t work in both directions, at least not for me. If you told me, “You must eat nothing but ice cream this week,” I’d be happy to comply. I’d grab my car keys and ice cream scoop and race to the frozen foods section of the nearest supermarket (after a quick stop at Baskin Robbins). Author and eating disorder expert Geneen Roth tells a story about a mother who worried about her daughter’s weight. Even when the mom locked sweets up in a cabinet, the daughter managed to smuggle sweets into the house and hide in her bedroom to gorge on them. When the mom took Roth’s advice to give the child free access to sweets, the girl tired of them and began to make healthier food choices within a few days. This was a clear case of what I call Forbidden Food Syndrome, in which forced abstinence increases the person’s desire for the “bad” food. I don’t doubt that Roth’s advice in that case was sound, but in my personal experience, food rules aren’t the only cause of secretive food hoarding and gorging. My mom’s food rules had more to do with good manners than with nutrition. I had to take at least one bite of each food on my plate, chew with my mouth shut, ask for permission to leave the table, and dirty no dishes after supper. Other than that, I could eat whatever I wanted, in any quantity. Even with that much freedom, I would hoard and binge on sweets, alone in my room, at every opportunity. I wasn’t eating out of defiance, but neither was I eating for “good” or healthy reasons. Even at age nine, I was eating for emotional reasons – comfort, numbing, entertainment, you name it. As an adult, I have a better handle on my emotional eating than I did at age nine. I’m well aware of the food-obsessed Jeannie who will run without hesitation right into rush-hour traffic if a brownie might be waiting for me on the other side of the road. I know intimately the defiant Jeannie who insists on eating a piece of garlic bread even though she knows that the third or fourth bite could easily get stuck in her esophagus or stoma and cause a lot of discomfort. I have to monitor myself every day in order to maintain the delicate balance between choosing not to eat a piece of birthday cake because eating it doesn’t serve my weight management goals and choosing to go ahead and eat the entire cake simply because I know it doesn’t serve my weight management goals. Sometimes I feel like a freak because I have to deal with issues like this. I watch “normal” people making carefree eating choices and enjoying complete eating freedom with no awful consequences (or at least, that’s the way it looks to me), and deep down inside, I hate those normal people. They’re not yoked to this heavy burden of disordered eating like I am. It’s just not fair. But I’m gradually relaxing about my eating issues enough to be able to listen better and to hear more messages from my normal friends and acquaintances, and to realize that they too struggle with things like Forbidden Food Syndrome from time to time. I have a disgustingly healthy co-worker who told me once that she can’t eat chocolate because it gives her bad migraine headaches. She avoids chocolate, but she confessed that she wants it all the more because she can’t have it, and when she tells herself it’s OK to eat one small piece, she finds that she can’t stop – she eats three, five, seven pieces even though she knows she’ll pay for it sooner or later. She doesn’t pay with obesity, she pays with pain. She doesn’t know the pain of obesity as I do, but she and I struggled with the same basic problem. Little does she know how valuable her chocolate story is to me. It reminds me that I’m really not a freak – I just have a more intense and widespread eating problem than hers. It’s a matter of degrees. She’s five degrees off-center while I’m 45 degrees off. Neither of us is perfect. We both have to work at making good choices – not just in our eating behavior, but in every piece of behavior that could have good or bad consequences for us or for our family and friends. To my mind, this is just part of human existence, part of the responsibility that adult humans bear for maintaining a civilized and (we hope) peaceful co-existence with each other and ourselves. All this may be too philosophical for you, but I’m telling you about it because thinking about my eating problems this way has helped to put them in perspective, and putting them in perspective makes them a lot more manageable. Perspective is the art of seeing things in correct relationship to each other. As I wrote in Bandwagon, without perspective, my computer’s monitor looks ten times bigger than my neighbor’s barn across the road. In fact, my computer monitor is tiny compared to that barn. Without perspective, my weight management challenges seem enormous. I lost all that weight in just one year, but my maintenance job goes on forever. But consider the alternative. I could go back to obesity. I could have a stroke and become a human vegetable, reliant on others for everything from speech to toileting. I could lose my limbs to diabetes, reliant then on others for everything from tooth-brushing to transportation. I could suffer cardiac arrest and die at age 60. Or I can work at maintaining my weight and my health, with a huge payoff of mobility, independence, and longevity. So…back to Forbidden Food Syndrome. Although I’ve said that reverse psychology doesn’t always work with me, I must also say that one of the reasons I chose the band was that living with it would allow me to choose from a wide variety of foods I like. My nutritionist told me I might have problems eating certain foods, like celery or pasta, and I was willing to take the chance because life without celery or pasta still looked pretty good to me. But when my surgeon, speaking at the bariatric surgery informational seminar I attended, said that gastric bypass patients need to avoid all foods that are high in sugar, fat, or simple carbs because of the possibility of dumping, I mentally walked into a barbed wire fence and backed right off. At the time, I had one gastric bypass friend who didn’t dump, but the bypass patient who spoke at the seminar reported that he does dump, and when he described a typical day’s eating, I thought, “That’s not for me.” That guy was justifiably proud of his weight loss and didn’t mind a limited list of food choices, but I knew that limited food choices would send me running straight for the junk food if only out of sheer boredom. The night of that seminar, I hadn’t eaten a chocolate chip cookie for several months, but just the idea of giving up cookies forever made me want to stop at a bakery on the way home. I chose the adjustable gastric band, and the breadth and flexibility of my “OK Foods” list is one of the things that makes my post-op life enjoyable. I do overeat from time to time, but not because of Forbidden Food Syndrome. Taking foods off the Forbidden list has robbed them of some of their power over me. As a pre-op, I would attend a co-worker’s birthday party and eat two pieces of cake (Forbidden) because I’d been avoiding cake and missing it so much. As a post-op, I recently walked through the break room at work and saw a birthday cake on the table. I briefly wondered what flavor it was (impossible to tell from the decorative frosting, whose neon colors can’t be found in nature) and told myself I could try a little piece of it later, on my official break. Lo and behold, come break time I was quite hungry and not in the mood for cake. I wanted my chicken salad, and when I was done with that, I had no room for cake, so I went back to work without another thought about birthday cake. Now, that’s freedom!

Im going to henry ford. It has thw rating of "center of excellence". I have heard a lot of positive comments about dr. KRAUSE at beaumont, royal oak. I did meet a lady in my nutrition class who works in the bariatric dept. for beaumont, and was having the sleeve done at HF, instead of beaumont bc of the center of excellence accreditation. I found that interesting. Sent from my SM-N920P using the BariatricPal App

I don't even know where to begin. Mentally, I am drained... I had been trying to lose weight for the last 15 years or so, with many, many, too many ups and downs; and in the process gained over 100 pounds. Now in the past year, I have lost almost 150 pounds. As I sit here 2 pounds away from 150 pounds lost, I am amazed (see ashamed, dumbfounded, embarrassed) that even with that much of a loss I have so much more to lose. I don't even know how to feel about it. How did this happen? How was I so far gone? I'd been 300+ since I was 17. This is just mind-boggling. During all the testing for the sleeve, a bunch of health issues were uncovered. Things that I feel like should've been found or addressed over the years as I've had other ailments and such that have required testing, but I digress. Anyway, after the sleeve was performed, I was notified of a malignant tumor on my stomach that was cut away with the sleeve,and a humongous staghorn kidney stone that had taken up residence in my left kidney. I have to follow up with an oncologist to make sure all is clear, and I've recently had 2 surgeries to get rid of the kidney stone. I feel like the sleeve has saved my life, truly, but my God this journey has shown me how bad off I really was (am?). I'm 34 and there were things happening in my body that don't typically affect people until later in life. (I've got a couple other issues not addressed in this post...) I had literally fallen apart! I'm grateful that none of this is fatal and the doctors are "rebuilding" me piece by piece. So as I'm trying to define what is healthy for me weight-wise, I have all these doctors in my head and it is literally driving me crazy. Bariatric surgeon gave me a goal, pcp has another goal, urologist has a goal... Meanwhile, I have tons of dietary restrictions due to the different health issues. I'm overwhelmed mentally and emotionally. This process has become far more than I bargained for. I'm grateful, for sure, but this journey is...just that. A true journey. Anyway, I guess this post is long enough. I just needed a place to put my feelings. :-)

I'm so glad that you had surgery so that they discovered the tumor. How scary! This journey is difficult alone never mind with the scare of Cancer on top of it. If you don't already - I would encourage you to go to a therapist who has experience in Bariatric Surgery. Maybe they can help you get your thoughts together. Congrats on the weight loss so far - that's definitely something to be proud of!

Check out the Bariatric Eating website- they have lots of options for Protein supplementation. Everything I've gotten from them so far has been really good. It's REALLY important that you get things that have the best quality protein- whey or soy isolates. Some of those "bullets" are based on Gelatin protein, which is nowhere near as bioavailable. I was given very specific instructions as to what and how much to eat at each stage...I'd get back in touch with your nutritionist if you haven't been given that information as yet. I wasn't given a calorie count per se, but I was told that I needed to get 70-89 grams per day of protein post-op. I'm using the tools on the Allergan Lap Band site to keep track. Hope that helps- good luck! Christine

When I was a little girl, my grandmother had a "tattletale" cookie jar. It was what Grandmama called a "German Hausfrau" - the part that held the cookies was her full skirt of dotted swiss and the top was her head and torso. She was a plump lady(the cookie jar - not Gran) with a kerchief over her curly hair; rosy cheeks and her mouth was an open "O". One arm was raised and held a rolling pin the other hand was raised with one finger caught mid-wag as in "naughty - naughty". When you lifted her torso to get a cookie, a voice box in the torso would cry out "Mama! Mama!". That cookie jar came to mind the other day when reading some of the comments other bandsters post. If you're a doctor, nurse or other bariatric professional, please say so. If not, if you're just like me - banded and providing your anecdotal account of what you're going through, please - for the sake of your readers - drop the preachy, holier than thou, dogmatic, goody-2-toes, "I always do just what my doctor, nurse etc say to do delivery of your message. Reading it can be a real burn-out:w00t:!

hi andre... welcome. i'm relatively new to this site and to being banded myself. actually just had surgery on monday, so i'm not even a week out. so far so good. the soreness is subsiding and i'm headed out soon for another walk. i'm in nyc too and might head over to central park or to the historical society. as for finding a doctor. checkout the sites for nyu (thinforlife.med.nyu.edu) and for lennox hill (LHH/MMIBS :: Home). others here have highly recc'ed dr. murian and dr. fielding at nyu. i met with dr. kruian, but ultimately went with dr. roslin over at lennox hill. as you embark on your own research, you'll find that bariatric surgeons are a relatively small community in nyc and many have worked with and for one another at some point in their career. i went with roslin and lennox hill partly because of his experience and his straightforward style. also, i appreciated that his office was convenient for me to get to from my home and my office. plus, several friends of mine had other procedures at lennox hill and i liked that it was a somewhat smaller hospital and very focused on patient care. at any rate, do yourself a favor and comparison shop. you're making a lifetime purchase, commitment and quite possibly forming a lifetime relationship with your medical team. also, pick-up "weight loss surgery for dummies." it's a helpful primer and will help you think of and ask the right questions. good luck with your decision and your quest for a healthier lifestyle.

I began seriously considering bariatric surgery in January2011. My husband and I went to an informational meeting with the surgeon I was considering using. Initially I was thinking lap-band but after this meeting, I quickly changed to vertical sleeve gastrectomy because you won't lose as much "excess" weight with the band as you will with the sleeve. Also, there is no foreign object (band) left in your body. So, the decision was made to do vertical sleeve. My husband was skeptical until we attended the meeting. Afterwards he was convinced and very supportive. My surgeon's office, Dr. Richard Shimer, sent the request to my insurance company (United Healthcare) to see if it would be covered. I did not have any co-morbidities and my BMI was 35.7 therefore they denied coverage. I appealed it but lstt again!! I knew I wanted to have the sleeve whether my insurance paid for it or not.... All pre-op testing was complete and my surgery was scheduled for 4/25/11. I was so excited but not nervous at all! I am now I am 11 days post op today and have lost 14.5 pounds as of today. I've never lost 14 pounds in my life!!! I am thrilled. I am feeling a little more comfortable in my clothes that were too tight before surgery. I am on full liquids. I am wondering at the point, how many meals are you having each day? I have read 3 per day and 6 per day. a little confused

I lost 21 lbs on my 2 week preop liquid diet. I was on bariatric advantage shakes for 2 weeks preop.

What stage are you in? You will have may more options once you get back to regular cooked food. For me that was 4 1/2 weeks. Before that, I used baby foods for purees. For soft foods, I just took what I wanted and put it in the blender with enough broth or Water to make it the right consistency. If you are already in the regular stage and lost about menus, go to: theworldaccordingtoeggface.blogspot.com She is one of us and understands what we are going through. She has many recipes and bariatric - friendly menu ideas and wonderful stories about world-wide travel while newly sleeved.

Bahahaha "circling the drain" Girl, I have nothing figured out...at least not in the bariatric world LOL

Unfortunately, there is no way we can answer your question. We're not doctors. If I were you, I'd find a surgeon who does both bariatric surgery and general surgery and ask him. Only he/she could answer your question.

I am self pay also Bc ins doesn't cover bariatrics but for the psych I was able to use my reg ins and paid $50 copay instead of $250. (Dr Baum)

Please take my comments as wanting you to enjoy maximum success. I failed with a lapband..partly not understanding how to eat. I found much success with the sleeve, losing 150# in 14 months (and maintaining for years now), but I had to understand how to do this. In the early months I strongly encourage you to eat dense,lean protein(fish, chicken, beef, other seafood etc.) As your main food each meal. Eat it slowly, chew carefully. You will get full really fast! It takes a small quantity! Then have a few bites of healthy veggies. My program called for doing that 5x a day. If you are mostly compliant with that you will have long term success. I am now four years out and I do sometimes"splurge" but it is in a controlled, not daily kind of thing. During the losing phase, following the bariatric recommendations most of the time is really important. Good luck, I do know it's difficult and most of us aren't perfect...but being consistently compliant is key. Sent from my KFJWI using the BariatricPal App

I have a little over a week before my big day. I bought several individual packets of protein drinks from my clinic to see what I might like best so I can purchase to have after surgery. Well so far they all gag me! Today I tried Bariatric Advantage iced latte. Sounds and smells great but the taste about made me throw up! I even have some crushed ice in it to try to help. If there is a shake that anybody likes, please share the name. I know I will need the nutrition after surgery but this stuff will make it impossible for me to get down.

Yeah, most likely LOL I tend to do that I texted back and forth with the girl last Friday afternoon. She seems really cool. They gave me a 53 page pdf about "Eating to succeed with Weight Loss after Bariatric Surgery". Apparently we discuss this packet over the course of the next 5 months. Each of the dietician visits are 1hr 15min video chats. The first visit is today so I guess I'll see how it goes.