“Too Much of a Good Thing…

…can be wonderful”, according to Mae West. Unfortunately, too much of a good thing can also be dangerous. As in having way too much fill in your Lap-Band.

I thought that maybe I had too much, but soldiered on, hoping I was wrong – hoping I’d just settle into the fill and things would adjust. Unfortunately, it progressed to the point that I was sleeping many nights in a chair because if I slept in a bed I awoke frequently with a mouthful of barf. Yeah, it was as pleasant as it sounds. Still, I kept going – I stopped eating after 7pm. I started drinking Maalox before bed. When my ear pain wouldn’t go away and I finally realized it could be a result of the STOMACH ACID washing into my EAR CANAL, I finally got the message and made the appointment.

What kept me going on for so much longer than was healthy for me? I keep asking myself this. I think it was sheer desperation. I was hoping for the Band to do more for me than it can. In some (most?) people, it does restrict portion size enough for them to lose the vast majority of the weight without having to work too hard, meaning that the Band provides an overfull feeling that is quickly learned and also prevents them from eating breads, pasta and the like. For me, about 25 pounds came off that way. The next 30 came through lots of hard work. Unfortunately, I still have another 80 pounds to go.

I am coming to terms with my reality. And I know I have other issues as well – the fibromyalgia and the subsequent pain and fatigue is a big cause of the weight gain. Emotional issues are big as well, and I’ve been doing a lot of work on those.

So, I had 0.7cc’s taken out yesterday (about THREE fills’ worth - sigh). I was tight enough that I even had to go down the hall and drink barium for a fluoroscopy for the first time ever - somehow that felt like a failure. It does feel good to not feel like I have a lump in my throat all the time, and to feel like I can sleep and function without barf shooting up into my mouth and ear (small pleasures – ha!). But, now I’m terrified to eat. This month, I’ve lost 8 pounds and have seen a huge shift in my body shape (this seems to happen every 15 pounds or so). I’m down a size in clothes (finally) and seeing great changes. I know most of this has come from all the steps I’ve made, but I also worry that the only way I've done it is by having my Band so tight. As I’ve mentioned before, not only does the Band not give me volume control, it does not prevent me from eating ANY kind of food. I have worked so hard this month: cutting my portions in half, exercising, taking care of myself, exorcising my demons…..I am terrified it will all go away. I know that if I keep my focus, it WON’T go away. I have to trust that I’ve learned enough and made enough progress to keep this up.

Restriction Rant

I have finally figured out that I am one of the (few, I think...) Bandsters who never experience "true" restriction: you know, the kind we were all hoping for when we had this done, the kind that says "you're full!" just before you PB, the kind that controls your portion size for you. Also, the Band is supposed to make it darn-near impossible to eat bready/starchy foods and even some uncooked vegetables. Nope. Not even now when I am way too tight do I have those limitations. I don't eat bread now because I don't want to, and it CAN get stuck, but it's not on the "never list".

I do have more restriction than being totally Band-less, sure - but it's not enough to get me to lose the weight. I do have a limit to how much I can eat, and will PB if I eat more than I should. Unfortunately, in order to lose, I apparently need to eat much much less than my Band will "let" me.

In search of this elusive restriction, I have gotten myself too tight. I really need to go in for an unfill. I'm sad about this, because it's been so hard to lose the weight, but I know it's the right thing to do - having stomach acid wash up through my esophagus a few times a day can't be healthy long-term.

I know, I know, "the Band is just a tool". I hear ya', and I knew that going in. But if we admit it, don't we all wish for it to be easy enough? I mean: you watch the quality of your food, and the Band watches your portions for you and then, voila! - all the weight is gone? I know the last 20 pounds are supposed to be hard, but the last 90?

I really didn't want to have the Band AND be on a strict diet, too. Especially reading some people's wonderful accounts of how easy it's been for them to lose the weight, and the Band was just that last thing they needed. I know the Band has been good for me, and it DOES really help me stay full between meals - a very critical ingredient in diet-adherance. But, I was really hoping it wouldn't be so hard - not this early in the journey anyway (weight-wise).

At least now I know - no matter how tight I am, it won't be enough to lose weight without dieting. Not the truth I wanted, but the truth nonetheless.

In Half

Half a Protein Bar
Sigh. It's come to this.

I'm still struggling to shed the weight I want to. I'm walking (briskly) regularly, tracking my food carefully (birthday cake, Jitterbugs, and all) - and never going over my "recommended" daily intake, and I've given up eating after 7pm.

Still, the scale Does Not Move. Rather, it does move, but in a bizarre pattern: it plunges down 4 pounds, then shoots up 6 pounds, then limps back down a lowly 0.5 pounds at a time. At times, I wonder if I should look around for a hidden camera. Or, buy a new scale.

Part of the reason I got the Band was portion control. My understanding was that you'd learn quickly how much was "too much" and would even barf if you ate too much on accident. I also cut my portions in half.

Problem is, I can still eat much more than the 1/2 to 1 cup of food at each sitting that Bandsters are only "supposed" to be able to eat. More fills don't help (in fact if anything, I need a little bitty unfill at this point). Just a word to those out there getting the Band - for some of us, it doesn't really restrict portions. It DOES help a lot with hunger between meals, and my meals are much much smaller, but from the scale's perspective, apparently they are not small enough.

So today I decided to cut all my food in half again. I really hope this works.

By the way, I've started using My Daily Plate to track my food. I used to use Fit Day, but the amount of data entry I had to do was daunting. My Daily Plate allows people to upload things to the group database (increasing your chances of finding a food you've eaten), and it also has data for many restaurants and grocery store items. [h/t to Beth for the suggestion!]

"Filling" In

I had another fill today. This brings me up to 8.5 in my Band. At the office, I was down to 277.4, a loss of 2.5 pounds since my last fill 3 weeks ago. So things seem to finally be moving. I've decided to use the clinic weight as my "official" weight, because our scale here seems to be a bit flaky. The scales at the clinic are finely calibrated to 1/10th of a pound, so I'm going to use those. I'm thinking they're a bit more reliable than the Target clearance-aisle scale I have here - the one that is frequently jumped on by my boys and has sadly seen more than its share of over-flowing bathwater.

I made a graph with my stats that should update dynamically every time I add new data. It's probably about time for some pictures, too! What do you think? Is anyone still out there? I think I'm just now getting the hang of this band thing....

So, the Lap-Band Update

Well, since I last wrote anything of substance about it, I have had two fills. And boy, have they finally made a difference. I know I’ve said it before, but I really truly finally feel restriction.

How do I know this time is “the real deal”?

• FOR THE FIRST TIME EVER, I have thrown up for eating too much (not just eating too fast, or not chewing enough). It was last weekend at a soccer party for my son. The avocado dip another mom made was Just. Too. Good. And I had a couple chip-fuls too many. Thankfully I could feel the trouble brewing and was able to make it to the bathroom (and thankfully it was empty except for me).
• I am finally feeling “full”. As in, when I obey the rules and adhere to “mealtimes” (snacking will kill you with the Band), I am not hungry. No more watching the clock and debating with myself – I’m truly Not Hungry. This is amazing.
• In a combination of the above two items, I am finally experiencing what Bandsters refer to as the “soft stop”. I believe a “hard stop” is what happened to me at the soccer party (easting too much and then having to PB/throw some up). The soft stop for me feels like a constricting of my stoma. I feel like I’m getting signals to not eat any more. If I disobey, I get the hard stop (PB). This is all new since my last fill on October 24th, so I’m still learning.
• I am learning to take small bites and chew chew chew. I know this is what we are supposed to do, but until the above happened, it was easy to forget. Now it is essential.

The scale numbers haven’t gone down much, but I’ve finally gone down a whole size or two: instead of being a 26/28, I’m most definitely a 24/2x. I was able to dig out some old favorite clothes and get rid of my 3x’es. I also had to get new bras.

I’m currently at 272, but my period is due any minute. I always thought that meant I was heavier and would lose after my period started, but a friend of mine always loses weight just before hers starts. I have no idea any more. But since I’m doing this NaBloPoMo thing to get back into the care and feeding of this blog, you’ll hear more numbers from me soon.

A Most Un-Ladylike Rant

there was no urge she could not suppress
From Anne Taintor

Why I am I not writing about my Lap-Band? Um, well, it’s because I’m FURIOUS. You see, I’m not so good at being furious. Even here on the internet, where the harshest yelling is just CAPS LOCK, I have a bit of trouble showing my anger. See, I was raised to be quiet, polite and unobtrusive. Even though it was okay for my dad to explode on a regular-yet-unpredictable basis, that kind of behavior was totally unacceptable from my pretty little head. I’ve worked through this with humor and with lots of therapy, but I still feel quite a bit uncomfortable about being angry. It isn’t ladylike. It isn’t prudent. It isn’t logical. Of course, if I had learned to yell or vent or anything instead of stuff my emotions I’d be a much healthier individual.

But since I still often try to tap-dance around the rage thing, I’ve tried to be nice here - to see the ways that I’m failing (and yes, there is always room to look at that area and make improvements). But I can no longer escape the reality of my overwhelming feelings. I’m absolutely furious at my clinic. My insurance claim was rejected again (remember the first 2 times it was rejected out of hand because my clinic NEVER BOTHERED TO SEND THE INFORMATION TO MY INSURANCE, even though I was told repeatedly they had). Now my clinic sent them 70 pages of faxes, but it’s not what my insurance needed, and from my review, much of what they sent was incorrect. For example, they say I have diabetes and hypertension. Um, huh? I have no idea where they pulled that information out of. Maybe all their clients develop diabetes from how incredibly sweet they are BEFORE surgery and then develop hypertension from how incompetent and unhelpful they are AFTER surgery?

I have spent HOURS on the phone and have gotten virtually nowhere. Now I’m being billed by the clinic AND the facility and everyone is treating me like I have leprosy. (Perhaps I do? Perhaps I should shower more often?) My clinic claims they’ve never had this much trouble with my insurance before. I find that incredibly hard to believe, seeing as how their incompetence so far has been stunning.

Add to the insurance woes the fact that I STILL DO NOT HAVE SUFFICIENT RESTRICTION and I’m a very very unhappy little girl. Yes, I’ve lost another few pounds. The scale is now bouncing between 276-279 and it’s that time of the month, so I’ll commit to a real number next Friday when things balance out with hormones and bloating and all that other TMI. I’ve also been under an incredible amount of emotional stress, so I should be glad that I’ve been able to lose weight under the circumstances (instead of gaining 20 pounds + like I have before). Unfortunately, the lack of restriction and inability to get in for fills in a timely fashion, combined with the possibility that I may end up with a $20,000 bill partly due to the incompetence of my clinic is only adding to my stress level.

So, 2 pounds in 6 weeks. I’m unhappy. I’m very frustrated. And I put off writing about it because it’s not very ladylike to rage and fume.

Here’s what I want to say: RUN. Don’t go to my clinic. They are so sweet and supportive BEFORE you have your surgery. THEN they jerk you around. You can’t get in for fills. When you do, they are way too conservative. It will take you 6 months to get to the right restriction, and they will lecture you on alternate visits about things you already know – one time they will commiserate with you and promise to get you at the right fill level, and the next visit they will shame you for creating all your own issues and tell you that you have to do all the work, not the Band. They will not file the proper documents with your insurance. They will write erroneous information in your file, causing your insurance to distrust you for being late, and for lying. They will tell you that every other insurance claim goes just fine and only you are being difficult. They will make you regret you ever bought their lies, had surgery, and got a freaking Lap-Band in the first place.

Trick Question

Every time I go in for a fill, the nurse asks a series of questions to determine if I am at the right level of Band tightness. One of these questions is, "Can you eat bread?"

Because bread, rice and pasta are on the "forbidden" list for Bandsters, I know the correct answer is, "I have no idea".

And yet, every single time, I answer, "Yes. Yes, I can".

Filled & Foreign

I went in for my fill on Thursday, and I keep thinking I'll have something profound to say (or at least something humorous) - but I don't. Shocking, I know!

Weigh in at home: 287.5 (and it has been 286.5 for the last two days, not that I've weighing obsessively or anything, oh no-no-no. It seems like I am always either avoiding the scale entirely, or having a love affair with it, secretly planing the next time we can be together - naked!)

Weigh-in at the clinic: 287.8 - I think. (I can't for the life of me remember the exact number, but I'm pretty sure the last number was .8, that the second and third numbers did not match, and that it was under 289. Sorry, you probably didn't want to know that much about how my crazy little brain tries to remember information.)

Anyway, the trend is back down from the high bounce to 290, but not any lower than it was 2 weeks ago.

I am feeling the restriction (hooray - finally!), but can still eat a fair amount. The great news is that for the first time ever, I actually feel like I have a Band! This is a welcome change.

There are so many new sensations to experience and interpret. I feel some "stuckness" in my throat - but it's hard to tell whether that is my Band, or my finally adhering to the "don't drink with meals" rule. I also find myself grazing less, and I'm pretty sure I'm less hungry. I think I am at a bit of a loss for words because I'm not not really sure what I'm feeling, physically. It's different, but I'm not sure what's what.

I have an appointment for Tuesday for yet another fill, which I was thinking I might cancel, but after the weekend I am now thinking I will keep.

It seems like I felt restricted at first, but now am looser. Is this a common Band thing? I can't decide if I'm really looser, or if I've just adjusted to the physical sensations.

I feel like a stranger in a strange land, but I'm very glad to be here at last.

I Stepped Away From the Samoas (but I'm Still Ticked Off)

Samoa from chado1982's photostream

I'm still feeling frustrated. No restriction.
None whatsoever.

I continue to slog through the other issues in my life. I'm coming out of another fibromyalgia flare. (Maybe it was the beer? Ha!) I knew weight loss would bring up the Head Issues and let out a bit of the Crazy that I had hemmed in so carefully and cozily with the Fat, but I wasn't prepared to deal with this slow start and unfilled-ness problem.

I haven't dared to check the scale since Sunday - I was still bouncing around 286.5-290.5. I'm discouraged, but am telling myself as long as the first three numbers aren't 291, I'm ok. (Not sure why that's my magic number right now, but I'm in no state to argue with myself). It is encouraging to be under 300 lbs, but it's all been from Hard Work and Starvation on my part. I'm too afraid to confront the Numbers head-on, but I'll jump on the scale in the morning so I have another reference point before my fill and weigh-in at the clinic tomorrow.

I didn't even binge today. I thought about it, and even defrosted the if-these-don't-make-you-binge-then-you-are-not-actually-breathing-
and-maybe-we-can't-be-friends-anymore Girl Scout cookies. But after 2 3 of them, I was full. I didn't want to eat more "just because I could". I was just done. I didn't want to deal with the guilt and fullness and aftermath. You could argue that leaving them alone would have been the best thing, and if that's where you're at in your weight loss journey, then I give you a hearty, chocolate-smeared high-five! For me, stopping at 3 was a Victory.

If I think about this too much, I get really frustrated. My eating has been so much better the past 3 weeks than the 3 months before that. And, I haven't had any alcohol since the infamous Mac & Jack's. Yet, my weight continues to want to climb. I feel like I should be losing, not holding steady or seeping up a pound or two (or seven).

I hate this because it feels like every other diet I've been on before. It feels pointless and frustrating and like I bought another one-way ticket to Crazyville. I got this Lap-Band for a REASON. If I could Diet and Starve and Exercise (like I did in my teens), I wouldn't need the help.

I'm in emotional limbo right now. I think I made an unconscious deal with myself not to dwell any more on the frustration until after tomorrow and my third - yes third - fill. I can't even anticipate what I might feel like afterward. My therapist has coached me (and has a dear friend) on what to say to the nurse and how to stand up for and get what I want.

What I want is restriction. What I want is to feel like this Lap-Band is actually working. What I want is a reprieve from this particular circle of Hell. If only Dante could have imagined this...

p.s. I'm STARVING right now. I am SO discouraged!

This is NOT What I Expected

Another fill today. She added 1.5cc's for a total of 4.0 in my 10.0 VG band.

Weighed in: 292.6 at NWWLS, 290.0 at home (up quite a bit - nearly 4 pounds. It's my period this week, but it's still quite a jump)

I still have NO restriction. None whatsoever. No difference at all in my life now than before banding. (Except the scars, depleted bank account and psychological damage).

I'm angry and frustrated and still feeling duped.

I eat moderate portions (1/2 to 2/3 of my "usual" volume) and still feel like I'm STARVING between meals. My stomach is growling right now.

I have another fill visit next week.

I'm getting more and more depressed.

Fills and Flowers

Flowers from Marybeth

I needed some moral support before my fill this morning. Marybeth graciously agreed to meet me for coffee and a pep talk. She also brought me these beautiful flowers - in pink, of course! The color listed on the cellophane was "Life" - I thought that was a beautiful harbinger of a good day. I chose to get this Band because I am choosing the Abundant Life - life to the fullest. And this fill is the next big step in this Life.

Marybeth told me hilarious stories, calmed my anxiety, and gave me a big "you go, Girl" talk. It was exactly what I needed on this big day.

The fill itself was pretty anticlimactic - I had to do bizarre leg-lifting yoga-like exercises on a table so the nurse could find my port and then - bam! She inserted 2.5cc's of saline. I have the largest band, the VG 10cc band, so this is a very conservative fill.

We chatted for a bit about what I could eat before and what I might expect now. I was careful the rest of the day, but honestly I'm not feeling much restriction. I go back in every week for 3 weeks or so until I get to my current "sweet spot" - where the Band starts working for me by filling me up on a small amount of healthy food. More long, slow, deliberate work.

Oh yeah, and I also got weighed in: 288.8. Some slight regression from my PCP visit, but I'll take it! The nurse was excited for me - I'm currently losing 2.6 lbs/wk by their calculations. I really appreciated the affirmation. One of the things I love about my clinic is that almost all of their employee (and all their fill nurses, I believe) have Lap-Bands themselves. They have been here. They understand. They are not going to blow sunshine up my arse, but they are going to acknowledge my efforts and encourage me where I need to change. The nurse who filled me today commiserated with me - she was ravenous until her 3rd fill and truly experienced Bandster Hell! It was encouraging to hear that - it reminds me that when my Band starts working, it will really work! I'm doing great now to be losing weight even without my "tool" working for me.

I'll weigh in tomorrow on my own scale, so I can compare apples to apples. I promise.

Oh, and I managed to stay away from the damn Jitterbugs tonight. Things are looking up!

Update (Thurs 6/14): Jumped on the scale this am as promised: 286. Not too bad! Last week I was both 288.5 and 285. If I can keep the Jitterbugs at bay, I'll be fine. Since I have another official fill visit next week, I'm feeling really motivated to make that scale go consistently down!

T-minus 11 hours and counting

I'm feeling better. I didn't even binge today in anticipation of my fill. I wanted my favorite hand-shaven Chinese chow mein noodles, but I didn't get them. I knew I'd feel like crap after all the carbs, fill or no fill. I'm proud of myself for that.

I'm ready to do this.

I want to do this.

Ok, so I'm still freaking out a little bit.

Big Fat Food Farewell...and Fills

To my "Anonymous"es: you probably are not going to like this post. You may want to grab your lean protein and Crystal Light NOW and run away, shielding your eyes. Or, you can stay, read it, and leave me sanctimonious advice. It's entirely up to you!

Yes, I am freaking about my first fill.
My fill happens in 2 days.

First, a word about "fills" and banding....
One of the ways banding is different than RNY or DS is that it is adjustable. The initial surgery is where they actually place the Lap-Band around your stomach. After that, you are on a 2-week liquids-only and then a 2-week mushies-only diet to allow your body to heal. Some people naturally lose weight during this time, because of the liquids and mushies. Some do not. (I did - yay me!)

The next 2-week period after this month of restricted intake is often referred to as "Bandster Hell". Why? Because in this phase, many people can eat anything. The band is not actually working at this point. When the band is installed (put in? secured?), it is left entirely unfilled. Clinics have started doing this to allow for the best possible healing. Some people have natural restriction because of the band itself, even with no fill. Some do not.

I do not.

I do not feel overfull when I eat. I do not PB (barf) when I eat too much. I can eat pretty much whatever I want to. I do find I am full for longer, and that I don't want to eat quite as much, but that is frankly probably just the result of being on a liquid/mushy diet for a month. During this Bandster Hell period, some people regain a portion of whatever weight they may have lost during the liquids/muchies phase. Some do not. (I did, but I'm afraid to fully face how much.)

So...
I am entirely unrestricted. I have slowly and not-so-slowly gone back to most of my "old" eating habits. Some of it has been unconscious, and some of it has come from the "oh-my-gosh-I'm-never-going-
to-be-able-to-eat-this-again-after-I've-had-a-fill" phenomenon. I've been having a big fat food farewell.

I'm afraid again to get on the scale.

I'm almost as nervous about my fill as I was about the surgery itself. I was so psyched up before the surgery: knowing the recovery would be a bit long and knowing MY LIFE WAS ABOUT TO CHANGE ENTIRELY.

And then, it didn't. Not entirely.

So slowly, I've slipped back into my old, pre-surgery life. Except, I'm actually post-surgery now. My brain is messed up and I'm having a hard time making sense of it all.

But now I am having those same pre-surgery feelings about my fill: OH MY GOSH MY LIFE IS ABOUT TO CHANGE ENTIRELY. I was ready before, and now I'm not quite-so-ready. I guess because I had the reprieve. Because I have those sweet, sweet bad habits again. In one way, I'm convinced now more than ever that the Band is the right thing for me and I need it, Oh boy I need it. And yet, facing the reality of the restriction and PBing and learning and mourning the foods seems so big again. Didn't I do this already?

I'm looking forward to the restriction, but I'm also facing down walls of shame again. I thought I was past all this, past the back-and-forth, past the "will I, or won't I?". I thought I'd only have to wrestle with it before surgery and then the choices would be made, my path would be set.

The truth is, I could cancel my fill appointment, live in denial, and waste this entire endeavor. I won't, but it is actually possible, and that scares me.

If I'd had RNY or a DS, I wouldn't have this choice: my path would be marked out; I'd be forever, irrevocably changed. I know that with the DS and RNY, one has to make many many conscious choices, especially the farther one gets out from surgery - please know I'm not slighting the hard choices you have to make, especially all the hard choices about the foods you have to constantly avoid. It's just that sometimes I wish I didn't have so many choices. I wish it wasn't all up to me.

I know - it's the denial and inaction that got me to this point in the first place. And I know I'm going to need the Band (and fills!) to get me out. It's just long, slow, plodding, confusing work.

I've got to let this Little Squeeze get tighter and see it as the embracing hug I visualized - as the supportive, loving hug I need to do what's best for me, and in the right way.

Lap-Band Q & A: What's a Fill?

Lap Band Drawing
from: www.sabariatric.com/lap_band.php

The Lap-Band is a silicone band placed around the patient's upper stomach like this---->

(photo is kinda gross, but very helpful for explaining*)

bands and fills
from: www.core.monash.org/placement.html

The band has a "balloon" lining it that looks like this ----->

(cool photo of unfilled and filled bands*).

I have the band on the right. Yes, the biggest band. *Sigh* - even in Fattyland, I'm still big.

ANYway, the Lap-Band is placed in the patient in the unfilled position and is left that way until the healing process is completed (usually 6 weeks).

Then begins the sometimes long and difficult process of finding the "sweet spot", or right fill level.

The band is filled when a fill doctor (or nurse), pokes a needle full of saline through the patient's abdomen into the port. (See top photo). At my clinic, most ports are routinely located on the middle right side of the abdomen.

There is no "right" amount of fill (saline to inflate the band). It is highly individual and is found through trial and error. It takes patience and flexibility.

As the patient loses weight, the stomach loses fat also and therefore the band becomes looser, necessitating another fill.

Some people take up to 3 fills to really start losing weight. (Remember that even then, weight loss with Lap-Band is only expected to be 1-2 lbs per week).

There is no malabsorptive component to banding - it works entirely on hunger and portion control. That's why it can take a while before the weight starts to come off.

When weight loss plateaus for 2 weeks, patients are advised to come in and get another fill.

*I'm having trouble getting the credits to post, so I'm putting them at the bottom:
the Lap Band Drawing is from: www.sabariatric.com/lap_band.php
and the Bands and Fills photo is from: www.core.monash.org/placement.html