To ask about laparoscopy and weight

[shouldnthavesaid]

I've been waiting for a diagnostic laparoscopy for ongoing pelvic pain, been steadily getting worse since I was 12 years old. I'm now 25 and on increasing doses of opiates and having to take on reduced duties at work. Been admitted to hospital several times in the last six months. Adhesions and a cyst both been found and gynae consultants keep saying my symptoms are fairly consistent with endometriosis.

I was scheduled for a lap in January. It was cancelled at the last minute because the doctor said I was too obese. I'm sixteen stone , size 18 on bottom and 16/18 on top. 5 ft 9 in height. She said the main issue was my waist size and she said the surgical instruments are too small , only the size of a biro pen, and she felt she'd be wasting her time operating as she didn't feel they would find much wrong or anything they could easily fix. Adhesions might be due to undiagnosed peritonitis as a child was one suggestion.

Colleagues (senior staff nurses) have told me this is largely BS.. I don't feel able to question anyone though.

I have tried , tried and tried to lose weight. I've had to deal with being catheterised on and off which meant I've been fairly immobile at times. Other times I've been flat in bed too sore to move.

My weight has remained as it was in January. They've said I've to get my tummy as flat as possible. Referred me to a dietician who said she was at a loss of what to suggest , I am eating fine and putting out what I eat in , but I can't do the exercise easily to create a calorie deficit. She didn't want me to cut my diet down any further. GP is saying same , it's exercise that's the problem.

I've been told it's a six month waiting list for pain management, will be June when I'm seen.

I've overdosed a couple of times on my medication as so bloody sore. I'm not helping myself but I am at the stage of no longer caring what happens, I just want to know what's wrong and if they can fix it.

I see a counsellor and she said she's worried about me and my thoughts/actions.

I'm desperate and I don't know what to do except start cutting down meals etc?

Can you swim? And yes to cutting down calories if you are largely immobile you don't need the standard amount.

Swimming and Keto. If you dont lose weight on Keto you have something else underlying.

As an alternative have they suggested trying some of the treatments for endometriosis e.g. Mirena, GnRH analogue for the short term to see if they can actually help? We had a patient who wasn't suitable for a diagnostic lap so we had nothing to lose just by trying something instead

I can swim yes , I can't when I'm bleeding (can't wear tampons) but can swim. A bit scared to as last time I did I landed up being admitted within 12 hours as pain after was especially severe , but maybe if I go slowly.

Normally I have two slices of toast for breakfast with either scrambled eggs or beans, a sandwich/salad or baked potato (sweet or normal) for lunch and then some sort of meat/fish and veg for tea. Yoghurt (frozen or normal) and fruit for dessert.

At work I have the same plus a mid morning banana/cereal bar.

I did cut calories to toast in morning only and no other carbs but the dietician wasn't happy, said I need healthy carbs with every meal - suggested bread or porridge for the, potatoes or bread for lunch and then potatoes or pasta/rice etc for tea.

My trouble is I binge eat too as a form of self harm, and I comfort eat when I'm down - counsellor is trying to help me with both of them (she specialises in eating disorders). I wish it was easy to binge or comfort eat on fruit or veg!

Yes have had a mirena , went into cervical shock so not allowed again. Had GNRH but I continued to bleed so they stopped them. I'm currently on mini pill as well. Have tried combined pill and utovlan in the past - and everything in weird and wonderful combinations (coil plus utovlan , combined pill plus coil).

I'll try to go for a swim this week and see how I get on , anything that helps would be a good thing.

So I'm just off the phone to the hospital.

I've to lose a kg each week roughly, my laparoscopy likely won't be until the end of June and possibly as late as July. The secretary thinks if I lost a kg each week for 7-10 weeks that would get a stone and a half off, which would take my bmi to 31ish. If I can do more even better.

She's gone through all my upcoming appointments - urology in 3 weeks for discussion over self catheterising and cystoscopy, dietician in June to check I'm losing weight, anaesthetics in 3 weeks for pre assessment and then pain team end of June/July to try and reduce opiates.

Feeling a bit calmer and more positive. I'm going to try and write set meal plans to choose from so I'm not tempted to eat crap or order out. No cakes or biscuits or sweets during the week, a meal out once a month only and using money spent on crap at the pool or gym. Here's hoping I can do it.

The minipill will also be affecting your weight loss. Use MyFitnessPal to tell you your macros and caloroe intake. Portion control can also be a problem without many people knowing or realising just how much they eat. I'd swap the toast out for porridge or overnight oats with a high protein yogurt.

Oh and Cereal bars are TERRIBLE. Please stop eating them and have fruit instead.

As a 17 stone binge eater, I really sympathise with you

Unfortunately exercise is actually only a small part of weight loss...diet is much more important. I believe the figures are something like 80% diet and only 20% exercise. You need to focus less on lack of exercise being the problem, and more on resolving you food issues (and I do realise how hard that is).

I think it's great that you have support from a counsellor.

I was at least a 20/22 on the bottom 16/18 on the top when I had a diagnostic lap. My cons was happy

You have three big meals a day and binge eat too, and the gp thinks you can't cut down?

Have porridge for breakfast, a sandwich for lunch and your normal tea.

I would maybe try cutting carbs, LCHF Dietdoctor site is good for advice. Kind thoughts

Pea I think she just flaps because I'm quite obsessive (have a diagnosis of OCD) and have gone through phases of making myself sick before as a way of controlling things. My relationship with myself, with food etc is absolutely terrible. I get fixated on something (diet being an example) and I take it to extremes in my mind. That being said I've not been underweight since I was 6 years old , so to me it doesn't seem a problem.

I think I can do this though, if I buy the right stuff and try hard. I was 19 stone 3 last summer so I've already done part of it. It's just to get closer to a bmi of 30 now.

Will cut back on bread during the day , will keep my toast (soggy oats make me feel sick, sorry ) but will swap out bread at lunch for cous cous , quinoa etc.

Will also make a conscious effort to not buy ice cream, biscuits or chocolate - will have one treat a week . I remember that worked when I was 16 (got down from 16 stone to 12), I'm sure it would work again.

Laparotomy instead?

You need to calorie count. Although your daily diet sounds good, you're not counting the binging, which could be bringing it up considerably. If exercise is hard, you need to lower the calories and count religiously.

A big sandwich can easily have 600+ calories in, which is too much for you right now. Likewise, two slices of toast, butter, and a tin of beans is a large breakfast.

I've been on your threads previously. They are talking absolute rubbish. There is no reason you can't have the lap at your current weight. What happens if you get your op date through and you haven't lost a kg a week? You need to get on to PALS and get this sorted. I don't doubt that your situation is complex but you're not getting good treatment at the moment.

You're doing well with your weight loss so far, you've maybe just hit a bit of a plateau. A few wee changes here and there and you could be back on track, but to be honest I don't think excersise is the issue here.

Your breakfast and lunch combined is too much IMO, it might've been ok when you were bigger but the smaller you get the less you need. Scrambled egg and toast is brunch to me, I could never manage a sandwich or baked potatoes after that.

Maybe switch to fruit and yogurt or even cereal at breakfast time if you're not into porridge, drop the mid morning cereal bar and have a crumpet or something for your carb fix. Lunch is fine and just be aware of your portion size at night. You've had a great weight loss so far so you know you can do it, good luck.

Second opinion?
It's possible to have a laproscopy at your weight, but more difficult surgically and anaesthetically

Laparotomy would give more adhesions, and longer recovery, more scarring etc.

Low carb can really help with food issues and cravings as it kind of gets you off addictive sugar rising foods, it helps with that sort of thing. Could maybe add a bit or intermittent fasting? Even missing breakfast, having a omelette or something for brunch and then dinner, could help and not snacking, but still keeping you full...

I have endometriosis and it is so hard with exercise but really worth persevering. What about walking? Start off small and build it up, in my experience the exercise itself really helped me to deal with both the pain of endometriosis and the mental stress of dealing with a chronic illness. Good luck with your weight loss and laparoscopy, I'm waiting for a date for lap no 5, not looking forward to it!!!

I was fine having it done as this size one year ago.
I'm 5 ft 9. I lost a stone to have it done, I got to a size 16 bottom and about 16-18 top (I have huge boobs though which don't change)
I did it with Cambridge diet, i stuck to around 500-800 cals a day, I had an active job then too so occasionally had an extra protein shake.
After the laparoscopy I went on to lose another stone.
I healed very quick, in fact they didn't keep me in. I was due for one night's stay but I was home within a few hours of coming round.
I had some bloating and my belly button was sore for a few weeks but it was fine

so yes, i agree with the keto, it works and i have underactive thyroid and on citalopram too which caused weight gain when i started on it so odds were against me

Honestly, if you're under a team who don't feel confident operating on someone laparoscopically at a BMI of 35 ish you need to find a more experienced one. Admittedly your risks will be slightly higher due to your weight but not ridiculously so. Yes you should lose weight for your general health, but you shouldn't be getting held to ransom like this. A diagnostic lap is a very straightforward procedure and honestly, the difference between doing it when your BMI is 35 or 30 is negligible.

However - weight WAS mentioned at my intial consultation, as I'd got up to 16 stone 4.. my all time heaviest. Hence I lost the stone before the op.. would have liked to have lost more but I did carry on