A Tool for Life

Source: Peoria Journal Star
Story By: Jessica L. Aberle
Date: February 25, 2003

Peoria — When her doctor finally suggested stomach stapling, Debbie Emanuels cried.

"I know I’m overweight, but I never thought I was a candidate for this surgery," Debbie remembers crying to her husband that night. "It kind of hurt my feelings."

When Debbie got married, she was a fit 150 pounds and swimming several days a week. After giving birth to two children, her weight fluctuated dramatically over the next several years, despite exercise. She tried all the different diets, but never felt full and always put the weight back on.

Her 5-year-old son’s friend constantly was making comments. "Your mom’s butt hangs over the side of the seat," he would say. Or, "If you’d quit eating the wrong foods, you’d be thin."

It didn’t help that the Dunlap woman was 39 and working in a sedentary job as supervisor for the Journal Star circulation department’s van crew. She would drive the teenagers to different communities to promote subscriptions door-to-door. They frequently would stop at gas stations to get treats and a drink.

She would eat whatever was "fast and easy."

In early 2002, Debbie hit her peak weight of 330 pounds. Her body mass indicated she was morbidly obese. Her feet, legs and back ached. She was not yet suffering from obesity-related diseases such as diabetes, heart diseases or high blood pressure, but she was headed in that direction.

"You really need to lose weight," she remembers her aunt saying. "You want to be there for your children."

Debbie’s two young children were her driving force. She did want to be there as they grew up. Her husband, Jim, was there to support her.

So she embarked on a life-changing journey, and there was no going back.

The Surgery

Peoria is the only downstate city offering a complete bariatric program — complete with pre-operation and post-operation support groups.

Five surgeons with the Peoria Surgical Group currently perform a specific type of gastric bypass, called Roux-en-Y at OSF Saint Francis and Methodist medical centers. More bariatric surgeries were performed in Peoria in 2001-02 than anywhere in the state. Surgeries topped 300 in 2002, with 80 percent performed at St. Francis.

"This is one business I wish I’d never have to continue for the rest of my life," said Dr. Thomas R. Rossi, one of the surgeons in the group. "I’d like to put myself out of business on this one."

But obesity rates continue to rise across the nation. In 2000, the surgeon general declared obesity a national epidemic; doctors began to recognize it as a disease. With more than 60% of all American adults considered overweight or obese, Rossi said the number of bariatric surgeries will continue to rise.

Peoria offers both the open and laparoscopic RNY, which work by minimizing food intake and limiting the absorption of nutrients. A third surgery, the Lap-Band procedure, where a silicone band is placed around a portion of the stomach to limit food intake, will be offered soon.

In the open RNY, the surgeon creates a new pouch by stapling off a very small section from the rest of the stomach. In the laparoscopic surgery, performed through several small incisions in the abdomen, the small pouch is actually cut away from the rest of the stomach, to guarantee complete separation.

The small stomach pouch forces patients to limit food intake to one to two ounces at a time in the beginning, and about three to four ounces for the rest of their lives. Overeating will cause severe pain, a leak in the pouch or vomiting.

Malabsorption is the second aspect of the surgery. Part of the small intestine is attached to the new stomach pouch and the portion extending from the defunctionalized stomach is reattached further down the digestive track.

This reworking of the bowel limits the time the body actually digests the food, forcing gastric bypass patients to commit to taking daily vitamin supplements.

But the surgery is just the beginning.

Risks and complications

After researching her options, Debbie decided bariatric surgery was her only resort. She went through the appropriate screening, attended support group meetings and signed a contract agreeing to lifetime follow-ups.

Dr. James DeBord performed her open RNY surgery on April 8, 2002.

It was major abdominal surgery, but Debbie told most of her family she was having a hernia operation. She didn’t want them to worry, even though she knew the risks of the procedure.

Debbie even entertained the notion of who would care for her children if she died from the surgery — .5 percent to 2 percent of gastric bypass patients die from complications.

"It’s definitely something that can happen," Rossi said, adding lesser complications include internal bleeding, abscesses, blood clots and heart attacks. "This isn’t your walk-through-the-park surgery. There are a lot of risks involved."

Despite all of that, "I had a peace, because I’d been praying about it," Debbie said.

Surgery went well, but Debbie developed a leak in the new pouch and needed a drain until it healed.

"I wanted to hurt someone," she said of the pain, adding she was so weak and tired those first few days she thought she had made a mistake.

But as she began to heal and graduated from the clear liquid to full liquid to a solid food diet, her spirits lifted — and pounds dropped.

Within a month she had lost nearly 40 pounds and was starting to get her energy back. After three months she had lost 76 pounds.

"It’s nice now to diet and not be hungry," Debbie said. "I lost control of my weight, but now there’s a light at the end of the tunnel."

As with most gastric bypass patients, there are foods Debbie cannot tolerate: Pork is the main one. It’s just a side effect of the surgery that all the patients have to deal with, said Melinda Lange, bariatric program director. They have to learn how and what to eat again.

As the pounds melt away, other common side-effects such as hernias and excess skin are becoming a problem for Debbie. Hernias are sometimes considered a blessing, however, as an inexpensive tummy tuck often can be performed at the same time as the hernia repair.

And with that tummy tuck in sight, Debbie is approaching her weight-loss goal, one milestone at a time.

Judging success

A major milestone came in December, just eight months after surgery. Debbie dropped under 200 pounds.

Not only did she put on a pair of jeans, but she called her surgeon to share the good news.

"I have never seen you wear jeans," her daughter exclaimed.

"You just keep getting smaller and smaller," her son said.

But the moment of truth came on a crisp January morning as she went to renew her driver’s license. Debbie had attained a feat most women only dream of — she weighed less than her license claimed.

As Debbie arrived with a Journal Star photographer to document the occasion, many people curiously asked questions. She didn’t hesitate to talk about her surgery. She was far from embarrassed. The new haircut and ear-to-ear smile told it all.

Debbie has lost more than 136 pounds. But more importantly, she’s healthier. She won’t be turned down for life insurance again because of her weight. She slipped into her wet suit by herself to go scuba driving. She’s walking two miles a day and plans to run — not walk — the four-mile Steamboat Classic in June.

"It was a good decision. It has been a positive decision. I have no regrets at all," she said.

The doctors are pleased with Debbie’s progress so far, but they judge success by more than just the number of pounds lost.

Success is based first on the patient’s ability to maintain weight loss and eliminate co-morbidity factors, such as high blood pressure, heart diseases, sleep apnea and arthritis. Bariatric doctors often frown on setting a weight loss goal and instead encourage a health-related goal.

The second barometer is the loss of 70 percent of excess body weight within 12 months of surgery.

"It’s for the long term," Rossi said. "We don’t want to focus on weight, we want to focus on (eliminating) health risks."

Ultimately, Rossi and Lange would like to see more research on prevention. By teaching young children proper diet and exercise practices, doctors hope the surgery can eventually be eliminated. Rossi also suggests getting employers to encourage healthy lifestyles among the nation’s work force.

"Smoking is the No. 1 preventable cause of death," Rossi said. "Obesity is No. 2, and it’s rising."

The Payoff

Larry Steele was not about to be another statistic.

At age 60, the North Pekin man weighed 360 pounds, took 13 pills and two to six shots of insulin every day. Steele constantly was exhausted. Often, his stomach was black and blue from injections and his fingers tender from pricking.

An insulin-dependent diabetic with several failed diet attempts, Steele’s last hope was gastric bypass surgery. His insurance wouldn’t cover the more than $34,000 procedure, so he spent his retirement money.

"My doctor said I’d just be kissing 10 years goodbye if I didn’t have this done," said Steele.

One year later, Steele is a trim 171 pounds. He looks great and is happy working on a new home and garage, where he enjoys tinkering with old cars. More importantly, he takes only one pill a day to regulate his thyroid.

"I’m not quite perfect yet, but I’m getting there," he said.

For Robin Perry, it was about mobility.

An admitted junk-food addict, the 37-year-old woman had battled her weight since she was 4 years old. She tried exercising, but as her size increased, her mobility decreased.

It’s been almost two years since Perry had bariatric surgery. She lost 112 pounds in the first nine months, and she continues to keep it off.

"My life has completely changed," said Perry, whose short, stylish gray hair and flattering figure are more characteristic of a model than a bariatric patient.

But day after day, Perry is up at 5 a.m. to work out. She consumes 80 to 100 ounces of water daily. There is no high-carbohydrate bread at her dinner table. And she is committed to attending regular support group meetings.

"I’m ecstatic. I’m thrilled, I’d do it again! I wouldn’t even have to think about it," Perry said. "I’m stronger, happier, healthier than I ever have been in my whole life."

No easy way out

Bariatric surgery often is seen as the easy answer, but Lange says that’s a mistake.

"It should be seen as putting your life on the line as a last resort."

Ninety-five percent of all gastric bypass patients have tried and failed at numerous other attempts to lose excess weight. And the surgery serves only as a tool; patients must continue to follow the diet and exercise program to maintain results.

"Surgery is a tool to help control and manage obesity issues," Lange said. "But it’s every choice, every meal that makes the results. It truly is the lifestyle change that makes the success."

Doctors know there are ways to trick the system — drinking while eating and consuming lots of sugar. But a permanent life change is mandatory for Peoria bariatric program patients.

They face harsh scrutiny of their life history and habits and undergo a psychological evaluation to determine if they even are a candidate for the surgery. Patients must sign a contract to attend support meetings and yearly checkups for the rest of their life.

The surgery itself is irreversible. The risk of death to reverse such a procedure — with no guarantee it would work — would be three to five times higher than the gastric bypass itself.

"It’s permanent," Rossi said.

The program

Patients can find permanent support for their decision at the Bariatric Center in the RiverPlex.

Although surgeons in central Illinois have been doing some form of bariatric surgery for more than 20 years, the support program is about 18 months old. Coordinator Lange and others worked on the material for three years before putting it all into place.

Peoria’s comprehensive program — complete with support groups, dietitians, physical trainers, psychologists, pharmacists and surgeon cooperation — is unique to downstate Illinois.

"It takes a multi-disciplinary team for the complex issues of those who face obesity," Lange said. "No one has all the answers."

But together the group offers information and support for those thinking about obesity surgery and those recovering. To even be considered for the surgery, a patient must commit to the program. The psychological interview lasts about an hour and investigates both mental and physical health issues, along with family history. A small percentage of people are turned away.

The support groups were introduced in the summer of 2000, when Peoria started seeing a drastic increase in bariatric surgeries. At the first meeting there were eight people, Lange said. At one meeting in January there were 46.

Pre-op and post-op support groups meet twice a month at the RiverPlex. Everything is discussed at the meetings, from recipes and excess skin to insurance problems.

"The information actually comes from the patients," Lange admits. "They’re the experts, the people living it. They become the teachers of the teachers."

Follow-ups are scheduled frequently within the first 12 months and then yearly on the surgery anniversary date for the rest of the patient’s life.

Currently there are 264 people in the program trying to get the surgery, Lange said.

"It’s a tool," she said of the surgery, "something they can work with, something they’ll be working at for life... and we hope it’s a long one."