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August 28, 2001

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Obese and Out of Options

Published in the Herald-Republic on Saturday, August 4,

2001

PAUL DUNN/Yakima Herald-Republic

Dr. Heap sutures a portion of Pat Mahoney's

midsection as she lies on the operating table, her head partially covered in the

foreground.

PAUL DUNN/Yakima Herald-Republic

Student radiology technician Kaprina Blumhagen positions

Pat Mahoney for an x-ray in preparation for the Yakima woman's surgery.

PAUL DUNN/Yakima Herald-Republic

Pat Mahoney contemplates her surgery-to-come after

undergoing a pre-operation blood test.

It has come to this for Pat Mahoney.

The Yakima Herald-Republic's 44-year-old circulation

director -- once a lean 125-pounder who ran five miles a day and ate " anything I

darn well wanted " -- is now 106 pounds over her ideal weight. At 5-feet-7

Mahoney weighs 256 pounds.

" In the last five or six years, my self-esteem has gone

down, " she says. " God forbid if there was a mirror around when I've had my

clothes off, because it just depresses me. I hate the way I look now. I wish

someone would have told me when I was a kid how miserable I'd be at age 40

because I'm fat. "

But her concerns go deeper than mere appearances -- her

weight threatens her health. She risks diabetes, heart failure and chronic

muscle and skeletal trauma by being what doctors consider " morbidly obese. "

Mahoney isn't morbid on this July morning, though -- she

manages what she calls her " fake smile " as she enters the emergency room

entrance at Kennewick General Hospital, where she will undergo a rare and

controversial surgery that will literally force her to lose weight.

The procedure, introduced in 1988, is called a distal

gastric bypass with duodenal switch. During the 2 1/2-hour surgery, Dr.

Heap of Richland will remove three-quarters of Mahoney's stomach, leaving her

physically unable to overeat.

Though it's not available in Yakima, doctors across the

country performed 40,000 similar operations last year, according to information

in the WebMD Medical News from Dr. Brolin, president of the American

Society of Bariatric Surgery.

Bariatric surgery is far from foolproof, though.

Information from the WebMD shows that about 1 percent of the procedures result

in death, and that as many as 20 percent of patients need additional surgery to

mend complications, such as abdominal hernias. Roughly 30 percent of patients

develop nutritional deficiencies.

The average bariatric surgery patient, Brolin says, is a

woman in her late 30s who weighs approximately 300 pounds.

Yakima's Stacey Whitmire, who weighed 353 pounds when

she underwent the procedure with Heap nine months ago, fit the profile closely.

" I'd be dead or diabetic by the time I was 40 if the

surgery had not been available, " says the morning radio show co-host and

promotions director.

Now, at 32, Whitmire's slimmed down to 218 -- about

where her doctors figure she should be at this stage. In another eight months or

so, she hopes to level off at her ultimate goal: 130 to 150 pounds.

Like Mahoney, Whitmire had tried every weight trick in

the book -- diets, drugs, exercise -- to no avail.

But the surgery, she says, has changed her life --

medically and cosmetically.

" I look at myself now at 218 pounds and say, 'Damn, I

look good.' "

WebMD Medical News notes the increasing demand for

bariatric surgery reflects the United States' obesity epidemic, where 55 percent

of adults are overweight and 4 million are severely obese.

According to the National Kidney and Urologic Diseases

Weight-control Information Network, the idea of gastric surgery to control

obesity has been around for about 40 years. Physicians got the idea after

noticing that patients tended to lose weight after undergoing operations that

removed large portions of the stomach or small intestine.

Today, Dr. Heap says, numerous advances and

breakthroughs make surgical procedures like the distal gastric bypass with

duodenal switch less risky and far more effective.

" It's like going from a Chevy to a Cadillac with this

new procedure, " the 62-year-old surgeon says. " My patients who have had the

surgery have so few complaints with this particular hook-up that I'm really

quite amazed. I like my patients to be able to lead a normal life -- surgery

shouldn't be a punishment. And, once you've lost 100 pounds, you're as happy as

a dog with two tails. "

However, cautions Heap -- who's performed some 1,000

obesity-reduction operations, including 70 duodenal switches in the past year --

none of the surgeries is 100 percent effective.

Obesity surgery is a last resort, adds Kathy Alyson

Beerman, a 46-year-old associate professor of nutrition at Washington State

University.

" My understanding is these types of surgeries are for

people whose weight is becoming a serious health issue and impacting their

lives, " Beerman says. " It's not recommended for people who just want cosmetic

changes. "

The cost alone should keep out the cosmetic crowd:

According to Janet , director of communication at Yakima Valley Memorial

Hospital, a typical three-day post-surgical hospital stay runs from $4,000 to

$8,000.

Heap estimates that cost to be more like $12,000 to

$15,000 for the duodenal switch procedure. Add to that the surgeon's fee --

which in Heap's case was $4,000 for the operation and three months of follow-up

care -- anesthesiologist's fee, which will run from $1,000 to $1,500, and a

variety of post-operative costs such as for vitamins and other medications, and

the total tab can run anywhere from about $13,000 to $25,000.

Many insurance companies now cover some of the

procedure, but patients should check their individual insurance plans for more

accurate estimates.

They should also check for local availability.

Heap is one of just two Eastern Washington surgeons who

performs the surgery. And though he believes in the procedure, Dr. Ted Rudd,

president of the Yakima County Medical Society and a practicing OBGYN since

1972, offers a differing opinion.

" The surgeries are dangerous and controversial, " Rudd

says. " Sometimes people who have that surgery are not well afterwards and can

get all types of digestive disorders. For that matter, any kind of surgery on

morbidly obese patients can be dangerous. "

And that, in effect, is why more surgeons don't perform

the operations, Rudd says.

" We have to deal with medical liability and

malpractice, " he says. " This kind of surgery is just an open minefield because

you could easily hurt the patients. And I think the results are not that

successful generally. There's a reason more surgeons aren't doing it. "

Rudd, emphasizing his lack of expertise in the field,

thinks the procedure might be useful in limited circumstances, however.

" There are times when people are so severely obese that

surgery is the only thing they can resort to, " he says. " It's certainly the last

thing you resort to -- the measure you take after everything else has been tried

and the patient's health is so severely compromised. But if surgery were the

answer to the problems of obesity in this country, I think we'd be doing it

pretty regularly. "

In specific cases, though, obesity surgery can be the

answer -- and it's no more risky than other surgeries, says Dr. Walter Medlin,

37.

" In selected patients, bariatric surgery can be quite

appropriate and quite successful, " the Yakima-based general surgeon says. " There

are patients who have complications and some who die from the surgery, but

that's the case with all surgeries. We're continually re-evaluating all types of

surgery and we're always trying to improve, but in terms of the approach of

bariatric surgery, there's nothing else that's proven to be nearly as effective

in reducing obesity. "

Medlin dismisses the notion that people who choose to

undergo obesity reduction surgery are sidestepping more appropriate lifestyle

changes.

" In our culture, obesity is seen as a moral flaw and not

a disease, " he says. " There's an attitude that people who are having surgery are

taking the easy way out, and that's not true. "

The surgery is not to be undertaken lightly, he

cautions, but it can be a life-saver.

" If you looked at overall life expectancy and

improvement in life, bariatrics is actually one of the most successful

life-saving surgeries out there, " he says. " Most bariatric surgeons require that

patients try other forms of weight-loss and have documented their attempts to

lose weight before they will be considered for such an operation. "

Or as Heap puts it: " Why would anyone come to see me to

get cut if they could do something else? "

That's a question for Whitmire and Mahoney.

Whitmire might have doubted her decision during the

first month after surgery -- if she'd had the energy to think about it. She

eased through that month pain free, but fatigue was another matter.

" I was in no way prepared for how hard it was going to

be, " she says. " Just typing or lifting a telephone receiver a few times could be

exhausting. "

But that seems like ancient history to the ebullient

radio personality. She's feeling like a goddess on steroids these days.

" I feel better that I have ever felt in my life, " she

says. " I'm in better shape now than I was when I was lighter because I'm more

active now. "

Mahoney, whose goal is to lose 115 pounds, is still

taking it a step at a time.

" There are lots and lots of fat people in the world, "

she says, " but there's going to be one fewer. "

Yakima Herald-Republic

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