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Thanks for all of your positive thoughts. I guess for me, it's hard to read forums and blogs where people seem to be losing massive amounts of weight and here I am struggling with a couple of stalls and even a few weight gains. I had a doctor tell me a couple of years ago that she had never had a patient whose body seemed to hold on to fat like mine does. In the past, I've been totally compliant with dieting and exercise and I struggled to lose the little bit of weight that I did lose. I'm finding that true again, even with my surgery. I'm praying that exercise will get the weight loss really going. I haven't been able to do much because I got a staph infection a week after surgery and my doctor doesn't want me doing much until mid to late January. I'm going to join the gym that my husband goes to and also got some kettlebells and a DVD for strength training. Thanks again. It helps to know that there are others who totally understand what this feels like. Blessings, Julie

Have a great News Eve guys! You are all sounding so positive and motivated! I haven't set myself any goals for 2013 yet! I haven't hoped on the scales for a couple of weeks and I must admit I am a bit scared too - I have not been eating so well over this Christmas period and just don't want to face any weight gain. Just a fear of going backwards and having that feeling of failure after so much progress! Lila - I too had a dose of the sun - my skin hasn't seen the light of day for years so I think it got a bit of a shock when I wore a tank top and went for a walk on the beach - it was really nice to feel the sun on my skin but I could have put lotion on - go figure! Dean - shame you have to work but thanks for doing your job to keep us all safe - hope you do get home to Celebrate the new year in with your better half and family :-) Aussie Girl - you are an inspiration! With your great outlook, I am sure some gorgeous man will want to be part of it! HAPPY NEW YEAR!

So one week out. Going back to work tonight. Have to do a couple weeks of GRAVEYARD yuck!! I feel fine. I have hypothyroidism. I am hungry all the time though. I have to admit I cheated a little and had some cottage cheese and mashed potatoes. I'm supposed to wait another week but the liquids aren't cutting it. No pain really. A slight bubbly feeling sometimes that feels like I have a leak or something but proBably just internal rumblings cause I'm not sick no fever etc. I'm a police dispatcher so no physical hard work. I'm more in pain about working graveyard then over my surgery. Well thanks everyone for being so candid on here. It helps me allot to see I'm where I need to be and what's ahead. I had lost 100lbs naturally 6 years ago. Kept if off for 5 years had $30,000 worth of tummy tucks boob job face lift then gained it all back from emotional eating. I don't want to fight this fight anymore. I hope this is the end if my battle and that the weight gain didn't completely ruin all this plastic surgery I already did.

I would honestly say avoid Fast food places-too much temptation in the beginning. Also, fast food is frozen, or soaked in salt. My brother runs a chicken chain, my boys both work in fast food and I come from a family of restaurant owners. Good ol' home cooking is best for weight loss! If you must, stick to the fresh items...like salads-thnigs that are raw. The chili's and other items have a tonne of sodium and preservatives. Preservatives are linked to causing weight gain...http://www.organicliaison.com/blog/2010/09/09/why-preservatives-additives-and-other-chemicals-cause-weight-gain/ ...and I would be soooo tempted to order "just a side" of fries! I went dining out with friends last night and ordered musself in wine sauce and passed my side of fries around the table-it was awsome-soft Protein, 7 cals a mussel and no guilt. If possible, make your own fast food at night for lunch-grill a bunch of chicken breasts and make a honey garlic dip or use a low fat dressing, and toss a big salad....I just have no willpower with fast food restaurants! Old habits die hard

Good luck! I'm supposed to get sleeved about the same time as you. Can't figure out how to add you to my friends list. If you know how, add me to yours. You are probably wise to do the liquids. My surgeon is not very strict either. He did say it will make things easier because rapid weight gain comes from your stomach and makes visibility better. So I'm with you, going to do it. After reading all these horror stories, I figure do everything possible. It's great that you are excited. After joining this site and reading all the things that went wrong, I have been thinking about canceling surgery. One lady sent me a great support letter so I printed it off and look at it when I start to freak out. Like you I'm not telling anyone about the surgery.

WHAT DOES PATIENT COMPLIANCE MEAN? The term “patient compliance” is a funny one for someone like me, who in some areas of her life doesn’t have the patience required for compliance. Maybe that’s just my funny little brain playing with words again. What does patient compliance mean? A compliant patient is one who follows or completes with their physician’s diagnostic, treatment, or preventive procedure(s). For example, John Doe’s blood work shows high LDL cholesterol and triglycerides (diagnosis: hyperlipidemia). He’s a compliant patient because he faithfully takes the medication his doctor prescribed, avoids eating saturated fats, and increases his exercise in order to lose some weight. His mother-in-law has high blood pressure (hypertension) and is recovering from a stroke, so in order to prevent the medical problems that challenge her mom, John’s wife Jane follows her doctor’s recommendation to reduce her own salt intake and join John for a daily walk. Their obese son Mark, who is scheduled to have bariatric surgery in two weeks, is compliant as he carefully follows his surgeon’s pre-op liver shrink diet to prepare for the surgery. Their sun-worshipping daughter Mary just had a suspicious mole removed and complies with her dermatologist’s recommendation to use sunscreen every day and give up the tanning bed. A highly commendable family, aren’t they? What about you? Are you a compliant patient? All the time, some of the time, or none of the time? Compliance is a practice that matters to me…does it matter to you? BARIATRIC PATIENT COMPLIANCE Most bariatric surgeons agree that the #1 cause of disappointing weight loss or other WLS “failure” is patient non-compliance with the surgeon’s protocol. In contrast, many adjustable gastric band patients (the disappointed ones, anyway) agree that the #1 cause of band “failure” (however they experience it) is that the band doesn’t work, no matter what (if any) protocol you follow. How can we reconcile such opposite views of WLS failure? What can surgeons do better or differently to improve patient outcomes? We already know what patient compliance means, so let’s take a look at the term “protocol.” In a general sense, protocol is a set of conventional principles and expectations that are considered binding on the members of a particular group, be it professional, social, or political. It’s also the formal etiquette and code of behavior, precedence, and procedure for state and diplomatic ceremonies. Protocol is a big deal to the British Royal Family, as witnessed by the flutter over the Queen’s order that Kate, the Dutchess of Cambridge must, as a former commoner, show reverence to the ‘blood princesses’. She is expected to curtsey to those born royal, such as Princesses Beatrice and Eugenie – both in public and in private. Although the media did a lot of speculating about Kate’s putative humiliation over this order, the importance of royal protocol can hardly be a surprise to a British citizen who marries into the Royal Family. In the medical world, the term protocol refers to the plan for a course of treatment – a physician’s diagnostic, treatment, or preventive procedure(s) like those followed by John Doe and his family. And like Kate Middleton, a bariatric patient can hardly be surprised over their surgeon’s insistence that they follow that protocol. Any surgeon worth his/her scalpel educates patients about that protocol from the time of an informational seminar to the day of a band patient’s first fill, with updates as time goes on. That’s why I feel impatient when I hear (very, very often) that new bandsters are shocked and vexed over the requirement that they follow a liquid diet immediately before and after their surgery, as well as after fills. “How can that possibly be a shock?” I ask myself. Did the patient sleep through their pre-op education, or were they so focused on the vision of themselves in a size 0 that they forgot the work that must be done to arrive at that size? Or (please say it ain’t so!) did the surgeon or other medical professionals in that bariatric program not spell out the details of their protocol when the patient was preparing for surgery? And then there’s the whole “Why does my surgeon say eat only ½ cup of food when my friend’s surgeon says eat 1 cup of food at a time?” dilemma. As I explained in Bandwagon, surgeons establish (and fine tune) patient protocols based on their own experience with their own patient population. If band manufacturers hired teams of auditors to ensure that every bariatric surgeon in North America used the exact same protocol, no one would be able to afford a gastric band, and very few surgeons would bother using the band for their patients. And a brand-new gastric band sitting in its package is completely useless until a trained and experienced surgeon implants it in a patient. Allergan and Ethicon Endo aren’t surgeons; they’re manufacturers of medical devices. So while speculating about the great variation in WLS protocols might be mildly entertaining, it’s not going to do a whole lot to get you closer to that size 0. If you choose a surgeon you trust and respect, you also choose to abide by their protocol, and enjoying that protocol is beside the point. I spent decades enjoying my own weight loss and weight gain “protocols” so much that by the time I was 54, I needed weight loss surgery. So whose protocol is healthier or more effective, mine or my surgeon’s? I lost 92 pounds by following a surgeon’s protocol. Is there a problem with that? I think not. OK, hang on a second while I climb off my soap-box. Ah, that’s better. Here I am again, standing on the ground, surrounded by living, breathing (if distant) WLS patients. It’s not fair to generalize about any of us, is it? But generalize I must in order to make a few more points. THE DOUBTING THOMAS I think some of us are by nature more likely to ignore, question, or defy authority figures, while others accept authority without voicing or even thinking a question. In the former case, we need to cultivate trust in the doctors who want to help us, while in the latter case, we need to cultivate enough trust in ourselves to dare to ask those authority figures for better or more detailed explanations of their instructions. I’m more on the defiant, or Doubting Thomas, end of the patient spectrum, but a few years ago I read a statement that struck me (out of the blue) as very true: SOME THINGS MUST BE BELIEVED TO BE SEEN I extrapolated that statement from a religious context into the context of my WLS journey (at that point in my life, I could extrapolate almost anything into the context of my WLS journey). When I had Lap-Band® surgery, I was convinced that I was a total failure at weight loss. Going into that operating room, I had to believe something I’d never seen myself do: that with the help of my band, I could succeed at weight loss and maintenance. And I did. Because truth can take a while to reveal itself, I think people like me need to ask ourselves, “What possible harm could befall me if I do follow an instruction whose proof of efficacy I can’t see right now?” Let’s go back to a previous example: your doctor tells you not to eat more than 1 cup of food at a time. You know you can easily eat 2 cups, so if you really want (or think you need) to eat all that, and no immediate negative consequences result from doing that, why shouldn’t you just go ahead and do it? Why should you blindly follow your doctor’s seemingly arbitrary and unreasonable instruction to stop eating after you’ve consumed 1 cup of food? It’s your doctor’s job to explain the “why” behind that instruction, but if she/he hasn’t done that to your satisfaction, and he/she isn’t sitting at the table with you and that plate of delicious food, I suggest that you consider what terrible thing would happen if you put away the extra cup of food for now. Will you starve to death? Really? What else might happen? Will you surrender your liberty, be forced to vote for your doctor’s favorite presidential candidate, or (worse) be compelled to clean his toilet every Saturday for the next 20 years? Oh, no. No, no, no. He’s your doctor, not your teenaged son, so let’s consider another, quite serious consequence of following his instruction. Maybe, just maybe, nothing bad will happen at all. Maybe even something good will happen. Just because your compliance doesn’t yield an instant reward doesn’t mean it won’t yield a future reward. What might that reward be? How about weight loss and the avoidance of side effects or complications? Doesn’t that sound good to you? Sure sounds good to me. I do much better at following instructions if I understand them, but I’m here to tell you that in almost 5 years of banded living, I didn’t truly begin understand my surgeon’s and dietitian’s protocol until I’d been following it for 6 or so months, and the scope of my comprehension expanded more over the next few years. In the meantime, I lost those 92 pounds I mentioned earlier. The lesson there is that you don’t have to completely understand or believe in a protocol for it to work, as long as you follow it as best you can. THE BELIEVER Now I want to talk to the folks at the other end of the patient spectrum, the obedient ones who wouldn’t even think of defying the advice of an authority figure. Their WLS journey can be bumpy too, even when they slavishly follow their doctor’s protocol, and here’s why. One of the problems with blindly following instructions that you don’t understand is that sooner or later you’re going to find yourself in a situation no one thought to warn you about. You won’t instantly know what to do, and you may waste precious time on unnecessary blood, sweat and tears. You may even end up doing something harmful. Without at least an inkling of the principles behind your doctor’s protocol, you’ll have a hard time coming up with a stopgap measure to help you survive a surprising and stressful situation. If you worry that any decision you make on your own will be the wrong one, ask yourself: “What’s the worst that could happen if I do nothing right now? What will happen if I do the ‘wrong’ thing?” Will you die? Surely not. If you’re able to breathe, ambulate, drink water, state your name and what year it is, and blood isn’t pooling in your shoes, you’re going to survive at least long enough to call your surgeon, leave a message, and wait for a call back. So unless the decision requires someone to dial 911 to speed you to the emergency room (if you can’t breathe, move, swallow, talk, remember your name or the year, stop the bleeding, or if something else life-threatening is happening), take a deep breath! And another one, and another one. Ah, that’s better! People on the Believer end of the patient spectrum are often reluctant to ask questions of their doctors because they’re afraid they’ll look stupid or make the doctor angry. I can only repeat the old saying that the only stupid question is the one you think but don’t ask. It’s extremely unlikely that your doctor is going to spank you if you ask (again), “Why can’t I take ibuprofen for my headache?” If your doctor seems irritated by a question like that, it may be because you’re trying their patience, or it could be because they’re having a bad day (worried or annoyed about something completely unrelated to you or their job, wishing they hadn’t eaten the whole pastrami sandwich for lunch, didn’t sleep well last night, etc.). It could also be because their bedside manner needs work. If that’s the case, you can set out in search of another surgeon, put up with the original surgeon’s rudeness, or do your part to lead that doctor towards kindness. If the answer to your question starts looking like a time-consuming project that your doctor doesn’t have time for right now, it’s perfectly okay to say something like, “Is there someone else in the office who could work with me on that?” or “Would it be better to make another appointment to talk about this?” THE DOCTOR Doctors, like other people, come in all shapes, sizes, and temperaments, and with varying communication skills. They’re not all made from the eternally patient, smiling, avuncular Marcus Welby mold, and not all of them are motivated solely by the desire to help other people. They’re often just as fascinated by science as by altruism. Like you and me, they work to earn money, and if their pay seems ridiculously high, just ask one of them how much money they borrowed to get through medical school, and how much they pay each year just for medical malpractice insurance. In many ways, I’m a “you get what you pay for” kinda gal. If 3 doctors quoted band surgery at a total of $13,000 to $15,000, and a 4th doctor quoted only $4,000, I’m not sure I’d feel safe with a bargain basement surgeon (nor would I assume that the $15,000 surgeon was the best). Last I heard, no courses in Bedside Manner or patient communication are required of, or even offered to medical students. Doctors must exchange important information with patients whose own communication skills vary greatly, and they must take a patient’s measure, choose a treatment plan, and explain it to the patient using a minimum of enigmatic medical terms, all within a matter of minutes before they rush off to the next patient or task. Doctors must rely on support staff to do hundreds of things to keep the doctor’s boat afloat, and it’s entirely possible that they have no idea how rude or careless or wonderful some of those people are because so much of that goes on in a way that’s invisible to the doctor. And which would you rather your surgeon focus on: the ink cartridge for the Xerox machine, or the pain in your abdomen? In medical folklore, surgeons are infamous for possessing a God complex, with big egos, enormous self-confidence, and an excess of superiority. When you think about it, it does take a lot of chutzpah to cut into another human’s flesh and fiddle with their innards in the effort to fix a problem., so it doesn’t surprise or bother me much that some surgeons have a hard time coming down to the lowly level (perceived or real) where their patients trudge through the mud of ordinary human existence. In many types of surgery, that’s not a big problem because the surgeon sees the patient maybe 3 or 4 times: the initial consult, the surgery, and 1 or 2 post-op follow-ups. Then the patient goes on their merry (we hope) way and the surgeon scrubs up and dashes into the operating room to cut into someone else’s medical problem. General surgery is usually a fix-it-and-go thing. If your diseased gall bladder gets tossed away and forgotten, do you really care if that also means your abdominal pain is also a thing of the past? But bariatric surgery, which treats a chronic and incurable disease that’s a highly complex tangle of physical, behavioral, and emotional problems, is a different matter. Successful bariatric surgery is not a fix-it-and-go proposition (and that’s reason #99 that I would hesitate to ever have surgery outside the United States, knowing that I have no local surgical back-up or support). Bariatric patients need far more education, aftercare and support than most other types of patients. I’m convinced that one of the causes of WLS failure (however you define failure) is inadequate patient education, aftercare and support. And on top of that, adjustable gastric band patients need even more education, aftercare, and support than most other bariatric patients. While I believe that too many general surgeons have been jumping on the gastric band-wagon without fully understanding the needs of those patients, it’s not fair to say that they’re all being careless or negligent when they fail to give patients what they really need. Unless they’ve had bariatric surgery themselves, they just don’t know what it is to walk in our shoes. They might consider the implanting of a gastric band to be an interesting and possibly lucrative addition to their practice without realizing that surgical expertise is only part of what the band patient needs. Doctors and other people with very high self-esteem can be hard for us ordinary mortals to deal with, but it’s a mistake to assume that they’re looking down on us. They may not be looking at or thinking about us at all, not because they don’t care about us but because their minds are so enthralled by and preoccupied with medical science. My father was a brilliant scientist whose head was so far up in the clouds that I often wondered what planet he was on. At the same time, I know he loved me when he noticed me (and I know now that nothing I could do would change that). In a sense, doctors who get heavily involved with their patients are doing those patients a disservice. The Hippocratic Oath exhorts doctors to “do no harm,” not to mop up your tears or hug you when things go wrong. If that seems harsh, consider this: doctors actually need to keep some emotional distance from their patients in order to treat them well medically. Without that distance, it would be very hard for them to make rational decisions about patient care. That’s why it’s considered poor practice for doctors to treat themselves or their loved ones. I’m not saying that it’s okay for doctors to be cold and heartless and should be excused for bad behavior. None of them are perfect (and neither are we, the patients) and you won’t find me worshipping at the altar of the AMA or the ASMBS. I’ve encountered some wonderful doctors and surgeons in my lifetime, and some bad ones too. The average American bandster might see 3-4 doctors on a regular basis (a few times a year): a primary care physician, a gynecologist (if you’re of that persuasion), a dentist, and maybe a chiropractor or a specialist like an eye doctor. The average American bariatric surgeon probably sees 20-30 patients a day (perhaps a few thousand per year). Since I’m not a mind-reader, and no one cares as much about my weight loss journey as much as I do, I figure it’s my responsibility to refresh my doctors’ memories each time I see them. I might wish that I didn’t have to repeat over and over again that (for example) I’m hearing impaired and need my doctor to look at me when he speaks, but that’s a minor issue compared to some of the bigger ones I face as a mature adult.

Are you a compliant patient? All the time, some of the time, or none of the time? This is a practice that matters to me…does it matter to you? What’s the big deal about it, anyway? WHAT DOES PATIENT COMPLIANCE MEAN? The term “patient compliance” is a funny one for someone like me, who in some areas of her life doesn’t have the patience required for compliance. Maybe that’s just my funny little brain playing with words again. What does patient compliance mean? A compliant patient is one who follows or completes with their physician’s diagnostic, treatment, or preventive procedure(s). For example, John Doe’s blood work shows high LDL cholesterol and triglycerides (diagnosis: hyperlipidemia). He’s a compliant patient because he faithfully takes the medication his doctor prescribed, avoids eating saturated fats, and increases his exercise in order to lose some weight. His mother-in-law has high blood pressure (hypertension) and is recovering from a stroke, so in order to prevent the medical problems that challenge her mom, John’s wife Jane follows her doctor’s recommendation to reduce her own salt intake and join John for a daily walk. Their obese son Mark, who is scheduled to have bariatric surgery in two weeks, is compliant as he carefully follows his surgeon’s pre-op liver shrink diet to prepare for the surgery. Their sun-worshipping daughter Mary just had a suspicious mole removed and complies with her dermatologist’s recommendation to use sunscreen every day and give up the tanning bed. A highly commendable family, aren’t they? What about you? Are you a compliant patient? All the time, some of the time, or none of the time? Compliance is a practice that matters to me…does it matter to you? BARIATRIC PATIENT COMPLIANCE Most bariatric surgeons agree that the #1 cause of disappointing weight loss or other WLS “failure” is patient non-compliance with the surgeon’s protocol. In contrast, many adjustable gastric band patients (the disappointed ones, anyway) agree that the #1 cause of band “failure” (however they experience it) is that the band doesn’t work, no matter what (if any) protocol you follow. How can we reconcile such opposite views of WLS failure? What can surgeons do better or differently to improve patient outcomes? We already know what patient compliance means, so let’s take a look at the term “protocol.” In a general sense, protocol is a set of conventional principles and expectations that are considered binding on the members of a particular group, be it professional, social, or political. It’s also the formal etiquette and code of behavior, precedence, and procedure for state and diplomatic ceremonies. Protocol is a big deal to the British Royal Family, as witnessed by the flutter over the Queen’s order that Kate, the Dutchess of Cambridge must, as a former commoner, show reverence to the ‘blood princesses’. She is expected to curtsey to those born royal, such as Princesses Beatrice and Eugenie – both in public and in private. Although the media did a lot of speculating about Kate’s putative humiliation over this order, the importance of royal protocol can hardly be a surprise to a British citizen who marries into the Royal Family. In the medical world, the term protocol refers to the plan for a course of treatment – a physician’s diagnostic, treatment, or preventive procedure(s) like those followed by John Doe and his family. And like Kate Middleton, a bariatric patient can hardly be surprised over their surgeon’s insistence that they follow that protocol. Any surgeon worth his/her scalpel educates patients about that protocol from the time of an informational seminar to the day of a band patient’s first fill, with updates as time goes on. That’s why I feel impatient when I hear (very, very often) that new bandsters are shocked and vexed over the requirement that they follow a liquid diet immediately before and after their surgery, as well as after fills. “How can that possibly be a shock?” I ask myself. Did the patient sleep through their pre-op education, or were they so focused on the vision of themselves in a size 0 that they forgot the work that must be done to arrive at that size? Or (please say it ain’t so!) did the surgeon or other medical professionals in that bariatric program not spell out the details of their protocol when the patient was preparing for surgery? And then there’s the whole “Why does my surgeon say eat only ½ cup of food when my friend’s surgeon says eat 1 cup of food at a time?” dilemma. As I explained in Bandwagon, surgeons establish (and fine tune) patient protocols based on their own experience with their own patient population. If band manufacturers hired teams of auditors to ensure that every bariatric surgeon in North America used the exact same protocol, no one would be able to afford a gastric band, and very few surgeons would bother using the band for their patients. And a brand-new gastric band sitting in its package is completely useless until a trained and experienced surgeon implants it in a patient. Allergan and Ethicon Endo aren’t surgeons; they’re manufacturers of medical devices. So while speculating about the great variation in WLS protocols might be mildly entertaining, it’s not going to do a whole lot to get you closer to that size 0. If you choose a surgeon you trust and respect, you also choose to abide by their protocol, and enjoying that protocol is beside the point. I spent decades enjoying my own weight loss and weight gain “protocols” so much that by the time I was 54, I needed weight loss surgery. So whose protocol is healthier or more effective, mine or my surgeon’s? I lost 92 pounds by following a surgeon’s protocol. Is there a problem with that? I think not. OK, hang on a second while I climb off my soap-box. Ah, that’s better. Here I am again, standing on the ground, surrounded by living, breathing (if distant) WLS patients. It’s not fair to generalize about any of us, is it? But generalize I must in order to make a few more points. THE DOUBTING THOMAS I think some of us are by nature more likely to ignore, question, or defy authority figures, while others accept authority without voicing or even thinking a question. In the former case, we need to cultivate trust in the doctors who want to help us, while in the latter case, we need to cultivate enough trust in ourselves to dare to ask those authority figures for better or more detailed explanations of their instructions. I’m more on the defiant, or Doubting Thomas, end of the patient spectrum, but a few years ago I read a statement that struck me (out of the blue) as very true: SOME THINGS MUST BE BELIEVED TO BE SEEN I extrapolated that statement from a religious context into the context of my WLS journey (at that point in my life, I could extrapolate almost anything into the context of my WLS journey). When I had Lap-Band® surgery, I was convinced that I was a total failure at weight loss. Going into that operating room, I had to believe something I’d never seen myself do: that with the help of my band, I could succeed at weight loss and maintenance. And I did. Because truth can take a while to reveal itself, I think people like me need to ask ourselves, “What possible harm could befall me if I do follow an instruction whose proof of efficacy I can’t see right now?” Let’s go back to a previous example: your doctor tells you not to eat more than 1 cup of food at a time. You know you can easily eat 2 cups, so if you really want (or think you need) to eat all that, and no immediate negative consequences result from doing that, why shouldn’t you just go ahead and do it? Why should you blindly follow your doctor’s seemingly arbitrary and unreasonable instruction to stop eating after you’ve consumed 1 cup of food? It’s your doctor’s job to explain the “why” behind that instruction, but if she/he hasn’t done that to your satisfaction, and he/she isn’t sitting at the table with you and that plate of delicious food, I suggest that you consider what terrible thing would happen if you put away the extra cup of food for now. Will you starve to death? Really? What else might happen? Will you surrender your liberty, be forced to vote for your doctor’s favorite presidential candidate, or (worse) be compelled to clean his toilet every Saturday for the next 20 years? Oh, no. No, no, no. He’s your doctor, not your teenaged son, so let’s consider another, quite serious consequence of following his instruction. Maybe, just maybe, nothing bad will happen at all. Maybe even something good will happen. Just because your compliance doesn’t yield an instant reward doesn’t mean it won’t yield a future reward. What might that reward be? How about weight loss and the avoidance of side effects or complications? Doesn’t that sound good to you? Sure sounds good to me. I do much better at following instructions if I understand them, but I’m here to tell you that in almost 5 years of banded living, I didn’t truly begin understand my surgeon’s and dietitian’s protocol until I’d been following it for 6 or so months, and the scope of my comprehension expanded more over the next few years. In the meantime, I lost those 92 pounds I mentioned earlier. The lesson there is that you don’t have to completely understand or believe in a protocol for it to work, as long as you follow it as best you can. THE BELIEVER Now I want to talk to the folks at the other end of the patient spectrum, the obedient ones who wouldn’t even think of defying the advice of an authority figure. Their WLS journey can be bumpy too, even when they slavishly follow their doctor’s protocol, and here’s why. One of the problems with blindly following instructions that you don’t understand is that sooner or later you’re going to find yourself in a situation no one thought to warn you about. You won’t instantly know what to do, and you may waste precious time on unnecessary blood, sweat and tears. You may even end up doing something harmful. Without at least an inkling of the principles behind your doctor’s protocol, you’ll have a hard time coming up with a stopgap measure to help you survive a surprising and stressful situation. If you worry that any decision you make on your own will be the wrong one, ask yourself: “What’s the worst that could happen if I do nothing right now? What will happen if I do the ‘wrong’ thing?” Will you die? Surely not. If you’re able to breathe, ambulate, drink water, state your name and what year it is, and blood isn’t pooling in your shoes, you’re going to survive at least long enough to call your surgeon, leave a message, and wait for a call back. So unless the decision requires someone to dial 911 to speed you to the emergency room (if you can’t breathe, move, swallow, talk, remember your name or the year, stop the bleeding, or if something else life-threatening is happening), take a deep breath! And another one, and another one. Ah, that’s better! People on the Believer end of the patient spectrum are often reluctant to ask questions of their doctors because they’re afraid they’ll look stupid or make the doctor angry. I can only repeat the old saying that the only stupid question is the one you think but don’t ask. It’s extremely unlikely that your doctor is going to spank you if you ask (again), “Why can’t I take ibuprofen for my headache?” If your doctor seems irritated by a question like that, it may be because you’re trying their patience, or it could be because they’re having a bad day (worried or annoyed about something completely unrelated to you or their job, wishing they hadn’t eaten the whole pastrami sandwich for lunch, didn’t sleep well last night, etc.). It could also be because their bedside manner needs work. If that’s the case, you can set out in search of another surgeon, put up with the original surgeon’s rudeness, or do your part to lead that doctor towards kindness. If the answer to your question starts looking like a time-consuming project that your doctor doesn’t have time for right now, it’s perfectly okay to say something like, “Is there someone else in the office who could work with me on that?” or “Would it be better to make another appointment to talk about this?” THE DOCTOR Doctors, like other people, come in all shapes, sizes, and temperaments, and with varying communication skills. They’re not all made from the eternally patient, smiling, avuncular Marcus Welby mold, and not all of them are motivated solely by the desire to help other people. They’re often just as fascinated by science as by altruism. Like you and me, they work to earn money, and if their pay seems ridiculously high, just ask one of them how much money they borrowed to get through medical school, and how much they pay each year just for medical malpractice insurance. In many ways, I’m a “you get what you pay for” kinda gal. If 3 doctors quoted band surgery at a total of $13,000 to $15,000, and a 4th doctor quoted only $4,000, I’m not sure I’d feel safe with a bargain basement surgeon (nor would I assume that the $15,000 surgeon was the best). Last I heard, no courses in Bedside Manner or patient communication are required of, or even offered to medical students. Doctors must exchange important information with patients whose own communication skills vary greatly, and they must take a patient’s measure, choose a treatment plan, and explain it to the patient using a minimum of enigmatic medical terms, all within a matter of minutes before they rush off to the next patient or task. Doctors must rely on support staff to do hundreds of things to keep the doctor’s boat afloat, and it’s entirely possible that they have no idea how rude or careless or wonderful some of those people are because so much of that goes on in a way that’s invisible to the doctor. And which would you rather your surgeon focus on: the ink cartridge for the Xerox machine, or the pain in your abdomen? In medical folklore, surgeons are infamous for possessing a God complex, with big egos, enormous self-confidence, and an excess of superiority. When you think about it, it does take a lot of chutzpah to cut into another human’s flesh and fiddle with their innards in the effort to fix a problem., so it doesn’t surprise or bother me much that some surgeons have a hard time coming down to the lowly level (perceived or real) where their patients trudge through the mud of ordinary human existence. In many types of surgery, that’s not a big problem because the surgeon sees the patient maybe 3 or 4 times: the initial consult, the surgery, and 1 or 2 post-op follow-ups. Then the patient goes on their merry (we hope) way and the surgeon scrubs up and dashes into the operating room to cut into someone else’s medical problem. General surgery is usually a fix-it-and-go thing. If your diseased gall bladder gets tossed away and forgotten, do you really care if that also means your abdominal pain is also a thing of the past? But bariatric surgery, which treats a chronic and incurable disease that’s a highly complex tangle of physical, behavioral, and emotional problems, is a different matter. Successful bariatric surgery is not a fix-it-and-go proposition (and that’s reason #99 that I would hesitate to ever have surgery outside the United States, knowing that I have no local surgical back-up or support). Bariatric patients need far more education, aftercare and support than most other types of patients. I’m convinced that one of the causes of WLS failure (however you define failure) is inadequate patient education, aftercare and support. And on top of that, adjustable gastric band patients need even more education, aftercare, and support than most other bariatric patients. While I believe that too many general surgeons have been jumping on the gastric band-wagon without fully understanding the needs of those patients, it’s not fair to say that they’re all being careless or negligent when they fail to give patients what they really need. Unless they’ve had bariatric surgery themselves, they just don’t know what it is to walk in our shoes. They might consider the implanting of a gastric band to be an interesting and possibly lucrative addition to their practice without realizing that surgical expertise is only part of what the band patient needs. Doctors and other people with very high self-esteem can be hard for us ordinary mortals to deal with, but it’s a mistake to assume that they’re looking down on us. They may not be looking at or thinking about us at all, not because they don’t care about us but because their minds are so enthralled by and preoccupied with medical science. My father was a brilliant scientist whose head was so far up in the clouds that I often wondered what planet he was on. At the same time, I know he loved me when he noticed me (and I know now that nothing I could do would change that). In a sense, doctors who get heavily involved with their patients are doing those patients a disservice. The Hippocratic Oath exhorts doctors to “do no harm,” not to mop up your tears or hug you when things go wrong. If that seems harsh, consider this: doctors actually need to keep some emotional distance from their patients in order to treat them well medically. Without that distance, it would be very hard for them to make rational decisions about patient care. That’s why it’s considered poor practice for doctors to treat themselves or their loved ones. I’m not saying that it’s okay for doctors to be cold and heartless and should be excused for bad behavior. None of them are perfect (and neither are we, the patients) and you won’t find me worshipping at the altar of the AMA or the ASMBS. I’ve encountered some wonderful doctors and surgeons in my lifetime, and some bad ones too. The average American bandster might see 3-4 doctors on a regular basis (a few times a year): a primary care physician, a gynecologist (if you’re of that persuasion), a dentist, and maybe a chiropractor or a specialist like an eye doctor. The average American bariatric surgeon probably sees 20-30 patients a day (perhaps a few thousand per year). Since I’m not a mind-reader, and no one cares as much about my weight loss journey as much as I do, I figure it’s my responsibility to refresh my doctors’ memories each time I see them. I might wish that I didn’t have to repeat over and over again that (for example) I’m hearing impaired and need my doctor to look at me when he speaks, but that’s a minor issue compared to some of the bigger ones I face as a mature adult.

Maybe your weight gain is due to your period coming too? I was losing quite quickly but the last time I weighed I gained 2 lbs and it's the same today. Bet when Aunt Flo comes it'll go away! At least I hope!! I HATE Aunt Flo!! Lol.

Still not losing weight. Gained 5 pounds while I was getting dehydrated. Dr said it was my body trying to retain what fluids it could. Then lost 2 after not being dehydrated anymore. Weighed this morning to find out I've gained the two back, stopped weighing everyday cuz it's just so disappointing. I'm about ready to throw the scale out the window. i walk about 40 minutes each day and just don't know wth is going on. I'm getting fluids and protein. Any ideas or similar experiences? Gen :-)

My main symptoms were unexplained weight gain and severe cramps. I also had hair in places they shouldn't be. Eventually to caused other problems, I have now had a complete hysterectomy. Since then my excess hair is better and I don't gain weight like I did before. The lapband is taking care of the weight from the PCOS. Some people say that PCOS is caused by weight, but that is not true, my symptoms started while I still weighed 140 pounds. If you are wondering call around to ob/gyn's and ask if they treat patients for PCOS. Tell them you want to be checked for it. This keeps you from dealing the drs. that will just tell you your crazy and that you need to eat healthier.

My surgery was 11/20 ...yea I might need to add more calories...i was getting around 800 but I think I've dropped again...i also try to eat like 5 small meals ...one of my faults and probably the biggest is I haven't been able to get out and walk as it's been so cold here...going to take the xmas tree down so I have room for my exercise bike for now ....it is frustrating seeing some of the others bigger weight loss..i try to remind myself not to compare cuz every one is different...also I'm sure I'm older than many on here....I'm 49...I've give thru cancer which eliminated me going thru menopause but I still have the hormone effects with weight gain...ugh!! I thoughT by now I would be down 40 lbs not 22! And yes I play that game with the same lb every day!

Hi... I was banded in Oct 2010 and have gone from 275 to 140. I am 5 lbs away from my goal weight, so really really close. The problem? I started feeling unwell just before Christmas, and developed a sharp pain in my left side. Went to my family doctor who did a chest X-ray. The X-ray showed mild lingual pneumonia from a poorly emptying esophagus related to gastric banding. I then went to my lap band clinic and had an emergency defill. So here's my worry: they took out too much restriction and I will regain my weight. I have a 10cc band, which according to the clinic's records had 11.75 cc (lap band surgeon thought this was questionable, he thought the real number was in the 9's). I am now at 8.75 cc, so they took out 3 whole ccs. I'm really really worried about weight gain. I had no input into the amount of cc's removed, this was non-negotiable with the nurse who did the defill. Some history: the lapband clinic has been trying to get me to have a defill for some time and I've always resisted, because (a) the restriction didn't bother me, and ( it was working. Now they "won", and I'm very concerned that the weight I've lost will come back. I'm looking for any wisdom from the lapband "tribe". Please share your experiences. Many thanks

I feel like surgery puts us at our most vulnerable. You know how folks say that weight gain is an outward representation of an inner issue... the surgery goes RIGHT TO THE CORE of that issue and forces us to work on it. I feel way more exposed right now than I did before surgery. Losing my safe cocoon of fat where I became invisible is almost terrifying to me. How long is your husband deployed? He might not recognize you when he comes back.

I went through this right up to the surgery. Right as I was about to get my Versed before being wheeled into the OR, I said I needed to use the bathroom. I remember staring in the mirror and saying to myself, "What the bleep are you doing to yourself?" I remember asking my husband up to the night before surgery, "Am I making a mistake? Am I jumping the gun? Can I do this on my own? I know how to lose weight." This was all true. I know how to lose weight and I can do a pretty damn good job of it. The question is....do I know how to keep it off? The answer is a resounding NO. I can't. I gain every pound I lose, plus some. I remember in college when I hit my high weight of 185. I was devastated. Lost some weight, then gained it back - all the way to my new high weight of 244. Freaked out about that. Lost weight, gained it all back to 262. Freaked out again. Lost weight, gained it all back up to 298. I saw the pattern and it wasn't pretty. I'm only 34 years old. At this rate, I'd be 400lbs before 40. I realized that I needed help. Not a magic solution, but a tool to help me. I know how to eat well. I know how to exercise. I just need help with portion control and being a bit smarter about my priorities in food selection. The sleeve help keeps me on track for those things. I think right now we're still in shock about what we did. My husband has said multiple times that he can't believe I did it. Not because he didn't think I would or could - but because it is a major major step. I don't believe I did it either. However, as time goes by and I start to take baby steps into my new post-sleeve life, I realize that it isn't so bad. My old habits were doing me no favors, and I can still live my life - with a few adaptations. Pretty soon, the old way of life will be a distant memory and very much a thing of the past - which means there will be nothing to miss. You're going to be ok. Once things are more "normal" and less restricted, I think you're going to settle in just fine.

I had my lap band done in 2008. Since then I have lost weight, gained it back, lost weight again, and then gained it all back again. I believe the weight loss that I have experienced has been due to me starving myself, not to the band. Starving myself is not sustainable and as soon as I start to eat regularly again, I gain about 30 pounds. I am currently at my highest weight (even pre-band. I was banded at 202 lbs) 206 lbs. I have had some trouble with my band. I can only be filled about half-way before I have trouble getting food down. My band doesn't have much liquid in it and it causes me to vomit/pb frequently. Right now I still vomit a few times a week even though my band isn't filled much. Food gets stuck daily for me. I used to have terrible guilt feeling that I had failed my band. Everyone knew I had the band done, so why hadn't I been able to lose a substaintial amount of weight and keep it off? Why was I such a failure? Well, after doing some research, I have come to the conclusion that I haven't failed the band, THE BAND HAS FAILED ME!!! Surgeons are starting to find that the band isn't as successful as they thought it would be. Many people are having their bands revised to the gastric sleeve and some RNY gastric bypass. My surgeon is at the top of the field, a famous weight loss surgeon. His staff is nice to me, but they make me feel guily when I go in. I need to eat less and less, they say. My surgeon recommends for me to eat 900 calories a day. 900 calories! This is madness!!! I am now in the process of contancting a different surgeon about gastric bypass and gastric sleeve. I have severe obstructive sleep apnea, high LDL cholesterol, and have stopped menstruating (I'm only 32). I believe my weight is a contributing factor in these issues. Ladies, I know that some of you feel you could have done better. You feel you could have followed more of the rules, eaten less, snacked less, starved yourself, whatever. But, I want you to seriously consider this idea that maybe the band isn't all it is cracked up to be. Maybe it works for some and not for others. Maybe, the band has failed you!

This foolish behavior deserves consequences. Maybe not as bad as a life threatening leak, but something...I suppose I can be happy knowing that if they are so silly as to push their program directly after surgery, despite the horrific medical consequences they could face, I should be at least happy knowing they weren't committed enough and they will likely be back in two years whining about their weight gains. Really, you ripped out most of your stomach and now you want to see if you can pop the dang thing because you feel you are immune to consequences. Smart...very smart! Edited to reflect a grumpy post in the middle of the night

I am 6 months post op and have to have gallbladder surgery. Has anyone else have this issue if so, did you experience any weight gain? I am 58 pounds down and don't want all of my hard work to go to waste.

You don't have much willpower because there is no such thing. We make a choice and we stick to it or we don't. We must focus on Protein and foods that will nurture our bodies, fuel our engines. There are no magic words or techniques that we can give you to make you decide to do it the right way. Get your protein in. Stay hydrated. Our sleeve only hold 4-6oz of anything....fill it with good things. Grazing = weight gain. Decide to stop doing it.

I feel the same. My sex life diminished proportionately with my weight gain, and I'm so looking forward to feeling sexy again. Fortunately I don't have to worry about periods (had a hysterectomy years ago) and from what I understand from talking to other sleevers, hormones that are stored in your fat are being released into your blood stream at a higher than normal level with the rapid weight loss, which is why all the out of the ordinary periods. I wonder if anybody else has heard this?? I didn't ask my doctor if it was true cause its not going to effect me like that but I thought it was interesting.

Whew - you're going to have a tough time but try not to stress too much. It's hard enough to eat in the beginning months post op, and to add in a pregnancy (and the worries about eating for the baby) I'm sure can't help. Every single person and every single pregnancy is different. This time around the morning sickness was awful for me. It lasted until about four months, went away for just over a month and is back now that I'm in the third trimester. That's just me pregnant with this baby. I actually had an easier twin pregnancy than this single baby! You probably cannot eat much at a time. If you aren't already, you really, really need to find a Protein shake that you like that doesn't cause you problems. Dairy can be an issue, so if you don't like your shakes try mixing them with something else. Because you're expecting, I wouldn't go for the lowest carb and calorie shake you can find. Something I'd normally consider a splurge, like the BSN Syntha-6 brand, would be IDEAL for you right now. The higher calories are something you need because you're growing a baby and you're not going to be eating many of your calories. I'd pair a scoop of the Syntha-6 with a scoop or two of the Syntrax unflavored for a protein heavy shake that will help boost your caloric intake. I'd drink at least one a day, but I might try for two if you're really having trouble eating. You need to eat slowly, chew thoroughly and try a variety of different foods. Certain things do tend to feel like they get stuck in the beginning when your new sleeve is still swollen. I'm not saying you should live on mushies but you need to pace yourself and take it easy. eggs are a huge issue for a lot of people around this time, so if you find they aren't going down well, back off of them and try them again each week until you can tolerate them. It's the opposite of typical sleeve eating, but I found that the only thing I could really keep down with morning sickness were carbs. Small, thin slices of toast, crackers, grits, oatmeal, etc. You may find the same. The reality is that your priority just shifted - now your goal isn't to lose weight. Your priority now should be to heal and eat enough to have a healthy baby. You WILL lose this weight afterward. There isn't a magic window with the sleeve, and you'll find that your restriction is very much still there once baby arrives. I've gone back and forth during this pregnancy with restriction. At times I'm amazed because I can eat an entire sandwich and other times I can only manage a few bites before I'm stuffed. Oh, and watch that acid. I was off my PPI for years and now I'm back on it again. I could have sworn I was starving to death around the clock...and you'd think as a sleeve vet I'd know better ('specially since I'm always reminding people that are newly sleeved to take their PPI) but as soon as I hopped back on my omeprazole I felt so much relief. So make sure your OB knows you need a PPI and make sure you're taking one. As soon as I got on mine again the daily heartburn and around the clock stomach rumbling went away. Good luck to you, and to all the ladies here expecting! Oh, and since this is a thread about weight gain, I'm currently 27 weeks and I'm up 20 pounds. I'm not thrilled but I'm not worried, either. Compared to my past pregnancy gains (97 pounds for one girl, nearly 80 pounds with twins) I'm kicking butt this time around. ~Cheri

Symptoms of Hashimoto's Disease: Fatigue and sluggishness Increased sensitivity to cold Constipation Pale, dry skin A puffy face Hoarse voice An elevated blood cholesterol level Unexplained weight gain — occurring infrequently and rarely exceeding 10 to 20 pounds, most of which is Fluid Muscle aches, tenderness and stiffness, especially in your shoulders and hips Pain and stiffness in your joints and swelling in your knees or the small joints in your hands and feet Muscle weakness, especially in your lower extremities Excessive or prolonged menstrual bleeding (menorrhagia) Depression

Well, I love sugar and carbs, that is where my weight gain came from. This is horrible, but I'm going to put it out there, but it was nothing for me to eat an entire cherry/chocolate/you name it pie by myself in a day. I was getting tired of buying bigger clothes and continuing on this downward spiral. I'm not even that old yet, but felt like I was 80. Years of in dabbling in raw foods, optifast, weight watchers, so on and so on, I finally decided it's time to do this and I did. My insurance did not pay for it, so I did and really want this to come up with this big chunk of change. The first few days of liquids are rough and personally I went through withdrawal, I was not a happy person without my sugar and carbs, but I powered through and here I am almost 6 months out and 69lbs down and could not feel better. I'm smiling a lot more and am happy for a change in a long time. I too got in the bad habit of drive thrus, I'm too tired to cook, it's too late, blah, blah, blah. But now, I want to cook and find it hard to eat at drive thrus. I'm not saying lap band is a super miracle, but it sure as hel* did something to me to get away from those sugars and carbs and the cravings have calmed down big time. Just giving you another perspective on things. I would make a goal for yourself to do the liquids for a week, instead of just a day and make yourself do it. Read success stories on here, whatever works for you to keep you motivated, or just shoot me an email, I'm on here every day and I can check on you and then you have some accountability. Then see how you feel after that week.

hmm, my doctor told me small amounts are ok. Yes coffee is a diuretic and a stimulant, but usually it causes me to not be hungry after drinking, but I haven't had any since my surgery since I am only a couple weeks out. I was told skim latte's are fine too and to add only sugar free flavoring or add chocolate protein powder to it for a mocha type coffee. I will be giving it a try around the 2 month mark. I guess everyone's surgeon is different. I do think some may worry if you drink in excess due to empty calories and possible weight gain because of that?

Studies have shown that nutrition plays a bigger part (like 85%) in actual weight loss than exercise...so, yes, you absolutely can lose weight without exercising. But in my own experience, I've discovered that my exercise habits have a direct impact on my nutrition habits!!! There is also a mental aspect for those of us who have struggles with weight loss/weight gain. Exercise is as good for your mental health as it is for you physically!!! I take one day off each week for rest and on those days, I don't have as much energy and I just feel kinda "blah" mentally.

I agree with the above poster. You feel so much better with exercise everyday. One of the biggest lessons learned in my weight loss was how much I needed the exercise. Once I got out and started walking I noticed all these older people out walking and realized that in order to lead a long healthy life you need to be active. My weight gain had more to do with being less active than it did with what I put in my mouth. Yes, you can lose weight without exercise but the key will be can you keep it off without exercise. I personally don't think it's possible unless you eat next to nothing.