Patient Articles - Losing and Loving it!
Two Women Experience the Early Effects of Weight Loss Surgery
By Lorraine Ash -- Daily Record, Morris, New Jersey
For the first time in her life, Holly Kapral cried with happiness when she went on the scale at her doctor's office. It ' d been three months since her gastric bypass surgery in July, and the 18-year-old college freshman discovered she’d lost 79 pounds.
She opened her arms to embrace her mother, Debbie Kapral, who'd had the same surgery in early 2001.
"We can actually put our arms around each other and hug," said Holly Kapral, who weighed in at 284. "I can't remember the last time I was under 300 pounds, maybe when I was 12 or 13."
In the Roux-en-Y gastric bypass operation, the gold standard in bariatric surgery, a 1-ounce pouch on top of the patient's stomach is separated from the rest of the 70-ounce organ using staples. A hole is then cut in the pouch and the small intestine is rerouted to it.
The new hookup lessens Holly Kapra's ability to absorb some fat and calories, although there's a downside: It also lessens her ability to fully absorb vitamins, which is why she needs to have daily protein shakes and vitamin supplements.
The pouch, the size of a shot glass, is her functional stomach. When it fills with food, she feels sated. In this way, her caloric intake is limited to 400 to 600 calories a day, allowing for steady and significant weight loss in the first year after surgery.
"Holly is top in her class," said Dr. Alexander Abkin, who performed the Kaprals' bypasses laparoscopically with Dr. Nicholas Bertha. The two, affiliated with the 3-year-old Morristown Memorial Hospital Obesity Center, have an office in Florham Park.
"In three months the average person is expected to lose 50 to 60 pounds. It varies, though," Abkin added. "What's lost depends on many things, such as age, motivation and support."
Holly Kapral and Sue Davenport of Dover, a 46-year-old nurse who had an adjustable gastric band laparoscopically placed around the outside of her upper stomach, creating a 2-ounce pouch, agreed to share their stories with Daily Record readers up to a year and a half after surgery.
They hope their experiences will educate others about the realities of living as an obese person and the difference bariatric surgeries can make.
For some of the 26 percent of the American population who qualify as obese because they carry at least 100 excess pounds, such surgeries are the only way to drop to a healthy weight and prolong their lives.
During Davenport's three-month follow-up, the same day as Kapral's, the nurse found she'd lost 44 pounds and was down to 211.
"I've gone down several sizes in clothing," Davenport said. "I feel great. No problems. No complaints. People keep asking me if I changed my hair or they notice my glasses."
The post-operative visits were jocular. Abkin said both his patients are doing very well. He told Kapral to be sure not to be late in getting her bloodwork taken. The bloodwork, done every three months for two years and then every six months for the rest of a patient ' s life, monitors heart risk and vitamin, iron and calcium levels.
"We stay on top of those things," the doctor said. "Instead of waiting for complications to occur, we take a proactive approach."
Abkin upped the folate in Davenport's vitamin complex after reviewing her bloodwork. He also told the nurse, who'd stopped losing weight in recent weeks, to wait two more. If her weight still doesn ' t drop during that time, he ' ll tighten her band, which will further restrict her food intake and cause weight loss to resume. Such adjustments are typical for gastric banding patients, who usually want to lose a maximum of 100 pounds.
Banding was more appealing than gastric bypass surgery to Davenport, who didn't want her anatomy changed. When her 2-ounce pouch fills, she stops eating and the pouch then slowly empties into the rest of her stomach. The silicone band can be tightened when a doctor injects saline into a subcutaneous port.
The brief procedure will be performed at Morristown Memorial, Davenport said.
"Sue is doing fabulously, "Abkin said. "She is a prime example of a properly selected patient picking the right procedure. We recommend the first band adjustment within eight to 12 weeks. Sue just waited a little longer."
In the meantime, she's increased her 30-minute daily exercise regimen to 45 minutes, plus extra walking at lunchtime.
Both women report more vitality and vigorous movement.
Kapral, a freshman at County College of Morris, said that walking the hills of the Randolph campus is good exercise and that she can even make it up and down so-called Cardiac Hill.
"I walk around school and nobody looks at me anymore like I've got three heads," she said. "Before I used to get these little looks from people."
She'd just signed up at The Body Shop for Women in her hometown of Jefferson to work out her upper and lower body.
She described a typical breakfast these days - two crackers smeared with peanut butter. She had eaten half a piece of chicken parmigiana a few days earlier. Three times a day she eats nothing larger than a cup of food, the maximum the smaller stomach created by the surgery allows.
"Everybody is cooperating with my change in routine," Kapral said. "If my friend and I go out for dinner, he buys whatever he wants and I take some of his, so I'm a cheap date. Hey, I ' m a cheap date, so if there are any guys out there!"
"Cheap but not easy," her mother added, smiling, and adding Kapral now walks with a spring in her step. "She's a completely different person. You can see she's happier. It chokes me up to watch the difference in her."
Both Kapral and Davenport seem surprised at how easy and painless it’s been to lose weight. Kapral said a few times, in the beginning, she didn't chew her food enough, ate too quickly, and vomited. But she's adjusted and can't get over that she has no cravings for any food anymore.
"It's like, did they do something to my mind, too, when they were operating? "she said. "Now I look at food sometimes and think,' Oh, I can't eat that. 'I love it."
Davenport said she's learned to eat until she feels a pain in her left shoulder.
"It's the weirdest thing, "she said. "The pain's not in my stomach and nowhere else but my shoulder. It makes no sense medically, but that's the way my body is going."
The two, with good support networks among family and friends, have even had some post-operative laughs as they work their way down in weight.
Since both Holly and Debbie Kapral have had gastric bypasses, they each eat small amounts of food. When they dine out with Holly's sister, they order just one meal and split it. Holly eats a quarter, Debbie a quarter and the sister, half.
"So there we were in the restaurant the other day arguing about what to put in this one omelet,"Holly Kapral said. "It's got to be something everybody likes and that's not easy."
They decided on bacon, cheese and onion, which tastes good, no matter what the portion size.
