2/9/12 Dear LBG...Waiting For The Sweet Spot

Next question...


I was banded on Fall, 2011. Pre-surgery I lost 25 lbs. Post surgery 14. Unfortunately, I haven’t lost anything since the first two weeks post surgery. I’ve had two fills, the first Jan 4th (hoped this would help with the hunger and start the New Year off right) and a second on Jan 23rd. I haven’t felt restriction after either fill. The doctor said after the second fill that it may take a while to get there because I had a lower BMI and may need more fluid to find that ‘sweet spot’. That being said, he is very cautious (not sure if that is the right word) about fills. He does about .5 cc at a time. I feel like I’m going to be back and forth with him forever to get there.

When there isn’t restriction, how to you keep on track with portion size? I find myself falling back to ingrained habits, ie: don’t leave food on your plate, don’t throw anything away, we don’t eat left overs so finish it tonight, etc. I also find myself taking bigger bites and hurrying to look for the next item. It is so frustrating. Even as I eat I’m scolding myself for doing it. It seems so stupid to know I’m screwing up but to continue to do it.

Should I be pushing the doctor for another fill or do I have to buckle down and fight through this time? I have seen progress, I’m just afraid that waiting for the next fill, March 7th, leaves me too much time to mess things up. I started attending Zumba classes twice a week and love them. I haven’t figured out how to fit more exercise time in and still be a good mom. My son is 5 and I hate taking time away from him to attend classes. Guilt is a lovely thing.

Sorry, this got to be a lot longer than anticipated. Thanks for the advise. It is appreciated.
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First things first…you need to hear this…you have a Band, BUT…it's NOT working…YET. I know you know this, but I need you to really GET this and understand that what you're going through/feeling is a completely normal part of the journey.

You've done something huge in getting WLS, you did your part in losing weight before surgery, you felt the restriction just post-op and got a taste of what the Band can do, you made it through Bandster Hell and followed the rules for the most part (while starving to death). Now you want results, you're ready and want to do your part, BUT the Band isn't helping you yet and sheer willpower and your resolve are starting to wane…things suddenly feel like they always did before, we get discouraged and we start to return to our old ways.

We're told that we get the Band and as we start to get fills that we'll have more and more restriction. Something no one prepares us for is how long that might take (and what should we be doing in the mean time), how different each Doc's 'fill schedule' is, and how different each person is with restriction/fills…not to mention that we actually have a choice on how tight to keep our Bands! Yep, even with all my 'almost OCD' research pre-op, I had no clue how variable and important all this would be to success. The only thing that I did expect is that I had put my expectations low so I wouldn't get discouraged…my goal was to have good restriction 'before the holidays' (7 mo. post-op).

Many Banders gain weight during this period. Some get so discouraged waiting (some more than a year) for restriction and get so ashamed of their weight gain or slow loss, that they stop going for fills. Some even have Docs that make them feel ashamed that they aren't losing more weight, and some have Docs who tell them they should be feeling restriction when they don't…it's no wonder some Banders throw in the towel before they even get the Band working for them.

After my first fill and no restriction (I had no fill at surgery), I thought that (after our post-op healing period) that the long wait between fills and the differences between Doc's in their schedules was ridiculous. Let me say here that I didn't know then that some Banders have delayed restriction after fills that takes up to a month before restriction shows up, so some wait between fills is necessary. I've seen some Docs who are too aggressive and others that are way too conservative…some treat every patient with the same schedule and others it seems like they only respond if you're not losing…those of us that are keeping our weight in check on our own have to convince the Doc that the Band isn't helping. I had a plan for how to approach my Doc about where I was and what I needed…convincing your Doc that he can trust your input will help you to work like a team and hopefully get you to the right fill quickly (I was lucky to have good Doc's along the way).

I called and got a second fill sooner than I was originally scheduled and 'thought' I felt a tiny bit of restriction (not). I went in for my third fill as soon as they'd let me and I had some restriction after the third fill. Once again, this journey is all about the choices we can make along the way, and the results or consequences. Before great restriction…You can diet. You can work out more. You can do both. You can do neither. You have to figure out what works for you.

Personally, I was trying hard just to not gain weight and to stay optimistic. I was a seasoned pro at dieting, and although I didn't diet (I'm telling you I was sorely tempted to start Atkins again, but for me, I needed to be doing what I would for a lifetime…that's what works for ME), I was able to at least not gain by white knuckling through the hunger…I had a full 5 week plateau where I didn't lose an ounce. I kept telling myself that I would continue on this way, even if I gained, and keep the faith that the Band would be there soon to help me. I can't swear what I would have actually done at that point if I started gaining a lot (but I can tell you a year later I was gaining after my unfill and I still stuck to my plan). The biggest thing to focus on is to keep working on what you CAN do and to not get discouraged. I soon found myself putting my efforts into 'building my headband' (much more important than I ever expected…we all need to stop 'scolding' ourselves). I also was working on making the changes I knew I'd need to for the long haul (like making habits out of getting enough protein, water, etc.). You need to work on packing up leftovers and throwing food out (it's a big change I had to make too). Maybe you need to measure portions until you have that down (I still have a digital scale on the counter and still measure meat sometimes), work on chewing more, add healthy snacks that will help with the hunger if needed. It was my fourth fill that finally gave me the real help I needed, at 4.5 mo. Post-op, and I seriously considered myself lucky that I reached it that soon…being patient was SO hard.

Now, you're 2.5 mo. post-op and you've had two fills…exactly where I was, but I'm wondering if you had any fill at surgery? I had no fill at surgery, but after my second fill I had 4.5cc's in my Band. If you only have 1cc or so, and your Doc only gives .5cc's per fill, it may take you quite awhile to get to good restriction (we're all different though, the next one could do it, but not likely…I think the average Bander needs 5 fills and a little more than ½ the Band full). The good news is that your two fills were less than two weeks apart, which is faster than the average Doc lets you come back…and I was going to say 'so that should speed things up', but your next fill is over six weeks from now…I'd certainly call and ask for a sooner one.

I'd also ask you HOW your Doc determines how much fill he gives you? If you don't know, it's a fair question to ask your Doc if you ask it in the right way and don't put him/her on the defensive. I knew that there were certain questions my Doc would ask me (i.e. List of foods I could/couldn't eat, what/how much I was eating, etc.), he would listen to how I felt things were going and what efforts I was making, and he also would put the fill in until he 'felt pressure' or 'bounce back' in the syringe (I asked him). Some Doc's have questionnaires each time, some Docs always do fills under flouro to watch the restriction. You may have to gain your Doc's respect and trust and then ask for a bigger fill if you need it (sometimes it's as simple as pushing a little for what you know you need). As you leave from a fill you could also ask to come back faster if the fill still isn't doing anything…my Doc would say 6 weeks and the scheduling nurse said 4-6 and she'd let me schedule for 4 weeks.

On a separate note, as an older mom of three I'll tell you one thing I've learned……whether you're working crazy hours and traveling the country or are home to do everything with them (I've been on all sides of this)…there will always be things that you'll feel guilty about when it comes to your kids…your kids will be happy when you're happy and are taking care of yourself…it's not about the quantity of time, it's about the quality. As women, many of us are givers and we get into the habit of putting ourselves last on the list (after I stopped working I put everyone before me). It was hard for me to change that, and I certainly had moments where I felt really guilty, but I made a commitment to put ME first when it came to getting my health back (and yes, you'll have to start reminding yourself of that when your son cries one day when you leave for Zumba). My kids are now in their teens/twenties, they've never been so proud of me, and they see how happy all this has made me and that makes them happy.

Hope some of that helps, and hang in there and don't lose focus on the goal. Keep asking! -LBG