Inpector Clouseau strikes again....

I got a phone call, out of the blue, yesterday from one of the managers at Healthier Weight. Apparently, a lady had written a letter to me about this blog and wanted to pass it on but didn't know how. This lady (who will probably be reading this) left the letter with Dr Ashton, my surgeon, who then passed it onto the practice manager and asked her to forward it to me. But of course, they don't have anyone on their books called Theresa...... let me explain.

I have never said much about my professional life. That's because I am desperate to avoid anyone I know in a professional capacity finding out about my band - rightly or wrongly - that's how I feel. As part of my job I have a web presence - in my professional name of course - including a personal web site as well as in the 'staff' pages of my employer. If I developed this blog in my proper name I imagined that one day, someone doing a search on the web for me in a professional capacity, might come across the blog. I had visions of bumping into somone at a conference and them saying "oh hello Theresa, I read all about your burping, and constipation, and saliva-pouring on your blog the other day - by the way, how's the work going?"!!!! Yuk!

I have also been a little afraid of my family finding the blog too. They know about the band now but in the beginning I wasn't going to tell them. Somehow, I feel comfortable being really honest about my band experiences with people that I don't know, but I'd feel really embarrassed if one of my brothers read some of this stuff!

Consequently, I have always used my middle name on the blog - Theresa. Ironically, as a child and teenager I always wanted to be called Theresa rather than my given name and now I am! In fact, I have continued to use Theresa as my name at the HW support groups and it's really nice being called what you want to be called for the first time in your life!!! So, back to HW. The manager who received the letter decided to become Inspector Clouseau for the day and worked out who I really was! I imagine it wasn't too difficult - this blog has all the details of when and where I was banded, and when all my fills took place. It wouldn't have been that difficult to narrow it down and identify the real me.

Anyway, the result is that this morning, I received the most wonderful letter through the post from a lady who has read the blog and found it "inspirational" (her word, not mine!) and helpful. She is having surgery very soon and I wish her all the best and hope that some of the experiences I have relayed here will help her and others like her. I don't claim to have all the answers (or even any of them!). I don't claim to be an expert on anything, other than what I am experiencing at any given point in time. I only know that before I took the decision to have surgery I read about other people's experiences through blogs and online forums and without their input would have found the decision-making much more difficult. Every so often I re-read the guidance manual that I was given by my provider. It's an excellent source of factual information and advice and generally keeps me on the straight and narrow (generally, I said!). But what it doesn't do, and can never do, is tell me about the huge breadth of day-to-day ups and downs experienced by fellow bandits. My experiences are not unique but we are all unique and the way that the band impacts upon our lives, our bodies and our minds is very individual. So, this is just my story. There are lots of others out there and they will all be different.

I find writing about it therapeutic, I hope you find it interesting and helpful (and even inspirational, ha ha!!).

To the lady who wrote the leter (I will e-mail you privately), THANK YOU for taking the trouble, THANK YOU for reading and THANK YOU for saying such kind things. All the best with your op.

That ol' chestnut

Ages ago I posted, several times, I think, about whether or not to tell people about my band. After much to-ing and fro-ing I finally decided to tell my family and later told some people in my church. I also considerd, at the time, that I might tell one person at work. I didn't have anyone in particular in mind, I just thought it might be nice to feel that I had one ally, as it were, in my workplace. After some thought about who that lucky person might be (!), I made the decision - it was to be Cathy. A woman of the world, always shown to be quite understanding and compassionate, and in small ways has been encouraging when I've attempted to wheeze up four flights of stairs - that sort of thing. Anyway, on the day that I was going to suggest we 'went for a coffee' or something, I found her in a foul mood. She was shouting and swearing about something or somebody - I cannot recall just now. But something told me that now might not be the best time to tell her my woes! I have since discovered, somewhat to my surprise, that she gets like this quite often and is regularly to be found (well, heard, actually) screaming at the latest person who has done her an injustice. So, my decision was reversed and I decided not to tell anyone at work after all.

A few months on from that I am re-visiting that ol' chestnut and thinking how nice it would be to have someone at work with whom I could share the occasional knowing wink or 'nudge, nudge'. I have returned to the question of whom. This time, I seem to have settled for Jane. I get on with her quite well as long as we don't have to spend too much time together! I always made her second choice before because she is a bit mother-hen-like and I was a little worried that she might turn into a bit of a nag, constantly checking up on what and when I was eating, and asking lots of questions. Back then I don't think I could have coped with that, I just wanted to get on with it all quietly and without fuss. But now I am more into the swing of this band, this appendage, this new friend of mine, and I think I could manage. In actual fact, I think I might be strong enough now to tell her straight, that I don't want to be pestered. Unfair though it might seem, if I want to talk about my band, my eating habits or my weight, I'll initiate the conversation - she won't be allowed to!!

So, I have kind of arranged to have lunch with her on Wednesday. I don't know yet if I will actually pluck up courage to do the deed then, or whether I'll regard that as an opportunity to size her up and affirm my choice, if you see what I mean, before aranging another 'talking' opportunity later on. Between now and then I have to work out exactly what I am going to say. I have rehearsed it in my head in the past and in my head it takes about five hours..... so I will have to come up with a form of words that adequately encompasses all the important bits and doesn't take all day! I'll let you know how it goes.

Lessons about eating out

I've just returned from a weekend away. I stayed with some colleagues at a hotel and so had to deal with all the challenges of eating breakfast, lunch and dinner away from home for the first time. On Friday evening, I ate in a small restaurant on the way to the venue in Norfolk. I chose salmon, which came served with chips and a generous bowl of salad. Bearing in mind that I only got filled less than a week ago, I only ate a little of the salad and found it a bit hard-going because it's quite hard and relatively indigestible. The salmon went down fine and I managed about ten chips - the first chips I have eaten since October!!!

Next morning at the hotel, I played relatively safe again and ate scrambled egg, tomato and mushroom with half a slice of toast. I tried to eat some grapefruit segments beforehand but had to give up on these as they were getting 'stuck' in my throat and kicking off a bit of acid indigestion. I had the same thing with the mushrooms and the skin on the tomatoes. Next morning I played even safer and went for tomatoes and toast only.

Saturday lunch was taken in a Tesco's cafe! I found a really nice prawn pasta salad which went down without any problems and was lovely. Today's lunch was had in the more celubrious surroundings of an olde worlde pub in the most beautful little English village. I chose butternut squash and goat's cheese lasagne (remember, I'm a veggie!). This was served with chips and salad. As an aside, I never do understand why restaurants always serve lasagne, which is rich with carbohydrate in the form of pasta, with chips - more carbs?! Anyway, the lasagne was delicious but took me ages to eat and, as usual, I was last to finish by quite some way. Others were going to have dessert so I insisted they have their plates cleared and order dessert while I carried on finishing my main course!! I also ate a little of the salad and about six chips.

On Saturday evening, everyone else was going to have three courses and I knew that if I tried this I would be there until morning! In the end, I decided to have a small starter (four tiny Thai fish cakes) as my main course, and a very slidey dessert - apple pie and custard - my first proper 'treat' in ages. During at least a couple of my meals over the weekend I ate bread and/or toast without difficulty.

What have I learnt from all this?

1. If eating out with others, bear in mind that whatever I eat, I'll finish ages after everyone else! Make jokes about being a 'slow eater' to avoid any awkward questions. Choose one or two small courses and have a starter as a main course to speed things up!

2. Genuine slider foods (like apple pie and custard) go down VERY easily, in relatively big mouthfuls, quite fast and with little 'chewing'. If looking to eat quickly, eat these foods and enjoy - but beware of the huge hike in calories....... ;-(

3. 'Good', healthy foods such as salad, crunchy / raw vegetables take loads of chewing and are relatively difficult to swallow. They cause minor acid indigestion at times (but not always) and should be eaten exceptionally slowly (especially first thing in the morning) when eating out with others (to avoid embarrassing moments).

4. There is no need to be afraid of eating out. It's different to how it used to be, but it can still be done and a lot of fun had along the way!

Pigging out

I have been a bit of a pig today. I was doing fine until lunch time. A few of us at work went out for lunch to the local restaurant bar. I was sensible and chose a meal that I thought would be quite small, and soft - I am still supposed to be on mush after my fifth band adjustment. I chose salmon fish cakes which came with a little side salad. I didn't eat the salad because I thought that would be too 'hard', but I managed both the fishcakes. I ate them slowly and was the last one to finish, as usual! So that was fine, and up to this point, although I had had more to eat for lunch than usual, it was by no means an excessive amount of food.

But eating food that has any amount of fat in it, as opposed to the very low fat food I have been eating for so long, seems to have the effect of waking up the fat gene in me. It's as though my brain suddenly remembers fatty food again and craves it. After lunch, one of my colleagues took us back to her office where she proceeded to fish out doughnuts and cookies from her goodie bag! I ate half a doughnut (which was pretty awful, actually, and very doughy) and a very small piece of cookie - but I didn't need either. About three hours later I ate a yoghurt, then while on the way to an evening meeting, I pigged a whole packet of soft mints. Prior to today, the most soft mints I have had in any one day is three! For both the yoghurt and mints, it wasn't that I was hungry, I just fancied some food.....

When I got to the evening meeting they were serving tea, coffee - and biscuits. I ate two, having not ate any biscuits for months. Afer the evening meeting, I suggested to my husband that we get a take-away. I bought a prawn mushroom curry with rice for myself. In a half-hearted attempt to be 'good' again, I put half of it on a small side plate thinking I would just eat half and either chuck the rest away or put it in the fridge for another day. In the event, I couldn't resist the urge and ate it all.

So, although I have walked about 8500 steps today, which is quite good for a mid-week day, I have probably consumed about 1600 calories - double what I ate yesterday. So, I suppose it's not a complete disaster because that's still less calories than I need in a day to maintain weight, but it's a timely reminder that although my body and habits have changed a lot, my 'fat' brain has not. In my head, I'm still a fatty, and probably always will be. That's why I so desperately need this band to work for me. It's too early to tell after my last adustment whether I now have good restriction, because I've not eaten any really solid food yet. But I'm keeping my fingers crossed. My life depends upon it.

Quorn cottage pie

Ate Quorn cottage pie for evening meal, with soft-cooked broccoli. The pie was quite nice - I don't normally eat Quorn so was pleasantly surprised. I was also surprised at how few calories it was - a full side plate of cottage pie and broccoli was only 165! Tonight was supposed to be my first day back onto mush after my last fill, but I made the move from fluids to mush a couple of days earlier. I am going out for lunch tomorrow with some colleagues and have already had a look at the menu - the only mushy thing I can see on it is salmon fish cakes - so that's what I'll have!

Basal metabolic rate

We looked at metabolism at the support group meeting last weekend and I found it really interesting - and helpful for sorting out exactly how much I need to eat (or not!) each day to lose weight. Basically, the metabolic rate is the rate at which a person burns energy. Contrary to popular belief, the heavier you are, the higher your metabolic rate is. How many of us have come across a skinny person who eats loads - and heard others say that that person must, therefore, have a high metabolism?! Well it's just not true. Imagine a normal weight person is a car. The car does absolutely nothing all day except idle with the engine switched on (this is the equivalent of this mythical normal person breathing, circulating their blood and beating their heart). At the end of the day, even though that car has gone nowhere, petrol (i.e. energy) has been used up. It's the same for human beings. But now imagine that the person is obese - and they are a lorry (bear with me!). The lorry also sits idling all day and at the end of that day, even though it hasn't gone anywhere, much more petrol (or diesel) has been used up than it was in the car. This is because the lorry is bigger, has a large engine and needs more energy input to keep it going - even though it is doing exactly the same as the car.

So it is with thin people and fat people. For the same activity, fat people burn more energy than thin people. Hence, the metabolic rate of a fat person is greater than that for a thin person. The energy we are talking about here, is the plain and simple calorie. That's what a calorie is - a unit of energy. So, if I did absolutely nothing all day except sit on my bum, I would need a certain amount of calories (energy input) simply to maintain my weight where it is now. That number of calories is my basal metabolic rate (BMR) and can be determined by (a) weighing yourself on one of those clever bathroom scales (or at your clinic or hospital) that will tell you what it is, or there are all sorts of web sites where you can look up your BMR from a table, based on your gender, height and age. I got mine from the clinic at the weekend and it's currently 1960. This value will go down as I lose weight.

In reality, most of us do not sit on our bum all day - we do stuff, and if we are taking any notice of the advice given to us by everybody, we should also be getting lots of exercise. Exercise burns energy so we have to take this into account too. There are two different ways of doing this:

1. If you have a pedometer that records the amount of calories you have burned throughout the day by walking, then you can simply add this number of calories onto your BMR.

2. If you don't have that then you can estimate your level of exercise and apply a multiplier. There is a standard table of four activity levels which can be found on lots of web sites which goes something like this:

Level 1: Essentially sedentary, sit down a lot, don't set aside any time for regular physical activity. Multiplier = 1.2
Level 2: Light activity, do some walking during the day and take part in formal activity / sports 1-3 times per week. Multiplier = 1.38
Level 3: Moderately active, job needs physical activity, you take part in formal activity / sports 3-5 times per week. Multiplier = 1.55
Level 4: Very active, very physical job, you take part in activity and sports every day. Multiplier = 1.73.

So, choose which one of these applies to you and mutliply your BMR by the value shown.

Whichever method you choose, you should now have a figure that represents your AMR (activity modified metabolic rate). In my case, if I choose a multiplier of 1.38 x 1960 gives an AMR of 2705. This means that for that level of activity, your body needs that many calories each day to maintain weight. If you then subtract from that figure what you are actually consuming each day (about 1000 calories in my case), you then have the number of calories of deficit. In my case this would be 2705 - 1000 = 1705. So, if this was the pattern every day, this means that I would be consuming 1705 calories a day less than I need.

Over the course of one week this would add up to 1705 x 7 = 11935. This is how many calories you will have effectively 'saved'. Now, 3500 calories is equivalent to 1lb weight. So if you divide the 11935 by 3500 you get 3.4lbs. This is how much weight you will lose in one week if you do level 2 amount of activity and eat 1000 calories per day (and your BMR is 1960 like mine)!!

It's important to remember two things here: one, that your weight determines the BMR, not the other way around, and two, that you need to adjust your own BMR periodically as you lose weight because it will go down. There's just one more thing. For a person of given weight and age, gender etc, your BMR will be higher if you have more muscle mass. So while I wouldn't recommend starting on body building (!), exercise that will add some muscle tone (e.g. swimming, yoga, pilates etc) will raise your BMR. This will mean that if you don't increase your calorie intake, your calorie deficit each day will be greater - and weight loss greater!! Simple!!

Post-fill impatience

I'm supposed to be on my second day of fluids today but have already lost patience! I stuck to fluids during the day but by the time I got home from work I was impatient to get back to mush. Everything I've consumed today has gone down really well, without any hint of any problems like I had before. This evening my will weakened and I decided to opt for a soft mush meal of mashed potato (ready-made from Tesco!), tinned tomato and scrambled egg. I ate it really slowly and it took about half an hour. I'm delighted to say that it all went down without any problems at all, and has left me feeling very satisfied. I will go back to soup and protein shake tomorrow for breakfast and lunch but will have mush in the evening again.

I am still not entirely sure what the reasoning is behind going on fluids for three days and mush for three days following a fill. I have heard people saying it is to allow the stomach time to settle after being 'disturbed' with the fill. I have also heard about some people who suffer terribly immediately after each fill - with pain, vomiting and indigestion - but this goes away after a few days and often they find they still don't have any restriction. It seems some people have sensitive stomachs and they react to fills. However, my stomach seems perfectly happy at the moment so I doubt it will do any damage going back to mush too soon - especially as I have been very careful about eating slowly and chewing carefully (if 'chewing' is what you do to mashed potato and runny scrambled egg!!!).

Liquid recipes

I made a banana milkshake and a lentil-based soup this evening - both of which taste delicious. Here are the recipes and calorie values:

Banana milkshake

One medium banana chopped into pieces (70 calories)
One small apple with peel and core removed, chopped up (35 calories)
One Weight Watchers low fat yoghurt (50 calories)
150ml milk (I use soya milk but any will do) (65 calories)
About 100ml water

Put all this in the blender and press 'go'! Makes about 6-700ml of thick, creamy shake. Ice cubes can be used instead of water. Total calorie value is 220. Ideal if you need a carbohydrate and/or dairy boost.

Lentil-based soup (may appeal more to vegetarians!)

One medium, boiled potato (120 calories)
One third of a pack of smoked tofu, chopped into pieces (150 calories)
Half a chopped, microwave-steamed leek (20 calories)
50g cooked green lentils (you could use red lentils) (160 calories)
Half a litre of water
Add vegetable gravy stock powder, black pepper, herbs and salt to flavour

Put all this in the blender and press 'go'! Makes three portions (about 300ml each) of creamy, thick soup with a slight smoked flavour. Total calorie value is 450 (150 per portion). Ideal for a carbohydrate and/or protein boost.

Band adjustment no. 5

I had my fifth band adjustment today. I had 0.3ml added, which makes me 0.2ml short of where I was when it was too tight. This is my band history so far:

Adjustment no. 1 - 19th January = 5.0ml added (weight 16 stone 6lbs)
Adjustment no. 2 - 15th February = 1.5ml added (weight 16 stone 0lbs)
Adjustment no. 3 - 26th February = 1.0ml added (weight 15 stone 8lbs)
Adjustment no. 4 - 4th March = 0.5ml taken out (weight 15 stone 3lbs)
Adjustment no. 5 - 22nd March = 0.3 added (weight 14 stone 12lbs)

With a bit of luck, this should be my last fill, although I understand that we often need to have a small top-up each year to allow for minor leakage. As always, the procedure was not at all painful, and the needle going in is hardly noticeable. Afterwards, I was able to drink a 200ml glass of water fairly quickly and without any problem. I have since drank a thick banana milkshake - also without any difficulty and no sign of pain, saliva or indigestion. Fingers crossed that this one will go well. I am hopeful that this will give me the perfect level of restriction - my 'sweet spot'.

Sharing experiences

I went to the HW support group meeting today and it found it really helpful. It wasn't so much the formal presentation (though that was also very useful), but more the general sharing of experiences among the bandits present. It's unbelievably helpful to know that other people have experienced similar struggles, successes and concerns as I have. I got so much out of the meeting I cannot hope to relay it all to you, but here's a selection of things I recall:

1. My hair is still falling out! I was advised to take some zinc supplement tablets or kelp. However, the hair loss is very widely known among people who have lost a lot of weight and is only temporary (I was assured that I wont go bald!). I bought some zinc supplement tablets from Boots on the way home - they are not chewable but seem small enough to swallow without any trouble.

2. A man who reached his target weight about four months ago (and looks fantastic) has not had a de-fill. He's stopped losing weight because he's chosen to consume more calories by eating 4-6 small meals per day. He says he eats anything, including some chocolate, but in limited quantities. He had also had a tummy tuck! It's funny seeing him now and not having known him before his weight loss - if I just saw him in the street I wouldn't have had the slightest clue that he was once super-obese!

3. I came away from the meeting feeling really reassured about getting another fill tomorrow. I have been a little anxious about it because of what happened last time (slime, pain and indigestion). However, hearing what other people can (or cannot) eat, it's clear that I do not have the same level of restriction as them. One man said he was in the same position as me some time ago and had had a very small fill of just 0.2ml and it made all the difference and got him to his 'sweet spot'.

4. I asked what signs a person gets that they are at the right level of restriction and was told (by several experienced bandits) that "you just know" when you get there - "you will know".

5. One person shared that although they had been banded and reached their 'sweet spot' a long time ago, they still exprienced very variable restriction - some days wondering "how in earth did I manage to eat all of that" and other days unable to eat more than a mouthful or two of a meal. I have had some hints of this - some days I seem to have restriction, and other days not.

6. Another man told us how during the week while he's at work he buys his lunch from a local sandwich shop. When he first went there he asked if they could make him a sandwich with just one slice of bread and since then they have nicknamed him "Arfur" - as in 'alf a sandwich!!! Nice to know that some outlets are willing to make special concessions for regulars.

Well that's it in terms of hard facts. The main thing I gained from today is just a sense of not being in this alone, that loads of other people have been there before me and are willing to share their experiences. If you are reading this and get an opportunity to go to a support group I would highly recommend it.

Carbohydrate cycling

Apparently, the carb monster is not necessarily a mental demon. The carb monster is the body's biological roller coaster that results with a blood chemistry imbalance. More often than not it has nothing to do with willpower or personal integrity. According to Drs. Richard and Rachael Heller in Carbohydrate Addicts, blood sugar swings are the leading physical trigger for carb cravings. They write, "High-sugar, refined starch, convenience and comfort foods feed the (carb) addiction like a drug. They produce correspondingly high blood sugar and insulin levels, which leads to more cravings. They also produce higher levels of the brain chemical serotonin. In sensitive people, particularly those who may have low serotonin levels to begin with, a carbohydrate binge is the equivalent of self-medicating, just to get the sugar high.”

So that explains why it is that I'm OK if I don't eat chocolate for weeks. But if I do eat one little morsel of it, I want (need?) more, and more and more........

According to The Merck Manual of Medical Information, “The theory behind high protein, low carbohydrate diets is that slower-burning energy sources – protein and fat – provide a steady supply of energy and thus are less likely to lead to weight gain. In addition, people tend to feel full longer after eating protein than after eating carbohydrates, because carbohydrates empty from the stomach quickly and are digested quickly. Carbohydrates also strongly stimulate insulin production, which promotes fat deposition and increases appetite.”

So that's why some bandits place such an emphasis on eating proteins indeed many American bandits have four band rules, the first of which, is "Protein First").

The 5 Day Pouch Test

I came across this web site today http://www.5daypouchtest.com/index.html which describes the 5 Day Pouch Test - a 5-day diet plan to help us bandits get back in touch with our pouches. It's American, so there's quite a bit of emphasis on proteins, but it seems like an interesting way of doing things - and all with good, sound advice and encouragement. The plan is designed for bandits who are struggling to deal with hunger, too much carbohydrate and unsure of restriction. The first two days of the plan focus on liquids only (especially protein drinks). The third day is soft proteins (e.g. scrambled egg), the fourth day is firm proteins and the final day is solid proteins. There are a few rules, like you can eat as often as you like, but not for more than 15 minutes at a time - and of course you cannot drink with meals. The web site is accompanied by a range of recipes for each of the days.

Mmm, interesting. I'm not sure I am ready to try this just yet, but some of the general principles are really helpful, and it's always useful to be reminded of what this whole thing is about.

Calories burned during exercise

I had a look on the Internet yesterday and found this fantastic web site that gives calories burned for a very wide range of exercise and activities: http://www.nutristrategy.com/activitylist4.htm. I looked up swimming and found that there are several categories. The numbers give calories burned per hour for a person weighing 190 lbs (I weigh 210 but this was the closest weight category available for me):

Swimming laps, freestyle, fast, vigorous effort - 863
Swimming laps, freestyle, light/moderate effort - 690
Swimming, backstroke, general - 690
Swimming, breaststroke, general - 863
Swimming, butterfly, general - 949
Swimming, leisurely, general - 518
Swimming, sidestroke, general - 690
Swimming, sychronized - 690
Swimming, treading water, fast/vigorous - 863
Swimming, treading water, moderate effort - 345

I swim mainly front crawl (freestyle) with some backstroke thrown in for variety. I also swim fairly vigorously so decided that my calories burned per hour would lie somewhere between 690 and 863 - I interpolated and came up with 780 (allowing for the fact that I weigh more than 190lbs and so will burn calories at a faster rate than in the table). Last night I swam for 45 minutes which gives a total calorie burn of 585. What I really wanted to do was to find out what this was equivalent to, in terms of steps walked (so I can see how swimming contributes to my target of 10,000 steps per day). Since one step burns 0.06 calories (I got this from my dietician and I've checked it against my pedometer and it's correct), then I can find the number of steps that my swim was equivalent to by dividing 585 by 0.06. Result? A whopping 9750 steps!

So, adding the steps equivalent and calories burned from the swim together with the normal walking I did at work yesterday, I 'walked' 13,500 steps and burned 800 calories. Since I only ate 880, I consumed a net calorie intake of just 80 calories yesterday!! No wonder I went below 15 stone for the first time this morning - 14 stone and 13 lbs. Fantastic.

Things are going swimmingly

I'm off swimming this evening! I used to do loads of swimming and am a member of an adults club. It's only a small club with about 20 members and we meet for social reasons as much as for the exercise. However, I haven't been for about a year so am really out of shape. The good news is that after a rummage around in my wardrobe, I found a brand new swimming costume that I had never been able to fit into before - and now it fits like a glove! I am slightly concerned about my skin. The chlorine in the water always makes my skin dry (and my hair smell!) - but my skin has been particularly dry now for some weeks. I guess I will just have to shower the chlorine off as best I can (I'm sure they put chlorine in the shower water too!) and then rush home and slather myself in E45! The next thing I will do when I get home is to attempt to calculate what an hour of swimming is equivalent to in steps - I am sure I have the information somewhere and will post the results on the blog tomorrow.

Full, twice in a day

It started with the lunch I had so lovingly prepared. The cherry tomatoes glistening and inviting, the cucumber and yellow peppers just crying out to be eaten, and the olives, spicy and chewy, just waiting to be stuffed - into my mouth. I also had some crunchy Ryvita minis and a pot of mixed tuna and cream cheese, to supply my protein needs. I started eating, doing my duty and chewing well. Within a short time, about a quarter of the way through my meal, I began to feel full. The whole meal was only about 240 calories, so not exactly a King's banquet. I have been happily eating small meals without any problem, so was a little taken aback to be feeling full so early. I should have put it to one side and not eaten any more. However, the 'food gene' in my head told me to have just a little more..... I stopped half way through and found the courage to put it to one side, aware of the conflict within me - my head telling me to carry on eating because there's still food on the plate and it would be a crime to leave it..... and my stomach telling my "stoooopppp! I've had enough!!"

So, I ate half of it, and ate the other half a couple of hours later. Then this evening I moved onto my next meal. It was sprouts, wholewheat pasta cooked al dente, spinach and smoked tofu. Delicious (it might not sound it to any carnivores reading this, but to me, a lovely meal!!). It was a low fat meal made of healthy ingredients - and it all fit easily onto a 7-inch side plate (as advised by my provider). The whole meal was about 300 calories. I got about one third of the way through it and began to feel very mild pain behind my breastbone. I paused for a while and ate a little more but at the half way point, quit. I still couldn't bring myself to throw good food in the bin so I've put it in a plastic tub and will eat it for lunch tomorrow!

So what's happening? I had a small aspiration a couple of weeks ago and since then I have been disappointed at the lack of restriction. I have been able to eat anything, including all kinds of 'difficult' foods. This morning, I decided I'd had enough and booked another small fill for Sunday 22nd March (in six days time). Then this afternoon, out of the blue, suddenly I'm getting real restriction and 'full' feelings for the first time. Odd timing, what?! I'm going to see what happens in the next few days and make a final decision on Saturday.

Salt cravings

For some time now, I have had a mild craving for salt. I add quite a lot of Lo Sodium Salt to my meals - much more than I used to. I thought it was simply because I am eating less processed foods and less food generally - so assumed I just needed more salt than I was getting. Indeed, this may be the case. However, looking on the Internet it seems that there a whole host of causes for salt cravings, including adrenal and thyroid gland problems, menstruation, stress and lack of calcium (click on the link above)! The only one of the possibilities that I think could apply to me is lack of calcium: "Some studies have shown that people who are deficient in calcium crave salt more frequently than those who are not." I have been taking a calcium supplement each day (well most days - I sometimes forget) because I am conscious of the fact that I don't eat much dairy produce. I just have a little (100ml) soya milk on my cereal in the morning and eat a low fat yoghurt in the evening. Given that a lack of calcium now seems to be a definite possibility, I will have to see if I can boost the calcium content of my food intake.

Eating in the right order

I mentioned yesterday that a fellow bandit had advised me to eat proteins first, veggies next and carbohydrates last. At the time I couldn't understand the logic behind this. Since then, however, I've mulled it over a bit and figured it out! My pouch, created by the band, has a volume about the size of a golf ball, or a couple of tablespoons of food. This is not large enough to take even a small meal. Therefore I have to eat very slowly to allow time for the food to pass through into my main stomach. If I eat too fast the pouch will get full too quickly and this leads to pain, indigestion and the like. However, towards the end of a meal, obviously I don't want all of the food to pass through - I want some of it to stick around for a while to give me a sensation of feeling full, or at least satisfied.

Now, in the handbook given to me by my provider, they recommend that I finish off a 'soft' meal (i.e. one made up of slider foods) with some crunchy vegetables or a piece of fruit. The thing about eating a meal in the right order follows a similar logic: Proteins should be eaten first for two reasons. First, proteins are more likely to contain fat than other elements of the meal. Foods containing fat have a greater tendency to turn into mush once chewed and tend to pass through the band more easily (I was told this by my doctor). Eating proteins first means that the pouch will empty relatively quickly leaving space for the food that follows. Second, we need to ensure that we consume enough proteins since these foods provide essential minerals and vitamins and also help to give a 'full' feeling. Therefore, eating these first means that if we get too full to finish the meal, we will have eaten the most important part of already.

Veggies should be eaten next because they can be cooked lightly so that they are still quite crunchy. Veggies will then stay in the pouch for longer and give us that 'full' feeling we seek. The idea behind the carbs being eaten last is because they are sometimes regarded as the least essential foods in terms of minerals and vitamins, and are relatively high in calories. The thinking is, that if we get too full to finish the meal, it will be the least essential carbs that are left.

Now, the advice about eating in the right order was given to me by an American lady. This is important because the Americans have a slightly different position to us Brits on the question of proteins and carbs. There is a much greater emphasis in the USA on bandits consuming high amounts of proteins and very little carbohydrate. This was brought home to me when I purchased an American gastric band recipe book a while ago - none of the meals has any carbohydrates in (e.g. potato, rice, couscous, pasta etc) and there is an enormous focus on proteins. In Britain, on the other hand, we are advised to eat a balanced diet. My provider recommends a meal is made up of one quarter carbs, one quarter proteins and half vegetables.

The result is, that while I see the logic behind eating in the 'right' order, I don't necesarily agree with it! It seems to me to be a good idea to consume proteins first to make sure they get eaten. It also seems to me to be a good idea to follow the advice of my own provider and finish off a meal with crunchy vegetables to give a full feeling. However, I think carbs are actually important - for energy, for instance, so would eat these before the veggies. If I thought I was getting full enough that I wouldn't be able to finish off the meal I would simply eat smaller portions of each part of it, rather than leaving out one whole element of the meal completely.

While I won't be following the American lady's advice in its entirety, I am at least happy that I understand the logic behind it now. Funny thing, this band, you almost need a degree in anatomy and nutrition to get the most out if it!!

Ramblings on restriction

I have been talking to some fellow bandits about how to tell if I have restriction or not – and how to be sure whether I am getting the 'full' feeling or not. What follows is a summary of some of the advice I have been given.

Some of us obese people, who have lived through a lifetime of over-eating have actually lost the ability to truly and accurately sense when and if we are 'full'. Some bandits use a hunger scale similar to that suggested by Paul McKenna (see my post http://gastricbandblog-theresa.blogspot.com/2009/02/i-can-make-you-thin-part-two.html). One on the scale is equivalent to Physically Faint and ten on the scale is Nauseous. Some dieticians advice that we should stop eating when we get to about number six on the scale. In other words, we shouldn't necessarily be aiming to feel 'full', just 'satisfied'. A full feeling may be accompanied by a sense of bloatedness. In my recent experience, this doesn't kick in for at least 10 or 15 minutes after I have finished eating!

The Paul McKenna Hunger Scale

1. Physically faint
2. Ravenous
3. Fairly hungry
4. Slightly hungry
5. Neutral
6. Pleasantly satisfied
7. Full
8. Stuffed
9. Bloated
10. Nauseous

If we eat until satisfied, then this should keep us going for about 3 to 4 hours and our next meal. If our next meal is more than 3 to 4 hours away, then healthy snacking is OK. Healthy snacks could include low fat yoghurt, perhaps with some cereal crunched in for added texture. Fruit is also an ideal snack. To reduce hunger between meals, hot drinks are a good idea (I occasionally have a low fat hot chocolate, for example), or suck a mint or chew gum (being careful not to swallow it!).

One bandit said that when eating meals, we should eat the proteins first, followed by the veggies and then the carbs last. I am not sure what the reasoning is behind this and I haven't heard of it before - but I am going to try it and see if it makes any difference!

Sometimes it takes a while to get in tune with our bands – it's like having a new part to our bodies and trying to get used to responding to it and working with it.

Personally, I think that I definitely have some restriction. I know that if I eat too fast I get hints of indigestion and very mild pain (iron fist – but very mild). I also think that I have been expecting a very definite “right that's it, I'm full” kind of feeling and this is probably unrealistic. In reality, I need to stop eating when satisfied rather than get to the point where I am full. Also, because of the time delay between eating and 'full' messages getting to my brain, I am probably continuing on past the point at which I am physically satisfied, if you see what I mean! As well as simply being impatient by nature (!), I think another problem I have is that I am a little afraid of consuming too many calories on a daily basis. The result is, that on so-called 'good' days I have actually not consumed enough. I should be aiming for 1000-1200 per day but have been regularly eating only about 850-900. What I think I should do from now on, is to continue eating the same size meals as I have done, but be much more willing to eat healthy snacks in between to control my hunger. I plan on taking a snack pack to work with me every day next week – full of apples, nectarines, yoghurts and the like. After all, if I ate a small apple, a small nectarine, a low fat yoghurt and a low fat cereal bar, it would still only amount to about 200 calories extra – which is exactly what I need!

Oh, it's soooo good to know that there are helpful people out there who are willing to pass on their experience, advice and encouragement. Thank you to you all.

First meal out

My other half and I went out for a meal with a large group (16) of friends last night. It was the first time I have eaten anywhere except at home since Christmas, and the first time since being banded that I've eaten in a restaurant. It was fortunate for me that we all opted for a two-course meal deal, otherwise I was going to start panicking about feeling 'obliged' to eat a third course! My other worry was that I had no idea what was going to be on the menu - but as it turned out there was quite a bit of variety.

In the end I decided to play safe with the starter and went for a spicy tomato soup. This, of course, is a 'slider' food so I knew it wouldn't fill me up too much and I could eat it at about the same pace as other people. I opted for baked cod on a bed of minted pea for the main course. Vegetables and baby potatoes came separately on large plates for the whole table. That was a good thing because it meant I could be very sparing about how much veg and potatoes I put on my plate. I selected one small potato, a piece of cauliflower, three mange tout and a spoonful of red cabbage.

The meal was absolutely delicious although it took me ages to eat. Everyone else on the table finished before I was even half way through, and I really was trying to eat as fast as I could! I lipread a discussion between two ladies who were saying that I was taking a long time to finish my meal because the 'loin of cod' had been really large. In fact, it wasn't a particularly large piece of fish at all, but little did they know! Then someone at the other end of the table called the waiter over and asked him to start clearing the plates away, but the waiter pointed over in my direction indicating that someone was still eating! Then the guy next to me began asking questions about the food on my plate and said that I seemed to be a very fastidious eater! I think I partly sparked this because I'd earlier told him that I am very fussy about my tea (I drink it extremely weak, black and sugarless) - but I am definitely not a fussy eater - he mistook slowness for fastidiousness!

I have to confess that I found the slow-eating thing quite embarrassing, particularly since it seemed to spark these three seperate incidents! It meant that towards the end of my meal I really was rushing it down and not enjoying it as much as I might otherwise have done. I guess the lesson to draw from this is that next time, I should just go out for a meal with my husband or a couple of family members who know about the band. Eating out in a big group like this I felt that all eyes were on me as I sat chewing everything to death. Having said that, the food itself was lovely and I really enjoyed it. My only real disappointment of the evening was that I didn't feel really full at the end of it. The meal was not large by any standards but was probably 50% bigger than my normal 7-inch plate size. This suggests that I still don't have enough restriction from my band and will need another fill sometime soon. I am thinking in terms of something like 0.2ml so that I don't get into the indigestion and slime problems I had last time.

I have a few more eating challenges coming up in the next few weeks. In a couple of weeks time I am going away for the weekend with some professional colleagues and will be staying in a hotel. I guess we will be eating together in the evenings so I'll have to go through the 'everyone's looking at me 'cause I'm eating slow' thing again. A few weeks after that I am going away with two male colleagues for a whole week in Scotland and staying at an activity centre. We have stayed there several times before and the food is pretty awful - very fatty and unhealthy, with battered vegetables and burgers frequenting the menu! Fortunately the place has separate cooking facilities available to guests which I may decide to use rather than filling my face with bad stuff.

My immediate challange is to get over the fact that I seem to be constantly hungry at the moment and am really struggling to keep to my 1000 calorie a day limit. It's particularly a problem during the mornings, something which is quite new to me as in the past I have always got hungry in late afternoon and evening. I'll keep you posted.

Don't buy HSBC travel insurance!

My husband just told me that he's renewed our annual HSBC travel insurance. He told them that I have a gastric band and the lady went away to ask someone about it. She came back and told him that they will renew our insurance but I won't be covered in the event that anything happens relating to my band. Now, I read something somewhere about the gastric band being treated by some companies as a 'pre-existing condition' but I am still unclear on what the position is. I wonder if they treat women with breast implants in the same way????!!

Personally, I think this is ridiculous and am searching for an alternate travel insurance provider who is a bit more enlightened. We bandits, after all, are loads more healthy post-surgery than we were before. The surgery was the solution, not the problem, and certainly shouldn't be regarded as a 'condition'! In theory, they should reduce our premium because of the band because we are less at risk of diabetes, heart attacks and strokes, to say nothing of all sorts of mobility problems.

I wonder whether we should have declared it at all? I guess I wouldn't be that averse to paying a slightly higher premium, but for the company to simply exclude this 'condition' and not cover it is just silly and money-grabbing.

Anyway, I will investigate further and see what I find out. Meanwhile, I advise you NOT to purchase HSBC travel insurance!

Hair falling out

Don't panic, I'm not going bald... but I have noticed an increasing amount of hair in the bath after I have taken a shower in the morning. At first, I thought I must just be imagining things, so I decided to just keep an eye on it for a while. But a couple of weeks on, now I am sure. I did a Google search and found quite a lot of stuff about hair loss in relation to dieting and weight loss. However, there was mixed information. In general, the web sites I looked at suggested that the hair loss is a temporary effect of weight loss, and in some cases, relates to a deficiency of certain minerals. Most commonly, lack of vitamin B, B12 and zinc were cited. Other sites said a lack of water was to blame and others said hair loss was common on low fat diets.

Anxious to get some more definite information, I telephoned my dietician when I got home from work today. He said that some hair loss occurs in about 40% of gastric band patients and is only a short term phenomenon. He assured me that I won't go bald (which was a relief)!! He said it commonly occurs about three months or so into the weight loss process - which is about where I am at now. He also said that it can sometimes indicate a slight lack of vitamin B and folic acids. Now, both these are included in the daily multivitamin that I have. However, he said that if I was worried about it I could get a vitamin B supplement as well. I don't think I will bother with an extra supplement, but I will make extra sure that I take my daily vitamins - I do sometimes forget.

While reading about hair loss on the web, I also came across quite a bit of information about other side effects of weight loss - including dry and flaky skin - something I am definitely suffering from. I apply E45 cream all over every morning and have started to use Bio Oil on the stretch marks on my tummy and under my chin (which is starting to get wrinkly - awful!).

So, the only problem I have now is to try and find the 'sucker' thing for the bath so I can get the water flowing down the plug hole a bit better than it has been doing! I do have very thick hair anyway, so losing a bit of it seems to clogging up the outflow in the bath...

Back onto mush

Well, it's been four days since I had a small aspiration and I have progressed from fluids back onto mush. In a couple more days I will back onto 'proper' food again and then I might be able to detect whether I have good restriction or not. It's actually quite hard to tell at the moment, partly because mushy foods are 'slider' foods and probably don't hang around in my 'pouch' very long, and partly because my cold and cough seem to have developed into some sort of bug that is now starting to affect my stomach. I feel a little nauseous as a result and cannot tell, when I eat, whether I am full, or just feeling bloated because of the bug!

I spent the required three days on fluids and experimented with some homemade soup again. I re-visited my favourite fish soup which went down a treat. I've also taken to chewing on Trebor soft mints which relieve the boredom and satisfy a peculiar longing to chew something! Yesterday I ate some Tesco vegetarian cottage pie which is lovely, and in the evening ate softly steamed salmon, soft-cooked filled pasta and over-cooked spinach. It was lovely though I didn't enjoy is as much as I might have done but for this bug. Today I managed some scrambled egg for breakfast which brought back memories of the last time I ate scrambled egg and it brought on some awful retching and saliva-pouring. That is all behind me now, thank goodness.

So, until I get rid of this bug, I won' realy know the status of my restriction. Until then, I will just continue to judge my food portions by the size of my seven inch side plate! The weight is still coming off, I'm 15 stone and 2 pounds now. I am hoping that in a week's time, I will venture into the 14's for the first time in decades.......

Working for a compliment

I'm at work today, doing some extra duties with colleagues. I was walking along a corridor with one of my colleagues, one with whom I have had occasional 'difficulties'. He said, quietly, "I hope you don't mind me saying this, Theresa...." - and my heart sank. I imagined he was going to make some complaint about a contentious issue that had arisen in a difficult meeting we'd had yesterday. But to my immense surprise and amazement, what he actually said, was, "....you look fantastic!"

Wow! I was slightly speechless for one of the rare moments in my life. Then I summoned up "how could I possibly mind you saying that?!" I thanked him and he asked a couple of questions about how I was 'doing it' (i.e. losing weight, though the word 'weight' was not actually mentioned!) - doing exercise, healthy eating etc. He said he'd couldn't help noticing while sat across from me in the meeting yesterday and thinking "wow, she looks really different!".

Well, you know what? I wasn't particularly looking forward to having to come into work on a Saturday. But it was worth every ounce of effort it cost me just to hear such a wonderful compliment - and especially from someone with whom I have had a little tension. It goes to show, you just never know what people are really thinking.......

Single Incision Laparoscopic Surgery

...or S.I.L.S as it is known for short. Professor Favretti, top surgeon at Healthier Weight (who operated on me!) has performed the first gastric band operation in the UK that involved a single incision - through the belly button! Click on the link above to go to the web page that includes a photo of the post-surgery belly button in question. Apart from the obvious advantage that a single incision is an aesthetic improvement, it also reduces infection risk and increases the speed of recovery.

Aspiration no.1

I travelled to Birmingham yesterday for a small aspiration. I had 0.5ml taken out leaving me with 7ml in the band - 0.5ml more than before my last fill. Straight afterwards I was able to drink a glass of water fairly smoothly, without any pain, gurgling, heartburn or 'slime'! Oh, the relief is palpable! I have been put on Rinitidine (an anti-indigestion formula) for a few days to reduce any inflamation in my oesophagus that might have been caused by the retching and saliva-pouring (what others sem to refer to as the 'slime').

Today I have been in Birmingham again, this time for a work-related meeting. A buffet lunch was provided so, being on fluids again (have I ever been off them?!), I drank some cold tomato soup that I had taken with me. Well, actually, I only drank half of it, it being decidely unpalatable. I have been feeling fairly full all day on relatively little food so the early signs are that I have good restriction wihout all the nastiness of pain etc.

It's been a long day and I could do with some food now, so I'm going to have some of my home-made fish soup again, left over from yesterday. This really is a winner, try it - here's the recipe:

1. Cook a boil-in-the-bag cod in parsley sauce in the microwave.
2. Defrost (in the microwave) a good handful of frozen prawns.
3. Boil, on the hob, some small-cut peeled potatoes together with a couple of handfuls of frozen sweetcorn.
4. Chuck all this in the blender with enough milk and/or water (2:1 milk:water is best) to produce the right consistency and add some vegetable (or other) gravy powder/granules.
5. Blend, heat up in the microwave if necessary, eat!

Lovely!

Crossing my legs.....

A funny (peculiar) thing happened last night. I was watching something lighthearted on TV and chatting away to my other half. I turned around in my chair to explain something to him. However, I was twisted a little awkwardly in the chair so I crossed my legs - you know the sort of thing - I threw one leg over the top of the other. I was just about to continue with my explanation but a niggling feeling in the back of my head was teling me "something's different!" So, distracted by this thought, I stopped mid-sentence to figure it out. My other half noticed the change in my demeanour and asked what was wrong. I thought for a millisecond or two, and then it hit me - "I've crossed my legs!", I said. The bemused expression on his face hinted that he hadn't a bloody clue what I was on about, so I tried again, a little more forcefully this time; "I have just crossed my legs - look!". Still no reaction, so I had to spell it out. "I haven't been able to cross my legs in years 'cause my legs have always been too fat!!!"

I've noticed something else too over the last week or so - I can feel muscles in my arms. No, I haven't been lifting weights, in fact, I doubt my muscles have changed at all. It's just that there's much less fat covering them now so I can actually see them!!

Half way there - woohooo!!

I adjusted my weight loss ticker again this morning and discovered that I have just crossed the half way point! Fantastic! OK, I know I am losing weight rapidly at the moment (six pounds in the last week) because of my problems with the band - and I guess that some of that weight is simply fluid. Once I get back off fluids next Saturday and start eating again I expect the weight loss to plateau for a week or so as I rehydrate. But do you know what? I don't care about the hows and whys of it, I'm over half way there and that's what counts!

Two steps forward, one step back....

Today hasn't been good. It started with the two and a half hours it took me to drink 200ml of tea, 200ml of orange and 200ml of strawberry shake, all accompanied with constant gurgling, indigestion, pain behind my breastbone and other shooting pains generally around my abdomen. Oddly enough, I could have coped with that, but then I ate some scrambled egg. It was prepared exactly the same as the scrambled egg I ate at about the same time yesterday - and I was looking forward to it. In fact I managed to eat most of it - carefully, slowly, and 'chewing' each morsel exaggeratedly (if chewing is what you can call it - more like squashing it with my tongue really!). Just as I was finishing the gurgling got worse and then I had quite nasty pain in the back of my throat to the point where I was even finding it difficult to breathe. My mouth then started filling up with saliva. I kept swallowing it, thinking I could somehow overcome this phenomenon by sheer willpower. But it was not to be. Fearful of a nasty accident on my desk I rushed down to the toilets. I spent what seemed like hours bent over the loo while loads of saliva just kept pouring out. This was accompanied by cramp-like sensations in my stomach, abdomen and upper chest. By the time this was all over I was really quite exhausted and felt quite ill for two or three hours. During this time I was actually afraid of drinking anything so started to get dehydrated. By mid-afternoon I became convinced that none of this was normal and phoned the bariatric nurse at Healther Weight. I explained my symptoms and she immediately said that I was obviously "too tight". I have arranged to see her for a small aspiration in Birmingham on Wednesday and until then I'm back on fluids.

These bands - are they weird or what? Last night I ate a small mushy meal of pasta, fish and broccoli - all without any problem - and yet today I can't even get pure fluids down without a struggle!! I tell you, the next time I hear anyone talk about the band as being a 'quick fix' or worse, the 'easy option', I think I'm going to punch them on the nose!!!

So, the result is, having got 7.5ml put in my band, I'm going to take a step back (but hopefully forwards, if you see what I mean) - probably to about 7ml (6.5ml gave me no restriction at all). It brings home the warning printed in my 'band book': "People occasionaly make the mistake of thinking that 'more is better' - that if the band is working well at one level of adjustment, it will work even better if we make it tighter. This is a serious mistake." (from Your Surgery: A before and after guide to getting the most from your surgery by Healthier Weight). I must confess that when the nurse said last week that she was going to put 0.7ml in, I was a bit disappointed. However, I described what and how I was eating (completely truthfully), and the fact that I could easily eat bread, pasta and other 'difficult' foods - she changed her mind and increased it to 1ml. I was quite pleased about that because I doubted that 0.7ml would make that much difference - how wrong can you be?!!

This evening so far, I have managed some Ribena and four squares of Dairy Milk chocolate (well, a woman has to get her calories from somewhere, doesn't she?!). I am going to keep trying to get fluids down and may be really adventurous and try some soup later.... ah well, no-one said this was going to be easy!

Some progress today

Things have faired a little better today, although it wasn't a good start. It took me about half an hour to sip through 200ml of hot lemon. This was accompanied by pains in the chest (about where my 'pouch' is). I followed this up with some orange juice which brought on a small episode of saliva-pouring (see yesterday's post). After that, I drank a strawberry shake and this went down fine! Since then things have got better and better. I ate some runny scambled egg for late breakfast - it was great to have some semi-solid food again! For lunch I ate mashed potato with gravy - lovely! This evening I managed a small plate of soft mashed broccoli, soft-cooked filled pasta, and cod in parsley sauce. It took me about 40 minutes to eat, slowly and carefully chewing each morsel. Apart from the odd twinge (I've had odd, mild pains around my abdomen), I had no problems eating all this pureed food, which is a really good sign that the band is beginning to settle down. I have also been quite full after eating each of my meals which is a good sign that the band is at last starting to do its job!

There seems to be a general consensus among more experienced bandits that when you get to the fill that is closest to your 'sweet spot', it takes up to two weeks to really settle down. Prior to that, indigestion and pain and saliva etc are fairly normal. I am now quite optimistic that I will be able to return to some form of 'solid' food in a couple of days from now.