So Weight Loss Surgery makes you Happy? - Paul Nicholas

So Weight loss surgery makes you happy? My first year with gastric bypass surgery.

I am Paul, I had RNY gastric bypass surgery on first of February 2018.

Has weight loss surgery made me happy? The short answer is no, want to know why then read on.

The build up to my weight loss surgery was a long one. The process from initial referral to completion of the gastric bypass surgery covered almost four years. I live in England and was lucky enough to be afforded my procedure by the NHS, National Health Service. Almost four years sounds along time and at thetime it was, it is only on reflection that I am aware of why the process can take a while, to enable us to get the most out of our surgery.

The NHS pathway is split into two sections, Tier three, getting assessed for compatibility with surgery and Tier 4 having surgery and post operative care.

After initially meeting the surgeon on September 19 2017, I was placed on the surgery list and given a date for surgery of December 5 2017. Two weeks prior I was to follow a LRD, liver reduction diet, consisting of four pints of milk or eight low fat yoghurts per day. After following this for two weeks I was called on December 4 and instructed not to come to the hospital as there were issues with bed space. I was called the next morning December 5, my birthday, and informed that surgery would not go ahead. I was given a second date of January 2 2018. Two weeks prior all over the Christmas and New Yearperiod I followed the LRD again. I attended the hospital on January 2 and again my procedure was cancelled due to bed pressures. I was then given my third date February 1, again I followed the LRD and this the third time my gastric bypass surgery went ahead. Third time lucky. So that was the build up. I was discharged from ICU just before 0900 on February 2 and away I went left to get on with my RNY gastric bypass surgery. 

The first couple of weeks passed with nothing more than exhaustion and a little discomfort. That said within four weeks I was beginning to feel very low in mood. Previously to having my gastric bypass surgery I had been prescribed Sertraline / Zoloft I continued to take this medication post operatively in liquid form although I had began to feel that I was withdrawing from the medication, on that I visited my GP who increased the dosage, things still did not improve. I was feeling incredibly emotional, erratic and distressed. The GP then suggested lowering the dose of Sertraline then moving to another medication called Mirtazapine/ Remeron. My mood continued to suffer, at my six week post operative check up I first brought to my nurse’s attention that I needed help mentally. Physically I felt great but mentally was becoming increasingly dark. The initial referral was made to the health psychologist on March 21 2018.

During April I started the Mirtazapine, things felt worse, a lot worse the GP twice increased the dosage hoping for success.  Between this time and the middle of May I experienced some of the most mentally, distressing, disruptive and damaging times ofmy life.

Every day I awoke feeling worse, my mood was getting lower and lower I was becoming snappy and emotional. Everything was making me cry, I could cope with nothing. I was shutting down, out and off. The more time I spent alone the more I found my self dwelling on my situation. Then to kick me while I was down all weight loss stopped, feelings of failure were soon visiting my troubled mind. I am a failure, even a bypass and I cannot loose weight. I will be like this forever, I hate myself more than ever before. I have always had issues with self worth but now I was being met with new lows. 

It is around this time that I began contemplating terminating my miserable unfilled existence. I would sit for hours considering overdosing on drugs, hanging myself, throwing myself off of cliff tops, walking into traffic or in front of a train to name a few. I just wanted this pain to end. Throughout these dark times my nephews got me through along with mum the impact of my actions on them was too much and stopped me acting on these thoughts. I became more distressed unable to do anything trapped in this cycle between suicidal and guilty, wanting to die but not able to act upon it. I began to consider ways of dying accidentally. Things were bad very bad. 

On May 2 I saw my bariatric nurse again, I was all over the place. I had lost no weight at all since being on mirtazapine and my head had almost fallen apart. In the appointment I kept crying, ranting and not making sense. My nurse was very helpful, he calmed and reassured me. He made a referral to the pharmacist for assistance and chased up the psychology appointment I was waiting for. My nurse also recommended going back to the GP to begin the process of coming off the mirtazapine. Researching I found later that this medication is unsuitable for use in weight loss surgery patients. The GP and pharmacist decided that Fluoxetine / Prozac would be the next medication to try. Within a couple of weeks of being on fluoxetine the darkness began to shift as well as the scale.

On June 4 I had my first appointment with the health psychologist, Tim. I talked with Tim about my unhappiness, my anxieties, and my visibility issues. People commenting on my appearance, this poor lady complimented me on my weight loss and I broke down. I saw Tim again the next week and we commenced my treatment. Tim recommended working on my issues of unmet needs as not only had I the issue of ineffective absorption of the medication I also could not use my usual method of comfort, to eat, as my gastric bypass surgery meant currently this avenue was unavailable. I confessed to Tim my fears of transferring this addiction to something else equally destructive. Tim recommended working on the unmet needs as these are what the addiction are trying to fill. 

In late June I started experiencing upper right gastric discomfort, stabbing pain under the ribs, which the GP believed to be gallstones. My dosage of fluoxetine was increased and the pains got worse. I was referred for a scan which found no evidence of gallstones. The GP then wrote to the psychiatrist for advice, wanting to avoid an unnecessary medication change. I also attended my six month check up where the nurse commented that I appeared better mentally. I thanked him for his kindness. 

The psychiatrist came back to the GP in September, suggesting that the fluoxetine was the most likely cause of the continuing pain. The suggestion was to terminate the fluoxetine and commence Venlafaxine / Effexor at this time I was not keen to do this, the suggested medication belongs to the same class of antidepressant as mirtazapine. I feared returning to those dark times of earlier that I had really only just got through. My GP tried to encourage me but I was just not ready.

As October closed my mood and quality of life had started on a downward spiral again, I fortunately noticed as I had begun shutting myself off again. I visited the GP who again suggested transferring to Venlafaxine, I reluctantly agreed. I had to reduce the dosage of the fluoxetine first and this took all of November, the dose lowered and my anxieties started to fly through the roofthe GP prescribed diazepam to assist with the transfer period. The GP then also advised taking both fluoxetine and venlafaxine together for the first two weeks as I was mentally unwell and Christmas was approaching and I needed to be able to be around people. Luckily the suggestion to take both helped and I got through this period and was able to be comfortable around people. Since discontinuing fluoxetine the abdominal pains have subsided, and venlafaxine is having a positive impact along with continuing psychological support. 

My first year with my gastric bypass has certainly not been easy or made me happy it has been the most testing and emotionally unstable year of my life, that is the truth. Family and friends expect me to be happy and question why I am not. “you look well" is a common comment if only they could see inside. The struggle mentally has been a real challenge one I grossly underestimated. Physically everything has been great and even with the medication issues I have still achieved a fifty percent excess weight loss which I am delighted about. I currently still have appointments with the psychologist and I continue to battle the demons. I just wish I had realised pre surgery how mentally prepared I really needed to be to go through this process. Even without medication changes this can be a very turbulent journey, the medication changes made it even more so.

Without the support I receive from the Bariatric Support Community the worst twelve months of my life would have been a lot more dire. The people have really helped me through those darkest of times. 

All that said, Do I regret my procedure? No I don’t, also weight loss surgery will not make me happy I have to do that, it is only now that I realise that. 

Going forward, I am around 35 pounds from target, and feeling much better in myself. My confidence is growing slowly and my issues with how I look are easing. I am now looking forward to a much brighter future heather and happier. 

Thank you for reading 

Paul

Paul@thegastricguru.com

Instagram.com/rnypaul