Fluids, tick. 'Purée' in progress.

Typical lunch box this week

So I started to update on my stories how I was going with Day 1 and 2 of the purée stage, but I fell asleep half way through the sharing and haven’t had time to continue since. It’s now Day 6. 🤦🏼‍♀️

Sooo, a quick summary instead:

Day 1
I shared that I had the yoghurt and 'squashed' strawberries for breakfast.

Cruskit, avocado dip & feta

I then had this: 1 Cruskit with avocado dip (as the avocados I bought were too unripe) and feta. And as I said it went down extremely easily and didn’t fill me up at all.
 
So I continued with a Salada (1 Salada that breaks into 4 squares), with avo dip on it.
 
I think I had some crackers and dip in the arvo.

Anyway, dinner was the thing that ‘concerned’ me the most. I had salmon and feta. (There’s many foods I’m not allowed to eat yet hence these non balanced meals btw).
 
This was on a side plate, not a dinner plate. I think the salmon was about 120g (I’d cut a larger piece in half and didn’t even think I should be able to manage all of this.
 

'The' salmon

But I did; and I didn’t even feel full afterwards. I felt satisfied enough though. My dietician said I probably wouldn’t feel restriction until the soft food stage; but I was really starting to worry. I know I was just Day 1 of purée, but surely I shouldn’t be able to eat a piece of salmon that big and not even feel full? 
 
Reminder: 
Day of APC: clear fluids 
2 weeks: fluids
2 weeks: purée
2 weeks: soft food 
After that, food of any texture.

Salmon patties dinner before

Completely coincidentally, the following morning (Day 2 of purée), I had a check in Telehealth appointment with my WLS surgeon. Ie. the surgeon who did my gastric bypass 18 months ago (I just realised, it’s 18 months tomorrow!!)
 
He referred me to my APC surgeon (they work closely together) but it was still very separate. I did my gastric bypass privately (using my Super), and the APC was done publicly. So he wasn’t really across me having had the APC when he rang.
 
He seemed to have some concern also about the salmon, so he asked to speak to me again in a fortnight.
 
Day 2 was pretty similar. I’ve been eating mostly crackers, dip, yoghurts, squashed strawberries, smoothies, salmon and cheese.
 

Salmon patties dinner after

I made salmon patties for dinner and had them with sour cream. They gave me a little bit of hope, in that I put two on my plate, and could only eat one.🤞🏼

Days 3-5 were pretty similar. There was possibly some small amount of restriction but overall not much. I had salmon a couple of those nights and was able to leave a little bit on my plate each time.

I am trying to trust the process, and although it doesn’t sound like it, these foods are ‘purée’ (consistency when swallowed) so I really shouldn’t judge the success of the procedure until I’m eating completely solid food.

The wedges

But that first night of salmon……. 😕

On Saturday night, Day 4, I went out to a very last minute dinner to celebrate my brother's birthday. It was at as pub and I ordered wedges. It seemed (even to me) strange that I was allowed to eat that. But other than chips, it was actually the only thing on the menu that I could have. They did have steamed vegetables but I thought they might be too tough. I sort of need to have very soft veggies that I can mush in my mouth. Purée stage is so weird. And the available choices don’t even seem overly healthy, either. Crackers and dip aren’t amazing choices. And at dinner others appeared a bit confused that I could eat the wedges. 😬

Dinner tonight before

Anyway, I shared the wedges with my niece; we didn't finish the bowl; not even close, but I managed many more than I thought I should be able to at the moment. 

Today was similar, however tonight (Day 6), has ended up being amazing. Literally a few hours ago I was lamenting to a friend about the restriction concern and wondering how long it might be that I have to wait to get another APC (it’s not unusual to need more than one). I even had a fleeting thought that I wish I had that ‘full’ feeling where you actually feel sick and uncomfortable when you eat. I had that a few times early on after the bypass. No one should wish to feel unwell, but I was just craving to have some hint of hope or proof that the APC has tightened me up. And feeling uncomfortable and/or sick is a big sign of that!
 
And then I ate dinner.
 
I ate salmon and roasted potato and sweet potato. (For reference of these photos, all of these meals have been eaten on small side plates). Tonight's piece of salmon was a lot smaller than that first night.
 
Anyway, I was so full about halfway (?) through the meal and then felt that discomfort feeling, in a HUGE way. I even thought I might bring it all up again and looked around for something to grab if I did get sick. (I didn't).

Dinner tonight after

Physically it didn’t feel good, but mentally it’s excited me! Maybe it has worked better than I thought?
 
We will see.🫠  Patience and hope, Kate, patience and hope...
 
So far I’ve lost 5.3kg since the APC; (2.5 weeks).

80kg down WLS update!

I haven’t had time to upkeep my sharing lately but finally, here’s a summarised WLS update! (That was meant to be a 'brief' Instagram post update but my understanding of 'brief' is somewhat skewed and I thought it would be best fit into a blog post). So there you go; my first blog post in a little while, too. 😉

 

So I had the RNY Gastric Bypass in September 2022. I lost 70kg by May 2023. And it was about that time that my restriction (surgically restricted exit from my smaller stomach) relaxed…a lot. Meaning it wasn’t as physically tight as when the surgery was first done. Soon after having WLS, my surgeon warned me that this is normal and is likely to happen 6-12 months post surgery. The nerves at the exit point heal, and over time, relax, and therefore become flexible, allowing stretching,

-80kg

which allows more food to get through. He emphasised that when this happens it wouldn’t be my fault or his fault, it’s just how our bodies naturally adjust.

 

To be honest I didn’t realise or understand this properly, and when I finally did, it was a bit of a hard pill to swallow (still is). I thought (unless I got it reversed), that this was permanent! Yes, I knew you could overeat and stretch it that way, but for the nerves to naturally relax over time??

 

So from May-August 2023 my scale weight plateaued. I believe the ‘bypass’ component of the gastric bypass is what saved me from putting on weight, as I found myself naturally being able to eat more and more quantities. And because I could, I did.

 

In August I started on Ozempic. After a month I started feeling it working,  and I lost about 10kg from September-December. I've hovered around the same couple of kg’s since. I've been within 1kg of losing 80kg for a few months; I just hadn't quite reached it yet: Until this morning when I did my usual Monday weigh in and I've finally lost 80kg! (Which is pure coincidence that I hit it the same day as posting this update!)

 

The restriction however kept loosening and it’s gotten to the point I sometimes feel I have no restriction left. It depends on what food I’m eating, so I clearly have some restriction. But for the most part, the quantity I can consume is hard to accept, knowing how much I paid for this surgery and more importantly, why I want and need it to continue working!

 

Just to reiterate, this has been a natural relaxation of the nerves - not me overeating to stretch! #PleaseSaveAnyJudgementalComments

 

The bypass component of my surgery hasn’t changed - food exits my smaller stomach and

My surgeon's sketch

travels along the rerouted route of my intestines that my surgeon created. So food that I eat ‘bypasses’ a lot of my intestines; so that I have less opportunity to absorb as many calories as I would otherwise.

 

So the gastric bypass sort of has two components -

1) the smaller stomach and exit point to reduce what you can intake - and then

2) the bypassing / rerouting of where it goes once it exits the stomach). 

 

The intestinal rerouting is absolutely what has saved me from putting on any weight since I’ve been able to fit in more and my eating choices have become poorer. I’ve basically ‘hovered’ since the 70kg in May 2023, and then ‘hovered again’ since the 10kg from the Ozempic. (Until today 😅) Usually plateaus and maintained weight would be awesome! But not quite yet for me, who still has a LOT of weight to still get rid of.

 

Concurrently though, mid 2023 I started actioning something that could help. There’s something called an ‘APC’ - which stands for Argon Plasma Coagulation. I’ve included a screenshot of what it’s about, and if you’re interested in the correct medical terminology, definitely Google it.

 

But in MY OWN words as I understood from my doctors; basically they can go into your stomach via an endoscopy, and use argon gas to BURN the exit point from your stomach.
When you burn skin, it ‘shrivels’, and the scar tissue that is created from that is something that can give you more restriction back; to a similar point to when I first had the big surgery.

 

It’s basically reducing the relaxed / stretchy opening between the stomach and the small intestine, and ‘tightening’ it up.

 

In June 2023 I met with the surgeon who performs APC’s, and via an endoscopy, he measured my exit point, to see where we were at. He told me that when the initial surgery is done, the exit point is approx. 8-10mm in diameter. 

 

In June, mine was 12-13mm. You wouldn’t think that a few extra millimetres would make much difference, but, look at my dinner plate one night: it does.😳

 

He agreed I’d be a candidate for an APC, and put me on the books to have a consult with him to discuss. (Although referred from and partially managed through my initial WLS private surgeon, the APC process has been through the public system here in Queensland, Australia).

 

I had the appointment in November 2023, he was thorough in his explanation, I agreed and signed the consent form to have it done. I was marked as a ‘Category 2’, and they said it would be about a 3 month wait to get a spot. I was craving it get it done so much! My Ozempic wasn’t working as effectively (it still worked and I would still take it, but this seemed like a better way for me to go, (especially with the current shortage).

 

Anyway, a few days ago, I got it done! It went really well, but we won’t know for a few weeks yet whether it’s been successful. There’s no way of pre-telling how each body will react. While they aim to ‘tighten’ it back down to 8-10mm; some people restrict too much, to the point they can only intake fluids, and would therefore need a dilation.

 

Likewise some people might not have much of a change in restriction at all, and therefore would need a further APC (or multiple). My surgeon told me that APC’s can be done almost as often as you need, and that many people have them done ongoing, following WLS. I found it interesting when he said that he sees the way of the future of WLS patients maintaining their surgery being managed by a combination of APC's and Ozempic (or something similar).

I haven't had any side effects or issues (within the last few days anyway), other than a tiny bit of reflux on the day of the procedure.

 

The thing that sux the most (right now) is that following an APC you need to go back and do the same post-op diet that immediately follows the initial big WLS. Which is 6 weeks of slowly reintroducing food textures into your stomach, so that the exit point has a chance to heal properly. You have to be on clear fluids only while in hospital. And then the diet is predominantly:

 

• 2 weeks of fluids only 
• 2 weeks of puréed foods
• 2 weeks of soft foods 

 

While I get it and accept it and know that I’ve managed it before; right now, a few days into the fluid only diet, it frigging SUX. Especially as I don’t feel any new possible restriction just yet. (That should 🤞 come when I start on soft foods).  I can have soups, smoothies and yoghurt, and those things are keeping me somewhat sane. But for the most part I’m hangry and grumpy and I hate it. 😭😭

Grateful for snow cones at the school picnic

 

Anyway, I’m hoping this will be a successful venture, and that it will kickstart me into the next phase of this huge journey. (Surely the stupid post-op diet should skim off a few kg’s in itself, seeing as I’m not eating anythingggg right now). 😩

 

So just a reminder that when you tune into any stories I manage to post over the next few weeks, that they’re coming from a place of hanger and headaches and that I’m not happy about it!! (I know that it’s worth it…just not right now while I drink a protein shake as I prepare, handle, smell and cook food for my kids).