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In a message dated 8/28/2001 3:01:25 PM Pacific Daylight Time,

melaniemag@... writes:

> http://www.yakima-herald.com/cgi-bin/liveique.acgi$rec=37890?home

Dr. Heap is 62????? OMG I met him for a consult before finding out I'd have

to self pay and I never would have put him in his 60's....LOL I was a phone

call away from making a date with him....He's a good surgeon!!

~*~ AJ ~*~

Age 37 5'8''

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 415.1

08/06/01 BMI 59 390.2 -24.9 lbs!

08/16/01 BMI 58 387.0 -27.9 lbs!

08/24/01 BMI 58 386.5 -28.6 lbs!

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History

Surgeon Trims Yakima Woman's Stomach

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

2001

PAUL DUNN/Yakima Herald-Republic

Pat Mahoney goes over a list of questions she'd brought

to Dr. Heap during her pre-operation exam.

Dunn/Yakima Herald-Republic

A monitor attached to Pat Mahoney's finger helps track

her vital signs during surgery.

At 7:45 a.m. nurses wheel Pat Mahoney into the operating

room, where she lies on her side, tubes sticking out of her like vines on a

trellis.

She's ready, but restrained.

" I'm starting to get kind of nervous, " she'd said as she

waited in the hospital lobby.

In a few minutes the Yakima woman will be unconscious as

her Richland surgeon, Dr. Heap, performs a distal gastric bypass with

duodenal switch. The controversial procedure, which involves removing a large

portion of the patient's stomach, forces dangerously obese people to reduce

their food intake.

Mahoney hopes the operation starts her on the road back

to self-respect -- which has been in short supply lately.

She's been told, though, that the after-effects of the

surgery will be tough. Take it one day at a time, doctors have advised, and

rejoice in getting through those first few post-operative days. She scoffs at

the notion.

" Are they kidding? " she asks. " I've had two C-sections,

when they cut you open and then give you a baby to take care of immediately

afterwards. Now that's tough. "

Heap has been encouraging, but he doesn't want to get

Mahoney's hopes up too high.

" I'm not God, " he tells her, " but I do the best I can.

Your chances of having a complication through me are one in 400 patients. I'm

not particularly worried that I'm going to kill you. "

Bright lights engulf Mahoney as she lies on the

operating table. The anesthesiologist, standing behind her next to a vital signs

monitoring machine with a dizzying array of knobs and graphic displays, asks if

she's ready, then slowly pumps a strong anesthetic into her arm, sending her to

dreamland five seconds later ...

Mahoney, who is 5-feet-7, has doubled her weight in the

past two decades, ballooning from an athletic 125 to her current weight of 250

pounds.

During her Army days, from 1975-78, she ran five miles a

day -- whether she wanted to or not -- and ate whatever she wanted.

But then she got married -- and pregnant soon

thereafter. That's when the pounds started to pile on and wouldn't come off. The

day her second child, , was born, Mahoney weighed 199 pounds.

" I remember saying at that point 'Harpoon me if I ever

get over 200,' " she recalls. " If I would have kept myself in shape after the

first baby (, born in 1978), I would have avoided all the heartbreak of all

the years after. "

By 1996, the harpoon had plunged, wiggling clockwise

like the needle on a bathroom scale. A hysterectomy that same year didn't help

matters; pretty soon Mahoney began feeling despicable.

She had become the enstein of obesity -- burdened

with the fat and the scars to prove it.

The forthright woman with the easy laugh was at the end

of her rope.

Mahoney's health demanded drastic action. Her goal: to

lose 115 pounds.

She's had 22 surgeries -- many of them directly

attributable to her weight. She's tried every diet imaginable, every diet drug

on the market and every prayer in the world to shed the pounds. Her exercise

program, such as it is, has been severely limited by her surgeries -- including

seven for knee problems.

Her right knee looks like the deflated crown of Mount

St. Helens -- the kneecap having been removed a few years back because it

couldn't stand the strain. And though the obesity surgery Mahoney elected to try

will, in many eyes, make her more attractive -- it's just the icing on the cake.

Mahoney's more concerned about walking again without

pain and fatigue, having more energy, improving her demeanor and being less

self-conscious about her appearance.

The surgical staff gathers around her as she lies on the

operating table, belly exposed. Heap enters the room with the confidence of a

man about to do battle with a foe he knows he can conquer.

" OK, " he asks the anesthesiologist " are we ready? " A nod

and a " yes " signal the beginning of the 21/2-hour surgery. Heap carefully cuts

an 8-inch path down Mahoney's midsection -- from belly button to breasts. He has

to work at it to get through the 2 inches or so of fatty tissue that encase

Mahoney's intestines. Once the cavity has been opened, he sticks his arm inside

and rummages around, feeling for areas of concern: ulcers, ovary problems.

It's an odd sight -- a regular Thanksgiving turkey

stuffing. Heap's obviously used to it, though -- his manner suggesting a

practiced routine. Small cloth rags are used to soak up blood, then discarded

onto a tarp on the operating floor. Suction devices keep the surgical area free

of welled-up blood.

Once Heap's satisfied that no surprises await him, he

gets down to business. To the untrained eye, Mahoney's insides are a mish-mash

of squishy, rope-like tissue. But Heap and his staff are unfazed.

" It's just like looking underneath the hood of a car, "

Heap explains later. " If you've never seen one before you're not going to know

what you're looking at. "

Minutes fly by. Heap calls out for instruments, suture

twine, suction -- and his assistants respond with assembly-line precision. The

occasional miscommunication draws an " Oh, come on, " from the gray-haired

surgeon.

After an hour or so, Heap gets to the stomach. Using a

device that he first clamps down, then slides at the top to shear the tissue, he

cuts around the curved end of the organ, taking a couple of passes to complete

the transection. He has to push hard to get through the stomach walls -- no

delicate shilly-shallying here. Finishing the procedure, he triumphantly

displays the 80 percent of Mahoney's stomach that she now no longer owns.

A moment or two later he reaches back into Mahoney's

cavity and cradles the remainder of the stomach in his hand, holding the

transected flaps together as he sutures them shut. Mahoney's stomach, once the

size of a football, is now just a banana. At this point, a royal blue tracing

fluid is pumped into the new stomach, causing it to bloat like a miniature bota

bag.

" We're making sure the new stomach won't leak along the

suture line, " Heap says.

Satisfied the pouch is fluid-tight, he works to hook up

the new stomach to the duodenum, the first segment of the small intestine, which

he has transected at about 2 inches beyond the pyloric valve, which regulates

the emptying of the stomach's contents into the small intestine.

After all the right connections are made, Heap checks

Mahoney's intestinal cavity to make sure the procedure has gone as well as

possible.

Finally pulling his hands out of Mahoney's open

midsection, he declares the procedure complete, and loosely sutures his

patient's gaping incision. The attending nurse then staples the slit closed.

" Well, how did it go? " Heap's second-in-command -- a

nurse with 30 years of surgery room experience -- is asked as Mahoney lies on

the table before being wheeled to post-op.

" It was really smooth, " she answers. " He's a master --

makes it look easy. "

A few minutes later, Heap's operating crew gives a

heave-ho and Mahoney slides from the operating table to an adjustable bed --

which is then wheeled into the post-operation room.

Mahoney's face is waxlike, pale, worn.

Every few minutes her eyes flutter open and she moans,

then falls back to sleep, her intermittent snores breaking the silence in the

room. An oxygen mask is placed over her nose and mouth to help her along.

Mahoney's attending nurse speaks to her every so often, judging how much pain

medication to administer and how well Mahoney's enduring her surgical

anesthesia.

" Pat, how are you doing? " the nurse asks.

" Hurt, " Mahoney replies.

The nurse gives Mahoney an armful of a pain drug called

" fentinyl, " which she says is 10 times more powerful than morphine.

" Even with the drug, though " the nurse adds, " some of

the patients directly after surgery are writhing in pain. "

Mahoney isn't writhing -- she isn't awake enough, yet.

After about an hour in the recovery room, she's wheeled into an elevator just

big enough to hold the bed and levitated upstairs to her room -- where she'll

spend the next couple of days. She's still not fully awake, but cognizant enough

to remember why she's there.

" I'm so thirsty, " she tells the nurse, then falls

asleep.

©2001 All Photos, Content and Design are Properties of the:

Yakima Herald-Republic

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