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Weight Loss Surgery: A Cautionary Lap-Band Tale
Oh, c'mon, buying things is fun!
In the Winter of 2008, I made the choice to have weight loss surgery. At that point, I tipped the scales at about 305lbs. My reasons, as any person faced with this decision will agree, were my own. I also made several mistakes at this point and those I think need addressing.
The biggest were: my choice to have the surgery in my hometown and the surgery I chose.
I live in a town of 100,000+. The Dallas-Fort Worth metroplex area is approximately three hours away.
There was an office of physicians in my town newly announced as doing weightloss surgery, but only two: the Lap-Band and Gastric Bypass. I researched both surgeries and had some ideas about each, but wanted to consult with a doctor in this office before making my final choice. I did think the Lap-Band would probably be it for me though as it’s reversible and a less severe choice than the bypass (as far as having my anatomy cut up and re-sown together and experiencing complications like the possibility of needing gallbladder surgery, “dumping syndrome,” and malabsorption problems.)
My step-sister chose to have a bypass in the metroplex area right before I had my procedure and was happy as a clam about the whole thing - I wish I’d followed her lead.
I met with the doctor. I was asked what insurance I had (Federal Blue Cross Blue Shield) and what procedure I would like. I told them I’d like to discuss my options and the doctor did a brief run down of each, but the attitude of the visit was very much “Why did you come here if you didn’t already know?”
I opted for Lap-Band… when I really should have opted for another doctor, but the Lap-Band requires frequent follow up visits for fills (injecting liquid into the band via a port under the skin in order to maintain the band’s tightness around the stomach and induce weight loss.) I wanted to be able to seek this maintenance in my hometown and not drive for three hours every time I needed to be seen. I was ok with the prospect of slower weight loss because - after spending most of my life in Weight Watchers - I knew slow weight loss was more likely to equal permanent weight loss.
The next time I saw my surgeon was the day of the procedure.
I was later told this is what’s called being a “heartbeat with insurance.”
I had the procedure 01/14/09. There was no psych consult, no diet beforehand, no meeting with a dietician or exercise specialist - I was told “eh, if you don’t like it, take it out!“. My last solid food and carbonated beverage was 01/12/09.
The surgery was a day surgery. I was put under, the band was placed, I was taken to recover, gently smacked awake, taken to radiology, made to do an upper GI and swallow contrast material so they could scan me and make sure everything was ok. This made me start to retch which caused one of my surgical sites to reopen. I bled all over the floor - I still have the blood-stained socks.
I was patched back up and sent home.
For the first twenty-four hours, I was floating. I was still high on whatever they gave me at the hospital plus the Twilight sleep patch behind my ear that was put there to prevent the inevitable nausea I get after being sedated.
After that? I was in hell.
I always joked about needing a Clockwork Orange Diet - one where I experience physical pain or discomfort at the idea of eating because I figured that’s about what it would take to get me to change my ways because I love eating THAT much.
Well, be careful what you wish for…
I vomited constantly. I was more nauseous than I have ever been in my life. I took my pain medicine and that made it worse. The worst part? I was still ravenously hungry. The Lap-Band had no effect whatsoever on that. I wanted nothing more than to eat and even the broths and soups I ate made me throw up. The whole time I was throwing up, I was terrified I was about to slip my band (cause the band to move which would cause the wrong kind of constriction - tales I read about this on the Internet said that people who did this couldn’t even swallow their own spit afterward.) Band slippage often requires additional surgery to correct and I was already in enough pain to not ever want surgery again.
I can remember my Mom coming to visit me at this point and me crying and just saying something like, “What have I done? If you were even considering this, don’t do it.”
My husband called the doctor to report how nauseous I was to the point we thought something was wrong. They shrugged it off.
We called again. The doctor finally admitted maybe it was my pain medicine. Sure enough, I had codeine sensitivity and things were a little better after I stopped taking the medicine, BUT instead of offering to replace it with something else, I was told to take liquid Tylenol… which I gave up on because it didn’t help a bit. So pretty much I did the majority of my healing without any pain management whatsoever $6.
Besides being physically sore, I was suddenly also faced with a very real sensation like mental torture.
Unable to rest or get comfortable, I resigned myself to the couch and watched TV all day. You don’t realize how much food there is on TV until you can’t have any. My husband would come home from work and I would just cry. I’d list everything I watched and what everyone ate: a detective show with sandwiches, a sitcom with delectable cereal being nonchalantly eaten straight from the box. It was anguish.
I don’t honestly remember the post surgery diet I was on. I believe it was a week of clear liquids, two weeks of full (milky), two weeks of soft and then normal food as tolerated. I’m not 100% sure though.
I was scheduled for my first follow up. I believe this was the first time I left the house, wore clothes, etc. I still felt like death. I presented myself in the surgeon’s office, looking and feeling like death and he said ‘well done.’ I wondered if he was even looking at me.
A friend got me out of the house after week two, but I still felt horrible. Basically it was just a couch vacation, from languishing on my couch to languishing on hers for an evening.
I took two weeks off from work total. “They” will say you can probably return to work after one, but just in case there were complications, I wanted extra time to feel better - boy, am I glad I took that much. Even if I was physically strong enough after Week One, psychologically was another story - I would have gone ballistic on everyone the first time someone brought in a take out hamburger for lunch.
I continued going in to see the surgeon for band fills. We didn’t discuss my treatment plan or how many fills I might need - at first I didn’t even feel any difference as the band tightened. He just kept telling me to come in.
I will try to sum up since I don’t really remember in what order things happened after this point.
The almost three years I had the band were the most miserable of my life. My band never slipped or eroded, but I still experienced pain, discomfort and almost constant vomiting. Anytime I am asked now about what I went through, I reply that the band is “medically controlled bulimia” - and I have the deteriorated esophagus to prove it.
Here are some things I wish I had known:
1. The band doesn’t make sense
Your stomach is not a sealed container. It’s more like a sieve. The whole reason the Lap-Band is supposed to work is because the area of your stomach that triggers feelings of fullness which it communicates to your brain is near the top. The band cinches up your stomach to create a small pre-stomach pouch that you are supposed to fill with food that will trick this area into early feelings of fullness.
My surgeon told me the whole goal of eating is to take pencil eraser-sized bites and wait MINUTES in between each. You should get so “bored with eating, you get up and go do something else instead.” (Yea, tell someone who feels like she is starving to death to sit in front of food and take pencil eraser-sized bites. That will surely work.)
So tell me this: you either follow this method and pulverize your food to the point that it slips straight through the band and defeats the purpose or you take big enough bites that you do fill up your pouch, but are then in agony as you feel each piece of poorly chewed food try to pass through your stoma (your new opening from stomach pouch to regular stomach. I call it having “food babies.” The very first time I experienced the feeling of eating something too big to comfortably pass through this opening, it felt like the worst ice cream headache ever.. in my stomach!)
2. To most surgeons, you are what I was: a heartbeat with insurance
Surgeons get paid for doing surgery NOT for aftercare. Chances are really good your doctor is going to LEAVE YOU. Hey, if you go have surgery in Mexico, you probably won’t get any aftercare at all! Which leads me to the next fun fact I wish I would have known:
3. If your doctor leaves, NO ONE WILL TOUCH YOU.
My surgeon left town and took his whole office with him within a year of my surgery. This left my town high and dry. There was no one in town who would even go near me. This made it extra fun when I ended up “obstructed” (the band squeezed my stomach completely shut for no reason at all - I was unable to eat or drink anything) and in the ER about a week after he pulled up stakes. The initial reaction of the ER was “go away, we don’t know anything about what you have,” but it was a three day weekend and I literally had nowhere else to turn so I actually had to walk them through how to take fluid out of my band so I would have some relief.
I searched doctors within a THREE HUNDRED MILE radius and was either refused as a new patient even though I could produce my operative report which showed there were no complications with my surgery, or was quoted a ridiculous “New Patient Fee” of anywhere from several hundred to several THOUSAND dollars.
4. Your insurance means nothing
If you find yourself in the position I did, abandoned by your surgeon and with no one else in your town or out who will help you, congratulations: you have now entered the world of cash-for-service!
It doesn’t matter that I have incredible insurance that paid for pretty much anything I needed, with no doctor to take my insurance, I was SOL. I resorted to go-between. A ridiculous middleman service that required cash up front and then contacted a network of providers near me (I used Austin mainly - the quack in Irving hurt me worse trying to give me a fill than I’ve probably ever been hurt in that position before) to secure an appointment to get me a fill. I had to use this service several times to secure fills to get me back up to the level I was at before the ER had taken some out when I was obstructed.
5. You are at the band’s mercy
Your Lab-Band follows no preset rules. It is also affected by things completely outside of your control like atmospheric pressure.
I am very much a creature of habit and might take the same identical Lean Cuisine meal to work for lunch every day. I may have no trouble whatsoever eating it or -two to three days out of five- I might throw it up.
I was also told swelling and water retention during my period could and would make the band cinch itself up.
The band is an implanted medical device. Think very carefully about all the ads you see on TV: “Call 1-800-fat-sttlmet4u if you have had any of the following… Lawyer Steve will fight for you!” If something goes wrong with it, you face more side effects or surgery. My band actually had a recall put out on it not too long after I got it: a little piece used to clip the port’s tubing and keep it from getting kinked up could come undone and cause said kinkage to happen. The best part: the recall was for bands not already inserted. For me who already had it? “Don’t worry. Take no action. You’re probably fine.”
The worst thing I worried about was getting obstructed again with no one to help me. Because my favorite thing to do is worry and panic, I immediately thought of one of my favorite books/movies: “The Stand.” There was a whole chapter in the book devoted to people who would have survived the plague if they hadn’t done x/y/z (ruptured appendix, fell off bike and cracked skull, etc) and gotten killed. I immediately put myself in this category: the world ends, I survive, except my stomach squeezes spontaneously shut and I starve to death.
6. You can still make all the wrong choices
What no one told me and I failed to uncover in my research about the band is: the band is a tool for weight loss, yes, but it’s a poor one. Since your stomach is intact, you can still stretch it. The quack I mentioned before in Irving mentioned a patient he was seeing who managed to stretch out his pouch so far that an upper GI revealed that his pouch just mirrored his intact stomach BELOW the band (one stomach, then lapband, then the other stomach.)
There is also something called “soft calorie syndrome,” where your band may actually be too tight (a state my surgeon had me perpetually existing in before he left.) You are physically unable to make the “right” choices when it comes to food because the right choices hurt. It never ceased to amaze me how I was suddenly limited in this respect after the band. I got to where I had endless cravings for salad because I hadn’t eaten a salad pretty much the entire time I was banded. The vegetables were a no-no for me and would get stuck and irritate me until I threw up. This kind of irritation is also what would cause potential obstruction because I’d get swollen. You start making choices that are easy and not right - high calorie, creamy, fatty soups, milkshakes, ice cream - things that are easy to eat because they slip through the band and don’t cause any pain or discomfort.
7. You can still gain it all back
I guess I knew about this potential, but I didn’t want to think about it. All in all, I lost about 70lbs with the band all together. The thing is: since it didn’t affect my hunger whatsoever, all it did was delay the inevitable. Every single food and eating related desire was still there, I was just physically unable to express it. The month the ER did a partial un-fill because of obstruction? Yea, I gained 20lbs. I lost it again after I got re-tightened, but it showed me the score.
I was probably only about 10 or 15 lbs up when I finally decided to make a change. I joined Weight Watchers for the thousandth time and started counting and tracking - something I should have done since Day One with the band. I don’t know what I was thinking. I was told a lot of things about what the band was supposed to be and there were also a lot of things that I should have done that I didn’t.
* * *
So I was un-banded (disbanded?) on Dec 6th (RIP Lappy 01/14/09 - 12/06/11) and opted for the gastric sleeve. I knew that if I didn’t get another form of surgery - for all my exercising and good intentions - without that safety net, I would still be back up past 300 in a year.
My experience was the exact opposite of the Lap-Band in pretty much every way. I feel fantastic and wish I got the sleeve to begin with and didn’t waste almost three years in misery, but what’s the cliché? Hindsight is always 20/20. The sleeve was still being refined as a technique back then so I may not have been as happy with it then as I am now so - here’s another one for you - everything happens at its own time and for its own reason, I guess.
I started off writing this as a comparison of each experience (hence the extended URL), but I realized I had far too much to write so the gastric sleeve will have to have its own hub later.
I do very much acknowledge that this is ONLY one person’s experience. There are lots of other people out there who love their Lap-Bands and have had fantastic experience with them. I just wanted to let you know what happened to me just in case you are making a weight loss surgery decision right now and need a con to weigh against the pros, etc.
I was very secretive about my surgery in the beginning. I felt a lot of shame - like getting surgery was cheating (and now I know that’s crap since it was one of the hardest thing I’ve gone through), but I don’t feel like that at all anymore so please - if you have any questions at all, ask away.