What is a soft stop ?? What is a hard stop ??

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What is a " soft stop " ?? What is a " hard stop " ??

These are one of the most basic of Bandster concepts, and very

essential to learn and heed. These signs apply mostly to those who

have reached a fairly good fill. Most people do not feel them before

that, but some may feel them briefly in the few days right after Band

surgery.

Not learning and heeding them gets many people into trouble -

discomfort, real misery, embarassment, and occcasionally a very

urgent situation needing quick medical intervention.

First, a little physiology. The band is placed just below the

junction of the esophagus and stomach, creating a pouch about the

size of a golf ball, AFTER a good fill is reached. (Before a decent

fill, there is very little pouch at all)

The pouch is in the CENTER of the chest, about 2 inches below

the " notch " in the lower neck. Many people think it's much lower.

This pouch expands safely to hold the ideal bandster meal of 1-1.5

cups of food. If we cannot eat this much, we are too tight for

stomach/pouch safety and are not getting enough nutrition.

The pouch is right next to the diaphragm, which is very sensitive and

full of nerve endings. When we overeat, or otherwise irritate the

stoma or pouch, it also irritates the diaphragm. The irritated

diaphragm sends signals to several different areas of the body, via

common nerve pathways. These signals are the " soft stop " or 'hard

stop " signs.

Right after surgery or right after a new fill, the stoma/pouch is

also irritated, and can send signals like the common left shoulder

pain. This is not from " gas " , but from an irritated disphragm caused

by the stretching of the internal organs BY the CO2 gas inserted at

surgery. The gas itself dissipates at the end of surgery, when the

instruments delivering it are opened and removed.

If we DO NOT feel and heed our " soft stop " signs and stop eating

(even spitting out a bite that may already be in our mouth) , we then

proceed to a " hard stop " which is sliming, a small to large pb, or

real barfing. Since these are all dangerous, we want to avoid them as

best as we possibly can.

THESE are the " soft stop " signs that mean STOP EATING ! you have had

enough to be satisfied! and more will cause trouble

1. a single burp or hiccup

2. ongoing hiccups (which are always diaphragm irritation)

3. a sudden sneeze

4. a sudden runny nose

5. left shoulder pain

6. pressure in the middle of the chest (where the overfull pouch is)

7. low back pain

8. a facial or eye tic

9. a few other much less common signs

Our own particular signs can be any one of these, and may change

depending on the situation. With practice, you will learn what YOURS

are. It's important to learn them, and then learn good Bandster

quantities, since , as time goes on, the esophagus gets much less

sensitive to a full pouch, and the stop signs are not reliably sent,

or we have learned to ignore them.

We must then SELF-limit our eating to 1-1.5 cups so we don't dilate

our pouches. As time goes on, we will be able to rely on the band

less and less, and will then need to rely on our own improved food

choice and eating habits much more.

One of the reasons we must eat slowly and carefully is to be able to

feel our bodies and pick up the first of these subtle signs. If we're

eating fast and without thought, we blow right past the soft stop

signs and suddently we are in pain or barfing - the " hard stop " .

These all takes practice to pick up, and to heed. We have to eat

mindfully, and pay attention. This means no TV, no distractions, and

ideally eating alone for at least a week or so after a fill. It also

helps to put a 3x5 index card on tyhe table in front of usfor awhile,

to remind us of the Bandster eating techniques - " pea sized

bites " " chew 15x " " eat slowly " etc.

Most of the barfing or embarassment episodes when we are out with

friends come from not paying attention, gabbing with people, and

forgetting the eating rules. It takes about 3 weeks of consistent

work to adopt a new habit like better eating techniques, and I

suggest we put in this 3 week period very early on.

Along with all this is the importance of understanding

that " satisfied " with a small band portion is quite different

than " FULL " . " Full " was usually stuffed to the gills, uncomfortable,

and way too much. I don't like it much when people say we will

be " Full " with a small band porton. I think this sets up unreasonable

expectations that lead to misunderstandings. SATISFIED, not FULL is

the goal of the band.

With the band, " satisfied " is more like " Ok, no longer really hungry.

This is all need. I COULD eat more, but no need to becuase I want to

lose weight " It's a common mistake to think that the band will MAKE

us stop eating. It is meant to give us early signs of being stisfied

(the soft-stop signs) so we don't need to get to the point of HARD

stops where the band revels and we get sick. It is meant as a subtle

reminder, not a hammer over the head.

This also means that we must learn the difference between real,

physiological hunger and what we call " HEAD and HEART hunger " . Most

of us eat for emotional reasons that have nothing to do with being

truly HUNGRY. We eat from boredom, depression, anxiety, fear, worry,

and habit - just becuase we " always " eat in front of the TV,

or " always " stop at that fast junk food place when we drive past it.

this is not real hunger, and we have to work hard on developng better

behaviors. Instead of automatically heading to the fridge when we are

bored or depressed, we CAN choose to go for a walk, do other physical

activity, call a friend for support, etc.

Sadly, the band does little if anything for emotional hunger, which

is why it's so important to work on the emotional eating and food

issues most of us have. These psychological areas are rarely

discussed, especially pre-op, yet are extremely important. I'm a very

strong advocate for therapy, starting well before surgry if possible,

and I also personally fund great help with Guided Imagery, which is

well-proven and uesed extensively with just the type of lifestyle

changes required by the Band .

all comments and questions encouraged, as always!

sandy r