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90 Pounds Gone …. and Counting

Karen knew it was time to consider weight-loss surgery when she began having trouble walking and exercising. "It was getting tough. I was having problems with my ankle and knee from arthritis, and I had asthma from being overweight. The weight on my chest was restricting my breathing," says the 46-year old Gurnee, Illinois resident.

Only four months after having laparoscopic duodenal switch surgery at the University of Chicago medical center, Karen is already 90 pounds lighter. She continues to drop about 4 to 5 pounds a week and expects to lose up to 180 pounds within one year of her surgery.

Karen's health has also improved. Her asthma has disappeared, and her knee and ankle are feeling better, making it easier to walk and exercise.

"Weight-loss surgery is not a short-term solution," says Karen. "For the surgery to be successful, you have to be committed to it for a lifetime. There are also inherent risks that go with this surgery. But if you've tried everything and you find that your life is deteriorating because of your weight gain, then I would recommend that you take a look at weight-loss surgery and see if it's appropriate for you."

Making the Decision

Karen's weight problems began in her late 20s. She tried lots of diets, but to no avail. The pounds kept adding up until she was considered morbidly obese.

"It was time to make a positive change in my life," she says. So, she started researching weight-loss surgery, which is also called bariatric surgery. That's when she learned that the surgeons at the University of Chicago Medicine performed these procedures laparoscopically, or through small incisions.

"I went to another bariatric center in the area, but they didn't do the procedure laparoscopically. They wanted to cut me up, filet me like a fish more or less. There would be a long scar, and I did not want that."

Karen met with University of Chicago surgeon Vivek Prachand, MD, and discussed two surgical options: duodenal switch surgery and Roux-en-Y gastric bypass surgery. While performed differently, both operations involve two main steps: First, the surgeons reduce the size of the stomach, causing patients to become full after eating only small amounts. Then, the surgeons "re-route" the intestines so that patients absorb fewer calories.

Karen decided to go with the duodenal switch procedure because the operation carries a lower risk of "dumping syndrome" than the Roux-en-Y procedure. Dumping syndrome occurs when food and fluid move too quickly through the small intestine after eating, causing nausea, diarrhea, and other symptoms.

The University of Chicago Center for the Surgical Treatment of Obesity is one of the few centers in the country that offers both the Roux-en-Y gastric bypass and the duodenal switch procedure to patients considering bariatric surgery. In addition, University of Chicago surgeons--Dr. Prachand and John C. Alverdy, MD--are currently the only surgeons in the Midwest to perform duodenal switch surgery laparoscopically. The entire operation is carried out through five or six small incisions, ranging from 1/4 to 3/4 inches in length, in contrast to traditional or "open" weight-loss surgery, which requires a 10- to 14-inch incision in the upper abdomen.

In addition to consulting with Dr. Prachand, Karen met with a dietician and clinical psychologist at the University of Chicago prior to her surgery. Both the dietician and psychologist helped Karen prepare for the surgery--and her life afterwards. Because the surgery would dramatically change her digestive system, Karen had to prepare to change her eating habits. For instance, Karen can now only eat small amounts of food at a time. She also needs to consume a lot more protein. Before the surgery, the dietician provided Karen with lots of advice and sample menus to help her make these adjustments.

Prior to her operation, Karen also had to have some medical tests and evaluations to make sure that she was healthy enough to have the surgery. "Fortunately, I don't have the kinds of problems that a lot of overweight people tend to have. I'm not diabetic and I don't have high blood pressure," says Karen. "So my testing was relatively easy. I had some blood work done but that was about it. A lot of people considering weight loss surgery have to go through a lot more testing because they have more health problems."

From Surgery to a New Life

On the day of surgery, Karen arrived at the hospital at 8 a.m. "I was a little bit nervous. But all of a sudden, it was time to go in and get the surgery."

After the three hour operation, the next thing Karen remembered was coming to in the recovery room around 4 p.m. "I felt like I had been hit by a truck," she says. "There's a lot of pain because they [the surgery staff] have to expand your abdomen with carbon dioxide gas so they can perform the surgery. Then, they're inside you with their little cameras laparoscopically. They remove three-fourths of your stomach, they remove your gallbladder, and they rewire you. Even though it's performed laparoscopically, it's still a major, major operation."

Karen received morphine through a patient-controlled pain pump for a few days to help control her pain. She began walking in the hallways the day after her operation. She also had to be careful about what she ate or drank. "I couldn't have any water for the first 24 hours or so after surgery," she says. "I was sucking on a sponge I was so thirsty. After a day, they let me have little bits of water. Then, they gave me little bits of applesauce and other severely pureed food. I ate very, very little because I would get full so fast."

Karen's operation was a success. She had no complications or side effects and was able to leave the hospital after four days.

"I went to stay with my best friend, Joan, of 30 years. She took care of me and made sure that I got all off the protein I needed and pureed my food. She was wonderful."

About a week after her surgery, Karen drove herself back to her own home and was feeling much better. She was able to go back to work three and a half weeks after her surgery.

She now eats a lot less than she used to. "I can eat anything I like. I just have to eat little portions because I get full fast. So, I eat a lot of small meals."

Karen also needs to get at least 75 grams of protein a day. "Everything I eat is meat-based or fish-based or includes eggs or cheese. It's kind of like being on the Atkins diet. I used to like pizza and cheeseburgers and all the things that probably got me fat. Now, the bread is not so important because it's so filling. Now, I can eat maybe half of a cheeseburger. But, usually, I take the bun off and eat the meat inside. Or if I'm getting a pizza, I might only eat the topping.

Karen also needs to take three daily vitamin and mineral supplements: a prenatal vitamin, a vitamin B12, and a calcium supplement. She'll need to take those for life because her body can no longer absorb nutrients as well as it used to.

Karen only has praise for the staff in University of Chicago Center for the Surgical Treatment of Obesity. "I think Dr. Prachand is one of the finest doctors that I have ever met," she says. "I didn't have a chance to get to know Dr. Alverdy as well, but he seemed like a swell doctor, too. The support staff has also been very nice. So, I would say everybody has been very great. They care about what they're doing, which is nice to know."

December 2003

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