Fwd: Dr.'s admit hunger returns after WLS...

[Guest guest]

Hi Guys~ I thought many of you might be interested in an article

that appeared in The Sacramento Bee today. I will include the

article for anyone who would like to read it. The Dr.'s are finally

starting to admit that hunger comes back and aversion to many foods

goes away too!!! So basically it's all up to each of us to keep the

weight off after the honeymoon period is gone. Wendi

Sacramento Bee

November 13,2005

By Dorsey Griffith

Procedure may be last hope for some people

On a crisp Saturday morning in south Sacramento, 19 men and women,

ages 20 to 69, are gathered for a seminar they hope marks the start

of a better and longer life.

For some, it is a chance to end reliance on blood pressure,

cholesterol or diabetes medications. For others, it is an

opportunity to sleep without fear of suffocation, to walk to the

mailbox without gasping for air. All want to take a drastic approach

to losing the excess weight that is making them sick: gastric bypass

surgery.

What they hear from a team of weight-loss surgery experts from

Methodist Hospital is less than reassuring.

" You are risking your life for this, " says Terri , bariatric

program coordinator. " Complications can happen. "

Diarrhea, constipation, excessive vomiting and vitamin deficiencies

can plague patients who do not strictly follow the post-surgery

dietary guidelines, warns Randee Reidy, the program's registered

dietitian.

And a final reality check: " You won't get rich with this surgery, "

says Dr. Aaryan Koura, the surgeon. " You won't get smarter with this

surgery. You won't get taller with this surgery. But you will get

healthier. "

As the stomach-shrinking procedure becomes an increasingly common

tool for weight loss, the risks are coming more sharply into focus.

A recently published study, for example, found that despite the

potential benefits of gastric bypass surgery, rates of

hospitalization double in the years after the procedure.

The finding highlights the importance of ensuring that patients

selected for the surgery are properly prepared, both physically and

emotionally.

" We have adopted a saying here: 'Just because we can, doesn't mean

we should,' " said , who helps evaluate patients for bariatric

surgery at Methodist Hospital. herself had the operation five

years ago.

" We are their last hope, " she said. " The hardest part for me is

knowing that desperation, but knowing that for some, the benefits of

the surgery are not going to outweigh the risks. "

Gastric bypass surgery involves creating a small pouch at the top of

the stomach with surgical staples or a plastic band. The smaller

stomach is connected to the middle part of the small intestine,

bypassing the rest of the stomach and the upper part of the small

intestine. The result - a smaller stomach - allows patients to feel

full more quickly, reducing overall food and calorie intake and

absorption.

Beyond meeting certain weight thresholds, most bariatric surgery

programs require patients to take steps toward a healthier lifestyle

months before surgery approval.

Ruthie Velasquez, for example, was told she needed to lose 10

percent of her weight, or 35 pounds.

" They tell you if you don't lose the weight you can't have the

surgery, " said Velasquez, 47, who lives in West Sacramento.

She had surgery a year ago at a Kaiser Permanente hospital in the

Bay Area and since has lost 123 pounds.

In the preceding months, Velasquez joined the YMCA to swim laps and

started doing 30-minute daily workouts at Curves, a gym for women.

She attended Kaiser's health and nutrition classes and skipped the

cookie aisle, opting instead for apples.

Kaiser also required Velasquez to meet with a psychologist, a

painful process that she said " opened up old wounds. "

Finally ready for the surgery, she said she had become her own best

friend. " I had to tell myself: 'Keep trying.' I had to be mindful. "

Dr. Sasha Stiles, a family practitioner who directs the bariatric

surgery program at Kaiser, said that how well a person understands

when and why he or she eats is a good indicator of whether the

person will keep the weight off long term.

" We know that hunger returns (after gastric bypass surgery),

intolerance to certain foods goes away and life stresses increase, "

she said. " There will be deaths in the family, motor-vehicle

accidents. Patients really have to learn about how to be safe in

other ways than eating. "

Patients with serious mental disorders or without supportive family

members also may be rejected, said Terri , of Methodist

Hospital.

Sherwood said she's ready to take the leap. At 5 feet 9 inches

and 277 pounds, the Sacramento grandmother attended a three-hour

orientation for Kaiser's program. Two weeks later, however, she was

informed that she had been rejected for the surgery.

The obstacle, her doctor explained, is that she could not verify her

previous attempts at losing weight, a prerequisite for the costly

procedure.

" I was crushed, " she said. " I had my heart set on this, and I got

denied. I feel all I was was a piece of paper who got eighty-sixed. "

In reality, she said, she had gained and lost weight many times over

the years. Each time she lost weight, she gained it back, and then

some.

The extra weight has taxed her body. She now takes blood pressure

medications and has varicose veins, ankle problems and blisters on

her feet.

" A month ago, I went to a Kings game, " she said. " It almost killed

me. I walked up one flight of stairs and broke out in a cold sweat. "

Following the rejection, she conferred with Kaiser staff and agreed

to enroll in an eight-week weight management class to boost her

chances for surgery eligibility.

" I'm ready for a change, " she said. " My grandkids are so active. I

want to be able to play with them, to run around, to wrestle. "

It's a common refrain among those who opt for gastric bypass

surgery. But while surgeons are sympathetic to the yearning for

regained vitality, they want their patients to be realistic about

the potential pitfalls.

" This is a high-risk population. When you are dealing with

hypertension, diabetes and heart disease, it all has to be

evaluated, " said . " If they are not psychologically ready or

medically ready, it won't happen or will get delayed. "

Gastric bypass patients are required to quit smoking before surgery

and to improve lung capacity if they have severe breathing problems.

They undergo heart stress tests, chest X-rays and gall-bladder

checks.

At 5 feet 3 inches and 329 pounds, Katrina Pruett was approved for

gastric bypass surgery at Methodist Hospital in early November, but

not before undergoing a battery of medical tests. A scoping

procedure, for example, found bacteria that causes gastric ulcers

and had to be treated.

Doctors also determined that a hernia years before had left

abdominal scar tissue that would require a larger - and riskier -

incision to perform the operation.

The 48-year-old Lincoln woman said she is well aware of the

potential dangers and prepared for them.

She said she wrote letters to each of her children, to be given to

them in the event she died during or shortly after surgery.

" You have to face this, " Pruett said. " There is always that outside

chance. "

Three days after her surgery, Pruett winced as she coughed, the pain

from her incision still sharp. But she sat up in her hospital bed,

waiting to be discharged, preparing for the next phase of her life.

" I know I'm going to live longer as a result of this, " she said,

tears in her eyes. " I'll be here for my grandbabies, my fiancé and

my kids. "

--- End forwarded message ---