July started off with a bang around these parts. July 1st found me spending the day at the hospital, going back and forth between my bariatric surgeon’s office and the outpatient radiology center. The next day, I was back at the hospital again for a frantically scheduled operation. And now, two weeks later, I’m adjusting to life post-Lap-Band. But to really understand what happened, we have to back up a little. Come with me, won’t you?
Back in January, I celebrated the second anniversary of my surgery by hitting my goal weight. Thanks to a body scan prior to surgery, I had settled on a realistic, maintainable goal for my body’s ideal ratio of muscle to bone to fat. I wouldn’t have been disappointed to surpass my goal, but I felt great, looked great, and was happy.
There are lots of possible side effects of the Lap-Band that people don’t necessarily toss around in polite conversation – bloating, ulcers, diarrhea, constipation, heartburn… a pretty un-fun collection of maladies, to be sure. For the many who think bariatric surgery is the “easy way out,” it’s really, really not. The side effect that I seemed to experience most frequently was acid reflux. It wasn’t an everyday occurrence, but I had to pay extra attention to my caffeine and carbonation intake (already extremely limited – maybe a few sips of beer every now and then) and make sure I didn’t eat within an hour of bedtime unless I wanted to see my food again. With some effort, I only experienced reflux every few weeks or so.
Then, earlier this year, the reflux started to become more frequent. I would have to wait two hours after eating instead of just one before I could lie down. Sometimes the reflux was so bad I was afraid to eat at all, which meant I had no energy for exercise. I couldn’t sleep through the night; I was constantly coughing (and when I thought I had a cold and took some NyQuil, I coughed it up in my sleep). Weirdly, snot would shoot itself out my nose, waking me from one of my many overnight cat naps to clean myself and the bed up. We invested in a wedge pillow to elevate my upper body and hopefully minimize the reflux, but it didn’t go away entirely. And I also had the added perk of crippling back pain, which I later discovered was a side effect of my digestive troubles.
When you’re not feeling well, Google can be the enemy. But all my misery sounded suspiciously like a complication with my gastric band – I figured it had either slipped or had begun to erode into the wall of my stomach. Armed with whatever knowledge I could find online, I went back to my surgeon’s office. The nurse practitioner agreed with my assessment (said this case was the part of MMI examples all practicioners pass when being interviewed), and we decided to remove all the saline from my band (it was mostly empty already), hoping that would allow any band slippage to correct itself. She also prescribed a proton pump inhibitor to make my stomach’s digestive juices less acidic to help with the reflux. It would take a while for my stomach to heal, so we decided to give the fixes six to eight weeks to improve things.
I was given a three-month prescription for the reflux medication, and after the second month ran out I didn’t get the final refill, opting instead to see how I’d feel without the meds. My reflux had definitely improved, in that I didn’t have acid burning my throat at night. But I was still waking up with heavy coughing, and I was still afraid to eat. My weight had dropped ten pounds below my target; I wasn’t necessarily unhappy, but Jason casually mentioned that he thought I was done losing. After a week off the proton pump inhibitor, the reflux seemed marginally better. And I’d discovered periodically bending over to touch my toes helped with my digestion, like reversing gravity was moving things around.
On Monday, June 29, I went to work like normal. I didn’t feel great – my back was killing me and my band felt tight so I didn’t really eat much, but I soldiered through. By the time we got home that evening, I had a brutal headache and just felt exhausted. Jason sent me up to bed to relax, and I took a bottle of water with me; I couldn’t sleep, so I watched some TV. It wasn’t long before I was in the bathroom vomiting up the water I’d been drinking. When I went back to bed, I could only stay on my back (on the wedge, mind you); rolling to either side caused a tightness in my band that shot burning pain through my chest. I only slept a couple hours that night.
I stayed home from work on Tuesday, and felt a little better. I managed to eat some soup, which had been the bulk of my diet for weeks, looking back now. I also managed to nap off and on throughout the day, catching up on the sleep I’d missed. At that point, I figured maybe I had some weird 24-hour flu or bug. But Wednesday morning, my band still felt impossibly tight. I knew it was empty, so I shouldn’t have felt such awful restriction. I headed in to work with Jason and Evan, following our normal morning routine, but I called the surgeon’s office from the car to make a same-day appointment. And just before lunch, the nurse sent me over to radiology to have an upper GI done.
An upper gastrointestinal series, commonly known as an upper GI, is basically a video x-ray. First, normal x-rays of my chest were taken for reference. Then I was given a nasty beverage filled with barium to drink, and the barium appeared on the x-ray video camera as black while my organs were lighter in color. The radiologist watched the barium make its way through my digestive system and looked for possible blockages. As soon as she turned the camera on, I heard her mutter, “Well, no wonder you feel like crap.” Turns out that instead of being near the top of my stomach in the correct position, my band was closer to the bottom of my stomach. So much of my stomach had slipped up through the band, in fact, that she couldn’t tell where the bottom of my stomach was. And barely a trickle of the barium solution was making its way out of my gigantic pouch. She took the video from several angles to get a better idea of just how much slippage had occurred; instead of the camera moving, I was rotated on a platform that took me from standing to lying down and back again. I’d have been impressed and geeked out if I wasn’t already working myself up about the out-of-pocket cost of a corrective surgical procedure not covered by our insurance.
Because to fix a slippage as bad as mine, surgery was the only option. There was no more fluid to remove from my band; it couldn’t get any more loose to give my stomach room to maneuver. The radiologist sent me back across the hospital campus to visit with my surgeon one more time, and he told me what I had already suspected – the band had to come out. I was surprised at what came next, though. He said he thought I didn’t need it any more, that I had “reset” myself and could maintain effectively. That was definitely scary to hear, because amongst all my concerns about money, there was an underlying whisper saying, “I don’t want to get fat again.” I inquired about revising my band to a gastric sleeve, a more modern procedure that has replaced banding as an alternative to a gastric bypass. But because my stomach had experienced trauma from the band slippage, it would be weeks if not months before the sleeve surgery could even happen (and he wasn’t recommending it unless I truly had trouble maintaining).
Then he dropped his next bomb – he was scheduling the surgery for the next morning. With a few weeks to prepare, I knew we could scrounge up the funds to pay for the operation. But there was no way I could get the money together in 24 hours. And so I was handed off to my surgery coordinator to get things set in motion and help me set up payment plans. She also brought me a box of kleenex and a trash can; between worrying about money and worrying about gaining all the weight back, I had gone off the deep end and was weeping openly. There were no operating rooms open the next morning, so I was scheduled in the 2 pm slot and directed to report to the hospital at noon the next day for pre-op.
I once I settled down, I headed home. I attempted to eat and drink a little, because I knew I wouldn’t be able to after midnight, but of course I couldn’t really get anything down. And I definitely didn’t sleep well that night; Jason mostly took care of getting Evan off to daycare the next morning while I napped and lounged waiting for “go time.” When we arrived at the hospital, I didn’t wait but a few minutes before the nurse came to retrieve me. I took a pregnancy test (negative), and then had my blood drawn for labs and was given IV pain reliever for my massive hunger-and-dehydration-induced headache. My surgeon and anesthesiologist both came in to visit with me and tell me how things would go, and just after 2 I was rolled into the OR, lifted on to the table, and promptly put to sleep.
My time in the recovery room was much shorter this time than after I’d had the band placed. As soon as I woke up and signed the discharge paperwork, I could get dressed and go home. I moved gingerly to avoid angering my four incisions (putting the band in only required three), but I felt pretty good, all things considered. Jason had his sister pick up Evan from daycare so we didn’t have to worry about it. Instead we went home and I was tucked into bed.
It didn’t take long for me to notice that my band was gone. My appetite returned with a vengeance, and I immediately knew that I didn’t have the restriction the band had given me; my usual portion sizes were leaving me starving. I also had a lot of swelling and water retention from surgery, so right away the scale bounced up over ten pounds – more than a little stressful for a person who is trying to avoid gaining weight and can’t work out at full strength for six weeks. Luckily the physical recovery has been easy; I was off pain meds after 48 hours and didn’t even feel sore after a week.
Life is settling in to a new normal. I’d adjusted to my band’s restriction and could eyeball my portions or rely on feeling full to trigger when to stop eating (a big no-no); now I have to learn to trust my mind over my body and get back to measuring things (and reaching for the water bottle when I feel hungry). It’s also been tempting to eat all the things the band had kept me from enjoying – steak, bread, soda, doughy desserts… the mind reels! I’ve had two weeks to indulge, and now it’s back to moderation. And I just couldn’t not work out for six weeks, so I’ve begun Walk Away the Pounds again (the same regime that helped with my loss that last time I had surgery) until I can run and lift. This journey has served to remind me that there’s never really an “after.” You can never really stop doing what keeps you healthy and go back to your old way of life. And I now have the benefit of seeing and feeling what life is like at a healthy weight in an active, strong body. I’m in no hurry to reverse all the work of the last two-and-a-half years.