Not A Magic Pill

Source: Peoria Journal Star
Date: June 24, 2007

Peoria — Larry Steele of North Pekin is convinced that he wouldn’t be here today if he hadn’t followed his doctor's suggestion to undergo gastric bypass surgery in 2002.

Steele was hospitalized in the intensive care unit for 47 days in November 2006 after having pseudo-cysts in his pancreas, a condition unrelated to the surgery. He said he never would have made it through the ordeal at his previous weight.

"There were two or three times I didn’t think I’d make it home," the 65-year-old said. "I know I wouldn't have made it in the hospital for 47 days if I was 360 pounds," he said. "I had enough trouble moving around in bed as it was."

Dr. J. Stephen Marshall, director of bariatric surgery with Peoria Surgical Group, said despite the risks — about 1 percent of patients die from complications — gastric bypass surgery is actually a life-saving procedure. Someone who is morbidly obese over time will face myriad other health risks, such as diabetes, stroke, heart attack or lung disease.

"Every year that goes by reinforces to us that obesity is a disease, and surgery will help,” says Marshall, who also notes that experience has helped the surgery group decrease the incidence of complications. “Pairing the surgery with support groups and education is key," he said.

Steele was featured in a Journal Star story in February 2003, a year after he underwent gastric bypass surgery. The specific type of gastric bypass is known as Roux-en-Y, in which doctors staple off a small section of the stomach to limit the amount of food a patient can eat. It works by making the patient feel full with less food and makes them intolerant of foods high in fat or sugar. It also allows them to absorb fewer calories because the small intestine, where most digestion occurs, is partially bypassed. Patients must monitor how much food they eat after the surgery, as overeating can cause pain, a leak in the pouch or vomiting.

In 2003, Steele weighed 171 pounds. Although his weight has fluctuated a bit since then — dropping as low as 160 — he currently weighs 172 pounds and says he's happy with the results of the surgery.

Here is how Steele is doing today, followed by the other two patients featured in the Journal Star in 2003.

Permanent changes

Before the surgery, Steele was a diabetic receiving six or seven shots of insulin a day. His doctor said if he didn't have the surgery, he would be giving up 10 years of his life. Since his health insurance wouldn't cover the procedure, he dipped into his retirement funds to pay for it himself, spending about $45,000 on care.

"Since I had to pay for mine, I had a lot more reason to make sure it worked," he said.

Five years later, Steele said he would do it again. He now has more energy to spend working on his classic cars. Recently he put a new engine and new transmission in his 1936 Ford truck and painted it, too, something he said he wouldn’t have had the stamina to do before.

Steele is also an inspector for the National Street Rod Association, looking over about 100 cars a year. He started inspecting cars again about three years ago after giving it up for several years.

"When I was so big, it would take me five minutes to get under the car, and five minutes to get back up," he said.

But Steele said that gastric bypass surgery is not the quick fix many people think it is. Steele attends support group meetings most Monday nights at the RiverPlex and probably will forever; as they help him keep the weight off.

"You're not going to go down there and talk in front of someone if you're gaining weight," he said.

And his eating habits are permanently changed. Right after the surgery, Steele had trouble eating spaghetti, macaroni, chicken and beef. He recently ate chicken for the first time in 3 1/2 years. He still doesn't eat much bread. And, five years later, he still eats only 3/4 cup of food at a time, on a small saucer with a small fork.

"I don’t eat near much as I used to," he said. "I used to eat 5 or 6 ears of corn. What do I eat now? Two tablespoons."

Steele will never eat more than 3/4 cup of food at a time, but he is not bothered by this. Nor is he bothered — too much, anyway — when he goes to a $10 buffet to eat $2 worth of food.

The trade-offs are worth it, Steele says. He doesn't have to ask for a seat extension when he travels on an airplane. He is trim enough to cruise around in his classic Plymouth. He is up a 5 a.m. now, doing chores, tinkering in the garage, working in the yard.

"I have so much more energy, I don't get tired like I used to," he said. "A lot of things change when you get rid of the weight."

Surgery Complications

Debbie Emanuels of Dunlap, who works as circulation district manager for the Journal Star, said she is satisfied with the results of her surgery despite having to deal with various complications.

Emanuels was 330 pounds at her heaviest and said she couldn't keep the weight off no matter which diet she tried. She had gastric bypass surgery in April 2003 and lost 138 pounds.

In July 2006, Emanuels had her gall bladder removed and a hernia operation. She also had a stomach revision to correct what doctors call a staple line disruption, when one or more staples becomes loose and food the patient eats leaks into the old portion of the stomach.

Marshall of Peoria Surgical Group said people who lose a lot of weight in a short period of time have an increased risk of gallstones or gallstone disease. Abdominal hernia is a common side-effect of the surgery. Staple line disruptions also are a risk, but the medical group has since modified the surgery to try and lower the incidence of it happening.

"In the old days we just applied a staple line and left the stomach intact," Marshall said.

"What we do now is, we apply a staple line and then divide the stomach so it’s not as easy for the staple line to become disrupted," he said. "There is a smaller incidence of staple line disruptions now — about 3 to 10 percent," he said.

During the revision, doctors completely detached Emanuels' stomach pouch and double stapled it. She was hospitalized for 10 days.

"I was so worn out," she said. "I thought, how am I ever going to get strength again? I’d sit on the couch and watch the grass grow."

Emanuels has had some weight fluctuations over the last few years. Balancing the demands of work and family leaves little time to exercise, although she does a lot of walking at work. After losing the initial 138 pounds after the surgery, her weight crept to 277 last July. She has been concentrating on eating less and is starting to lose weight again; she weighed 182 pounds at her last doctor visit on May 8.

Emanuels eats much less than she used to before the surgery. When she goes out to eat with her family, she doesn't order her own meal, but she'll take two or three bites from everyone else's plate. Or she'll order a kids meal, eat the small hamburger and give the french fries away. She said she has to be careful not to snack when fixing dinner because if she has a few bites while preparing a meal, she reaches capacity before the family even sits down together.

Emanuels said something that has been difficult to get used to is that she can't eat and drink at the same time. When she eats a meal, she can't have any beverages within half an hour.

"It has been a real struggle for me," she said. "It seems like I’m always thirsty."

She's also always cold now and has started drinking coffee to warm up.

"That's one thing after the surgery — after you don't have all that extra padding, you’re freezing."

She still has the "dumping," or vomiting after eating certain foods. It occurs when food is digested too rapidly. It feels like the flu, she said, and although it's worse right after having the surgery, certain foods can trigger a reaction years later.

"It just hits you, and you better be near a bathroom," she said.

To this day, Emanuels can't tolerate rice. But, despite the side effects, Emanuels is content with her decision.

"I'm glad I did it. I could never seem to do a diet and lose anything," Emanuels said. "The stress on my feet and legs, I don't have that anymore, and that's so nice."

"Give it a lot of thought."

Robin Perry of Pekin, 42, had gastric bypass surgery in April 2001. She weighed 257 pounds and lost 112 pounds in the first 9 months after surgery. Perry said she worked out five days a week and was keeping the weight off until a bulging disc in her back made it difficult to keep up with vigorous exercise.

She currently weighs 175 and would like to lose 20 pounds, she said.

"Unfortunately as you go along, you're able to eat more and more like a normal person," Perry said. "I certainly can't eat the amount of food I used to eat, but I have a tendency to snack, which is a huge no-no."

Marshall, who has been performing gastric bypass surgery for about 18 years, said the stomach is typically the size of a walnut immediately after surgery. Marshall said doctors like to see the stomach stay the size of a golf ball, but it can increase to the size of a tennis ball if a patient eats too much.

"There is some natural stretching, it just happens. If people overeat constantly, they will stretch the pouch," Marshall said. "So what the patients have to learn is to eat so they're not hungry versus eating as much as they can — even though it's not that much, that still puts stretch on the pouch."

Perry said that she has always struggled with overeating, but she knew going into the procedure that she would face the same issues on the other side of it.

"It's just one of those things, you know, you didn’t get to be 100 pounds overweight because you had a good relationship with food," she said. "They surgically alter you and you do your best, but it’s still a struggle."

At least now it's a fight she feels like she can win.

"I need to get the 20 pounds off, but that's a lot less daunting than having to get 100 pounds off," she said. "Before I had my surgery, it seemed like it didn't matter what I did. Either I could lose the weight and couldn't sustain it, or I just couldn't do it at all. Even though I've had my issues with weight gain, I still feel like it's something that I can do. It's not a lost cause for me anymore."

"When people ask me about (the surgery), I mainly just tell them not to listen to the stories they hear about it, to give it a lot of thought. If it's something they do choose to do, they have to be absolutely ready for it. And they have to understand that it's not a magic pill, it's not a magic bullet. It's not something that's going to cure all of their problems or all of the issues that they have with food."