Blog 3- Meeting the Consultant, Dietician and Psychologist
Thank you for taking the time to read my previous two blogs! I am now two weeks post op and feeling better! I still have no appetite, my wounds feel tender, and I often feel very cold and tired, but progress is being made. I have decided to use this blog to talk about my experiences of meeting the consultant, the dietitian and the psychologist so it gives others an idea of to expect.
Meeting the consultant
I was due to have my initial consultation with the consultant on the 08/08/22 at the closest hospital to me, however I tested covid positive that morning. Jacks mum tried to attend the appointment without me, but the consultant was unable to talk to her. Luckily it was very easy to rearrange the appointment and I finally saw the consultant on the 16/08/22.
When we arrived at the hospital a nurse took me to a private room where she checked my height and weight to calculate my BMI (Body Mass Index). I was very nervous about being weighed as I have always felt embarrassed and ashamed of it. Thankfully the nurse was discrete, and I wasn’t made to feel embarrassed. My BMI at this appointment was 52. Normal BMI is between 19-25, with a BMI over 30 being obese. I knew that your BMI must be over 35 to be considered for weight loss surgery so knew I would meet these criteria. Whilst waiting to be called in to meet the consultant, I had to complete a sleep apnoea and an anxiety and depression assessment. I luckily don’t have sleep apnoea however I was concerned about how high I would score on the mental health assessment (more on this later).
I was soon called in to meet the consultant. I will be honest the first consultation felt very intimidating and I left feeling a mixture of nervousness and excitement. I was thankful Jack’s mum; France came with me. The consultant initially asked me why I was there and what surgery I was considering. He asked me about my medical history, about previous methods I have tried to lose weight and explained the three types of surgery he offers and the associated risks. France and I still joke about the main words we heard Mr Agrawal say during this appointment which was ‘death’. On reflection I liked the way Mr Agrawal discussed everything with me. He didn’t sugar coat anything and explained weight loss surgery isn’t an easy option but is a helpful tool to aid weight loss. He provided me with three information booklets to take home and read and once I had decided to email him to start the next part of the process. There was a £100 fee for the consultation which I had to pay upfront, and Mr Agrawal asked me to lose at least a stone before my surgery to make it safer. I also scored highly on the mental health assessment which meant I needed to be assessed by a psychologist to check my mental state to ensure I could psychologically cope with the demands of the surgery. Once I was home and discussed with my mum and Jack my options, I had decided I wanted a gastric sleeve and emailed Mr Agrawal the same night. One advantage of going privately was that to a certain extent I was able to choose a date which suited me and by the following day I was booked in to have my gastric sleeve on the 17th ofOctober 2022. The only problem was I would have to go a different hospital further away than planned but after researching the hospital I was happy to go ahead. I went back to see MR A on the 12/09/22 where I signed the consent forms and was weighed again. I had almost lost 1 stone so Mr A was happy to proceed with the operation in October.
Meeting the Dietitian
As part of my package with the hospital I have access to a dietician. This included prior to surgery and for two years folIowing surgery. I received a phone call from the dietitian about a week after booking the surgery. She sent me an email with a zoom appointment on the 07/09/22 and some information resources to look through as well as some questions I needed to answer prior to the appointment. The resources came from a website called nutrition and diet resources (NDR) and it was recommended that I purchased a book called Recipes for life (picture inserted in the blog). The book has several recipes which can be eaten throughout the stages following surgery (more of this in a later blog). The questions I had to answer prior to the appointment related to; my previous diet history, what I was eating and drinking on an average day, whether I was an active person and what support I have at home.
The day of the appointment came round, and I had just finished three-night shifts so was very tired however Liz was very understanding. We started off by discussing the answers I gave to the questions and in particular the emotional relationship I have with food. This isn’t something I like to discuss openly with people however I want to be honest on this blog. I have found over the many years that I have struggled with both my mental health and weight that food has been an emotional clutch for me. My mood massively contributes to the decisions I make regarding my diet for example, when I feel low, I would reach for convenience food, sweets and chocolate etc. however, when I was feeling good, I would eat a balanced and healthy diet. Liz discussed how the emotional relationship with food will change following surgery and ways to help me cope on tough days.
After this, Liz explained the process of surgery and how my diet would change following the surgery. For example, weeks 1-3 post op involved sticking to a liquid only diet to allow the staples in my stomach to heal and to prevent a staple line leak which can be fatal. The liquid diet includes thin yoghurts, thin soups, no added sugar angel delight, sugar free squash, protein water and protein shakes. The following weeks (puree stage, soft food stage) involved introducing foods to then get back to a normal diet which is high in protein and low in fat and sugar. Liz explained that from week 1 post op I should be aiming to consume 60-80 grams of protein a day. One of the side effects associated with having a gastric sleeve relates to absorption issues as you are only able to eat small portions. This means you are more susceptible to anaemia, vitamin B12 and other deficiencies. Liz explained that I will need to take calcium, B12, iron and a multivitamin supplement every day and have a B12 injection every 3 months as well as regular blood tests to ensure I have no deficiencies.
The last part of my appointment involved discussing the Liver reducing diet (LRD) that I would have to follow prior to surgery. Liz explained that my BMI meant I would need to follow the diet plan for four weeks prior to surgery. It involved having four slim fast shakes a day, unlimited tea, coffee, sugar free squash and water and an optional sugar free jelly and Bovril to drink. The idea of this diet is to shrink your liver prior to surgery to make the operation safer and easier for the surgeon. Depending on who the surgeon is, your BMI and where you are going for surgery, the LRD can be different in plans (low calorie food, milk, soup or shakes) and duration. I have heard that some surgeons abroad don’t make their patients do the diet, however I think it mentally prepares you for life following surgery and the dietary restrictions you will face. I will discuss more in future blogs about the food aspects of this surgery and my experience of the LRD.
The recipe book recommended by the dietician !
The Psychological Assessment
Following on from my appointment with the dietician, I needed to organise a psychologist assessment and report. Unfortunately, I had to pay privately to see one however Liz signposted me to Kay who was trained in supporting bariatric patients. This was the one appointment I was dreading as I find opening up to people about my struggles with mental health very difficult to talk about. Kay immediately made me feel at ease and reassured me that anything I say is said in confidence. Kay asked me about my reasons for surgery, my relationships with family and friends, my self- image, and my relationship with my body. I found it very hard to answer some of kay’s questions, but I wanted to be honest with her. I said that I have a good relationship with my family and friends and have a lot of support from Jack who has been behind me every step of the way.
The questions regarding my self- image and esteem were the hardest to answer. I have a very negative self- image and people who know me well know I find it very uncomfortable to receive and accept compliments. I also struggle to put myself out there in social situations as I feel very self- conscious and unsure on what to wear. This became apparent when Kay asked me to describe myself in a positive way which I was unable to do without her encouragement. As already mentioned in my previous blogs, the bullying I went through as a child and the emotional abuse I went through as a young adult have all negatively impacted on my self-image, self-esteem, body image and confidence. Kay identified that I am a person who tends to bottle up my emotions, wear a mask around people to convince them I am ok and take on a supportive role around other people and their emotional needs. She advised me to ensure I give myself time for self- care and become more open when I am struggling. I have been working on becoming more open and thankfully I have a few people who I turn to for support.
Although there are some mental issues I must deal with, Kay supported my decision 100% to have surgery and suggested ways to deal with some of the negative comments I had received when I did tell people about my choice, for example surgery being the easy option! We also mutually agreed that when I am ready it would be beneficial for me to have some counselling to improve my mental wellbeing. Kay sent my report through to Mr A and Liz and I finally had the confirmation that my surgery was going ahead.
Once again thank you for taking the time to read this blog and again I want to apologise that its very lengthy and probably boring to some people. I also appreciate that the process I went through is MUCH faster than going through the NHS and for that I am very fortunate! I hope that this blog is giving people a small insight into the processes involved in bariatric surgery!
In my next blog I will be talking about the Liver reduction diet and how I prepared for surgery!
Thanks once again!
Heather Aka The sleeved midwife
