My NHS experience in the UK

[JJCool 104]

I wanted to write this to help anyone considering the surgery the benefit of my experience. I don’t represent the NHS or anyone else’s journey – I just want to be open about what mine has been like.

For those who have been through it, sorry if this is all familiar to you and boring. I hadn’t ever had surgery before this and had never stayed in hospital before so I enjoyed reading about the experiences of others to help me understand what to expect. And there isn’t that many to fine online from people in the UK going through the NHS so just wanted to add mine.

Before October 2015 I had been meeting with my GP (local doctor) regularly to treat an anxiety disorder that I have had at a serious level for about a year, as well as to facilitate my recovery from a lower back injury. After a few months of counselling, drug treatments and physiotherapy he suggested to me that he thought both could be relieved to some degree by a serious weight loss and he referred me to meet with a bariatric surgeon.

I’ll try to explain some of how the National Health Service works in the UK, as I understand it. I’m not a professional in this area, this is just as it has been explained to me.

In the UK a governing body called NICE (National Institute for Clinical Excellent) set recommendations for our medical trusts (all the hospitals etc in a region that make up a group, and that group has an amount of funding allocated to it.) The management for that trust then decides how that money is allocated, and usually bases these decisions on the guidelines set by NICE.

In regards to bariatric surgeries, NICE recommends:

· Patients with a BMI above 50 be referred for bariatric surgery assessment

· Adults with a BMI of 30 or more for whom interventions such as weight loss clinics and programs have been unsuccessful can have a discussion about alternative interventions for weight management such as bariatric surgery

· Adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes within the past 10 years are offered an expedited referral for bariatric surgery assessment

As well as some other particulars (you can read more about that here Soup (both of a particular brand) and a pint of milk a day. I don’t know if this is the way my bariatric team work or if they made this specific to me but it was fine and it worked.

On the day of surgery, I met with the nurse surgeon and anaesthesiologist separately to discuss any last minute questions and to talk through what I was to expect. It was such a nice experience, the worst part of my day was when I had to change into the hospital gown and realised that the dressing gown I brought from home (which was a short one) wouldn’t actually cover my backside. So if any of you happened to see someone with a red face clutching their gown closed at the back with both hands while walking through a hospital – yeah that was probably me.

I was reassured at every stage leading up to the operation and wasn’t really scared at all. Such a relief! I didn’t wake up for many hours after the surgery and I found out later that they thought I might have to be moved into ICU (Intensive care unit) afterwards because of this. But I did wake up finally in the recovery suite that evening and in my hazy state I apparently fought with the oxygen mask enough to amuse the nurses so they knew I was ok.

I was moved to a ward with three other women – only one other had a bariatric procedure but she didn’t speak English so no one I could compare notes with. I had two days in hospital – I won’t go through it in detail but will just note that in that time I had the most wonderful care from the hospital staff. I was visited by my surgeon and the bariatric nurse each day and they were both happy with my recovery. I started taking small amounts of Water on the first day and by the second was allowed other liquids such as tea, milk etc. The thing I found the most difficult about being in hospital was that they wanted to weigh each wee I had, so had to wee into a cardboard bowl. I don’t know why but this led to me being a bit wee-shy, but they weren’t going to let me go until they were sure that the liquids I was drinking was going through as expected so I had to just get on with it!

I had a drain in my right side while I was in hospital to drain away any internal bleeding from the surgery and that was removed on the day I left the hospital. I had water proof dressings on each of my 5 wounds so could shower without any issues straight away and didn’t have to have the dressings changed until about a week later.

When I was discharged I was sent off with a load of medications, which is all part of the NHS service. I was pretty surprised; it took two large carrier bags to carry them all! Included was:

liquid paracetamol (for the pain) and ibuprofen (for pain and inflammation)

Liquid sytron (Iron supplement)

Effervescent Adcal D3 (Calcium and Vitamin D supplement)

Multivitamin pills (to be crushed and mixed with water for the first few weeks – yuck!)

Enoxaparin injections (for the avoidance of blood clotting)

Lactulose solution (for, erm, regularity)

Lanzoprazole tablets (to reduce stomach acid, and heartburn)

And I was sent on my way!

I had a pretty sharp internal pain and a big dent behind my biggest incision for the first few weeks that made getting about quite difficult. I rang the nurse and she explained to me about how the remaining stomach was given an internal stich to the inner muscle/fat lining of my skin to stop it from twisting while it heals. And as she predicted it popped around week 3 as the internal stitch dissolved. It gave me a bit of a scare at the time, I was bent over shaving my legs and literally felt a *pop* and I was too scared to move! But then I remembered what it was and was so relieved that all the pain suddenly left so I was happy.

And it’s been plain sailing ever since. I have been able to move through the food stages as planned and haven’t have any vomiting or diarrhoea. I met with the nurse again at about 6 weeks and she was happy with my progress and my healing. I have an appointment with the surgeon in about a month and will continue to meet with them both over the course of the next two years at least – or longer if necessary.

So that’s me, I fully appreciate that everyone’s journey is different so please don’t use this as canon. But I hope I can help anyone doing research for their own operation. Based on my experience I would recommend it whole-heartedly.

Jo x

[KristenLe 5,979]

It sounds like a great experience - thank you for sharing! I had a very different picture in my mind!

[catlady2012 73]

I wanted to write this to help anyone considering the surgery the benefit of my experience. I don’t represent the NHS or anyone else’s journey – I just want to be open about what mine has been like.

For those who have been through it, sorry if this is all familiar to you and boring. I hadn’t ever had surgery before this and had never stayed in hospital before so I enjoyed reading about the experiences of others to help me understand what to expect. And there isn’t that many to fine online from people in the UK going through the NHS so just wanted to add mine.

Before October 2015 I had been meeting with my GP (local doctor) regularly to treat an anxiety disorder that I have had at a serious level for about a year, as well as to facilitate my recovery from a lower back injury. After a few months of counselling, drug treatments and physiotherapy he suggested to me that he thought both could be relieved to some degree by a serious weight loss and he referred me to meet with a bariatric surgeon.

I’ll try to explain some of how the National Health Service works in the UK, as I understand it. I’m not a professional in this area, this is just as it has been explained to me.

In the UK a governing body called NICE (National Institute for Clinical Excellent) set recommendations for our medical trusts (all the hospitals etc in a region that make up a group, and that group has an amount of funding allocated to it.) The management for that trust then decides how that money is allocated, and usually bases these decisions on the guidelines set by NICE.

In regards to bariatric surgeries, NICE recommends:

· Patients with a BMI above 50 be referred for bariatric surgery assessment

· Adults with a BMI of 30 or more for whom interventions such as weight loss clinics and programs have been unsuccessful can have a discussion about alternative interventions for weight management such as bariatric surgery

· Adults with a BMI of 35 or more who have been diagnosed with type 2 diabetes within the past 10 years are offered an expedited referral for bariatric surgery assessment

As well as some other particulars (you can read more about that here https://www.nice.org.uk/guidance/QS127/chapter/Introduction)

My BMI is above 50 so I was referred on that basis.

I was pretty nervous for that first meeting as I had no idea whatsoever as to what to expect. It turns out that I actually met with three people that day at the bariatric clinic. First the nurse who described in detail the three procedures they offer – adjustable gastric band, sleeve gastrectomy and gastric bypass. We talked through the pros and cons of all three and she sent me away with detailed booklets on each which outlined

· what the surgeries were,

· how they work,

· how they affect eating afterwards,

· how much weight I can expect to lose,

· what the benefits of each are,

· what the risks associated with each are,

· what are the alternatives,

· how I should prepare for such a procedure

· detailed information on the pre-assessment procedure,

· the day of operation,

· what I should expect after the procedure,

· my discharge from hospital,

· what to do if I become unwell after surgery,

· follow up appointments

· and some good links for further reading.

We had a lovely chat where I was encouraged to ask questions, and spoke generally about how experienced the team was and what her recommendations were.

Afterwards I met with the dietician at the clinic who explained to me how they like to see patients achieve weight loss before the surgery and gave some really reasonable advice on how to achieve this. This was the first time I had ever spoken to a health care professional who actually seemed to understand that weight loss isn’t just a matter of will power – it was so refreshing! He also talked me through what the pre-op diet would be if I chose to go through with the surgery and explained to be the importance of shrinking my liver at that time was. If I didn’t comply with that special diet for those two weeks in advance of the surgery I could cause the surgeon to refuse the surgery or cause serious complications which could result in death. That’s a pretty motivating reason to follow his instructions!

Afterwards I met with the surgeon who talked me through her experience of each of the three surgeries, and gave her opinion on what would be best for me. She had me lie on the table to look at my tummy and explained that different people shapes mean different levels of complexity for each of the different operations.

When we were done I was sent away to think about whether I wanted to go ahead with surgery and do some research to help decide which would be my preference.

Over the following few months I met with the dietician to discuss my progress with losing weight before I started the pre-op diet, with the surgeon to discuss my decision (vertical sleeve) and my understand of what that involved (to ensure that I understood exactly what I was agreeing to) and to discuss possible complications. And also the nurse for general check-ups, to discuss what I had learnt in my own research, to answer any questions I had and to be invited to a support group with other pre and post-surgery patients.

I also had three sets of blood tests – the first for the surgeon to get a snap shot of all the usual things that blood tests are meant for (in other words, I don’t really know.) She asked my GP to put me on medication to lower my cholesterol from that so the second test was to check that all was in order after that. My final blood test was on the day before surgery, and was to take a snap shot of my blood details to match with in case during surgery I lost blood and they needed to give me a transfusion (gulp).

During the lead up to the op I also had an upper endoscopy by the surgeon – this was honestly the most awful medical procedure I have ever had done. I didn’t know in advance that if I didn’t have anyone come with me to the appointment that the medical team wouldn’t be able to put me under for it (otherwise I would have DEFINITELY had a friend drive me!) so I was on my own and went through it awake. I have a pretty strong gag reflex and dry heaved my way through it. But when it was over all way fine and my surgeon confirmed that I didn’t have any polyps or stomach ulcers and so she was happy to go ahead with the surgery.

So I had two weeks of pre-op diet which wasn’t too difficult for me. It was made up very specifically of 4 yoghurts and 4 cans of Soup (both of a particular brand) and a pint of milk a day. I don’t know if this is the way my bariatric team work or if they made this specific to me but it was fine and it worked.

On the day of surgery, I met with the nurse surgeon and anaesthesiologist separately to discuss any last minute questions and to talk through what I was to expect. It was such a nice experience, the worst part of my day was when I had to change into the hospital gown and realised that the dressing gown I brought from home (which was a short one) wouldn’t actually cover my backside. So if any of you happened to see someone with a red face clutching their gown closed at the back with both hands while walking through a hospital – yeah that was probably me.

I was reassured at every stage leading up to the operation and wasn’t really scared at all. Such a relief! I didn’t wake up for many hours after the surgery and I found out later that they thought I might have to be moved into ICU (Intensive care unit) afterwards because of this. But I did wake up finally in the recovery suite that evening and in my hazy state I apparently fought with the oxygen mask enough to amuse the nurses so they knew I was ok.

I was moved to a ward with three other women – only one other had a bariatric procedure but she didn’t speak English so no one I could compare notes with. I had two days in hospital – I won’t go through it in detail but will just note that in that time I had the most wonderful care from the hospital staff. I was visited by my surgeon and the bariatric nurse each day and they were both happy with my recovery. I started taking small amounts of Water on the first day and by the second was allowed other liquids such as tea, milk etc. The thing I found the most difficult about being in hospital was that they wanted to weigh each wee I had, so had to wee into a cardboard bowl. I don’t know why but this led to me being a bit wee-shy, but they weren’t going to let me go until they were sure that the liquids I was drinking was going through as expected so I had to just get on with it!

I had a drain in my right side while I was in hospital to drain away any internal bleeding from the surgery and that was removed on the day I left the hospital. I had Water proof dressings on each of my 5 wounds so could shower without any issues straight away and didn’t have to have the dressings changed until about a week later.

When I was discharged I was sent off with a load of medications, which is all part of the NHS service. I was pretty surprised; it took two large carrier bags to carry them all! Included was:

liquid paracetamol (for the pain) and ibuprofen (for pain and inflammation)

Liquid sytron (Iron supplement)

Effervescent Adcal D3 (calcium and Vitamin D supplement)

Multivitamin pills (to be crushed and mixed with water for the first few weeks – yuck!)

Enoxaparin injections (for the avoidance of blood clotting)

Lactulose solution (for, erm, regularity)

Lanzoprazole tablets (to reduce stomach acid, and heartburn)

And I was sent on my way!

I had a pretty sharp internal pain and a big dent behind my biggest incision for the first few weeks that made getting about quite difficult. I rang the nurse and she explained to me about how the remaining stomach was given an internal stich to the inner muscle/fat lining of my skin to stop it from twisting while it heals. And as she predicted it popped around week 3 as the internal stitch dissolved. It gave me a bit of a scare at the time, I was bent over shaving my legs and literally felt a *pop* and I was too scared to move! But then I remembered what it was and was so relieved that all the pain suddenly left so I was happy.

And it’s been plain sailing ever since. I have been able to move through the food stages as planned and haven’t have any vomiting or diarrhoea. I met with the nurse again at about 6 weeks and she was happy with my progress and my healing. I have an appointment with the surgeon in about a month and will continue to meet with them both over the course of the next two years at least – or longer if necessary.

So that’s me, I fully appreciate that everyone’s journey is different so please don’t use this as canon. But I hope I can help anyone doing research for their own operation. Based on my experience I would recommend it whole-heartedly.

Jo x

[JJCool 104]

It sounds like a great experience - thank you for sharing! I had a very different picture in my mind!

Thank you! I know some others on here have had a totally different patient journey within the NHS, but I hate to see it given a bad rap. We in the UK are so lucky to have this wonderful service and though it is currently woefully underfunded the staff still manage to do an excellent job for the majority of the time.

Jo x

Sent from my iPad using the BariatricPal App

Edited August 11, 2016 by JJCool

[GinaCampbell 434]

Wow Jo! What a difference! So glad that your area seems to be in better control.

Sent from my iPhone using the BariatricPal App