SURGICAL PROCEDURE Less weight, more life

For the morbidly obese, the bypass surgery may be their last chance to live a normal life.
CORTLAND -- If there's one thing an extremely overweight person would want to make clear to a thin person, says Luis Santiago of Cortland, it's this: You just don't get it.
"Just because I'm fat," says Santiago, "that doesn't mean I'm not intelligent about diet and exercise. If I could have lost weight [in a conventional way], I would have. If I could have exercised, I would have."
Karen Wrightsman of Cortland calls conventional weight loss methods "an impossibility" for the very obese.
"Obesity can be profoundly debilitating. Even if you have the best intentions, exercise is sometimes beyond what we can do. I know women who couldn't walk three steps without being out of breath."
Santiago and Wrightsman are among dozens of people in the area who have undergone gastric bypass surgery to lose weight since Dr. Mohammad Rashid of Warren started offering the procedure last summer at Trumbull Memorial Hospital.
Santiago, who is 6-foot-2, weighed 385 pounds the day of his surgery, Jan. 4. He lost 70 pounds in the first 10 weeks and hopes eventually to weigh the same as he did on his wedding day, 220 pounds.
Wrightsman, 5-foot-3, weighed 271 when she had a gastric bypass Aug. 24, and has lost 70 pounds in six months. She's halfway to her goal of 135 pounds.
Both are very typical of Dr. Rashid's patients. He estimates he's done 45-50 gastric bypasses on morbidly obese patients since June 2001.
Morbid obesity is defined as being 100 or more pounds overweight, or having a Body Mass Index of 40 or higher (a healthy Body Mass Index is around 20).
Effects of obesity
Adverse health conditions associated with obesity include diabetes, heart disease, osteoarthritis, sleep apnea, gastroesophageal reflux, gallbladder disease, infertility, skin ulcers, urinary stress incontinence, and pancreatitis. Social, psychological and economic problems can also have a debilitating effect.
When considering surgery, Dr. Rashid consults with the patient's primary care physician first.
"Heart and lung function are the major things we look at," Rashid says. "Most of these patients have underlying health problems, and we want to know what they are and if they'll be a problem. We also look at any pre-existing conditions like diabetes, and get clearances for those."
Some insurance companies also require a psychological consultation. "We need emotionally stable patients, because this is a major life change. They can't continue the way they have in the past. They have to be mentally prepared for change. In some patients, it also helps to figure out the psychological reasons for their obesity."
Gastric bypass surgery is considered a last resort for patients who have tried and failed with conventional weight loss programs. In fact, many insurance companies require a documented history of medically supervised weight loss efforts that have failed.
Though there are risks to the surgery, the risk of death from obesity is greater than risks from possible complications like peritonitis, an abdominal infection.
Insurance coverage for gastric bypass is becoming common, but is still difficult. Patients are advised to document everything, from health club memberships, to prescription histories, to descriptions of daily activities.
Gastric bypass can cost from $13,000 to $33,000, depending on the type of surgery chosen and the patient's condition.
Types of procedures
The most common gastric bypass Dr. Rashid performs is the Roux-en-Y procedure, which restricts the size of both the stomach and the intestine. First, most of the stomach is stapled off to leave a 15-20cc pouch.
The outlet for the newly formed pouch is joined to a lower portion of the small intestine. This allows for a feeling of fullness in the new pouch, and malabsorption of calories in the shorter intestine.
Weight loss is guaranteed because the patient literally cannot eat and absorb enough calories to maintain the pre-surgery weight.
The hard part, though, comes after surgery. The patient goes home three days later with a list of rules and prohibitions. Chew all food thoroughly, don't drink fluids while eating, avoid high-sugar and high-fat foods, avoid alcohol, milkshakes and carbonated beverages.
Because of the malabsorption, nutritional deficiencies have to be prevented with vitamins and minerals. Periodic checks for anemia and low iron levels are necessary.
Patients are told to exercise, which becomes easier as they lose weight.
Support groups are strongly recommended to deal with emotional issues. Many people involved with gastric bypass surgery describe it as a last chance.
"People are desperate," says Rashid's office manager, Karen Wagner. "Society doesn't realize it, but there are people out there for whom diet and exercise just don't work. This is their last chance to be healthy."

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