UBM - My Complications Part 1
DISCLAIMER: Weight Loss Surgery (WLS) is not for the faint of heart. My blogs will be no exception. The pictures at the bottom of this page are actual pictures/ x-rays from two of my procedures.
How about my most scariest of complications: My one and only dumping episode.
Dear god, I count my blessings there was only one! I gave you the definition in my previous blog which included a few symptoms. What I didn’t really dive into is that there are two versions, early and late dumping. One is more intense than the other. Early exhibits the symptoms I previously referenced, and late; well, that ones just a bitch. 10 out of 10 would not recommend. If you make it too late dumping, you my friend are royally ᗡƎꓘƆՈℲ. That's right - ᗡƎꓘƆՈℲ - Reason being that you've most likely eaten too much sugar, cream, fried food or just plain too much of something and your stomach said: “Nah bro! This ain’t right”. My late dumping episode didn’t start with any of the aforementioned. At least not in an obvious way. You see the night before, T and I went for dinner and I ordered a children's cheeseburger. I had half for dinner and saved the other half for lunch the next day. I made sure to not add ketchup and to only use a tiny bit of mayo to keep the sugar and oil to a minimum. I had every intention of eating the second half at lunch the next day; however, my co-worker Steve told me he needed my help on a sales call during our lunch break. Knowing that I had only had a protein shake on my drive in, I figured I would be safe to eat my left-overs early (somewhere around 10) so I could digest and be ready to head into the field during our lunch hour.
About an hour later, I started to feel nauseous. It was coming on strong and so I ran to the bathroom. By the time I got there, I was doubled over with severe abdominal pain and stomach cramps. I tried to sit down, but it got worse; I tried to lay down, but it got worse; I tried to lean to a different side, but it got worse. No matter what I did, the pain just kept getting worse. In fact, it was getting to be so bad that I was starting to have trouble breathing. I could only take small gasps of air. (Pretty sure this was when I went into full panic mode) About 15 minutes later, while still in complete distress, I started to sweat profusely and began to get confused. (Side note, this wasn't the time when we took our cell phones everywhere; like to the bathroom) I didn't know what to do. You know in the movies when you see the person who has just woke up from being drugged and starts crawling on the bathroom floor; they are soaking wet from sweating, looking like hell and completely confused? Yeah! That was me minus the drugging part! It was so weird. I was stuck in the bathroom, barely able to move or breathe, completely alone, and phoneless. The only thing I could think to do was to strip down to my bra and underwear and lay down on the floor where the tile was cold to try to cool down. Shortly after, our receptionist, Bryanna came looking for me. I told her I was scared and to go get John, our office manager. I know that sounds weird but, John and I were friends and I knew his girlfriend was a WLS patient and he would know what to do. Sure enough, I heard his British accent:
John - “Meeeee-shell, what’s going on, love?”
Me - “John, I'm dying, aren’t I?”
John - (chuckling says) “ No mate, you’re dumping. Give it, I say, about 10 more minutes. You’ll be fine”.
I’m not kidding when I say that I was in a delusional state of mind at that point. I was convinced I was going to die. But, he was right, 10 minutes came and went (didn't feel fast at all) and oddly enough, the pain and sweating just stopped. It didn't taper off, it just poof, stopped. My breathing returned to normal and I was able to sit up. I was so exhausted. To describe my level of exhaustion....hmmm.... I'd say....imagine how someone would feel if they went into labor, and delivered a child in the middle of running the Boston marathon. I wish I could say I was being dramatic but, I'm not. I was so incredibly sore and beyond weak. What's even more insane to me is that with all the stomach cramping I had, I never puked and I never had to poop. (I know, just what you wanted to know) Anyway, I stood up, got dressed, and went to the mirror to put myself back together. When I looked at myself, my face was still damp, flushed and go figure, my hair was now curly. I had sweat so much that my hair was no longer straight. It had returned to it's natural curl. Ahhhh... secret revealed! Once I returned to the office, I ended up needing someone to take me home as there was no way I could drive. Once home, I went straight to sleep and didn't wake up until the next morning. I swore to myself, I would never allow myself to get into that situation again. And to this day, I haven't broken that promise.
So, what happened? Stupid me didn’t put two-and-two together that bread breaks down into sugar. In a single sitting it normally would have been fine but having it the night before and then so soon the next day, put my body into sugar overload and became too much for my body to process. So what did I learn from this? Plan EVERYTHING. Yes, I understand that this may make me a buzzkill but it’s better than going through that again. I always want to know where I’m going to eat so I can preview at the menu and can plan out what I’m going to eat. It also helps me to be considerate to those around me as to not take so long when ordering. Listen, this concept works for people with special food allergies, vegans and recovering alcoholics. I deserve the same respect. Secondly, I listen to my body. When I'm eating and my heart starts to beat faster, I know it’s time to stop eating. If I go any further than that, then the smell of food will start to bother me and I’ll have to excuse myself and walk away for a minute. Sometimes, I’ll step outside to get fresh air. It sounds weird but it helps keep me from puking. If I have bread in the evening, I won't have bread or sugar the next day. Lastly, anyone who knows me and has sat next to me long enough can tell when my food or water has gotten stuck. I usually get the hiccups. That is the tell-tell sign. Side note: I've only puked about 5-6 times from not following a proper process/diet/portion. In 12 years, that is unheard of in the bariatric community. Again, there are patients who overdo it daily resulting in getting sick daily. Yikes! Can you imagine?
My most risky complication: By year five, I started developing pain in my left side where my gastric remnant "original stomach” is. (see picture for reference) My original WLS surgeon dismissed my complaints of pain and even called me crazy, comparing me to people who claim to get runny noses post surgery. I mean, runny noses sounds a lot like pain and the feeling that there are little fires under your skin and the feeling that your stomach is literally twisting. Oh yeah. That sounds equivalent enough to not even bother trying to look into it. 🙄 I didn't need to feel dismissed, I was dismissed and it was devastating.
Fast forward to year nine when I stumbled across another bariatric surgeon on accident and while getting my nails done, if you could imagine that. During my consult, I explained what had happened over the previous years with my previous surgeon and that my symptoms were being dismissed. This doctor who had also personally had WLS asked a series of questions, asked me to isolate where my pain was and then immediately walked me over to the x-ray machine so we could do what's called a barium swallow (see x-ray below). By the end of our visit, he told me he suspected it was a combination of gallstones and something called "gastrogastric fistula" a.k.a stomach fistula.
(I feel like I defined this already but, I'll do it again) Definition: Gastrogastric fistula is a complication in gastric bypass patients that connects the pouch to the bypassed stomach. It is noted that fistulas are very rare; however, when they occur, it's noted that the complication of the gastric leak usually is a catastrophic complication, leading to sepsis and necessitating reoperation for drainage. - Let me pause here. My friends... if this doesn't encourage you to speak up for yourselves and fight for answers, then I don't know what will.
Both would require surgery but he needed confirmation of the fistula. In order to confirm the fistula, I would need a very unique type of CT scan but first he wanted my gall bladder removed immediately. (Side note, my first surgeon knew I had gallstones - He didn't remove my gallbladder during my surgery because it was too dangerous; however, he also didn't call me back in to remove it at a later time which I didn't realize would put me at risk) Given the severity of these situations, I was heading into surgery in 2 weeks. (scroll down to see the gallstones). The week after my gallbladder surgery (4 years ago today... hooray), he sent me to HOAG to do the CT scan. I met with a doctor who got my new surgeon on the line while he conducted the test. Between the two of them, they had me basically doing a combination of yoga and different contortions all while drinking barium on this machine so they could pinpoint where the barium was flowing through my digestive track. It sounded like a photo shoot. All I could hear was, "Yes, right there. Wait, back up... Hold it right there, Hold it. Hold it. Turn to the left, lift your left arm, ok now lay on your side and then... Boom. We got! That's a wrap!" This went on for about an hour but whatever they did, it worked. Together, they saw the suspected fistula that had been developing. These fistulas occur because there wasn't a complete division during the original surgery. This would be the unintentional connection from the gastric bypass pouch and the remnant stomach. What this meant is that it could disrupt my weight loss progress but more importantly food could eventually enter my “old” stomach which doesn’t have the ability to digest and would eventually lead to sepsis. Folks, I can’t say this enough… be your own advocate. I’m so thankful I spoke up sounding crazy or not. He didn’t mess around. I had my gallbladder removed which had a ton of gallstones; one was the size of a quarter if you could believe that and then two weeks later, I had my fistula surgery. Both of these surgeries prevented potential life-threatening emergencies from occurring.
So, how do you prevent all of this? Some, you can’t. And some you can proactively prevent. Follow these doctor (not me) recommended steps: (I'll insert my input where applicable)- Take your vitamins - check with your doctor periodically as the recommendations change. Also, when you get your vitamins, ask a specialist how to take them. As an example: B12 should be sublingually, Vitamin D should be taken with a Fat and Iron should be taken with Citrus. Also, not all gummy vitamins are good for you.
- Get your bloodwork done annually - Tip when getting your bloodwork: Ask your doctor to order a full metabolic work up including: Vitamin D (you may need to fight your insurance for this one), B12, thyroid (for women), Cholesterol, Iron, A1C (these should all be included). Call the clinic ahead and ask them to pre-order pediatric tubes so you don't have to "give" so much blood. Sometimes it works, sometimes it doesn't matter. Don't be alarmed - a full work up for me is anywhere between 13-18 vials - Fasting required
- Barium Swallow - it’s a type of X-ray that looks for abnormalities in your digestion (picture for reference at bottom) - Fasting required
- Annual or Bi-Annual Endoscopy - this is important to check for acid reflux, ulcers, hiatal hernia, other hernias, leaks and other issues - Fasting required/ You'll be put under and you'll need a driver
- Depending on your age, colonoscopy - this is important to check for pullups, diverticulitis, colitis, leaks, ulcers and other issues - Fasting required and there is a liquid prep you'll need to do. I've heard you can ask to be put on the Gatorade and Metamucil combo - Ask your doctor/You'll be put under and you'll need a driver
- Ask your doctor for the latest list of medicines you are NOT allowed to take - Depending on which WLS you've had, the list can vary - RNY has a more extensive list vs. the Sleeve when it comes to the list of medicines. Once you have that list, give it to your primary. This is important as it's common for them to recommend anti-inflammatories which a no-no's for RNY patients
- I personally recommend getting or staying in therapy to address eating addiction, body dysmorphia (post about this topic coming soon), confidence, relationships, grief (leaving your old life is a form of grief) and other underlying and unresolved issues
- If you haven't had your gallbladder removed, make sure to get it checked periodically - a gallbladder attack post RNY specifically could be extremely complicated and dangerous as emergency surgery isn't a standard procedure and raises additional risks. Having it removed when the doctor can take their time and plan their course, is a much safer option
- Last but certainly not least, keep moving. At the absolute very least, walk for at least 30 minutes per day. If you do not start moving from day one post surgery, it'll be hard to establish a baseline of commitment to your new life. I'm not saying it's not possible but, remember, once you go in for surgery, you're life changes. That's why your surgery date is called a birthday. You are basically reborn. So keep in mind, once you wake up from surgery, your mindset needs to change. It's not easy but it's necessary.
- Another important recommendation from me: If you have a partner during this process, you need for them to be 100% committed to your success. This means, if they are overweight, I recommend they adapt to a dietary change, commit to becoming your walking partner and to truly be successful, I recommend they join you in therapy. I know this sounds strange but take it from me. If your partner has bad habits, it could be influential to you, the patient. Also, partners of WLS patients have a hard time processing the changes you are going through. They will struggle with your new found confidence and may become jealous. They struggle with the fact that you are no longer reliant on them which makes them feel less important in your life. This can lead to unintentional sabotage. I'm not saying this always happens but, I've personally witnessed it with some of the folks I've mentored. You do you boo. But do your research. This is more common than you would think.
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