Fear of the future (lapband)

by Christine on November 27th, 2010

filed under Christine's Life Updates, Gastric Banding Surgery

I have a cousin, Shodi, that was one of the first people to have the lapband surgery, wayyyyy back when. She lives in Texas, and apparently her surgeon was the guy that “invented” the surgery.  She had the lapband and lost a bajillion pounds of weight, looks fantastic!  I didn’t know Shodi when she was overweight; the only time I really remember meeting her was a few years ago, and she looks healthy, normal, fit, and gorgeous!

But according to my mom, after she lost the weight, Shodi started having major issues with acid reflux. I don’t know all the details, but apparently Shodi’s surgeon decided to take all the saline out of the band. (He kept all the “hardware” inside her, just took all the fluid out.)  This was a while ago, and while the acid reflux issues were aleviated, Shodi started to gain weight again. According to my mom, Shodi has gained all the weight back and then some.

Apparently Shodi has returned to her surgeon to ask to start the fill process once again, but her surgeon said no. He told her that the only option left for her is to have gastric bypass surgery.

I don’t know the surgeon’s reasoning for this, whether the stomach acid is close to eroding the band through the stomach or what other medical complications may be. However, my cousin got the feeling that the surgeon was just trying to scam her for more money, more work. She doesn’t understand why she can’t just get a fill, especially since all the hardware is still in place. I don’t understand either.  (I recommended that she talk to another weight loss surgeon to ask those very questions. Get another opinion!)

All this leads me to be really apprehensive about my own band and my ability to keep the weight off. I know that in the next year I’m going to have to get my port taken out entirely because it sticks out in the most bizzarre way, and it will eventually push itself through my skin. (read more here)  That means I won’t even have the hardware in place in case I ever start gaining my weight back.I’ve always doubly-appreciated the band because of the peace of mind I feel that if I ever started to gain weight again, I would have the means to go to the doctor, get another fill, and keep my weight from ever being a problem again. But this is not necessarily the case, especially since I need to get my port removed.

Statistically, most gastric banding patients don’t lose very much weight. (Most patients lose approximately 30% of the weight they needed to lose. So, for me, I wanted to lose 100 pounds, but stasticically I should have only lost 30 pounds! The fact that I’ve lost all 100 pounds of the weight I needed to lose defies the odds.) Furthermore, most gastric banding patients gain all the weight back. I do not want to be a statistic. I know that I can fight these statistics by learning healthy eating behaviors and exercising regularly. In other words, don’t allow the band to be a crutch, but use the band as a means to live healthfully.  Although I feel like I’ve done that, I have this uneasy feeling that I might have the same problems as my cousin Shodi and gain weight down the road. I don’t want this to happen to me. I’m fearing the unknown future.

This is the only picture of Shodi that I could find of her “overweight.”

Here’s a picture of me with beautiful Shodi from a few years ago….2003 maybe? Can’t you tell we’re related?!? We have the same eyes!

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Pregnancy and the Gastric Band

by Christine on September 23rd, 2010

filed under Gastric Banding Surgery, General Information

Pregnancy and the Gastric Band

When I underwent my gastric banding surgery, I was surprised that there was not more information available about issues concerning pregnancy.  This seems particularly important because the band may severely limit the ability to consume food, perhaps a healthy variety of food, which is important when a woman becomes pregnant.  In fact, with all my consultations with doctors, the only question on this topic that was posed to me was, “do you believe you may be pregnant?”  They confirmed any pregnancy doubts with two pregnancy tests prior to surgery; had I received a positive test, I believe I would have been denied the surgery.

I have one “real life” friend named Andrea that had the gastric banding surgery performed perhaps six years ago. Two years ago she had a baby. When we were talking about the band, I asked her if she had the band taken out when she discovered that she was pregnant. “Oh no!” she said. (I’m paraphrasing here.) “There’s a gross misconception that you need to ‘eat for two’ when you’re pregnant. It’s not true: you only need to eat 10% more than you normally would. So if you eat 1500 calories a day, then you only need to eat an extra 100-150 calories for the baby. That’s totally do-able with the gastric band in place.”

Good point, and it made me realize that I knew very little about pregnancy and the gastric band. I hope this blog article is informative for anyone who has the band who is considering getting pregnant or who has recently discovered that they are pregnant!

What effects does the gastric band have on pregnancy? For instance, does the lack of eating decrease a woman’s fertility rate?

Actually, the gastric band may be able to increase a woman’s ability to get pregnant. According to Ajay Goyal, MD, FACS from the New Jersey Bariatric Center, “being seriously overweight causes an increase in the level of two key hormones related to fertility – estrogen and testosterone…[an increase in these hormones are] directly related to infertility, causing irregular or heavy periods.”  A high BMI increases the risk for pre-eclampsia, gestational diabetes, hypertension, and spontaneous abortions.

The weight loss that comes with gastric banding surgery may actually improve a woman’s fertility by helping her achieve a healthy, regular menstrual cycle.

A recently study in Australia compared birth outcomes for pregnant women in three categories: women that have had gastric banding surgery, morbidly obese women, and a sample of normal-weight women. The study showed that babies produced from banded patients were healthy. Furthermore, women that had the gastric band gained significantly less weight during pregnancy and had significantly lower pregnancy-induced hypertension than obese patients.  The babies’ mean birth rates were comparable in all three subject groups.  This study is good news for women who have had gastric banding surgery and want to get pregnant.

It’s important to note that any weight loss surgery (gastric banding or gastric bypass) itself does not directly impact an individual’s fertility.  Weight loss surgery impacts the stomach and intestines and should not disrupt the functioning of the baby-growing organs in women or the baby-making-seeds in men.

Can you have the surgery if you are planning on getting pregnant in the future?

Absolutely.  Most bariatric centers recommend that you wait at least one year before getting pregnant. This is because surgeons want you to lose weight and increase your ability to have a safe pregnancy. Achieving a healthier weight, which may also eliminate diabetes and heart problems, will help achieve a healthy pregnancy.  Practicing safe sex for this one-year period is very important. (Note that gastric bypass patients may need to discuss oral contraceptives with their surgeons; not all oral contraceptives may be absorbed after the procedure.)

What happens if you get pregnant while you have the gastric band? Will you need to have it taken out? How safe will your baby be if you have the band?

You probably won’t have to get the band or port taken out. Unless you have complications, you should not need to get your band out. However, you may need to make an appointment to see your bariatric surgeon to have a small amount of saline taken out of the band so that you can eat a little bit more.

Despite the assurances of bariatric centers attesting to the safety of the band, the results of at least one Austrian study from 2001 were a little disturbing.  The researchers followed 215 morbidly obese women of reproductive age that had had gastric banding surgery.  Of those women, seven had unexpected pregnancies. Five of those were full term and two women had first trimester miscarriages. Two women had serious band complications (1 intragastric band migration and 1 balloon defect) which required re-operation.

Other studies are more assuring. A 2001 study followed 20 women (who had gastric banding) who had completed a total of 22 pregnancies. All 22 pregnancies were successful and complications were minimal.

One gastric banding patient had a remarkably easier pregnancy after receiving weight loss surgery as compared to her pregnancies before surgery.

I had two miserable pregnancies both resulting in emergency caesareans. In the second one it was difficult to monitor the baby in labour as the fat made it hard to pick up his heartbeat. I had to have an emergency caesarean which was awful. The theatre table was a bit narrow and I was terrified of falling off. The pregnancy was awful too as my diabetes meant the baby got very big. I hated having the growth scans since the scanners struggle to get good pictures and I felt really guilty.

After my gastric bypass I tried pregnancy once again. It couldn’t have been more different. I was more comfortable, less breathless and everything was so much easier. I had a normal sized baby and was thrilled to give birth naturally. (See source)

Will you need to get the band deflated when you find out that you’re pregnant? This is a point of contention in the medical community, but more recent evidence says probably not. Most recent studies have shown that when the band is totally deflated, pregnant women gain more weight than is healthy for the baby, which in turn is linked to an increase in the incidence of fetal macrosmia and gestational diabetes.  Most surgeons these days are recommending that you keep your band inflated, or to take out only a small amount of saline from the band.

However, one UK website said that the band should be emptied at 12 weeks pregnancy.  Another resource said that the band should not be re-inflated until after breastfeeding has fully completed.  These conflicting opinions may be confusing to you, so it’s best if you discuss your options with your bariatric surgeon.

Will I be able to take in enough nutrients for both me and the baby?

Everyone who has had gastric banding surgery should take nutritional supplements. If you are pregnant or planning to get pregnant, this is even more important.  The gastric band means that you eat less; eating less means that you are consuming fewer vitamins and nutrients.  One researcher states:

Key supplements to increase include iron to form new red blood cells, calcium for mineralization of fetal skeleton, folic acid to prevent birth defects, vitamin B1 (thiamine), vitamin B12 and vitamin A. Women should also take protein supplements in the form of protein shakes or protein bars as one cannot take the recommended daily allowance of 60 grams of proteins per day from foods. I recommend taking at least half or 30 grams in supplements and the rest from foods rich in proteins.

The New Jersey Bariatric Center has a very informational list of proteins shakes and protein-rich foods that are recommended for pregnant band patients.  See this website.

One source states that a mother’s weight loss has a beneficial effect on fetal and infant outcomes, such as normal birth weight.

I found out that I’m pregnant! Now what?

1.       Contact your General Physical (GP) immediately to confirm your pregnancy with blood tests.

2.       Contact your bariatric surgeon to let them know and to schedule a time to chat with them about it. Don’t be in a hurry to get the gastric band deflated because you may not need it completely reduced.

3.       Arrange blood tests to assess your nutritional status. You may have nutritional deficiencies because of your surgery. Double-check what your nutritional health is by having a simple blood test done.

4.       Follow your doctor’s instructions regarding nutritional supplements. What you might need for supplements is probably different from what is recommended for non-weight-loss-surgery patients, so make sure you’re not following “blind” advice from a book. Instead, follow the instructions set out for you specifically by your own GP and surgeon.

5.       Do not continue to lose weight during pregnancy. You probably aren’t going to need to pack on 50 pounds for the baby, but it also isn’t going to be healthy to continue to lose weight. You will need to adjust your priorities and mindset; you’ll need to change gears from “weight-loss mode” to “healthy baby mode.”

Resources for Further Reading

Abenhaim HA, Kinch RA, Morin L, Benjamin A, Usher R. Effect of pre-pregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet. 2007. 275(1): 39-43.  http://www.ncbi.nlm.nih.gov/pubmed/16967276

Beard et al. Reproductive considerations and pregnancy after bariatric surgery: Current evidence and recommendations. Obes Surg 2008. 18(8): 1023-1027.  http://www.springerlink.com/content/g1wp77705w52m641/

Biensman-Pailleux J and Gaucherand P. Laparoscopic adjustable gastric banding and pregnancy. J Gynecol Obstet Biol Reprod. 2007. 26(8):770-6.  http://www.ncbi.nlm.nih.gov/pubmed/17604570

Coupaye et al. Nutritional consequences of adjustable gastric banding and gastric bypass: A 1-year prospective study. 2008. 19(1): 56-65. http://www.springerlink.com/content/83t810685210612h/

Dixon JB et al. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol 2005 Nov; 106:965-72. Abstract online at: http://general-medicine.jwatch.org/cgi/content/full/2005/1122/1

Dixon JB, Dixon ME, O’Brien PE.  2001. Pregnancy after lap band surgery: management of the band to achieve healthy weight outcomes. Obesity Surgery (11) 59-65. Abstract available at: http://www.healthierweight.co.uk/research/gastric-band-articles/lap-band-safe-during-pregnancy/

Jasaitis Y., Sergent F., Bridoux V., Paquet M. Marpeau L., Teniere P. Management of pregnancies after adjustable gastric banding. 2007. 36(8): 764-9.  http://www.ncbi.nlm.nih.gov/pubmed/17512137

Karmon A and Scheiner E. Pregnancy after bariatric surgery: A comprehensive review. Arch Gynecol Obstet 2008. 277(5):381-388.  http://www.ncbi.nlm.nih.gov/pubmed/18299862

Martin lF, Finigan KM, Nolan TE. 2000. Pregnancy after adjustable gastric banding. Obstet Gynecol. 95(6): 927-30.

Realize Gastric Band. http://www.realizegastricbandnj.com/realizeband/pregnancy-after-lap-band-realize-band-surgery.html [accessed 03 May 2010]

Weiss, Helmut, H Nehoda, B Labeck, K Hourmont, C Marth, and  Aigner. 2001. Pregnancies after Adjustable Gastric Banding.  Obesity Surgery. 11(3) 303-306. Abstract available online at: http://www.springerlink.com/content/9m1v493335135338/

Whitehead R.G. Dietary Reference Values. Proceedings of the Nutrition Society. 1992. 51:29-34. http://journals.cambridge.org/action/displayFulltext?type=1&fid=748416&jid=PNS&volumeId=51&issueId=01&aid=748408

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Eating in Secret and Hiding Food

by Christine on June 30th, 2010

filed under Christine's Life Updates, Eating Disorders, Gastric Banding Surgery

Eating in SecretDo you have any “secret” food that is hidden in your house that only you know about?

Do you “hide” food away?

Do you eat in secret?  At night when everyone is asleep? Do you sneak into the kitchen when your kids go outside to play?

Do you feel guilty when you eat certain things, making you want to eat them secretly?

Chocolate candy bars.

I have a stack of them. Mr. Goodbar, that’s my downfall.  My husband doesn’t eat them. The candy bars have nuts in them, which he doesn’t eat.  These candy bars are all mine. I don’t have to compete with a tribe of faster grabbers to snag one for myself. They are mine, all mine!

I have the candy bars on the kitchen counter (I don’t have to fear hubby eating them) but I cover them up with a towel or notepad of paper, etc.

I cover them because I want them to be secret.

I generally only eat the candy bars when I sneak into the kitchen for a water refill when Hubby is safely in the living room. Or, I might eat one if Hubby goes downstairs to play computer games. The eating feels “secret,” which is really silly because I know Hubby wouldn’t care less if I ate them or not.  Usually, I only have a bite or two at a time. I don’t gobble the whole thing down at once.

Eating the candy bar isn’t that big of a deal, really. I don’t want to put anything off-limits to me. I’m not on a “diet,” after all, but just trying to make healthier choices and eat in moderation. Cutting candy bars off entirely would send me into major binge-mode.  That being said, I’ve given this candy bar some kind of power over myself by hiding it, making it “secret.”

HMMMMMM.

Is this disordered eating?
Is this unhealthy?
What would a more positive change to this behavior involve?

That’s the only food I can think of that I hide like that, but in a similar-yet-unrelated tpic…I also hide my laxatives.  There’s a little bit of backstory that I suppose needs to go here. In one of my eighty-thousand-million attempts to lose weight, in a land far-far away, I somehow got it into my head that if food leaves my body quickly, then surely some of those calories would not get absorbed. I was never able to purge (and yes, I tried) but I found some kind of mental relief by taking laxatives.  Big binge? No problem…it’s nothing that four or five extra-strength ex-laxes couldn’t eliminate in a few hours. Owch.

I discovered later that there’s a growing movement to include laxative abuse into the DSM-IV definition of bulimia. In my case, I think that the definition would fit. I think I had bulimic tendencies, even though I didn’tvomit my food. Disordered eating, indeed.

There’s a few things ironic in here. Firstly, it’s ironic that I was even approved for gastric banding surgery. My psychiatric evaluation prior to surgery was a big joke — he never even asked me questions about any history of disordered eating.  Even if he had, I probably would have lied. The second bit of irony: I vomit all the time now, thanks to the gastric band. But oh, there’s a big, huge difference between my vomiting and laxative abuse.  I puke because the food is stuck in the gastric band and I need to get it out. When the food is stuck, I can’t breathe. My eyes water. My heart rate elevates. My saliva starts spilling out of my mouth because there’s no place downwards for it to go.  I do not — I repeat, I do NOT — vomit on purpose because I want to eliminate food that I eat.  It’s the intent that’s quite different between these vomiting versus laxative abuse scenarios.

Since my surgery, my laxative abuse has almost entirely gone away.  I don’t get frantic over the food that I eat because with the gastric band, I just can’t “binge” the way I used to.  I’m not frantic, so I don’t feel any need to “purge” the food I eat.  Even if I have that secret Mr. Goodbar on the counter, I really don’t get worked up about it.  That being said, since my surgery I’ve had problems pooping regularly. This week I realized I went five days without pooping. Clearly, in such instances, a little help is needed. I put Benefiber in every I drink, but it doesn’t help. I’ve gotten “cleanser” lemonade things that haven’t helped.  Grapes, prunes, sundried tomatoes, apples…I’ve tried them all.  Sometimes…a little extra action is necessary. Again, there’s a big different in intent her: pooping because you need to versus pooping to relieve your head after a binge.

There’s a cabinet where we keep all our medications, and the laxatives should go there. But they aren’t there. They are hidden, even now. I know Hubby wouldn’t care about it. I know Hubby wouldn’t use them. But I hide them anyway. Why? Why do I do this? When I take a laxative, it’s always, always in secret. And then I feel guilty for doing so.

Hmmm.

I’m not sure how to resolve either of these issues — the hidden candy bar, or the laxatives. What would be healthier ways of dealing with both of these issues?

Many thanks to Prior Fatgirl (link to blog) for making me think about this today….

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145.5 (79.5 pounds lost) Steering Wheel Gap

by Christine on June 3rd, 2010

filed under Christine's Life Updates, Diet, Food, Nutrition, General Information

MedifastToday I woke up and discovered that the scale was down! Hooray! I think I can now safely say that I’ve lost 80 pounds and am working on my 85 pounds-lost-mark!

It’s the little things that I notice — and love — the most about losing weight. Today I noticed that there is  SO MUCH SPACE between my body and the steering wheel in my car. It’s astonishing!!! I feel so far away from my steering wheel, but I can’t move my seat up because the leg length is just right. I have such a big gap between me & the wheel that I could easily bend my knee and put my foot on the seat (kind of like a halfway “perching” on the seat). It’s strange seeing all that room!  As my friend Sandy said, maybe I need to bring a pillow with me in the car to put on my lap to fill that gap? Nahh, I like the space!

I have had ZERO appetite the last few days. Today is no exception. So…I’m doing the Medifast protein shakes for a day. I remember how disgusted I was after my Medifast period, and how much I craved real food. I know I need the calories, but I’m just not hungry for food. The protein shakes will be a good way to ensure that I get the calories I need, yet doesn’t require that I choose food that sounds or tastes good. So yeah….protein shakes for the day. If I’m still feeling “blah” about food tomorrow, I’ll do protein shakes for another day!

The Medifast shakes were required by my surgeon prior to the gastric banding surgery. You can buy them online at http://www.medifast1.com/shopping/shopexd.aspx?id=155.  At only 100 calories per packet/shake, it’s a great low-calorie meal replacement!  The website also has areal food for sale (like Nutrisystem) but I have never had any so I cannot vouch for their effectiveness. My friend Christy has used them though and has lost 30 pounds with the Medifast meals. I had lost 25 pounds in 8 weeks drinking only the Medifast shakes.

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Gastric Banding: Port Problems

by Christine on May 26th, 2010

filed under Gastric Banding Surgery, General Information

Okay I’m going to get personal here.  I’m going to share with you some photos that, well, I haven’t shared with anyone.

So I got the gastric banding surgery a year and a half ago. With the banding surgery, the surgeon places an inflatable band around your stomach, which can inflate/deflate as needed. This helps curb your appetite and helps to limit your portion sizes. In order to inflate the band, the surgeon accesses the port site. You can read more about the surgery/band/port site by clicking here.

My port site is located just above my belly button, to the right hand side. When I got the surgery, I had to press pretty hard to feel the hard knobby bump that is the port.  My surgeon, the amazing Doctor P, said to me at the beginning, “sometimes my patients ask me, ‘will I be able to see the port through the skin?’ and I always reply, ‘if you can see the port, then you should celebrate because it means you can stop losing weight now!”

Well, that time has arrived. I can officially see my port site protruding through my skin. So for all you people that are considering gastric banding surgery (and I would recommend it; I have had terrific results), I am posting these (gross, graphic) photos to show you what may happen eventually.

Exhibit 1: A view of my stomach straight on. It’s somewhat flat. It doesn’t look that bad, right? I mean, sure, I’ve got a little weight left to lose, but I don’t have rolls of fat.  You can also tell by this photo that the incision areas (five of them) are not even noticeable.

My stomach, "straight-on" view

Well, that’s the straight-on view.

Exhibit 2 and Exhibit 3 (two views to show that I’m not making this up) is what *I* see when I look down towards my toes. No I am not sucking in, sticking my abs out, or doing anything exceptional except for just standing.

The Bulge.

The Bulge again. I'm not making this up.

There you have it. THE BULGE.  I look like I belong to the cast of Aliens, don’t I?!  I don’t believe that I’ll ever be able to do a bikini. (Ha! Imagine…I’m even TALKING about a bikini??) Not with this deformity jutting out of my skin.

I half wonder if the port site isn’t attached properly. It is clearly attached at an angle; I can actually GRIP IT and wiggle it around. I think it’s supposed to be attached flat, against your abs. But I’m not entirely sure about anatomy and the proper way of attaching port sites, so I’m not entirely sure what the deal is. Anyone know?

But here’s the whole point of why I am bringing this up…..

Yesterday I brought two air conditioners into the house (read “Attack of the Mouse” by clicking here). They were quite heavy, so I adjusted the weight of the air conditioners against my stomach/hip for better leverage, especially when I hoisted the heavy objects into the window. In the process, the air conditioner PULLED at my port site.

IT HURT LIKE A MOFO!

I wonder…since I can actually PULL at it with my hands, and because it juts out so much, I wonder if I could actually pull it off its attachment to my abs? Could I tear it right off, like a stripper with Velcro pants?

Today it doesn’t hurt as much, but it was quite tender during Yoga last night. For any gastric banding patients out there reading this, please be aware of potential port problems in the future.  You may want to discuss this with your doctor.

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