Gastric Sleeve Surgery – a 2009 Case Study
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 26th 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, free 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. 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 is still having a milk drink for morning tea. For lunch she has managed an entree size of chicken and sweet corn soup. It takes her an hour to eat, but it fills her up. She drinks 600mls of water during the afternoon. For dinner she is 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 the 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 lose 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 said that as she was warned her 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 adjusting 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 14-12 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 to her taste just recently and was beginning to enjoy some foods again in moderation. However, she qualified that some foods still had a bad taste to them.
Jenny said her energy levels are a lot better than what they were but said that her energy still fluctuates day to day.
Jenny has 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 and now only takes it when she needs it. Jenny said she still experiences reflux on a regular basis but only takes Nexium every 3to 4 days.
Jenny said that she could eat more food but explained that she can eat different amounts at different times, and is not sure why. For example, on some occasions she can eat a whole mango, but not at other times.
Around 9 weeks she has 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 will be 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 has lost 1.875 kgs per week, but said that she does not lose this amount consistently each week. Jenny warned that her weight frequently plateaus. Translated into stones, Jenny has lost 3.75 stones. Jenny has reduced from a Size 26 to a Size 22 (pants) and Size 20 (shirt).
Jenny said she is happy with her progress, and admitted that if she exercised more she would likely have lost more weight. However, her living situation precludes 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
Jenny has now lost 30kgs since deciding to have gastric sleeve surgery. She lost 6kgs prior to the surgery and 24 kgs since. She believes she has reduced three sizes. Her shirt sizes are reducing faster than her trousers.
Jenny said that she tends to lose 3kgs in a week, and will then plateau for several weeks. She finds the irregular weight loss trends frustrating.
Jenny said that foods tastes different. Sweet foods taste sweeter, and fatty foods taste oilier and fattier and have become unpalatable. Essentially the taste changes have 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 feels full so quickly and vomits if she eats too much in a short period or eats too quickly, that this manages her eating. Jenny said that because she has had the taste of food and feels full she doesn’t miss eating.
Jenny said she still has reflux but said that it is not as bad as it was. She is only occasionally using nexium and finds that she now only gets reflux every second day.
Jenny said that other people were commenting on her weight loss frequently.
She was pleased with her decision to opt for surgery.
Watch this blog for more information on how Jenny is going.
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