Wednesday, August 18, 2010

You've Been Slimmed!

I went in for a fill today. I have lost another 8 lbs and am now down to 302.8 lbs from my original weight of 361. I have lost a total of 58.2 lbs! My clothes don't fit me anymore! I now have 8.2cc's of fluid in my lapband.

It has been a month since my last fill. This last month has been a difficult one. After my last fill I have had lots of trouble with food getting stuck even when I eat slow and small bites. I end up having to try to throw them up. It's not really throwing up but relaxing my throat and letting the food come back up. What comes up is a bunch of mucous with food in it. According to the nurse this is called slimming because your body produces lots of mucous to move the food down to your stomach. Since it doesn't get down into your stomach with the band a lot of slime is created to try to get it down there. Getting rid of some of that slime and food does help you feel better but it makes me feel like I'm bulimic.

Wednesday, July 21, 2010

How the Lap Band Really Works

I highly recommend anyone interested in understanding how the lap band really works should read the following article. It really opened my eyes.

-- John...

It is Not about Restriction
Terry Simpson, MD

The Lap-band is NOT about Restriction.
When talking about the band, some patients talk about restriction. Let's first be clear about one thing: the purpose of the band is not restriction; the purpose of the band is to lose weight by suppressing the appetite.

When band professionals talk about restriction we are talking about something totally different than "restricting what a person eats." In fact, many band surgeons avoid talking about restriction so as to not confuse patients. The band works by dimming the appetite, and this provides a conscious control and decision made by the patient, it does not work by "making" a person do something, or keep them from eating too much.

The Lap-band works by suppressing your appetite.
As a result, you are less interested in food between meals, making it easier to resist temptation. The analogy is when you are near a vending machine when you are hungry-- what do you do? Probably find yourself with some junk food that is not a part of your plan. But, when you pass a vending machine when you are full, it may not even catch your eye. Having the appetite dimmed makes you less tempted by the many food choices modern living throws at you - -this is what the band does, by suppressing appetite you become less interested in food.

What you should not feel, with the band, is the sensation of being "stuffed."
When you eat Thanksgiving dinner, you can feel stuffed. Contrast that with the sensation two hours after you eat your big meal, at that point your appetite is suppressed. It is the subtle dimming of the appetite that the band should provide. Being stuffed after a large meal is a complicated sensation of the abdominal wall stretching and a lot of gas in the bowel, in addition to feeling a diminution of appetite. You will not, and should not, feel the abdominal wall stretch with the band. You should not feel the "near nausea" and you should not feel bloated.

Key point:
You should NEVER eat until you feel full. It is best to stop eating before you "feel full."
If you do eat until you feel full you will most likely be overstuffed. This leads to the universal key to success -- patients who eat a small volume of food (which, if you measure, is consistent) will be successful with the band. If you want to succeed, you need to know how much you are eating, and then stop eating -- it is in your control, but the band will help you -- not by stopping you, but by allowing you to feel satisfied after the small volume.

Early on, most Lap-band patients do have a sense of "restriction", particularly, after the first fill. When we place the band on a patient the stomach above the band typically will hold one to two ounces (by volume, not by weight). The stomach has a lot of muscle fibers, and the wall of the stomach is fairly thick. When food is consumed, it arrives in the pouch, and meets some resistance, first against the newly adjusted band, and then against the stomach which does not stretch easily. People love this feeling! It is a sense of control over food -- a leash. But it is not permanent. It makes it difficult to eat more, because the top part of the stomach and the band will resist it. If you over eat you will feel uncomfortable.

This is the honeymoon phase, you feel full with less, no appetite, and if you try to eat more it doesn't work. They eat a small amount of food, they feel satisfied, and they are losing weight.

For patients who rely on this sensation, they will find it will take ever increasing volumes of food to obtain this sensation. The initial response is to have their band adjusted so that they can "feel full again." Against a tighter band, the upper stomach stretches a bit (and if they eat fast it stretches more)and they again have the sensation of "feeling full." This becomes a cycle, a tighter band, the stomach stretches more-- and then instead of going back to its original size, the stomach stretches more and more, to where it takes more to fill it.

The person, who continues to eat until they have this sensation, will find that it takes more and more food to obtain this feeling. Two things happen -- first the stomach stretches to where it accommodates more food, and to stretch it means you have to eat more. The second is that to "feel full" it takes the brain time to register this sensation -- this is not the sensation registered by the hypothalamus, but registered in the conscious cortex. So your stomach can be full, but your brain won't register it for a while, and if you keep eating you can overeat. As a result, the pouch dilates. Similar to a balloon, when you first start to blow up the balloon it takes a bit of force. As you continue to fill the balloon, the wall of the balloon stretches (thins out), it is easier to blow it up -- the same is true with the upper pouch. Early on, before the pouch is stretched, it takes a little bit of food to cause it to stretch, but with chronic over-eating the pouch will accommodate more and more food. The stomach wall is thinner, it is easier to stretch, and to get that sensation it takes more food than at first. Often patients will complain that they "don't feel restriction," and wish to have the band made tighter.

There are two potential results to this: one is the patient will passively stretch the stomach and esophagus and not be eating a small amount of food. These patients simply do not lose the weight that the surgeon expects. The other is that the band will be forced down the stomach, the band will slip, which generally requires operative intervention to reposition it.

For those patients who are rigorous about the volume of food they eat, and do not let the stomach to tell them when to stop eating - they do very well. This is one of the keys of successful patients: only eat a certain portion of food - period. If the band is properly adjusted, the appetite will be dimmed for several hours. Once your brain realizes that a small amount of food keeps you satisfied your eyes will adjust to the amount you eat.

Some describe a "soft stop." Where before a sense of fullness occurs, there is a signal from your body -- this can be a runny nose, a sigh, or a subtle ache in the left shoulder. Patients who find this "soft stop," do very well with the band.

The other advantage of eating small portions is it becomes a lifestyle change -- you will have the ability to gauge the amount of food you can comfortably eat, knowing it will keep you satisfied for several hours.

You can always -- always, always, always, -- eat more food, because, contrary to what we believed for a long time-- food passes by the band within a minute and then into your stomach. But the key to successful patients is not how much they can eat, but how little they can eat to suppress hunger.

The band goes around your stomach, not around your brain, or your lips.
This simple concept, of eating a specific volume of food -- eating it slowly, and then walking away, is the key to successful eating habits of patients. This means that the band works with effort from you -- not by it doing everything for you. You have to make the decision to eat a small volume of food, and let the band work with you.

The sensation that we would want the band to produce is the "soft stop." The soft stop is when you eat a small portion of food and walk away. Sometimes this is difficult, like most things, practice makes perfect. To set yourself up for success -- we recommend you use smaller plates, along with smaller utensils. If you go out to eat, ask for the to-go bag immediately, and remove the excess food from your plate. You can physically always eat more food, but the advantage about practicing small portions and walking away, is ultimately your eyes will get use to what the stomach is telling it, and it will be much easier to eat smaller portions as time goes on.

It isn't uncommon for patients to want an adjustment because they say they can eat more.
The first question we ask is, "Why are you eating more?" The typical answer is, "Because I can." The typical response, "Just because you can does not mean you should." Since the band's job is not to restrict the amount of food you eat, do not leave that to chance -- that is your job. Part of personal accountability is to account for, to measure, to know how much you are eating at a time. The band is empowering; if you eat an appropriate amount and make appropriate food choices, you will be satisfied for several hours. This results in either weight loss, or weight maintenance (if you are at your goal). The purpose of the band is to assist you to lose weight -- and this occurs only with active participation by you: you chose what to eat, you choose how much to eat, and you practice walking away after eating that amount. The band is a tool to allow you to eat less and have your appetite dimmed resulting in weight loss, or maintenance. It is a tool to help you adopt a healthy lifestyle -- you still have the choices to make, but the band allows you to be satisfied with those choices.

"If I could eat less and walk away, what would I need this band for?" -- a common question we are asked. Without the band, if you eat a small amount of food and walk away your appetite would rise within a couple of hours -- you would find yourself hungry and wanting more food, possibly leading to unwanted snacking. You would also find, if you willed yourself to withstand the hunger, your weight loss gradually decreases. The band fools your brain into thinking you ate more.

Think of it another way -- the hypothalamus does not have eyes -- it doesn't know how much you ate, it doesn't know if there is a lot of food around and you are not eating it, or if there is a band on your stomach. The hypothalamus reacts very simply to the stimulation provided by the upper part of your stomach. Stretch that thermostat, it thinks you are eating a lot -- do that consistently over time, and it behaves as if you are eating a lot all the time and will allow your body to release fat stores and not cause your body to go into a metabolic slow-down. Conversely -- if you go on a diet, without the band --and that part of the stomach is not stretched, your hypothalamus thinks you are in a famine -- it doesn't know that there is a lot of food around you.

The purpose of banding is weight loss. Patients who are successful do not "feel tight," or "feel restricted." Instead, successful patients report that they rarely have an issue with the band; they do not "feel restriction." Successful patients come for adjustments when they notice that their appetite is returning between meals -- patients who are not successful rely upon the band to tell them when to stop eating.

The band, in successful patients, is empowering. While, on occasions, the band is "fickle" the proper way for the band to work is for it to allow you to eat less and not be moved by an appetite.

There is another group of Lap-band patients who do not like any sensation of restriction
-- a group we call volume eaters. They want to eat a lot, when they want to eat, and they do not like the sensation of a "hard stop." Nor does this group want to eat a small volume and walk away and allow their appetite to be suppressed. One patient even asked for pills for nausea, because she could not eat "a quart of chili." Yes, this person thought a quart was a normal serving size -- not a cup, a quart! Sometimes these patients come in for an adjustment, then come back thinking that the band is too tight, because when they overeat they become acutely uncomfortable, or feel as if they are "obstructed." Often these patients will come in for a fill, then an unfill, then another fill.

It does take a bit of work to change a person's perspective about the volume of food they eat. For some there is a feeling of deprivation, a period of mourning, but ultimately the band can become a tool to overcome this sensation, and allow the patient to eat. Remember, if you want to be a 125 pound person, you have to eat like one. The band allows your body to re-set the thermostat to the amount of food that it takes to keep you satisfied between meals.

To be more specific - food does not stay in the pouch above the band for a long period of time. Typically it travels through this area fairly quickly, usually less than a couple of minutes. The effect of the band is NOT to have food stay above the stomach in that small pouch - the effect of the band is on your appetite after a small amount of food stimulates that. Does this mean you can eat more -- yes, you can. That is always in your control.

So the first lesson -- Eat a specific, and small, portion of food, and walk away.

Tuesday, July 20, 2010

Return from Vacation

I returned from my vacation to Jamaica on Sunday evening (July 18th). I stayed at an all inclusive resort and had lots of fun. I was very active playing volleyball, snorkeling, and sailing. The food and drinks were very good there. Even though I was able to eat a fair amount of food, I tried not to be excessive. I was very selective about what I ate there and if I didn't really like it, I didn't eat it. I tasted a lot of different foods and drinks though. I tried to make sure I drank my liquids before eating and this worked pretty well.

Yesterday I had an appointment with the clinic to get a fill. I was surprised to find that I had lost another 7 pounds WHILE ON VACATION. This far exceeded my expectations.

I have now lost a total of 50 lbs and am down to a weight of 311.

I am finding that I'm being more selective on what I eat, focusing more on quality than quantity of food.

It is nice to know that one can enjoy themselves and still lose weight. :)

At the clinic they added another .5 cc's of fluid to my lap band so I now have a total of 7.7 cc's in my lap band.

Thursday, July 1, 2010

Just a little... if you please

Today I went in to get another fill. My weight is at 318 which means I've officially lost 43 lbs.

I had noticed lately that I don't feel as full as when I got my first adjustment so I decided to get another. In a couple of days I am going on vacation to Jamaica for two weeks and will be staying at all inclusive resorts. I wanted to make sure that I don't overeat. The nurse only added .2cc though so that I won't be in a situation where I'm overfilled. I'm not sure that will do anything for me... but it's better than nothing.

I haven't had any problems with throwing up (like some people do). The only problem I've noticed is that some foods are uncomfortable to eat and seem to get stuck. I have to make sure to eat slowly and cut my food really small and chew it well. This helps in most cases, but with some foods I always seem to have a problem no matter how small the bites are. For example, if I have gluten free german pancakes for breakfast I can only eat about a half before it is too uncomfortable. I'm not quite sure why it's so uncomfortable. It's a soft food. I would think steak would be uncomfortable, but I don't have any problems with meats. Evidently this is a very common problem people with Lap Bands have, but the foods that get stuck differ between people.

It will be interesting to see how I do on my vacation -- with unlimited food and drinks. I'm hoping I at least don't gain weight. I'll let you know. :)

Monday, June 21, 2010

Checkup After First Fill

Today I had a checkup after my first fill a week ago. I weighed in and lost another 2.4 lbs which puts my total weight loss at 39 lbs (current weight 322 lbs).

I had a fluoroscopy to check on the constriction of the band. There was good flow and the nurse said I didn't need another adjustment right now.

Since my fill I have been having problems eating my meals. The first couple bites of food seem to get stuck and are very uncomfortable. I have to wait a minute or two until the feeling goes away before I can eat. The nurse said the food is sitting on top of the band so my body may just need to get used to the band being there. I have been trying to make sure I eat small bites and chew my food really well, but that really hasn't helped.

I know I'll need another fill in the future because I think I am physically able to eat more than the small plate of food I should be eating -- but so far my self control has been good.

I am still using the silicon patches, although they are starting to get pretty nasty. I wash them daily and have tried to peal off the lint stuff that seems to get stuck to them. The patches seem to be doing a good job and the scars are fading slowly. I think it will take a while though before they are completely gone (if ever).

Monday, June 14, 2010

Tattoed with scars

In the last two weeks I haven't had any noticeable problems. I did notice that recently I have been hungrier. I had been told that as you lose weight around your stomach the band will become loose and you'll be able to eat more (that's why you get adjustments to the band -- which I did today)

Since I had the lapband surgery I have been using vitamin E oil on the scars two times a day. I haven't noticed any change in the scars. Other people have reported that their scars are fading... but not mine. I have had several previous surgeries (gall bladder removed, hernias repaired, exploratory surgery for suspected cancer) and have the prominent scars to prove it.

So with this surgery I didn't want to have any additional prominent scars. After using the vitamin E oil and not seeing any changes I decided to try something else. Some people recommended mederma so I decided to ask the pharmacist at Bartell Drugs. The pharmacist said from what he has been told the best thing for scars is silicon patches. I decided to try this (it's cheaper than mederma... but still expensive). They have a guarantee on the package so if it doesn't work I'll get my money back.

I cut strips of the silicon patches to put over my scars and have left them on for about two weeks now... only taking them off to clean them or reposition them. I have noticed that the scars seem to be smoother and are no longer raised up. They seem to be fading a little bit. From the instructions on the package it can take a few months for the scars to fade. I'll keep you posted!

1st Adjustment

Today I had my first adjustment. I have lost 37 lbs so far. I am down to 324 lbs now (my original weight was 361). I haven't really been doing anything except taking daily walks for about a 1/2 hour and only eating 3 meals and not eating past being full.

The adjustment is done at the clinic, Northwest Weight Loss Surgery. I didn't meet with the doctor, the adjustment was done by a nurse, Bethany.

First she has to find the port. To do this she has you lift your legs so the stomach muscles will flex and force the port upward toward the skin. My band holds up to 14cc's and initially had 4cc's inserted into it by the surgeon.

Bethany took a small needle and poked it through my skin into the port. She extracted the existed 4cc's (to make sure how much was in there) and inserted an another 3cc's of liquid for a total of 7cc's. My band is now half way full.

She had me drink some water to make sure it went down fine. She also gave me some advice:

• Don't drink carbonated soft drinks. She's had problems with this before and
evidently the air can cause the stomach pouch to expand.
• Each small bites and chew your food well. Big chunks of food can get stuck
in the band and wreak all kinds of havoc.
• After an adjustment there might be some irritation so try eating soft foods
for a day or two.

There was no real pain except for the minor needle prick.

I'm supposed to see how I do at this level for a week and go back in a week if I need more of an adjustment. If I feel hungry, don't have a good weight loss, and can eat too much then I'll need another adjustment.

Once I got back to work after my appointment I had my lunch. I didn't really notice anything different other than feeling full after eating two/thirds of my lunch. Since I've read that some people throw up -- and I don't want to do that -- I stopped eating at that point. So far so good. :)