Oh, no... not the dreaded "End of the Road" speech (<-- Lengthy)

[NewSho 20]

It's finally happened.

I went in today for a much-needed Fill under flouro and had 2 huge disappointments. Today was a great day. I am scheduled to go a birthday celebration later (so in case I was too late to come back home and change) so I was dressed up, fluffed up and was given compliments all day.

Disappointment #1

At this office, after you check in, you're given your patient chart to carry into the examination room once it's your turn.

So of course I spent my wait time, reading my chart information. (Do you blame me? Besides it's my information, LOL.)

Well, turns out that I miscalculated my start weight from my LapBand surgery, in fact I thought I'd lost more weight than I have from that point.

Not including the weight I lost previously, that means I only lost 32# in the 10 1/2 months since my 2005 surgery. And granted, I'm packing some recent post-op swelling & Fluid retention weight since my recent December Tummy Tuck/Abdominoplasty but this was a crushing blow. :cry

OMG, I knew I was a slow loser but come on.... that's ridiculous!

Disappointment #2

Once I was called in the exam area, the nurse located my port, stuck the mini needle in and I proceeded to the X-Ray/Flouroscopy area. There my surgeon and the radiologist watched carefully as I drank the barium swallow.

Well, I drank and we all watched the screen. As the fluid progressed my surgeon began shaking his head. He asked me if I felt any restriction. I told him yes, but it was no where near the level of restriction I had a few months ago.

He shook his head again and told me that I was as full as he wanted my band to be full.

I must've looked at him blankly because he reiterated that he was not going to fill my band. He explained that I was at 2.7- nearly 2.8 and he thought that any more than that could possibly be dangerous.

Then I finally realized what he was saying and I was asking "but what am I supposed to do?" He said it probably all up to me now because he didn't think the band should be filled any more. Gee, and everyone's always telling me that I am one of his all-time favourite patients but apparently not - because he thinks I'm at the end of the road.

I was in total shock. He asked how much weight I'd lost so far (it's been a long Weight Loss road but trust me I'll spare everyone the dreary details of my journey) and I was so rattled I told him the wrong weight. So it seemed like I'd lost more than I actually had (by then, he'd already handed the chart back so he didn't have it in his hand) to which he responded that I'd lost what is projected with the band, half of my excess weight. (Actually I haven't lost as much as I need to, but I set VERY realistic goals based on his original clear, honest projections of what the band could do and not do.) He kept telling me that I looked good and that I've come a long way with the band.

It was so bad, I think he actually uttered the phrase "We're through. We're done here."

So I'm trying to keep my head and see the humour in this but the ugly reality remains: My surgeon thinks I'm at the "End of my Band Road." Not only am I nowhere near my goal, but I still can't even get my BMI under 30. I think as of today, my BMI is like 30.1 or 30.2 and I hardly call that the end of the road.

So with less restriction than I've had and with fighting the urge to eat more, I'm stuck. Before leaving, I even asked him outright that if I get the cash money or financing to pay outright - if he'd consider revising me to a Gastric Bypass. (It was always my understanding from him that if the Band didn't work out that we could always consider the RnY if things just didn't work out.) He actually said no, and that he thinks I look great. Um, yeah thanks but HEY.... I'm still a work in progress - I am absolutely convinced that I can do better. But I need the help of the band for restriction. I'm no sloth but I realise that I have a weight problem and to work on it I need the help of my tool.

I just don't know what to do... right now I'm still in shock but I think my surgeon just told me he doesn't want to be my surgeon anymore even if I get the $22K cash (which I don't have, mind you) to pay for a bypass.

So, I'm in a pickle. I really do like my surgeon (I thought he liked me too but I'll find out if I've been 'dumped' as a patient or if he just doesn't think I need a fill. I assume it's the latter, but a girl can't be too sure of anything these days.) I don't have as much restriction as I should and I'm actually pretty band-compliant. No I don't want to be PB-ing or Vomiting with every meal but I do need a bit more restriction to allow me to keep my calories restricted enough to lose the extra weight I need.

I don't know... I didn't think I was just a fiasco as a patient. I do refer to myself as a Remedial Bandster due to my slow loss but I guess I didn't realize that he has no faith that I have any potential as a patient.

Here's the irony, when I was in the waiting room, the other patients also told me how good I looked. Later, one of them said "Oh my god, you look great. I can't even believe you're not at goal. I bet the doctor is going to ask you to be in his brochure or whatever. You're like an advertisement." (In reality, I don't think I'm an ad for anything. With that 30 BMI even when he's asked if I will speak I won't even speak up when I attend my doc's seminars with my friends - I just think that would be ridiculous at my weight. Standing up at a seminar? Like I think I'm successful or something? Not even close. )

No, apparently not. Not even close to being in his brochure - I'm not sure if he wants to see me again.

I don't know what my next step is... and I appreciate you guys listening to me.

This journey is going to be even harder than I thought - and that's saying something!

Any good wishes, expressions of sympathy or kind thoughts are appreciated.

Happy band journeys to all,

"New" (and apparently not going to get to be Brand New) Sho

[banded_for_life 2]

What size band do you have? I am sorry that your doctor treated you that way...you are not through wit the band and the band is not through with you...we will figure this out. :eek:

[Parvathi 2]

Sorry to hear about this, New. I can definitely see how it would be discouraging. Perhaps its something he'll be willing to revisit later - or even get a second opinion?

Just out of curiosity, what size band do you have? I have the 4cm band and my current fill level is 3.3cc, I believe (though I may be + or - 0.1cc)...

[Alexandra 55]

New Sho, that must have been upsetting, but I'll bet it was just a case of miscommunication. Surgeon's don't "dump" bandsters as patients; I'm sure he just meant he didn't want to fill you at that point. We all do reach a point where more Fluid is NOT the answer. Being too tight is not a good thing, as I'm sure you know. Eventually the tissues above the stoma--the pouch and esophagus--will themselves stretch and lose sensation. That may be why you're not feeling restriction. If he's seeing it on the fluoroscope it must be true. The passage of time may help restore some of that sensation, but even if it doesn't adding Fluid to the band will only make it worse.

All that said, who are you to question when everyone tells you you look great? My BMI is now between 30 and 31, and I get up in front of new patient seminars all the time. I've been told I look "normal" too, and I take that as the highest possible compliment.

I'm not telling you to be finished if you don't think you are, but don't think the only way to move forward from here is by tightening your band. It's tight enough--it's taught and continues to teach you how to eat less. You will lose more weight if you are motivated to do so; the band is still in there keeping you from undoing all the marvelous progress you've made so far. That's its role, while YOURS is to find new behaviors and approaches to continue your progress.

Don't think you've been dumped. Think, rather, that your band wants you to take control for a while. And so does your surgeon. I know many doctors are concerned about bandsters who rely too much on their bands and want to be too tight, so it's not unusual really for a doctor to suggest NOT filling a band that already provides good restriction. Don't take it personally.

[lljpaisley 0]

Wow, that must have been disappointing for you. I know the feeling ( well not as bad as you) because I know my band is tight, I feel restriction, I go to the gym regularly but I don't seem to be losing weight! I am trying to figure out what to do - smaller meals at night, more intense workouts, etc. I even am considering another fill although I feel restriction daily. Good luck

[bandayed 0]

I just read your post and I'm sure you're disappointed about your appt. but I think that sometimes it's just plain hard being a bandster. I think we are all so used to thinking of ourselves as and seeing ourselves as fat/overweight /heavy that our own perceptions of how we look are often lagging the reality of how we look. Even if your #s aren't as great as you'd like them to be, they're better than they were, and people consider you an "after" that's a huge NSV!

I also noticed in your thread that you use alot of break up terminology about your relationship with your surgeon.:think Please don't take his refusal to give a fill as any kind of personal rejection. It is also NOT the end of the road....The band is a lifelong tool and as your body continues to change (even if it is slowly) your situation regarding fills will change and perhaps in 6mos (or whatever) your band will be looser and therefore your surgeon will see you for a fill. For now, try to think positively -- think of all the compliments you got yesterday and how great it felt to be gussied up -- you've come a long way and even if it's not as far as you'd like, the road don't end 'til YOU say it ends!!!!!!!!!!! Hang in there and stick with your band....after all this time banded you know how things can change day to day!!!!

[MeganA 35]

You're considering the RnY to lose your remaining 17 pounds? I think you need a reality check and to count your blessings at this point. You have been a huge weightloss success, and you have a healthy band and digestive track.

Have you thought about why you feel so frantic about this?

Megan

[kimalicious 5]

So, why would they make a band that held more fill if they didn't want the doctors to fill it to their potential? I hear of people on here with 4.5 in a 4 cc band and they are flying high and doing just fine. I would see if there was another fill doctor in your area who is not stopping you from getting the fill you need. This band doesn't work without it. You should call and ask your doctor this and once you find a better fill doctor let him know you will be taking your fill money elsewhere since he can't help you any longer.

[NewSho 20]

Well, I do appreciate everyone's words.

Honestly, I must assume that everyone knows my story (and those who don't are lucky, LOL) so I must have Sorry I thought I'd said it. I have a Inomed 4cc band - and apparently my doc thinks 2.7-2.8 of fill is all I should have. Honestly, I sensed a finality in his voice - he wasn't just being firm. And there wasn't a rudeness - although he is blunt - but a sense of, I don't know... resignation? I can't put my finger on it.

---> To BANDAYED -

[ Honestly I a VERY dry sense of humour, which was reflected in my post. Please realise: my surgeon is NEVER inappropriate - but the scenario of sitting there and having someone explain that they were through just reminded me of that. I guess it would be less inflammatory (although less humourous) to say I'd been 'fired' - a boss sitting across from the desk telling an employee that the were 'at the end of their road' with a company. So don't think there's anything to it beyond that. I was more setting a scene of how the conversation felt. It was simply a metaphor.]

I thought things would seem better if I slept on it, but I think today, it seems clear. I wasn't able to speak with his Patient Coordinator/Office Manager, but I will try to gently find out what's behind this. And sad to say, I'll find out if he's washing his hands of me as a patient, and if I should have my file transferred. (To where? Who knows. ) I don't mean to be so fatalistic - it's just in my years of knowing this man, I haven't ever seen him act this way so I don't really know how to interpret it.

If it is "The End" then I have to try to figure out what's next. If it's just "The End of Fills" then I'm still screwed. I know people (including the one in his current TV/print ads) that have fills up to 3.3 and in that range. I've had big-time health issues in the past so maybe he thinks I should be handled a lot more lightly - so that means I only get 69% of band capacity? Honestly, my mind can't get around it. Plus I know when I have good restriction and when I don't. Now my restriction is barely passable, and it doesn't seem to be getting better - what do I do if it gets worse?

----> To ALEXANDRA:

[Thank you so much for your reply, it was really heartfelt. If my calculations are correct, with my band at current levels - I'll lose maybe 1/2# to #1 a month for the next year or maybe none at all. 6 to 12# in my second year (or worse, no loss) and nowhere near goal. Oh that's sad for me - really sad. What's next down the road? From no loss, I fear the next thing would be gaining. That's one of the things that I thought set the band apart from the bypass-style methods - but I didn't realize I would only get a little past 2/3 of fill capacity before being shut down. ]

Believe me, my goals were realistic - I did NOT expect RnY results with the band and I knew I had to accept slower loss. At my projected goal my BMI would have been 28 (although if I had my preference I would have aimed for 27, and even 26 but I was trying to accept reasonable weight loss instead of outstanding weight loss) But this is ridiculous. I'm as band-knowledgable and reasonably band compliant as any other patient and goodness knows I've gone through more than any other person I know to work on my weight. This is not an exaggeration by any means, I'm just feeling a bit wiped out at the thought of finding out this is all the help I'll receive from the band.

I refuse to accept 30 BMI, but I've done all I can on my own. The lesser restriction is already starting to affect me and I have been struggling for weeks turning into months to not give in to having had less restriction.

I'm not one of these SuperWomen who can proudly proclaim all that they could do with or without the band. Nope, I'm very realistic about me - the band allows me to eat less and make better food choices. If I am restricted, I eat less. I can't imagine why some people think that's a difficult concept. It doesn't make me any less dedicated than any other Bandster but I am fully disappointed that may get no further help with my tool.

Without that help, there is very little statistical chance I'll succeed. I've tried eating right, exercising and every diets from WW, Atkins, Palm Beach, low carb to Phen-Fen (which really did work for me, actually - until it was taken off the market.) I dread returning to the scene of those diet crimes and trying them again as some kind of Failed Bandster.

As for the question of would I consider a bypass ( EEK!) to lose 17#, no that's not it. But if I'm at maximum with the band, I can only look ahead to what my next few years will be like if I no longer have a working tool to help me. I've watched my weight yo-yo back and forth for years, and I was trying to be pro-active to prevent it. I'll do my part, but I still need some help and I guess I thought the band would have given me a BIT more time to actively work on getting nearer my goal, and then maybe maintain it.

But if I honestly knew the band wasn't a good choice for me (I'm one of those people who doesn't believe it's right for everybody) then I would have had a RnY bypass. A bypass wouldn't have been my #1 choice but if it were explained to me that I can only get to BMI 30 with the band, I'd have had the RnY that I was initially approved for. I'm not proud - I need a working tool. Period. But when a surgeon tells you to your face that he won't take $22,000 to try to get your body where it should be - that's a real wake-up call. What makes me any less deserving than any other patient?

When I went out last night, I got several compliments on how I looked. But finally I told my cousin and good friend the truth - my surgeon and I are having a disagreement and he may not continue to work with me. My cousin looked at my face and knew how upsetting this was. She told me to brace myself because she knew I viewed myself as a work-in-progress.

I guess I just didn't realize that the only person who thinks I'm worth working on, is me.

I didn't think a fill to maybe 3cc was such a big issue - I was already there in the room, ready to go. Just a tiny adjustment might have given me a bit more help. I guess I feel like he thought I wasn't worth the effort. I can't quite discern whether he thinks I'm a Band Failure (hard to argue that point, but I'd try) or that I've done well enough. Neither is true - and to my mind, I'm still in the fight. I mean really, I'm walking around still 'technically' obese and if anyone thinks I invested all that time, money, effort and exertion to still be obese, then they are wrong.

As I said, I'll try to find out more clearly what this means.

But I do know that I hadn't given up on me - and I guess I'm feeling like my surgeon has.

Not ready to give up on my apparently un-recognized potential,

(Not feeling so) "New" Sho

[Desi80 1]

i think you need to calm down a bit. My surgeon always tells me she is my doctor for life. I'm sure yours still feels the say way.

That said you are close to goal, this is nothing some serious exercising can not do for you. Each person and their stomach is different so even though i have great restriction at 2.5cc, another person may not be feeling anything. Looking at your floro you seem to be having great restriction, and i think you should be glad your surgeon is trying to look out for you (because he cares) and not get to aggressive. I would try pumping up the exercise and see what comes of it.

[HeatherGurl 0]

I may have missed it somewhere... but why can't you have another fill? Did your Dr. give you a reason, like will you not be able to eat and drink only Water?

NewSho~I am pretty sure the band will help you maintain what you have lost so far. I can tell by your posts that you are very frustrated, so let it all out (like you are) that will be your best therapy. Figure out exactly what YOU want and get your butt to work accomplishing it! Anyone can do something if they put their mind to it.

Please don't give up! If you want a BMI of 25, you might have to work your ass off to get there, but if that is what YOU want, then do it.

[Alexandra 55]

You know, I'll bet all of this hand-wringing is for naught. Call the doctor and ask him why he didn't want to give you another fill. And then ask him WHEN you might be able to get one. Perhaps there is a physical problem he saw on the fluoro that is telling him to go slow. Perhaps your restriction really WAS pretty intense, and the fact that you couldn't feel it indicates a problem right there.

Call him and ask. There is no magic formula to the amount of fill anyone has--it's an individual thing. If he thinks you have maxed out for now, find out why he thinks that. And then move on.

Your "barely passable" restriction is still restriction, and if you let it guide you there is no reason at all you can't continue losing weight. It gets harder you have less to lose; the lighter you are the fewer calories are needed to maintain your weight. That's common knowledge. Tighter bands do nothing to change that reality, and it will always seem unfair to those smaller people trying to lose weight.

[NewSho 20]

Alright - some good suggestions here.

And you're right, I'm glad I vented here before I charged into the doctor's office and demanded they transfer my file to someone else since "I'm through" or whatever he meant.

Heather - my doctor didn't give me a reason. We all looked at the flouro, but if he saw something (I was concerned about having an enlarged pouch but I the last time I suspected that, I went on mostly-mushies until that sucker got back on track...) I'm lucky because I take a Rolaids or two every day for Calcium but I rarely if ever have any big time digestive problems (probably because I have less restriction but that's another story). Oddly enough when I was heavier, less fill in the band did it's job, of course as I get smaller, I need a bit more - doesn't make sense but that's what I've found on my long, winding band journey.

It's odd, though, I never thought of myself as a lost cause - just a slow (very slow) loser. I will step up the game a bit though, if at all possible.

I don't know if I can get to a BMI of 25 - but I thought I could swing 27 or 28 BMI with some work. (Now with malabsorption I could have been down to my 20's with no trouble, but naively I thought the risks weren't worth getting down a few sizes more. I might have miscalculated there but I've come this far, so I better ride this Band train until I run out of track! :-)

And I do appreciate the more active Bandsters' encouragement for me to exercise. I'm just frustrating because I have only calorie restriction to get me there. I just had a serious Full Abdominoplasty with Muscle Tightening so I'm not cleared to exercise yet. (Not that I was exactly an Olympic athlete before but I'm normally a bit more active.) Heck, I could just start picking up my sister's tubby tabby cat just this week but I can't start any major exercise programs right now. This was my second surgery within a 7-week period so I wasn't able to be active at all, much less exercise. I'm still on 'medical leave' although I'm healing very well thankfully and I should be 'released' soon. That's what frustrates me since I am normally burning fewer calories - as I get more active I'll need more calories to keep going so I am struggling not too eat too much and it's a battle I'll lose without some serious intervention.

I have an idea - I know someone I can call to see if they have any insight on what's happening over in my surgeon's world. It took all the energy I had to not response with Fourth of July fireworks to what my surgeon said, so I might see if someone else can do a little "mediation" and see what the reasons are.

I'll try to find out more, and I'll report back.

I appreciate the continued support - I felt like I should share this also because this could be a major wake up call for us Bandsters so hopefully everyone else can learn from my fiasco and do better than me!

Again, thanks.

I'll let you guys know.

[mjensen1 1]

Having worked with some of the best band surgeons in Texas and witnessing many fills, I am wondering if possibly he miscommunicated to you that he didnt want you to have more fill "right now" and didnt mean not ever. When they do the fill under fluro, they are looking to see how narrow the flow of barium is. Maybe yours is where he thinks it should be for now. That doesnt mean if you lose more weight it would not change. Sometimes the docs just arent clear when they speak.

Also, from personal experience, I know that removing a small amount of Fluid and increasing your caloric intake can help boost your metabolism. My doc did this, unbeknownst to me, during a yearly EGD. Boy I was shocked when I lost down below my goal weight, thinking everything was the same as it always was. When he "confessed" that it was a little experiment to see if it really worked, I was surprised but pleased and relieved. I am in this for the long haul and hav always worried how the band could be managed for my lifetime. This makes perfect sense.

I also found out later, and had confirmed by a surgeon who is also banded, that if you remove all the Fluid and leave it out (my case - 6 weeks) then start putting it back in, you will have more restriction on a lesser amount of fluid. Again reassuring me I can manage my weight for the rest of my life.

Hang in there!

[the best me 6]

Also, from personal experience, I know that removing a small amount of Fluid and increasing your caloric intake can help boost your metabolism. My doc did this, unbeknownst to me, during a yearly EGD. Boy I was shocked when I lost down below my goal weight, thinking everything was the same as it always was. When he "confessed" that it was a little experiment to see if it really worked, I was surprised but pleased and relieved. I am in this for the long haul and hav always worried how the band could be managed for my lifetime. This makes perfect sense.

I also found out later, and had confirmed by a surgeon who is also banded, that if you remove all the Fluid and leave it out (my case - 6 weeks) then start putting it back in, you will have more restriction on a lesser amount of fluid. Again reassuring me I can manage my weight for the rest of my life.

Hang in there!

Yes, and YES! Excellent advice, IMO.