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Hi, All, I had the ESG on November 15, 2017. I haven't posted in a really long time, so I thought a quick update might be due. At this point, I haven't lost any additional weight since my last post. My spring and summer were full of parties, guests, business and school and church functions where I was surrounded by incredible food, drink at every turn. I must say, I am pleased that my weight stays in the same range (+-2 lbs) and I am able to eat much less. I learned that it is critically important to be mindful of the quantity of food. It is too easy to take one bite too many and it only becomes clear that it was one too many after the fact. I have lost only about 15% of my original pre-op weight, so I am disappointed that I haven't lost more than that, but I have been able to live like I have always dreamed...I can start my day with a small breakfast and then I am not hungry until many hours later. I can order an appetizer and be satisfied. I do regret that I did not go with the more invasive surgery. Ghrelin is still an issue for me and I learned that sometimes reflux can give a similar feeling to hunger, so I need to remember to take my antacid meds. As for the Ghrelin, I still take contrave and the combination of the ESG and the med seems to keep me really steady. So, I was also afraid that drinking alcohol would be a problem, but it is not at all. Well, one needs to nurse the glass of wine or drink for quite a while longer than normal, but alcohol does not hit me like a ton of bricks (usually.) A good vitamin is an absolute necessity. I have been using Secretagogue Gold (recommended by my Hippie-doctor (integrative med md)). If I don't take an easily digestible multi-vitamin, I have started to get nighttime leg cramps (and I am an absolute baby about them--screaming, dramatic:) As long as I take a good vitamin, I am fine. I had to have foot surgery 6 weeks after my ESG and so I really stopped exercising until the past few weeks. I wasn't able to walk without pain until this summer, so I had to start back slowly and have just started jogging on the treadmill again. Maybe this will help me get off of this weight plane. My sister had surgery the same day and has not had as easy of a time as I have. She is also stuck at the same weight and had to have emergency gall bladder surgery a few weeks ago. I think that was the source of a lot of her issues. She was having gall bladder attacks and thought that it was related to the ESG, but it was not--just a bunch of gall stones. She is much better now, although she is also stuck at the same weight as I am..(..sisters, sigh) She spent a lot more time on the phone with the nutritionist trying to figure out why her weight had stalled...too much food? not enough food? too many carbs? not enough? I just keep reminding her that she hasn't gained any weight (not even after ice cream and other treats.) So, was it worth it? $10K to lose ~30lbs? Well, yes, if this means that this is the new normal, which it seems to be. I can live like this. Eating smaller portions, no panic when I realize that there aren't any low carb items on a menu. I eat less, have less hunger and less body weight. Yes, this was worth it, but I do think that the laparoscopic gastric sleeve would have been a better choice for me in the long run. My 1 year anniversary is just 9 weeks away and I would like to have more weight off by then, but I am really going to have to focus to get that done. I'll let you all know how it goes. Have a good fall! I will check back in around mid November.

I am going to keep this short (If I can!); I’m English and English people tend to keep things to ourselves with strangers, especially if it is a point of failure so I am nervous about posting this. I had a gastric sleeve on 23rd July 2015, so 2 years and 7 months ago and it has been easy peasy with regards to food. I used to think that I couldn’t really support other people as I never had issues with the operation, or the months that followed nor with the huge weight loss. I felt fantastic, healthy and was going to the gym 3 or 4 times a week, swimming a couple or more times a week and walking my lovely Labrador a couple of hours a day. I could walk up steep mountains and still have breath to talk non-stop. Life was great. My second son got married at the end of Feb 2016 and I had a glass of champagne and a couple of small glasses of wine at the reception. The three drinks lasted 9 hours. For the rest of the year the drinks increased. I would have a couple of glasses of wine at the weekends. Then after a rough day at work (I have a very stressful job) I would have maybe one gin and tonic. That became a glass of wine and a gin and tonic and so on. I would have odd weeks where I didn’t drink at all so I never really saw it as an issue. I enjoyed it but did not really crave it. Jump to January 2017 and I had skin surgery. Tummy tuck lower and upper eyelids and a breast reduction and uplift. The first four weeks were perfect and then I started having the wounds split on my tummy and breasts. I was very ill and had to go to the hospital every day to have the wounds redressed and packed (they were black and absolutely stank at this point) initially I had three open wounds and as one started healing another would appear. In all I had 17 wounds along the scars and had to have additional surgery in June to clean 2 of them out and re-stitch them. In 2017 I had a total of 6 months off work because of this and slept in a riser recliner for 4 months. So, I started drinking heavily around May last year (that’s not an excuse its just the reality). I did it in secret, I hid bottles all over the house where I knew my husband or sons wouldn’t go (like the washing machine lol). I hid them in wellington boots, in old handbags, in my laptop workbag, in the garden, the car, behind furniture. I tried a few times to stop but just couldn’t. I spoke to a gentleman on here who had the same issue in the past, he said he had never posted about it because it would just get backlash and I felt the same. I told three close friends, I stopped drinking and lasted 3 weeks then started to drink more than before. I would get alcohol at different shops daily, so they wouldn’t judge me! Once I bought two ltr bottles of gin and the woman behind the counter said, “watch out, you will become an alcoholic with all that”. I nearly burst out crying, I felt so ashamed. It got worse and worse then a lot worse. I was drinking 4 pints of beer and half a ltr of gin a day. I functioned well in my job and no one suspected a thing. Even the friends I had told before didn’t know I was back on the booze. Then one night, I was driving home from work, stopped to buy some gin, and thought I’d get some ready made up ones too which come in cans. I drank 3 whilst I was driving home. That was my wake up call. Im an ex policewoman and have been to many accidents where the drivers have been drunk and I was ashamed of myself. I saw the Doctor the next morning and whilst I was telling him what I had been doing and sobbing my heart out, I had a panic attack and ended up passing out. He was so good with me and signed me off work for a month and referred me to a drink and drug support group. He then put me on a 10 day detox at home where I have to take a ton of tablets. This is my last day. Tomorrow I only have to take 6 tablets a day of one medication and the other one has stopped. I have my first appointment next week with the support group. Once they have seen me I will again change medication and will need to stay on that between 6-12 months. I am so lucky to have had the guts to see the GP and tell him the truth. I feel so embarrassed and ashamed. Throughout all of this I have kept to my eating plan, stuck to drinking 64oz water, and taken all my vitamins. I cant believe that I have had the control over that yet not over the alcohol. On the day I saw the GP my Blood Pressure was 202/147 so I have to go every day and its now normal. I am now 176llb so have put 40llbs on, not through food but through drinking calories. I haven’t read through this after typing it as I might just lose nerve and delete the lot so if it sounds odd or the grammar is poor please excuse that. I am still having withdrawal symptoms (just the tremors) but at least I wake up in the mornings and can remember what I did the night before. I know people here who have a glass of wine every night after work. Some people can, I obviously can’t. Just be careful. Please.

You really can only stretch your tummy so much. If you eat more solid food, it will fill up quickly. At over a year out, I sitll max out at 4 oz. of solid Protein, and generally am very full with 3 oz. At first, I could only eat 1 oz. of solid protein with nothing else. Now I can enjoy a small amount of vegtables and a starch with my protein. For now, I think the important thing is to concentrate on making healthy food choices, getting enough protein and Fluid every day and avoiding eating so fast or so much that you feel ill. In my opinion, the thing to watch for as time goes by is eating things that go down easy, such as chips, popcorn, candy, ice cream, cakes and Cookies, etc. Or drinking a lot of calories, such as milk shakes, coffee drinks, or sweet alcoholic drinks. For example, I was in Starbucks on vacation. I could have chose the pumpkin Spice Latte and a slice of the Pumpkin Bread for a total of 630 and 17 grams of protein. Instead, I got my usual Soy Latte and an oatmeal, which I ate with Splenda, saving the nuts and dried fruits for a salad another day. 270 and 12 grams of protein. (I was excited to see they had Greek Yogurt Parfait till i read the nutrition info - 6 grams of protein and 270 calories! - it pays to read the label!) I do enjoy treats, but I pace myself. They are treats now, not everyday all I can eat extravaganzas. It's working for me. I've maintained my weight since March. Yeah Sleeve! Lynda

You can try "lifestyle remedies" like elevating the head of your bed on bricks or whatever, not eating for the 4 hours before bed, avoiding foods that may be a trigger (tomatoes, greasy food, spicy food, alcohol, chocolate, peppermint, etc). If none of this works (there are other lifestyle remedies that I may have forgotten - try googling) you may need a revision to bypass unfortunately. It's a very common problem. Good luck!

@LumpySpacePrincess@LumpySpacePrincess that is an eloquent and empathetic view- thank you. I don't watch tv much and avoid "trainwreck reality" shows like the plague so haven't seen this but your response reasonated. My dad was a mean, volatile alcoholic, but I am quite sure he didn't want that life. I am quite sure"Penny" would love to have a normal full life but she doesn't even know what that looks like. It doesn't excuse or enable the behavior but empathy allows us to care about the human while hating the behavior.

@FINFAN3DP yeah it did work. I lost about 90 lbs in about 1 year and a half.. but I used to go to the gym every day almost. Then I started working so my eating schedule and habits changed... but what really I think hurt me was the alcohol.. I love wine.

Good point. I recently discovered myself that drinking alcohol seems to coincide with me eating more.

Alcohol is really dehydrating. Make it difficult on the band because the body retains fluids.

Mine was quite easy and I only had to pay my ins. co-pay of $20. I spent about 45 min. Telling the Dr. about what diets I had been on in the past, how I normally eat, if I or my family had drug or alcohol issues, when I first start gaining weight, what my expectations were after sx, If I had a support network, those sort of things. Most of all just be open and honest, the only person that would get hurt if you don't tell the truth is you. They just want to make sure that you are prepared for it mentally. I also think they want to know if you are likely to have other issues in place of food ( ie drugs, alcohol, shopping, etc).

In my case I have to watch what I eat in order to loose weight even with the band. I do not eat junk food at all. I exercise daily and really work hard to loose the weight. My weakness is not chips, candy, Cookies or cake. My weakness is margaritas. If I could just not give into my cravings for margaritas I would have it made. Even though I do cheat with alcohol, I am still loosing weight pretty steadily. I recommend that you start keeping a food journal. There are several places online that you can do this or just simply buy yourself a small note pad and start keeping track of your food and Water intake. By doing this you will be able to look back and reference what you have been eating and figure out why you are not loosing. I eat between 1000-1200 calories each day. If I have a margarita or two, I try and calculate them into my daily calorie intake. But I always focus on getting my 70 grams of Protein and at least 64 oz of water each day. Without my protein I lack the energy for my workouts. I'm sure that if you check with your surgeon's office or meet with a nutritionist you can get a specific diet plan to follow that will aid in your weight loss effort. Good luck to you!

It's me again. Neossa. I am 6 month post op MGB. After 3 month of my surgery I had small amount of alcohol and since then...I realized that I can drink decent amount of alcohol after my surgery. Before surgery I was drinking beer like a fish. After surgery I can even drink 2 beer at a time or 2 glass of wine. I am not drinking daily...but once a week. Over the weekend. I wonder my capacity of drinking after MGB. When I google stuff ppl says....they can't drink after surgery or they get high faster. But I don't feel like I am higher or tipsy. I KNOW its not good. and I am still half way to my weight loss journey. I need advise or a conversation for alcohol after Mini Gastric Bypass. Should I drink ( Off course NO) or I can occasionally drink 1 glass of alcohol. Thank you all in advance who can comment on it.

I eat out all the time w/ hubby or alone. I never seem to have any issues ordering. if I'm w/ hubby, we split a meal, I ask for my own plate. He lets me choose what were gonna eat, based on what i find that has the most Protein. i too find that the appetizers are not much in protein and are often deep fried. (I try to stay away from all fried foods and foods w/ sauces) If i'm out shopping and need to eat something, I often stop in at a taco place and get a chicken soft taco, ask for a fork, throw out the shell and just eat the inside. (it's like a cheap chicken salad) and I'm full when I'm done. or, if there is a subway in the area, i'll just ask for some tuna. Cost's me either $1.00 or $1.50 and that's a cheap lunch too, and I'm full from that lil cup of tuna. i try not to pay for things i'm not going to eat, so just ask and they will often accomodate you. When i was at a casino at the coast recently....i went to the restaurant and asked for a small side order of crab. I told them about 1/4 cup was all i wanted. They charged me $3.00 for the side of crab and it was loaded w/ protein. see what I mean....be creative....it works. you will lose the most amount of weight in your 1st 6 months.......so I am staying away from most all foods like sauces, potatoes, candy, chips, alcohol, beads, Pasta, (carbs in general) trying to mostly only eat protein foods. Best of luck to you.... It's not hard at all, you just need to be creative sometimes. just because it comes that way, you don't have to eat it. I also have a "medical card" issued from my surgon, allowing me to order 'child portions" from a menu. I've only had to pull it out once when they told me that was intended for children under 12.......lol ...... it worked!

I'm seven months out and have had alcohol several times. My surgeon said no alcohol for 6 months, but I had a few glasses of wine at a party at 5 months out. I don't drink on a regular basis, and never more than a few glasses of wine, but I haven't noticed it has a differnet affect than before surgery.

Karey, where did you stay in DR? We stayed at the Riu Palace in Punta Cana for a week last June. I'm not sure I'd want to do an all-inclusive with the band, though. It tends to encourage me to drink too much, and I'm finding that alcohol has a much stronger effect on me these days! Congrats for maintaining! Tami

Phyl, so sorry the restraunt couldn't make special arrangements for us bariatric patrons, so it's their loss. I wonder if they have carry out???? If she was nasty about it, I'd let her know that you'll be letting others in on the fact that they shouldn't go there if they expect to get what they pay for. Our Golden Corral is like that. A nurse in my doc office had bypass 2 years ago, and she went there and tried to order a childs dinner buffet. They refused, so she said she'd be letting all of her patients at the office know about it. Now, they probably won't be going out of business any time soon, but we did go there to eat about 3 to 4 times a year and if you multiply that times the number of patients that have ate there in recent years, and their families, then you can see they are losing out on some business. I believe as the trend grows here in the US for bariatric surgeries, that more and more food joints will realize that people are just trying to control their portions, and they'll have to bend the rules to keep up with the trend. Persistance is the key. AppleBlossom, inline skating sounds like fun, but we don't really have anywhere here to do it. I bed you'll have some killer calf muscles after all that!! Marcy, you're so funny. You've spent all this time raising those chickens, and can't even enjoy them. Oh well, you did get all the crab meat, which I'm still jealous of!! I'm starting to think you were a little "wild" in your pre-kids days with your comments about doing anything once!! Shannon, that's a tough decision to make about the fill. I'd question myself as to whether or not I was getting all my protein and liquids in each day before making a decision. If your absolutely sure you're getting all the requirements in from your doctor, then it seems it may be time for a fill. Or, you could try to up the numbers. If your doc requires 60 grams of protein a day, try to up it to 70 to see if it makes a difference. For myself, I'm to get in 55 to 70 a day, but the more protein I eat, the fuller I stay. I can eat a 20 gram south beach bar and be hungry 2 hours later, but if I mix a shake with a scoop and a half of powder, which is 35 grams, I'm full for 3 1/2 to 4 hours. It may not hurt to try and start to figure out where your own sweet spot is, and how many grams it takes to keep you full for 3 to 4 hours. It may help you out with not needing a fill as often. Chim, I'm having an ok day. It's another hot one here, but relief may be in the forcast for Thursday. At least I have one night of excercise behind me already this week, and tomorrow I'm going to a friends to swim for a few hours with Hunter and DH, so that will be another night. Tonight is my night off, maybe, have to converse with DH on this one!! Kathy, your trip is getting closer. I bet you're getting excited!!! Jeanie, how's your new students?? I bet you come and are totally exhausted. I've only got one to deal with, and I can't imagine a classroom full of them!! Dini, sounds like you're enjoying your time off. I bet Annafrancesca is getting spoiled rotten with her grandma right now!! Sunny, where have you been lady. Haven't heard from you since the chicken salad!! Hope you're ok and it didnt make you sick or something!! Cazulay, so the food got the best of you for a day. It happens, but today is a new day. Wipe your slate clean, and your conscious, and go right back at it. This has got to be a worse addiction than drugs, or alcohol, or tobacco, because we have to eat to live. But you'll be ok, we all will. Practice makes perfect, one day at a time!!!!

Hey Everybody, Cals today very good until I got to the bar. Then...... like Phyl says.... there was this Vodka......and..... Well I felt the need, NEED, to drink. I wasn't wasting cals. on fancy drinks so I downed the vodka straight. Lemon drops, you dip a lemon in sugar, down the vodka, then bite the lemon. Did you know that Vodka taste exactly like rubbing alcohol? Yuck! Cals today not too good, not horrendous, but not too good. OMG, I just glanced at the TV, which I am not watching, and Tom Cruise sliced someones head open straight down the front. DH's kind of movie, YUCK!

Okay...forgot....who was talking a couple days about mushroom pie and did I miss what exactly that was? I think it was mushroom pie. Something like that. Fill needle....I've got one in a package in case of absolute emergency, but on Monday I'll just grab that red bag in the drs room when she isn't looking. My appointment is in the afternoon so there are bound to be a bunch in it from the day. She won't miss it, and we can put the needles through the dishwasher. If we fill with Rum, the alcohol will kill any germs anyways, so who would care if they were sterile?

Hi all - I am happy to report an "official" two pound loss, but now the even better part of that is that I am not obsessing about it. I just kept up the exercise and writing down everything that goes into my mouth. That seems to be the key for me. I'm going to NYC for a week starting tomorrow. Robin you are absolutely right, I am like and alcoholic. I can't eat like I used to, but could easily stuff the wrong stuff in. I also think there has to be a balance - for me, it can't be about being "perfect." I'll flunk! Woofay - so sorry to hear about your loss. It is really hard to not revert back to the comfort things we have used all our lives. Could you make something for his memory? I'm thinking that busy hands help me, may they would help you. Heart mending takes time. Maybe plant a tree or a flower bed in his memory. Hugs to a special you! Drews - thanks for filling us in on that group. It is fun to enjoy outdoor concerts in the summer, but is it the best place to talk? How's the knee? Have a good week, I'll probably be able to email anyway. It is good to stay in touch. Hugs,

Adjustments - for those of you who didn't want to click on the link: How to Tell When You Are Perfectly Adjusted You are losing 1-2 pounds per week. If you are not losing 1-2 pounds per week: A. You may need an eating adjustment 1. Are you eating 60 grams of protein a day 2. Are you eating 25 grams of fiber 3. Are you avoiding all liquid calories a. Soup can be sign of “soft calorie syndrome” b. Alcohol contains a lot of calories – 7 calories per gram (1) It’s also a stomach irritant c. Fruit juice is just sugar water 4. Are you making healthy food choices from a wide variety of foods? a. Are you avoiding soft foods b. You can’t just eat what’s easy c. Cheese is glorified fat 5. Are you drinking 6-8 glasses of water a day between meals 6. Are you eating too much junk a. Chips, chocolate, nuts, ice cream, cookies and other highly processed junk foods are too calorically dense to be regular parts of a healthy diet. But don’t avoid them completely to the point where you feel deprived. b. Stay out of fast food places 7. Are you getting in two servings of calcium daily 8. Do you always eat the protein first 9. Then the vegetables or fruits a. Five servings a day b. Potatoes are NOT a vegetable 10. Is your portion size appropriate? a. Meat or fish (1) 3 ounces – the size of a deck of cards b. Vegetables (1) ½ cup – the size of your fist c. Starch (1) If you eat the protein and the vegetables first you don’t need much (2) Avoid: rice, potatoes, pasta 11. You might try avoiding artificial sweeteners a. Some people think that artificial sweeteners stimulate the appetite b. They are HUNDREDS of times sweeter than sugar c. They teach you to like things too sweet d. There is no evidence that people who use them are any thinner than people who don’t 12. Avoid most diet foods a. Real food usually tastes better b. Real food is more satisfying than low calorie substitutes c. When you are only eating a tiny bit the caloric savings is not that great (1) Use a teaspoon of real butter instead of a tablespoon of diet margarine (2) The body has no way to break down artificial fats a. They may go into permanent storage b. Some people think liposuction is the only way to remove hydrolyzed fats from the body B. You may need a behavior adjustment 1. Are you eating only when you are hungry? a. If you’re not sure drink 8 ounces of water and wait. 2. Are you eating three meals a day? a. With maybe 1 or 2 small snacks 3. Are you sitting down to eat? 4. Are you eating consciously? a. No distractions, turn off the TV, put the book or newspaper away, pay attention to your food and your companions 5. Are you eating slowly? a. Put the fork down between bites b. Take 20 to 30 minutes to finish a meal c. Taking longer might cause the pouch to begin emptying 6. Are you taking small bites? a. Tiny spoon, chopsticks, cocktail fork 7. Are you chewing well? 8. Are you drinking with your meals or too soon after your meals? a. Practice water loading between meals b. You won’t be thirsty if you are well hydrated before the meal 9. Are you stopping at the first sign of fullness? a. Sometimes it’s a whisper: not hungry, had enough b. Hard stop versus soft stop 10. Do not eat between meals. Stop grazing. 11. Do not eat when you are not hungry C. You may need an activity adjustment 1. Are you getting in 30 minutes of physical activity at least 3 times a week? a. Over and above what you would do in the usual course of your day b. Could you make it 4 or 5 times a week? c. Could you make it 45 or 60 minutes? 2. Are you taking advantage of opportunities to increase your physical activity? a. Taking the stairs instead of the elevators or escalators b. Walking on the escalators instead of riding c. Parking your car further away from the entrance d. Getting out of the car instead of using the drive through e. Getting off the bus one stop before your destination f. Washing you car by hand instead of the car wash g. Playing with your kids D. You may need an attitude adjustment 1. Are you committed to your weight loss journey? 2. Are you totally honest with yourself about how much you are eating and exercising? a. Log your food and activity on ww.fitday.com for 3 days 3. Are you using food inappropriately to deal with emotional issues? a. Have you identified what the emotions are that drive your eating? b. Can you think of more appropriate ways to deal with those emotions? c. Are you willing to seek help from a qualified counselor? 4. Are you attending and participating in support group meetings? 5. Have you drummed up some support from your family and friends? 6. Have you dealt with saboteurs realistically? 7. Do you have realistic expectations about the weight loss journey? 8. Are you still obsessing about food, weight, dieting, eating? a. Obsessive – compulsive thoughts (1) Obsess about something else b. Perfectionism (1) All or none, black and white thinking c. Patience with the pace of healthy weight loss 9. Are you acknowledging your successes with non-food rewards? 10. Have you learned how to take a compliment? 11. Are you giving up diet mentality? a. Stop weighing yourself several times a day or every day b. Stop dieting c. Stop depriving yourself d. Stop defining food as “good” and “bad” e. Stop rewarding and punishing yourself with food 12. How do you feel about all the changes taking place? E. You may need a band adjustment 1. You feel like you are making healthy food choices in appropriate portion sizes but getting hungry between meals? 2. You can still eat white bread, fibrous vegetables and large portions. 3. You are having to struggle to lose 4. You are gaining weight in spite of eating right, exercising and having a good mind set. F. You may need your band loosened 1. There are times when you can’t get fluids down 2. You are vomiting too much a. How much is too much? 3. Do you have frequent reflux or heartburn at night? a. Do not lie flat or bend over soon after eating b. Do not eat late at night or just before bedtime c. Rinse your pouch with a glass or water an hour before bedtime d. Certain foods or drinks are more likely to cause reflux: (1) Rich, spicy, fatty and fried foods (2) Chocolate (3) Caffeine (4) Alcohol (5) Some fruits and vegetables a. Oranges, lemons, tomatoes, peppers (6) Peppermint a. Baking soda toothpaste (7) Carbonated drinks e. Eat slowly and do not eat big meals f. If you smoke, quit smoking g. Reduce stress h. Exercise promotes digestion i. Raise the head of your bed j. Wear loose fitting clothing around your waist k. Stress increases reflux l. Take estrogen containing medications in the morning m. Avoid aspirin, Aleve and ibuprofen at bedtime (1) Tylenol is OK n. Take an antacid (Pepcid complete) before retiring o. Try other over-the-counter heartburn medications p. See your health care provider 4. See your health care provider immediately (or call 911) if a. You have a squeezing, tightness or heaviness in your chest, especially if the discomfort spreads to your shoulder, arm or jaw or is accompanied by shortness of breath, sweating, irregular or fast heartbeat or nausea. These could be symptoms of a heart attack. b. If your symptoms are triggered by exercise. c. If your pain localizes to your right side, especially if you also have nausea or fever d. If you throw up vomit that looks like black sand or coffee grounds. Or if your stool is black, deep red or looks like it has tar in it. These are symptoms of bleeding and need immediate attention. (Note: Pepto-Bismol or other medications with bismuth will turn your stool black. Iron supplements can also make the stool tarry.) e. If your pain is severe This was written by Jessie H. Ahroni, Ph.D., A.R.N.P., C.D.E., B.C.-A.D.M.

You’re likely having a bad bout because of the uric acid stored in your fat being released as you lose weight. Worse is that you can’t take nsaids post surgery to reduce the inflammation. Do you take the gout medication, which reduces the amount of uric acid your body produces, everyday (can’t remember its name) ? it takes a couple of months to really work but by then you may have lost enough weight that you may not experience gout again. There’s still plenty of protein sources you can eat. You likely will be starting or about to start soft foods so look to beans, eggs, slow cook lean meats, continue with your protein shakes, yoghurt, make rolled oats on milk, etc. but check your plan to be sure. You will already doing a lot to help reduce uric acid production because of your low fat, low sugar, no alcohol diet. Contact your medical team for help to manage the pain. Hope you feel better soon.

I was confused too. Everyone kept talking about the liquid diet before sugery but my doc only has me on an "atkins type" diet for 2 weeks pre-op. I'm on a 1,200 calorie no sugar, no bread, no 'white food', no alcohol. 20-50 grams of carbs (mainly from veggies). When I asked my doc he said it was because I didn't have any co-morbidities and in overall good health. Ask your doc before changing your pre-op diet though. Good luck! I'll be going in a week before you so I'll let you know how it is!

I was very tired until a few days ago. I am not sure what changed cuz I have been keeping my protein high and 800 calorie diet the entire time. After I spent time with my family, I think it is a fat thing. I really did not feel playing the jolly fat girl-I felt more serious. One of the things I noticed is that many people in my family (who never ever drink alcohol) are addicted to food-they eat it non stop, massive portions that have nothing to do with actual hunger. Seeing this from a new perspective made me think of my family members that have died because of morbid obesity, including my 34 yr old brother. At Easter, I watched my mother (and aunt) eat and I watched their eyes-it was like a hole neither could fill-they did not taste nor enjoy a thing. They are eating to die, rather than eating to live. They asked me many questions about my surgery, but most alluded to how much of a quick fix they believed the band to be (successful bandsters know that is hogwash). They want the band, but I think they have bigger issues than the band will solve. I trolled this site for months before posting and making a decision. I think if we eat to fill some sort of hole that you cannot recognize or acknowledge you should not have this surgery-you will be very disappointed. I feel so bad for those who have had a band for a year and are frustrated that they have only lose 9-20 lbs. I do not think they understand the tool factor of the band and neither does my family. Most of my family is well over a hundred lbs overweight with many of the medical issues that accompany obesity. Although I come from an extremely supportive family for whatever I do, the first words out of their mouths was that at 75-80 lbs overweight, I was not fat enough for LB. Well I just did not want to wait till I got high blood pressure and/or diabetes and had to have parts cut off by body like my father. Anyway, this started about my observations of my own family, but from reading 1000’s of posts, I extended my observations and I think if those of us having problems with the whole “I can still eat as much as I want thing” need to check out the old timers thread-LB is a tool, a great tool and I think some people spend too much time trying to trick the band rather than use it as it is intended. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p> <o:p> PS-as I reread my response I notice it has strayed far from isabellesma-sorry. </o:p> <o:p> </o:p>

A lot of people talking about caffeine withdrawals but I don't experience them. I have given up caffeine several times and I don't see a difference, except lack of focus maybe. I was taking one caffeine pill in the afternoon, then I went back to coffee after 6 weeks. I went without coffee 6 weeks, then I slowly added it back it. Slowly because I have never had any acid issues, and I know coffee is acidic. I have never had GERD issues and I don't want to start. I drink cold brewed coffee for the lower acid content. No issues. I do limit myself to 8-12 ounces. I used to drink 24-36 ounces a day before surgery. I gave up sodas and alcohol about 3 years ago, and I only had black coffee, tea and Water. I also make an iced coffee Protein drink. I put cold brew coffee, water, unflavored protein and ice and my blender and I will have that sometimes in the late morning. I forget to eat a lot and if it is mid day and I haven't had anything to eat yet, I will do that to get my protein started for the day. It is a very nice change of pace.

Wow, it has been great reading these post, now I don't feel alone. I have 2 for you: I have been going to the same ob-gyn for years. He has saw the scales go up and down like crazy. I asked him is there anything that would help me (meaning meds) He said" sure, duct tape. It really hurts when you rip it off" Hopefully, I will like my new Ob dr. 2nd jerk, getting a pedicure, same girl that has done them for years. Was talking about Lap band, this nasty man beside me says, "just stop eating" I shouldn't have been so rude, I just smiled and said, "just stop breathing" Of course then I explained that if I was an alcoholic I could never have it again or if I was a drug addict I could never have them again, however food is required to live. Then thanked him for putting his comment into our conversation. I'm from the south so I sure he didn't realize I was being sarcastic. Why do people think this is the lazy person's way? I am only 5 days post op and it has been very painful. I didn't come out of surgery skinny. Oh well, let's keep our head up and lose the weight with this valuable tool. Good luck everybody. We are all beautiful.

Current Weight-Specific Legislation No federal laws exist to prohibit discrimination against obese individuals, and only Michigan’s civil rights legislation prohibits employment discrimination on the basis of weight at the state level (34) . The District of Columbia forbids discrimination on the basis of appearance including weight, and Santa Cruz, California includes weight in its definition of unlawful discrimination (129) . In the spring of 2000, San Francisco passed legislation to ban weight discrimination, adding weight and height to existing characteristics (such as gender, ethnicity, age, and sexual orientation) that are protected (130) . Advocates in San Francisco gained support for this legislation when a health club created a billboard with a space alien saying, "When they come, they’ll eat the fat ones first." Overall, few locations have weight-specific legislation, so most obese persons are forced to use existing human rights statutes for legal protection. In particular, overweight individuals have depended on the Rehabilitation Act (RA) of 1973 and the American Disabilities Act (ADA) of 1990 (131) . Employment discrimination cases encompass the vast majority of such actions. The RA was the first effort to prohibit federal employee discrimination against individuals with disabilities (32) . A person with a disability is one who has a physical or mental impairment that substantially limits at least one major life activity (activities such as walking, breathing, self-care, and working), has a record of such an impairment, or is perceived as having an impairment (34) (129) . The RA does not actually include obesity as a specific protected impairment (32) . The ADA expanded federal disability discrimination legislation by extending mandates to private employers, state and local employment agencies, and labor unions (23) (131) . Like the RA, the ADA protects disabled but qualified employees who can perform essential aspects of employment (131) . The Equal Employment Opportunity Commission (EEOC) implemented regulations for more flexible interpretation of ADA impairments, allowing obesity to be included in its broader definitions (129) (132) . The guidelines of the EEOC do not consider obesity alone to be an impairment. However, obesity can meet impairment definitions if one’s weight can be attributed to or results in a physiological disorder, or if a person’s weight is severe as in cases of morbid obesity (132) . Under the ADA two kinds of cases can be pursued: those involving actual disabilities, and those of perceived disabilities. An actual disability claim requires that an individual’s obesity be substantially limiting in at least one major life activity. A perceived disability occurs when one is regarded by others as having an impairment (131) . Here, the obese individual must demonstrate either an actual impairment that does not limit life activities but is perceived to be limiting by others or that there is no impairment at all but that the individual is perceived as having one. As many courts do not recognize obesity as an actual impairment, obese individuals must often use perceived impairment claims (131) . Inconsistent Rulings Although alleged discrimination is being met with lawsuits, the overall picture of cases pursued under these statutes is one of mixed results. The majority of courts have ruled that obesity, per se, is not a disability (32) . In Krein v. Marian Manor Nursing Home, for instance, an obese nurse’s aid was discharged because of her weight. The court held that her obesity was not a disability and, thus, was inadequate to qualify the plaintiff for discrimination protection (131) (133) . Similar court rulings were held for a flight attendant in Tudyman v. Southwest Airlines and for a labor worker in Civil Service Commission v. Pennsylvania Human Relations Commission, where both plaintiffs failed to show that their obesity caused, or was caused by, a condition that would qualify them for state protection (31) (37) . Later cases continue to follow this trend. In Cassista v. Community Foods Inc., an obese woman was denied a cashier/stocking position because of her weight (131) (134) . In the case of Philadelphia Electric Co. v. Pennsylvania Human Relations Commissions, an obese woman was refused employment in a customer service position due to her obesity, despite having passed pre-employment evaluation. The court ruled that her obesity did not impair her job performance and, thus, could not constitute a disability and receive protection (37) (135) . Although few cases have held that obesity on its own constitutes a disability, several court rulings have demonstrated circumstances in which obese plaintiffs have been successful. In the case of New York Division of Human Rights v. Xerox Corporation, an obese plaintiff was denied a computer programming position because her obesity made her medically unsuitable for the job, according to the company’s physician (32) (136) . The state court recognized broader definitions of disability under New York law and ruled that her obesity was an impairment as defined by Xerox’s medical staff, although she had no other medical conditions and could perform the duties of the position (32) (37) . In the case of King v. Frank, a postal worker alleged that he was fired because his supervisor perceived his obesity to be an impairment (137) . The commission ruled that because the employer perceived the worker to be substantially limited in work (one of the major life activities of the RA), he was granted protection under the RA (32) . Finally, the case of Gimello v. Agency Rent-a-Car Systems also accepted a disability claim in which the court concluded that the plaintiff’s obesity was a physical disability because he had sought medical treatment for his condition (36) . Unresolved Issues: Blame and Disability The legal issue of whether obesity is a disability has not been decided. Very obese persons or individuals whose obesity is attributed to an underlying medical condition may have the most success under the ADA (131) , but it is difficult to predict which cases will be successful. Court decisions of whether obesity is an impairment may be the result of many factors besides ADA guidelines, such as court beliefs, cultural perceptions, academic views, previous case rulings, and weight bias in judges. Inconsistent court decisions will likely continue until ambiguities in existing legislation are resolved. Under the ADA there is no standard for determining how obese a person must be for weight to be considered a disability (37) (132) . Being moderately fat will only be considered a disability if accompanied by an additional impairment, whereas obesity on its own does not meet ADA impairment definitions. Morbid obesity can meet disability requirements. Korn (138) notes that limiting the protection of the ADA to morbid obesity ignores the majority of the obese population and reinforces misperceptions that anything less than morbid obesity can be personally controlled. Courts have generally viewed overweight as voluntary and mutable and, therefore, have disqualified it as a disability (131) (138) . The ADA does not actually require a condition to be immutable or involuntary to be considered a disability (32) . The RA and ADA protect other mutable conditions like alcoholism, drug addiction, and acquired immune deficiency syndrome, all of which involve voluntary behavior (32) . Although the EEOC states that being voluntary is irrelevant in the definition of impairment, the fact that obesity is rarely considered an impairment without an underlying medical condition suggests that the EEOC sees obesity as controllable (138) . Another unsettled issue is the applicability of the perceived disability theory. Because courts are unlikely to accept obesity as an impairment, overweight persons can stand on this section of the law. Yet successfully applying this theory to obese individuals may be unlikely, because the plaintiff must prove that the employer perceived weight to be an impairment, not just that the employee was perceived to be overweight (131) . Legal pursuits are not necessarily easier for obese individuals proceeding under actual disability claims. Successfully proving that one’s condition substantially limits a major life activity does not necessarily satisfy legal requirements. Both the ADA and RA can deny protection even if one’s obesity does impair life activities (34) . The obese plaintiff must also prove that he or she can satisfy the essential functions of the position, and those who cannot perform job duties with or without reasonable accommodation will not be protected (34) . Whether it is advantageous for obesity to be considered a disability is a matter of debate. Despite the legal advantages of the disability label, considering obese persons disabled may have unwanted ramifications. For example, it may be undesirable for overweight children to consider themselves "disabled." Because weight is a disabling condition in only a minority of cases, it may be harmful to attach a disability label to a condition already severely stigmatized. A key problem is that existing statutes were not intended to protect against weight discrimination (129) . Categorizing discrimination claims under current disability definitions makes less sense than finding other strategies to fight weight discrimination. Several suggestions have proposed revising the ADA. One option may be to change definitions of disability in the ADA to explicitly include obesity (37) (138) . Doing this would allow individuals uniform protection for having limiting conditions due to obesity, although this option would also mean attaching a disability label (37) . Others have concluded that the EEOC should declare issues of voluntariness and mutability as irrelevant to decisions determining impairment and enforce that they be excluded (131) . An alternative is to create new legal options for obese employees other than the RA and ADA. Adamitis (129) suggests that the most appropriate alternatives are state and local laws for protection from weight discrimination. It may be more realistic to consider state statutes, which often provide broader coverage, than to focus on federal laws (129) . As mentioned earlier, legal cases prove only that discrimination based on weight is perceived and that legal justification for seeking relief is growing. One cannot infer that discrimination is widespread from such cases. Prevalence studies are necessary.