Texas Lap Band Surgeons Talk With You » Lap Band Follow-Up

Mistake of the Week #9

Rachael Keilin, MD — Mon, 28 Dec 2009 12:01:43 +0000

I will not single anybody out, but it seems like every weekend one of us docs gets a call between midnight and 4am from a patient who says they are too full. The most common thing they say is that they’ve felt too tight since their fill earlier in that week, but that they thought they’d just “tough it out.”

So my mistake of the week is this: IF YOU ARE TOO TIGHT, THE BAND WILL NOT RELAX ON ITS OWN

There are some people who actually don’t feel the full effects of a fill for up to two weeks afterwards, but the opposite -m a feeling of being too full (e.g. the feeling that the food is not going down, everything but liquids comes back up as a productive burp, lots of night-time reflux or vomiting)- is NOT going to get better. As soon as you feel that way, call the office and get an unfill. If you wait until the weekend, it may be Monday morning before we’re able to see you. Don’t assume that we’ll be available to meet you in the ER for an unfill or that somebody there will be able to treat you. If you feel too full, your best bet of being unfilled the quickest is to call or come in during business hours Monday-Friday.

Mistake of the Week #8

Rachael Keilin, MD — Sat, 28 Nov 2009 13:13:40 +0000

I have a magnet on my fridge right at eye level. It has a picture of an extremely fit/athletic woman and it says, “What you eat in private, shows up in public.”

I thought about this when a patient came in recently, angry because she wasn’t losing weight. She had eaten a large fast-food lunch just before she came and brought her extra-large soda with her into the office. I can’t help but think that she did that to thumb her nose at me and Betty – nobody can honestly say that they’re unaware of the “no soda” rule.

So here’s my mistake of the week:

do not assume your weight loss or gain either affects anybody else or is anybody else’s responsibility

I am not trying to be harsh, but your success or your failure is your own. We can help, cajole, educate and fill, but the final choices that are made when you stand in front of the fridge are your own. We will know whether or not they were good choices when you come to the office and weigh. I will celebrate your triumphs and console your setbacks, but in the end you get to keep your weight or lose it, nobody else. Rebelling against the rules or against the doctors or Betty or Amy or Lori doesn’t accomplish anything in the end, except sabotage your goals.

What has weight loss given back to you?

Rachael Keilin, MD — Wed, 18 Nov 2009 15:44:00 +0000

I don’t know how many of you out there are on Facebook, if you are please sign up for mafia wars and add me, but it is really a great place to connect with people you haven’t seen for years. I was looking on there this morning and saw how many comments there were about being thankful. I usually don’t post a lot of mushy personal stuff since for the most part I am a private person…..ok Dr. Hekier you can stop the hysterical laughter! I thought it would be a good idea for us to do that a little on here.

Let’s give the docs a break from writing for a few days and let all of you have the floor. Now this isn’t going to be the mushy I’m thankful for my family and friends kind of thing. We all will just take it as a given that if you have them you are thankful for them. This is a I’m thankful for whatever it is weight loss surgery gave you back or did for you. I think in this type of forum you can help people to see that even the little things are important.

I will start it off…….I am thankful for the experience it gave me. I never thought I would end up in a job helping those that are going through the same type of journey. Life has a way of preparing you for things that you aren’t even aware of. I became a nurse because of the way I was treated after my surgery. Just because I “chose to do it to myself” (have weight loss surgery) was no reason to leave me walk the hallway alone or tell me I just needed to push the button again because I needed more pain medication for a “person my size” (anesthesia confirmed the morning after that my epidural had slipped out and I was receiving no medication post op). At that time weight loss surgery was not as common as it is today and no I did not have my surgery in Texarkana as they did not do it here at the time. After that hospital stay it gave me the strength to start college…..2 weeks later…and fulfill my dream of becoming a nurse…..4 years later! I vow to you….you will not walk alone unless you choose that path.—meet me at Wadley December 14th at 7pm—–Lori

Lori’s Thankful for….And wants to know what you’re thankful for!!!

Rachael Keilin, MD — Fri, 13 Nov 2009 20:11:44 +0000

Give the docs a break from writing for a few days and let all of you have the floor. Now this isn’t going to be the mushy I’m thankful for my family and friends kind of thing. We all will just take it as a given that if you have them you are thankful for them. This is a I’m thankful for whatever it is weight loss surgery gave you back or did for you. I think in this type of forum you can help people to see that even the little things are important.

At that time weight loss surgery was not as common as it is today and no I did not have my surgery in Texarkana as they did not do it here at the time. After that hospital stay it gave me the strength to start college…..2 weeks later…and fulfill my dream of becoming a nurse…..4 years later! I vow to you….you will not walk alone unless you choose that path.—meet me at Wadley December 14th at 7pm—–Lori

You’ve Got a Lap Band – Now Rock On!!

Rachael Keilin, MD — Sat, 31 Oct 2009 17:41:09 +0000

So, you went to this big seminar thing….learned all about the surgery, what it takes to get you insurance to cover, how much it costs if you are not insured, what requirements you have to meet, do you just have to be overweight or do you have to have an illness along with the weight. You went through all the steps, went through the weeks of liquids, went through a surgical procedure,followed by more liquids, had your first fill or two………..then what???

Where are you….we miss you….and we want you to finish what you started!! I have been to several health fairs and have come into contact with MANY people that have the band….. a few who still have some to lose…..many that have reached their goal. I say…..COME SEE US!!!!!! I had one person tell me they were embarrassed to go back because they had felt like they had not lost enough……all the more reason to come in for a fill. It’s a surgically implanted tool…YOU have control of the tool!! I’ve had a couple that said they knew they had about 50 more to lose but they were “satisfied” now…..only to keep talking and find out they were a cash pay and economics would not allow them to come in……..call and talk to Susan….you never know what can happen until you try. I’ve seen many that have reached their goal…..COME SHOW US!!!!

You LAP BAND patients are the best way we have of getting the word out about the Lap Band….there are so many people that only get to DREAM of having this surgery. We want you more than satisfied….we want you happy, healthy and fulfilled. We have the monthly support groups to assist you with just about any issue you can imagine…..short of getting your kid a date for the prom or taking care of your dog while you are away…..although that could be arranged (the dog not the prom). Please do not let issues go unspoken. Together we can find a way!!

On the other hand….if you are happy healthy and fulfilled at your goal or even with a little excess I say…Strut your stuff baby and tell them where you got it!!!! Just don’t forget to keep in touch….I just love going “OMG YOU LOOK FABULOUS!!!!”—Meet me at Wadley November 9th at 7pm for support group—LoriWh

Mistake of the Week #6

Rachael Keilin, MD — Wed, 28 Oct 2009 15:37:26 +0000

This one comes courtesy of Debbie-Doo. When I asked the nurses what common mistakes they heard people making, the Doo immediately said, “eating Kentucky Fried Chicken right after having a fill!” I asked if KFC was really all that common (since I”m looking for general principles here) and she said that while KFC itself may not be a specific problem, going out for lunch/dinner after having a fill certainly was. Thus, this week’s mistake:

AFTER EVERY FILL: LIQUIDS FOR 24 HOURS, MUSHIES FOR 24 HOURS

This is not a suggestion, it’s a rule. Your stomach needs time to adjust to the new constriction level and if you go and eat a regular diet meal right after getting a fill, your stomach may spasm and you’ll start throwing up. This will lead almost certainly to an unesscessary unfill (leaving you hungry for 6 weeks) or possibly even a slip. We tell you these rules, not because we’re mean people (or not only because) but because there’s thought and science behind every idea.

What is the best thing you’ve lost besides weight?

Rachael Keilin, MD — Fri, 16 Oct 2009 17:08:06 +0000

I was lurking on a Lap Band support forum and noticed a thread that really inspired me. The initial poster asked people to respond with comments on what else they’ve lost besides weight. I’ll reprint a few of them now, but I want to hear from all of you: what have you lost? Or, if we’ve already covered it, what have you gained (like self-confidence, an addiction to knee-high boots)?

Things people said they lost: sleep apnea

two chins

a closet full of Lane Bryant clothes

reluctance to fly on an airplane

a couple of friends

the ability to blend in with the background

a fear of having my picture taken

a worry about what I’m going to eat for my next meal – 1 hour after finishing the last one

ugly granny panties

the worry that guys are just talking to me to be nice, not ’cause they’re really interested in me

my bust

swollen ankles

listening to the chair creak when I sit down

But I don’t wanna come in…..

Rachael Keilin, MD — Mon, 13 Apr 2009 21:07:02 +0000

I’ve heard some patients ask why they have to come in every 4-6 weeks. There are several answers depending on why you think you shouldn’t come in. In no particular order:

“I’m losing weight, why should I come in?” Remember the scale is not the only judge of whether or not you’re successful. Some people lose weight dysfunctionally, i.e., they lose weight ‘cause they’re throwing-up all the time or are not getting enough protein and are losing muscle mass. Sometimes even if you’re not hungry and even if you’re losing weight, you still need counseling/advice/needling about making good food choices or exercise or both. Plus we get lonely and like the company J

“I’m gaining weight and I’m too embarrassed to come in” This is especially silly to me – when you’re gaining weight is precisely WHEN you need to come in. You may need a fill, you may need an unfill, you may need a shoulder to cry on, you may need the re-start diet, but whatever it is, it’s not at home. It’s here with us. Our whole job is to help you lose weight, not just to be cheerleaders when you do well. EVERYONE has plateaus, EVERYONE has setbacks, so that’s when you need to come in for a mental/band/educational adjustment.

“Nothing ever seems to help, so I’m giving up” Some people need many adjustments, some people get many adjustments and un-fills over the course of their weight loss journey. While this can be frustrating, I often think at least some of the blame lies in the eating behavior of the patient – eating too fast, eating things that are difficult to chew adequately, eating beyond the “full” point. Sometimes it takes patience to learn how to use the band, how to feel “full” and when to stop. Again, all of those things are learnable during clinic visits and especially during support groups.

LapBand Loosening part two

Rachael Keilin, MD — Tue, 31 Mar 2009 20:18:40 +0000

I want to re-iterate what Dr. Hekier said in an earlier post about loosening the band. I recently had a patient who had their band loosened after almost a year of frequent vomiting and PB’s at every meal. Every time they came to the office we pleaded with them to let us loosen the band, but they were so worried about re-gaining some of the 80 or so pounds that they had lost and so they refused. After giving my best puppy-eyed pleading look, we finally agreed on an unfill. And what happened? After having been at a plateau for the year the band was too tight, the patient lost 12 pounds in two weeks after the unfill.

What is the moral of this story?

The band is not meant primarily for restriction. It is not meant to be a barrier to food intake or a mechanism to induce bulimia. It is meant primarily to help control hunger and to allow for small portions to be eaten without feeling hungry afterwards, not to keep you from being able to eat anything but a small portion. This may be a subtle difference, but it’s crucial. When you’re too tight and using the band as a barrier, you’ll eat whatever will go through which usually means ice-cream & chips. Nobody in the history of the universe has EVER lost weight on a steady diet of ice-cream and chips. Never. But if you use your band to allow you to eat the kind of diet all of us wish we could stick to (protein plus a healthy side) and not be hungry, then you’ll run back for an unfill when you’re too tight ’cause you’ll realize that being too tight keeps you from eating good, fat losing foods. THE BAND SHOULDN’T KEEP YOU FROM EATING – IT ALLOWS YOU TO DIET WITHOUT SUFFERING!

Loosen your Lap Band and lose some weight

Dr. Ron Hekier — Mon, 16 Mar 2009 04:01:10 +0000

Every few weeks we see a patient who had fluid removed from their Lap Band on the prior visit, and they lost weight since that time. Patients say “How can that be? I thought you need to tighten the Lap Band to lose weight, not loosen it.”
Remember remember remember: The Lap Band works best when it helps you control your hunger. If it is so tight that it stops you from eating, that is bad.

If you find significant restriction to many foods, together with symptoms or regurgitation or reflux, you are possibly too tight.
Do not rely on the tightness of Lap Band to keep yourself from eating. Rely on the lack of hunger from the Lap Band to help you.
If you are a bit too tight, you might find that you have difficulty eating many types of solid food. As a result you might be eating a lot of soft mushy foods, liquids, or crunchy fried foods. These are the foods I hear about people eating when they are too tight: soup, chili, yogurt, ice cream, shakes, potato chips, tortilla chips.
Well guess what? If you are too tight, and you are eating those foods, you aren’t going to lose weight, and in fact you’ll probably gain weight.
When you are too tight, by removing fluid from your Lap Band, you are allowing yourself to make proper food choices. So don’t be worried, don’t be surprised. For some people, taking fluid out of their Lap Band is what they need to achieve their weight loss goals.