Patient Articles - When Danger Lies in Weight
It wasn’t a look in the mirror that brought Tricia DiPinto to the decision point. It was looking at her 5-year-old son, Joseph.
“I knew he was going to need me,” she says, “and the way I was going, I wasn’t likely to be around long.”
A little over a year ago, at 33, the Hopatcong homemaker was at the end of her rope. She weighed 299 pounds and had diabetes and congestive heart failure, and her blood pressure was out of control despite four medications. Her cholesterol count was 398 milligrams per deciliter (mg/dL), and her blood triglycerides – ideally they should be at 180 mg/dL – were in the stratosphere at 2,697 mg/dL. Still worse was how she actually felt – even breathing was a struggle. And she’d tried at least four major diet programs repeatedly without success.
Her need to hang in there as a mom – and a wife to her supportive husband, Romolo, prompted her to call a friend who’d had a gastric bypass surgery. The friend took her to a seminar where she learned about this surgical treatment for morbid obesity, which Saint Clare’s Hospital began offering last year.
DiPinto had the surgery August 3, 2005. Within six months she had lost 119 pounds. Her diabetes was gone, her blood pressure was an excellent 115 over 60, her cholesterol was down to 148 mg/dL and her triglycerides had been reduced to 268 mg/dL, still a bit high but a stunning improvement.
“I’m a new person now that I’ve lost all this weight,” she says. “I don’t ache any more, and I can breathe again.”
Medical miracle? Absolutely. But DiPinto is the first to point out that gastric bypass surgery isn’t for everyone. It is an extreme remedy that is only for severely obese individuals who’ve tried and failed to reduce their weight with diet, exercise and medications, and it requires people to eat in a careful new way for the rest of their lives.
“It’s not a cosmetic operation,” explains Edward Pucci, D.O., a bariatric and general surgeon at Saint Clare’s. “It’s a tool to help morbidly obese individuals make lifestyle modifications necessary for good health.”
Gastric bypass surgery is only recommended if you have a body mass index – a figure based on height and weight – of 40, or 35 if you also have serious obesity-related medical complications, as DiPinto had.
The procedure works by restricting a patient’s food intake. Doctors create a 1-ounce pouch about the size of a thumb within the stomach and separate it by stapling. A short section of the small intestine is attached to the pouch so that food can bypass the remaining 90 percent of the stomach and 3 to 4 feet of small intestine, limiting the fats (and calories) the intestines absorb. Because the pouch is so small, patients are sharply limited in how much food they can consume, and how quickly. They must adhere to a postsurgical diet of liquids for the first week, pureed foods for the next four weeks, and small amounts of solids, which must be eaten slowly and chewed carefully, for the rest of their lives. Most patients lose three-quarters of excess weight within one to two years after gastric bypass surgery.
“It can be difficult,” says DiPinto, “but honestly, your stomach doesn’t allow you to falter.”
DiPinto’s operation was performed by Alexander Abkin, M.D., medical co-director of the Center for Weight Loss Surgery at Saint Clare’s, using a minimally invasive, laparoscopic approach. In such a procedure, he explains, “five incisions measuring about one-half inch each are made at strategic locations to allow place of special instruments so that we can do the surgery without putting our hands into the patient’s abdomen.”
Medicare and most insurance companies cover the costs of gastric bypass surgery, though some insurers require confirmation of medically supervised attempts at weight loss. Patients are in the hospital for two or three days after the procedure, and recovery takes about three weeks. Saint Clare’s also offers lap band operations, which isolate part of the stomach with an adjustable band.
“The truth is,” says Dr. Abkin, “if there were a magic pill to make you not hungry, then I guess the surgery would be obsolete.” But there isn’t.
“The operation teaches you something most severely overweight people cannot teach themselves, and that is self-control,” says DiPointo. Food had become an addiction for her, she recalls, and she turned to it “as comfort and as a numbing agent.”
But that doesn’t mean it was just a failure of will. Hereditary factors put DiPinto in danger; she had struggled with obesity and high blood pressure since age 4, and her father had died at 36 from a heart attack and pulmonary edema brought on by clogged arteries.
Before patients undergo gastric bypass surgery, they’re given extensive tests to rule out metabolic or endocrine disorders to be sure that a simpler treatment couldn’t relieve the extreme obesity. They also receive psychological counseling to make sure they’re ready for the commitment and lifestyle changes that will be required.
Both Dr. Abkin and Dr. Pucci say they’ve turned away patients who were looking for a “quick fix”.
As Dr. Pucci explains, if a patient who has had gastric eats too much too quickly, or eats food that are too rich, the portion of the small intestine that remains functional becomes distended and he or she experiences an unpleasant “dumping syndrome” as the body releases a chemical called serotonin followed by insulin to counteract the sugars it can’t process. The result can be palpitations, abdominal cramping, nausea, dizziness or diarrhea.
“I’ve experienced it,” says DiPinto, “and I don’t want to again.”
After the operation, collaboration between the patient and surgeon continues, and levels of vitamins, calcium, and iron are regularly checked. It’s challenging, but most patients don’t mind coming back, says Dr. Abkin, “because we’ve given them back their lives.
At 180 pounds, DiPinto feels she has reached a point where further weight loss will be more difficult. But her healthiest weight would be 150 to 160, she says, and she’s working hard on the treadmill to shed additional pounds.
“I didn’t have this drastic surgery to go three-fourths of the way,” she insists. And she says Romolo remains her firm ally as her campaign to reclaim her life goes on. “He loved me at 300,” she says, “and he loves me at 180.”
