It's a journey not a race

As if anyone would want to race in this weather anyway!

I really do want bandsters to think of their effort to lose weight and get healthier as a journey. The metaphor is apt and the imagery sound. Did anyone ever hear of a "rushed journey?" Of course not! Journey connotes slow and steady progress, enjoyment and movement toward a goal.

The process from first office visit to goal weight is a journey just as each individual meal is a journey.

A meal is obviously NOT a RACE! The slower you eat, the more you chew, the better you do. You start a meal hungry and you end satisfied. To paraphrase and yes butcher Paul Simon and his hit "Feelin' Groovy."

"slow down your eating too fast-

You gotta make the mee-aall last!

Just kicking down the re-fridge door-

Looking for food and feeling hungry!"

Don't race! Don't do it! Slow down! Every bite is no bigger than a dice and every bite gets chewed 15-20 times. When we go slow sticking and accidents are far less likely to happen. We enjoy the flavors and textures of the food more. We spend time with our companions and enjoy good company and conversation.

When I went to the ASMBS and Master Surgeons Course last month one of the key points of emphasis was the 20% of bandsters who fail to lose significant weight-more than 20% EWL. The feeling was that a critical time for bandsters is the first 12 weeks after surgery. If they don't get off to a good start then bandsters quickly get discouraged and lose faith in the band. Whatever a practice can do to keep bandsters motivated, on track, and losing during this important time will really improve results. Our answer has been to provide follow-up visits every 2 weeks for the first 10-12 weeks , to encourage interaction with the Nutrition Team and Dr. Newman and to stress attendance at Support Group or Jane's Tuesday morning Eating & Learning Group. We also want bandsters to stay in touch by email or phone and to keep the clinical team aware of their trials and tribulations. Let us be your cheerleaders. Let us help you. There is never any reason not to ask a question. There is never any reason to be embarrassed. There is never any "good" reason to avoid follow-up. If finances or insurance ever become an obstacle to care please let us know so we can work together to resolve the issue. Your health, happiness, and weight loss are our primary concern.

Another critical time is the period after a band has been drained or decompressed. It is important to promptly resolve the issue and get the bandster back on track. If the bandster has a big slip and an operation is likely to be needed then do it sooner rather than later. Prevent discouragement and disillusionment from setting in. Fix the problem and get the bandster back on track. Our usual plan is to leave a bandster empty for no more than 4-6 weeks. If the slip or problem hasn't resolved then reoperation is needed and the sooner it is done the easier it is to do and the more likely the bandster is to go to continued weight loss.

A few one liners to hang your hats on:

As much as you can't spend your way out of debt, you can't eat your way out of stress. In fact, stress eating is part of a vicious cycle. The more you eat in response to stress, the more unhappy you become about your slow weight loss which then leads to more stress and then more eating and then……….

Eat food comfortably! Don't eat comfort food! The purpose of the band is to allow bandsters to feel satisfied when they eat less food. It is not to cause discomfort, food intolerance, or bulimia. If this is happening then something is gravely amiss. When bandsters eat, by and large, they eat the same foods they always ate just less of them. Banding doesn't mean the end of eating just the end of over eating. When eating causes pain or problems then we need to know and fix it together.

Comfort foods are different things to different people but generally mean high calorie soft solids and liquids-think mashed potatoes with butter, milk, or gravy, mac & cheese, ice cream, cakes, cookies, and pies, and cream soups. Sometimes we eat these things because we crave them and that is certainly an issue, but the more worrisome problem is when we eat them because we have to! When all a bandster can get down is "slider" food or "comfort" food then there is a serious problem. Get yourself in to the office so we can help.

To paraphrase the great Yogi Berra: "90% of weight loss is 100% mental." Get your head in the game. You can't lose weight if you don't have focus and commitment. If you don't understand something-ask! If you need something-ask! If you need the help of others-get to Support Group.

I am not sure who beyond me gets credit for this: practice makes perfect and perfect practice guarantees a "loss." Do it right every time. Don't cheat. Winners never cheat and cheaters never "lose." You have to play by the rules to lose with a band. You need to make good food choices. You need to separate liquids and solids. And you need to come for follow-up. If you do those three things-you will LOSE and you will SUCCEED!

Good luck!

Enjoy the journey!

Stop and smell the daisies and the roses!

Adam

PS: Jen, Julie, and Kitt are now graciously helping out with off-hour urgencies and emergencies so don't be surprised to see one of their smiling faces if you call after-hours and need fluid out. You will always still get me or Arthur on the phone first and then we will make a plan for your care. If it is a matter of health, welfare, or safety-ALWAYS call! You get the quickest response that way. If it is a question of logistics or a NON-URGENT matter then you may of course send an email.

Too Tight Ain't Right!

Hardly a day goes by when Adam and I are in the office, and often on the weekends, also, when we don't have to deal with someone whose band is too tight. Why do I bring this up? Because being too tight doesn't allow the band to function properly and if not treated promptly leads to serious complications such as slippage and possibly erosions. When the band is too tight most people have more "sticking" or "slimming" or they actually vomit what they have just eaten. Most patients let know about these symptoms right away and that is good. We see them promptly, adjust their bands by taking fluid out, and that usually takes care of the problem. These symptoms often occur suddenly following an adjustment to make the band tighter and are usually, but not always, related to eating foods that are known to be a problem such as steak, pork chops, or spare ribs, over cooked shrimp or lobster. These chewy foods stay as big pieces and rub the lining of the stomach surrounded by the band causing it to swell making the passageway between the pouch and the rest of the stomach even smaller. When we remind people that these foods are known to be a problem they tell us they were able to eat them before with out any trouble. Yes. You might be able to eat steak, and pork, and shellfish before the band is properly adjusted but once you reach the "sweet spot" where you get full after eating about 5 or 6 ounces of food you have to be careful and avoid chewy foods.

Being tight and having these symptoms and ignoring them will lead to "slippage". If corrected right away there generally is no long term problem and you will be able to get on with your weight loss. If not corrected for several weeks the slippage may not improve with a simple adjustment of the band and an operation will be needed to fix it.

The more difficult problem is when patients get tight but don't have these dramatic symptoms. They notice they are having more trouble with certain foods and they avoid them. They have less protein and more fat and carbohydrate because those are easily digested and cause fewer problems. The exceptions, of course, are bread, rice, and pasta that are pasty and form clumps and do "stick". Soup and stews become frequent meals. These foods don't fill up the pouch and don't satisfy. Because the band are too tight and people unknowingly change what they eat, they may stop losing weight and come in saying they need a fill because they are eating too much, are too hungry and are not losing, or even gaining weight.

In the past Adam and I were often fooled by this and would do a fill only to quickly produce obstructive symptoms like those in the first paragraph. Now that we have fluoroscopy in the office we can see what is going on and we no longer get fooled. If there is anything peculiar about your eating habits or weight loss we suggest doing fluoroscopy and a barium swallow. This always shows if the band is too tight, or if a slip has occurred.

Lastly, there is the problem of heartburn. In all of our patients we look for a hiatus hernia when we do the banding operation. Heartburn or gastroesophageal reflux disease (GERD) is almost always associated with a hiatus hernia. When our patients have a hiatus hernia we repair it and their heartburn or GERD almost always goes away. If it later comes back that STRONGLY INDICATES that their band is too tight. Similar to heartburn is the development of asthma in someone who hasn't had it before. New asthma in someone with a band is probable caused by the band being too tight. At night, when they are asleep, small amounts of food are regurgitated and go down the wind pipe (trachea) irritating it and the bronchi that are its branches. This may cause asthma.

SO...having heartburn come back after it was relieved by the banding operation or the development of asthma in someone who never had it before are reasons to call me or Adam and let us know about this. These symptoms are almost certainly related to the band being too tight. AND PLEASE don't worry that taking fluid out will mean that you won't lose weight. Yes you may temporarily stop losing but in the long run you will be much more successful with weight loss if the band is properly adjusted, neither too loose nor too tight. Keeping the band properly adjusted is tricky and requires us working together and seeing each other frequently. Remember, IF YOU SEE MORE OF US, WE'LL SEE LESS OF YOU.