The pain in Spain….

….falls mainly on the grain.

Basically, I'm in Spain for a week, working in the field. I was here at the same time last year and experienced the same problems with my band then as I'm experiencing now. It's got really tight, and I'm struggling to know why. It's taking me ages to drink anything, I've just tried to eat half a banana and had to rush to the toilet to throw up, I can't eat any bread at all, and I'm only managing soup and soft stuff in the evenings. But why? Here are some thoughts:

Flying: Last year, I thought it might be something to do with the flight - the cabin pressure or associated dehydration. But the only things I can find on the web about bands and flying are anecdotal, and relate only to long haul flights, so this doesn't seem likely.
Activity: I've been getting lots of exercise, but I get intense periods of exercise at other times of the year too and have no effects like this.
The food: I've not been having my usual breakfast (half a litre of strawberry milk-based protein shake), lunch is a huge white baguette with cheese or tuna and salad (I don't normally eat bread, and never white), and evening meals are 3-course, large, and very low in fat (I normally have a small, protein-rich meal with a 'normal' fat portion).
Drink: Earlier in the week there is no doubt that I got dehydrated, but for the past couple of days I've been working much harder to make sure I get enough to drink.
Climate: Last year it was very warm, but this year has been much cooler - more like typical British temperatures in October. So this doesn't seem likely.
Medication: I am taking methylphenidate for my ADHD and it is known to suppress appetite - but I wasn't taking this last year.

So the most likely thing seems to be the change in my food and drink habits. I'll be back here again next year and I'm not sure what I can do to change things, to be honest. However, on the plus side, although I'm suffering a little at the moment, this glitch may result in kick-starting some more weight loss….

Last year, I arrived in Spain weighing 17st and 3lbs. I arrived home after one week sighing ten pounds less. Then, without any particular effort on my part, I lost a further 22lbs over the following six months or so. So when I arrived in Spain this year, I weighed 14st and 13 lbs. The way I am feeling at the moment, I will not be that weight when I get home tomorrow. And who knows, maybe the loss will keep coming?

Sparkling insight

One of the comments on a post a few days ago, generously contributed by Sparkler, demonstrated incredible insight into some aspects of my predicament. I'm going to address them one by one and see where it takes me:

This is a really tough time in the journey...all the newness has worn off, you're nearly there so you're probably pretty comfortable with your weight right now, so the urgency has dropped.

That is SOoooo right. Truth is, if I didn't lose another pound - I'd be a little disappointed but I wouldn't be devastated, because the worst of the weight has gone. I started at 20 stone, I now weigh about 12 and a half. I'd like to be ten and a half - but I'm thin enough that I can walk, jog, swim - and all with relative comfort. I can buy 'normal' clothes in 'normal' shops for the first time in my adult life and so the urgency has gone. Spot on Sparkler. But when I sit down and really think about it - I don't want to settle for this - it is less than I wanted when I started out and I want better. I am not looking for perfection but I do want to be in control of my eating and my weight. No, I wouldn't be devastated if I didn't lose another pound, but I don't think I would look upon my band experience as a complete success either.

Everything about the band is so familiar which means it doesn't take much thinking about.

Yes, you're right again. But this is the problem. I often THINK it doesn't need thinking about because it's so familiar - but actually it does. For example, I thought I'd 'cracked' the think about not drinking after eating - I thought it had become second nature. But in the last few months I have got back into bad habits again. Also, I have had more slime and regurgitation events in the last few months than I've ever had. This is not because my band is too tight - it's because sometimes I just forget it is there and get back to old eating habits (eating too much, too quick, the wrong type of food, eating while distracted etc). I probably need to get out my old 'band manual' and re-read it again from start to finish and keep on reminding myself that I have a little friend inside me - and it's going to be there for life....

I'd be interested to hear what your restriction is like now on an average day. Do you still eat the same small portion sizes or are you able to eat more at a sitting? Do you still have certain foods that are a no-go area? What's it like once it all becomes routine, mundane and everyday?

When I make good food choices I have excellent 'sweet spot' restriction. My meals are small and they fill me up. I can't guzzle a drink down fast like I used to but have to take it in smaller mouthfuls and slowly. I'm much more restricted in the morning and can't really eat much till mid-morning. IF (and it's a big IF) I don't eat chocolate and other 'bad' foods, I exist very happily on about 1200 calories a day and don't feel physically hungry at all. There's no sign of my band getting looser. There are very fews that are a no-go area - mainly chips (French fries), very fatty foods like battered fish (chip-shop style), and the skins of cherry tomatoes and grapes! I avoid white bread but can easily eat whoolemeal bread (though not in large quantity). Many of the things that I used to perceive as big problems or difficulties - just aren't! I can eat out but do so very cautiously. So far I have avoided having any embarrassing incidents while eating out and would like it to remain that way!

Good luck with getting that focus back to fight off that last stubborn stone and a half. Actually having a break from the strict regime probably won't do you any harm as once you get back to your walking and cut out the lovely but lethal chocolate you'll be like a new dieter who has a really rewarding first three weeks or so. A post-Easter resolution perhaps?

You may be right about having a break from the strict regime but I think I need to get back to it soon. Now that work has eased off I am finding time to get back to some exercise - walking, stepping and swimming mainly. I think you are right - I will wait until I am firmly back in the UK after my trip and then set a date to kick-start my band-life.

Many thanks for your insight and encouragement!

Pre-band fears part 3: Being called a cheat!

I suppose it was the 'outing' of Fern Britton that did it - she was 'found out' with the gastric band and called a cheat in the British media. I suppose that in the early days of the band I didn't know enough about how it would work so I think a part of me believed that there was an element of cheating involved. Of course now I know different. I know from experience that if I want to, I can eat pretty much anything. I can eat all of the unhealthy foods that I used to be able to eat. I can eat chocolate in volume and binge on the stuff almost as easily as I used to. I know that other famous celebrities gave had their band removed because they gained weight eating loads of chocolate! I know from months of hard work that band success means careful calorie counting, rigorous maintenance of a food diary, tonnes of exercise and constantly making good, nutritional food choices. It means sticking to a whole heap of rules, like chewing everything to death, eating slowly, not getting distracted while eating, using small utensils, eating off a side plate, practising environmental control and balancing proteins, carbs and veggies. It also requires sticking to the hardest rule of all, which is not to drink for at least one hour after eating!!

Because I was uncertain about how the band was going to work, I was careful early on not to tell anyone except my husband, that I had a band. Over time, and as I've learned more about what is involved in making the band work for me, I've become more relaxed about telling people. I guess I feel more confident that I am not a cheat! I feel I can explain to people properly how the band works and I can justify my reasons for having one. Some would say why do I need to justify anything to anybody - but that's just the way I am!

About six weeks after getting banded I told my immediate family. Since then, I've told several close colleagues and friends. Even just today, I told my office mate (as he was stuffing his face with a muffin!). Whereas many months ago I couldn't really see myself telling anybody, now I firmly believe that I will probably eventually tell everybody! I think that basically I'm just a coward, and am scared of telling people in case it doesn't work. That's why I expect I will eventually 'out' to everyone only once I reach my target!! I said I was a coward!

So, as far as people calling me a cheat is concerned - I no longer have that fear. At the end of the day, it's my body, my money and my health. As is plainly clear for anyone who knows me to see, the band has done wonders for me and it clearly does work. If having something that only does 30% of the work is being a cheat - then I confess to being one. But I jest. I am not a cheat, I don't feel a cheat, and anyone who thinks I am one is plain and simple WRONG! There.

Pre-band fears part 2: Being sick

Before I got banded I'd read and heard so much about bandits being sick that it really began to worry me. I got the impression, from various forums and web sites, that vomiting was a normal everyday part of life being a bandit. I read stories about people throwing up while they were eating out - much to everyone's embarrassment. I'd also read about people who more or less threw up every time they ate. But then, to add to my confusion, I read advice and guidance from bariatric surgeons and doctors saying that being sick was not a normal everyday occurrence for bandits - or at least that it shouldn't be. So, I decided to plough on ahead with surgery anyway and deal with vomiting if, and when, the time came.

Over a year on, what has the reality been? Well (and I advise you to read this before you eat if you've got a weak stomach!), first, there are three different kinds of vomiting with the band:

1. The 'slime'
2. Regurgitation
3. Vomiting - proper

I'm going to break with tradition and deal with these in reverse order.

3. Vomiting: We've all done this, whether from over-eating or too much of the amber nectar! This is when we bring up partially or fully digested food from the stomach. For bandits - this means the main, lower stomach. In the normal run of things, this shouldn't ever happen to a bandit purely from eating too fast etc because the lower stomach has much greater capacity than the upper pouch. However, vomiting could result from a tummy bug or other illness. Proper vomiting is dangerous for bandits because 'it' has to come up through the stoma created by the band, past the pouch and into the oesophagus. If the band is quite tight, forcing partially digested food past at a great rate of knots can cause band slippage. This is why if you ever go to a country where tummy bugs are likely, always take a supply of anti-sickness medication with you. Personally, I have not vomited at all since having the band.

2. Regurgitation: This is bringing back undigested food from the upper pouch. This occurs if we eat too fast, too much, without chewing enough, and sometimes with particular types of food. It can also occur if you drink after eating. This is the type of 'vomiting' that most bandits are referring to. Regurgitation is unpleasant, to say the least, and if it happens too often, can begin to cause damage to the oesophagal wall. This is because of the acids that accompany food digestion which can attack the walls of the oesophagus, and also because of mechanical damage. It's best to avoid regurgitation! Although brought on by not sticking to the basic rules of eating slowly, chewing well and taking small mouthfuls - it is much more likely to happen if the band is too tight. So, if it's happening to you on a regular basis and you are sure you're sticking to the rules (and not drinking after eating) you should get your band checked out - it could be too tight. It is a misnomer to think that a 'too tight' band is a good thing because you will lose weight more quickly - you may also cause permanent damage to your oesophagus and there are a variety of other complications too, some of which require surgical intervention and the removal of the band. So it's not worth it. My personal experience is that since being banded I have regurgitated three times. The first time was when I got angry with my iPhone because it was misbehaving(!), and in my anger I scoffed down two thirds of an iced bun before I remembered I had a band.....! By then it was too late and I had a very unpleasant 20 minutes leant over the sink. The second and third times both happened at work while eating my lunch and working at the same time. In other words, I got distracted and ate too big a mouthful without chewing properly. Mia culpa.

1. The 'slime': This happens - a bit like regurgitation - when you eat too much without chewing properly. Food gets 'stuck' in the pouch, unable to get through the stoma because some less well chewed food is blocking the way. It can also happen if you drink after eating - the liquid can't get through the stoma because the food you ate, nicely sitting in the pouch and making you feel full, is blocking the way. So, the body produces what seems like tonnes of saliva to lubricate the oesophagus and pouch to try and remove the blockage. Usually, this does eventually work and you get a real sense of relief when the blockage clears. But meanwhile, your body is producing loads of this saliva and until the downwards blockage is cleared it has to go somewhere - upwards! The slime (as most bandits call it - I'm sure there's a correct technical term for it somewhere!) builds up gradually. You'll be eating something and start to feel an unusual heaviness around the breastbone (where the band is). Then you'll feel gurgling and things happening in your gullet, and then in your throat. Then you'll notice that your mouth is filling with saliva, and it's no good trying to swallow it because your mouth just fills up again. At the point when I notice the gurgling sensation, I know I've just got time to make it to the toilets at work - as long as no-one tries to stop me or talk to me on the way. Once, while rushing to the loo at work, my mouth full of saliva to bursting point, I passed a colleague in the corridor. Inevitably, he said "hello" and I just grunted. I often wonder what he thought.... Anyway, persaonally I went through two phases of doing lots of sliming - both were when my band was too tight and both times I ended up having an aspiration (de-fill). Since then, I still occasionally get the slime - but it's always when I've eaten too quickly, not chewed, or drunk after eating.

So, if you chew well, eat slowly, eat small portions, don't drink after eating and take anti-sickness tablets with you when you go abroad, you need never have any fear of vomiting with the band! On a more serious note, if you're already a bandit and regularly regurgitate or vomit, there's something wrong - either with your eating behaviour or with the band. Get it checked out. Vomiting, of any kind, is NOT a normal part of everyday life post gastric band surgery - and don't let anyone tell you that it is.

Pre-band fears part 1: Eating out

I promised a couple of weeks ago that I was going to post a few articles exploring some of the concerns I had before I got banded - and how those things have panned out. Funny, when I look back at those concerns, none of them were about the surgery itself, any medical issues or worries about complications etc. Here's some of the things that occupied my anxious thoughts at the time:

1. Eating out
2. Being sick
3. People calling me a cheat
4. Eating cold food
5. Not being able to eat enough when I need extra energy (like when on a long hike)

I might think of some more as I work through them. So, here's for the first one - eating out:

A couple of days before surgery I went through a 'cold feet' phase of asking myself was I really doing the right thing? I'd somehow got it into my head that never again, would I be able to eat out. I'd never be able to go out for a meal with my family again and I probably wouldn't even be able to join colleagues eating lunch in the staff canteen! I'm not sure exactly where I got these ideas from, perhaps from the consultant I saw who said I wouldn't be able to eat a 3-course meal again and I'd have to order a starter instead of a main course.

So what has the reality been? Well the first thing to say to any would-be bandits out there, is DON'T PANIC! You WILL be able to eat out! I don't eat out on a regular basis but have eaten out with friends and family groups on a number of occasions since being banded. I guess when I eat out I don't attempt to stick to all of the usual rules, but neither do I completely 'blow it' by stuffing myself silly. A happy medium then, is what I aim for. Typically, I would have a small starter (usually soup but no bread) to begin with. Soup goes down nice and easy so doesn't make me feel full. Then I usually choose a starter for my main course. I did try a main meal a couple of times but they were just too big. I felt bad at leaving so much food and attempted to eat more than was comfortable. So, a starter as a main course suits me fine. A typical starter would be Thai fish cakes, tuna salad, salmon. I tend to avoid 'mixed' food like curry, bolognaise etc because they have lots of unknown fats in the sauces. In the past, I ALWAYS had dessert. Nowadays, my brain wants dessert but my stomach doesn't! I also like to have a sweet taste in my mouth at the end of a meal. So, my solution has been to order a dessert to share with my husband. He's quite a fast eater and I'm so slow, so that he ends up eating 75% of it - which is fine!

So that's what I eat. Now what about the eating process itself? Well, I was never a particularly fast eater before, but now you can bet your last dollar that I will be the last to finish every course! This has been slightly embarrassing at times because people who don't know about my band obviously wonder why on earth I'm such a slow eater. However, I just pass it off with a comment like 'sorry I'm a slow eater' or 'sorry - I've been talking too much'. I also have to be doubly careful not to eat or swallow too big mouthfuls in case I end up getting hiccups, slime or worse. I don't suffer too much with any of these but am more likely to if distracted. Therefore, when I eat out I am particularly careful to focus on the eating process and avoid any mishaps.

I've seen a number of info-bites from bariatric surgeons and associates commenting on eating and drinking while eating out. Most have said that bandits should not try to stick rigidly to separating eating and drinking while out. In fact I again, try to go for a happy medium. On the one hand, it's usually impractical to avoid drinking when you're put for a meal. I generally try to swig down as much fluid as I can before the meal begins, and limit my intake afterwards. On the other hand, however, I have to be careful that drinking after I've eaten doesn't bring on an attack of the slime. If there's food sitting my pouch and I have a drink, one of two things can happen. Either the fluid washes the food through (no problem there then), or it gets blocked, turns the food into liquid mush which only has one way out - UP!! DefinItely to be avoided.

So is it possible to eat out when you have a band? Absolutely yes. However, if you have good restriction you won't be able to eat a normal three meals. You'll also have to eat slowly and be careful not to get distracted. In the weeks coming up to Christmas I have several celebratory meals coming up. I'm looking forward to them every bit as much as I would have before being banded. Looking back to my pre-band fears I realise they were largely unfounded. While what and how I eat are slightly different to what they once were, I can still go out and fully enjoy the company of family and friends. I guess that's it really - the emphasis is more on enjoyment and company and less on food. That's the band for you!

Very tight this morning

Odd this band isn't it? I really struggled to drink a cup of tea this morning and then an hour later only got half way through my usual bowl of Oatso Simple porridge. I ate a very light lunch with some white fish and veg and potatoes left over from yesterdays' evening meal and was stuffed after a small portion. Now I know that this is how many bandits start their day, but it doesn't usually hapen this way for me. I'd be delighted if it stayed like this but I fear that within an hour or two I'll be back to my normal self and eating moderate portions again.

I've heard that stress can lead to tightening of the band, also mentrual periods, de-hydration and various other things. And I am a little stressed - but I have been for weeks and nothing about my band has changed before now. I can't really think of any obvious reason why it should have suddently tightened up like that but I guess I will just make the most of it and hopefully lose a pound or two in the process!!

SO much to remember!

I used to think banding was simple - it restricts your stomach, you can't eat as much, you feel full sooner and for longer. Oh if only it were that straight forward! Here are a few of the 'rules' I have to remind myself of daily:

1. Eat three small meals per day
2. Chew everything to death and eat small pieces
3. Don't drink after eating
4. Use small utensils and a side plate for meals
5. Practice environmental control
6. Keep reminding your husband to hide the baguette and biscuits
7. Take a bagful of food with you to work every day (breakfast cereal, milk, orange juice, Actimel, lunch, healthy snacks)
8. Write everything down - food, calories, drinks, exercise, steps.....
9. Make sure plenty of your meal is made up of protein to keep you feeling full for longer (it takes away the hunger)
10. Don't overcook the vegetables - the crunchier the better
11. Beware when eating fruit with skins or peels - eat extra slowly and not in front of everyone (hiccups can be violent)
12. Take healthy snacks to work - better than eating chocolate
13. Keep reminding your husband to add healthy things to the shopping list (fruit, yoghurt, cottage cheese) - and to remove things that are too tempting (biscuits and baguettes)
14. Drink, drink, and drink some more
15. If you think you're hungry, have a drink first - then eat if you still feel hungry after half an hour
16. Is it real hunger or just head hunger?
17. If you start thinking about chocolate, do something to distract yourself.... (MUCH easier said than done)
18. Keep reminding your husband not to bring you a cup of tea immediately after you've eaten
19. Worry about whether you've got the right level of restriction at least every five minutes......
20. Remember to cook a double portion of dinner so you can take half of it to work for lunch the next day
21. Cook meals that are nutritionally balanced
22. Take your daily multivitamin, and calcium tablets, oh, and lactulose occasionally......
23. Stop buying huge amounts of fod on the weekly shop - it will end up going mouldy
24. Get excited about strong restriction in the morning - and then get disapointed when it wears off in the aftrnoon
25. Find time to walk
26. Find time to go to the gym
27. ...or do anything else physical
28. Keep reminding your husband to put most of the bread in the freezer - I can't eat so much these days so it will go off if left in the bread bin
29. Refrain from getting annoyed when every other person you see asks you, in a loud voice, how much you weigh....

Oh I could go on! There are so many lessons to learn in living with the band but it's just impossible to keep them all in your head at the same time. So as fast as I remember one lesson, I forget the rest. Today, I went to work with what I thought was a lovely lunch (leftovers from last night - but nice, nonetheless). However, whereas last night I put quite a lot of low fat melted cheese on it - today I didn't. The result was a very bland meal with absolutely no fat in it, unappetising and completely lacking in protein. End result? One hungry lady mid-afternoon - looking for snacks and 'nice' things to eat.....

When will I ever learn?!!

Been a good girl so far

I've had a much better day so far today. I started out with an early morning visit to the gym. Once at work I had to hit the ground running and didn't gave time for anything more for breakfast other than a banana. Still, that and some drinks kept me going till lunchtime. I'm lucky in having a Sainsbury's close to where I work and so popped along there in search of some healthy food. They do some good healthy choices foods for lunch including a good range of low fat sandwiches, salads and pasta dishes. I opted for a low fat cheese salad sandwich and a low fat Greek yoghurt with crunchy bits and fresh fruit. I ate a Nutrigrain on the way home and have just finished my dinner. I had potatoes, mixed veg (broccoli, mushrooms and green beans) and a spicy vegetable bake.

I may have a yoghurt before going to bed but all in all unfeeling relatively saintly! Having said that, I have found it quite tough today. I've faced some very serious temptation from a half eaten packet of cashew nuts in the kitchen cupboard, from the chocolate vending machine at work and from my husband offering to go and buy a takeaway when I got home from work! Sometimes things are there to make our lives difficult! If I manage to 'keep a lid on it' until I go to bed I'll be very pleased with myself. Who knows, I may even start to losesome weight again?

Changing my mind?

I don't know - yesterday I posted in a more positive vein about the success, or otherwise, of my latest fill. I'm already doubting the wisdom of my optimism! Earlier today I asked for advice from the readers of the UKGastricBand forum. I don't normally do this, but I tought I would post the same basic text here in case any of my blog readers can offer any insight and post a comment.

I need some advice on whether I need another fill or not. It's been just over a week since my NINTH fill and I've been eating solids for most of that time. I have 7.7ml in a 10ml band. My sequence of fills has been:

• Op 15th November, first fill ten weeks later.
• 5ml under x-ray, followed by 1.5ml then 1ml. This took me to 7.5ml which was too tight (slime, indigestion).
• Had de-fill of 0.5ml, then later top-ups of 0.3ml and 0.4ml - taking me to 7.7ml. That was way too tight (acid reflux, couldn't drink properly, slime, constant indigestion etc).
• Had second de-fill of 0.5ml, then later top-ups of 0.3ml and 0.2ml - taking me right back to 7.7ml which is where I am now!

I definitely have restriction - there's no way I could eat a big plate of food now like I used to. I have more restriction in the morning. I can eat absolutely anything, including the so-called 'difficult' foods (e.g. crusty bread, asparagus and pineapple, chewy fish etc) although I have to go slowly with some veggies and fruit that have skins. Having said that, I have never experienced 'iron fist' and never regurgitated, been sick or had a PB. After both of the occasions when my band was too tight, I did experience 'slime'. I keep hearing or reading about other bandits and the typical meals that they eat. I just read a magazine article that described people who could only manage one potato, a small piece of meat and some veggies. And another who said that a meal out consisted of just a starter. And another who said they couldn't manage more than 900 calories a day. A lady at a support group said she takes ten minutes to be able to drink a glass of water - it takes me about ten seconds!

Well I can still eat more than all of them. Although I generally stick to about 1200 calories a day - I have to work quite hard at this. If I ate entirely guided by my hunger I could easily manage quite a bit more than that. A typical evening meal is four baby new potatoes, half a side plate of veggies and a 'normal' sized piece of salmon. This leaves me feeling pleasantly satisified or even full - but within a couple of hours I'm getting hunger pangs again. I think they really are hunger pangs, rather than 'head hunger'.

Don't get me wrong, I am losing weight - but I feel I am having to work so hard at resisting the hunger - which is what I got the band for. I'd love to be able to relax and just eat when I'm hnugry and know that that amount would keep me losing weight.

I don't want to be so tight that I take an hour to eat an apple, say (!) - but does this level of restriction seem right to you? Am I being fussy? Do I need another fill or is this risking going through the de-fill cycle all over again?

Strategies for emotional eating

As you have probably gathered if you read my blog regularly, I'm a self-confessed emotional eater. I have a few strategies that help - not all of the time but some of the time. However, sometimes I think it's OK to just let go - even thin people eat [i]some[/i] chocolate and crisps!

1. Keep a packet of soft mints and have one or two when needed (about 10 calories each). I know it's not the same as eating chocolate but it puts a nice sweet taste in your mouth which often does the trick for me. Because you can chew and suck these they can be eaten while on the puree stage or after a fill.

2. Keep a bar of chocolate in the house - under lock and key by your other half! When you're in need, get him/her to bring you a couple of squares.

3. Have a low fat hot chocolate (40 calories) - or something similar.

4. Have a 'healthy' naughty snack - such as dark chocolate which has less calories, less fat and is less addictive. Or get some low fat crisps, or make up a great big fat sandwich mainly filled with salad but with the tinest slither of cheese.

5. Get some low fat biscuits that you don't like very much - they'll provide a sugar boost and some 'comfort' when you need it - but since you don't really like them you won't be picking them through the day! I use Rich Tea.....

6. Some of the high protein drinks that you can have while on purees or post-fill are very filling and although not fatty, they can trick your mind into thinking you're drinking a nice McD shake or something like ice cream....

Hope that helps someone out there!

A word on fizzy drinks

Among the online bandits on various web sites I have seen a nmber of discussions about whether or not it's OK for bandits to have fizzy drinks. It would seem that there is a lot of variation in what different providers recommend. The topic was raised at the Healthier Weight support group meeting on Sunday. Our health educator / dietician said [paraphrasing], that as long as we can manage fizzy drinks and want to, there is no reason, as far as the band is concerned, why we should not. Some bandits have been told that the gas can stretch the pouch and others have even been told that the acid can corrode the band (though it would have to corrode through the wall of the stomach first). Our man said that HW do not believe there is any fundamental problem with having fizzy drinks and a band. Of course there are other reasons for not drinking the fizzies - like the fact that most of them attack your teeth and don't contain any nutrients etc. Personally, I find that I can no longer tolerate fizzy drink straight from a can or bottle - I have to pour them into a glass first to let some of the bubbles dissipate. But otherwise, no problems. So this may be another one of those toics where us bandits just have to agree to differ - and just abide by what our own provider says.

Conference conundrum

I was out all day at a conference today, which normally would see me looking forward to some posh grub for lunch. But not this time since I am on fluids after yesterday's fill. The last occasion I was at a conference was in March this year - and I was also on fluids then after a fill. On that occasion I took a strawberry shake and some cold vegetable soup with me. I recall the shake being OK, but trying to drink cold soup was no pleasant and I left most of it. So, last night I gave some thought as to what I could take with me to eat at today's conference. My better half came up with the brilliant idea of taking some hot soup in a flask (I know it seems obvious to you but I didn't think of that last time!!). I also took a shake, with yoghurt, banana and apple blended in, and a Weight Watchers yoghurt. So while everyone else sat down to a lovely buffet with masses of fresh fruit and cream cakes for dessert- I ate a bowl of luke warm soup, some shake and a yoghurt! Oh, I suppose it wasn't so bad!

Here's a funny thing. At the conference I went to in March, I met a lady called Margaret who I am actually working on a project with. Up to that point we had communicated by telephone and email but I had never met her. I had to explain, on that occasion, that I'd had a 'minor hospital procedure' (referring to my fill) and that I was on liquids only for a few days. At today's conference, Margaret was there again - and again I had to explain I'd had a 'minor hospital procedure' and was on liquids only! I mentioned to her that I'd only met her twice and both times I was on liquids - I explained that I usually ate 'normal' foods! I almost told her about my band at one point because I think she thought I had some grave illness that kept necessitating these strange eating habits. But I decided against it and simply tried to reassure her that it was nothing serious.

Everything I have eaten so far has gone down fine without any problems.

Any secrets to weight loss?

I was complemented on my weight loss today by a fellow bandit and asked if I had any secrets to share on how I'd done it. Below is roughly what I replied:

I don't really have any secrets to weight loss - just 'rules'!! I am very lucky because I have always eaten very healthy foods (eg loads of vegetables, fruit, fish etc) - my problem is that I've eaten a lot of the unhealthy stuff as well!!! Especially chocolate and cheese. I'm also lucky that pizzas, KFC and burgers have never 'done it' for me - and I'm a vegetarian which helps too! So for me, I haven't had to re-learn eating good food, just cutting out the bad stuff. I don't keep chocolate or cheese in the house, or crisps or anything else that I might be tempted to snack on (although I 'steal' some of my husband's French baguette when I'm feeling naughty). I also stick to most of the band rules most of the time (eg not drinking after eating, chewing well, eating slowly, eating off a small plate, getting lots of exercise etc etc).

HOWEVER - I'm no saint! I have very bad days when I binge like crazy and am just coming to the end (I hope) of a period of about three weeks when I've generally been very naughty and not lost an ounce!

If I could pass on ONE lesson to others that has helped me enormously, it would be to maintain a daily record of everything you eat, everything you drink and every bit of exercise you do. Count every calorie, weigh everything and write it down - and keep doing it even when you are SOooooo bored of doing it you could cry. When I go off the rails, it helps to look back at the days when I did well and remind myself what I ate and when. And when I'm just getting bored with the whole thing, I can look at my record and remind myself of how far I've come.

All the best, Theresa

Drink: Should it be water?

Did you watch 'Embarrassing Bodies' last night? They had a feature on drinking water. Thhey showed that (a) you need to drink about 2 litres of fluid per day, and that (b) it doesn't have to be water - it can be in any liquid form:

Experiment 1: They showed two people - one who drank 2 litres of water and one who drank 4 litres of water in a day. The colour of their urine, and hence their hydration levels, were identical. So, in other words - 2 litres is enough.

Experiment 2: They also showed two people who drank 2 litres of fluids in a day. One drank water only, the other drank a mixture of tea, cofee, soft drinks etc. Result? Exactly the same hydration levels in their body!

So, if you are like me, and find drinking water a bit of a bore, my advice to you is to find a range of low calorie (or zero calorie) drinks that you can have instead. I use low sugar Ribena (20 cals per half a litre), fruit tea, black tea and coffee and the occasional Diet Coke.

Drinking harder than eating - EUREKA!

On My 22nd, a couple of weeks after my last fill, I posted ("Saliva, tightness, choking and all that jazz") about the weird experience I was having of being able to get food down, but struggling with liquids. I had asked a number of people about this and although I found a few others who had experienced the same, nobody could explain the phenomenon. Logic suggests that liquids should go down much more easily than solid foods - but t'was not the case..... Anyway, today I happened upon a web site called http://www.fillprovider.net/. It has been set up by an anaesthetist Dr. Kai Rabenstein who, on one morning per week, runs a clinic (in the south east of England) providing fills for gastric band patients(at £75 a time). He started the clinic after his wife had a gastric band fitted. The web site includes some really interesting advice and guidance - interesting because it is particularly frank and honest. For example, he says:

"I think it needs to be spelled out clearly that, certainly for the initial weight loss period, perfect restriction sometimes means being so tight that you experience some regurgitation of food, drink and saliva - known as "productive burps" (PBs). Patients who are horrified by this prospect and the consequent need to develop strategies to hide PBs from others in a social context ....... are unlikely to find success with AGB [adjustable gastric band] implantation and should probably choose a different WLS [weight loss surgery] strategy".

I don't know about you, but I find this approach refreshingly honest. So, back to the drinking and eating thing. Dr Rabenstein says:

"Because the oesophagus (the gullet) and the stomach itself are designed by nature to actively advance food "down the line" through a wave of muscular contraction (called peristalsis), patients with AGBs may find that with tight restriction they can still swallow food (which is solid and therefore will be gripped and propelled beyond the band by the peristaltic movement) but not liquid (which is too "elastic" for peristalsis to get a grip on). That means that in case of temporary severe restriction, the need for an emergency defill can sometimes be avoided by eating sodden solid food or semi-solids."

So I wasn't going mad after all!!

What a relief !!

I went to see my nurse today. After describing my symptoms (heartburn, acid reflux, slime, vomiting, pain and difficulty drinking), she immediately recommended an aspiration. In order to ensure that my stomach has time and space to settle down (especially after all the acid), she took out 0.5ml, taking me to 0.1ml less than I was at when I had my last fill. She suggested that once I had given my stomach a chance to settle, I could go back to the clinic and have a small re-fill in a couple of weeks or so. At first, this amount of de-fill (0.5ml) seemed a little alarming - I expected her only to take about 0.2ml out. In a way it feels like going backwards. But on the other hand, the relief I have felt since is worth the backtracking.....

Obviously I am back onto fluids for three days and then mush for three days before reverting to solids again. After getting back to work following my de-fill today I immediately tried some drink, and found, with enormous relief, that I can drink again!! Oh, the sheer heaven of being able to drink a glass of anything and not suffer all the burping and gurgling and acid and pain and slime! The absolute beauty of being able to drink a glass in a couple of minutes instead of taking an hour or two! At the time of writing this I have already drunk twice as much today as I have typically got through per day in the last week or two. I am now on a mision to re-hydrate over the next few days and get some serious moisture back into my skin, hair and nails!!

I asked about the oddity of being able to eat easily but not drink without a great deal of trouble and the nurse didn't immediately have an answer. I hypothesised that it might be because solid food somehow 'opens' up the stoma between the pouch and stomach, whereas drink doesn't have enough 'force' to do this and 'backs up'. On reflection, the nurse recalled a number of gastric band patients who have noted that sometimes when eating, the first few mouthfuls are more difficult - and then the restriction appears to ease off. This could indicate that my theory has some merit. Anyway, there doesn't appear to be any other obvious explanation. I will raise this issue when I next go to the support group meeting and see if my doctor has any suggestions - I am curious!!

I am sitting here watching 'Britain's Got Talent', with a finished glass of Diet Coke by my side and plans to re-fill it during the ad break! Just such a simple pleasure in life holds such meaning and satisfaction!!!

Saliva, tightness, choking and all that jazz

I got some really good advice yesterday from the UKGastricBand forum. One piece of advice was to take Gaviscon for the heartburn. My husband very kindly went out and bought some Gaviscon liquid today while I have been at work - so I haven't tried it yet. However, I have heard about Gaviscon and believe they have a very good reputation. I don't intend taking it in the long term - just long enough to get me over this current bout of extreme tightness and associated acid.

Another nugget of information I got was from a lady who herself has experienced this odd thing of finding it easier to get solid food down than liquid. I was so relieved to find someone else who had experienced this because I really was starting to think I was going mad!! I guess it's possible that solid food kind of 'pushes' its way through the stoma of the pouch into my main stomach, whereas liquid may just 'sit around' and temporarily block the stoma. I have certainly felt something that can only be described as a 'suction' effect sometimes - this may be when the liquid makes it to the other side (of the stoma) so to speak!

I am aware that stress, emotions, 'that time of the month' and other things can be a reason for the band suddently getting very tight. A man at the Healthier Weight support group told us about a time when he was experiencing huge stress at work. He found that over the course of a week, he went from having 'normal' restriction to a point where he couldn't even swallow his own saliva! And in his case, he had not just had a fill as I have, but had been banded a couple of years before - so this really was completely out of the blue. He had to get an emergency aspiration.

I don't think I am anywhere near that point - but I did have a bit of a fright this morning. I woke up in the early hours half choking. I rushed into the bathroom and had to spit out some saliva. I remembered this man's story and wondered if I was experiencing the same thing. I slowly drank through a cup of hot water and reassured myself that all was OK - I could at least get liquid down. In hindsight, this morning's experience was almost certainly related to the fact that I went swimming last night - swimming late in the evening always makes me very snotty next morning - so I suspect I was simply 'choking' on a bit of snot / saliva in the back of my throat (sorry if this is all a bit too graphic - hope you're not eating while you read this!!!).

There is a hint that my band restriction may not be quite as ridiculously tight today, although having said that, I have so far eaten very little (haven't really felt the need!). I haven't had quite so much pain and fluids are going down slightly quicker (I can drink 0.5 litres in about one hour, as opposed to two!!!).

I will persevere and be patient and see what tomorrow brings.....

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.