Author:Dr. Ron Hekier. LapBand surgeon in Texarkana, TX.

If I had a nickel……

… for everytime I heard someone say, “I’m a stress eater.”
Here’s a news flash, I think every human alive is an
emotional eater and more likely to eat when they are
facing stress.

I found this checklist on the internet regarding
emotional eating:

1. Do you reward yourself with food?
2. Do you eat more when you’re feeling stressed?
3. Do you ever eat even if you aren’t hungry ?
4. Do you ever eat to feel better or to calm yourself down
   from an emotional event?

This is how I answered those questions:

1. Hell ya.
2. Duh, of course.
3. Really?
4. Who wrote these stupid questions?

Emotional eating, when done in moderation, or as an
infrequent reward is actually a good thing.  Just reached
a major milestone at work?  A family member get married
or graduate school?   Did you reach a fitness milestone in
terms of lifting a goal weight, or running a certain distance?

For any of these events, reward yourself with some junk food
or extravagant food if you desire.

Emotional eating is different.  Emotional eating becomes
stressful eating when it is done often and not as a reward but as
a crutch.

A family member has a health issue so you’ve been
eating junk food every day for 6 weeks?

Your kids are having school trouble so you’re
eating ice cream every day for the past month?

Having marital issues so you eat chips and cookies every night?

All of the above situations are stressful enough, but
guess what happens when you turn to food for comfort
and have unhealthy food on a regular basis?
You get even more stressed out!
Why?

Because eating junk often makes you feel like junk.
(You are what you eat.)

Because eating junk often makes you gain weight
so you feel stressed out about your weight.

Because eating junk often makes you feel guilty because
you know you shouldn’t do it, which in turn increases
your stress level.

OK, you probably know all this,
so what can you do to combat
emotional eating, and how
do you approach eating and stress?

My personal stressful eating solutions:

1)  Repeat to yourself over and over again,
eating crap will only make my stress worse.
Take a step back and stop before you grab that junk food
and recognize that it will not solve the problem or
get rid of the stress you feel.
That’s usually not enough, but it is a good start.

2)  Are you keeping a food journal everyday?
You should be!  Food journals are for anyone who
wants to expects to control their weight.
Don’t accept the excuses that you can’t journal your
food intake because you don’t have the time,
it doesn’t help, you’re on the road, or whatever.

I’m busy, I travel, I have a full time job, 2 kids, and
I record every single thing I eat, and this is what I
look like approaching my mid 40′s:

(See my post about food journaling and other tips:
How I ate 5,423 almonds and got in the best shape of my life.

So once you start keeping a food journal, commit yourself
to recording everything you eat as you are eating it.
If you are recording the chips you are eating, or the
ice cream, or the candy, that journal will stare you in the
face and you will be less likely to eat it.

3) Be aware of your comfort food and then keep healthier
options on hand and to replace the unhealthy options.

Don’t eliminate.  Replace.  It’s a lot easier to substitute
one aspect of a habit than to change that habit altogether.

I know that I am a stressful eater.  This past week I’ve
been working on a tax issue.  That’s enough to make
anyone go nuts.  I’m aware that this week under the
stress of this tax issue. I’m more likely to make
poor food choices and be an emotional eater.
So I made sure to turn to healthier choices in
prepartion for emotional eating.
When I am stressed, my snack of choice is crunchy food.
I know that, so I made sure I have plenty of carrots at
home and this week I’ve eaten enough baby carrots this
week to make Bugs Bunny jealous.

Another mainstay for me are hazel nuts and almonds
and this week I’ve been eating a lot of hazel nuts to satisfy
my craving for crunchy food.

Carrots and hazelnuts are a lot better than tortilla
chips and salsa, Oreo cookies, KitKat bars, or
peanut M&M’s, which are some of my personal favorites.

So I recognize my weakness, crunchy food, and made sure
I had a substitute.  Think about yours.

4)  Don’t let yourself get physically hungry.

During this stressful week, I’ve been trying to keep my stomach
full and not have to deal with physical hunger.  So I’ve been
nibbling on carrots throughout the night.

I’m having about 10 hazelnuts at at time several times a day.

I’ve stayed away from protein shakes, instead going for more
solid foods, like chicken or meat to reach my protein intake goals.

By eating more solid food more often, my stomach will stay
physically full and I’ll have less physical hunger to contend with.

We are all emotional eaters.  Make a plan for it, and don’t let your
emotional eating add to your stress.

Author:Dr. Ron Hekier. LapBand surgeon in Texarkana, TX.

Every day in clinic we always get asked by one
or more patients, “How much fill do I have?”
Who cares?!

I find it curious that people always ask
“What’s my fill? How much do I have?”

Then they rush home and put their fill volume
on their ticker on lapbandtalk.com or
obesityhelp.com and compare it with other people’s fill volume.

Let’s all remember that the Lap Band is an
‘adjustable gastric banding system’. Notice that first word?
Adjustable; it is adjustable for each person.

A fill that works for you won’t work for your friend,
and vice versa. Trust me, I wish I knew what fill would
work for you, because then I would give you one fill and
one fill only, and we would see great weight loss results
for you more quickly.

However, the average person needs probably 3 or 4 fills
until they are around their ‘sweet spot’ or what some
call ‘The Green Zone.’ Not too tight, not too loose, but just right.

Next time some one asks, what is your fill volume,
remember that makes as much sense as you seeing
your friend wearing a nice pair of shoes and asking
“Nice shoes, I want a pair just like that, what size are they?”

Your friend’s shoe size is different than yours, and so to
will be their adjustment volume.

We’ve seen people with 0 fills lose 80 pounds in a year,
and other people need 7 fills in their first year.
It’s different for everybody.

Don’t judge your fill based on what someone else has.
Better yet, don’t even worry about the fill volume in your
LapBand.  Focus on the symptoms of hunger and satiety.

Posted by Dr. Rachael Keilin a Texas lap band doctor.

 
 
 
We had an earlier post titled
Loose skin after LapBand and weight loss Surgery.

In that post I talked all about things such as smoking, exercise,
multivitamins, and sun exposure.

As both a cosmetic and weight loss surgeon, I’ve seen
many of my own patients for cosmetic procedures, as
well as people from other bariatric surgeons
who need more

Here are a few more thoughts on loose skin after
bariatric surgery, whether LapBand, gastric sleeve,
or gastric bypass.

There will be times when a patient has done all
the right things: lost weight slowly (1-2 pounds per week),
took vitamins, exercised, stayed hydrated and took
care of their skin.

But they may still have more loose skin than they
feel comfortable with or that keeps them from wearing
clothing that would fit the “new” them. For these folks,
there are several more serious options to consider.

For arms, chins and some abdomens SmartLipo
laser liposuction can help tighten skin and get
rid of remaining excess fat under the skin that
prevents it from tightening.

While it is a surgical procedure, it is much less
invasive with a dramatically shorter recovery time
than major surgery. SmartLipo patients can expect
about 50-70% of the results they might see with
traditional surgery, although with only about
5-10% of the recovery time and discomfort.

However, there will be some patients who simply have
too much loose skin to be addressed by the SmartLipo
laser alone. For them there are more agressive surgical
options such as

All of these are major operations requiring
general anesthesia and at least 2 weeks of
recovery time and larger scars than with
laser lipo.

However, there is no substitute for the amount
of skin tightening and body contour change that
can be achieved with these operations.
I like to tell patients that they will look
dramatically better in their clothes, although
without clothes will have some scars.

Some insurances will pay for some of these
operations. Mastopexy (breast lift) and
panniculectomy (surgically removing the apron of
skin at the bottom of the abdomen) are the
most commonly covered by insurance companies,
although there is no guarantee that an individual
policy will pay.

Less commonly, I’ve seen insurance pay for
brachioplasty (arm lift), but neck/face lifts
are almost never covered. Look in your insurance
manual or on the insurance company website to
see what benefits your plan has to offer.

Last, I want to caution you against all of the
silly and non-effective therapies out there.

Recently one of the nurses showed me the other
day an ad about a compression garment that
allegedly reduces your clothes size and
tightens skin – permanently! That’s nonsense.

And let me state for the record that there
are NO therapies for cellulite approved by
the FDA specifically for permanent cellulite reduction.

You can pay thousands of dollars for
endermologie, body wraps, massage, creams
and lotions, but within a few hours, your cellulite
will be right back.

Please be skeptical when you see these ads
by major cosmetic companies or pharmaceutical
companies – none of their goops or potions work
for fat or cellulite, so save your money.

If you have loose skin after weight loss surgery, whether
Lap Band, gastric bypass, or gastric sleeve, and live
close to us in Texarkana, TX, check out:
my cosmetic surgery practice with before and after photos.

 
Q:My Mother is 80 yrs old approximately 5ft3in
otherwise somewhat healthy.
In the last 11 days she has fallen twice.
The other health issues are diabetes, depression,
OCD,and eating continuously without regard for the
complications of morbid obesity.
Do you think The Lap Band procedure would be helpful?

Oakhurst, NJ

Answered by

Author:Dr. Ron Hekier. LapBand surgeon in Texarkana, TX.

To review, elderly age alone is not an indicator
for LapBand surgery. As an example, a recent
article in the Annals of Surgery reviewed outcomes
for LapBand, Gastric Bypass, and Gastric Sleeve
procedures in the state of Michigan.

Not surprisingly, the review found that as the patient’s
age at the time of surgery increased, there were
significantly more serious complications from the
stapling procedures, gastric bypass, and gastric sleeve.

But it’s already well known that the LapBand has
less serious complications than other weight
loss surgery procedures since it involves
no cutting of the stomach or intestines so there was
no big surprise there.

Among several of our elderly patients are two patients
now in their 80′s who had their LapBand when
they were 72 and 75 years old. As noted above,
you can find a bit about their stories in the article
What’s too old for Lap Band surgery?.

But before consideration of the LapBand
for your elderly mother, I think several important
issues should be first addressed.

Why did she have two falling episodes recently?
Is it a neurological issue, such as a TIA
which could be a warning sign for a stroke?
Is there a cardiac issue that needs to be addressed?

As importantly, you write that she is
“eating continuously without regard” for
the consequences.

Unless a person wants to change, no procedure,
not a gastric bypass, gastric sleeve, nor LapBand
will have a chance in achieving successful weight loss.
Every bariatric procedure requires a lifestyle change
and a commitment to proper eating.

If your mother doesn’t want to change, you can’t
force that upon her.

Posted by Dr. Rachael Keilin a Texas lap band doctor.

Are you “off your lap band diet”? Are you
outside of the box? Do you eat things that you
know you should not have?  If you answered
yes to any of these questions, it is time for a
lapband “restart”.

You have been given a wonderful tool – but just
like a hammer, your lapband does not work without
some effort from you!

To restart (may be started any day of the week):

Day 1-7 Slim Fast Optima 3 cans/day, protein
supplement, chewable multivitamin.

Day 8-9 pureed/mushy foods

Day 12 – eternity: small plate of food, 1/2
of this from protein food

**REMEMBER: you may feel like you can eat
more – but do not test the band to see if
that’s true!
Follow the rules and allow the band time to
work.  Just because you CAN does not mean you SHOULD.

What’s the purpose of the restart diet?
It is to refocus your mind and become
a conscious eater.
The restart diet parallels some aspects
of the pre-op diet, when you had good
mental focus on your LapBand.

If you have lost your focus, and are not
being conscious of everything you eat,
it might be time to try to the restart diet.
Are you cheating, are you procrastinating, have
you regained weight, have you had to go
back to old clothes that used to be too big?

Try the restart to get back into the proper frame of mind.
Be conscious and think about everything you eat.
Think about every bite.
The LapBand works after you eat, not while you eat.
If you eat slowly and the LapBand is in a good adjustment
spot, you will feel no restriction, but your hunger will be
controlled.

Following we have posted some reader comments and
questions and our responses.

Jennifer

I got my band 4 years ago. The first two years
I did great and lost 80 lbs. The second two
years I have fallen off the wagon and gained
a lot of weight back. If I do this restart diet
will I be back on track?

Dr. Ron Hekier in reply to Jennifer.
The restart diet is a temporary way to refocus
your mental efforts. Follow all the other tips
that we suggest. Use the restart diet to refocus
and start over.

Amy

I got the band in 2006. I lost almost 70 pounds.
I then got pregnant. They never took out the fluid.
My child is now a year old and I have not lost any
of the 60 pounds I put on. I think my band will
only allow for 2 more fills. I do not feel ANY
restriction and am really frustrated. It worked so
well the first time and now it seems like it is
not working at all. Should I go back in for a
different band? They removed all the fluid in the
fall and started over. It hasn’t helped. HELP

Dr. Ron Hekier in reply to Amy
There is no such thing as “my Band will only
allow for 2 more fills.”
Work with your surgeon to see if you are near
your sweet spot. Don’t focus on restriction,
focus on the lack of hunger.
Take a look at the dozens of articles on this blog.
Good luck!

Dr. Ron Hekier in reply to Stephanie
Glad to hear you are getting back on the
right track. Remember we try to give you multiple
avenues for support so that you can succeed. We
mean it when we say that “your success is our success.”

As I type this I am sitting here with my family and
in-laws on vacation in Bedford, NY. Our dedication to
your support means that wherever and whenever we
can help, we will strive to be there for you.
And of course we say it a million times
“If you aren’t losing weight, a fill is not
necessarily what you need.”

Stephanie
I recently visited the dr.s office. I have been
eating all wrong and all the wrong things (this i knew)
but boy did i recieve a reality check,
i did not understand at first why i had to do the restart
diet at the time. In my mind i just figured a fill
would do the trick, i learned something that day,
it was time to get back inside the box so i had a good
look in the mirror and realized i had been all wrong,
now i am back inside the box have done the liquid
diet again and walking.
But i am loosing wt. slowly and some weeks not at all.
Do i begin again? i’m on a diet counting calories
but sometimes i slip but no ice cream ( which use to be the
regular on my diet) now i eat the lowest calorie
yogurt i can find. Thanks Dr. Hekier I realize
now what I must do. Stay inside the box.

Dr. Ron Hekier in reply to Penney.
See my reply to your other comment. If you are
throwing up you DO NOT need a fill. You likely need fluid
taken out. Take a look at the blog and you will find
several posts by either myself or Dr. Keilin on the
importance of not being too tight.

Penney
I have had the lapband for over a year and a half.
I have lost very little weight but I have lost
inches. I try to exercise when I can but back and
feet problems tend to make this alot harder for me.
I try to make my portions small but I feel so hungry
when I am finished its almost like I have not eaten
and I will say this I am always throwing up. I could
not figure out why and then i realized only having 6
teeth on top makes it harder for me to chew my food
as tiny as I should. I have bit my lip so many times
that I have permanant scars. I recently lost my job to l
ayoff and I am feeling as though I am depressed
and I tend to eat stupid things when I feel this way.
I want to get back on track. I need a fill it has
been so long. But I do not want to feel as though
you are angry at me when I step on those scales and
only weigh the same or a pound less or more. I need a
fill and I need to get back on the bandwagon. What do
you suggest?

Dr. Ron Hekier in reply to Sherry.
Yes,
You will feel hungry on a liquid diet because
liquid goes through the Band quickly. You can’t stay
on a liquid diet forever. Ask Oprah.

Joanne
I was banded in June 2007 and lost 80 pounds.
I have another 15 to go to meet my original goal,
and about 30 to meet the goal Dr. Hekier suggested
pre-op. I then gradually started sliding back into
my old ways. I stopped exercising and started eating
a little more, and then a little more. It was after
I gained 5 pounds that I finally woke up. I went
back to support group in May (had stopped doing
that too!) and then began the restart.
I finished the 7 days of liquid and the 2 days of
mushy foods. I did it!!! I’ve lost some weight this
past week, but that’s not the major accomplishment.
My head is now back in this thing!
In the past, every time I fell off the wagon
(diet-wise) I seemed powerless to stop the slide;
I’d regain all I had lost and then some. But the
Lap Band has given me the tool I need to
regain control. Thank you!

Sherry
On the lap band restart, drinking only slimfast
3xday, should you be hungry, because I’m starving.
Just like when I did the liquid diet prior to having
the lapband. Does this mean something is wrong with
my lapband?

Stef
I was told about the Restart diet by a friend…
I have been banded for about a year and a half….
I am way off track and trying to get back on track…
What I am wanting to know is while doing the slim
fast what kind of protein supplements would be best
to use… In the past I have used Body Fortress…
My biggest problem is not getting my protein in…
and how often to you use the protein supplement??

Dr. Ron Hekier in reply to Stef
The US RDA calls for about a daily intake of 0.7
grams of protein per kilogram of body weight.
To get your weight in kilograms, divide your weight
in pounds by 2.2. So if you weigh 200 pounds,
that is 91 kilograms.

Then multiply that by 0.7 grams. So 91 multiplied
by 0.7 is about 63. So the US RDA for protein intake
for someone weighing 200 pounds is 63 grams of
protein per day.

However it gets complicated in two ways.
Firstly, the guidelines are for people of an
average fairly sedentary lifestyle, and
people with active lifestyles who are actively
exercising may need more protein.

The other confusing factor is that the protein
requirements are generally calculated for people
of relatively normal body weight and composition.
So for people who are seriously overweight, this
calculation may overestimate the amount of daily
protein required.

We find that many lap band patients have a tough
time getting enough protein from meat products
that they were accustomed to before surgery.
As a result, many choose to supplement protein
intake with protein supplements. Lately the
most popular seem to be the Nectar protein in
cherry flavor, the 100% Any Whey protein powder
which is tasteless and can be added to either
liquid or food products, and Premier Protein Shakes,
which are available to us locally at Sam’s Club.

Dr. Ron Hekier
The Lap Band does not work through restriction;
it works through satsifying your hunger. You are
the one responsible for your portion control. This
week I visited with a patient who had her surgery
8 months ago. She lost very little weight and then
in the past month finally lost about 6 pounds.

She said that finally something clicked in her mind
that she needed to eat less. She realized that
she had to make the conscious decision to eat
less.

Remember you are trying to break a habit of eating
large and frequent portions. The hunger you had
before would make you continue that old habit.
With the hunger control of the Lap Band you can
control your old habit and create a new habit.

Become a conscious eater and think about each
bite you take, and the portion size of each meal.
After you eat your small portion, get up and walk
away from the table. Remove yourself from access
to food for at least 15 minutes. Let your brain
catch up with your stomach.

Shannon
I had my surgery June 2008 and still have not
found my “sweet spot.” The only time I have
asked to be unfilled was when I could not
drink water. Right now I feel no restriction.
At my last appointment I did not get a fill and
was told to begin the re-start diet. I was also
told again about portion control. My question is,
how can you have portion control when you have
no restriction?

Rachael Keilin, MD in reply to Shannon
Portion control is not only about what you can’t
eat, but how little you can eat and not be hungry
during a reasonable interval between meals.

Your stomach is often a poor guage of hunger since
there is a time-delay between when your stomach
feels full and when your brain registers that it’s
full (i.e. receives the information from your nerves
and processes it). Therefore, eyes and measuring cups
are a better way to judge portion, or the size
of your fist, or the surface area of your open hand.
Use those as guides then let your hunger tell you
whether or not the adjustment is correct. Remember,
the band is not there to keep you from eating too
much, it’s there to help you diet without feeling hungry.

Dr. Ron Hekier in reply to Shannon
That is perfect. Remember that the goal with
the Lap Band is NOT to see how MUCH you can it.
The goal is to see how LITTLE you can eat. Eat
until you are not hungry, don’t keep eating until
you feel stuffed.

Author:Dr. Ron Hekier. LapBand surgeon in Texarkana, TX.

I wear many hats.

For several years I was an assistant coach of
my older girl’s soccer team, and had to help
teach and motivate a group of girls from the
ages of 6 to 9 years old.

As a surgeon, I’ve seen thousands of patients
over the years and with my weight loss surgery
patients in particular I have an ongoing
relationship in which I must teach and motivate.

I’m an independent physician working in a
surgery group with 3 other surgeons, and we
have to work with various employees, vendors,
clients, and service providers to make our
business successful.

Each aspect of my life brings with it different
objectives.

As life gets more complex, it becomes more important
to simplify what you can.

Everyone, every single person alive on this earth, has
goals that they need to reach and the
people around them will either help them achieve
those goals and prevent them from reaching them.

So here’s my advice.

1) Get 3 sheets of paper. On the top of each sheet
write down a specific objective.
Something specific.

“I will lose 25 pounds in 4 months.”

“I will teach all of the kids on the soccer team
how to dribble the ball with both feet by the start
of the season.”

“I will complete a text I’m writing to sell on
the internet within 30 days.”

“I will have all of my gymnastics students able
to walk across the balance beam by the end of the
current semester.”

“I will have all of my second grade students learn
multiplication by the end of the year.”

“I will increase my sales 10% this quarter.”

2) On the sheet of paper, make two columns.

The first column is called Balloons
, as in hot air ballons.
Down this column write down the names of people
that can help you rise up and reach your goal.

The second column is called Anchors.
Down this column write down the names of people
that are weighing you down and making it harder
for you to reach your goal.

This simple step is 90% of the work.
Look carefully at the list.
You have just identified those people that can help
your action and you will have also identified
the negative people that are bringing you down.

3) Final step:
Eliminate the Anchors, interact more with the Balloons.

Is someone an anchor because they are negative and
keep telling you that you can’t do something and
therefore creating doubt or anger in you?
That’s not going to work.
Get rid of them, or tune them out if you can’t get rid of them.

Are you trying to lose weight, but one group of
friends keeps wanting to go out and
drink margaritas a few times a week?
That’s not going to work.
Spend less time with that group of friends.

Are you trying to spend more time on a business
project so that you can complete it, but someone
is taking time away from you on a daily basis
without offering anything in return?
That’s not going to work.

Eliminate the people that are causing you to sink.

How about your Balloons?
Increase your interaction with those that
will help you reach your goal.
This can be a specific person that you want to
interact with more frequently.

“Want to lose weight and found a personal trainer
that is motivating you to exercise and eat properly?

Don’t see them once a week, dump the other
meaningless aspects in your life and
see them 5 times a week.”

This can also be a virtual interaction.
“Want to teach a group of girls how to dribble a
soccer ball with both feet?”

Find online resources or a book that mirror your
philosophy for teaching and turn to that resource
on a continuing basis.

Social inventory:
The people you interact with are either helping you
or hindering you.
There rarely is a middle ground.
Even if someone seems
to be be in the middle and having no positive
nor negative effect in your life, they are taking some
amount of time and some amount of effort from you that you
could be spending with people that will help you achieve your
objectives.
Out with the bad. In the with good.

Without this philosophy you will remain stagnant at best,
or decline at worst.

Remember, “no anchors here.”

Posted by Dr. Rachael Keilin a Texas lap band doctor.

One of the most frequent questions we hear at our
informational seminars is, “will I have loose skin
after I lose a lot of weight with weight loss surgery?”

That’s a tough question to answer because it’s different
for every person.  Increasing age decreases the elastic stretch
of the skin, so older patients are less likely to have their skin
shrink back with weight loss than younger people.

Smokers’ skin is dramatically less elastic (which is why they have
such dramatic face wrinkles) so they, too, are more likely to have
loose skin after weight loss.  Women who have dramatic stretch
marks after pregnancy also are more prone to loose skin,
especially on the abdomen, given that the skin there has
already been over-stretched.

But all of that is variable: we have patients in their 60′s with
minimal loose skin and smokers with no batwings whatsoever.
We can’t predict ahead of time which category you will fall in, so
it’s a little bit of a dice roll- you’ll just have to see what it looks like
when you get to your goal weight.

Having said that, there are things you can do to help loose skin
recover as you loose weight.  Remember first that the weight and
the skin stretch didn’t happen overnight, so it may take significant
time for the skin to recover.

Many plastic surgeons advise waiting for up to two years after you reach
your goal weight before doing any surgical procedures for your
loose skin.  This is to allow enough time for your skin to “shrink”
some on its’ own and to make sure that you are nutritionally stable before
trying to heal a major incision. (People in active weight loss phase are
“catabolic” meaning they are breaking down, not building up tissues
which is counterproductive to healing).

While you are losing weight after your weight loss surgery
and while you are waiting your two years, here are
ome other things you can do.

1) Exercise dramatically improves skin quality in several ways:

it increases circulation to the skin,
it decreases the subcutaneous fat under the skin and
it improves the “frame” on which the skin is draped.
All of these improve overall body/skin appearance.

2) Taking a multivitamin every day, especially with Selenium,
vitamin E, C and A will help with skin elasticity.
Smokers benefit from extra helpings of folic acid, B6 and B12,
(which can be found in combination in many drug or health food stores).

3) Adequate protein is crucial, and remember that we are always pushing
for all of our weight loss surgery patients to eat more protein than
any other nutrient.

4) Keeping your skin in optimal condition from the outside
in is important, too.  Exfoliate your skin with a loofah or
buff puff while in the shower or bath, then immediately after
bathing and drying off, apply moisturizer with aloe and/or shea
butter all over your body.  This gets rid of old dead skin cells
on the surface which can trap free radicals causing skin damage and
then the moisturizer protects and nourishes the new healthy skin
revealed underneath.

5) Probably the most important thing to do is to reduce or eliminate
sun exposure. Sun exposure causes IRREVERSIBLE damage
to your skin and premature wrinkling. So do tanning beds.
I put on a facial moisturizer with SPF protection everyday,
even in the winter.
If you must have that bronze appearance, use a spray tan solution,
or get a spray tan at your local tanning salon or MedSpa.
My husband and I always get a spray tan before we go off on a
vacation in a sunny locale, and the spray tan generally
lasts 3 days.

After all is said and done though, I want you to remember
this: even if you end up looking as wrinkled and saggy as a
Shar-Pei dog when you reach your goal weight, I guarantee you
will be a happier healthier person than if you were overweight
but with cheeks and tummy smooth as a baby’s behind.  Don’t let
the fear of loose skin be an excuse to keep you from losing
your excess weight.

For those patient’s that need a more permanent option, I do perform
tummy tucks, breast lifts, laser liposuction and other cosmetic procedures.
You can see some of my patient before and after photos here:
Dr. Keilin’s cosmetic surgery before and after photos.

Posted by Dr. Rachael Keilin a Texas lap band doctor.

We really encourage people to drink water because it’s a fundamental
component of weight loss.  Our brains are wired so that thirst is often
mistaken for hunger.  Staying well hydrated is therefore an easy way
to stave off hunger.

Before reaching for a high fat, high calorie snack, have 8 oz of water.
If you’re still hungry 20 minutes later, then it’s likely actual hunger,
but you may often be surprised that the drinking alone knocked out
the snack hunger pangs.

If you have some water 15-30 minutes before eating, you will likely
eat less at the subsequent meal.  Again, you knock the edge off the
hunger and the water will fill up your stomach a little bit, so you’ll
end up eating less.

Drinking very cold ice-water 3-4 times per day may also help boost
your metabolism.  Your body actually has to burn calories to raise your
body temperature back up after your core temperature is dropped by the
ice-water.  While this is only a temporary effect, every calorie burned
is a few less you have to worry about, so why not try it?

Remember that with the LapBand, we highly recommend that you do
not drink while eating.  It is thought that drinking while eating can
wash the food through the LapBand and your stomach making
you feel empty and hungry.  So we recommend not drinking while
eating a meal, and after you eat to wait about 30 minutes or even
60 minutes until you drink something.

Did you know that even slight dehydration can be a major contributor
to fatigue?  It’s true!  Steadily drinking water throughout the day so
that you maintain a good level of hydration can really give you an
energy boost (which of course will give you the kick you need to exercise….
just sayin’).  Dehydration is also one of the primary common causes of
headaches.  So water will make me more energetic with fewer
headaches?  Sign me up!

The best thing about water of course, is that it’s cheap, it has no calories
and no carbonation.  While I freely admit that our local water is fairly
revolting tasting, you’d be amazed how good it becomes with a simple
tap filter you can buy at WalMart for about $12 and replace every 3 months or so.

Somewhat counter-intuitively, drinking lots of water can help keep
bloating and swelling down.  Because drinking more water will make you
urinate more and urinating also eliminates sodium, you end up overall with
less swelling-causing saltwater in your body.  The decrease in bloating comes
from the number one worst complication of even mild dehydration:
constipation.  Drinking 6-8 glasses of water per day can eliminate constipation
in many people without medications or fiber supplements.  Many LapBand patients
seem to deal with constipation because they eat so much less food, so this might
help.

What will water not do?  It contains a few minerals, but overall doesn’t
have a whole lot of nutrients.  I’ve never understood exactly what “toxins”
people claim are flushed out by water (or by enemas, but that’s a different subject)
so that’s a myth.  Water won’t prevent cancer.  And as mentioned earlier,
bottled water is no healthier than tap water.

But with those few caveats, water is a cheap, universally available diet
aide.  Try it! You may establish a habit for life :)

My question is about Lapband port pain.
I had Lapband surgery almost 6 years ago. I have
lost 100 lbs and maintained my weight within
5-10 lbs of my goal. In 2009, I had a tummy tuck
to remove the excess skin.

Since my port was lopsided and protruding, the
surgeon repositioned the port somewhat deeper
(My port is located on the right side of my body).

I have been experiencing pain near my port and
abdominal swelling for more than six months. For
the fear of having it removed and gaining weight,
I have been dealing with the pain.

Now, I have days where I walk stooped over because
of the pain and have to sleep in the fetal position.
I read past answers of the possible causes of port
pain (lifting, exercising,etc). None of them apply
to me.

In the mornings, my swelling and pain is usually
gone and my abdominal area feels “sore”. At times,
I think the internal pressure (constipation,
flatulence, overeating, or even gaining a few extra
pounds) causes my abdominal area to become distended
and cause pain near my port.

Can these be possible causes for excessive pain
and swelling? Is repositioning the port a consideration?

Camden, AR

Posted by Dr. Rachael Keilin a Texas lap band doctor.

First let me congratulate you on your weight loss and
maintenance at goal!

For reference you might want to refer to our earlier
post which includes pictures and Xrays.
LapBand port pain

Now let’s address the port issue. I perform both LapBand
surgery and tummy tucks, so I’m familiar with
re-positioning the port during abdominoplasty. I think
there are several possible reasons for your discomfort
and swelling around the port.

There may be what is called a seroma formed around the
port. A seroma is a collection of fluid, usually plasma,
that can form in any space in the body, but most commonly
when normal drainage patterns are disrupted as they are
in a tummy tuck.

Since the lymphatic system cannot drain fluid away as
well since the tissues of the abdominal wall have been
moved, fluid can collect and is most likely to do so
around a device, like the LapBand port.

This would account for the swelling and tenderness. It
is not necessarily a bad thing, but may need ultrasound
(a sonogram) to diagnose and may require surgical drainage.
Moving the port to a new location on the abdominal wall
(e.g. from the right side to the left) may also help
resolve the problem.

Moving the port may also help if the problem is being
caused by an irritation of the muscles of the abdominal
wall or the overlying skin as a result of the tummy tuck.

Especially since your port was moved deeper and presumably
therefore closer to the muscle, it may be causing muscle
spasms when it did not before in a more superficial position.

Moving it to a new location and possibly re-locating it
more superficially may resolve this problem easily with a
fairly small outpatient procedure. Muscle spasms make
sense with some of the symptoms you’re describing,
especially feeling like the pain is exacerbated when your
stomach is distended and therefore putting the muscles on a
bit of extra stretch.

Your LapBand surgeon should be able to help you figure
out what the right next step is and with moving the port to
a new location if need be.
I hope you get to feeling better soon!

I am 63, can I still have the lapband surgery?

Lenexa, KS

Answer from

Author:Dr. Ron Hekier. LapBand surgeon in Texarkana, TX.

People want to know if they are too old for
the Lap Band surgery.
It all depends on your personal health status.
You are never too old to lose weight and get healthier.
Imagine if you were a smoker and you asked “I am 63,
can I still quit smoking?” Of course you can and you should.

One of my personal favorite patients is a retired doctor.
She is now 80 years old. When she was 72 years old she came
to our office seeking the LapBand. 8 years ago, we did not
have as much experience performing Lap Band surgery.

We had been performing LapBand surgery for less than one year,
and we had only performed about 30 LapBands. (We now have
performed nearly 2,000 Lap Band procedures over 9 years.)

So back then, as doctors with marginal experience with
Lap Band surgery, we did not know how well an older patient
would do with the LapBand. We were almost skeptical and
asked her why she was considering weight loss surgery
at her age.

She told us that her knee pain had gotten to the point
that she could hardly walk
and had to use the scooters when she went to grocery
stores or Walmart.  We agreed to perform her surgery,
and with the little experience we had at the time we
weren’t sure how an older person would do with weight
loss after Lapband surgery.

At the age of 72, she underwent the LapBand surgery
and lost 70 pounds in a year and a half.

She has regained a bit, and over the past year has
regained 10 pounds, but we met with her recently and
have her trying new strategies to get that weight off.

Nonetheless, she is an 80 year old who weighs
50 pounds less then before she had her LapBand
surgery at the age of 72.

If someone doesn’t think that is a big deal, they should
take a 50 pound bag of dog food and ask your average
72 year old to carry that around all day for the next 8 years.

This patient is the first to say that the LapBand
has changed her life in unimaginable ways.
She used to need a scooter for Walmart, but with
her weight loss she went on a tour of Italy a few
years ago and did a large amount of walking.
She signs up for routine travel trips, knowing she
has mobility that she never had before.

Dr. Keilin mentioned this patient and another
70 year old in her answer to a question just like yours:
Is 71 too old for the Lap Band?

We have another patient that is 80 years old.
He had his LapBand 5 years ago when he was 75 years
old and he lost over 75 pounds in his first year after
surgery, and he now has a weight loss of 140 pounds,
5 years after surgery.

These are two examples, and they don’t necessarily
represent typical results for any patient, regardless of age.
But I hope they show you that irrespective of your age,
the LapBand can work to not only help you lose
weight, but also to maintain healthy weight loss.

Meet with a Lap Band doctor, they will be the
one who can tell you if the Lap Band is right for you.