Living healthy is a challenge in today’s society where there are so many choices that keep us from exercise and a healthy diet. Fast food, television and computers are some of the distractions that can keep us sitting in place instead of keeping active and feeling good about ourselves. When you add to that possible genetic factors and medical conditions, many feel discouraged about their ability to lose weight and lead an active, healthy life.
According to information provided by Flagstaff Medical Center (FMC), more than one-third of all Americans are overweight, and an estimated five million to 10 million Americans are morbidly obese, which significantly increases their risk of serious, health-related conditions and diseases.
For many of these people, dieting and exercise just aren’t enough to bring their weight down and im-prove their health.
One of these individuals was Mike Smith, a 55-year-old resident of Joseph City, who at 6’4” tall and weighing 340 pounds felt a sense of hopelessness about his future well-being due to his weight and health.
For Smith it became a vicious cycle when his weight gain began to cause pain in his knees, requiring medication. In turn, the side effects of the medication altered his metabolism, leading to even more weight gain and other complications.
Smith’s health declined even more in 2002 when he was diagnosed with Type 2 Diabetes, a condition in which the body either isn’t producing enough insulin or isn’t using it adequately.
According to Smith, all of the men in his family not only suffered from diabetes, but died young from diabetic related issues. It appeared to Smith that he might be facing the same fate.
“I began researching for solutions and came across information that stated 90 percent of individuals who were obese and diagnosed with Type 2 Diabetes no longer suffered from the diabetes after having bariatric surgery,” recalled Smith, who felt that after years of concern he was seeing a light at the end of a dark tunnel.
The first step toward that light was almost the last for Smith after he contacted his insurance company regarding coverage for the surgery.
“They refused to pay for the surgery. It was something that they perceived as a cosmetic need, not a medical necessity,” explained Smith. The $47,000 price tag for the surgery was something that, like most of us, Smith could not afford on his own.
It wasn’t until a full year later that Smith happened to read a notation in his insurance newsletter stating that bariatric surgery would now be covered by his insurance as long as certain criteria were met. Smith met the criteria, and began the process of improving his health and his future.
Smith chose to have the surgery done at the FMC Bariatric Surgical Weight Loss Center in Flagstaff. For Smith, the process prior to having the actual surgery took nearly a full year, but the timeframe varies depending on insurance requirements.
After attending an informational meeting, Smith made arrangements for bypass surgery. The first step of that process was to receive a psychiatric evaluation.
“The evaluation was to determine how I would handle the lifestyle change, my state of mind and the reactions of the people I care about,” stated Smith.
The changes brought on by the surgery can have a dramatic impact.
“The surgery is not a quick fix or an easy way out. If you’re just doing it to look good, you would have to really be strong about it. For me, the weight loss was a bonus. My reasons for the surgery were to im-prove my health and get rid of the diabetes,” he said.
Celeste Hebets, bariatric clinical manager at FMC, emphasized the importance of having a higher ob-jective than just improving looks.
“This isn’t like plastic surgery; this is a complete lifestyle change. It requires becoming educated and wanting to lead a healthy lifestyle,” Hebets said.
An individual automatically qualifies as a candidate for surgery if he or she has a body mass index (BMI) of 40 or more. Those with a BMI of 35 qualify if they also have high blood pressure, Type 2 Diabe-tes or some other medical issue that has occurred as a result of obesity.
“There are a lot of prejudices regarding obesity. Obese people are perceived as lazy, and that they should just eat less and exercise. It’s really not like that,” explained Hebets.
Smith was fortunate in that he had the complete support of his friends.
“I’m not married and I don’t have kids, so there were no family pressures,” Smith said, referring to how the surgery can mean major changes not only for the patient, but also for close family members.
“You really have to be mentally ready for the changes that you will experience. The evaluation also determines if certain medications, like those taken for depression, may need to be adjusted,” Hebets stated.
Once Smith completed the psychiatric evaluation and was accepted into the program, he met with a nutritionist and begin a program of exercise, diet and nutrition.
“This is a very important aspect of preparing for the surgery and how you’ll live healthy afterward. You receive information on how much water you need to drink, what foods to eat, even how to chew food prop-erly,” explained Hebets.
While becoming educated on healthy eating, tests are conducted to determine any underlying medical conditions, and a sleep study is conducted to determine the risks associated with undergoing the surgery under anesthesia.
“We tell people that the entire process will take about six months. Sometimes it’s less or it may go a little longer, but in general, that’s the length of time that you’re looking at,” said Hebets.
She noted that Arizona Health Care Cost Containment System (AHCCCS) patients might experience a wait of up to one year.
“The patients with AHCCCS need to check with their plan, but, generally, instead of receiving the nu-tritional education from us, their insurance will have them work through their primary care physician, but we still provide all the requirements for their physician,” stated Hebets.
FMC offers three different procedures. There is the band procedure, which restricts the stomach to a small permanent pouch; the sleeve procedure, which is another restrictive procedure; and then there’s the bypass surgery, which Hebets referred to as the “gold standard.” This procedure actually reroutes the intes-tine higher up on the stomach so that food goes through the system faster. “With this proce-dure, patients have follow up with medical care to ensure that they are giving themselves enough vitamins and minerals through supplements, since the nutrition is not being absorbed from the food,” explained Hebets.
Smith chose to have the bypass surgery and almost immediately following the surgery, was seeing the results for which he had hoped.
“Four hours after the surgery my blood sugar was normal and I haven’t had an issue with diabetes since,” stated Smith, adding that he had been taking seven to eight different medications prior to the sur-gery and he was able to discontinue using all of those, as well.
Although Smith has lost 110 pounds as a result of the surgery, some of the changes weren’t so visible to anyone but him.
“I love eggs, but now I can’t stand the smell of them cooking. If I want to eat eggs, I have to go to a restaurant. I used to hate yogurt and now I love it,” stated Smith.
There have been several occasions when Smith overindulged slightly and his body had an immediate reaction politely referred to as “dumping syndrome.”
“If I eat a piece of pie, I’m fine. If I decide to eat two, I instantly feel like I’m going to be sick and my body reacts strongly to it,” he said.
According to Hebets, research has shown that on average a person who is 100 pounds overweight will lose 40 pounds by the end of the first year of using the band procedure. A person using the sleeve proce-dure will lose 57 pounds and a person who selected the bypass surgery will lose 60 to 80 pounds. Individu-als who use diet pills and strict diets will only lose an average of 10 to 12 pounds by the end of a year.
Insurance companies are seeing the positive results of these surgeries and are now willing to offer cov-erage. They find that the surgery pays for itself over a short period of time when compared to the lifetime costs of medications and doctor visits.
What really makes the surgery so impressive are the long term affects on health and well being.
“Statistics show that with the weight loss there is a 52 to 92 percent drop in hypertension, cardiovascu-lar disease is reduced by 82 percent and sleep apnea is reduced by 72 percent. More impressive than that is that there is an 89 percent decrease in mortality rate over a five-year span,” explained Hebets.
The possible complications of the surgery are minor. FMC has seen eight cases of slippage from the band procedure in the past six years, with only two of those patients having had the surgery done at FMC. Only one percent of the individuals receiving the bypass surgery developed an internal hernia due to the surgical procedure.
Smith also has to maintain a steady intake of vitamins and water since his body no longer absorbs nutri-ents like it did before.
Since the surgery, Smith has seen some major life changes. He enjoys exercise and recently was able to resume his lifelong passion for surfing. He recently returned from a trip to Hawaii, where he surfed for the first time in more than 15 years.
There are some awkward moments when dining out that Smith has learned to overcome.
“The doctor told me that when I order fast food to just order a kid’s meal, but that’s just not something I could do,” admitted Smith.
Instead he would order a regular meal and cut the burger or sandwich in half as soon as he opened it, and put the second half away for another meal.
“It’s not tempting to eat more than I should that way, not that my stomach would allow it,” said Smith. At other times, when he left a meal half finished at a restaurant he would be asked if something was wrong with his meal or if something else could be brought. “It was a little embarrassing, but you adjust to it,” he said.
Following the surgery, support groups help the patient to adjust to a new way of living, but the support of family and friends is critical.
“It’s a dramatic life change and it’s certainly no quick fix,” said Hebets.
An informational session is held from 6 to 7 p.m. on the second Tuesday of each month at the Northern Arizona Healthcare Education Center, located at 1000 N. Humphreys in the Fort Valley Shopping Center in Flagstaff, just south of the hospital.
More information on the Bariatric Surgical Weight Loss Center.
source: azjournal
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