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?

dont cut down meals.. just cut out all carbs except , say, a small handful of salad a day. I was allowed one bag of rocket a day and stuck to that.
Have protein shakes and if you can't do that, think eggs, Quorn etc.. no baked goods, no wheat..

(I meant, think meal replacement rather than go without anything... or switch all carbs for protein)
It can be done.. i've had to do this many times and about to again..and i have an awful sweet tooth!
good luck!

Would your pain levels allow you to lift small weights? Increasing your muscle mass will help to increase your metabolism and should help with weight loss. You could do a little and often throughout the day, lots of weights or conditioning exercises can be done whilst you are sitting too.

I'd count calories on my fitness pal you might be eating more than you think.

I'm not sure what you are asking - whether you can have the op at your current weight or whether you're after diet advice. So I'll give you both

First up - you can have a diagnostic laparoscopy at your current weight. If you really are a uk size 16-18 as opposed to a US 18 then definitely; a US 18 is more like a uk 22 so size alone isn't a great guide. However I have anaesthetised people for laparoscopic surgery with a BMI in the 40s and weights of 120-130kg. It is technically more challenging (veins are harder to find, keeping you breathing while asleep is a bit more tricky and waking you up at the end needs careful management) but it is medically completely possible and while the risk is increased, it goes from minuscule to minimal. Modern anaesthesia is safe.

Second - you can lose a kilo a week. With an obsessive personality you need to be careful not to fixate though. There are a couple of methods that may work for you - the low carb idea is good if you don't want to calorie or portion count (but you do need to stick rigidly to allowed foods). Think Slimming World red days, so unlimited lean protein and non starchy veg, unlimited fruit, then 2 slices wholemeal bread and a small portion of dairy only per day. Alternatively, work out your daily energy expenditure (many sites offer a TDEE calculator) and then aim to eat at least 500 kcal less per day. This way is harder as you need to track everything you eat, quantity and calorie wise. Cheat the app and you don't lose.

I don't recommend vlcd approaches like meal replacement diets unless very short term (prior to obesity surgery) as rapid significant weight loss is implicated in gallstone formation. A short term kick start is fine and they are safe if you can cope with the hunger at the start.

(Anaesthetist who does a fair amount of preassessment advising and risk stratification!)

I am MUCH bigger than you but have never come across this either for diagostic gynae procedures or more serious operations. Over the years (decades) my weight has never been mentioned by a surgeon. Is there another doctor/hospital you could be referred to? I most definately would if I could. (is your doctor even qualified?!?).

I am so sorry you are having to go through this. It's rather awful. I wish you the very best of luck.

I've just remembered what was said to me.
I was upset at the time, didn't question it (to doctor) but at least it spurred me on to lose that first stone before the op.
At my first consultation (at a hospital), they told me it that the lap' could not be performed there, had to go to another hospital where the operation table 'can support your weight'. At the time I was around 16 stone. They didn't weigh me, they went entirely by how I looked. I felt like the most morbidly obese person on the planet. They didn't mention about the surgery but about the table.
I found this very odd and remember going onto a forum about it, where others agreed it was odd, as people twice my size could go on an operating table.
As I said, when they did the lap' it all went very well. I had no bleeding and was sent home that day.
My shoulder hurt for a few weeks, because of the gas (?) which apparently is very common
The biggest problem I had was having my period a few days later and that killed because everything had been stirred up

Even now, I'm thinking , WTF??? ! As, why would this particular Hertfordshire hospital, only have lightweight operating tables?!

I will speak to GP when I see her in a weeks time, I think it will be a case of me needing to lose the weight - I still think the instruments being the same size as a biro is utter bull though. Have been accepted for day surgery before under GA when my bmi was far higher , and have cared for patients with bmi of up to 45 so I assume it's not as much anaesthesia as a gynae issue. I know for IVF they won't help you unless your bmi is 30 or below..

Last time - when they cancelled it - was horrendous. The doctor took one look at me and shook her head and said to a passing nurse , get a bmi of that patient please. The nurse weighed me in the corridor and they did it 4 more times , height as well before deciding they wouldn't do it.

Coincidentally had a wisdom tooth whipped out yesterday so struggling go eat at all now!

Diet wise I have just done my shopping/meal plan , going to reduce carbs as much as possible with the exception of work days . I'm doing 12 hour shifts for the first time since October on Tuesday so I need to be doing good energy wise.