Notes to Self About Lapband Issues

This post is really from me to me, to remind me of some lapband issues I’ve encountered recently, and to record a status update.

1.  Hiccups mean that my pouch is full.  When they happen while eating, stop and put down the fork/spoon and put the rest of the meal away for a later meal or snack.  Be sure to wait for 30 minutes to start liquids again or hiccups can pop up if you start drinking too quickly.

2.  First Bite Syndrome is something I’ve just learned about but recognized as an explanation for the throwing up I’ve been doing lately.  I’ve written before about productive burping before and this is sort of a variation on it.  It’s been happening several times a week lately, almost always on a weekday.

Here is a great explanation of what’s happening and how I should handle it:

First bite syndrome is not uncommon. For some reason the esophagus, and therefore our pouch will sometimes spasm, and tighten up when we take the first bite. When it does this, then anything added after will only hurt and cause you to PB.

What is suggested for issues with first bite syndrome is to begin the meal with a couple of sips of a very warm liquid—water, tea, coffee—small sips of it hot! Then take the tiniest bite imaginable—chew well, and wait. Let it hit your pouch and allow the pouch to accept it, after a couple of minutes—serious minutes, as in 120 seconds—not just a few seconds—try another tiny bite. Then wait again.

If after a few bites, you still feel good, then proceed as usual with your meal. If it feels stuck–just stop! Then in a half an hour or so, try some fluid, and stick with fluids for a few hours minimally before you try again. Anytime you end up PB’ing, the best thing for your stomach is to go onto liquids for a period of time, allowing your stomach to settle without causing further swelling.

Source:  From a post by Kat817 on Lapbandtalk.com

I don’t have FBS problems on weekends because I wake up more leisurely (post 5:30 most days) and start the day with a cup of coffee, putting off breakfast (usually yogurt with a little bit of fruit) for at least an hour.  My esophagus/tummy have time to relax.  And I can spread out my breakfast time when I’m not watching the clock to be sure I’m dressed and ready to leave for work no later than 7:20am.

Tomorrow is my first visit with my surgeon in 2 months, and I haven’t had a fill in three months.  He did take some out before that because I really was PB’ing a lot because it was too full.  The band is small (mine holds 10cc) and we haven’t found my “sweet spot” yet.  I’m hungry a lot, which is a sign that I don’t have enough restriction in the band.

I needed to understand the difference between PBs and First Bite Syndrome to be sure I’m ready for another fill, and know how to adjust to make things work better.

I know the nurses (one in particularly is very harsh) will give me grief for having my weight loss slow down during this period even though I did lose 8 lbs.  I’ve been eating more carbs than they would like (they want me at about 40 and I’m eating more like 80-90) but it’s still well below what is considered normal for a balanced diet – and I feel better when I eat some.  Not prepared sweets so much as beans, strawberries, and dairy.  I’m not giving them up.

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Status Report:

1.  Nutrition: I’m eating between 1000-1150 calories/day, with approx. 80-90 gms carbs, 40 gms fat, 70-85 gms protein.  Fiber is too low because I’m not eating enough vegetables even though I want them (they don’t stay down well yet).  Cholesterol intake is under 100.

2.  Weight status: 204 lbs down from 310 lbs for 106 lost.  44 lbs to go to my goal of 160.

3. Exercise status:  still low but have started working out with a personal trainer in the pool and on the weight equipment.

Life Beyond CPAP

My CPAP rubber parts have been soaking in white vinegar/distilled water for a final cleaning before I pack the whole thing up to put away in the back of my closet.  The machine itself cost over $1,300 so I’m taking very good care of it, just in case I need it again at some point.

But for now, and hopefully forever, my sleep apnea is gone.  I had a home sleep study that showed my apneas have gone from 38/hr to 1.3/hr – and normal is under 5/hr.  I only snored for 3 minutes the whole night.  I was happy dancing to hear the word that I’m normal and no longer need the machine to help me breathe at night.

Much as I didn’t like being tethered to my ResMed CPAP, not using it has been an adjustment, one I didn’t really expect.  For one thing, it’s awfully quiet in the room.  Roomates told me at conferences that the machine didn’t make that much noise, but as the masked person with the elephant hose, let me tell you that there is a persistent wooooshing sound in my ear as the air moved.  It was actually comforting and after getting used to it, the sound helped me sleep.  I think I’ll get a “white noise” sound machine to do the same thing for me now.

My special CPAP-friendly pillow is in storage and I’m adjusting to being able to move my head without the mask shifting out of position or the hose wrapping around my neck and strangling me.  Well, not really, but sometimes it felt like that.   Now, though, after several months of restless sleep and fatigue, I wake up feeling rested and having had deep, vivid dreams – which means I’m getting REM sleep.

One of the things I had heard before my surgery was that bariatric surgery patients – both bypass and lapband – often found that medical conditions often disappeared on their own.  Things like diabetes, high blood pressure, and sleep apnea.  So I had suspected that my sleep problems, which began acting up 2 months after the surgery, were related to getting a lapband.

Losing weight can also help the apnea go away or at least be more minimal in intensity.  But I’ve been almost this low before one year after I got my CPAP, and all that happened is that my air pressure were adjusted slightly.  This time, it’s quite different.  I’m more than ready for it.

Between a Medical Rock and a Hard Place

It’s hard enough to follow medical instructions when you only have one set of them.  Having more than one set puts us patients between a medical rock and a hard place.

For the last few weeks, I’ve been experiencing some dizziness when I bend down or stand up suddenly, plus headaches, lack of energy, and fatigue even though I’m getting at least 7 hours of sleep using my CPAP.   People at work have been asking if I’m okay because apparently I’m very pale.  I finally decided it was enough of a concern that I should get it checked out.

Yesterday I went to the health plan and got checked out. They took 4 vials of blood to run a battery of tests including checks on levels of B-12, vitamin D, potassium, and iron.  I was asked what I eat on a typical day and how much I usually drink (60-68 oz of water).  Even without seeing the lap results, the doctor said it seems my potassium and electrolyte levels are low, as well as probably my iron.  The things I know I’m doing right are protein and calcium, but I haven’t really figured out how to eat the right kinds of foods to give me nutritional balance in much less food and with the restrictions that come with the band. There’s a lot I can’t eat.

I was told that I should be drinking Gatorade in addition to my water, to increase my electrolytes, and having a glass of OJ in the morning.  While I adore OJ, the lapband people told me to avoid all juices and fruits because of the natural levels of sugars and carbs.   They want me eating about 40 gms carbs per day, which I haven’t begun to reach.  But since my last fill in late January, I’ve been working hard to keep my carbs lower than I did before – and now that I think on it, that’s when I started to feel dizzy and tired.

So what to do:  listen to the “whole body” doctor or the “lapband and weight loss” doctor?  No matter what, I’m going to be violating someone’s medical advice.  I called the lapband office to talk with a nurse, but found them pretty dismissive of me getting advice from anyone else, which made me more upset.  She called back 10 minutes later to say the surgeon wants to see me on Monday morning at 8am. Lab results won’t be back by then but being able to talk with him and not just nurses is a Good Thing.

I’m willing to follow a limited eating program.  I knew that was part of the deal when I got the band – and let’s be honest, it’s just necessary on any food plan.  I don’t expect to be able to eat everything I see or want.  But I want to feel better, have more energy, be more balanced even if it means the weight loss is slower.   I’ve lost 85 lbs at this point in under a year; it’s going to be slower from now on anyway.

I just wish the doctors would understand that I’m a person and not just a lapband or a set of numbers on a lab report.  It’s my job to remind them and figure this out for myself if they can’t come to terms amongst themselves.

Image source:  http://allergyasthma.wordpress.com

Feeling the Restriction

I had my second saline fill almost a month ago and am finding it much harder than I’d anticipated after fill #1.   There definitely is restriction and I find that I’m PB’ing almost every day, so I’m watching food very carefully.  I think the problem today was eating too soon after having taken a pill (which is hard by itself).  Every day it seems that something goes wrong, but I really don’t know why I couldn’t keep down yogurt.  I mean, how can you gag on yogurt?

So I was anxious going to Boston this weekend, since it meant eating out and being away from normal routines.   I stocked up with some NuGo Chocolate Peanut Butter bars for the train rides (it’s a 2 1/2 hr train ride from New Haven to Boston’s Back Bay station, only 2 blocks from my hotel; no way was I going to drive).   I also brought a water bottle I refilled often, and a blender bottle with individual packets of protein powder.   I rounded out my meals with Greek yogurt parfaits from Starbucks, which was right in the hotel.  I’d hoped to be able to have a crab cake appetizer at Legal Seafood, but given the state of my tummy, the yogurt and protein worked out better.  Plus they were lots cheaper.

But being in Boston was wonderful.  I’ve only been back once since moving away in 2007 and it was great to see old stomping grounds and do a little shopping (zilch at Filene’s Basement, which doesn’t have many fluffy lady sizes at all but scored a pair of on-sale womens petite pants at Talbots that fit perfectly).  Didn’t really feel like spending much time in the mall, though I walked around for exercise, but I finished my Friday getting a hot stone massage at the spa, which was awesome.

Saturday was Family History Day, co-sponsored by Ancestry.com and the New England Historic Genealogical Society.  They had hoped to get 350 people and ended up getting another meeting room and topping out at 731 people, the max that the fire code would allow in the spaces.  It was a totally awesome event with 6 different classes (2 offered twice) on topics on immigration and naturalization, organizing materials, getting the most from your ancestry.com subscriptions, Family Tree Maker software, and resources available through NEHGS.

They also brought in professional equipment for free scanning of documents onto individual flash drives as well as offering free individual consultations with professional genealogists.  I took advantage of both – they were great opportunities and were booked up through the day.   I’ve been playing around online with new eyes and am starting to figure out how to better track what information I have and what steps to take next.   The event was so worth it on many levels.

When is Throwing Up not Vomiting?

I’m warning you in advance, this is going to be TMI for a lot of people.  Feel free to skip; I won’t be offended (and I won’t even know, which makes it all very easy).  But this is something I need to record as part of my lapband journey so I remember the lesson.

If you’d asked me before I started this process if throwing up meant anything but vomiting, I would have said no.  I know better now both from research and personal experience. The “other kind” of throwing up is known in bandster land as PB’s or Productive Burping.  It sounds a lot more pleasant than it is.

The experience came on Friday at lunchtime while sitting in the law school dining hall.  My lunch was about 2 oz of sliced turkey from the sandwich lady and a hardboiled egg from the salad bar.  Both were proteins that I thought I could handle but I couldn’t, at least not together.  I ate about 1/2 of the turkey and maybe 1/2 of the egg when I started feeling sharp pain in the middle of my chest, just under the bra line and just above where my port is located.   I knew I was in trouble but didn’t know what to do.

One of the dining hall staff sitting across the room facing me saw my face and recognized what was happening; she had gastric bypass and lost 145 lbs several years ago.  We’d talked about the procedures before and she knew where I was in my process.  Apparently my face had turned gray.  She led me outside, going through the kitchen to the closest door, to get me with some fresh air, and asked one of her colleagues to bring me a bottle of water.

I knew I had to throw up.  I wanted to but food was just stuck and I didn’t know what to do.  She told me to try and relax, that being stressed and scared just made it harder.  (Easier to say than do.)  All of a sudden, part of the lunch was on the sidewalk.  My chest felt better but there was more there, and sure enough, I did it again a short while later. I ended up back in my office waiting to see if things were settled down enough for me to go home early.  I managed to PB another 4-5 times, fortunately in the restroom, and finally figured that everything I’d had for lunch was gone.  That’s when I went home.

What was different from normal vomiting was that this stuff was slimy with saliva and mucus generated by the body to try and lubricate the blockage.  Nothing tasted sour the way it does if you really vomit, since that brings up stomach acids and tastes horrible.   It’s really important for bandsters to not vomit if at all possible, since the pressure needed to eject stuff from the big stomach can dislodge the band as the material comes through the small opening to my pouch and then up the esophagus.

There are several reasons why this happened, and I need to remember this lesson.   I was eating too fast, the pieces are more normal size instead of the “pencil eraser” size – and the food was too dry.  My food needs to be moist, in small pieces, and eaten slowly.  I was good at it in the beginning but have slipped up.  That has to stop.

I’ve had one fill which hasn’t really done much of anything to restrict my eating, which I’m doing from willpower.  I’m usually not exceptionally hungry and have been able to avoid trouble spots.  But I’m hoping the next fill will help add a little restriction until we get to the sweet spot.

In the meantime, Friday’s lesson was one that I had to go through in order to really understand why those eating rules matter.