This may be helpful to some to help you get back on track and get back in touch with your band.  Please refer to the “How to eat appropriately for weight loss after Lap-Band surgery” for long term guidelines on properly using your band.

 

How many of you lap-band patients have asked any of these questions:

Does my pouch still work?

Have I broken my pouch?

Am I doomed to be a failure at this too?

Can I lose the weight I’ve regained?

Is the honeymoon with pouch over?

If you have asked yourself any of these questions, just know that you are not alone. There is a way to get back on track with your band and to feel the tightness again. It is called the 5 Day Pouch Test. This is the 5-day plan that has been developed and used to determine if your pouch is working and return to that tight newbie feeling. And a bonus to this plan, it helps one get back to the basics of the weight loss surgery diet and it triggers weight loss. Also, it is not difficult to follow and if you are in a stage of carbohydrate-cycling it will break this pattern.

The 5 Day Pouch Test should never leave you feeling hungry. You can eat as much of the prescribed menu as you want during the day to satiate hungry and prevent snacking on slider foods and/or white carbohydrates. You must drink a minimum of 64 ounces of water each day. A reduction of caffeinated beverages is suggested, but do not stop caffeine cold turkey.

Weight loss is not the intent of the 5 Day Pouch Test; however, many who have tried this plan report a significant drop in weight. More importantly they celebrate a renewed sense of control over their pouch and eating habits and easily transition back to a healthy post-surgical weight loss way of eating.

Prescribed menu:

Day 1 and 2: Liquid Protein

The first two days are all liquids. You can have as many low-carb protein shakes as you like to satisfy hunger or cravings. In addition drink at least six 8-ounce glasses of water each day. The purpose of all liquids is to break any snacking, grazing or processed carbohydrate habits. In addition the liquids will work to cleanse your system and prepare you for the following three days.

Low-carb protein shakes, broth, clear or cream soups, sugar-free gelatin and pudding.

Day 3: Soft Protein

The next three days you get to eat as much as you want as often as you want! Ahhh, but there's a catch: it has to be solid protein(not liquid like what was mentioned before) and you only get 15 minutes each time you sit down to eat. No drinking 30 minutes after meals and no drinking with your food. A dry pouch will hold your soft protein longer helping you to feel full and fed longer.

Protein Recommendations: canned fish (tuna or salmon) mixed with lemon and seasoned with salt and pepper, canned turkey or chicken, eggs cooked as desired seasoned with salt pepper and/or salsa, fresh soft fish (tilapia, sole, orange roughy), baked or grilled, and lightly seasoned.

This starts your program with "soft" protein. Measure your portion (1 cup volume or 4-6 ounces weight) and eat only until you feel full, not overfull. Remember, no water for 30 minutes after you meal, and no fluids with your meal. We are going back to the beginning and fluids will prevent you from feeling the pouch. If you need to add a moist condiment (Miracle Whip or mayonnaise) to the canned fish I understand, but keep it to a minimum so the meat is not too moist. One reason we lose the sense of tightness in our pouch is that we eat "slider foods" - foods that are too moist and do not stay in the pouch very long, they slide right through the stoma

Day 4: Firm Protein

By now you should be experiencing that familiar tightness that will reassure you that your pouch is working. Remember to drink plenty of water between meals. Take some time to meditate and rediscover the wonder of your pouch. Often we don't like that uncomfortable tightness of the pouch, which is why we gradually move toward slider foods that don't make us uncomfortable. It is always my preference to eat moist protein so I don't get uncomfortable, but doing so allows me to consume more than I should. Lots of times I hear, "But I don't like that uncomfortable tight feeling of solid protein in my pouch." But the very purpose of the pouch is to signal fullness, which often comes by way of slight discomfort when we are eating in compliance with our bariatric owner's manual. The slider foods will never ever signal fullness. They are dangerous and in most cases non-nutritional. Rediscovering the pouch with this 5-day plan reminds me of how the tool really works. I hope by now you are rediscovering your tool and enjoying the hope and excitement because your pouch still works

Protein Recommendations: ground lean meat (beef, turkey, lamb) cooked dry and lightly seasoned, shellfish, scallops, lobster steamed and seasoned only with lemon, salmon or halibut steaks, grilled and lightly seasoned.

Day 5: Solid Protein

Remember to chew, chew, chew. Measure your portion (4-6 ounces) and eat only until you feel your pouch tighten. Remember, only 15 minutes per meal, so you'll have to work fast to chew your food completely. By now you should be out of any carbohydrate cycle you were in and perhaps you have lost a pound or two. You will have new confidence in your pouch and your ability to work the tool for your health and emotional well being.

Protein Recommendations: white meat poultry cooked dry and lightly seasoned, beef steak (if tolerated) grilled or broiled.

Day 6 and on: Low fat, low-sugar, heart healthy diet

Now is the time to get back to your healthy lifestyle. You are more conscious of when you feel full and you have retrained your pouch and brain. Remember to choose low fat foods, low-sugar items and whole grains.

The 5 Day Band Pouch Test was created by a band patient, Kaye Bailey. Ms. Bailey is the voice behind the popular website, LivingAfterWLS.com which has become the premier online destination for weight loss surgery information and support. The website boasts an extensive article and video library, recipe collection, eZine newsletters and active support forum called The Neighborhood. Ms. Bailey's interaction with the community and dedication to quality on-going education and support for those who chose surgical weight loss for the treatment of obesity is unsurpassed.

For more information on the 5 Day Pouch Test, visit the website at:

http://www.5daypouchtest.com/

Erica Van Hamme, RD

Reference:

Bailey, K. The 5 Day Pouch Test. LivingAfterWLS, Liability, Co. 2007-2012

 

Having a strong support system is essential to being able to make lasting lifestyle changes after bariatric surgery.  In fact, it’s essential to just recovering physically and emotionally after the surgical process itself.  Finding people who will truly support you takes some work (and some training).   What you are looking for are those people who care enough about you to have unconditional willingness to support you in ways that are helpful to you.  This basically means that they are willing to learn what you find to be supportive, and to practice honing this communication with you.  Notice, this puts the bulk of the responsibility on you (the supportee) for carefully choosing and then training your support system.  This will involve ongoing conversations about what works and what doesn’t.  It also means that expecting support from people who are incapable of providing it (either due to lack of willingness or skill) is a set-up.  Like everything else about life after surgery, taking a proactive stance will serve you well.

The following article is  about ways we can invalidate each others’ experiences. It may help you begin thinking about which people in your life are capable of offering true support and ways they can be supportive (or at least not be unsupportive).

http://mindfulconstruct.com/2011/02/18/75-things-people-say-to-shut-up-your-feelings/

"Addiction transfer" is what psychologists call the phenomenon when people give up one addiction--overeating, for example--and transfer that addiction to something else such as alcohol abuse, gambling, or excessive shopping.  There have been anecdotal reports of addiction transfer following weight-loss surgery, with one of the more serious addiction transfers being to alcohol.  Some procedures, such as the gastric bypass, allow food and drink to bypass most of the stomach and part of the small intestine, which can results in alcohol being passed more rapidly into the bloodstream.  A study published last year on gastric bypass patients found that a single galss of wine was enough for patients to reach the legal driving limit of .08 percent and it took longer for their blood alcohol content (BAC) to return to zero after drinking; 108 minutes compared to 72 minutes in a control group.

But are weight-loss surgery patients more likely to abuse alcohol? A study led by Dr. John Morton, Director of Bariatric Surgery at Stanford, examined the issue of addiction transfer after bariatric surgery and found no evidence of post-operative addiction transfer to alcohol abuse.  The study was made up of weight-loss surgery patients surveyed both before and after bariatric surgery.  The researchers found that the patients drinking habits changed significantly after surgery; they consumed fewer drinks at one time, and also reported drinking fewer times per week.  Additionally, Dr. Morton found that 40% fewer patients drank at all post-operation.

Another study looked at 121 post-op patients and found that there was no statistically significant difference in alcohol abuse.  There was actually less post-op alcohol abuse reported, at 17% down from 21% pre-op.  Also of note, a study conducted by the same researchers on gastric band and gastric sleeve patients did not find significant changes in alcohol metabolism, in terms of higher peak and long to BAC of zero.  Weight-loss surgery patients should, however, exercise caution when drinking, as associated behaviors like being more relaxed and being around friends who are likely snacking can sabotage weight loss efforts.

Every fall the clinic sees some lap-band patients who haven’t been in for a while, but are suddenly struggling with night cough, heartburn or feeling overly restricted.  These patients come in questioning whether they are suddenly “overfilled” and requesting to have some of their fill removed.  Based on their reported symptoms and persistence, the medical staff has little choice but to comply.  And each January, we see some of these patients back again, often having regained a significant amount of weight, feeling frustrated, discouraged and angry.  Some report that after several fills, they are unable to get to that “sweet spot” of perfect restriction they had before.  Ongoing struggle, frustration and despair can result.

Many patients who choose the lap-band do so because it is “less invasive”.  Since the typical lap-band involves the same risks of surgery and amount of incisions as the RNY, and one might argue that having a foreign object incorporated into one’s body is equally as radical as having ones “intestines re-routed”, I have to wonder if what feels less invasive about the lap-band is really the level of commitment.  Does the lap-band feel safer because it is easier to reverse?  Because it is adjustable?  Because it allows for a “bandcation”?

In many ways, success with the lap-band requires more commitment and vigilance than the RNY.  I frequently tell patients that both the beauty and the curse of the lap-band is that one does not really start seeing results until one has made an investment in enduring lifestyle changes.  These changes include figuring out how to sustain healthy diet and exercise habits despite what else might be going on in life.  This includes learning how to make good choices during the holidays and while on vacation.  Getting fluid removed from the band for a special occasion or because a patient “deserves a break” from the band does not empower the patient to really develop an understanding of nor increase control over the eating behavior which contributed to obesity in the first place.  In some cases, these breaks can cause heartbreaking setbacks.  For example, the typical patient will gain back 10 lbs over a 2 week band “holiday”.  This means that over a 1-2 month period (think scheduling difficulties, weather related cancellations, ambivalence over getting the fill put back in), a patient could easily undo a year’s worth of weight loss progress, or even return to their per-surgery weight.

Patients and medical professionals alike pretty much agree that the lap-band is a tool.  However, just as having a hammer in my basement does not make me a master carpenter (and I assure you it does not), simply installing a lap-band does not allow for magical weight loss success.  The lap-band is a precision tool, which must be maintained and used correctly at all times.  This means getting fills as scheduled and eating correctly (see Jody’s recent blog about eating appropriately with lap-band) as well as learning to have the band as a welcomed guest for holidays, vacations and other special events.

Dr. Tom Brown, bariatric surgeon at the Colorado Bariatric Surgery Institute (CBSI) and expert for Doctors of Weight Loss, is now extending his Lap-Band fill clinic and aftercare program for individuals with the Lap-band who might be traveling, have relocated, or their surgeon may have moved or retired.  Dr. Brown is highly experienced, with more than 25 years in surgical practice, the past 10 years specializing in bariatric surgery. He has performed more than 3000 weight loss procedures, almost all of which have been performed laparoscopically, minimizing pain and scarring for his patients.  He and the other Doctors of Weight Loss experts are committed to providing supportive, innovative, professional care for bariatric surgery patients. Dr. Brown's comprehensive weight loss program at CBSI has an emphasis on long-term attention to dietary and lifestyle issues that contributes to highly favorable outcomes and has earned its reputation as one of the leading programs in the Rocky Mountain Region.

STOP, THINK and CHANGE

(is not just a behavior curriculum for elementary children with impulse control)

 

STOP the shame ….     STOP the negative thoughts ...

STOP the tape recordings:

“You can’t”  …. “You won’t” …….

“I should have ….. could have …… would have…”

STOP 

“Be vigilant; guard your mind against negative thoughts.”  ~ Hindu Prince Gautama Siddharta

You are NOW ready to build the new YOU after bariatric surgery                                                (even if It took you a minute to get there or you need to start again)

THINK

Why you chose to have surgery ……

 

YOU KNOW …..

 

SO

PLAN, SEARCH, ORGANIZE, GET SUPPORT

And then transition your

THINKING

into