Gastric Sleeve Surgery – a 2009-2011 Success Story

If you are thinking about having weight loss surgery then hearing someone else’s story is a great way to start.

Jenny underwent a gastric sleeve procedure on the 26^th October 2009. She agreed to chart her progress in this blog. So, be aware that as this blog gets longer, Jenny will be getting thinner!

Jenny said that before she made her decision to proceed with the gastric sleeve surgery she googled the various surgeries. She said she considered both lap band surgery and the gastric sleeve procedure.

Jenny knew that she fulfilled the criteria for bariatric surgery for the following reasons.

Firstly, her Body Mass Index or BMI was more than 40. In fact, it was actually 50.

Secondly, Jenny had a history of unsuccessful weight loss attempts including LA Weight Loss,  Tony Ferguson meal replacements, joining a gym, using a personal trainer, consulting a dietitian and attempting a variety of fad diets used to sell magazines.

Thirdly, Jenny’s weight was affecting her physically in a number of ways. She was experiencing back pain, joint pain, foot pain, fatigue, fatty liver and difficulty walking short distances and performing certain tasks.

Fourthly, her weight was impacting on her psychological state. Jenny was experiencing depressed mood, low frustration tolerance, irritability, poor self-esteem, extremely low body-esteem and lowered confidence levels.

Fifthly, Jenny admitted her weight was also impacting on her socially. She reported social withdrawal, increased conflict with her partner, siblings and other family members, as well as a deterioration in her working relationships and her work performance.

Overall, Jenny’s weight was significantly impacting, in a very negative way, on her quality of life.

In her quest to get information about weight loss surgery, Jenny consulted two bariatric surgeons and attended a support group for people who had undergone various bariatric surgical procedures. Based on her research and the advice she was given Jenny elected to have gastric sleeve surgery.

Once she made her decision, Jenny was referred for screening by a psychologist, and consulted a dietitian and exercise physiologist.

Jenny was accepted for surgery and commenced a weight loss program three weeks prior to the surgery.  The program consisted of meal replacements three times a day, low joule vegetables and two serves of fruit daily. Her weight three weeks prior to the surgery was 150kgs. By the time of the surgery her weight was 144kgs.

On the day of the surgery Jenny was hydrated with an IV drip, and sucked on ice.

The day after the surgery, Jenny was commenced on clear fluids. She said she was advised to drink 30-50mls of water every 15 minutes to ensure hydration. Jenny explained if she became dehydrated she would be more likely to experience nausea and be readmitted to hospital for intra-venous rehydration.

By day 4 Jenny weighed 139kgs, and was progressed to mixed fluids.

By day 5 Jenny admitted she was missing savoury and more substantial food and attempted to eat pureed vegetables. Although what she attempted to eat was the liquid consistency of custard, she said it caused discomfort.  The next day she said she went back to mixed fluids.

Jenny said that from day five her intake included the following. For breakfast 250 milliliters of Up and Go, a proprietary liquid breakfast in Australia. For morning tea, 250 milliliters of reduced fat iced coffee. For lunch, Velish Soup, made by Campbell’s. For afternoon tea, 25o milliliters of milk. For dinner, 150 grams of low fat custard.

In addition to this food intake, Jenny said she took a Berocca Performance as a supplement.

A DietPsyche dietitian analysed Jenny’s intake. It was estimated that Jenny’s total energy consumption was about 2500 kilojoules and 35 grams of protein a day. This intake was considered nutritionally inadequate.

Jenny mentioned that she had been given some protein boosters after the surgery and intended to contact the hospital dietitian to obtain approval to take these supplements. Jenny said the protein boosters were called Dymatize and were 45 grams of protein per serve, and 180 kilocalories.

By day 11 Jenny had not weighed herself but believed her weight was the same. She said she had been warned she would plateau until she began to eat more food. Jenny explained that they were warned about weight plateaus.

Jenny said she began to feel much hungrier by day 6. However she said she avoided transitioning to mushy foods on the advice of the dietitian. By day 9 Jenny was feeling so hungry she upgraded to pureed foods. She said that being on fluids only and watching other people eat normal food was challenging.

Her diet by day 11 was Up and Go for breakfast. She was still having a milk drink for morning tea. For lunch she had managed an entree size of chicken and sweet corn soup. It took her an hour to eat, and she said it filled her up. She was drinking 600mls of water during the afternoon. For dinner she was having pureed vegetables and some pureed mince.

Jenny said she was feeling tired. She said she didn’t regret having the surgery but was concerned about her weight plateau.

On Day 14 Jenny said she consulted her consultant dietitian. Jenny said her dietitian was extremely happy with Jenny’s progress. She had lost 12 kilograms since commencing her meal replacement diet four weeks prior to her surgery on 26.10.09. By Day 18, Jenny was given permission to transition to soft foods, or foods that when you chew them they become mushy in your mouth.

Jenny said that on Day 14 she was eating one weetbix with milk for breakfast, pureed fruit or milk at morning tea, soup at lunch, milk coffee at afternoon tea, mashed pumpkin, potato and mince at dinner and occasionally custard at supper.

Jenny said that even though she was still very tired she was feeling good about her weight loss.

On Day 15 Jenny consulted her psychologist. She said the psychologist gave her tips to manage food cravings and also talked to her about how relationships can change when the person having the bariatric surgery loses considerable amounts of weight. The psychologist told Jenny that sometimes spouses and other friends and family members had to actively adjust to living with a new and often completely different person.

At six weeks post-surgery Jenny has achieved a total of 17kgs weight loss. She lost 6kgs prior to surgery and 11 kgs subsequent to surgery.

Jenny’s weight loss plateaued for 2.5 to 3 weeks, two weeks after the surgery. She said it was explained to her that the plateau represented the body’s adjustment to her already significant weight loss and her reduced food intake. By six weeks post-surgery Jenny said she had once again begun to lose weight.

Jenny said that she suffered severe reflux after the surgery and said that it was explained to her that the body took time to adjust the amount of acid it produced and initially would have been producing the acid required for a full stomach, not one that had just been resected by between 60 and 85%. Jenny said that she took Nexium daily to manage her reflux but by week five had begun to take the Nexium second daily.

Jenny reported experiencing signficant changes to her taste buds. She said, “Everything tastes awful. I cook something and although it looks good and smells good, when I go to eat it, it tastes awful.” Jenny said that she had read on forums that this happened with other people who had gastric sleeve procedures.

Jenny said her energy levels were improving, but still fluctuated from day to day.

By week five to six Jenny was eating a weetix with hot milk for breakfast, a large salada cracker with cheese or ham for lunch, a yogurt through the day, grapes or a small packet of rice crackers at afternoon tea and a meal that would fill a quarter to half a cup for dinner. Jenny said that she could only eat 1/4 to 1/2 a meat patty for a meal. She said she did not drink 1/2 hour before eating or during eating or she would feel full too quickly.

Jenny said that other people with gastric sleeves said they vomited if they ate too much, but Jenny said that while she had felt uncomfortable after eating she had not vomited.

At 9 weeks post-surgery Jenny had lost a total of 22.5kgs.

At around 7 weeks Jenny complained of a change to her taste buds. She said that all food tasted bad. Foods she had previously enjoyed, stopped tasting good. She spoke to the doctor about it and he said this was quite common. At the support group one woman who had undergone the procedure 7 months before still had problems with taste, however most people said that it improved around 12 weeks. Jenny said that she had noticed an improvement in this symptom over a period of a few weeks.

Jenny said her energy levels were a lot better than what they had been but warned her energy still fluctuated day to day.

Jenny had experienced difficulty with reflux since the surgery. She was on two anti-reflux medications daily for the first month (Nexium and another drug she cannot recall the name of). After four weeks one of the drugs was stopped and she proceeded to wean off the Nexium. Initially she took the Nexium second daily but moved on quickly to taking it only as needed. Jenny said she still experienced reflux on a regular basis around 9 weeks post-surgery but was only taking Nexium every 3 to 4 days.

Jenny said that she could eat more food but explained that she found she could eat different amounts at different times, but could not work out why. For example, on some occasions she said she could eat a whole mango, but not at other times.

Around 9 weeks she had been able to eat a larger variety. For example, on the day this blog entry was made she ate a baby tin of baked beans for breakfast and a part of a cup of coffee. For lunch she had a good 1/2 cup of Thai Green Curry (chicken) including rice. Her evening meal was 1/2 cup of stir fry vegetables and meat with rice. Between meals she may or may not have yoghurt or fruit or a plain biscuit.

At week 9, Jenny had lost 16.5kgs post-surgery. She lost 6kgs presurgery over 3 weeks.  Overall, she had lost 1.875 kgs per week, but said that she did not lose this amount consistently each week. Jenny warned that her weight frequently plateaued. Translated into stones, Jenny has lost 3.75 stones and had reduced from a Size 26 to a Size 22 (pants) and Size 20 (shirt).

Jenny said she was happy with her progress, and admitted that if she exercised more she would likely have lost more weight. However, her living situation precluded this.

Jenny admitted that she compared her weight loss to other people but further disclosed that this was not a good thing to do because everyone appeared to lose weight at a different rate based on their age, weight, gender, genetics, diet and lifestyle behaviours such as exercise.

Entry 21.01.10, approximately three months post-surgery.

Jenny had now lost 30kgs since deciding to have gastric sleeve surgery. She lost 6kgs prior to the surgery and 24 kgs since. She believed she had reduced three sizes but believed her shirt sizes were reducing faster than her trousers.

Jenny said that she tended to lose 3kgs in a week, and would then plateau for several weeks. She found the irregular weight loss trends frustrating.

Jenny said that foods tasted different. Sweet foods tasted sweeter, and fatty foods tasted oilier and fattier and had become unpalatable. Essentially the taste changes encouraged healthier food choices.

She said she was still tired but had noticed an improvement in energy two months post-surgery.

Jenny said that she had adapted easily to eating less. She said that because she felt full so quickly and vomited if she ate too much in a short period or ate too quickly, that this managed her eating. Jenny said that because she has had the taste of food and feels full she doesn’t miss eating larger amounts.

Jenny said she still had reflux but said that it was not as bad as it had been . She was only occasionally using Nexium and estimated only experiencing reflux second daily.

Jenny said that other people were commenting on her weight loss frequently.

She was pleased with her decision to opt for surgery.

Entry 29.12.11 – twenty-five months post-surgery.

Jenny’s total weight loss to date has been 73kgs, 6kgs of which she lost pre-surgery.

In the first 12 months Jenny lost 60kgs. However, she then became pregnant in October 2010 and during the pregnancy initially lost a few kilograms but then maintained her weight. She weighed about 93kgs pre-pregnancy and at the time of birth was about 88kgs. After delivery she dropped to 83kgs. As of 29.12.11 she is 76.5kgs.

Jenny said she was warned her fertility would increase with the weight loss, and this proved true! Her baby was born by Caesarian section and he weighed 6lbs 6 1/2 oz.

Jenny said she attended a support group recently and the psychologist and dietitian did not recognise her until she introduced herself. Looking at her before and after photo you can understand why. They disclosed that they believed Jenny would not lose more than 60kgs!  Jenny said she is still losing but is averaging a loss of about a kilogram a month. She has lost about 6.5kgs since the birth of her baby boy and while some of this could have been contributed to by the extra energy requirements of breast feeding, her baby was supplemented with bottle feeds and she had a brief period of illness during which she ate less.

This was Jenny’s third child and third Caesar. She said it was also the quickest and least painful recovery. She did not need pain killers and attributed her quicker recovery to her weight loss and improved health.

Her dietary intake has increased since the last blog about Jenny in early 2010. For breakfast she eats cereal – two weetbix or 1 cup sultana bran or a single serve of oats with 1/2 cup milk. For lunch she eats deli meat (approximately 50gms) and vegetables (no more than one cup), and on some days will eat one slice of toast with it. Another lunch option she will have is a toasted sandwich but she qualified that she may only eat 1/2- 3/4 of this. On other occasions she may eat two cruskits with ham, cheese and pickle. She usually misses morning tea because she is busy with the children but for afternoon tea will eat sliced fruit with the children. If she paces herself she can eat a whole piece of fruit, but would need 1/2 hour to eat it all. For dinner she eats another 50gms meat with vegetables and sometimes a small carbohydrate serve like pasta or potato. She emphasised that the doctor encouraged her to focus on eating her protein first, however, she made the comment that it is difficult to eat even an entire lamb chop. To optimise her protein intake Jenny drinks 500-750mls of a proprietary iced coffee.

Her doctor told her that her only nutritional deficiencies were B12 and Vitamin D. So she supplements with these. She takes 3000IU Vitamin D and one B12 under the tongue daily. She has annual blood tests to monitor her nutritional status.

Jenny said she feels completely different within herself having lost 73kgs. She now fits into size 10-12 and has adjusted to being slimmer. She said she has had to make a conscious decision to stop shopping in the plus size stores.  She commented that she is treated differently by people, particularly men. She has noticed men looking at her. She felt she stood out in a bad way when she was 150kgs but was invisible to males. She now feels she blends in, but is more visible to the opposite sex. Her experience is that people are “nicer” to her. She gave the example of store assistants being more helpful when her weight dropped from size 20-22 to size 12.

In relation to body changes Jenny provided the following measurements:

Pre-surgery: Bust 145cms; waist 130 cms; hips 152cms; neck 41cms; shoulers 134cms; right upper arm 43cm; left upper arm 43cms; right and left forearm 30cms; right thigh 83cms; left thigh 84cms; right calf 50cms; left calf 52cms.

Current (73kgs weight loss): Bust – 96.5cms (48.5cm difference); waist 86cms (44cm difference); hips 106cms (46cm difference); neck32m (9cms difference); shoulders 100cm (34cm difference); right upper arm 28cm (15cm difference); left upper arm 27.5cm (15.5cm difference); right and left forearm 20.5cm (9.5cm difference); right thigh 52cm (31cm difference); left thigh 50cm (34cm loss); right calf 33cm (17cm difference); left calf 34cm (18cm difference). In total Jenny has lost a gargantuan 327cms from her body.

These size losses have left loose skin. Jenny said she went from a 20-22H-I cup in the bust to a 14E. She believes that once her weight stabilises she would advantage from a breast lift  and a tummy tuck. One thing she has noticed is how jelly like her stomach has become since her significant weight loss. Fortunately she has not ended up with skin folds, other than an overhang where she had her C-sections.

Jenny said she escaped the tuckshop arms and has been able to wear short sleeved shirts. She said she would be happy to wear a swimsuit but with shorts. The thing that annoys her the most is her stomach. She said bras can  address her breast issues and was delighted to be paying only $20 for a bra, when previously she was paying $100! There was only one shop in her capital city that provided for her bra size. Now she can shop anywhere. Yahoo!

Interestingly, her shoe size has changed with her weight loss. She was a size 11 and is now a size 10.

Overall, Jenny’s only complaint was that the doctor’s did not give her enough information on what to expect post-surgery. This included the fatigue, the taste changes, the weight loss pattern, or what to try and eat to optimise nutrition.