Success Stories - Barbara Martucci
By PAT MINDOS
Herald Staff Writer
DOVER — Four years ago Barbara Martucci could not bend over to tie her shoes or squeeze through a turnstile at the train station.
The 47-year-old Denville woman's life has dramatically changed since she had weight-loss surgery at Dover General Hospital in 2002.
"I have a new body, a new man and a new life," said Martucci, the director of education and the emergency management coordinator for Saint Clare's Health System. Dover General is one of four hospitals operated by Saint Clare's Health System.
Martucci, who stands 4 feet, 11 inches, used to weigh 260 pounds. Now a size 10 dress fits her 149 pounds. Before her surgery, walking was a chore. She can now dance vigorously without sweating.
"For me, it's a miracle," she said.
Dr. Alexander Abkin, who performs bariatric surgery at Saint Clare's Dover facility, said surgery is better than diet alone for markedly obese individuals.
"Nothing else works," Abkin said. "Diet alone only works for about six months and has a 5 percent success rate. Even with exercise, the results are dismal."
Bariatric surgery, combined with post-operative diet and exercise, has a 90 percent success rate, he said. All three factors are important because surgery alone is not a magic wand for weight loss.
In the past year, Abkin and his partner, Dr. Nicholas Bertha, have performed 750 bariatric surgeries. Abkin and Bertha are the co-directors of Saint Clare's Health System's recently launched Center for Weight Loss Surgery at Dover General.
More than 23 million Americans exceed their ideal body weight by 100 pounds. They also suffer from medical conditions such as high blood pressure, diabetes and pulmonary complications, according to the American Society for Bariatric Surgery.
For these patients, bariatric surgery, also known as weight-loss surgery, could be the solution to their health problems. The surgery limits how much a person can eat by creating a small gastric pouch and bypassing a portion of the small intestine. More than 68,000 of the procedures were performed in the United States last year, according to Saint Clare's Health System.
For Hardyston resident Ann Kievit, the desire to live motivated her to undergo weight-loss surgery.
"I was going to die, my health was the main concern and my grandchildren need me because they love me," she said. Kievit, 53, had gastric bypass surgery done at Hackensack University Medical Center two years ago. The 5-foot 4-inch woman weighed 236 pounds before the surgery. Since then she has lost 76 pounds.
"This is not a surgery to be taken lightly," she said. "If you forget about a healthy lifestyle you can gain weight back. Or you can continue exercising and watching your diet."
The surgery is also not for everyone, she said.
"If you're going to do it just to lose weight, don't do it," she said. "If you are doing it mainly for your health — to stay alive — that's why you should do it. You cannot love food and be successful with this surgery," she said.
The weight loss center at Dover General, which will move to its own 18-bed unit later this year, wil l offer mostly semi-private rooms and provide support services, such as nutritional counseling and behavioral health counseling for bariatric surgery patients.
Right now, up to 12 patients are cared for in the hospital's medical/surgical unit by nurses specifically trained for post-operative care related to bariatric surgery, said Jeff Snyder, the hospital's vice president and chief administrative officer. The new unit wil l open after renovations are completed in an existing wing of the Dover facility.
The hospital's weight loss center complies with standards of a Center of Excellence set by the Surgical Review Corp., a subsidiary organization of the American Society of Bariatric Surgery. The standards require a physician who performs bariatric surgery to have completed 125 surgeries before joining Saint Clare's Bariatric Surgery physician panel. A physician must perform 50 surgeries each year thereafter, Snyder said.
The hospitals require patients to have psychological and psychiatric evaluations prior to the surgery. Patients have to attend an educational class to learn what awaits them. Diet and a behavior evaluation are also required.
Surgical weight loss support groups, which meet once a month, help those who have undergone the surgery get through any post-operative issues. Hackensack Medica l offers a group run by nurses and a psychologist. There is also a group that meets once a month in Sparta for those who have had the surgery or are considering the surgery.
Post-operative nutritional counseling is important, said Jo-Ann Lee, a registered nurse and the administrative manager of Hackensack Medical Center's bariatric rehabilitation program.
"These people need to look at why they ate so much in the first place," she said. "Usually, it's for reasons other than hunger."
Once they have the surgery, patients need to eat healthy foods and small portions. Exercise is also necessary.
Kievit had to wait to have the surgery until her health improved.
She controlled her diabetes through insulin injections three times a day and could not have her surgery until she had stopped smoking for two years. Smokers are three to 10 times more prone to developing an ulcer where the new stomach connects to the small bowel, Abkin said.
A patient with a history of alcohol abuse or recent drug abuse is also not eligible.
For Kievit, the first six weeks of recovery was the hardest.
"Mostly you drink fluids and you can only eat pureed food," she said. It was not until a month later that she started eating real food.
Martucci knew she made the right decision after she lost 77 pounds in six months right after the surgery. There are still challenges. "If you eat too fast or the wrong foods, you have severe diarrhea or vomiting," she said. Both she and Kievit walk for exercise.
just celebrated her three-year anniversary of having the surgery this month. Since the surgery, the mother of two has had to cope with another lifestyle change — her divorce.
Looking back on having the surgery, she said, "My end result taught me that I made this decision for myself but more important, no one should ever be convinced that they are too fat to be loved."
Who qualifies for this surgery?
Dr. Alexander Abkin specializes in laparoscopic gastric bypasses and laparoscopic adjustable gastric bands surgery at Saint Clare's Dover facility, both of which are types of bariatric surgery. To be approved for surgery, Abkin's patients have to meet criteria established by the American Society for Bariatric Surgery.
A man has to be at least 100 pounds over the ideal weight for his height. A woman needs to be 70-80 pounds more than her ideal weight. Patients with medical conditions such as diabetes, sleep apnea, high blood pressure, infertility and degenerative joint disease could weigh less.
What types of weight-loss surgery are available?
Laparoscopic adjustable gastric banding system is the least traumatic of all weight-loss surgeries. There is no cutting, stapling or rerouting of the bowels.
For this procedure, four or five small incisions are made with long-shafted instruments. The doctor implants an inflatable silicone band into the patient's abdomen. Similar to a wristwatch, the band is fastened around the upper stomach and creates a new, tiny stomach pouch that limits how much food can be eaten.
As a result, patients experience an earlier sensation of fullness and are satisfied with smaller amounts of food. This results in weight loss. Surgery is done in the same day surgery unit at Saint Clare's Dover facility. The patient is not admitted to the hospital.
Laparoscopic RY gastric bypass requires a two-day hospital stay. The doctor separates the stomach, creating a one-ounce-sized pouch. The small intestine is re-routed to the pouch and bypasses the rest of the stomach and the first three to four feet of small bowel. Usually five small incisions are made, which allows less pain and faster recovery.
Gastric bypass, or stapling, is an open surgery. The internal procedure is similar, but the incision is usually 10 inches or longer. There is more pain, longer recovery and more complications. Hospital stay varies by surgeon and can last four to seven days.
What is the criteria to determine which surgery should be done?
"Patients usually do the research and tell us which one they want," Abkin said. "We make sure that it is the correct choice for them."
Is this procedure covered by insurance?
Most companies cover the surgery if it is medically necessary and if the patient has tried other medically supervised weight loss prgrams. People considering this surgery should check their insurance coverage.
What should patients do who are considering weight loss surgery?
Stop smoking and drinking alcohol. Research the different types of surgery and confirm that surgeon is certified by the society for bariatric surgery in that state. (www.asbs.org)
