"You don’t get to be *insert my start weight here* without fucked up eating patterns."

"You don’t get to be *insert my start weight here* without fucked up eating patterns.

This is a direct quote from something my dietician said to me on Monday. 😅
(Although she said my actual start weight).  (I'll be ok to share what it was one day, by the way.  No time soon though!)

It may sound brash or a strange thing to say in a dietician consultation, but it was actually quite the comfort to hear this.

Ever since I started this journey properly (as in, decided on a surgeon), I've been regularly seeing both a bariatric surgery dietician and a bariatric surgery psychologist.  Obviously both are accredited in their individual fields for general help in their areas, but they choose to specialise in assisting people who are or have undertaken weight loss surgery (WLS).  I believe my psychologist will only see WLS patients now!  (She doesn't see any clients who don't.  She still counsels in any area you need to talk about; it's not just WLS related talking, but her client base are WLS patients only).

When I first announced to my GP that I wanted to have WLS, the first thing she said was that I need to make sure that I find a surgeon who takes a holistic approach, and incorporates both dietetics and psychology within their team, as these aspects are crucial for long term success.  From my own research, most WLS surgeons do have teams that include these, but they vary surgeon to surgeon in terms of how much it's encouraged that you use them.  Some surgeons have them as part of their 'official team', ie a dietician and psychologist who work alongside them in their physical clinic, and some surgeons just have recommended people you can contact.

My original surgeon had a very strict plan in place as to how often you had to see his.  I remember going to visit for my very initial consultation, and I firstly spoke with his head nurse.  I was a 'WLS freshie', as in, I was bright eyed and eager and uneducated.

She showed me an A4 piece of paper, which had the process that their clinic followed, to do WLS.  The first step was to have the initial consultation with her.  TICK!

My eyes wandered down the page, as I took in all of the other things I had to tick off.

Rightttttttt down the bottom of the typewritten A4 page, was 'Surgery'.  It was at the very bottom of a long list of pre-work that they needed me to do first.

It was surprising, but comforting, that they were so detailed, and this proved to be the main catalyst for why I ended up choosing to go with them (originally, until I changed my mind!)

As part of their protocol, they required all of their patients to visit their:

Dietician:           2x before surgery / 1x after surgery

Psychologist:    1x before surgery / 2x after surgery

So, 3x total each.  You could always see them more as you saw fit, but those numbers were the clinic's minimum requirements.

Conversely, my actual surgeon (the one I ended up swapping to), had no such requirements.  You had to see one of his dieticians before surgery, because you had to be educated on your pre-op diet, but aside from that, I don't believe they had any mandatory visits that you had to tick off.

So my original surgeon required me to see the psychologist 3x in total.  My actual surgeon didn't require me to see the psychologist at all.

To date I've seen mine 13 times.😂

I've taken full advantage of the holistic view that my GP originally mentioned, and have made it a (self motivated) priority to see them both regularly.  (I've seen the dietician 8 times).

And I will continue to do so!  I feel so lucky, in that I adore both the psychologist and dietician, so it's easy to want to continue appointments.  The irony is not lost on me that I can say that about a dietician.  No offence to the worldwide cohort of dieticians and nutritionists out there, but up until now, I was not a fan of them.  To be fair I can't even recall having a terrible experience with one, to make me form this overarching opinion.  I must have talked to one at one stage though, because I've always been very anti them.  I was losing my mind when I got diagnosed with gestational diabetes (GD) in pregnancy and was forced to see a GD dietician.  I visited them (internally) kicking and screaming.  (Fortunately they decided I didn't need to continue to see them, and immediately released me from their books).

But the reason I hated the idea of them so much, (I'm sure they're all lovely people!) is that I didn't need to be told what to eat.  I may be fat, but I do know what to eat.  I just don't!  A dietician, in my mind, was never going to solve that issue for me.  I needed a weight loss psychologist.

Anyway, the dietician that I was paired up with from my original surgeon was just the best.  I was happy enough to see her initially because I knew that she had a specific task to do for me: to educate me on the pre-op diet, and to coach me through safely introducing foods again to my rerouted and surgically altered digestive system.  That was fine.  I was cool with that.  It was about physical restrictions.  No problem.  I needed an expert for that, yes.  That was okay.  What wouldn't have been cool was if she had lectured me on how to eat a balanced diet and discussing the food pyramid.🙅

She did all that (the coaching through restrictions), but she's also been almost like a weight loss psychologist herself.  She's very understanding, respectful and I guess also 'accomodating' of my history with food.  She's done more for me than just coach me on the physical food restrictions and reintroductions.  Obviously I discuss more psychology based stuff with my psychologist, and definitely see her more, but the dietician has been a surprising highlight to my 'health team'.

I asked her, sensitive and tentatively on Monday, whether she has other clients with binge eating disorders / behaviours, and she threw her head back almost laughing and exclaimed "yes!  Of course!  That's why there's such a thing as weight loss surgery!"

In retrospect it was a silly question.  But I was feeling quite low in confidence and was starting to feel like the only person who's ever had an issue with overeating.

I've been struggling a bit with old habits creeping in and its been getting to me.  You don't want to spend thousands of dollars and physically alter your body, for it not to work.  I mean, every weight loss venture, you want it to work!  But this time feels like there's a lot more (expensive) stake.

And of course, it's not that it's *not* working, it's just that its fucking scary when you realise how vulnerable you actually are.  

-I decided to have the surgery.

-I had the surgery.

-I dealt with all of the restrictions.

-Now I have an altered digestive system AND free reign of food, so now it's 1000% up to me.

And I've said this before, it's not like surgery fixes your brain.  You go to hospital one morning and a few hours later you've been cut at and rewired physically.  But that's it.  Decades of learned behaviours don't get fixed in that hour in theatre!  (I wish they did)...

Have you ever heard of people talking about how it's still possible to stuff up weight loss surgery because you can find ways around everything, for example, melting down a Mars Bar and drinking it through a straw?

It's an old adage that's been around for years.  Years and years before I even remotely contemplated having surgery myself.

To be honest it was probably a contributing factor as to *why* I never seriously considered doing surgery myself.

Not that I would ever melt down a Mars Bar and drink it.😅

But I guess I've starkly realised this month, that you don't have to melt down a Mars Bar to stuff up weight loss surgery.  (I mean, you can bloody EAT a regular Mars Bar like before, anyway!  Why would people even need to melt it??😜)

But there's so many other things you can do, and that's really scaring me.  

This whole journey has had it's 'hards'.  It was 'hard' to navigate the process of having WLS.  It was 'hard' doing pre-op.  It was 'hard' to recover from major surgery.  It was 'hard' having 3 months of restrictive eating.

But this part feels the hardest -  coming to the realisation that it's VERY easy to still 'overeat' (whatever that means for you).

I haven't fixed old behaviours.  I've been trying!  And I'm making progress!  But the issues are still there and will take longer than a day in surgery to resolve, or at least manage.

And that's why my dietician said what she said on Monday: "You don’t get to be *insert my start weight here* without fucked up eating patterns."

I was discussing the old behaviours that I've noticed creeping up.  (I feel like I officially 'binged' for the first time since surgery 2 weeks ago).😞

She looked at her computer, and she said "Kate, I don't think you're ever going to completely cure your binge eating behaviours."

That statement took the breath out of me.  I was instantly crushed.

I felt like she'd lost hope in me, and that she'd deemed me a failure.

That's not it whatsoever, but I've been feeling low and that's how I initially took it.

(Two days later, I remembered that I'd already realised this fact years ago!  More on that another day).

But on Monday this is what was the catalyst for her to comfort me by saying what she said, about how you don't get to my size without fucked up eating patterns.

It was so true and just so comforting to hear in that moment, because I was feeling pretty failure-ish!

A minute later she also said: (I scribbled these in the notes of my phone so I could remember them):😁

"You can’t expect to unfuck yourself in 3 months".

Again, true.  (Well, its actually been 4 months since my surgery, but I'm sure the same statement still stands for 4 months too).

And it'll be the same for 5, 6, and so on.

I guess I just have to remember that I accepted a few years ago that I will always have an issue with eating behaviours.  And as much as it was confronting to be told that this this week and remember that it's actually likely true, it's actually not as scary as it could sound.  It's probably a fact, and the sooner you can accept stuff, the more freedom you acquire.  And that in turn gives you more time to deal with things.  And manage them, which is all I need to do.

I've given myself this HUGE, helpful tool to catapult me forward, but it's always going to need management, and new strategies and habits, which are technically within my control.  Frightfully hard, and marred by my eating disorders, but literally still, within my control.

I'm making progress, I'm making improvements, I'm inching forward and I'm making better choices overall.  And maybe this is simply a good time to remind myself that life, and success, is never quite linear, and all I can do is to keep trying.

xx

P.S. Apparently you can get these: 

You don't even need a straw 😉

What type of weight loss surgery did I have?

Hi! 👋

Okay, so in true Kate fashion, it's now 9 weeks since my previous post, surgery is on Monday....in FIVE DAYS - and I haven't even told you what type of surgery I'm getting. (Let alone anything else, but let's focus on one topic at a time).😅

EDIT - I started writing this in September and never finished it.  I only had a little bit more to write; it was practically done.  It's now January and 'Kate fashion' needs to be entered into a dictionary to describe the most annoying term of not getting things done because I'm actually ridiculous.  I'll fill you in when I can but let me just finish and publish this blog post first!  (I'm now currently 4 months post op).

Before I delve into the details on any part of this, can I please just say for the record that I feel a bit weird sharing info about any part of this process. Why? Because it really feels like everyone who's battled their weight has already had weight loss surgery (WLS). I feel like I'm the only one who's never looked into this prior to now, and I'm finally jumping onboard with what everyone else has already done, and thus is all over.

I know that it's not entirely correct, and maybe I just happen to know of a LOT of people who have had it done. But I still feel really late to the party. I'll share anyway because when do I not Hahaa, but also it's possible that there's someone out there who is struggling, is contemplating this path or is just interested.

I guess what I'm saying is my apologies to those readers who have gone before me. And for everyone else, please remember that I am in no way an expert, this is just my own experiences. I've had to educate myself very quickly about how this all works.

SO! My usual disclaimer is now done haha.

I really wanted to tell my story consecutively, so that it organically make sense. But...if it's taken me 9 weeks (EDIT: + 4 months!) to get around to my first real insight, then let's just let that idea go and get my stories out there, in whatever order!

Because of this there's going to be things that don't make sense until I get to explain them, such as the fact that 3 weeks into pre-op, I decided to change surgeons. I'll share why in another post,  but to help me tell stories such as this one, for now I'll call them Original Surgeon and Actual Surgeon.

So I went into this with the idea that I wanted to have 'the sleeve' (Vertical Sleeve Gastrectomy (VSG)). Because I never thought WLS was for me, I was very uneducated about the entire process. I really knew very little, including the types of WLS's available. 

My old boss had had lap band surgery many years ago, and I was vaguely aware that that wasn't really done anymore. I'd heard of the term 'mini bypass' but the method that I'd heard used the most was the sleeve. #GastricSleeve and #vsg were the only hashtags I ever noticed.

I knew what the sleeve was, and it sounded like it was the new 'go to' WLS option. The current gold standard. So, before I did any research, I was confident that that's what I would want. With some things in life, I just like to go with the majority. It's going to sound like this regardless of how I attempt to explain it I think, but it's really not at all like me being a sheep or a follower. But instead, for many things, I like to do the average thing: take the safest route. 

Such as with WLS, if 80% (I made that figure up just now) of WLS patients have the sleeve, then I'm not going to be inclined in the slightest to want to do some other method that's less well known. I am very strong minded and research and educate myself fully about things so that I can make informed choices. But I'm also going to be very influenced by the figures. There's a reason most people do the sleeve!

Okay, I still totally sound like a sheep, I know. But I'm really not! 😂

Anyway, so that thought process was the first line of influence for me, and I started getting ready to do my own research.

Once I made the decision to do (some type of) surgery, I was full pelt into it. I don't ever do things by halves. lol, case in point:

Why have 1 baby when you can have 2?

The very first time I saw my GP after I made the decision, we only had 2 minutes to chat, so it was a very rushed mention. She was so supportive and encouraging about it, and I said that I'd come back the following week after I'd done a bit of research, to talk properly about it and to get a referral.

As I was walking out of the door, I remember her saying that different WLS methods are good for different types of people, and that she wasn't too sure herself, but she thought that bypass surgery was the one that would probably suit me better?

I was so surprised, because as I said I'd already assumed I'd be 'normal' and be on track for the sleeve! She said again that she wasn't too across the different methods and maybe she was wrong and had it mixed up?

I briefly looked up what the bypass was, and I was like yeah, nah, just the usual sleeve still, thanks!

You can google yourself all of the different weight loss options, but if I had to explain this to someone unfamiliar sitting in front of me right now, this is how I would describe them (and how I did, each time I discussed the options with family and friends while I was deciding).😆

(Again, these are my (VERY non-medical, VERY non-technical) words!  Just trying to get the idea across: please don't take my layman's terms as anything other than what they are.😂)

________________________

Lap band: where they put a 'rubber' band around your stomach so you can't eat as much.  Not often performed any more.

Sleeve: where they cut 80% of your stomach and remove it from the body.  This causes restriction as to how much you can eat.  Not reversible.

Mini gastric bypass: where they cut your stomach and make a little pouch (but leave the remaining stomach inside you), and reroute your intestines so that food 'bypasses' some of the digestive track.  So that you have a smaller stomach but also less chance for calories (and nutrients!) to get absorbed.  So this results in weight loss via restriction like the above, as well as malabsorption.  Reversible.

Roux-En-Y gastric bypass: same as the mini bypass but there's more rerouting of your intestinal tract.  (Two joins rather than the one that the 'mini' bypass has).  Reversible.

SADI: a combination of the sleeve and bypass.

________________________

There are other types and I think there's different names for some, but these were the ones I started learning about.  I'd obviously crossed the lap band off my list, and I crossed the SADI off my list too.  One surgeon told me something along the line of that the SADI used to be called something else, and it had poor outcomes or something bad happened, and they renamed it...yeah that was enough for me to cross that one right off my list! 🙅

Here's a diagram of the main ones I was looking at; sleeve vs one of the bypasses:

Sleeve vs bypass

Anyway I started to do my research and everything supported my desire to choose the sleeve. I went back to my GP and got referrals to weight loss surgeons.

I had initial consultations with two different surgeons to compare (Original Surgeon and Actual Surgeon).

My first appointment ironically was with my current surgeon (Actual Surgeon). Still very new to this whole thing, I rattled off that I would be looking at the sleeve but would be guided by him as the expert. I asked what he would suggest for me, and he said, and I'll always remember this: "If I had to bet my own life on giving you the right surgery, I'd do a bypass on you today."

What? 

Another professional saying bypass...

This surgeon is very renowned and an expert in his field.  I'd first saw him on TV actually, on an expert panel.  So while I remembered what he said, I still was stuck on the majority, and was hoping I could convince myself that this expert didn't know what was best for me.😂

The following week I went to meet the Original Surgeon for the first time.  Similar conversation, but less strong wording on his behalf.  I told him I was looking at the sleeve, and what would he suggest.  He said it was up to me (as did the other surgeon), but if he had to suggest something, he'd suggest one of the bypasses.

Damn.

So, as I thrust myself forward into choosing a surgeon, starting preparation and then pre-op, and getting everything organised, I continued my quest to prove to myself that the sleeve was the better choice for me.

I'd chosen the second surgeon I'd met with ('Original Surgeon') as my surgeon to go with.  I started meeting with his dietician and psychologist, and they too were both gently leaning toward a bypass within conversations.

I didn't have to decide until I signed the consent forms a couple of weeks out from surgery, so there was no imminent rush to choose.  But it was still hanging over my head.  I felt exactly like it was when I was trying to decide on birth options for my twins: attempt to deliver naturally, or choose a caesarean?  Everyone (medical professionals) were recommending a caesarean, and deep down I knew that was what I should do, but I really wanted to attempt a natural delivery.  (I ended up choosing the caesarean, which I think I already knew that I should*, but it took months of pondering for me to finally be able to make that decision).  

*Should = do what was best for my babies and me.

(A C section ended up being the safest thing for us 3). 

Anyway, that was pregnancy, this is weight loss surgery!

I first met with the surgeons in May.  My surgery was planned for early August.  Late July it was time for my consent paperwork to be signed.  And I still couldn't make up my mind.  I rang the surgeon's office and asked if I could meet with the surgeon one more time to discuss the different surgeries before signing on the dotted line.

(This will have been only the second appointment with him, its not like I'd been to see him 7 times and kept going over the same stuff).

They said they could make that 'consent appointment' actually a discussion appointment, and I could always come back the following week to sign the paperwork.  I knew that I would, because there was no way that I would have wanted to go in and discuss alternate options and then sign immediately after!  

However, ironically, that's actually what I ended up doing...

I went along and met with him.  I asked him to be specific as to why he suggested a bypass for me.  In a nutshell, the reason this was everyone's suggestion, was that a gastric bypass was proven to be better for long term weight loss, especially when you have a lot to lose, like I did.

I also remember my Actual Surgeon telling me that it was very common for patients to get the sleeve, but then end up coming back 1-2 years later and requesting a revision surgery from sleeve to bypass, because the sleeve was no longer working for them.  He said let's not waste my time and an enormous amount of money twice over, and just get the right* surgery first up.

(*Right surgery for me). 

So, back to the Original Surgeon 'consent appointment' that was now a 'discussion appointment'...

After he discussed the different surgery options, he then said that they had had some results come back for me.  This surgeon had required me to do 101 tests prior to surgery 😳

One of those was a gastroscopy (endoscopy) (where they shove a camera down your throat and check the upper part of your digestive system).

I'd had all of the required tests and as far as I knew, had gotten all of the results back from each one, including the gastroscopy, and everything was fine and in order. (?)

He proceeded to tell me that they'd discovered that I had something called 'Barrett's Oesophagus'.

I had no idea what that was, and to be honest, still am not very confident in my education of it.  In my own words to sum up the brief overview that he gave me in the room that day, Barrett's Oesophagus is damage to the oesophagus:  Apparently the cells in our stomach wall are tough and 'hardened', so to withstand all of the stomach acids that we have.  The cells of the wall of our oesophagus, however, are 'not tough'.

Over time though, if people have a lot of reflux (stomach acid coming up into the oesophagus), the cells in the oesophagus can change, and harden, to mimic the type of cells that are in the stomach.  (To handle the acid).

And then over time, with the cell changes, they can change even more and become cancerous.

Whoah.  I was just expecting to have a chat about which type of surgery was best to fix my weight problem.  I was so blindsided from this diagnosis; I wasn't expecting to have any results given to me this day.

That's pretty much all he told me, and all I was able to ask was "so it's not cancer though, is it?"  Because hearing the words 'cell changes' is pretty frigging scary.  As is asking that question...

He said no, not currently, but I would need to have a gastroscopy every year to monitor it, and that this diagnosis would be another reason to support me having the bypass done.

Sold.

That was the defining moment that made me finally make a decision.  I specifically remember saying to him "ok, well I'm not going to muck around with that, bypass it is then."

(Apparently bypasses are better for reflux because physically it's harder for the stomach acid to come back up due to the rerouting of your digestive tract; whereas with a sleeve it can come straight back up just like it used to).

I'm still surprised by this diagnosis, because as far as I knew, I've never really had a reflux 'problem'.  I had really bad reflux during the second half of pregnancy, but surely that wouldn't be enough to cause this, having been from such a concentrated period of time?  I've experienced reflux other times for sure, often when I've eaten a lot of high sugar foods.  But not often!  Maybe pregnancy tipped me over the edge from the little I already had?

Anyway, I dunno.  I already have to have annual colonoscopies, so it'll be easy to add in the endoscopy and do both ends at once.  I'll have a chat to my specialist and doctors one day and try and get a bit more understanding surrounding it.

Anyway, so I signed the consent form right then and there, and never looked back!  (Never looked back at the surgery type I chose, I mean).  I looked back many times and as mentioned ended up changing surgeons the week after this appointment!  Which I will explain.  But that's how I came to decide what surgery type was best for me.

I remember being told that it will also depend on the day when they open you up, as to whether they can even go ahead with your chosen type of surgery.  I was told that even if I chose a bypass, I would be consenting to both a bypass and a sleeve. Because if for some reason anatomically they couldn't perform a bypass, they would change to a sleeve on the day, while you're opened up!  I don't know in what circumstances this would happen, I imagine it could be an issue if they couldn't reach certain organs, especially if your liver was too big, which is the point of pre-op, to shrink your liver for surgery.

I remember my Actual Surgeon also mentioning at one point that unless he told me, I would have no idea of knowing what surgery he performed, once he'd closed me back up.  (Btw it's keyhole surgery, so technically you're not actually 'opened up'.😅). But he was just saying this to hint at the point that when all is said and done, all weight loss surgeries basically work in a similar way, so not to get *overly* caught up in which is best.  They're all weight loss surgeries and you still have to work at each and every one.

On the day of my surgery they were able to perform the bypass, so that's what I have had done!

A Roux-en-Y Gastric Bypass.😊

And because I posted my first 'before and after' photo on my Instagram just this morning; here it is here, too.  My first one that I've shared in 9 years.💗