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OBGYN.net Broadcasting presents Part VII of a series on Weight Loss Surgery. This series is unique in that we follow the patient from pre-op to one year post-op.
Dr. Mark Smith: "Hello, I'm Mark Smith and it's now been four months since December when Roberta had her surgery in Germany. We're sitting here today to talk with her a little bit, we want to get some follow-up on how she's doing and, basically, what has happened in the four months since she and I went to Germany and she had the surgery - Roberta."
Roberta Speyer: "The first thing that I think everybody wants to know is did I lose any weight, and I hope you can tell from this film - yes, I've lost 43 pounds which is absolutely phenomenal to me. I've never lost 43 pounds in my life, the most I every lost when I was starving and dieting and taking diet pills was maybe 30- 35 pounds. So this is the single largest weight loss I've ever experienced. There's been a lot that's gone along with it, and that's what I think is important for me to share with all of you. When you watched my other interviews, especially the one right before the surgery, I talked about what it was like being fat and what it was like growing up as a fat kid. I talked about the fact that I had a wonderful life, a wonderful career, and a wonderful family. Yet, this fat issue was something that you carried with you everyday and people saw that you were fat before you even were able to open your mouth, and people made assumptions about you and how difficult it was. I guess technically I'm still fat; I weigh 225 pounds now instead of 268. But the funny thing is if you weigh 225 pounds on the way up it's terrible, but when you weigh it on the way down it's marvelous, so I guess everything is you're perspective at the time. I realized some things now that I didn't realize before, and that was it wasn't just how other people perceived me that was difficult to live with, it was how I perceived myself. The weight loss has given me so much more confidence, it's made me much more happy to be inside my own body. I dress better, I wear makeup, I do my hair, I'm happier, and I have more patience with people. A lot of things have changed, I think. Have you noticed these changes working with me?"
Dr. Mark Smith: "Everyone is commenting on just how happy you seem these days."
Roberta Speyer: "I am, it's changing my life and it's a feeling almost like being released from some sort of prison that I was trapped in, and now I can see endless possibilities. I can see that Dr. Weiner was correct, if I've lost 43 pounds in four months, it's not unbelievable for me to think that I'll lose 100 pounds in a year. But really the most wonderful thing about having had the lap band is knowing that I won't lose it and that it will come back. It's truly a loss and it will be gone forever. I don't have a particularly high fill; a fill is when they go in after the surgery and they put fluid into the port that they inserted during the surgery that you saw. I believe the port holds up to 5 mm's?"
Dr. Mark Smith: "Five cc's."
Roberta Speyer: "Five cc's, five mm's - what would that be like - a martini? Five cc's and that is absolutely full and most people don't have it that full at any point, but I only have two so I actually have a lot more room for even more appetite suppression. I haven't felt and Dr. Mark hasn't felt that I need to do that because I'm having such good results with the two cc's that I have now. If I start to plateau, if that starts to become a problem, then I have that option. The good thing about only having the 2 cc's for me is that I'm not suffering from problems with eating foods and having trouble with emesis or vomiting, as we all know it to be. It's happened a few times, maybe five, since I had the surgery. Usually when it happens, it's because I've eaten something out at a restaurant that is fairly fibrous like meat or one night it was steamed mussels. I'm a very animated person and I'll be talking and not chewing my food well enough and you swallow it and you're really swallowing a piece of food that's rather large. It would come down to that point of restriction and get stuck there, then you'd have a drink and another bite before you realized things weren't moving. At that point, the only way for it to move is up and out but it's not as bad as it sounds because most of us when we think of having a problem of vomiting, it's usually because we're really very sick or we have food poisoning, and it's just a horrible thing. This isn't like that at all because the food isn't processed food in any way, and it's almost like if you coughed something back up because you swallowed it the wrong way, so it's not that offensive. I do have a funny story about that though, the first time it happened I was with our CEO of our company, Jim Edlund, and we were at the top of the Rockefeller Center at the Rainbow Room. They had these beautiful fillet mignons at this party we were at, and I thought I'd just try a little bit; it's very tender. Immediately after eating it, I knew I shouldn't have eaten it. So I went into the restroom and it's a very posh restaurant and they had the lotions and the attendant. I went in and I couldn't get it up so I finally decided I had to put my finger down my throat and make myself throw this stuff up so I could go back to this party, and I'd been in there for fifteen minutes. So I did and I finished what I had to do, opened the bathroom door, and I walked out. A woman looked up and her eyes opened up and I suddenly realized she thought I must be bulimic so she was expecting this skinny little girl to come out of the stall, and I came clomping out. Our Editor, Barbara, said I should have said to her - well, you have to start somewhere.
We thought that was kind of a funny joke that I wanted to share with you. But really I would say that the main points for me that this weight loss has accomplished is a feeling of control over my own life, a feeling of satisfaction with myself, and also from a health standpoint, let me hit on that, I'm not as tired as I was. I have far more energy, I get into work early, and I stay late. I don't have to take a little nap in the afternoon like I used to want to after lunch because I don't have lunch. I don't have the obsession or the constant thoughts of food. After I first had the surgery, I still think I felt the same way about food and wanted food, I just couldn't eat as much. But over the four months, especially I would say maybe in the last month, I've noticed a real evolution in my attitude towards food. If I go to a party and there's food sitting around, I talk to the people first and then eventually I wander over to the buffet table and have something to eat. I'm not focusing on the food. I don't enjoy grocery shopping as much as I used to, I just don't care about it. I like nice food, I've always liked nice food but I'm very satisfied with incredibly small portions. I think I probably eat about a quarter of the volume of food.
So have I been dieting a lot? Two things that were stressed to me before this surgery was that I had to diet and I had to exercise. I have to tell you, I've just been a very naughty girl. I travel an incredible amount for work and other than the fact that when I'm in Europe and on the road I'm walking a lot and carrying all that computer equipment, I haven't exercised. I haven't done that, and I think maybe that's something in the next four months I want to try doing more of now that I feel better about myself. It's pretty hard to put on a leotard and go into a gym when you feel like a cow so now that I'm starting to feel a little better about myself, I'm going to try to push that as my next goal and do more exercise. But no, I really don't diet because I don't eat that much. If I want to have a little bite of something, it doesn't really matter what it is. Do you understand what I'm saying? If I see a dessert and I want to taste it, I'll have one spoonful. I'll taste it, that was nice and it satisfies me, and I don't have any cravings for food. My whole attitude about food and the importance it plays in my life and just the amount of brain cells I devoted to thinking about it, I really think all that has now been freed up for other things - maybe for thinking about how I look, doing my hair, doing things with my career, or my family. So it's like it's given me back time, which is an interesting revelation. What do you think? Because Mark and I work together everyday, of course, I work far more than he does but what have you noticed about me?"
Dr. Mark Smith: "She has more energy than I do."
Roberta Speyer: "What have you noticed different in these four months in this evolution because what I'm talking about is how it feels being inside this body and looking out but you see it from a different perspective. Would you mind sharing that with our viewers?"
Dr. Mark Smith: "Sure, I think in watching Roberta for years before - I knew her before the surgery - and then watching the change over the last four months, there's really been some very dramatic transformations. You can just tell she's happier; she's happier with herself, her job, and her life. Little things don't bother her, not that they ever really bothered you but..."
Roberta Speyer: "They always bothered me, they still do."
Dr. Mark Smith: "But she laughs much more, she's just happier. We've all gone through periods like that but we can tell. People that are around her have commented she's just happier with herself, and I think that stems from what she mentioned and alluded to earlier about her own self image. There's no question on the health benefits or the decreased disease conditions with the loss of weight but in all levels of attempts at weight control, whether it's under or over, the person's self-image is a very, very important part of that. Even the people that try to lose weight below the normal body weight have the same types of problems, and that's what's so critical. It's become very, very obvious that her own self-image of herself has really improved, and we're very happy to see that."
Roberta Speyer: "Of course, they were living with the beast. Interestingly enough, after I had the fill I was leaving for a business trip for two weeks to Europe. We had discussed that maybe I had reached a plateau for about a month - I was at 25-pound weight loss and hadn't lost any weight - and we were thinking maybe it was time to have another fill. The paradigm shift really started to happen while I was in Europe, and I think it was because I was away from my usual lifestyle. I was away from my family, having to cook, and having to be around food so much so I had two weeks where I was really out of my usual routine, and during that time I now have noticed is when I really started to change my attitude about food. Then because of that attitude change where food started to be playing a less significant role in my thought process in my life, I went from maybe eating a third as much as I usually did to a quarter. Then it kicked in and I had another weight loss without having another fill. So I think that's a very telling and interesting point for people to consider, and that is there's the restriction that the lap band surgery provides for you and that's a tool to help you control your appetite. But as you start to lose weight and change your feelings about yourself, food, and the importance it plays in your life, there's another whole benefit that you gain in your ability to lose weight that is beyond just the restriction."
Dr. Mark Smith: "That brings up two good points, Roberta. I think the first is the fact that anyone that works with weight control and attempts at weight loss know very well that it's not just the function of losing weight, it involves behavioral changes. Changes in behavioral habits, modifications of your whole way of looking at food, eating food, and the thing that's so difficult to that is that it's very hard to make those changes and a whole set of habits and behaviors that we have unless there's positive feedback. So until you start losing the weight and you get the positive feedback, then it's very difficult to undergo those changes and be motivated to make those internal behavioral type changes. The second thing is that it takes a while when people start dieting that we say - you have to undergo mental changes. You just can't do that overnight, it takes a while to develop those changes and modify them inside, like you say. So what you're seeing is the thing that everyone requests when they work with people that are trying to lose weight and that is you've got to accompany it with behavioral changes itself. I think you've done a very good job of losing weight, and I think the audience is probably astounded right now."
Roberta Speyer: "You started with the adjustable band, but it was replaced?"
Dr. Weiner: "It was adjustable. The rubber band was developed in the eighties by the same company that also produced it, and then we made adjustments. They made it better by changing the sizes. Now we have this lap band in three sizes, and we have a safe technique with very good experience."
Roberta Speyer: "I'm very, very happy I did this. I know when they were wheeling me down to the surgery, I had that moment when I was thinking, 'why am I doing this?' But now that it's over, I really have to say that it was not as difficult as I feared it would be. I can already see that it's going to make a huge difference in my life, and it's going to improve it greatly. I'm really just delighted that I chose this procedure over any of the others. I think I'm going to have a much better outcome because of it."
Dr. Weiner: "I have one comment on the topic of pain. You really don't have pain, but it is important that we are using no-cutting trocars, or non-sharp trocars. We are using dilation techniques, the step system, and there is no cutting of your muscle."
Roberta Speyer: "That's the InnerDyne trocar, correct?"
Dr. Weiner: "This is the InnerDyne trocar, yes."
Roberta Speyer: "What is different about that than a traditional trocar? Why is that causing me less pain?"
Dr. Weiner: "There's no cutting of the tissue of the abdominal wall - it's only dilation. After removal of this trocar, of this step system, you have a very small defect and, therefore, less pain. This technique is also much safer. You have very little danger of organ injury or of muscular injury, so this is very safe technique."
Roberta Speyer: "The highest incidence of morbidity is trocar injury with this procedure, if you don't use this, isn't it?"
Dr. Weiner: "Yes. But we have this step system now, and morbidity is 0%."
Roberta Speyer: "Fabulous. Thank you very much. Thank you for taking on this case and doing such a wonderful job with me. I really appreciate it very much, doctor, and I'm looking forward to seeing you again. We'll be following up in the future with the new and improved Roberta!"
At this time, three years post-op, Roberta is satisfied with the outcome of her surgery and hopes you have found her story helpful in your search for answers. Please direct any questions about LAP BAND surgery to your personal physician, or email the product makers directly at: http://www.inamed.com/contact/bio_patient.cgi. Due to time restraints Roberta Speyer and the OBGYN.net team cannot respond to personal emails. See Professor Rudolf Weiner's website about Weight Loss Surgery to see if this option is right for you. Visit www.profweiner.com.