For lap-banders, stretching the stomach can be especially tricky, and that is why if you feel your portions are getting bigger than 4 oz, it is extremely important that you become more conscious of your serving size and try to cut back. Easier said than done, right? Well, it’s not easy to cut down on your portions once you stretch your stomach, that’s for sure. That is why at DayOne Health, we came up with a four step stomach-shrinking plan for lap-band patients to make getting back on the dieting wagon a little easier.

Step #1:  Back to Basics

Do you remember your first week after your weight loss procedure? Trying the liquid diet from time to time can be very beneficial – especially if you feel that you may have exerted your stomach too much. By no means should you treat the liquid diet as a regular post lap-band diet; nevertheless, when your stomach is in distress either due to swelling or stretching, staying on liquids is your best bet. While on liquids you must remember to monitor your calorie intake, make sure you get enough protein, and watch your carbs. Depending on how long you strained your stomach and how severe the pouch is, we advise our DayOne Health patients to stay on liquids for two to three days.

Below you’ll find a short list of things that we usually recommend to DayOne Health patients. If you have questions regarding portioning, please reference your dieting booklet or contact your bariatric dietitian. So the first step of your diet will revolve around:

• Low-carb protein shakes
• Clear or cream soups
• Sugar-free jello or pudding
• Low-sugar popsicles

Step#2:  Soft Foods

The second step is the slow progression from liquids to soft foods. Soft doesn’t mean typical “slider” foods that will go straight though the band, but soft protein and things like soft fruit and veggies that will fill your stomach and are at the same time easier to digest. During this part of the diet, you can steam your veggies as a side or a snack, or munch on berries. In terms of meat we advise our patients to stick to fish, steamed or canned. If you find your canned tuna to be rather dry, you can add some low fat mayo to ease it up, but not too much so it doesn’t slide right past through the band.

During this phase it is important that you portion your food well. To prevent overeating, measure your food and make sure your portions are between one or half a cup. The objective is to get your stomach back to its original size it was fresh after the lap-band procedure. Also, it is very important for you to keep to the rule of not drinking with your meals. Wait half an hour with your meal after drinking, and don’t drink earlier than half an hour after a meal. Drinking with your food will put the strain on your pouch again, and make the food slide faster down the band. So, keep your drinking separate from your eating at all times and continue the soft food diet for two days.

Step #3:  Firm up

After soft foods, you can start on firmer protein like ground meets and seafood. Again, make sure your portion size is appropriate, meaning four ounces of solid food three times a day, plus two 100 calorie snacks in between. By now you should feel that your stomach shrunk, and hopefully you are able to feel full after eating considerably smaller portions.

Step #4:  Back to Normal

By the end of the week you can finally start eating regular foods again. Nevertheless, you still need to watch your portions. This last step includes implementing all the golden rules of the lap-band diet while eating regular foods. Now when your stomach shrunk back, you should not have problem with getting full on four ounces of food. Remember not to drink before, during, or right after your meals, eat three meals a day, and count your calories. Also, observe whether you get full on four ounces of food. If you notice that you are still hungry after you ate the recommended portion, you should contact your weight loss clinic. Most probably your band is just too loose and you need some extra fluid put in.

We hope that this simple four-step plan will help you get back on track. Please remember that all our DayOne Health patients are more than welcome to call us any time to schedule their appointments or discuss their eating.

If you are not DayOne Health patient, but you would like to hear more about our lap-band program call our Chicago weight loss clinic at 312-239-3838 and speak to real lap-band patient about our comprehensive weight loss program. You can also schedule your one-on-one consultation with a lap-band surgeon.

What is a gallbladder and how does it work?

The gallbladder is a small sac located below your liver in the right upper abdomen. The gallbladder is a storage area for bile that is produced in the liver. When bile is needed, the gallbladder pushes it out into the common bile duct that carries it to the small intestine. Once the bile is in duodenum, bile salts break down fat and help with digestion. While gallbladder stones are formed in the gallbladder, it is when they pass through the ducts that they can get lodged causing inflammation of the gallbladder, ducts, or the liver. If left untreated, gallstones can lead to infection and even death.

What are gallstones?

The gallstones are pebble-like substances, usually hardened cholesterol, which form in the gallbladder and may travel to the bile ducts causing blockage or inflammation. Gallstones usually develop as a direct result of chemical imbalance in bile stored in the gallbladder. Researchers usually lists main causes of gallstones conditions as increased amount of cholesterol, inadequate amount of bile salts, or incomplete emptying of the gallbladder. The stones vary in size from a grain of salt to a golf ball, and their mere presence can cause formation of additional stones. If you have a family history prone to gallstones, are overweight or diabetic, eat foods high in cholesterol and low in fiber, and/or you’ve experienced significant weight loss, you are at an increased risk of developing gallstones.

Gallstones and weight

If you are a bariatric patient you have an increased risk of developing gallstones, first due to your higher weight and co-morbidities associated with it, as well as the relatively rapid weight loss. If you are taking cholesterol-lowering drugs you are at an even higher risk because the medication, while decreasing the amount of cholesterol in blood, significantly increases its amount secreted into the bile. The relationship between higher BMI and gallstones comes from the reduced amount of bile salts. Decreased amount of bile salts leads to higher concentration of cholesterol. This in turn, interferes with the emptying of gallbladder and further increases the risk of developing gallstones.

Lap-band and gallstones

Even though you will cut down on most of the fatty foods after the lap-band procedure and your new eating habits will largely improve your co-morbidities, change in diet may contribute to the development of gallstones. Prolonged fasting or “crash diets” can cause the liver to secrete more cholesterol than normal into the bile causing gallstones. If you keep on track with our lap-band giveaway contest winner, Amy, you will know that this is exactly was what happened to her. After losing almost 90lbs in ten months after her lap-band procedure, Amy experienced what is commonly referred to as  “gallbladder attack”. With strong stomach pain, Amy rushed into the ER where she was diagnosed with gallstones. Like most of the patients, Amy initially didn’t associate her pain with her gallbladder; after all, she’s avoided fatty foods and watched her diet. If you are at increased risk of developing gallstones don’t ignore prolonged pain, nausea and vomiting, or a fever. If you think you may be experiencing the gallbladder attack, contact your doctor immediately.

If you are interested in lap-band procedure or you are interested in our DayOne Health comprehensive weight loss program, contact our patient advocate at 312-239-3838 or schedule your one-on-one consultation with a weight loss surgeon.

What is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent abnormal pauses in breathing or instances of low breathing during sleep. If you are affected by OSA you may experience daytime fatigue, slower reaction times, vision problems, attention deficits and development of conditions such as hypertension, stroke, diabetes, and arrhythmia. If you think you may be experiencing some of those symptoms, you should immediately talk to your doctor. Don’t let your sleep apnea go unnoticed; untreated, sleep apnea can be life threatening.

Sleep Apnea Causes

Essentially there are three types of sleep apnea that are currently diagnosed: central sleep apnea (CSA), obstructive sleep apnea (OSA), and mixed sleep apnea (both CSA and OSA together). While CSA is caused by issues with nerve signals that initiate breathing, OSA results from a physical block of airflow that prevents effective breathing. If you are significantly overweight, the increased pressure on your upper airway caused by the additional fat tissue may predispose your airway to collapse. With overall lower reflex activity during sleep, your neuromuscular activity can significantly decrease your ventilatory motor output to upper airway muscles, this in turn can highly increase your chances of airway obstruction. This effect is even more pronounced in patients anatomically predisposed to an airway collapse.

Link between Sleep Apnea and Weight

Despite the exact mechanisms underlying the relationship between weight and sleep apnea remain unknown, multiple research showed the significant decrease in airway collapsibility after weight loss. Researchers believe that increased amount of fat tissue can have both chemical and mechanical consequences on airway tone and ventilatory control stability. Like most co-morbidities, sleep apnea may not only result from being overweight, but can also cause further weight gain. This is also why you definitely should not wait with being diagnosed and starting the treatment. Studies have shown that the CPAP treatment does not only help with sleep apnea symptoms but can also lead to lowering your weight. Similarly, losing a considerable amount of weight for instance after the lap-band surgery, can significantly improve your symptoms and lower the risks associated with sleep apnea. After losing a considerable amount of weight, many of our DayOne Health patients were fully freed of all sleep apnea symptoms.

Sleep Apnea Diagnosis and Treatment

If your doctor suspects sleep apnea, he will most likely refer you for further testing, called sleep study or polysomnogram. The sleep study usually involves you spending the night in a sleep center or sleep lab while techs check on your breathing patterns. If the study shows that you have a sleep apnea you will most probably be prescribed to use a CPAP – machine that will help you breathe easier while asleep. If your apnea is closely related to your weight, doctors usually agree that while the use of a CPAP machine is crucial to manage symptoms, the only way to resolve OSA is a significant weight loss.

If you would like to learn more about sleep apnea and ways to fight it with a comprehensive weight loss contact, DayOne Health’s patient advocate and a lap-bander  of six years at 312-239-3838. If you would like to discuss you weight loss with a weight loss surgeon, schedule your one-on-one consultation.

What is a lap-band adjustment?

Lap-band adjustment is a regulation of the band restriction around your stomach. This adjustment can be done during regular follow up visits and is a vital part of your bandster lifestyle – especially during the first year after your weight loss surgery. You need to remember that when the band is put in, the mechanism is empty. So, about four to five weeks after the procedure you’ll need to come back to have it filled with saline. The surgeon will inject the saline fluid though the port and make sure that the opening between the upper and lower part of your stomach is optimal. During your first adjustment you may not get the best restriction right away, and you may have to come back to your doctor’s office to tweak it and get you in what bandsters call a “sweet spot”. Remember, it is extremely important that you are honest with your surgeon and inform him if the band was not adjusted properly. A band that is either too tight or too loose will not give you the expected results.

How many lap-band adjustments will I need?

Be prepared that during your first year after surgery you will need to have your band adjusted approximately every three months for the best results. Because the first year’s visits are so often and so important, at DayOne Health we offer our patients the first year of adjustments free of charge. This way we make sure that our patients don’t skip on their follow up just to avoid extra spending. It is estimated that during your first year you will have from four to six adjustments. Every next year, we recommend our DayOne Health patients to visit at least once every six months or twice a year. Not every follow up visit will end up with an adjustment; nevertheless, it is crucial that you stay in touch with us so we can monitor how everything is going. Those visits are extremely important for a number of reasons, with early complication detection being one of them. And don’t worry; we’ll remind you when the time comes!

Warning signs

The way your surgeon will do your adjustment is under the fluoroscope machine. During the procedure, your weight loss surgeon will ask you to drink some contrast and then view on the fluoroscope how much of it drips down through the band while adjusting the amount of saline in your band. Now, despite the restriction assessment accuracy of this adjustment method, you may find that the day after the adjustment your stomach doesn’t feel right. In other words, the adjustment that seemed perfect during the procedure, may feel a little tight the next day. If you feel that the band is too tight, or opposite, you don’t feel restriction at all, please contact us right away. Never wait with informing your doctor of anything that you feel is happening to your band or stomach. Sometimes the band can get tighter in the mornings or on an account of stress, or in the case of women, during their period. Nevertheless, if your tightness is not going away three hours after you wake up, definitely let us know. If you would like to hear more about the post-adjustment warning signs leave us a message.

If you would like to hear more about the lap-band procedure or DayOne Health lap-band weight loss program contact Gladys, a real lap-band patient and our patient advocate, to hear more. To check whether you’re a candidate for a lap-band procedure, talk to the lap-band specialist to book your one-on-one consultation with a surgeon today or register for a free seminar.

Weight-related infertility

Multiple studies have shown that weight can strongly influence how likely you’ll get pregnant. Problems with getting pregnant stem not only from cycle irregularities that can be caused by polycystic ovarian syndrome (PCOS) but also by the single fact of being overweight. Research shows that even among women with regular cycles and otherwise no obvious fertility problems, high BMI decreases the chances of pregnancy. In addition, the higher the BMI the harder it gets. One of the studies by Dr. Van der Steeg shows that for every BMI unit over 29, the chances of getting pregnant fell by 4%. In other words, if your BMI is between 35 and 40, it will be 23% to 43% harder for you to get pregnant than if your BMI was between 21 and 29.

Will the lap-band help me get pregnant?

The reason behind the weight-induced infertility lies in hormonal imbalance caused by the way fat stores and releases hormones. So, if your BMI is over 30, then the high amount of fat tissue may throw your hormones out of balance and make getting pregnant harder. Obviously, the simplest treatment that is usually offered in this case is significant weight loss. If you are significantly overweight and there is no other reason for you to not be able to conceive, a weight loss procedure may be your best option. Choosing lap-band surgery will definitely increase your chances of pregnancy by the mere fact of making you healthier and losing those extra pounds that prevent you from becoming a mom.

How soon after losing weight can I get pregnant?

Usually we recommend for our DayOne Health patients to wait about a year after their weight loss. The reason why is that we want your body to first get used to your new weight and get some balance before throwing it off again with pregnancy. Also, getting your body used to its new shape will highly decrease the chances of you gaining a lot of weight during pregnancy and make it easier for you to lose it after having your baby.

Is pregnancy with lap-band healthy?

All of the available weight loss surgeries will help you lose weight, and as a result help to get pregnant. Nevertheless, while researching your options you should also pay attention to the mechanism that the procedures cause to make you lose weight. For instance, malabsorption procedures, such as gastric bypass or duodenal switch, will cause you to not digest certain foods and not absorb them properly. This means that pregnancy after these procedures will require more attention to whether you are getting all the nutrition you need. In contrast, with gastric band your pregnancy will be no different than without it. Once you know you’re pregnant, you book your office appointment, and we will simply remove all the fluid from the band which gives you the room you need to give your baby all the nutrients he/she needs.

If you believe that your fertility problems may be connected with your weight contact our patient advocate at 312-239-3838 and learn about the ways lap-band can help you with conceiving. If you would like to meet with a bariatric weight loss specialist schedule your one-on-one consultation with a lap-band surgeon today.

What do you discuss during the support group?

The answer is simple: whatever you feel is worth discussing! And you can be sure that even if you don’t have any idea what you would talk about, once you get there the conversation will flow on its own. Many of our DayOne Health patients say that they really enjoy our support group meetings because hearing other patients’ stories inspires them and gives them valuable tips on how to deal with their weight loss struggles. What is most valuable about these monthly meetings is that you can share your experiences with those who best understand and relate to them. Also, if you decide to come to the support groups you will have an opportunity to meet other patients in different stages of their journey. In other words, inspire and be inspired! No matter if you are a newbie or an advanced four year bandster, our support group is always open to hear your story.

Why is participating in the support group important?

First of all, like we mentioned in the first part of this blog, support is extremely important for your weight loss. Despite the fact that when we think about an immediate support environment we first think closest friends and family, many of our DayOne Health patients are very private and decide not to tell even the closest family about their lap-band procedure. If you happen to be as private as they are, the support group and patient advocate will most likely be the only people with whom you will be able to share your struggles. At DayOne Health we are all very dedicated to providing our lap-band patients with the most caring and supportive atmosphere possible; nevertheless, no specialist no matter how experienced, will be able to provide you with what a fellow lap-band patient can – a certain level of understanding comes from common experiences. And exactly for that reason, we not only have bariatric patients on staff to assist you, but also organize monthly support group meetings.

Who can attend the support group meetings?

All present and future lap-band patients are more than welcome to attend our DayOne Health support groups. The DayOne Health lap-band support group is hosted and facilitated by our bariatric dietitian who not only prepares the groups’ starting topics, but also answers patients’ questions regarding the lap-band procedure and nutrition. The group meets every month on Thursdays and Mondays alternately. If you are interested in attending contact us or call our patient advocate at 312-239-3838 for details.

I think I can feel my band! Is that possible?

Unfortunately or luckily, on a daily basis you can’t. It’s impossible for you to feel the lap-band because there is no “feeling” on the outside of the stomach or in organs surrounding the place where the band is. One of our DayOne Health patients told us that she could feel her lap-band when burping or having a gas build up. You need to remember that you need to differentiate between feeling the band and feeling the port. Again, during your day-to-day activities you won’t be able to feel the band. You will feel your lap-band, or rather tightness from it, and only in a few instances:

• you don’t chew your food well enough
• you just had a lap-band adjustment
• your band is too tight

So what am I feeling if it’s not the band?

You need to remember that what you will feel is tightness but not the band itself (no “poking”, “rubbing”, or “bumping”). Moreover, you need to remember that feeling something is very subjective and has a lot to do with the fact that you’re consciously aware of the band inside. By thinking about it, you are more prone to “blame” body reactions as being connected with your band, and confuse what you feel with a feeling of the actual band. In our Chicago weight loss clinic, patients reported feeling their lap-bands very rarely. And, patients who told us they could feel the band never described it in the same way, as another patient’s experiences.

In that case, maybe that’s the lap-band port?

This might be true, as the port is one of the things that you can definitely feel. Immediately after surgery, you will feel soreness in the area where the port is placed. That feeling will most likely persist from two to four weeks post weight loss surgery. Later, once the site of the port is fully healed, you will still be able to feel it from time to time. Depending on how your port was placed, sown onto or under the muscle, the port will feel a little differently. In the beginning of your weight loss journey, your lap-band port will most likely be placed onto the muscle. After the healing period is over, you will be able to find the port if you press your stomach firmly and try to feel the port out with your fingers. Don’t worry. You definitely won’t be able to see it on the outside.

How will the port feel?

Our Chicago weight loss patients often say that they can feel their port “slightly pulling” or “poking” them if they sit in a particular way, cringe, or lay on their stomach. In addition, patients can feel it when contracting their abs. Moreover, once you lose all the weight, the port may often be slightly visible on the outside, especially if you decide to get a tummy tuck. Therefore, once our lap-band patients lose weight, they often want their port to be put under the muscle. Once your port is placed under the muscle, you can’t feel it at all. Neither bending, sneezing, laying on your stomach, or doing pull ups will feel any differently than without the lap-band.

If you would like to hear more about how the band feels or learn more about the lap-band procedure, please contact our Chicago DayOne Health clinic at 312-255-1915. Our lap-band patient advocate, who is a lap-band patient herself, will be more than happy to answer all of your questions. You could also sign up for a one-on-one weight loss appointment with one of our bariatric surgeons.

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Why does my band feel tighter in the morning?

Morning tightness of the band is nothing to be alarmed about. It is something you may experience once in a while during your weight loss journey. Most often, patients visiting our Chicago clinic, report the feeling of tightness two or three days after their band adjustment. The more fluid you have in your band the more likely that you’ll experience morning tightness. The primary reason for the tightness is water retention. Natural water fluctuations in your body may cause an occasional swelling of your stomach, and therefore the feeling of increased restriction. In addition, freshly adjusted stomach swells a little on its own. This, in addition to water retention, may increase the feeling of tightness.

Is my band too tight then?

Please don’t confuse morning tightness of the band with getting too much restriction from your adjustment. The difference between the two is that, the morning tightness goes away; the general tightness doesn’t. When patients call our Chicago clinic two or three days after adjustment to complain about the tightness, we ask them usually to wait few hours before scheduling the appointment. If your band still feels too tight around the lunchtime, it means that you will most likely need to see your weight loss surgeon.

Is my lap-band going to feel like this every morning?

Usually, once the post-adjustment swelling of the stomach is gone, it is very rare for our patients to feel the morning tightness. The rule of thumb is that if you feel tight for over two days, we ask you to come by for the readjustment. Nevertheless, if you can’t even hold down fluids it’s considered an emergency! Please remember, if your lap-band feels tight and it is not letting you eat anything long after you wake up, it’s very likely that there’s too much fluid in the band.

If you have any questions regarding the lap-band, or you feel that your band may be too tight please contact our Chicago clinic at 312-255-1900 begin_of_the_skype_highlighting              312-255-1900      end_of_the_skype_highlighting begin_of_the_skype_highlighting              312-255-1900      end_of_the_skype_highlighting begin_of_the_skype_highlighting              312-255-1900      end_of_the_skype_highlighting or e-mail at pcc-chicago@dayonehealth.com.

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Most bands can hold up to 10ccs of saline. Nevertheless, there is no such thing as the set and universal amount of fluid that would give the best results for everyone. Every patient is different. While for some, even a completely deflated lap-band can give enough restriction, for others the band needs to be almost full.

How does the doctor know there is enough fluid in my band?

At DayOne Health, we do all lap-band adjustments with the use of a fluoroscopy machine. This technique, allows the weight loss surgeon to see the amount of restriction at any point of the procedure. Just before the lap-band adjustment, the surgeon will ask you to drink the barium contrast and with the help of an x-ray, he determines whether the adjustment is really needed. If the doctor sees that the fluid passes into the stomach too quickly, he proceeds to adjust the band. In order to make sure the right amount of fluid is added, the patient is asked to drink some more of the contrast during the procedure. Once the weight loss surgeon sees the upper portion of the stomach empty with an optimal speed, the adjustment is complete.

How do I know that my band is well adjusted?

Like we mentioned earlier, there is no such thing as a universal number of ccs that all lap-banders need to succeed. Everything depends on how you feel with the band.

First of all, you should:

• Feel full after eating 4oz solid meals.
• Not be hungry quickly between meals.
• Be losing weight of about an average of 1-2 lbs per week.

However, you should:

• Be able to tolerate any solid food.
• Not feel pain while swallowing.
• Not feel sick when drinking fluids.
• Not have heartburn
• Not experience night cough or choking.
• Not have a constant upper abdominal pain that worsens when you eat or drink.

If you experience any of those symptoms most likely you have too much restriction. In that case, you should contact your lap-band doctor immediately. The band won’t loosen up on its own, so don’t even hope it will get better over time without doctor’s intervention. If you feel you can’t even hold liquids down, it is very likely that you will need to get your band adjusted the same day to avoid dehydration.

If you would like to hear more about the band adjustments or about a lap-band in general please call our Chicago clinic at 312-255-1900.

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1. Eat slowly, but not too slow – This simple rule goes hand in hand with the first and foremost golden rule of a lap-band eating in general: If you won’t chew it enough it may get stuck in the band, if you over chew it will just slide past it without filling up the stomach as early as it suppose to.
2. Eat before the party starts – Don’t even think about starving whole day, just to stuff yourself with the dinner. The longer you keep your stomach empty, the more likely you will overeat once you get to that dinner table. Every lap-bander should remember to always keep to the healthy eating – even when it comes to festivities like this.
3. Eat the special stuff – Why would you fill up on things that you can have every day? Is that mac & cheese so special you need to eat the whole plate of it? Taking under consideration that your banded stomach gets filled up after a half cup of a solid food, you should really think what’s worth digging into.
4. Avoid finger foods – Remember, finger foods are usually high in calories and fat. With the  exception of veggies, stay away from foods you don’t need a fork and knife for.
5. Stop when you’re full – If you have a lap-band this is very important. Luckily, in our Chicago clinic we still haven’t seen any post-thanksgiving band slips, but you certainly don’t want to be our first.

Similarly to all other “eating celebrations”, don’t challenge yourself with impossible goals like: “this year I’m just going to stick to a small salad, and that’s it”. There is no reason for you to miss out on the turkey! And as a matter of fact, from the position of lap-band nutritional directions, it would be really unreasonable for you to fall short of your body’s daily protein demand.

To better prepare yourself for the Thanksgiving, make sure your band is well adjusted. Don’t wait until the last moment with making your appointment with the weight loss surgeon. If you need a lap-band fill, or you want to loosen up a little before the celebration, now is the last moment to call your doctor.

If you need to schedule your appointment for a lap-band adjustment or talk to our dietitian, please call our Chicago clinic at 312-255-1900.

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