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Sunday, March 2, 2008

The Band is not Rocket Science

Well, no, but it is a little more complicated than a lot of people think. It's a simple idea--little piece of plastic, smaller stomach pouch. But it is placed on a pretty complex organ, the stomach, which tends to be grumpy and do its own thing. Plus, it is a very mobile and vascular organ, and it tends to push around things like lap bands if we aren't very nice to it.

Yesterday in my perusals of the LBT board, I came across a thread started by a relatively new bandster who wanted to know how to get better nutrition in liquid form. It seems she likes to be very, very restricted, and had posted another thread about how she never talks to a doctor or even her fill nurse about her weight loss, eating habits or anything, just plunks down the cash and gets filled. And she felt this was very empowering, being in charge like that and getting fills whenever she felt like it--every day, if she wanted, according to her posts. So here she is on another thread, clearly overfilled since she can only get liquids down. I don't think she is a bad bandster, but I do think she is misinformed and the rapid weight loss only encourages the misinformation. Who would want to go back to eating solids and slowing her weight loss if she can take liquids all the time and not be hungry and lose weight rapidly? Never mind the fact that the band is supposed to be a healthier way to lose weight than the pure starvation of the malabsorptive procedures.

It's easy to see how people end up with eating disorders after bariatric surgery.

There is a reply on her thread from another member who I believe is less than a year out and lost over 100 lbs and is below her goal weight. She said she liked that kind of restriction too, and spent "months and months" sliming every day. She found it "helpful". And when she got hungry...Peanut M&Ms. This member posts frequently and I've never read anything this alarming by her before. But it goes to show the boards can be a dangerous place. People offer advice like this frequently. Anything that works to lose weight is fair game. They avoid the Complications section of LBT...don't want to hear about people losing their bands after slips and erosions. And more and more it seems people are accepting daily vomiting as normal for bandsters.

The nutritionists at my surgeons' office give a pretty convincing speech about how vomiting every day is NOT normal and is a reason to get in to see the surgeons ASAP. But this positive reinforcement thing is very hard to combat: why change what you are doing when you are losing weight? Well, the reason is, vomiting makes your stomach twist and collapse itself pretty violently. Most of the force of vomiting is produced by the skeletal muscles of your chest and abdomen and by the diaphragm, but the stomach makes deep twisting movements (I want to say they are beta reflexes...where is Bob Martindale when you need him?) that can move a lapband out of place and prolapse the stomach through the band. Add to that the risk of Mallory-Weiss tears, mucosal erosion and other problems associated with frequent vomiting...there is a long list. But it seems pretty sensible to say that anything that forces your stomach to move a lot when you have a piece of plastic around it that you don't want to move, probably isn't a good idea. Plus, wouldn't it be nice to keep food in your stomach and get nutrition from it?

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