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I just wanted to say a few words about post-op eating, portion size and band fills.
I thought the info/posts on the dangers of having the band too tight was a very useful and an important warning.
The dangers of developing oesophagitis or chronic reflux problems were well aired, but there is also the danger of migration/erosion which should be mentioned. Erosion or migration is where the band starts to “eat its way through the wall of the stomach”, and can be potentially deadly if stomach contents find their way into the abdominal cavity causing peritonitis. The band has a fixed circumference and cannot expand. If the stomach tissue becomes very swollen, because of constant acid irritation, frequent vomiting etc over a long period it cannot “burst” the band but can cause the band to migrate through the living tissue of the stomach where the restriction is – there’s nowhere else for the tissue to go!
I’d advise any post op band patient who is experiencing constant acid reflux or repeated daily vomiting/regurgitation to have the band aspirated (saline removed) and have an x-ray or endoscopy to check if there has been damage.
Generally, I think that in our haste to lose weight as quickly as possible after surgery we sometimes try to run before we can walk, rushing to get our fills as quickly as we can in order to find that elusive “sweet spot”.
I have to tell you that the sweet spot (the place of ideal restriction) is really more of a psychological than a physical place.
The whole aim of surgery is to allow us to get to the point where we can eat small and sensibly, and almost to be able to do it by choice and habit, not to have to rely on the restriction caused by our bands. This is what we should be aiming for – to let our banding help us train ourselves to change our eating habits and our attitude to food.
I met a patient of ours a couple of weeks ago who came back to us for a tummy tuck after having the band over two years ago. He was 23 st. when he came for surgery, and just under 12 st. when he came back. He struggled in the early stages to “get his head around” living with his band, as everyone does, but eventually learned to live by a few very simple rules. I thought it would be useful to share them.
1) Eat regular meals and don’t snack between
2) Eat healthy stuff – not junk
3) Drink lots of water between meals
4) Never eat a meal that’s bigger than your fist
5) Do plenty of exercise
When he left he told me he was thinking of having some of the saline removed. He said he could still do with losing a little more weight, but wanted to be able to do it on his own, and not rely on his 7ml of band restriction.
Deborah often talks about “the Devils sitting on your shoulder” who made you eat.
The reasons we become obese are so many – unhappiness, boredom, anxiety, comfort (the feeling you get when getting through that bar of choc/family size crisp packet etc is something that NEVER lets you down!) All surgery does is make you eat only small amounts at any one time. After we have the surgery - sad but true – we’ll STILL get unhappy/bored/worried and need comfort.
The Devils will still be there, and maybe the best thing to do is to find things other than food – or the obsession with our weight and jumping on the scales every hour- to give us what we need. If we really focus and grit our teeth and get on with the rest of our lives – especially in the first few months after surgery, lots of us can get past the worrying about/constantly thinking about food stage, and as we begin to lose the weight we start to feel better about ourselves, and a bit more self-confident, and that in itself can give us the strength to maybe face some of the problems which made us fat!
The psychologist at our hospital always asks patients in the pre-op interview “ If you have been using food as a reward, to “sweeten” your life, what will you use after surgery when food is no longer an option?” One patient, quick as a flash, replied “buying clothes that might actually look good”.
Best answer I have heard!
A final point about band fills.
Our patients get to the point of being full time on solids 6 weeks after surgery. There’s no earthly point in filling a band until a patient is on solid food full time, because the restriction only really works (or should work) with solid food, so we ask patients to look for the first fill some time after 6 weeks post-op. All restriction is supposed to be is allowing you to feel satisfied and pleasantly full for about half an hour after a meal. It’s not supposed to make you feel uncomfortable and it’s not supposed to prevent you from eating solid food. A gastric band is not supposed to give you “righteous pain”, and really the whole point of it is to allow you to learn for yourself what a good size (small) portion is. The self-discipline bit is hard to do, and often it takes a long time.
Don’t be hard on yourself for making mistakes or having lapses, but do try to learn from them. For most of us it took YEARS of bad habits with eating to get fat to the point of morbid obesity. We’re not going to undo a lifetime’s bad work in a month or two after surgery, but we can start. Half the battle is being able to realise when we are going off track – snacking, obsessing about food or our weight loss (or lack of it over the last week!). THE AIM, LONG-TERM, IS TO MAKE FOOD AND EATING A VERY SMALL PART OF LIFE – EATING TO LIVE, NOT LIVING TO EAT.
Dr Cierny often quotes a presentation at last year’s IFSO (Bariatric Surgeons’) congress in Paris, where it was shown that the patients who do best (over 5 yrs) with the band were those who didn’t hurry to have the fills, kept fills relatively low-volume and lost a slow but steady average of just a few lbs a month over the first 2 years. He thinks this is good steady weight loss, and really isn’t too concerned when patients go a month or two hardly losing at all. Better by far, he feels, to lose weight more slowly and keep it off, than to lose quickly and then have major set-backs, require aspiration or suffer physical problems because of an over-tight band. He believes, and we do, that a band should be a tool to help you learn to lose weight and eat and live healthily, not a tool to make you lose weight in spite of yourself.
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[b]Cosmetic Bliss[/b]
Weight Loss Surgery Consultants
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