Booked my next fill

After several weeks of prevaricating, I have finally decided to get another fill. It's booked - I'll be acting the pin cushion again on Thursday 7th March at the Birmingham clinic of Healthier Weight. I could have got it done sooner but on 27th April I am going away, to Scotland, for a week on work-related business. I didn't want to get a fill just beforehand as I would have had to somehow manage fluids and mush while away with colleagues. Not only would that have been difficult from a practical perspective, but would also have been rather interesting, shall we say, to try and explain!! So, why another fill? I haven't said too much on here about progress since the last fill because it's so been so variable on a day to day basis. I haven't really sorted out in my mind out whether the last fill 'worked' or not! If I can generalise about my experiences at all, here are the generalisations I would make:

1. Most mornings I have to eat my breakfast carefully and pay particular attention to eating slowly. If I don't, I get lots of burping and gurgling and mild indigestion. I also find that hot drinks go down easier in the morning than cold drinks. I usually drink my tea first and drink the cold orange juice after - otherwise the orange seems to 'stick' somewhat (i.e. it goes down slowly).

2. If any time I completely forget to eat slowly and take small mouthfuls, I get 'slime' (I have previously referred to this as 'saliva-pouring' - but most bandits call it The Slime - sounds like a horror movie!!). I had this quite spectacularly after wolfing a Danish pastry down a week or so ago (probably a good reminder that I shouldn't have been eating such food anyway!) and it was rather unpleasant. I also wolfed some berries down at breakfast yesterday morning and had to sit and wait for five minutes while my oesphagus sorted itself out! I've only had slime twice since my last fill.

3. Occasionally, probably once or twice a week, I get what feels like really good restriction. After eating a meal the size of a 7-inch side plate I feel really full and cannot eat any more - and don't want to eat any more. I feel as though the band should be producing this level of restriction all the time.

4. Most of the time, especially at lunch and evening meals, I can quite easily eat a full side plate of food. I have noticed I can eat slightly larger mouthfuls than I was a couple of months ago and am chewing less than I probably should. But most of the time, that's fine and I suffer no ill-effects. After meals, I can eat a fromage frais or yoghurt and sometimes some fruit too. After lunch, in particular, I often feel hungry again within a couple of hours.

I realise that if now, occasionally (see 3. above), I get good restriction, then having another fill could mean that occasionally I am very tight - or even too tight. In the early days of being a bandit I used to get my knickers in a proverbial twist about this - being too tight, I mean. I used to worry that I wouldn't be able to eat enough or consume enough calories to supply the energy I need to lead a normal life (!). However, I am now experienced enough to know that there are ways around this. For a start, if I was occasionally too tight to eat solids, I could always have a protein shake instead. I have previously made some lovely protein drinks by adding milk, bananas, apples and all sorts to the strawberry powders I get from my provider. Alternately, I could adopt the philosphy of my surgeon - if you're not hungry, don't eat!! Obviously I wouldn't want to be like this all the time. However, if another fill gives me good restriction most of the time and too much restriction occasionally, then I would be very happy with this.

Somebody posted on the UKGstricBand forum that at a fill, their doctor had asked them if they wanted to be comfortable, tight or very tight. I think that most of the time I would describe my current situation as too comfortable, and occasionally as moderately tight. I don't want to be very tight, and never have wanted to be. But too comfortable means I have to put in a lot more effort and willpower than I'd like. After all, if I'd had willpower aplenty I wouldn't have bothered with the band in the first place!

I'm no sinner.....

My husband said he heard a song on the radio today that went something like this: "I'm no saint, I'm no sinner, it's all cool, if I get thinner". As well as fitting in well with the title of yesterday's blog post, I also thought it sounded like an excellent anthem for all bandits!!

I haven't been quite as much of a glutton as yesterday but have still eaten some 'forbidden fruits' today. This afternoon I ate a Danish pastry - and paid for it. I was enjoying it so much that I forgot my good habits and ate it too fast. Soon, I was experiencing the familiar feeling of indigestion and an intense burning in my upper chest (good job it didn't happen on the first aid course I had just finished or I might have had some well-meaning first aiders thinking I was having a heart attack!!). This then developed into the build-up of saliva in my mouth and I was back to some fairly serious 'saliva-pouring' that went on for ages.

I have never read anything about this phenomenon but I imagine it is the body's way of helping the blocked food to get down. By producing excessive amounts of saliva, it helps the food to turn to mush and go through the stoma into the stomach. However, until the blocked food starts moving, the excess saliva has only one way to go - and that is up! It seemed to go on for about 20 minutes - I think the longest period I have experienced this - and it left me feeling knackered!

Anyway, I have decided I am not a complete waste of space - I'm going swimming this evening and expect to burn off quite a few calories, including that darned Danish pastry!!!

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.

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!!

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.

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.

Indigestion, pain and tiredness

A couple of days on from my 3rd fill now, and things are worse, if anything. I am struggling to get anything down - even water, black tea etc. So, I am struggling to consume enough fluid and keep hydrated. Thicker liquids like soup definitely go down a bit easier. In addition to the indigestion-like feelings in my throat, today I have also been getting cramp-like tightness in my chest, in my back and in my lower stomach too! It's such an effort, and a pain - literally - to drink that it's getting me down. Yesterday by mid-evening I still only managed about 400 calories so I sucked a bar of Dairy Milk chocolate and got my calorie count up to 650. I have bought another bar today in case the same thing happens. I know I shouldn't really be eating chocolate but I am not alone in this. I remember reading about a lady who found she was struggling to eat after a fill, and the only things she was able to eat were chocolate and ice cream! I went a for a short walk with my hubby today and after about 20 minutes I was ready to quit - I just felt sooooo tired and lifeless and weak. I am sure this is because I'm just not eating enough at the moment. This was also brought home to me this morning when I weighed myself - I was two pounds less than yesterday and three pounds less than the day before! I know I bought into this to lose weight, but there are sensible ways to do it, and silly ways......

So, what goodies have I got planned for this evening? Well, I will be attempting to finish off the fish soup I made last night and once again attempting a yoghurt or fromage frais. I may also try a strawberry shake - however, I won't stick it in the blender, I'll just mix it by hand so it has fewer bubbles in - bubbles make the indigestion pain etc worse.

I must confess that when I was thinking about whether or not to have a gastric band, I read some horror stories about people vomiting, not being able to eat, getting 'iron fist' pain and so on - and I thought - I'll be careful and that won't happen to me.......Mmmmm, little did I know then......!

Colourful food and other stories

Here's what I took to work with me this morning! Starting from the left, the pink stuff is a high protein strawberry shake. Next to it is a smoothie I made with strawberries and nectarine, together with some fresh orange juice for 'breakfast'. Further to the right is some 'green' homemade soup consisting of cauliflower, sprouts, spinach and butternut squash. There's also a low fat hot chocolate and some sugar-free summer fruits cordial. Although I intended consuming all of this, in practice, it didn't work out this way: I didn't quite finish the shake (explanation below), the smoothie was horrible so I left it (!), I didn't drink the hot chocolate or the cordial.

So why? Well, I have been really struggling to get anything down today. After taking about an hour to drink the shake this morning my mouth started to fill up with saliva! I did what most of us would have done - I simply swallowed it - but it just filled up again! In the end I had to rush down to the toilets to spit it out. Since I have been home this evening this has happened twice more. I spent about five minutes solid leaning over the kitchen sink simply letting saliva pour out of my mouth. How weird - it wasn't vomiting - there were no stomach contractions or anything, it just kept pouring out! I have also been suffering quite a lot with indigestion-like feelings in the back of my throat and upper oesophagus. It's actually been quite an unpleasant day and there seems to be no clear pattern to it. I still feel, as yesterday, that it's more difficult to get down 'thin' drinks like water, tea, LemSip (I have a cold and cough!) and Ribena. After my first episode of saliva-pouring I took courage and ate a bowl of freshly-made fish soup. The soup was quite thick (and lovely) - and by going very slowly I ate it all. It went down much easier than thinner drinks. Later, I tried a low-fat fromage frais (I ate one last night without any problem) and it brought on another episode of saliva-pouring!

Some people on the UKGastricBand forum suggested that these experiences are not that uncommon after a fill and that after a week or two my stomach should settle down. I will try to progress onto purees on Sunday morning (that will be three days) and see what happens, but to be honest, I'm far from optimistic. If I cannot get down any purees by the middle of next week I will contact the nurse and see what she advises.

Fill number three

I travelled to the Healthier Weight clinic in Birmingham today for my third band adjustment ('fill'). I already had 6.5ml of saline in my band and a further 1ml was added, making a grand total of 7.5ml in a 10ml band. There's not much to report about the procedure itself - it's all over very quickly and is painless. Although I was able to eat solids for breakfast this morning, I have been on fluids since. I will have to stay on fluids for three days and then switch to purees for a further three days. So far I have had a couple of soups, a smoothie, a yoghurt and drinks. I've noticed that quite a lot of the time while eating/drinking I get a sensation in my upper oesophagus/throat that is a cross between acid reflux and indigestion. It's only mild but nevertheless not particularly pleasant. I have also noticed that it is worse with thin drinks like tea, water and Diet Coke (yes, I tried some but the fizz was too much!). Thicker soups and smoothies don't produce this sensation as much. I am not sure at this early stage what this all means. Is the band now too tight? Possibly, but it will be nearly a week before I eat any solids and find out.