Bari_Hopeful

I’m currently in puréed stage - which in all honesty, I’m not hating - but this thread gives me hope in what to look forward to! 👌

I’m two days post-op from a One Anastomosis Gastric Bypass (aka “Mini Bypass”), and while this process took about four years (NHS England), I’d say just take each day as it comes. Like nervy mentioned, most bariatric programs will give some sort of information booklet to prepare for surgery which might include lifestyle changes and food plans or suggestions to help adapt into post-op life, like adequate hydration, healthier food choices, and incorporating enjoyable movement/exercise. I think often looking at the “big picture” can feel a bit overwhelming, but taking it day by day or even meal by meal I can be less stressful. My current post-op life seems to revolve around scheduling times to eat puréed meals and getting my fluids in, alongside the medication timings. Hoping I’ll get the hang of things in the next few days. ☺️ You can do this! 🙏💕

Surgery happened on 19th March - the only unexpected thing about all of it was arriving to go over surgical consent with my surgeon to find out my expected surgeon was out of the country…! So, I was given two options: 1) Reschedule when the expected surgeon is back, or 2) have the operation with the surgeon present. Granted, I trust all the surgeons on that bariatric team, so I was perfectly happy to have the surgeon who was on duty that day - but I did want to know his specific procedure of doing the OAGB/MGB especially as I still felt a tad cheated by my original surgeon’s planned measurements. Based on my BMI this surgeon said he would do a 125cm biliopancreatic limb with a long (12-15cm) and narrow (34 French bougie) pouch. (As opposed to a shorter 80cm bp limb, a shorter and wider pouch which would stop at the crow's foot and be an approximate 40 French bougie in width.) I was beyond thrilled and relieved to hear this! And so far, he’s never had any patients suffer from reflux or needing revisions. 🤞🤞 Later on in my room (shared with five other ladies), I overheard one of the ladies talking to another about her surgery - she had come for a revision to RNY from an OAGB done by my originally expected surgeon because of severe reflux. I feel like a dodged a bullet and won the lottery all in one go! And so far, I’m feeling pretty darn good on this Day 2 Post-op. So much to be grateful for! 🙌🥳💕

Whelp, to my utter shock and pleasant surprise, I received The Call yesterday - giving me my pre-op and surgery dates! 😮 My surgery (One Anastomosis Gastric Bypass aka Mini-Bypass) will be on 19 March! 🥳🎉 Two weeks from today! I still nearly can’t believe it… I’ve started the LRD Milk Diet today, and am grateful it’s so simple and requires minimal brain power for me to spend thinking about. 😅 Here’s hoping for the best! 🤞🤞

Thank you so much, @ShoppGirl! Perhaps it’s commitment mixed in with a good sprinkling of desperation? 😅 Being reliant on the NHS definitely makes me feel like this is my “only chance” to really help myself get healthier. And I’m super-grateful that once I have the surgery, our bariatric team offers support (both nutritional and psychological) for the first two years post-op as and when requested. I think that will be a great help!

Awww, I love hearing your good news from your appointment! 🥰🎉 This gives me great hope and encouragement! I have to admit, I do have a teeny-tiny bit of apprehension for the OAGB since it seems at least here in the UK (and perhaps other parts of the world) that it’s not totally standardised when it comes to technique and method. I wish I could know exactly what’s happening under the knife, so to say. But I suppose this is where trust comes in between patient and surgeon, and that’s what I’ll have to rely on. 🤞🤞 Seeing and reading about so many VSGers' success gives me incredible hope as well, and I remind myself that we're all given a tool to work with, and that tool in the long run won’t work to the best of its potential by itself - it’s what we make of it that matters most, right? So, we shall give it our best! I am so, so deeply sorry to hear about your mother and that she suffered complications from her bypass that resulted in her passing. 💔 Last month, I lost both of my parents, though from separate unrelated health conditions… if either of them had been through something I was medically considering, I think I would be extra cautious about that as well. Please be assured of my thoughts and prayers for you and your family - and for your continued success with the VSG, especially with this new year! ❤️‍🩹

Hi, NeonRaven! Apologies for the massive delay in response to your reply! So, so much has happened since my last update - and as of most recently, I’ve just had my last two Tier-4 appointments this week! 🥳 I met my surgeon and my anaesthetist - both were exceptionally kind, compassionate, and patient with all my very numerous and specific questions, haha! I can’t give enough thanks for being able to have them as my physicians! You are AMAZING for having successfully endured a TWELVE WEEK milk diet!! 👏👏 Wow! During my surgeon's appointment, I have to admit that he did a most impressive and valiant job in trying to sell me the VSG; however, I was pretty staunch on wanting a bypass due to my history of diabetes and hypertension (both currently in remission, thankfully, though this is managed primarily through a massive carb/starch restriction). While he gave an extensively good list of “pros” for the sleeve, one of the “cons” that concerned me was the increased likelihood of regain and the need to be on lifelong GLP-1s. He said this would most likely become the normal course of treatment for sleeve patients in the future. Also, if one were to suffer GERD, then it would be a straightforward step to revision to RNY. Prior to this appointment I had the OAGB (One Anastomosis Gastric Bypass or Mini Gastric Bypass) as my first choice, then changed it to RNY a few months ago when I had a gastroscopy and found some bile in my stomach (apparently that’s pretty normal…?) I was worried that the bile would rule me out of having the OAGB, but found out during this surgeon’s appointment that I shouldn’t have any issues with bile reflux - what RELIEF! So, I’ve requested the OAGB for my first choice as my surgeon feels the RNY would be too malabsorptive for me (he will do an 80cm BPL rather than the standard 100-200cm). After having all my questions answered and discussing the surgery options, I feel 100% confident and reassured in my surgeon and in going forward with the OAGB. 😊 At the end of our appointment, I was told I’m now on the waiting list for surgery! 🙌🥳🎉 (Although the MDT will happen sometime in the next 3 weeks.) He said surgery will most likely be within 4-6 months (though the anaesthetist said perhaps 3 months or sooner 🤞🤞). SO EXCITED! Pre-op assessment will be either in person or via phone with bariatric nurse about a month before surgery date. Anyhoo, there we are! How was your one-year post-op appointment??? I hope all went well and that your stall has passed. 💕

Oh gosh! 😮 I’m glad you’re still alive - you experienced all my worst fears regarding bariatric surgery! I am so sorry you went through all that… how frightening it must have been… and I hope you were able to recover well from it all. Truly, thank you for sharing that. ❤️‍🩹

Good question! As an American-settled-in-the-UK this continues to be a learning opportunity for me. 😅 So, in the UK we have the National Health Service (NHS) which provides general health care for everyone; however, if you can afford it, you may also purchase private health insurance and go to private hospitals/doctors to receive treatment much faster. Now, (as I understand it, though I am more than happy to be corrected on this) all the public hospitals and healthcare facilities throughout the UK are grouped together geographically under “trusts” (kind of like state or county boundaries) and each trust determines how their finances (allotted by the government) are distributed to cover which departments of healthcare. Aaand now to the Tiers! Perhaps as a way to weed people out, the weight management services offered via the NHS have progressive levels of treatment. (See photo below to see how it progresses upward in a narrowing manner.) Tiers 1-2 involve your local doctor and local service to help manage weight, like joining Weight Watchers or Slimming World and checking in regularly with your doctor. Tier 3 requires a referral from your primary care doctor to a Tier 3 provider (my trust used “The Weigh Ahead” which was operated through a private hospital group (Spire). (It took about 9 months from referral to 1st Tier 3 appointment.) My Tier 3 program lasted 6 months and could be extended 6 additional months if desired (I agreed to that because the support was so helpful). It comprised of monthly virtual meetings with a someone to go over nutrition and exercise goals, keep track of weight, measurements, and blood pressure, and general accountability and encouragement. I also had about 3 or 4 meetings with an NHS bariatric psychologist to go through any issues that might come up regarding food, surgery, eating disorders, etc. Both cleared me for moving forward towards surgery and thus, Tier 4. Also, by the end of Tier 3, you are expected to have lost 5-10% of your body weight before being discharged and referred to Tier 4. From Tier 3 discharge to my first Tier 4 appointment it was approximately 18 months. (Also, for some trusts, their Tier 3 programs can now offer GLP-1s. Mine was not one of them, alas!) Tier 4 is nearing the homestretch! Here you meet with various consultants (dietitian, bariatric nurse, anaesthesiologist, surgeon - and some Tier 4s may require a psychological evaluation, if it wasn’t covered in Tier 3) to see if you’re mentally and physically fit and ready for surgery. (I’ve heard some Tier 4 programs may also offer the alternative option of GLP-1s.) I’m not sure if Tier 4 also includes aftercare, but if it does, then that’s 2 years of follow-up and support offered from the Tier 4 bariatric team, which includes access to the dietitian and bariatric psychologist. After 2 years, you return to your primary care doctor for follow-up and monitoring. If you've made it this far, thank you for time and curiosity. 🤓

Thank you muchly! Also, (though is is off-topic to this post), I noticed in your sidebar info that one of your previous surgeries was the MGB which was then revised to gastric bypass (I’m assuming Roux-en-Y) - if you don’t mind my asking, what were the reasons for revision? I originally felt rather strongly about choosing the MGB over RNY due to the one less anastomosis and seemingly less likelihood of bowel obstructions and marginal ulcers; however, due to a recent gastroscopy and finding out I had issues with bile in my stomach (plus, I have no gallbladder), I’m 99.9% certain I’ll be going with the RNY. I’m interested in hearing from anyone that has had both surgeries and their experiences (and/or complications/disappointments) with them.

Yesterday, I changed My Surgery from Mini Gastric Bypass to Gastric Bypass (see 1st screenshot). However, my profile and display info on posts still says “Mini Gastric Bypass Patients”. (See screenshots 2 and 3.) How can I remedy this? Thank you in advance!

Cross-posted to General Weightloss Surgery Forum, but then thought it might be more appropriate here since I’m still pre-op. 🙃 It’s been a few months since I last posted, but having just had the 2nd consultation (out of 4 total) on my trust's Tier 4 pathway I thought I’d share that experience just in case anyone else is searching for information regarding the NHS process (even though it seems to vary rather greatly between trusts). My 1st Tier 4 appointment was on 31 May with one of the bariatric dieticians (via phone call). My 2nd appointment was with the bariatric nurse on 2 September (also phone call). Like the previous appointment, I reported my weight and had a medication review. Then we went through “What To Expect for Pre-Op/Surgery/Post-Op/Hospital-Stay/Aftercare”. I was also greatly relieved to find out that my trust gives a 5kg “cushion” of possible weight gain before surgery - they seem very compassionate and understanding given the long waiting times post-Tier-3 discharge and the difficulty in either losing or maintaining one's weight. I AM SO RELIEVED I COULD CRY. 🙌 Originally, this trust had a 6-9 month wait time from Tier 3 discharge to Tier 4 surgery, but since a few surrounding trusts lost funding for their bariatric services, this trust has taken up the additional patients, so the wait time from Tier 3 discharge to surgery is more like 2-3 years now. We are hoping to have my last two appointments (in-person consultations with the anaesthetist and surgeon) before the end of the year. Once those appointments are done, the Tier 4 consultants will meet as part of the Multidisciplinary Team (MDT) review and decide whether or not I will be approved for surgery. And if approved, surgery is usually 1-2 months post-MDT meeting. I won’t know who my surgeon is until I have the consultation - patients are assigned to whichever surgeon happens to be assigned to the bariatric clinic that day. Although I did find out that 4 out of the 5 surgeons in this department all perform robotic bariatric surgery via DaVinci, so that’s pretty cool. Also, it’ll be the Milk Diet for the Liver Reduction Diet. Good to know for the mental prep! So far, my experience with the Tier 4 consultants and department secretary has been really, really good - I’ve always been met with kindness, encouragement, and compassion. Despite my own impatience, I’m so grateful for everyone I’ve encountered thus far and am looking forward to the next appointments! Whelp. There we are. Hope this was helpful/insightful. We're getting there! 🫠 Any other pre-op NHSers here? If so, how’s your process going?

It’s been a few months since I last posted, but having just had the 2nd consultation (out of 4 total) on my trust's Tier 4 pathway I thought I’d share that experience just in case anyone else is searching for information regarding the NHS process (even though it seems to vary rather greatly between trusts). My 1st Tier 4 appointment was on 31 May with one of the bariatric dieticians (via phone call). My 2nd appointment was with the bariatric nurse on 2 September (also phone call). Like the previous appointment, I reported my weight and had a medication review. Then we went through “What To Expect for Pre-Op/Surgery/Post-Op/Hospital-Stay/Aftercare”. I was also greatly relieved to find out that my trust gives a 5kg “cushion” of possible weight gain before surgery - they seem very compassionate and understanding given the long waiting times post-Tier-3 discharge and the difficulty in either losing or maintaining one's weight. I AM SO RELIEVED I COULD CRY. 🙌 Originally, this trust had a 6-9 month wait time from Tier 3 discharge to Tier 4 surgery, but since a few surrounding trusts lost funding for their bariatric services, this trust has taken up the additional patients, so the wait time from Tier 3 discharge to surgery is more like 2-3 years now. We are hoping to have my last two appointments (in-person consultations with the anaesthetist and surgeon) before the end of the year. Once those appointments are done, the Tier 4 consultants will meet as part of the Multidisciplinary Team (MDT) review and decide whether or not I will be approved for surgery. And if approved, surgery is usually 1-2 months post-MDT meeting. I won’t know who my surgeon is until I have the consultation - patients are assigned to whichever surgeon happens to be assigned to the bariatric clinic that day. Although I did find out that 4 out of the 5 surgeons in this department all perform robotic bariatric surgery via DaVinci, so that’s pretty cool. Also, it’ll be the Milk Diet for the Liver Shrinking Diet. Good to know for the mental prep! So far, my experience with the Tier 4 consultants and department secretary has been really, really good - I’ve always been met with kindness, encouragement, and compassion. Despite my own impatience, I’m so grateful for everyone I’ve encountered thus far and am looking forward to the next appointments! Whelp. There we are. Hope this was helpful/insightful. We're getting there! 🫠

Did you have any psychological input during your Tier 3? (I don’t know if you had to go through Tier 3?) I had about 4 sessions with an NHS bariatric psychologist, but I believe I’ll still be having a Tier 4 psychological consultation to sign me off ? for the MDT. Also, two weeks post-approval for the LRD! That is AWESOME! I think my trust tends to do the two-week milk diet. Even though I currently eat fairly low calorie keto, I think the milk diet would help lose a bit of pre-surgery weight at least. ?

Hello, Wendyjane! The NHS is the National Health Service - socialised tax-funded medical care provided in the United Kingdom. The tier system is basically various levels of care for varying conditions. For those seeking weight management help through the NHS. Google AI summarised it really well for me: Hospitals are grouped into governing bodies (trusts), and each trust, I believe, decides how to invest in the tiers, which in turn impacts just how much and what kind of support is given. For example, when I went through Tier 3 in my trust, I was given 1:1 virtual support (zoom meetings) once a month for a year with a nutritionist to help me implement healthier lifestyle changes, and during that time, I also met with an NhS psychologist for 3-4 months to work through any issues I may have regarding food and mental health. I really enjoyed the support I received from my Tier 3 programme (“Weigh Ahead”). I was also held accountable for my weight, blood pressure, and body measurements. Tier 3 aims to help you lose 5-10% of your total body weight in order to be referred to Tier 4. The current Tier 3 service in my trust now allows patients to receive prescriptions for Ozempic and Mounjaro to help with weight loss. (I’m sure you can imagine I was sorely sad to find out I missed that opportunity! Whereas I think the injectables will be available to me only in Tier 4 and from the bariatric surgeon?) Also, in Tier 4, if you so desire to go forward with bariatric surgery, then you have multiple appointments with various consultants: the bariatric dietitian, bariatric nurse, bariatric psychologist, the anaesthetist, and finally the surgeon. Once your appointments with each of these completes, then they meet together as a “Multi-Disciplinary Team” to discuss each case and decide if that patient is a good candidate to go forward with surgery. If yes, you’re then placed in another waiting list. According to my trust, I am not meant to gain any weight from the time of my Tier 3 referral until surgery. This has been really, really challenging… and at times, frankly speaking, exceedingly discouraging. I hope this helps as an explanation. ☺️

Hi, NeonRaven! Thank you so much for your reply and sharing your experience! I find it so helpful to hear how other NHsers have experienced the process since it seems so much more elongated from the U.S. process. And you make such a good point about the London privilege - now it makes more sense why I’ve seen more internet presence and response from London NHSers. (And quite a few from the far north of England as well!) About three or four years ago during my annual diabetic review, my nurse had suggested bariatric surgery and that gave me a lot of hope - she was able to refer me for Tier 3. I had my dietitian appointment yesterday and it went really well! It was about 30 minutes and went over the Tier 3 lifestyle changes, continued lifestyle changes (balanced meals, regular exercise, blood sugar monitoring, weight maintenance, etc), medications, and then any questions I might have. She was very positive and said she would be recommending me to go forward for surgery when the MDT meeting happens ? (once I meet with the next consultants - psychologist, anaesthetist, bariatric nurse, and surgeon - how soon? No one knows.) Needless to say, I am so relieved, so happy, and so excited to be moving forward even if it’s one step. I’ve found out that my hospital trust now does their “one-stop” clinic as separate virtual appointments, rather than in-person. (So, perhaps it will be quite some time before that MDT meeting?) And then the endoscopy and ECG will be done at the pre-op assessment once a surgery date is confirmed. I am so glad to hear your NHS experience has been so good and positive. I am so sorry to hear about your mother's complication and her passing, but it is so hopeful to hear she was able to put her diabetes into remission (that’s one of my big hopes!) Congratulations on your weight loss and wishing all the health and success! ? PS - funny enough, I have not had any group sessions whatsoever in this process. I am wondering if I’ll have a group session with the bariatric nurse?

Your post gives me great hope of making it to a “normal” weight - with a sigh of relief that it’s really possible! I thought I’d also be settling for overweight.

I recently came across this expected weight loss calculator/predictor: SOPHIA Bariatric Weight Trajectory Prediction. Thought it was pretty neat! Sounds like you’re off to a great start!

I posted this in the Pre-Op Q&A, but thought perhaps it might be helpful to post it here as well since maybe those post-op could help…? Edit: typo

Hello, hello! This is my first post here and after searching for this topic, not much came up for me, so here I am! ? I was wondering if anyone here could share their experience going through the NHS Tier 4 appointments, particularly this first meeting with the bariatric dietitian? I'm assuming each trust probably has their own system of doing Tier 4, but for me, this is my first Tier 4 appointment and it’s a video call. After this appointment, if all goes well, I will (eventually ?) progress onwards to the in-person-at-the-hospital “one-stop clinic” to meet with the bariatric nurse, anaesthetist, psychologist, and surgeon. I was successfully discharged from Tier 3 in Dec 2023 and have since been waiting for a Tier 4 appointment - the time has finally come! ? Needless to say, I’m both excited and nervous - and happy to receive any words of advice or wisdom anyone can offer. Also, for what it’s worth, I’m under the Portsmouth NHS trust (Queen Alexandra) and hoping for either the OAGB or RNY. Anyone have any experience with the QA bariatric team? Thanks in advance!