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Wednesday, May 28, 2008

What To Expect for Potential Bandsters

Yesterday I visited my long-time friend and former roommate, who has been considering having lap band surgery for a while now. We chatted a little bit about my experiences and I tried to convey some of the pros and cons of the surgery, and the fact that it doesn't work for everyone, and it isn't magic. But it made me think more about exactly what I would have wanted to know before having surgery. I'm very glad I had surgery, but knowing a few more things would have made the early stages a little less bumpy.

What to expect: Pre-Op
1. Your insurance might require a pre-op diet.
Some people have to have as long as a 6 month medically supervised diet before their insurance approves their band, if they are lucky enough to have insurance that covers it at all. So when planning your time off and when the best time is to have surgery, make sure you find out exactly what the timetable is from your doctor AND your insurer.
2. You'll have a lot of tests. In addition to the standard blood work, physical assessment and history, I had functional testing with a physical therapist, body composition testing, an EKG, a psychiatric evaluation (that I had to pay $400 out-of-pocket for), and then was sent for a sleep study. I ended up with CPAP, which helped my sleep when I was still obese, and helped approve my surgery. Many people also have extensive cardiac and pulmonary testing, and other things as their physical status dictates.
3. You will pay out-of-pocket for a lot of this testing. My insurance covered some of it, but I still ended up paying about $1500 for the pre-op testing. Your mileage may vary.

1. Surgery on morbidly obese patients is technically difficult.
You should expect all the staff you encounter to treat you with respect and dignity and never make you feel bad, but if it seems that they are making a lot of special preparations for you in the operating room or before, it is because they want to make sure you are safe. Like it or not, surgeons and anesthesia personnel who treat the morbidly obese expose themselves to a higher complication rate and a higher litigation rate because so many more things can go wrong when treating MO patients. As such, try not to take it personally if you notice a lot of preparations being taken. It is for your safety. Things might not go perfectly in every way, but try to realize that medical treatment is performed by humans who are trying to be as perfect as possible, but still are not perfect.
2. Some people have a lot of pain after surgery, but most report that it is less painful than anticipated. A lot of people have this surgery as an outpatient procedure, meaning they do not spend the night in the hospital. They have as good outcomes as those who stay overnight, although I'm glad I was able to stay just the same.

1. You will not be eating normal food for at least a month.
The post-op diet varies according to surgeon, but usually goes something like this: 2 weeks of liquids only, 2 weeks of pureed food, and 2 weeks of soft foods. The reason for this is that your stomach is sutured around the band, and everything needs time to heal, form scar tissue, and create a "groove" around your stomach for your band to sit in. If you eat regular food too soon, the stomach has to "churn" to digest it, and this can disrupt the healing. This disruption can lead to the band becoming dislodged later. At best, that means your band gets unfilled for a month while the stomach heals, which sucks. But at worst, you have to have the band removed emergently, and your stomach may be at risk for permanent damage. You want to do whatever it takes to make sure your stomach heals properly and your band does not become dislodged. That means following the post-op diet as prescribed.
2. Following the diet isn't easy. The band is not yet filled with fluid when you first have surgery, so it is not really 'working' yet. The band works when it is tight enough to keep food in the upper pouch of your stomach, and for most people that doesn't happen until they have had at least a couple of fills. Even if just the band itself is providing restriction, the liquids and purees go right through, and you will feel hungry. In addition to feeling hungry, your brain will be telling you that you want to eat food. That's what it has done for years, and that's part of how we got to the point of having bariatric surgery. Do whatever it takes to get through this period and stay on your diet. It's not for long, and as long as you take good care of your stomach and your band, you won't have to go through this again.
3. You might not lose any weight in the first few months after surgery. Most people expect the weight to start "falling off" like with gastric bypass patients. Often times we tell all our friends and family that we had this surgery, and then post-op they expect us to be losing tons of weight. This can create a lot of pressure for us. Most people lose some weight when they are on liquids, but gain at least some of it back when we start eating "real" food. They say that any weight lost in the first month, or even first few months until we've had a few good fills, is "bonus" weight. This time is for healing, not weight loss.
4. You probably won't feel any different in the time between healing to the point of no pain post-op and having enough fill to feel satisfied on small meals. During this time, your hunger will be the same as pre-op, and you'll probably be "able" to eat much more than you think you should. You might even wonder ,"What did I have this surgery for anyway?" Be patient. This is a slow process. Use this time to learn the bandster rules for eating, and try to keep the amount of food down to what your doctor prescribes for you.

Weight Loss, and Life with a Band:
1. Weight loss happens more quickly in the beginning
(once you've achieved a good fill level and are losing weight for real) and slows down as you get closer to goal. The more you have to lose in the beginning, the faster the weight loss will be, as a general rule. The average weight loss for a band patient is supposed to be about 1-2 lbs per week, but a lot of people who start out with BMIs greater than 45 can lose much more than that in the beginning. Then it starts to slow down and they wonder what they are doing wrong. This happens, and it's a natural response for your body.
2. Plateaus will happen. They are normal. They are the body's way of saying, "Whoa! What's going on? Let's conserve resources before we lose them all!" I don't know any secrets to getting through plateaus. The best suggestions I have are to watch very carefully what you are eating and doing, keep track of calories every day for 3 or 4 days (I use fitday.com, others use sparkpeople or daily plate) to see if you are getting more than you think you are, measure food with measuring cups and/or a food scale, and do something differently. Maybe you've gotten used to a certain breakfast that isn't working for you, or you've been doing the same exercise routine for weeks and your body is used to it now. Some people increase their calories for a few days, then drop them a little lower than before to stimulate weight loss. A lot of people talk about the "starvation mode" that you supposedly go into when your calories are low. I don't know that I really believe in that, personally. Plenty of people are starved against their will, and they lose weight. Not that I am advocating a starvation diet, but I'm just saying that I think this theory is more of a way to justify eating more. Just my opinion.
3. You can "eat around" or outsmart your band. You'll discover that a lot of foods that we liked eating before being banded go down JUST FINE even with very good restriction. Things like ice cream, cookies, chocolate, etc.--go down, no problem. This will sabotage your weight loss. One thing that happens to a lot of people is they get to a very tight restriction very early after surgery, and they have trouble eating solid protein and good, nutritious bandster food. Because they can't eat what they are supposed to eat, they start eating what "goes down" instead--high calorie, non-nutritious junk food. They don't lose any weight, but they are restricted, so much that they frequently barf up food that they are trying to eat. The solution is to have some of the fill taken out, so you can tolerate the foods you should be eating. This is often what has happened when you meet a person who has been banded for over a year but has only lost 30 lbs.
4. The band is on your stomach, not your brain. "Head hunger" is a problem for all of us. You'll be surprised, once you start paying attention to your actual physical hunger, how often we eat when we aren't hungry. You'll have to learn how to deal with this in ways other than eating if you are going to be successful with this.
5. The band won't do all the work. Some people keep getting fills until they are so "tight" that they can only eat a few bites before they vomit something up. This is not healthy--over time, that tight restriction on your stomach will cause problems, either from the band eroding through the stomach, or the stomach slipping through the band, which cuts off blood circulation to your stomach and is a medical emergency. The trick is to learn the proper "sweet spot" for restriction--the level should be at the point where if you eat a proper bandster meal, you stay satisfied for 3-4 hours.
6. "Satisfied" is not the same as "full". You shouldn't be eating to the point of "full" any longer. It takes a while to learn this. Most of the work of weight loss with a band is the mental game--making the right choices, not eating when not hungry, not snacking frequently. The band is just there to keep you from feeling hungry--I think of it as a mechanical appetite suppressant.
7. You must exercise. Science hasn't decided how much exercise really helps weight loss, and it's certainly possible to lose weight without exercising. But exercise will help preserve your muscle mass so that you lose more fat. Exercise will also make you feel 1000% better. Start out by walking, as much as you can tolerate, and work up from there. As you start to notice your workout is getting easier, increase the time or the intensity. Believe me, if you learn to make exercise a daily part of your life, you will reap enormous benefits from it. There are a million ways to do it, incredibly busy people find ways to do it, you can too. You owe it to yourself. I think I owe a lot of my weight loss to my exercise. But even if it didn't help me lose weight at all, it still makes me feel so much better, I can't go without it.
8. Don't listen to the haters. People might ask, "Why don't you just diet and exercise? Why do you need to do something as drastic as surgery?" Or you might meet people who are jealous of your weight loss, or tell you that surgery is "cheating". You can't waste your energy on this. You know why you did it, and you don't have to tell them your reasons if you don't want to. It's good to have a spouse, family member, or good friend on your side from the beginning, but some people have to start out with no support, unfortunately. Usually, the people who really care about you are scared by what they have heard about WLS (usually about gastric bypass) and don't want anything bad to happen to you. To those who are close to you, tell them what you know and why you decided it was best for you. You don't have to discuss it with anyone else. I didn't tell most people I knew about my surgery until after I had it. By then, it was too late for anyone to try changing my mind. People mean well, but they don't understand what it is like to live in your skin, or how long you have been thinking about how to deal with this. That said, make sure you have examined all of your options thoroughly before you decide to have surgery. As fellow blogger Melting Mama says, weight loss surgery is not a cure for life.
9. This surgery is not for everyone. It requires more effort on your part, especially in the first year, than any of the other weight loss surgeries. You have to watch what you eat, and exercise. You might not tolerate certain foods any longer. Many bandsters can't swallow chicken, bread, asparagus, pineapple, popcorn, fruit with skins (like grapes or apples), or any meat that isn't very, very moist. Stuff that gets gummy or doughy might get stuck, and that is painful. If you eat too quickly, don't chew well enough, eat too big a bite, or eat something that doesn't go down well for you, you can barf (some call this a PB, or productive burp, because it's just food, no digestion has occured). A lof of barfing is bad for your band, so you want to avoid this at all costs. It's harder to get your nutritional needs met because you are eating so few calories per day (as low as 800 to as many as 1500 calories a day, usually). And the weight loss can seem slow--but this is also a benefit, since rapid weight loss tends to produce the "cancer look" that some RNY patients have. You have to be willing to make changes in your lifestyle. This is a lifetime thing. But, I think the benefits are absolutely worth it.

Wow, that was much longer than I expected it to be. I hope it's helpful to someone. Some of this stuff you find everywhere, I guess, but some things I never heard before I was banded and had to learn on my own. Good luck to everyone out there.


She Smiles said...

This is a brilliant post. You're a good friend for sharing this information with your friend, and wonderful for sharing it with your blog readers!!

Diz said...

Totally awesome! Thanks for the words. So far the exercise is dialed in, the pre-op diet, and i have a date. I've got to remember to eat slow and chew to mush. Not worried about haters, cuz I only told 4 people. They are totally supportive. I'll be checking back on this blog often. I appreciate you.