“A Great Feeling”

By Catherine Pritchard

            Donna Carter was scared.

            She was 46, weighed over 310 pounds and had several serious health problems, including diabetes and hypertension. She also had severe asthma and the three medications she was taking weren’t doing enough.

            “My pulmonologist told me that by the end of the year I would be on oxygen 24 hours a day,” she said. The idea terrified her. She knew her obesity caused or exacerbated her health problems but she couldn’t lose weight, despite endless dieting and exercise.

            Carter decided to do something radical. She decided to have bariatric surgery.

            That was in 2002. That year, Carter underwent a gastric-bypass procedure in which her stomach was reduced to a small pouch that was attached directly to the small intestine past the first section of that organ. The surgery changed her digestive pathway. It also changed her life. Carter lost more than 150 pounds. She also shed her diabetes, hypertension and asthma and all of the medications that went with them. She never had to go on oxygen.

            Sixteen years later, Carter has maintained her weight loss and is a believer in the value of the surgery. As the bariatric coordinator for Cape Fear Valley’s Village Surgical in Fayetteville, she regularly tells people about her experience.

            Nearly 40 percent of Americans are obese, including 93.3 million adults, according to the Centers for Disease Control. Adults are considered obese when their Body Mass Index is 30 or higher. The normal range is 18.5 to 24.9. A growing number of Americans are morbidly obese, typically defined as being 100 or more pounds above ideal weight or having a BMI of 40 or higher.

            The excess weight can cause serious health problems. Obese people are at increased risk for many serious diseases and health conditions, including hypertension, diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, some cancers, body pain and more.

            Over the past three decades, a small but steadily increasing number of morbidly obese people have turned to bariatric surgery to help them lose their life-threatening excess pounds. In 2017, 228,000 people in this country underwent bariatric surgery, up from 158,000 in 2011, according to the American Society for Metabolic and Bariatric Surgery (ASMBS).

            Village Surgical began performing bariatric surgeries in 2002, said James Classen, M.D. Carter was its second laparoscopic patient. Since then, Classen said, the practice has performed about 3,000 bariatric surgeries. “Our results are good,” he said.

            Other Cape Fear Valley practices also perform bariatric surgery, including Ferncreek General Surgery. Ijeoma Ejeh, M.D., a physician at that practice, did a year-long fellowship in Atlanta focused on bariatric surgery and advanced laparoscopy.

            Like any of these surgeons, Ejeh does many types of surgery but says she finds bariatric surgery the most fascinating.

            “You have somebody who is limited by their medical illness that was either brought on or exacerbated by their weight and they can’t do something as simple as tying their shoes,” she said. That can all change for the better after the surgery.

            “The first thing some of them tell me is, ‘Look! I can cross my legs!’” Ejeh said. “‘Look! I can tie my shoes!’ Then it’s, ‘I don’t have to be on my diabetes medicine.’ ‘I don’t have to take my blood pressure medication anymore.’ I think that’s great.”

            There are several types of bariatric surgery. A decade ago, many patients chose “lap-band” surgery to address their weight issues. In this laparoscopic procedure, an adjustable band was placed around the stomach to restrict the amount of food the patient could consume, thus lowering caloric intake. As recently as 2011, lap-band procedures accounted for more than 35 percent of bariatric surgeries, according to ASMBS.

            By 2017, fewer than 3 percent of bariatric surgeries involved lap bands. Classen said that’s because the procedure was more problematic and produced more complications than other procedures.

            These days, most bariatric patients choose to have either a Roux-en-Y gastric bypass, which Classen and Ejeh both described as “the gold standard” of bariatric surgery, or the gastric sleeve, which is slightly less complex because it involves only the upper half of the abdomen. The gastric sleeve has become the most popular weight-loss surgery nationally, chosen by nearly 60 percent of bariatric patients in 2017, according to ASMBS.

            Both procedures are excellent, Classen and Ejeh said. Classen said the Roux-en-Y – the procedure done on Carter – typically produces more weight loss than the sleeve. In the first year or two after surgery, the average Roux-en-Y patient loses 70 percent of her excess weight while the average sleeve patient loses 60 percent of her excess weight. More hunger-affecting hormonal changes are associated with the Roux-en-Y procedure.

            The Roux-en-Y is a better option than the sleeve for some patients, including diabeetics and those who suffer from acid reflux, Classen said. The hormonal changes that occur because of the procedure can decrease or end a diabetic’s insulin problems and many “walk out of the hospital never again taking shots or pills,” he said.

            Diabetics who undergo a sleeve procedure should also see their diabetes improve. But because the sleeve causes fewer hormonal changes, their improvement is proportional with their weight loss, Classen said. And if the weight comes back, the diabetes comes back, he said.

            Classen said weight-loss surgery can also produce significant improvement in other health issues. Once painfully aching hip and knee joints can become livable after excess pounds melt away. Sleep apnea improves about 75 percent of the time and urinary stress incontinence about 90 percent of the time. Hypertension improves about 75 percent of the time.

            Many bariatric patients eventually regain a little weight but often not enough to rekindle other diseases or disorders. “You only have to lose 40 to 50 percent of your weight to have improvement in your comorbidities,” Classen said.

            The best part may be the improvement in the way a patient experiences life.

            Rebecca Morris, Classen’s nurse, weighed 255 pounds in 2004. She was 31 then and had been heavy since childhood. “I tried my whole life to diet,” she said, but it never worked for long. She’d lose 40 pounds, then regain 60. Morris said she was always out of breath, she sweated too much and she struggled to bend over.

            Then she had weight-loss surgery and, like Carter, her co-worker, her life changed for the better. Smiling, she recalled the day her 9-year-old son told her, “Wow, Mom, I can put my arms all the way around you!”

            Morris said five of her cousins were so impressed, they also had weight-loss surgery. All had great results, she said.

            Classen and Ejeh don’t do weight-loss surgery on anyone under 18. But there’s no age limit as long as a patient is in good health. Classen said he did weight-loss surgery on a 75-year-old woman several years ago and she’s still doing well with it.

            In June, Ejeh did gastric sleeve surgery on 68-year-old Annette Roach of Fayetteville.

            Roach, who weighed 375 pounds at her heaviest, had thought about bariatric surgery before but had chickened out. Also, she said, “I thought I can do it on my own.” She couldn’t. Meanwhile, she had worsening health conditions, including bad knees, high blood pressure and diabetes. She went to one of Ejeh’s free monthly seminars about bariatric surgery, then made an appointment with Ejeh, then decided to take the plunge. By mid-December, she had dropped to 277 pounds and her other health problems had improved.

            Roach said she aims to lose another 90-100 pounds in coming months while Ejeh wants her to lose another 120 pounds. It could happen.

            “I never thought I would get under 300 pounds,” Roach said. “I had tried so hard.”

            She flew recently and was elated that she didn’t need an extender to make the seat belt fit.

            “It’s a great feeling,” Roach said of her weight loss. “People don’t realize it if they’ve never been heavy.”

            If you’re interested in learning more about bariatric surgery, both practices hold free seminars on the subject each month. For information, call Village Surgical at 910-323-2626 or Ferncreek General Surgery at 910-485-3880.

January-February 2019