Am I making the right decision?

[TBH183 6]

To begin with - this is very difficult for me to do. By that I mean talking to strangers about something I'd much rather ignore. This path however, is no longer open to me and if I don't do this now - it'll never get done and by that I mean serious weight loss and the route to achieving it.

I'm not sure how familiar you good people are about how things work in the UK so a little background info is unfortunately necessary or you'll think I'm just barmy! Which may be the case but I don't want to frighten you too soon.

The NHS run a 4-tier programme that deals with tackling obesity with surgery offered at the end funded by the NHS. This is a one-stop option whereby if after surgery, the person regains the weight, a second chance is NOT an option. The NHS will only pay for ONE operation. Additionally, any cosmetic procedure to deal with flaps of skin post surgery is also NOT funded by the NHS.

I entered at Tier 2 which is a monthly series of appointments with an advisor to steer people in the direction of self-help. The Starting weight I've listed is my weight at the start of my Tier 2 journey. Ultimately it's more of a self help stage whereby you discuss options with the advisor and have monthly weigh-ins. The result of this is that I joined a gym near where I live and started going religiously. I also started looking at my diet and trying to come up with ways to cut down on calorific intake. My progress was slow but steady but I stalled at month 5 and after discussions with my advisor, was referred onward to Tier 3.

Tier 3 lasts from 6 months to a year and deals with all the psychological issues surrounding a persons relationship with food. It also provides additional support in the body of a dietician, an 8 week series of group sessions (which are compulsory) plus a follow-on seminar "Bariatric Surgery - warts and all!" which is also compulsory. Upon acceptance to Tier 3, the question "Are you looking towards bariatric surgery at the end of this process?" is asked. If you answer no, then you can still go through the programme but surgery is taken off the table and if you request surgery at a later date, then you have to repeat Tier 3. Another part of this stage is that you have to lose between 5% and 10% of the starting bodyweight to even be eligible for surgery. For me that equates to losing between 30lb and 40lb.

I'm currently half way through this stage, completed the group session and attended the seminar and at my last appointment with the dietician at the beginning of May had lost 10lb since February. I started writing a food diary at the beginning of the Group Sessions and my dietician recommended between 1800 and 2200 calories a day. This has helped reduce portion size and focus my mind on just how much I am eating and of what - most beneficial even if really inconvenient at times (both in terms of writing the thing and of what it reveals).

I've since joined a second gym so that I can continue my exercise regime (mainly cardio) before I start work. I work shifts - 12 hours, days and nights, 14 shifts in 28 days. This has allowed me attend a gym from between 4 and 6 days per week. I don't attend when I'm on nights because sleep is also important and due to the nature of my job, I will not sacrifice more sleep than is necessary by getting up early just to go to the gym.

Tier 4 is the surgery itself with all that that entails. I have yet to investigate this in depth and quite frankly, I'm frightened to do so in any depth but basically requires collaboration between 6 different professionals including a psychologist and the main players in the surgical team led by the Surgeon.

So back to my original question: "Am I making the right decision?"

This question is more a way of focussing my mind on the whole topic of surgery.

The whole idea of going under the knife frightens me silly. I'm afraid of the process. I'm afraid that the Surgeon will dictate a different operation from that which I want. I'm afraid of the risks. I'm afraid that after all is said and done, it won't work. I'm afraid of what happens if I don't take the surgical option. I'm afraid of the dietary restrictions pre and post surgery. I'm afraid of what will happen financially when, if I opt for surgery, the whole process starts, as I will need to arrange time off for pre-op appointments at a location to which I will have to travel. I'm afraid of the next 30-50 years post surgery and the dietary restrictions over that length of time and will I be able to continue with those restrictions? I'm worried how I'll be able to do mundane things like food shopping post surgery. And I'm also VERY afraid if all other steps short of surgery don't work and I'm left with only one course left open to me.

I'm getting advice from a variety of sources. Close friends and my life partner say that if I can do it without surgery, do it that way. It'll take longer but would be more beneficial. My dietician is stating that having the op could seriously help with my Type 2 Diabetes (tablet and diet controlled) and potentially cure me of it (my current HbA1c, cholesterol, BP, liver and kidney functions are all good as were the results from my recent retinal photography). Also that I'd lose a lot of weight very quickly so any up-and-coming mobility impairments are mitigated before they even become a problem. This would also address my original concern - weight loss while there is still time to benefit from it. I have yet to speak to my diabetic nurse about it but I've an appointment with her in September so I'll raise it then.

In the meantime. I'm lost. I know of no-one within my acquaintance that has undergone this form of surgery to ask. It was suggested that I join a forum and get the story straight from the horse's mouth as it were. How did you good people come to terms with the implications of surgery? How did you cope with all the life changing decisions required by surgery? What advice did you get? Which did you follow and which did you discard? And why?

I'm not even sure that I'll get a response from you good people but I must try and get more information from those that have gone through the process and what the successes were and where the potential pit-falls are.

Thank you in advance and apologies for the length of this post.

Dave

[Joann454 1,329]

Dave, you'll get a reply. Possibly lots of them. Today is a holiday in the US so maybe they'll be slower coming than normal.
I'm very new to sleeve surgery. I was sleeved a week ago today.
I came to this decision because ever since my thyroid crapped out me I have been unable to lose weight unless on a severely restricted diet which is hard to do with a normal size stomach. I shared so many of your fears. I asked myself, even if I could lose the weight would I keep it off. I've been doing this for years. I decided it was unlikely and that I needed help. The preop and post op phases are difficult but they're temporary.
I'm following my Drs orders (except I want to use straws but we'll see)
I'm not sure why the Dr wouldn't let you decide which procedure to get. Unless you have GERD. Although I've read the bypass is better for diabetics. Which are you leaning toward?
I hope vets answer a lot of your questions as they can speak to further out in the process. Best wishes.

[TBH183 6]

Thank you for your quick response and thanks for letting me know about the holiday in the US.

I'm not sure what a GERD is so will have to Google it.

The Surgeon will have final say over which type of surgery I go for - if I finally opt for it. As the op will be funded by the NHS s/he will opt for the one that is most beneficial to me - in their opinion - taking into account everything health-wise that relates to me. That decision will be made after various appointments with psychologists, nurses, dieticians, etc. so we're a long way from that point. Of the 3 types of surgery offered (Sleeve, RNY, can't remember the other one), I would personally opt for the sleeve but may be over-ridden later. The 2 week milk diet pre-op is a bit daunting though as is all the pre-planning and cooking for post op meals (if you can call mush a meal).

[PatientEleventyBillion 851]

We can't say if you're making the right decision, that's all on you in knowing what's best for yourself.

[Joann454 1,329]

Yeah. Google GERD if you have it the sleeve isn't a good option. Both procedures are wonderful though. You will lose on either and each have their pros and cons which you'll learn about no doubt.
Don't give up your only chance to do this. You can always change your mind at the last minute if you decide not to do it. It's a wonderful opportunity. Then you can learn all about the procedures and life after them. It's a rare person who regrets surgery. They do exist though. I wish you well on your journey.

[TBH183 6]

Thank you Joann.

I googled GERD and I don't have that.

[James Marusek 5,244]

I had RNY gastric bypass surgery 4 years ago because my obesity was beginning to seriously affect my health. I had Type 2 diabetes (using 2 prescription medicines to control), high blood pressure (another 2 prescription medicines to control), severe acid reflux (GERD), sleep apnea, and frequent urination problems. When I left the hospital 2 days after surgery, I was off all my blood sugar meds and haven't taken any since. Around 2 or 3 weeks after surgery, I was off all my high blood pressure meds and haven't taken any since. So I am pleased with the results from surgery. What I found astonishing is how quickly the weight came off after surgery and how quickly the medical issues were put to bed. This photograph shows you what 6 months can do.

[catwoman7 11,212]

I gained and lost the same 50 lbs for years and years and had over 200 lbs to lose. I knew I'd never be able to do it if I couldn't even lose and maintain a 50-lb loss. Plus I wasn't getting any younger (I was already in the 50s). Luckily the only obesity-related issue I had was early onset arthritis, but I knew if I didn't get the weight off, all those other issues would be just around the corner. Plus I had visions of having a massive heart attack or stroke when I was far too young to die just because of all that excess weight. At some point I realized surgery was the only way I could get it off once and for all.

I did a lot of research before I had it - plus I attended several orientation sessions and post-op support groups to get as much information as I could. I also joined forums, as you did, and read everything. By the time I had surgery (two years ago), I was very comfortable with the idea and eager to proceed.

I have lost 236 lbs and now have a normal BMI for the first time in my life. I have not felt this good in years. I am SO happy I had this surgery and would do it again - in fact, I'd do it every year if I had to. It's given me my life back.

Yes - you will have to restrict your eating for the rest of your life. That's the only way to get weight off. You need to be OK with that before consenting to surgery. You will have to make some significant changes to your lifestyle, or it's not going to work for you.

Complications are not common with either surgery, and most are minor and/or preventable. These surgeries are now so commonplace and so many advances have been made over the years that they are among the safest surgeries out there - safer than a knee or hip replacement, for example. Mortality rate on the bypass is 0.3%; it's even lower on the sleeve. That means you have at least a 99.7% chance of surviving - those are some pretty good odds!

I cannot recommend this surgery enough to people who need it - but I also know that you need to be in the right place mentally to do it. It involves work and a radical change in your eating habits. There are also rules you need to follow for life. I sometimes say I wish I'd had this surgery 20 years ago, but then again, I'm not sure if I was in the right mindset to be successful back then. I think I had the surgery at the right time *for me*.

Read forums, read books, read things on the internet. Become very informed about the surgery and "talk" to people who've had it. You're doing the right thing by joining this forum - join even more, and read, read, read. I read everything I could get my hands on before taking the leap. And I am so glad I went through with the surgery. It was one of the best decisions I've ever made.

Edited May 29, 2017 by catwoman7

[OutsideMatchInside 10,166]

I'm kind of excited because I just watch an obesity documentary about the NHS discriminating against the obese, so I knew all the tiers!

Get the surgery. First of all, you are never going to get this chance again on the NHS. You are lucky to be this close now. You will never be any younger than you are right now and the longer you wait the more damage you do to yourself. So unless you think you can afford to self pay at some point in the future, get surgery now when it is available to you.

Secondly, every single day you are obese you are straining and damaging your body. Sure you can lose on your own, we all can, but can you keep it off. Forever, easily. Even people that regain after losing, usually don't regain it all. Even if they do, the time they were smaller was still a break to their body. Your other medical issues would be resolved in a couple months.

My diabetes was well controlled with a couple pills a day and a low carb diet. Within 2 months of surgery I was completely off meds.

I wouldn't roll the dice with the NHS, if you can have surgery now, have it, you won't get the chance again.

[Sherrie Scharbrough 311]

Hi Dave, I had my RNY July 2 2013. Before I discuss my weight loss story I was insulin resistant and had diabetes for 30 plus years. I took 100 units of Levermire twice a day plus 500mg of Meteformin twice a day. Without getting my sugars under control. I took 12 different medications. Now I take 4 with three of them for high blood pressure. I really wanted to be off those too but I just don't know how to unstress myself. If you figure it out let me know. I am able to get out and walk. I walk 3 to 4 miles 3 to 4 days a week. Which I also have Fibromylgia, Osteo arthritis, Psroriatic arthritis also. All I heard from my DR's was exercise will make it all better. But...how can you do the exercise when you are in pain and it makes it worse to do it. It kind of just goes to the wayside for sure. It defintly helped me with my pain levels I'm not saying I am pain free but to be able to get out there and feel so good about what I am doing is a blessing for sure. Now here are my stats: HIGH EST WEIGHT 249#s (this time I managed to lose from 285#'s before on my own) SURGERY WEIGHT 232#'s LOWEST WEIGHT 117#'s CURRENT WEIGHT 125#'s!! The best thing is I lost 132#'s in 6 months. I did gain 8#'s back but I have maintained my 124# loss for 3 and 1/2 years. Still going strong. I won't say that I wish I would have had it sooner because I was not ready for the work it takes as WLS is a tool!! We have to do the work. Would I do it again YES YES a million times YES!!! Now you and only you with the help for your Dr can decide which surgery you need to do. Good luck and I am sorry I wrote a book. Keep us posted and I look forward to following your progress!!

[2ndSpring 350]

Hi Dave,

Welcome to the forum. You are asking all of the right questions (not everyone does) and thinking about the small details and how it will impact your life. This is definitely something to go into with your eyes wide open. The better educated you are, the more successful you will be.

I'm about 8 months out and I wholeheartedly recommend it. I wish I had done it years ago. I wasted so many years being overweight and waiting to do things until i was thinner. The surgery stopped my body from fighting me and allowed me to focus on changing my mental issues around food. It is much easier to adopt new mindsets when your stomach isn't screaming to be fed.

There are foods I have given up permanently, but i don't miss them. I also don't miss overfilling myself. I am able to eat out in restaurants and no one has noticed i eat so much less than them. I eat slowly and put the fork down between bites, so I wind up finishing at the same time as everyone else.

All in all, it has been a great experience.

Best of luck and keep us updated.

[Firefeather83 15]

Hi Dave,

i am a month out out from my sleeve. I am struggling every day but don't regret anything. I know I need to put the work in to get the results I want. You can do this just like I can do this. I made the right decision for me and you can too. Don't look back, just look forward.

Megan

[TBH183 6]

Thank you each for your replies thus far. It is certainly giving me much more to think about.
Up until now I was vehemently opposed to surgery of any kind but perhaps I was a bit premature in that. I'm still not sold on the prospect and probably will never be entirely comfortable with the notion of surgery to solve my problems - it just seems too easy and I was always told if something seems to good to be true then it usually is.
I think I need to sit down and do a full and frank cost/benefit analysis and have further talks with family.
And both of those tasks fill me with dread! [emoji43]

Sent from my F8331 using BariatricPal mobile app

[Firefeather83 15]

Dave,

i was also scared about the surgery and it being "too good to be true". To be blunt, whoever said this is the easy way out was on crack. This is not easy. This is only a tool to help you get what you want. If you don't do the work, (changing habits, stop emotionally eating, becoming an active individual etc) then it will not work as per your expectations.

For example, my dad is 6'9" and pushing 550 lbs. He got the gastric bypass surgery. Did great for 2 years. Dropped all the way to 250 lbs. then he became an alcoholic and is now as big or bigger than he ever was.

It it was my biggest fear doing the surgery to be like my dad. To sabotage myself and not let the tool work with me to be successful and let me tell you, this is a whole brand new life for me. A whole new way of trying to deal and make better habits. Some days I make progress and some days I don't.

i think your family will be more supportive than you may imagine. If there are individuals who are not supportive or detract from your goals, choose to spend your time with those that are supportive of you.

You are are choosing to make a change in your life. Don't let fear stop you.

Megan

[Navigating the Wilderness 824]

Hi Dave,

I am going to take a slightly different tact than most on here. Yes, I think you are best served getting surgery. To put it in perspective, I never had a problem losing weight, ever. I needed help with keeping the weight off once I lost it. To me that was what the surgery was about. Not doing it so I could lose weight, but doing it so I could lose weight and keep it off. I have been very happy with my surgery.

What I wanted to encourage you to do was not focus on IF you should have surgery, but focus on what surgery gives you the absolute best chance at losing and keeping the weight off. Since you only have a one-time shot at it, you need to make sure you choose the surgery that is best for you. I am not arrogant enough to tell you which surgery is best for you, but I would encourage you to ask all groups here what they think. It is an amazing journey.

All the best!