Revision

I'm glad I didn't call this "Gwen's Lap Band Journey" or something like that.  The lap band will soon be history.  I am learning that these days, the lap band is much less favored since the most recent long term studies are showing what I have experienced...only 30 to 50% of excess body weight lost at best.  Many have a lot of reflux or other complications, but I have not.  I just am not losing weight with it.  So, the paperwork has been submitted for revision, it appears that Aetna is likely to approve it since I meet their requirements, and once that has happened I will schedule surgery (on a Saturday, since I am having surgery at my place of employment--I don't like everyone knowing my business.)  I am taking as little time off as possible.  In fact, I plan to be back at work within the week.  I took a lot of time off for my lap band and it really wasn't necessary.  I have no benefit time now, due to issues with my family, and I can't afford to not work.  My job isn't sedentary, but I think I can get my circulating nurses to push the stretchers for me for a week, and beyond that I don't really have much physical work to stress about.

What remains is to decide exactly what the revision should be.  Both of the surgeons I have met with have suggested the vertical sleeve gastrectomy, a popular revision choice from a lap band.  The surgeon who will perform my revision is someone I work with fairly often and I have a lot of confidence in his skill, plus he's a good person.  Dr. D is sure he could perform the lap band to VSG in a single surgery, but if I choose a RNY it might have to be 2.  My thoughts have been that my metabolism just isn't strong enough for a mostly restrictive procedure.  (VSG is considered to have a very small bit of malabsorption involved due to the loss of gastric secretions.)  On the other hand, I know a lot of people with RNY, and it seems most of them have regained significant weight.  Still, the long term studies are still showing 50-70% excess weight lost at 5 years post op.  50% for me would put me at my pre-pregnancy weight--higher than I want to land at, but not terrible.  70% would put me at my lowest lap band weight, which would be fantastic.  So my question is, am I able to be one of the 50-70% people?

My current thinking is this:  if he gets in and sees that he can do RNY in a single operation, do that.  If he's going to have to come back for a second procedure but he thinks he can do the VSG at that time, do that.  The VSG is easily revised to RNY or DS if needed later.  So if I am going to need 2 operations anyway, it makes sense to do the sleeve and hope that's all I'm going to need.  I really, really don't want another surgery if possible.  I have a lot of stuff to do and laying on an operating table isn't on that list.  I'm supposed to be at the head of the bed with the machine, on the other side of the drape.

It's on my mind a lot.  I'm back on the Obesity Help site for the first time in several years.  Things have changed around there, although it seems the drama between the different types of WLS is still there.  And apparently the lap band folks who haven't been revised are kind of defensive about the band.  Whatever.  I don't have time for weird internet forum madness, I just want to make an informed decision about my own surgery.

Meanwhile, Lucy has just turned 2!  She had a rough day today--partly being sick, and I think partly just being 2, and some family stress taking a toll on her as well.  But usually she is happy and fun.

Not Friends

My band and I are not friends.  I've finally concluded that.  Perhaps if I can get back to some reasonable level of restriction again, this will work for me.  But I haven't really had much benefit from my band since immediately post-partum (and the baby will be 2 next month).  I have been seeing the PAs at my surgeon's office.  My surgeon is down to just one surgeon, herself, and she has 2 PAs and the bariatric endocrinologist.  The PAs are both pretty new to practice, and do not look like they have ever struggled with weight.  I'm older than both of them, and I'm not even 40 yet.  Anyway, I have been in about 6 times since Sept 2010, and have had fills ranging from small to infinitesimal.  They give me very little information about how much is in my band or how much they are giving me--I think they don't want patients to fixate on the amount that is in the band.  But I'm pretty fed up.

Here's the thing that I would tell anyone else interested in a lap band.  You will need to see a surgeon who specializes in bands for as long as you have your band.  That sounds simple when you are looking into surgery.  Why would that be a problem?  But the chances are very slim that you will always live in the same place and have the same insurance.  Even if you have the same employer for the rest of your life, they change their insurance plans all the time.  You may start out with your aftercare covered, but later on that changes.  And if you find yourself without your fills covered, you are looking at anywhere from $150 to $300 or more per visit to adjust the band.  If you have complications during a time that you don't have insurance coverage (you may, in fact, never have insurance coverage, like a lot of people with this surgery), you may have to pay out of pocket for surgery to revise the band, replace the port, or remove it altogether.  There isn't a good way to predict what will happen in the future or how you will be paying for it.  These days you can't even predict whether you will have a job or a home, much less insurance coverage for bariatric procedures.

The band requires a lot of adjusting, and this takes time, and money.  I feel like every fill I have gotten since I delivered my daughter has done absolutely nothing.  I still get hungry after 2 hours.  I can still eat anything, and a lot of it.  I'm still gaining.  I'm not going back to the bariatric endocrinologist, because I don't think he has much to help me with.  The last time I saw him, he broke it down like this:  I can eat 1100 calories a day if I want to lose 0.5-1 pound per week.  AND I need to eat at least 75g protein per day.  If you take the general rule of thumb that surgeons use, a good quality protein source should have 10 calories per gram of protein.  (Of course, protein itself has 4cal/gram, but no one eats food that consists SOLELY of protein.)  So that would mean I get 750 calories of high protein food per day, and about 350 calories leftover for the rest of the day for fruits and veggies (they actually don't want me eating fruit at all, which I don't think is that healthy or sustainable).  I'm not willing to stop drinking coffee or to stop putting cream in it, so that is a few calories right there.  Basically, I don't find this plan sustainable.  He might be right, that this is what my body will require because of my specific metabolism.  He may also be right that I should be concentrating on weight training, not running at all, and taking L-carnatine supplements.  But basically this plan seems extremely bleak, and definitely not possible without a lot more restriction.  So, I'm going nowhere here.

The last problem is one I have alluded to, that my insurance doesn't like me going to my surgeon.  They pay at the out-of-network rate, but only with a lot of complaining, even though they are only asked to pay for the equivalent of an office visit.  I'm lucky they pay at all.  They want me to see the bariatric people at my employer, even though they don't actually do bands at all.  They have a nurse practitioner that manages their band patients, but they don't place them.  Still, I've decided to go this route, because I'm tired of the hassle with Aetna, I don't feel like I am really getting what I need at my surgeon's office, and because I am strongly considering revision surgery anyway, and that is where I would be able to do it.  So next week I go see the nurse practitioner for a fill, hopefully a decent one, before she goes on maternity leave.

Would I do this again?  No, I don't think I would go with something that requires such constant attention as the band.  It has just been too difficult between changes in employers, insurance, and providers, to get the consistent care I need, and frankly it's too hard to get to the office so often with a small child at home and a full-time career.  I still don't think I want a Roux-en-Y.  I'm not sure what the best solution is for me.  I just know that my body needs a frighteningly low amount of fuel per day to keep me at a healthy weight, and I can't do that on my own.

More Information

It turns out that it's not "just stress" that makes me exhausted all the time.  (I put that in quotes because people say things are just because of stress as though stress is an imaginary entity, something that doesn't really exist and have actual impact on our physical bodies and world.)  My hematocrit is low, and my iron is extremely low.  That's not something that happens overnight, that is a chronic issue.  So, a good recipe for creating iron deficiency anemia is to be vegetarian for 20 years without paying much attention to what you are actually eating, have a diet high in carbs and not much iron rich food source, then lose 70 pounds, shed a large portion of your lean body mass, then get pregnant and breastfeed, all while adding ever-increasing stress to your life (especially the constant escalation of stress involved with living with someone in active addiction).  Seems legit.

My iron is low enough that my doctor wants me to skip the oral supplementation and go to IV infusions, 5 of them.  I hope that this will help increase my energy level a little, although I'm sure it's not the only cause.

I'm tired, but not just physically.  I am spiritually tired.  I have nothing left to draw upon.  I've been thinking a lot about how to get self care back into my life.  It's something that has slowly gone by the wayside, and I need to renew myself.

May Day

I've had nothing really to say in the past few months about weight loss.  I'm very discouraged.  I've gotten some fills, but still can eat plenty.  I try not to anyway, but my life has been so incredibly stressful in the past few months, weight loss just has not seemed like any kind of priority.  I'm hoping things are starting to take a turn for the better, but I have such a long way to go with weight loss.

One of the most discouraging things was being told not to run, that I should be doing resistance training instead.  I can walk, or swim, but no running until I have more lean mass.  It's extremely frustrating because I don't seem to be able to fit resistance training into my days.  I'm experimenting a bit with bits of resistance within my day--not going to a gym, but things like pushups, squats, stuff you can do with a few spare minutes.  But I feel very frustrated that the things that are easiest to fit into my schedule are things that I shouldn't be doing.  It seems like I should do whatever exercise works for me, but apparently not.

It would appear that the past few years have not been good for my lean body mass.  I lost 70 lbs, between the band and running.  That was apparently largely lean muscle that I lost.  Meanwhile, I was in grad school, probably not helping the cause much. Then I got pregnant and had a baby.  More lean mass lost, and fat gained.  And now I have a baby/toddler.  I now know why new moms have a hard time losing baby weight, because it is so difficult to find a good way to fit exercise into the day when you have so many new responsibilities, plus all the old ones.  I'm trying to be creative and flexible about it, but it is very, very hard.

I'm still gaining weight, and depressed about it.  My eating, frankly, needs a lot of improvement.  My restriction could improve, but I just feel really discouraged by my exercise restrictions and limitations and by the band itself.  I recently had a surgical patient who had had a DS (switch) and have really considered whether I should pursue revision surgery.  If I was certain that I was not going to have any more babies, I would do it right now.

So there it is.  My daughter is doing great, 19 months old now and adorable, so much fun to be with.  My job is good.  My husband has been struggling, but is doing a bit better now. I'm just exhausted.

Updating

Well, I am stuck in this rut, which is why I haven't had anything to post. I'm very discouraged. I have been at the same weight essentially since Dec 2010.

I have tried several things in the past year and a half, but it seems like nothing is going to really help until I can exercise more regularly, and I just can't do anything regularly right now, between my job and my toddler. I was actually ready to give up on the band entirely and look into having a revision to something else.

I joined Weight Watchers again, mainly because my employer requires one of four "health improvement" options to keep benefits premiums down (you can elect not to do any of them, and pay a higher premium the following year-5 or 10% more). I find that I don't journal my food regularly and once a week weighing isn't great for me--I'm better with daily weighing, so I can't cherry-pick which weight I want to record. But it's free, and it does help me keep track when I can remember to journal.

I had my last fill in January, and they recommended I have metabolic testing done. They have a bariatric endocrinologist at the office now, and he sees patients whose metabolism turns out to be low enough for treatment. Mine was 88% of predicted, which turns out to be not that bad, but not great either. He didn't recommend medical treatment (i.e. ephedrine). He looked at my fill history and noticed that my current level is much lower than when I was losing weight, and they have only been doing tiny fills every 3 months, so he was going to talk to them about being more aggressive with adjustments. He said my lean body mass is quite low. I'm guessing I have had a series of events that have caused me to burn muscle--including stress (grad school, personal issues), significant weight loss, running, pregnancy, and breastfeeding. He recommended I do NOT run right now--he felt it's okay for maintaining weight loss but while losing weight will not allow me to rebuild lean muscle--I should do resistance training and walk (use a pedometer, 10,000 steps a day goal). According to my testing I need to eat about 300 calories a day fewer than I am, and to do that I will need more restriction.

So I feel a little more hopeful that the band can still work for me. I did get a pedometer and find that I generally walk about 10,000 steps (or more) at work, but not so much on my days off, so I am working on that now. I took Lucy for a long walk this morning after breakfast and already have taken almost 7500 today.

We'll see. I hope that getting back up to a better restriction level will help me out. It sucks being at this weight--I'm still 35 pounds less than when I had surgery, but 40 pounds from my goal. Even losing 20 would make me feel a whole lot better.

Random Thoughts

Yes, I've been away. Between work and my toddler, I don't get much blogging done! (Or really any computing.)

I have had some posts percolating for some time, but at this time they seem to be just little thought bubbles, so that's all I've got.

-I secretly want to be a mommy blogger. I follow a ton of crafty-mommy blogs, and I don't know how they do it (or if they even do it, or if they are faking!) but I am amazed. Maybe they really have secret helpers or elves that do the magic behind the blogging curtain. I'd love to spend my days hanging out with my girl and making fun stuff. And decorating my house, and doing all this crazy DIY stuff. But, yeah. I'm doing pretty well just to read their blogs from time to time.

-I read an article recently on CNN that was titled something like "Horrible guests, vegetarians, and other Thanksgiving nightmares". I think the title wasn't quite that nasty, but that was the idea I took away from it. I'm an omnivore nowadays, but I spent over 20 Thanksgivings as a vegetarian. Why is a vegetarian at Thanksgiving dinner such a nightmare? For every snooty, finicky, self-righteous vegetarian, there are at least 20 who want nothing more than to enjoy your company and a nice meal, and who will do anything to avoid you stressing out over feeding them. It's not that big a deal, really. Thanksgiving dinner to me has always been more about the sides than the bird anyway.

-The difference, for me, between now and when I was losing weight is not what I'm eating or even my level of restriction, it's running. I was running at least 10 miles a week when I was losing weight. Now, well, running has been sporadic at best. It's very hard to find time to run on top of everything else. I've experimented with getting up earlier on days I work (like 4:45) to get in a run, and that has worked best, but this week it wasn't really possible between working and staying up late cooking for Thanksgiving. Next week, though, I hope to get back at it. At least I'm not gaining. I am hoping to lose 5 lbs by the end of the year. Not gaining would be a minor victory.

That is all for now. Happy Thanksgiving y'all.

Frustration

Well, I'm super frustrated with weight loss. I have been gaining and losing the same 5 lbs for months now. In fact, I've been at this weight for nearly a year and it's making me crazy. I've tracked my calories, and I'm paying attention to urges for mindless eating. I'm NOT getting regular exercise, because I still haven't figured out how to fit it into my schedule, but I am working on it (looking at biking to work, and I'll be going to shorter shifts soon so I'll have a bit more time on work days). But I think exercise is a fairly small part of the problem. My stress is probably a big part of it.

One of the big stressors is the house hunt. In June, we signed a 1-year renewal on our lease of the house we are in. In August, our landlord announced he was selling the house. A few weeks later, we got the foreclosure notice from his bank's attorney. Needless to say, this threw us into a tailspin. We had wanted to buy a house, but were planning on a year from now. We just spent all of our money on treatment, and we have huge amounts of debt. But, when we looked at the situation, we realized that going to another rental is likely to end up the same way, since so many houses for rent right now (especially the nicer ones) are first homes of people who bought something else and couldn't sell their first place, and many of these end up in foreclosure.

There actually turns out to be a lot of upside to our situation. We consulted a couple attorneys (our landlord is an attorney, so we wanted to be sure of our position) and found that current federal law protects us because of the foreclosure. In fact, in many ways we seem to have more rights than the owners. Once foreclosure proceedings began, our lease became protected even if the house is sold or auctioned. Also, we were able to use our deposit--all of it--towards rent, because in either a sale or auction there is nothing compelling the original owner to return our deposit for any reason. Many people have told us we can "squat" here, not paying rent at all now, but that isn't true unless we don't care if we are evicted. And we do care, because we are using this time to look for and purchase a home, and we want to have this place to live in until we close on a house.

So, it's good--we are buying a house!--and we will end up paying less for the mortgage than we do in rent, but it's quite stressful nonetheless. We might buy the house we are in, since we love the location so much, but that is not a certainty by any means.

We are accustomed to having a lot of stress in our lives, and we are trying to learn how to cultivate serenity instead of chaos. I am hopeful that this process has a side effect of helping me to change whatever behavior is keeping me from losing this weight.

A couple weeks ago, our Lucy turned 1--I can't believe it. We had her first birthday party, and it was much bigger than we had intended, and it was exhausting for all of us, but fun. It was a pretty traditional party--kids, presents, cake, chaos--but we decorated with Indian elephants, to celebrate her heritage. She had fun, although she was frequently overwhelmed by everything happening around her. We dressed her in the cutest baby sari that I found online. Super adorable. When I get the pics off the camera, I'll post some.

Summer Pics

Two-Legged Life Again

I am out of my boot, my xrays show good healing bone, and the sprain is mostly healed. My ankle still gets a bit sore, but I went back to work this week and it went fine. It's kind of good, actually, after almost 8 weeks at home, to be back at work, although I've enjoyed the summer spent with Lucy and the past few weeks with hubby as well. I was afraid of losing my skills at work, so it's good to get back to it.

Being laid up for a couple months, or at least having less than usual activity, isn't great for weight loss. But I think I am getting to understand my emotional triggers for eating a lot better now. There is a lot of talk in the WLS community about "emotional eating" and that basically seems to refer to eating for any reason other than actual physical hunger. This, I have found, is a vast generalization, to the point of becoming meaningless. Emotional eating? Most eating is associated with emotions. The advice given is that one should start therapy and get a handle on their "emotional eating" before going through with WLS.

This is well-intended advice, but again, I think it is a bit meaningless. What I am learning about myself is that I have a lot of underlying anxiety. My daily life, in fact, is filled with a lot more anxiety than I have ever been conscious of before. I don't notice my anxiety because, A, I am so used to it and have lived with it for so very long, and B, I self-medicate before I notice that I was anxious. Frequently the self-medication is food, but not always. I also read, shop, or sew or do other crafts. None of those things is bad in itself, but they do help me continue to ignore the anxiety that led me to those activities in the first place.

I'm hoping that as I start to notice myself suddenly get "hungry" (which is actually "appetite", an emotional trigger, rather than "hunger" which is physical, and comes on gradually) and realize that it is often because I am experiencing some anxiety over something, that this triggered eating will diminish. My weight loss has halted again, and I suppose I should also determine if I need another fill. I don't think I really do, I think that I do more eating when I'm not hungry than I realize. So, I am more focused right now on improving this area of life.

I'm pretty frustrated by this weight loss thing, to be honest. I am still 20 pounds above pre-pregnancy weight. I would like to have another baby, and I don't have much time to do it, but I can't fathom getting pregnant at this weight for a starting point. It's depressing. Getting back to the gym should help a little, though. And we are doing pretty well about following the goals I listed in my last post--preparing meals at home, eating at the table, eating lots of fruits and veggies. Lucy is doing much better with her solids and pretty much eats what we do.

I'm not saying much about hubby's progress because it's not my place to do so here, except to comment that he is doing much, much better and we are feeling much more hopeful for our future. I'm very happy to have him home and on a better path.

"Normal" Eating?

I was raised by an anorexic/bulimic. This isn't a secret, and if my mother read this, she would agree. Her mother was also an anorexic, and felt she was overweight at 90 lbs. My mother knew the ins and outs of her eating disorders before I was even born. It was so not a secret, in fact, that she explicitly inducted me into the club as a pre-teen (or as they are called now, "tween"). She taught me, in clear language, that "this is what women do": diet to be thin, purge if necessary. I don't think this would have come to me naturally without coaching; I was and am much more prone to simple overeating. But this was my instruction, and I followed instruction until I realized that it was making me sick and miserable. This was around age 16.

Now I am raising my own daughter. She is only 9 months old, but I realize that she is already learning how to eat from me. She has been slow to take to solids, and it became clear early on that she was mostly interested in things she could hold herself, and things that her dad and I were eating. No baby food or purees for her. She wants real stuff. She often isn't interested in food at all, anything I offer her, so we skip a lot of "meals" since she is getting her nutrition from formula still. At least once a day I put her in her high chair and eat a meal with her, but it's rarely 3 times a day.

This isn't just her, though. I don't really eat "meals" when left to my own devices. Since I was banded, it seems like so much trouble to go through to prepare a meal for just myself when I'm only going to eat a cup or so of food. It's a lot easier to pick something out of the fridge that will keep me satisfied for the next several hours. And lately, those choices have not been particularly band-wise.

I realize this isn't normal. And while in a lot of ways it makes sense for me, my daughter is not banded. If she is lucky, and has good, healthy instruction in childhood, she will never need to consider something like that. But how do I teach her normal attitudes about food? How can I teach her how to choose a normal, healthy meal when I don't really know what that is myself?

My mother cooked meals for us, don't get me wrong. There were plenty of nights we ate out, or ate TV dinners, but usually she cooked dinner, we almost always had a packed lunch, and sometimes on weekends she would make breakfast. She is a good cook. And I give her a lot of credit for feeding us healthy foods and not letting us become picky eaters. We always had a good variety of foods, and when I ate with friends, I was always the least picky eater of the bunch.

I don't know why I have this aversion to preparing meals on a regular basis. I do, but I don't understand it. But I'd like to overcome it and teach Lucy healthy attitudes about eating. I think it is probably "normal" to have parents who cook or prepare most of your meals, to usually eat at least one meal together, and to eat sitting down, slowly. Not scarfing down something over the sink (I do that regrettably often). It's "normal" (I think) to learn when you are full and not be forced or cajoled into eating more than that amount. It's "normal" to mostly eat freshly prepared food (that is, not packaged/store bought/restaurant food) and to have sweets only "occasionally" rather than with every meal or every snack. Am I right? Am I missing anything here?

I don't eat normally. My husband doesn't either; we both are in the habit of grabbing something when we are hungry. He is better about it being something healthy than I am. He is more of a cook than I am, especially an everyday cook. But maybe I could make some sort of list of eating goals, and work toward them slowly, with a goal of modeling more "normal" eating than I had modeled for me? (Because, despite all those home-cooked healthy meals, the majority of the eating that took place in our house was anything but normal.)

Goals:

1. Cook dinner at home most nights.

2. Eat a variety of vegetables and proteins

3. Have fruit instead of sweets

4. Prepare healthy breakfasts at home (this I'm reasonably good at, especially hot cereals)

5. Eat slowly, at the table

Those seem like pretty normal goals. Any other bandster parents have comments to add? I have an opportunity to break or diminish the cycle, as my daughter is still a baby. I don't want to screw it up.