Surgery gives recipients ‘second chance at life

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Weight Loss Surgery gives recipients second chance at life

Doug Salisbury was a long-time dieter. Nothing worked.“I was more than 500 pounds,” he said. “I work in a profession where obesity is really high. I drive a truck.”
He had a gastric sleeve on Dec. 22. “With his encouragement and knowledge of it, it helped me make that decision. I’ve lost 81 pounds so far. I’m glad I had the surgery because I do more now than I did two months ago,” the Bowling Green man said. “I’m off all my medications but one. I’ll be 44 this year. I feel like I’m 25. I get out and do things I couldn’t do three months ago. It’s hard to do things because you’re carrying so much weight.” Salisbury tells as many people about the surgery as he can. “I try to preach it to a few people to help them out,” he said. “As a matter of fact, I helped a co-worker get his surgery this week.”“All don’t have the same efficiency and all don’t have the same detriment,” Nwanguma said.

How the surgeries work

In Roux-en-Y gastric bypass.

The surgeon creates a small pouch at the top of the stomach. The pouch is the only part of the stomach that receives food. This greatly limits the amount that you can comfortably eat and drink at one time. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food flows directly from the pouch into this part of the intestine. The main part of the stomach, however, continues to make digestive juices. The portion of the intestine still attached to the main stomach is reattached farther down. This allows the digestive juices to flow to the small intestine. Because food now bypasses a portion of the small intestine, fewer nutrients and calories are absorbed.

The Gastric Band System

In the adjustable laparoscopic gastric band procedure, a band containing an inflatable inner silicone band is placed around the upper part of the stomach and fixed in place. This creates a small stomach pouch above the gastric band with a very narrow opening to the rest of the stomach. A port is then placed under the skin of the abdomen. A tube connects the port to the gastric band. By injecting or removing fluid through the port, the balloon can be inflated or deflated to adjust the size of the band. The Gastric band restricts the amount of food that your stomach can hold, so you feel full sooner, but it doesn’t reduce the absorption of calories and nutrients.

Gastric sleeve gastrectomy.

With a gastric Sleeve part of the stomach is separated and removed from the body. The remaining section of the stomach is formed into a tube-like structure. This smaller stomach cannot hold as much food. It also produces less of the appetite-regulating hormone ghrelin, which may lessen a person’s desire to eat. However, gastric sleeve gastrectomy does not affect the absorption of calories and nutrients in the intestines.

The duodenal switch

With biliopancreatic diversion begins with the surgeon removing a large part of the stomach. The valve that releases food to the small intestine is left, along with the first part of the small intestine, called the duodenum. The surgeon then closes off the middle section of the intestine and attaches the last part directly to the duodenum. This is the duodenal switch. The separated section of the intestine isn’t removed from the body. Instead, it’s reattached to the end of the intestine, allowing bile and pancreatic digestive juices to flow into this part of the intestine. This is the biliopancreatic diversion. As a result of these changes, food bypasses most of the small intestine, limiting the absorption of calories and nutrients. This, together with the smaller size of the stomach, leads to weight loss.
How they compare
The gastric band surgery is not doing so well, accounting for 8 percent of surgeries, Nwanguma said. “A lot of patients have issues with the gastric band band,” he said. “Food can get stuck. Sometimes they get a port infection with the gastric band.”
The duodenal switch accounts for 2 percent, Nwanguma said. It carries a high risk for nutritional disadvantages, causing vitamin deficiency which can lead to ailments such as dental decay and hair thinning.
The two remaining bariatric surgeries account for 90 percent of surgeries done in the U.S.,” he said. “The sleeve accounts for 50 percent, and the Gastric Bypass(Roux-en-Y) accounts for 40 percent. I see the numbers for the sleeve going up.”

Bariatric Surgery is not without risk

While many of the outcomes of bariatric surgery are happy, it’s not without risks, which can include excessive bleeding, infection, adverse reactions to anesthesia, blood clots, lung or breathing problems, leaks in the gastrointestinal system, and rarely, death. Longer term risks can include bowel obstruction; dumping syndrome, causing diarrhea, nausea or vomiting; gallstones; hernias; low blood sugar (hypoglycemia); malnutrition; stomach perforation; ulcers; vomiting; and rarely, death.
The weight the patient is carrying is more dangerous than the surgery itself. The only thing that can permanently reverse disease is weight loss. “Our outcome here is very happy,” he said. “You change people’s outcomes in a positive way.” Some patients are thrilled with the outcomes of their gastric sleeve surgeries with Dr. Nwanguma.
Why they did it
“I had been struggling for many years with my weight. When I heard about the sleeve, I thought ‘That’s interesting,’ ” said Janet Harper of Bowling Green. “I did research. I was extremely nervous. It took six months to have the surgery.” She lost 90 pounds and went from a size 18 to a size 8. Other than taking pain medication for three days, Harper hasn’t had any other issues. “It was the best decision I ever made,” she said. She worried about eating at first.
“It’s not simple to have surgery. You have to change a mindset,” she said. “What if I mess up? If you mess up, then the world’s not going to end. You just pick yourself up and start over.”Harper probably eats “what a 2 or 3 year old would eat.” “I take vitamins every day and I drink my protein drinks. You have to eat slow so you can find the optimum of what you’re full at,” she said. “It takes 30 minutes for the brain to feel full. If I eat too much, I start to belch.”  Harper doesn’t count calories. “If you do, you’ll panic,” she said. “You count carbohydrates and proteins.”
Andrea Ford of Scottsville does count calories. She tries to stay within 1,000 and 1,200 a day. Within that, she takes in 30 carbohydrates a day. “It’s hard when you’re working 12-hour shifts,” said Ford, who is a nurse. Ford has lost 140 pounds. She was wearing a size 24-26 and now wears a size 14. She was wearing a size 3XL scrubs and now wears a large. “I had several co-workers who had the surgery,” she said. “Most of them say it was the best thing they’d ever done.”  Ford said she had been obese since she was 7 years old. She did everything she could to lose weight. She felt she had no control over it. Then one day she decided to try bariatric surgery. “I had, PCOS, polycystic ovary syndrome,” she said. “I had been told I had to lose over 100 pounds to have a healthy pregnancy.”Now Ford feels “good.” “I have more weight to lose. People treat you differently. People treat you kind and people notice you more for some reason,” she said. “To me, I feel like the same person. People encourage you. It is encouraging to know you can lose the weight.”
Marvin Daniel of Bowling Green said he’d have bariatric surgery again tomorrow if he needed to. He lost 82 pounds, going from a size 44 to a size 32 and from a 2XL to a medium. “I went to a meeting with my wife. I had no intention of having it,” he said. “I had it and she had it six months later. She’s lost 100 pounds.” There are so many health benefits he has experienced, including lowering his triglycerides and cholesterol. “I couldn’t walk from the parking lot to the office without being out of breath. I was on four blood pressure medications a day. Now I’m on none,” he said. “I’m not off all medications, but gradually I’m going that way. The doctor told me I’d extended my life expectancy seven to nine years. Gastric sleeve surgery saved my life. I don’t think I would’ve been around without it.”
Follow features reporter Alyssa Harvey on Twitter at twitter.com/bgdnfeatures or visit bgdailynews.com.
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