Stepping in the meeting room at 8.50am today and was greeted by Mr Tun, one of my staunch supporters in my bariatric surgery support group. He is as usual, very happy to see me. He is four years since the sleeve gastrectomy and he has lost about 40kg of weight and gained 10kg back.
But to me he is still “big”, about 110kg now, something still can be done, I told myself, and I told him that too regularly in recent meetings. My colleague, Dr Hew, an endocrinologist, always reminded me, Mr Tun’s weight is going up again! One thing I know for sure is that he is happily telling other members to exercise is a no-no for him. He always says he is the bad villain in the group.
Madam Anne was also there when I stepped in. She is our new member, about 3 months after “sleeve”. She WhatsApp the group a few days before, mentioned her weight is stagnant for the last one month! She said she needs help! Madam Anne is about 54 years old. She has lost 17kg in 3 months, and she is about 86kg now. She still has great difficulty in swallowing solid foods. She likes to munch on watermelon whole day, which is about 2 glass-cup a day of cut watermelon. She prefers to drink coconut water since the surgery because it is easier to drink than plain water.
She has lost 17kg in 3 months, and she is about 86kg now.
Oh, our dietitian today is Ms Huong, who is standing in for our regular dietitian, Ms Humaira. After greeting everyone, we sat down and conversations just happened spontaneously.
The very first thing I learned today was Madam Anne had been comparing herself to her colleague who has had similar surgery done somewhere else. She wants to know why she is not losing as much weight as her friend, especially her friend not even doing any exercise.
The Expectations
My first reaction upon hearing that was I hope she does not think any less of me as her surgeon compared to her friend’s surgeon. I guess it is logical thinking to a layperson, similar surgery should give similar results, hence the doubt why her result is “inferior”.
I find myself defensively explain everyone loses weight at their own pace. And our oesophagus responds differently to “sleeve”, some have no problem with water and while the others find them hard to swallow. I even use the term “oesophagal manometry” to explain our food-pipe motility may be different before and after surgery!
All I could do was emphasizing on there is no way the weight will not come down, it is a matter of time. Mr Tun was very helpful and not helpful at the same time. He said it was normal to have stalled weight loss after surgery for a period of time and it will resume. However, by lowering down his voice a bit, but this is only the third month after surgery, it is a bit “unusual”. Alas, we are not professional weight loss counsellors, forgot it, that is the beauty of this support group, everyone entitled to their opinion.
The Meet-Up
Mr Yun texted me that he could not find the meeting place. I use the meeting room at Subang Jaya Medical Center’s health screening centre, just one floor above my favourite cafe, Starbucks. The meeting room is all the way inside, that is probably why it is tough to find. I have this meeting every 3 months. It has been two years in the running.
The last one was a grand one. It was held near the lobby of SJMC because of larger space. It was in April. I have roped our psychologist, Alex Ng to give a talk, a dietitian who specializes in obesity from International Medical University, Ms Teo, and our in house physiotherapist, Raj. Of course, my loyal corporate sponsor for the food every single time without fail, Ms Maggie from Medtronic. The last one was very well attended, I think about 30 participants. But I “tak larat”, no energy in Malay, to have such grand gathering every three months!
I went out and guided Mr Yun in. He, as usual, looks a bit tired. But he denied he is tired every time I ask. Maybe is the look, the dark circles around his eyes. He too, having “slow progress” after surgery. He had the “sleeve” end of April. Almost about 10 weeks ago. He is about 17kg lower now. I guess when we look at 17kg in 2.5 months, this number is actually very good. However, the problem is this happened mainly within the first 2 weeks after surgery. The next 1 to 1.5 month just “stalling” like Madam Anne.
I always tell them, look at the bigger picture, they have lost “too much” weight in the beginning, the body needs time to adjust to this rapid process, hence, the little stalling along the way. Of course, it is my job to make sure they are eating the right amount of protein, the right amount of water, the “no amount” of sugary drinks and processed junk if possible. Cannot emphasize enough how important is exercise. I personally do not believe the weight loss without exercise after surgery will last.
Cannot emphasize enough how important is exercise.
Consistency is the key to whatever we want to excel. I always tell them, the goal is useless if no effort to persist and be consistent. I think the goal is secondary, we just have to do it, not for this month, not for the next 3 or 6 months, it should be forever. We should all eat the right amount of protein, fruits and vegetables, and of course no much simple carbohydrates junk.
Eat slowly every time. Run away when encountering packaged food if possible. Exercise consistently. If there is a blip, do not look back, pick up where you let go, do the right thing again the next day. The ability to come back to do them again is the virtue of consistency. Because as humans, we have to enjoy life once in a while, a little ice cream does no damage.
The Importance Of A Support Group
Ms Fiza and Ms Ani came next. Ms Ani had her “sleeve” 8 months ago. She lost a good amount of weight and gained all her weight back after previous gastric banding is done somewhere else many years ago. Introduced to me by her father who I did hernia repair and certified me credible to do surgery on her daughter.
She is doing well and able to show off with tighter clothes, which we all agreed it is important to alter our clothes to fit us well while we are losing the weight. It makes us feel good and wants to keep it up. Conversation then wandered through how one outlet is charging exorbitant fees for clothes alteration.
Ms Fiza, my pioneer in this support group. She has put on a bit of weight. She said her weight regain actually helps her reflux a bit more. Her gastroenterologist, Dr Ranjeev told me the esophagitis is bad. I told her I can correct it with another surgery, which she replied a firm “No”. She had her surgery in March 2015, 4 years and 4 months ago. I remember the date well. She makes sure I remember it well too. She will start by “I am a special case” to any new member. She will start the story by “I went through hell” or “I almost died”.
She will start the story by “I went through hell” or “I almost died”.
She has had the sleeve, and a leak, a tiny leak that diagnosed two months after surgery. She was my first “leak”, and I am not proud to say she was not my last. She presented about two months after surgery with fever and chills. We drained the pus laparoscopically but failed to identify the source. She again has to go through drainage procedure percutaneously second time and underwent gastric stenting to seal the leak. The stent worked for her and she recovered fully, but not without suffering the heartburn while the stent was in place. I have never doubted she would survive the complication because she was never in sepsis.
She did lose a lot of weight. She lost from the initial of 120kg to 65kg at the lowest. But from what she described to other members, I do not think she remembered the good part of the surgery. As her surgeon, I feel for her.
She is the most supportive member I have. She will come up with all sorts of tips and advice that are helpful. She showed up today because Ms Anne needed help. She even came to see my second “leak” patient in the hospital helping reassuring that everything will be fine. She was organized in her daily living, which she will determine what to bring or what food to pack for the whole day.
She has regained her strength to exercise regularly, just like before the surgery. She lost something from the surgery, and some point she doubted herself why went through the surgery in the first place, but I believe she is determined not to let it affect her life. She is going back to school now and hopes it does not affect her attendance in this group. Lucky for us with social media, she will always be here!
Madam Zai came in the last. We have 6 members showed up today. That is not too bad at all. Ms Zai is 56 years old and had the surgery 7 months ago. She has had the “work” done. She came to me with symptomatic gallstone disease and a large abdominal wall hernia from previous surgery. She was almost 90kg overweight with a BMI of 52! I removed her gallbladder, did a “sleeve” for her, fixed her large abdominal wall hernia at one go! She is now 40kg less and walking with ease. She was a bit “scared” first few months because nothing seems to go down the food-pipe easily but eventually, she settled down. One thing though she still wearing the same loose outfit which can hide shape easily. This is especially true for Malay female with their loose “baju kurung”.
The Round-Up
We actually discussed a lot today. From Japanese buffet to ordering various foods for others but ourselves. From how to stop craving to bad-mouthing our staple food, the rice (even though everyone is crazy about “nasi lemak”)! From why Dr Cha is not savvy in social media to talk about some other surgeon antic of keep calling patient until a yes answer to surgery. I again gave a lame excuse for not having bariatric surgery every week because I still like to do other general surgery works, such as colon and gallbladder surgery. The truth is I do not mind more patients.
Maggie brought in the food. Today’s from an outlet called Breakfastology at Sunway. Healthy sandwiches, the way we like it. I made an excuse to go operate on an anal fistula, which all the members said that is enough said, no need to elaborate. We took a group picture and shared in our WhatsApp group. The message notifications started beeping once the photo is shared. Other members that cannot make it today texting greetings. Ms Huong then started the routine body composition analysis on every one. We parted today knowing Madam Anne is more confident dealing with weight stalling and no more keto fad diet post operation!