Navigating Level 4: Preparing for Surgery and Embracing Change

In this episode of The Road to Transformation: My Journey to Weight Loss Surgery and Beyond, I dive into the next stage of my journey — transitioning from Level 3 to Level 4 in the weight management programme. I share insights into the multidisciplinary team (MDT) meeting process, what to expect in Level 4, and the key preparations you need before surgery. 

You'll hear about:
 ✅ Understanding the MDT meeting and its role in your progression
 ✅ Meeting with your surgeon and choosing the right procedure for you
 ✅ The important dietary changes you should start making before surgery
 ✅ The liver reducing diet (LDR) — what it involves and why it’s crucial
 ✅ Preparing for your surgery date, including your pre-op appointment 

I also discuss some of the surprising challenges I faced, from giving up fizzy drinks and chewing gum to learning the importance of timing your meals and drinks. Whether you're preparing for your own weight loss surgery or supporting someone on their journey, this episode offers valuable insights and practical advice. 

💬 Got questions or want to share your journey? Join our supportive Facebook group: Our Road to Transformation: Our Journey to Weight Loss and Beyond. 

If you enjoyed this episode, please subscribe, leave a review, and share with anyone who may find it helpful. See you next time! 

Transcript

Hello and welcome to The Road to Transformation, my journey to weight loss surgery and beyond. I am your host, Amy Mandelj and this podcast series will walk you through my journey to weight loss surgery, from deciding to ask the GP for help, right the way through to my surgery date and all the steps in between and of course the progress beyond surgery. 

Hello and welcome back to episode three. 

In this episode I want to cover the transition to level four weight management programme and what goes on while you're in there. So in the last episode we covered level three, going through all the relevant appointments, a couple of things that I may have missed. So when you have your physio and your dietician appointment, they're also assessing that mentally you're okay and that you understand that it isn't going to be a quick fix and it really isn't going to be a quick fix is surgery. 

There's a lot of work that needs to go into it and yeah you need to be prepared. So once you've gone through all your appointments and you've ticked off everything that you need to do in terms of finding a support group, getting a certificate to say that you've been to two support meetings, you then get moved over to the multidisciplinary team meeting. I think that's what MDT stands for. 

You don't attend the multidisciplinary meeting but your team does. So your level three team will meet with the level four team and the surgeons and they will essentially discuss you, discuss your mindset, discuss how you've got on with the programme, discuss how you've managed with the diet implementations and they ultimately decide if you need to stay on the level three programme for a bit longer or if you're going to move to the surgical team. Again, this isn't something that happens quickly. 

I think my multidisciplinary meeting was in the December and it might have even been October and I got moved on to level four in the middle of the February. So yeah, things take time. You just have to trust the process and they tend to keep you updated via text message. 

Once you hit the level four programme, the process starts again. So you have a physio person, you have a dietician and you have the surgeon that you'll meet and discuss. When it comes to going to the surgeon appointment, it's a really good idea to have done your research into what procedure you're wanting. 

So I'd looked at the different options in terms of a gastric sleeve, a gastric bypass, a gastric band and because of the amount that I had to lose, when I first started this process, I was 23 and a half stone. So I had around about 12 to 13 and a half stone to lose. And looking for me personally, the different factors, I opted for the gastric bypass and there were a lot of things that contributed to that. 

Now, one of the factors was the percentage, the percentage of excess fat loss. I think that's the term. So there were other factors like with the gastric sleeve, they take away 70% of your stomach that's physically cut out of you and removed. 

With the gastric bypass, your stomach remains there, but they create a pouch within your stomach. Should anything bad happen, this can be reversed. It's not the easiest to reverse, but it can be reversed. 

So I went into that surgeon appointment with all this information and was told about the mini bypass. Now a mini bypass is like half a sleeve. So when they create your, your stomach pouch, they create it in the same shape as they would removing half of your stomach, but they don't remove it. 

And then they replumb one area. So it's known as a mini bypass. In fairness, the result rates are on par with the full bypass. 

But when I looked into it further, if you have any kind of acid reflux, the sleeve and the mini bypass can make that worse. Like there's a reason why they did it the original way at first. Like there's a reason why the gastric bypass was created as it was. 

And I had all that in mind and my surgeon was like, I'm more than happy to do whichever surgery you want, go away and do your research into the mini bypass and come back to me and let me know. So I did that. I did more research, deep dived into all the different variants, spoke to people from the support group, and ultimately as a single mom figured it was safer to go down the full bypass route, and that's what I did. 

With your physio appointments, they're wanting to make sure that you're still doing exercise three to four times a week, at least half an hour to an hour at a time. And I was able to tick those boxes. 

And then when it came to the dietician, it was all about preparing for surgery. So how can you add more protein into your day? What aspects are you not going to be able to do after surgery? So you can't have sugar in your coffee after surgery. You can have sweeteners. 

So making that change now makes more sense than waiting until after surgery. Fizzy drinks are a no-no. They make you feel bloated. 

It causes pain. It's not worth it. And that was going to be a real big one for me because I like flavour and I like texture. 

I just like fizzy. So that's been a real difficult thing to come to terms with. Also, chewing gum. 

Chewing gum is a no-no. Again, because when you're chewing gum, your stomach is producing stomach acid. It makes you think you're eating. 

Therefore, you get full and it hurts. So if you can stop doing these things before surgery, it gives you longer to adjust. You're also told that you can't drink while you eat.

And for a lot of people, that's kind of a standard. They don't anyway. But I found that I like to have a drink with my meal. 

So you can't drink 10 minutes before you start eating. And equally, when you've finished eating, you need to wait half an hour to 40 minutes. Because if you eat and drink at the same time, it can trigger dumping syndrome. 

And that can either make you sick. It can make you have bellyache. It can cause stabbing pains. 

Even to making you feel really tired and like your energy's gone. So these are all things that I've been adjusting to. Looking when you go shopping for the nutritional values on things. 

So I think it's 5% fat and 3 grammes of sugar in every 100 grammes. Now, some people are fine with slightly more sugar. But I found the one meal that looked healthy on the nutritional values was the sweet and sour chicken. 

So I bought an Aldi sweet and sour chicken that was high protein. And I thought, bonus, it's got high protein. It's going to be amazing. 

And I had three mouthfuls and felt sick. You might hear the term foamis. And the only way I can describe it is like you need to burp. 

But it feels like all there is is bubbles coming up. It's not a nice feeling. And ultimately, to get rid of that, you need to be sick. 

So it's kind of readjusting. And I've now started to only try new things when I'm in the comfort of my own home. As a just in case measure, they continue to get you into the hospital or to the doctors for weigh-in appointments. 

So they'll weigh, they'll measure and go through all that process with you. Now, they're not wanting you to fail. They're giving you the support that you need to be able to succeed the programme. 

But like I said, in level three, they don't want you to go above the weight you were when you first started. That is like the main thing that you don't go above the weight that you were when you first started. If this happens, you're likely to stay on the programme for longer and you could even be kicked out of the programme. 

So try and keep on top of that and kind of have a record of what your highest weight was when you were referred. So as it gets closer and closer to your appointment, like I say, these things aren't rushed. But when I hit level four, they told me that the surgery would be within 12 months of entering the level four. 

So I would have surgery by 2025, by the February 2025, which obviously happened. So as you get closer and closer to your date, you will be invited in for a group session. And in this group session, they cover what you need to do prior to surgery. 

So two weeks before your surgery date, you'll get asked to go on what's called a liver reducing diet, LDR. And what this does, it makes it easier for when they're performing surgery to safely get to your stomach. They need to manoeuvre your liver out of the way so it doesn't get damaged basically. 

So with that, you do have three diet options. I opted to go on the shakes diet because I thought basically the diet is under 800 calories per day. And personally, I didn't want to mess it up. 

I didn't want to go above the calories unintentionally, where the shakes diet was literally four shakes a day. You can get pre-made ones, you can get powder and add water to it. That was the best option for me. 

I know people have done it where they've had food and they've weighed and measured everything to ensure they don't go above the 800 calories. But for me, that won't work best. And also make sure you stick to having four shakes a day. 

It might feel like on the outset, listening to this, it might feel like that's impossible. I'm going to want to go above. But in reality, after the first two days, like the first two days, by far the hardest. 

But once you've got those first two days out of the way, I ended up doing the liver reducing diet for three weeks purely because my surgery date got moved and I'd already gone past the two worst days. So for the sake of a week, I didn't want to go through that again. And by week three, I was full after having two shakes. 

And I really had to think and push myself to have more. But if you have, if you're having 400 calories a day, your body is going to enter a starvation mode and it's going to cling on to everything that you put in. So at least by having four shakes a day and splitting them regularly, you're likely to continue losing weight while you're on that plan. 

In the first two weeks of the liver reducing diet, I actually lost a stone and a half. And in the third week, I didn't lose any extra because I was struggling to have the four shakes a day. It's also important to raise, you're not guaranteed to lose weight on the liver reducing diet. 

Don't worry if you don't lose weight. It's not about the weight loss. It's about shrinking your liver and making it so it can be moved. 

So they discuss that with you in the group session. They also discuss what to do after surgery. So after surgery, you have, depending on what area you're in, in Leeds, you have two weeks on liquid, two weeks on puree, two weeks on soft, and then you get back into normal food. 

So you need to be prepared for this. Like I currently can't have soup because I had soup for two weeks straight. So you end up finding those, those areas that aren't great. 

What else do they cover? They cover your medications. So they'll obviously speak to the pharmacy team, but any medications that you're on will be switched to a liquid or dissolvable form for that first two weeks post-surgery. So you're only having liquid. 

And then after six weeks, you get given a multivitamin. You get given quite a few different vitamins to have. So obviously that will change depending on where you are in the world. 

So after you've done this, it's then just a waiting game for your appointment to come through. Keep your phone with you. If you're in Leeds, they will phone you. 

I had the phone call the last week in November and the original date I was given was the 4th of December. Now the only issue with that was I have a crystal business and we had stalls on the run-up to Christmas. So I asked, I phoned back and asked if there was an alternative date and got booked in for the 9th of December. 

This then on the 27th of November got moved to the 16th of December, which was absolutely fine. It worked out for the best, but yeah, it's important to kind of have in mind what you've got coming up, what food you're going to need, what support you're going to need and buy in and prepare as much as you can. And also kind of check what date you're going to have to start the liver reducing diet. 

That tends to start two weeks before the surgery date. So have that in mind so you can go and prepare and get your shakes, get whatever option you're wanting to do. And then, yeah, you have a pre-op, which tends to be the week before surgery where they will do blood tests. 

They do an ECG just to make sure everything's okay with your heart. They take your height and they weigh you so that they can pass that information on to the anaesthetist. I can't say that properly. 

So yeah, that's the level four, the level three multi-discipline meeting level four and pre-op. If you do have any questions, please pop them in the comments. That's absolutely fine. 

And I will come back to you when I can. I think that covers everything that needs to be covered. Thank you so much for listening and I will see you next time. 

Thank you for joining me for this week's episode of the Road to Transformation, my journey to weight loss surgery and beyond. Please remember to subscribe and review if you have enjoyed what you have heard. Remember, all journeys are different, but I wanted to give you an insight into my journey through the NHS. 

Feel free to share with any of your friends and family members who are thinking about weight loss surgery. You can also join us in our Facebook group, the Road to Transformation, our weight loss journey, where you can share your experiences too. The link is in the show notes. 

I hope to see you next time. Thank you.