Time to talk about the band

I haven't mentioned it before, but I have a gastric band (or lap band as I call it, short for 'laproscpoic band').

I had the surgery in October 2006 and lost almost 40kg, bringing me to a weight where I felt fantastic and looked great. Shortly after getting to my goal weight, in January 2007 my band slipped out of place, resulting in the need for revision surgery to put it back into place. Due to really bad reflux and 'night coughing' - one of the symptoms of a slipped band, all of the fluid had to be removed from my band while I awaited the revision surgery 3 months down the track. This caused me to put on about 6-7kg which I was never able to lose.

I don't think I ever got back to that 'sweet spot' of restriction after the revision, and that weight never shifted. Then, in July 2008 I moved to London and strangely enough was able to maintain my weight at the 6-7kg above goal. I say 'strangely' because a lot, if not all of my Australian friends who have moved to London have fallen subject to the 'Heathrow Injection' and put on quite a significant amount of weight in the initial months of living in London. This is usually attributed to increased alcohol intake, eating out more often, and eating heavier, stodgier English food.

Anyway in January 2010, after 18 months in London I had to return to Melbourne for a few months (8 to be presice) as my visa had run out and I needed to go home to sort out my Italian citizenship and return to the UK with unrestricted working rights. During this time I put on a further 6-7 kilos, due to a few factors:

• I didn't work for the first 2 months that I was home, giving me more time to eat out of boredom (a problem for me)
• I was excited to eat foods that aren't available in London but are favourites in Melbourne such as certain chocolate bars and biscuits
• I stayed with my parents while I was there, so I was being cooked for again, rather than cooking for myself so I was unaware of what was going into my meals

My mum never cooks unhealthy foods, but she does cook with a lot more carbs than I'm used to eating, and I have to admit it was so nice to be 'looked after' that I just enjoyed everything she put in front of me at mealtimes.

Now I find myself back in London, around 14kg above my lowest, and ideal weight. You will know from previous posts that I am getting active again at the gym and I'm also doing the couch to 5k running program and so far things are going well. So now I am left with the task of finding that elusive 'sweet spot' with my band that will allow me the restriction to get this weight moving downwards in a more rapid and consistent fashion.

I found a great surgeon here who actually did some training with my surgeon from Australia, and I'm booked in to see his nurse, Beth on Friday. Beth is amazing, she has been so supportive of me while I've been here and I really appreciate knowing that I can call her when I have questions and she always seems to have time for me.

My only concern is that I had a barium meal done a few months ago and it showed that my bad was too tight (!) so I'm concerned that Beth won't put any more fluid into my band on Friday. I disagree with the diagnosis for a number of reasons. My surgeon in Australia is part of a practice that are at the forefront of the lap band surgery, the head of the practice was actually the first in Australia to perform the procedure. About 12 months ago I was given a DVD by the practice that explains that the band works in a very different way to how it was first believed to function.

Initially it was believed that the band provided restriction around the top of the stomach to drastically slow down the flow of food to the main stomach, only allowing it to trickle very slowly down over the course of a few hours, thus making us feel full a lot faster, and for a lot longer than someone without the band.

Now it has been proven that what the band actually does is effectively slow down peristalsis,the wavelike muscular contractions by which food is moved down your oesophagus and through to your stomach. The band is a barrier to the food getting to the stomach, so each time you swallow a mouthful of food, peristalsis will push it down to the band, where only a very small amount will get through, then the rest is pushed back upwards. Peristalsis will then push the remaining food back down again, and again a very small amount gets through and the rest is pushed back up by the band. This goes on for about a minute before the entire moutful is through to the 'main' stomach.

So as you can see, the food doesn't actually hang around in the pouch like we thought, and when you look at the barium test it's supposed to look like the food is getting stuck and being pushed back up your oesophagus (the test was performed using marshmallows as the 'food'). The test wasn't performed for long enough to show that the mouthful took a minute to get through the band, so it seemed to me that the technician performing the test is unaware of the new information regarding how the band works.

I think a better indication of the level of restriction is to assess the volume and type of foods you are able to eat, and whether you are getting hungry in between meals. During my optimum weight loss, I was unable to eat bread, or any hard, red meat such as steak, although mince was fine. I also wasn't hungry and didn't snack between meals, and my meal sizes fell within the recommended volume of half to one cup per meal.

These days I can eat a whole bread roll with all the fillings and two hours later I'm snacking on chips or chocolate! In the last month or so I have cut out all bread, pasta, rice and potato and increased my protein intake which seems to help, but I still need to snack between meals and that's just not the way I know the band can work for me.

I know I'm not a medical expert, and what's right for me might not be right for the next person, so I'll just have to have a good chat with Beth on Friday and hope for the best.

Wish me luck!