It's been awhile

Wow it's been awhile... things have been happening at a fast and furious pace.. my life has changed so much. I now weigh.. weight for it (yes the spelling is deliberate) 156kgs... That is a grand total of 33kgs from my op and 46 from my heaviest!!!!!! Can I just take a moment to jump around for joy!!! once again.. 33kgs in 4 months.. it is huge!!!!! I look great and I feel amazing. That isnt the only changes in my life. I am now in a relationship with the most amazing person and so in love. I have a new job which I start in 2 days.. so things are happening in my life and all for the better. I have noticed though in the last few days my hair has been falling out in clumps.. apparently its normal.. Taken from a very helpful blog: Gastric Bypass truth the skinny on life after weightloss surgery: "Why We Lose Hair After Weight Loss Surgery



First of all, everyone loses hair every day as part of the natural cycle of hair growth.



But after weight loss surgery, our bodies are forced to live on drastically lower amounts of calories. To compensate for the reduction, all the remaining nutrients are channeled to the organs that need them most. And our hair isn’t one of them.



So suddenly, our hair must do without the nutrients it needs to grow. And it also has to compensate for that loss. It sends more strands into “resting” phases and temporarily suspends production of new strands.



Not to mention the fact that hormones go haywire after surgery and while all that fat is being metabolized. That just doesn’t help matters.



The upshot: hair starts falling out."

So there you have it... I just need to up my protein, be good about taking my vitamins... and maybe use some hairloss shampoo...
oh well...

Yes! I can eat sushi..... Oh wait, no I can't!

So I have been stressing about my plateau, but I went to the Dietician on Monday and I had dropped 3 kgs, so exited! I felt great. So now I weigh 174kgs, which amounts to 15kgs post surgery and 28kgs from my heaviest weight. Then we were discussing this past week. I told her about my first episode of dumping syndrome... It not fun, trust me. I was out with friends and ate off the platter in front of me. OBVIOUSLY a beeeg mistake. I had such bad tummy cramps.. basically I was out of commission for several hours... Not fun.. So the dietician says to me, well if you are out you can have sushi, limit it to 4 pieces of a roll and some sashimi. So the first thing I did was at lunch I rushed out and bought myself a californian roll and 2 pieces of sashimi.. I had two pieces of the roll which walking to my car. As soon as I opened my car door, I bent over and the sushi came straight back up. Yuck. Then drove a little further, at the robots, car door open, wommitting again... then as soon as I got back to the office, I ran to the bathroom and a little more came up. So clearly I cannot eat sushi. Pity. But that experience has killed any craving I had for it. sushi is dead to me... (okay maybe not - but definately for a long time)...
I had my first session with the personal trainer yesterday too. That was fun. I worked up quite a sweat and really enjoyed it... (SHOCK GASP HORROR) I never thought those words would come out of my mouth. Yes I enjoyed exercise. wow. sorry having an epiphany here. exercise used to be evil, and since I have lost a small child in weight, its not that bad, and hopefully the lighter I get, the easier it gets.
I also went to the support group meeting. It was my first one post op, It was quite a bleak one, because they had a counselling session for everyone because my surgeon has been diagnosed with pancreatic cancer and its a poor diagnosis. It's quite a shocker, so if you can please keep him in your prayers. But what shocked me more were post op patients who were a year post op and had only lost 30kgs so far. I nearly fell over.. I am planning on having lost 30 kgs by the end of may... 50 kgs by the end of july and all my weight by feb next year. I have made a chart tracker and exercise features heavily in that equation because that is something I have learnt, diet helps but exercise loses the weight. I did a little exercise last week and 3 kgs went bubbye... so theoretically if I move my ass for a min of 30 mins a day, 5-7 days a week, a poo-load more weight will fall off me never to return again... whoop whoop

Plateau Shock Horror Gasp!!!!!!!

This was my reaction: "Seriously?? WTF??" but sadly yes, my weightloss has slowed to a mere trickle. 1kg a week is not good enough! I go through all this trauma, sacrifice and hassle to lose a kg a week. Ive been a good girl, eating my soup and yogurt adnauseum enough is enough. I went to go see my dietician. She says more than likely it is a reaction to losing so much weight so quickly, my body has gone into a type of shock where its trying desperately to hang on to every last ounce... stoopid body, doesn't it know the fat isn't wanted here. Out Damn Fat Out... So what the lovely Lady did for me is to increase my food to 6 times a day, and give me more variety such as Mince Yippee whoooooohooooooo I am dancing a jig... and tuna mayo with tomato, soft boiled egg, scrambled egg, yogurt with bran in it, cous cous. (I used to hate cous cous, I will embrace the cous cous because it is not liquid!!!! Also she said I was more than likely retaining fluid due to the blood clots that I developed... So my water needs to be increased, and I need to get moving. I am meeting with a personal trainer today to get my A into G... So we will see. My next appointment with her is next tuesday and I hope to see a beeeeeeg jump on the scale.. let us cross fingers...

What is Gastric Bypass Surgery

Basically this picture says it all... but if you want a specific detailed description... here it is (Copied from Chrysalisclinic website) : Hybrid Restrictive & Malabsorptive Bariatric
Procedures: Roux-en-Y Gastric Bypass Cesar Roux, a renowned Swiss surgeon, described the Roux-en-Y technique about a century ago, long before bariatric surgery had ever been contemplated. Basically, it makes use of a segment of proximal jejunum to function as a conduit to drain various parts of the upper gastrointestinal tract into the small intestine, thus ‘bypassing’ part of the gastrointestinal tract. Usually when this technique is employed in non-bariatric surgery, the loop used as conduit is about 40cm. In bariatric surgery the technique has been modified by making the Roux loop 120-200cm long.



The Components of the Operation
This Roux loop is anastomosed at its upper end to a very small pouch constructed from the upper end of the stomach and at its lower end, usually 150cm distal to the upper anastomoses, to the proximal jejunum where the bowel was divided to construct the Roux loop. (An anastomosis is the point at which two parts of the gastrointestinal tract are joined, in such a way that there is an opening between the two.)
The operation, therefore, comprises a small gastric pouch of 30-50ml capacity and a 150cm long Roux “alimentary” limb of small bowel that acts as a conduit for food from the gastric pouch to where bile and pancreatic juice now enter. As a result, ingested food is now only exposed to the digestive juices much lower down the small intestine and the length of bowel in which digestion of food and absorption of the nutrient components is greatly shortened.
The small gastric pouch has a restrictive function.
The long Roux loop adds a malabsorptive component, because food in that length of small intestine is not exposed to the digestive enzymes from the pancreas or the bile that facilitates digestion by those enzymes.
In addition, because the fundus of the stomach is by-passed, secretion of the hormone ghrelin that stimulates the appetite centre of the brain is greatly reduced and appetite is duly suppressed.



The Execution of the Operation
The mechanics and physiology of the operation were worked out long before laparoscopic surgery was developed.
In those days the operation was done via a laparotomy, using a large incision in the abdominal wall to obtain access to the stomach and intestines. Of course we can still do the operation in this way and, if for any reason laparoscopic surgery is not feasible, the laparoscopic operation can be converted to an open laparotomy or the surgeon can plan to do it open from the start.
Laparoscopic surgery really began in a big way in the early 1990’s as a result of technological advances in video cameras, etc. and the consequent development of instruments and techniques to do operations that previously were all done open.
Laparoscopic surgery involves making 4-6 small (5-12mm) incisions in the anterior abdominal wall, through which plastic or metal ports are inserted into the abdomen. The abdominal cavity is distended by insufflation of carbon dioxide gas into the abdominal cavity.
Then, a telescope connected to a light source and a video camera is inserted into the abdominal cavity through one of the ports. The surgeons, looking at a video monitor, are now able to see clearly inside the abdomen. The view is very well illuminated and magnified. However the field of vision is small and depth of field is lost because they are looking at a two-dimensional image as opposed to the three-dimensional vision they would see with their own eyes at open surgery.
The next step is to insert the instruments through the other ports. These instruments have very long shafts and very small working parts. The assisting surgeons hold the camera in position and retract tissues to give optimal visibility and exposure to the operating surgeon.


The Steps of the Operation
1. We first construct the small gastric pouch:
We identify the oesophago-gastric junction (OGJ) and mobilize the fundus of the stomach off the diaphragm.
Then we identify a point on the lesser curve (right edge) of the stomach 5cm below the OGJ and we cut through the attached fatty tissue to expose the posterior wall of the stomach. Once into this space (the lesser sac) we cut any attachments of the stomach to the pancreas.
We now insert a stapling device and place it across the stomach at right angles to the vertical axis, close the jaws and “fire” it. This cuts across the front and back walls of the stomach and staples the front wall to the back wall.
We complete the construction of the pouch with further firings of the stapling device from the end of our first staple line to the angle of His, the angle between the left side of the oesophagus and the fundus of the stomach.
During all this we take great care to avoid damage to, especially, the pancreas, spleen and oesophagus.
2. Division of the Omentum and Gastro-colic Ligament
We now find the lowest part of the omentum, a large “apron” of fatty tissue that hangs off the transverse colon.
We cut through the omentum, at right angles to the transverse colon.
After exposing the transverse colon we proceed along the same trajectory through the gastrocolic ligament, another fatty membrane that connects the greater curve of stomach to the transverse colon.
This is done to create space for the small bowel to come over the colon and bypassed stomach.
3. The Gastro-Jejunal Anastomosis
We now lift the transverse colon to find the duodeno-jejunal flexure and then grasp the proximal jejunum and bring it up over the front of the transverse colon and the lower part of the now-bypassed stomach
When we are satisfied the jejunum is lying comfortably and can reach the gastric pouch without tension we make a small incision in the loop of jejunum and another small incision in the staple line of the gastric pouch.
We insert one jaw of the stapling device into the lumen of the jejunum and the other into the lumen of the gastric pouch and when we are satisfied both are well into their respective lumens we close the jaws of the device and fire it. This results in a side-to side anastomoses between the gastric pouch and the jejunum.
After removing the device an opening is left, which we close by suturing the hole transversely to avoid causing any narrowing.
The anaesthesiologist pushes a nasogastric tube into the pouch while the surgeons watch to make sure it does not damage any staple lines. The anaesthesiologist then injects a blue dye while the surgeons occlude the jejunum to check for any leaks. If there is a leak it is repaired with a suture. If there are no leaks the anaesthesiologist advances the tube into the efferent (alimentary) limb and fixes the tube to the patient’s nose.
4. The “Y” Jejuno-Jejunal Anastomosis
We now measure out the 150cm alimentary limb in 10cm segments.
We then stitch the intestine at the 150cm mark to the proximal jejunum between the duodeno-jejunal flexure and the gastrojejunal anastomosis.
We make incisions in the two loops of bowel we have now aligned side by side and we anastomose the two, side-to-side, by suturing the one incised loop to the other incised loop.
5. Completing the Roux loop
The short segment of proximal jejunum between the gastrojejunal and jejuno-jejunal anastomoses is now exposed and divided by placing the stapling device across the bowel and firing it.
6. Closing the Mesenteric Windows
In constructing the Roux-en-Y bypass we create a window between loops of bowel. Other loops of bowel could, potentially, slip into this window and become obstructed. We, therefore suture the mesenteries of adjacent loops of bowel to each other to close this window.
The Post-operative Period
The standard practice is for the patient to be taken back to our GIT Ward after the patient has recovered from the anaesthetic. Only if the patient is at particularly high risk for cardiac or respiratory problems does he or she go to the high or intensive care unit.
In the GIT Ward the patient will have a nasogastric tube (in the nose), a tube in the bladder (urine catheter) and a drip in the arm.

As soon as the patient is awake enough the physiotherapist will get him/her out of bed and for a walk. This will be repeated later in the day.

On the following day, if the surgeon and critical care physician are satisfied that all is well, the nasogastric tube and urine catheter will be removed and the patient will be allowed to sip small volumes of water. If the patient tolerates this well, the volume of the liquid allowed is gradually increased.

The staff keeps a close look-out for any problems developing and if things do not go smoothly blood tests and or X-rays may be done. If the surgeon is concerned about a leak or bleeding he may decide it is necessary to take the patient back to the operating room to be re-explored.

If all goes well and the escalating volumes of oral fluid intake are tolerated, the intravenous fluids are discontinued and a liquid diet is introduced.

Usually after 2-3 days the patient is ready to go home with some pain-killers and some iron and vitamin and mineral supplements. In many diabetic patients their diabetic medication requirements are greatly reduced from early after the operation.

For the first month the patient is strongly advised to only drink liquids and pureés to avoid any risk of the staple lines holding the newly re-arranged gastrointestinal tract from disrupting.

The patient is encouraged to keep in regular contact with the dietician to ensure he/she is taking enough protein, water and fibre and does not become constipated.

Unless there are problems with the wound or anything else relating to the operation the patient usually sees the surgeon for a check-up after 3-4 weeks, as well as the endocrinologist to review the status of the blood glucose and lipids blood pressure, etc.




For more information look up www.chrysalisclinic.co.za

Disaster strikes

Friday I was feeling great and went for a looooong walk from my house to the nearest shopping centre and back. Saturday I was still feeling good and went to a friends hen party, that night I started feeling a little niggly (you know the feeling when something doesn't feel right) I just put it down to overdoing it at the hens party. Sunday I started feeling bad, I was super tired, I had pains in my chest, which radiated up into my arms and pins and needles in my hands. I hardly slept that whole night and was up at 6am because of the pain. Now those that know me, will understand that this is so wierd! I was clammy and sweaty and I couldnt breathe properly and walking even short distances caused me to get out of breath. at 830am I phoned the Chrysalis Clinic Coordinator, the sweetest person ever, Gill Gibson. She said to me, hang on, I will phone you back in 5 minutes. She called me back straight away and said that I must go see my hospital physican Dr John Turner at 10:30am and if it got any worse between now and then to go straight to the emergency room. (so don't panic then?) The problem was, I live with my dad who had conveniently gone away for 2 days for business. Crapeola!!! So I phoned my aunty carol to come and take me to the doctor. My dad had phoned our neighbour Dorothy who has a key to our house. She came over to check on me... I obviously didn't realise how bad I looked. I went to the doctor and he first did an examination, then he sent me for a chest xray which was inconclusive. Then I went for something called a D-Diner blood test to test for a pulmonary embolism. Dr Turner informed me though that more than likely it would come back positive because Ive just had surgery, and if it came back positive we would have to treat it like an embolism. The only certain way would be a ct scan with contrast but I cant have that because I wont fit on the scanner. His secretary obviously heard this and phoned the Xray department and they said no of course I can I am way under their weight limit of 300kgs. So I toddled off to go have a ct scan. It took forever but eventually it came back, and guess what. DING DING DING we have a winner, not one, not two, not three, but four clots in my lungs... Yippee.... NOT!
Straight to the ward, do not pass go, do not go home and pack a hospital bag. Whoopdioo... Luckily I was put back in my old room with the nurses that I knew. I had to have clexin injections, not one, not two, not three, but four a day. 120miligrams twice a day... my thighs looked like pin cushions. It was insane. Then I started on warfarin tablet on the tuesday. I was finally discharged on saturday morning. Hospital is boring when you feel well. I am now on warfarin tablets every day for the next 6 months. :( but its a small price to pay.

First week in hospital

The first pic is of my bandages on my legs, I needed to wear compression bandages on my legs to prevent clots. The second pic is my first meal, The third pic was my first 'solid' meal, as in full liquids. The fourth pic is of my hospital tags. Waking up in my room, my dad, sister, and aunty Carol and a good family friend Fern were there.. I was so tired, I had an awful nasogastric tube in to drain the blood from my stomach, an oxygen mask on and a catheter in... oh and my drip.. wow... I must have looked like a disaster. (Can you picture it) I also had six very small cuts in a half moon shape on my tummy, but I was so out of it, I was so hot, my aunt was sponging my face down, and somehow I managed to pull my nasogastric tube out.. Murphy's law! Only I could manage something that stupid. The nurses came and got me out of bed and I had to walk to the door and back, not too far (luckily) Then they sat me in this reclining chair in the room. The physio was there to give me breathing techniques.. they put the tube back in, but to be honest most of it was a blur, the silly fools gave me a self dosing mophine drip, he he he, I so abused that drip! (evil grin) They (the nursing staff and physio) wanted me to sleep in the recliner, but at 11pm I just couldnt do it anymore and asked if I could go back into the bed. I really needed to stretch my legs out. I cant sleep upright. its impossible. The nurses wouldn't let me, so I got so upset I was crying, and pushing my blood pressure up so eventually they relented, but I had to sleep with the upper half of the bed elevated. Which I did. It was so much better. The next day, they gave me a little bit of water to drink, and then kept increasing it a bit. eventually I got to 100mls and then they took the nasogastric tube out. The oxygen came off, then my catheter came out. I started walking up and down the corridor to keep active and get moving, hospital is quite boring after awhile. :) I had to get regular injections of a drug called clexin which is a blood thinner to prevent clots. On Wednesday my drip came out and then thursday I got discharged. It was such a good feeling.

before surgery

Wow... before the surgery I was feeling so nervous... but at the same time... I felt 'thank goodness its finally here.' It was such a short space of time.. it was hard to wrap my head around it. I had previously tried 3 times to have gastric bypass surgery but due to the medical aid refusing to pay and other issues it never happened. Then end of November last year my sister suggested I re-look at having gastric bypass. I phoned Gill Gibson to ask her about it, knowing that their offices closed for December I made an appointment for when they opened on the 10th of January. I also found out which plan of Discovery Medical Aid paid for the surgery and changed my plan over to that one. On the 10th of Jan I had an appointment with Gill Gibson, but because I had been on the programme before, I knew who I had to see, so I had an appointment with Claire McMahon the dietician, straight after seeing Gill Gibson.
She put me on the programme and it was a whirlwind of seeing the dietician, the endocrinologist, the psychologist, the psychiatrist, the biokinetist, the physician and the surgeon.
I had a gastroscopy and a chest xray and blood work done. I went on an exercise programme, and diet. I lost some weight... and this is all before I left for a holiday in disney on the 27th of January. Initially the date for the surgery was booked on the 7th of March but then the surgeon was going to be away, so it was moved up to the 28th of February. I went to Disney and gained 4 kilos in 2 weeks. Came back, lost those 4 kilos plus 3 more... and then all of a sudden it was the day before surgery... It was my friend Lesley's birthday and went for Drinks at Peddlars and then dinner at Tangos... it was a lovely way to have my 'last meal' :D
I had to have my meal and drink at 10pm... I went home took a sleeping pill and went lala's. In the morning the anethetist phoned me to check that I was ok. He said I could have a glass of half apple juice and half water before 8am... I ran myself a nice bath with lavender bubble bath and sat and relaxed. My hospital bag was packed and waiting. I got ready and my dad drove me to the hospital at 10am. I was checked in.. the nurses were so lovely... I put my sexy hospital gown on.. you know the one that you can't turn around in... I believe its the peekaboo model :) hehehehehe.
They were running late for the surgery so we waited and waited and waited... eventually I took my contact lenses out and the porter wheeled me down to the operating theatre. Gill Gibson was with me keeping me company. I waited in the recovery area outside the operating theatre for quite a while.. eventually I said I had to go to the loo.. so blind I hopped up and went to the loo... came back, made idle chitchat... then eventually it was time to wheel me into the operating room. I transfered over to the operating table. I took my arms out of the gown, so it was just draped over me, trying desperately to not think that in a little while everyone is going to see me starkers... Gill assured me that they keep everything except the operating site covered with sterile drapes. I joked with the anethetist and the nurse that I was there for my cheeseburger and milkshake... then the drip went in and the oxygen mask went on and that was all she wrote... lala land.