Catching up on the mental aspects of weight loss

by Christine on December 5th, 2011

filed under Christine's Life Updates, Gastric Banding Surgery

On Friday I was hanging out with a friend, drinking some truth serum, and sharing insights. My friend shared that he thinks that my depression that I have been dealing with lately is due to a major identity crisis. “I don’t think that your head has really wrapped itself around the weight loss you have had,” he said. “And I don’t think you’ve really figured out who you want this new Christine to be.”

Huh.

You know, I think he is onto something, on both accounts. I don’t think I’ve really wrapped my head around my weight loss. Oh sure, I’ve had a jolly good time shopping for clothes in new, small sizes. I still get a major thrill whenever I buy something in a Size 2 or 4! I’ve embraced all the NSVs, and I’ve embraced the number on the scale. I have worked hard at Maintenance Mode, and one year later I’m doing pretty good with it.

But all of that stuff is external, really. I definitely haven’t embraced the image I see in the mirror. I still battle with the urge to lose MORE weight, and I definitely do not have an accurate vision of what my body truly looks like. My weight loss has had an impact on the relationships that I have with other people. I’ve lost several friends due to their jealousy over my weight loss. I interact with people–especially men–in a completely different way. I flirt, and I’ve never done that before. I am not used to the attention I get. I have difficulty looking people in the eyes; I’m still afraid of what I see reflected back at me. Scorn? Disgust? Nothing at all?

I could go on and on. There’s a lot of mental and emotional stuff to embrace with a major weight loss, and I definitely haven’t addressed a lot of those mental issues. It’s funny to me that I’m coming to this realization 3 years after my surgery, and one year after reaching my goal weight.

But my friend was also right when he pointed out that I haven’t figured out who I want this new Christine to be.  I definitely don’t want to stay the same old Christine–the one that is afraid to look people in the eye, the one that’s filled with self-loathing, the one that many times would rather die than to embrace Life.  Who should New Christine be? What kinds of clothes should she wear? What kind of attitude should she have? How can New Christine interact with people in a more positive and rewarding way? How can New Christine go through life happier, with a more rewarding and fulfilling life?

Yup, this depression may very well be caused by a much larger identity crisis.

I’ve been trying to sort through that this weekend. Maybe even come up with some answers to that.

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My most embarrassing “band” experience yet!

by Christine on November 21st, 2011

filed under Christine's Life Updates, Gastric Banding Surgery

Oh lord! I honestly wasn’t going to tell a single soul about this experience, it was SO embarrassing! But since this is a blog about my gastric band and weight loss, I figure it was worth sharing, in the hopes that you can avoid making the same mistake someday.

This weekend we went to the symphony. Hubby’s friends are professional violin/viola players.  They are pretty amazing musicians….One is probably going to transfer from the Philadelphia Symphony to the Boston Symphony (he got an offer, just needs to decide what he’s doing) and his wife plays private engagements, such as the United Nations and White House dinners, etc.  They’re exceptionally talented, and they were playing this weekend as soloists with our local symphony, so of course we had to go see them play!

We were seated in the 3rd row, super close to the stage! My seat was exactly center, so I had about 10 people on either side of me.

At intermission I was starving, so I bought a small package of peanuts and scarfed them down. I was talking with friends and not paying attention to what I was doing. Big mistake, of course.

We sat back down in our seats, the lights went down, and the orchestra picked up. Our musician friends came on stage and wow, they were incredible!

And then I noticed that my peanuts were stuck. I started swallowing really heavily. I was having a hard time breathing. My eyes started to water. Classic “stuck” signs.

I thought maybe it was just a minor episode, and that if given enough time it would pass on its own.

Nope, no such luck.

At one point I looked around in panic, looking for an escape. At the end of the 10 people in our row to my right was our friend who just had foot surgery and is walking around on crutches. He can’t get up and let me out.  On the other side of the row of 10 people to my left were these little old 90 year old people that were having problems getting around.

Oh no.

I was trapped. Literally.

The saliva was building up, so I started considering my options. I had possession of a nearly-empty water bottle, so I thought I’d give that a try. I leaned over, pretending to put something in my purse, and did a dainty little barf into the bottle.

Success!

I sat up. Recapped the bottle. Put it under my seat.

And then I started sliming again. You guys know who have bands….I had gotten rid of the saliva that was built up, but I didn’t get rid of the actual blockage. I started to get backed up again.

Oh no.

Panic. I looked around for escape, but came to the same conclusion that I was trapped. Well, the bottle worked one time, it would surely work again. Right?

I leaned over and let it go.

It was like a geyser, you guys. Like some kind of freaking poltergeist decided to give my stomach an old heave-ho. A jet-explosion of foamy saliva-y barf erupted, filled up that bottle in about 2 seconds, and then overflowed. On my hands. On the seat! OMG! On the floor! On my pant leg! On my shoes! OH NO!

I kicked hubby’s jacket out of the way just in the nick of time. I sat there leaned over, looking at the mess I just made, trying to rub my slimy hands off on my pants legs, trying to scrub the side of the newly renovated theater seats with my sweater sleeve.

Look, it was peanuts. And you gastric banders know….if I had eaten chocolate or tomato soup or something else that has a dark color…it would have been a far worse scenario. As it was, it was mostly clear and foamy, and certainly didn’t show up as a stain on my clothes or anything. Maybe that’s the silver lining of this story?

OMG!

Apparently I was discrete enough that my friend sitting to my right didn’t have any clue what happened. And my hubby on my left wouldn’t have known either except that I told him to get his jacket out of the way. I was mortified.

First rule of thumb when going to the theater: (1) Don’t eat or drink ANYTHING.

Second rule of thumb: (2) NEVER get trapped on the inside again.

 

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Gastric Band Surgery Q&A Part 2

by Christine on October 4th, 2011

filed under Christine's Life Updates, Gastric Banding Surgery

Periodically I go into the Google Analytics of my website and discover that some viewers are asking questions about the gastric banding surgery and looking for the answers at my website. Here is the lastest group of “Questions and Answers” about the gastric banding surgery that might be of use to new bandsters.  This is Part 2 of the Q&A. Read Part 1 of the Q&A here.

 

How do I know if my gastric band is too tight?
If you cannot take a swig of water immediately after a fill, then your gastric band is definitely too tight. That’s the easy part.  However, finding the right balance between “tight enough to lose weight and be happy” and “too tight” might be a difficult balance to achieve. I know that I struggle with this almost 3 years after surgery! If you are finding that you cannot eat enough calories to survive (you know, if you’re dizzy and having a hard time concentrating because you’re not eating enough), then your band is too tight. If you find yourself choosing protein shakes, milkshakes, ice cream, and soup all the time because anything more solid than that is painful, then your band is too tight. If you find yourself barfing during most meals because your food is always getting stuck, then your band is probably too tight.

All that being said, I like to have my band pretty tight—maybe even tighter than most people. I know that I can’t eat certain foods, especially breads and pastas. Just because I can’t eat certain foods doesn’t mean that my band is too tight. I know a lot of bandsters that can no longer eat steaks or dry chicken. Again, this is normal and not necessarily an indication that the band is too tight. On the other hand, if you simply cannot be happy unless you have steak, and you find your band too tight to eat steak, then you might want to consider getting some saline taken out.

All in all, there’s no real hard and fast rule about finding whether the band is too tight or not. It’s really a matter of personal preference. However, a good rule of thumb is that if you cannot swallow any liquid, or if you have problems eating solid foods of any kind, then you should definitely loosen your band a bit. Other than that, it’s a matter of what you can live with or not.

 

How long is the gastric band waiting list?
Honestly, I think it depends on what region of the world you live in, what hospital you are going to, what surgeon you are seeing, etc. I know in the UK, the country only allocates a certain amount of money for the gastric band surgery, and so you might be on the waiting list for quite a while. According to www.gastricband.org.uk the waiting list in the UK can vary from anywhere between 3 months to four years.

I was banded in upstate New York, USA. I was not placed on any waiting list. Once I completed all my pre-surgery testing and requirements, I was immediately put on the pre-surgery diet. My surgeons gave me 2 months to lose 25 pounds on the pre-surgery protein shake diet, and as soon as I lost that weight I had my surgery. And yes, my insurance paid for the surgery in its entirety, but that really depends on your insurance carrier, your health background, the hospital you’re going to, and a lot of other factors.

I really recommend you check out the forums at www.lapbandtalk.com, especially the regional forums to inquire about this question.  (FYI, LapBandTalk.com is free to use and is a fantastic resource for anyone considering the banding surgery.)

 

Does gastric banding hurt?
Yes, the surgery itself does. But I personally found it to be a tolerable pain, that did not last very long (only a few days…maybe 7-10 days) and went away little by little, every day.  I’ve read other blogs from banders that found the pain to be too much, too intense, and last too long. I think part of the pain has to do with your tolerance, as well as your surgeon’s capabilities.

The band should not hurt once your body has healed from the surgery. If you are in pain several week or months following your surgery, you should definitely talk to your surgeon to find out what’s going on.

Will throwing up hurt the gastric band?
Fantastic question!

In my personal opinion and experience, I think all bandsters experience purging/throwing up due to food getting stuck in the band. Bandsters have all kinds of terminology for this experience, such as “sliming” or “B/Ping” etc.  This is a very common occurrence, especially once the band gets close to your “sweet spot,” which is the optimal tightness that allows you to live and eat happily but still allow you to lose weight.

Despite the common occurrence of the purging episodes, throwing up can hurt the gastric band, so you should really be careful about it. I believe the band is most vulnerable during the early stages of the process, when the band is deflated and fits loosely on the stomach. If you have a violent barfing episode, the heaving of the stomach can dislodge the location of the band around the stomach, thereby reducing the effectiveness of it. If the band becomes dislodged, you might not realize it right away. The doctor can find if the band has moved by using an X-Ray, or if after a few weeks or months you are not losing weight.

However, it also makes sense to me that barfing can hurt the band if it is filled with saline and tighter. When you are heaving, your stomach might press against the band with such a force that it could rupture the band. (Think of it like squeezing against a full balloon. What happens? The balloon explodes!) If your band “pops” like a balloon, the only way to fix this is by replacing it with another surgery.

All that being said, I’ve personally never heard of anyone having these problems – either band slippage or band “poppage”—because of a barfing episode. It’s just something to be aware of and watch out for. I think this is relatively rare.

 

Why has the gastric band come loose?
Oh dear! Your gastric band may have come loose for a number of reasons. Perhaps there’s a leak in the band itself, in the tube, or the port, or in any of the connections. There’s a lot of ways a leak can occur in the whole gastric band mechanical system. The band could also be loose if it merely has slipped from its ideal location. For instance, if it slips up the stomach, you probably would feel like it is very loose.

These are very serious causes, and only your surgeon can fix these problems if they occur. However, there might be a fairly simple reason for your band feeling a little looser. Your band is a semi-permeable membrane, which means that your band can actually absorb and release liquid through its lining! A lot of bandsters feel like their bands get tighter when they are stressed out, or feel like they get looser when they are dehydrated, like after a night of drinking. Therefore your band might feel a little bit loose just because you’re dehydrated. Eat something salty and drink a lot of water and see if your band feels any better in a day or two.

If you suddenly feel like your band is much looser than it was before, then you really should make an appointment to see your surgeon. He can check to see the saline level in the band or do an X-ray to see if the band has slipped, both of which are fairly painless and non-invasive tests.

 

Does a gastric band affect pregnancy?
The gastric band does not have to negatively affect pregnancy, but it’s important to understand the unique concerns that expecting mothers might have. Read my article about pregnancy and the gastric band here.

 

Can gastric band slip and then go back again?
If your gastric band has slipped from its location around your stomach, it’s possible but unlikely that it would go back again. If it slips, it is most likely to stay “slipped” until your surgeon goes back to replace it in the correct location.  Sorry! I stand corrected! See Angela’s comment at the very end of this post. Angela said that this very thing happened to her…her band slipped out of place. She had an un-fill, and then the problem corrected itself.  I had no idea that this was possible. Interesting, and thank you for sharing Angela!

 

Can you feel the gastric band through the skin?
No, you cannot feel the gastric band through the skin, but you may be able to feel the gastric band’s port through the skin. The port is the receptacle where your surgeons inject the saline. Read more about the components of the gastric band system in this article.

 

Gastric banding menus
Here are some resources for finding out what to eat –or not eat!—with the gastric band:

  •  This page lists the post-surgery diet requirements, as well as a list of foods that are typically not processed well by band patients.
  • Here is a list of mushy food ideas.
  • This forum has a lot of great food ideas.
  • This website has some food ideas.  

 

How much food can I eat during the mushy stage?
You should only be eating no more than a cup of mushy foods at any given sitting.

 

How do you locate the lap band port to make it unnoticeable?
It’s unlikely that a severely overweight person can see the port through their skin. However, as you lose weight and get closer to your goal weight, the port may become noticeable, either by touch or by site. I had many talks with my surgeon about this very topic of moving my port (which had become dislocated) to a place less noticeable. There are a variety of locations where your surgeon can put the port to minimize its appearance through your skin, from putting it under the abdomen, moving it to your side, etc.  Read about these options in more detail here.

 

Will the port from my gastric band protrude if I lose a lot of weight?
It might, possibly yes.  See this page for some ideas about moving the port if it is really bothering you.    Please note that the different banding systems have a different profile port. For instance, the Lap Band system uses a port that has a higher profile, which means that it sticks out further than other systems.  I have a Realize Band system, which uses a smaller profile port, which means that it’s flatter and thinner than the Lap Band system. However, many surgeons find the Realize Band port to be difficult to access when the patient is very overweight and has a lot of fat covering the port. It’s difficult to find where the port is because it is so much flatter, so the doctor might have to jab around with the needle a little more to find the injection site. Even more reason to find a surgeon with a  lot of experience, so you can minimize the needle-jabbing process!   My surgeon told me that a lot of doctors put a smaller profile port on male patients and a higher profile port on female patients. Doctors do this based on their experience and comfort level. You should discuss the type of hardware that he’s putting in you before your surgery, so you are aware of what you’re getting. Don’t forget that you can have an opinion about what kind of system you receive from your surgeon!

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Mystery of Appetite Suppression

by Christine on September 16th, 2011

filed under Gastric Banding Surgery

As I was reading up on the whole process behind appetite, hunger levels, and appetite suppression, I kept coming across information about a hormone called Ghrelin. This is my own take on the information that I’m reading.

Ghrelin is a hormone produced by cells in the stomach and pancreas that stimulates hunger. Before you eat a meal, ghrelin levels rize, consequently signaling to your brain “Hey man! I’m hungry!”  To turn off the ghrelin, people typically eat food; if you eat enough food, ghrelin decreases and you’re less hungry.

Ghrelin is regulated by the hypothalamus, which we have no mental control over. No amount of “willpower” can change how the hypothalamus works.  However, the gastric band can actually work to control your hypothalamus!  When normal people eat, the foo consumed stretches the upper stomach as it works its way en route to the lower stomach. When this streching happens, the hypothalamus sends out a hormone (pro-opiomelanocortin), which suppresses ghrelin. If you don’t eat, the upper stomach isn’t stretched, so you’re hungry.

With gastric band patients, when you eat, your food remains in the upper stomach for a longer than normal period, keeping the upper stomach stretched out. Consequently gastric band patients feel full after just a few bites of food.  Smart patients will quit eating soon after that, or at least moderate the amount of food that they eat. (It is very easy to get used to the “full” feeling and start to ignore it.)

This is one reason why your doctor tells you not to drink when you’re eating food. Liquids will help wash that food out of your upper stomach, into your lower stomach, thereby reducing the amount of “stretch time” you’re getting. Consequently you’re more apt to feel hungry sooner after your meal.  I would think that foods that are more fiberous, that stay in the upper stomach (take a little more time to break down), may also help you feel fuller for longer.

Interestingly, there have been a lot of studies that show that mere surgery alone can have an effect on ghrelin levels. Gastric bypass patients have been known to show an actual drop in ghrelin levels following surgery, where as gastric banding patients experience a drop in hunger but not in actual ghrelin. With sleeve gastrectomy, the area of the stomach that produces ghrelin is removed.

Researchers apparently are working on some miracle anti-obesity vaccine right now that would prevent ghrelin from reaching the central nervous system, thereby helping to suppress the appetite and preventing weight gain. Preliminary studies are being done on rodents and pigs.

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Why stress makes the gastric band tighter

by Christine on September 15th, 2011

filed under Gastric Banding Surgery

My blog reader Kris was able to link me to an article explaining why our gastric bands feel tighter when we are stressed (or PMSing).  How very interesting! The article can be found here. The answer is that the gastric band is a semi-permeable membrane that actually can absorb fluids in the body!

Often times patients will come in because their Lap-band feels too tight. They find more difficulty with some foods, and are uncomfortable. They ask me “does stress cause the band to tighten?” The answer is, yes, it does.

The biology of stress is this: when you have stress, be it physical stress (like an illness) or mental stress (like your mother-in-law coming by for a short two week visit)…the body reacts by retaining fluid. You may notice that wedding rings are tighter, and there is more swelling in the legs at night.

The balloon of the adjustable Lap-band is a semi-permeable membrane, meaning it is osmotically active. In plain English: the more water you retain,  some is transmitted to the band, so it swells.

If a patient has 5.5 cc in their band (we measure it) and they come in and it feels tighter, we find they have 6 cc in the band. Where did the ½ cc come from? That is from the extra water the body is carrying. Since the balloon on the band is semi-permeable it will retain more water also.

This is the same reason that most people find the Lap-band to be tighter in the morning. In the evening you may notice you have some swelling of your ankles – by gravity your body water has gone down to the legs.  In the morning that swelling is gone, and the water has gone back to the central compartment of the body where the band is. If we measure the band in the morning it can have 0.25 to 0.5 cc more in it (which can make a difference).

This is also why we don’t like bands being too tight. People need room for stress – of all kinds. Leaving room in the band to allow for this, means that patients will have fewer difficulties.

 

Upon further web searching, I see that there are several scientific studies that have been performed that have verified this claim, such as this one here.

This knowledge makes me realize two things: (1) When your band is too tight or too loose, don’t go running to your doctor to get it fixed right away. Give it a little time to see if the saline levels balance themselves back out. Also, (2) If you experience a “looser” band, it doesn’t necessarily mean that your band is leaking or is broken. First try increasing your fluid consumption and see if that fixes the problem. If there is a noticeable decrease in “restrictive feeling,” then go see your doctor.

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