Bariatric surgery ‘hard, but so is being overweight’

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This article is not medical advice. If you have concerns, consult your physician or medical professional. 

Dara (not her real name) had enough of the ups and downs. Controlling her weight was an ongoing battle. She was ready to take drastic action even if it meant altering her daily living for the rest of her life. After much consideration, her doctor submitted the referral to the bariatric surgical program.

Bariatric surgery is the designation for surgical procedures that change the digestive system to help with weight loss. Strict standards must be met, and it is not the appropriate answer for every overweight person.

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The Kingston Bariatric Centre of Excellence at Hotel Dieu Hospital offers two options: the non-surgical Medical Weight Management Program and the Bariatric Surgical Program. The local centre of excellence is one of eight locations throughout the province that are part of the Ontario Bariatric Network. There are three surgery-only sites plus regional assessment treatment centres. Referrals must be sent to the OBN for admission to the program.

Now in her mid-30s, Dara’s weight has been problematic throughout her life, even as a youngster at school. Allergies and food intolerances to dairy, gluten and other foods make dietary choices difficult.

“I was diagnosed with celiac disease almost 10 years ago,” Dara recently wrote in an email interview with this author. “Initially I had lost 160 pounds (72.5 kilograms) after diagnosis, but over the years I slowly regained it back.” She believes the allergies did not have a direct role in the weight gain, “but gluten-free substitutes always have more calories and sugars than normal items.”

Submitted in January 2021, Dara’s referral was accepted by OBN. “There were many tests and appointments that I needed to attend to be approved,” she mentioned. “They wanted your health to be as optimal as possible.”

A selection of the medical tests may be ordered, or for a few candidates, the full slate of tests. The bariatric network’s requirements can be rigorous for good patient care and positive outcomes. The tests encompass cardiac imaging, a stress test on a treadmill, an electrocardiogram and pulmonary function tests. The pulmonary function tests “are a group of tests that measure how well your lungs take in air, release air and move oxygen from the air into your body’s blood,” the network described. “For some tests, you breathe normally and quietly. For other tests, you force air in or force air out during testing.”

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The patient’s general health is assessed by blood tests such as CBC (complete blood culture), blood sugar and levels of vitamins and minerals. As well, blood may be tested for Helicobacter pylori (H. pylori), “a common bacteria that can cause stomach ulcers and stomach cancer,” the OBN said.

The patient will have two more critical tests related to the abdominal region. A gastroscopy may be performed, in which a thin, flexible tube with a light and camera called an endoscope is inserted through the mouth and throat down to the stomach so the physician can see the esophageal and stomach lining and the duodenum (the first section of the small intestine) on a computer monitor. A tissue sample may be taken to test for H. pylori.

As well, a colonoscopy may be ordered to examine the large bowel. Before the procedure, the patient will be given instructions regarding food and medication for the several days leading up to the colonoscopy — no solid food, no dairy and no red-coloured drinks, according to Ontario Colonoscopy Clinics. Lots of clear fluids are permitted, and the doctor will order a preparation to clean out the bowels the day before the procedure.

On the day of the colonoscopy, the patient will receive a sedative; they will not be able to drive immediately after the test and will need a driver to get home. During the procedure, an endoscope is inserted into the rectum, and “the scope is over one metre long and about the width of a finger,” the OCC said. “Images from the scope are transmitted to a video monitor that your doctor uses to inspect the lining of the bowel.”

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Completing the required tests and assessments, and learning an abundance of information on the permanent lifestyle change, Dara attained final approval for the surgery. The operation took place in early September, about eight months after admission to the program.

The Kingston centre offers three types of bariatric surgery: the Roux-en-Y gastric bypass; the vertical sleeve gastrectomy; and the duodenal switch. Dara underwent the Roux-en-Y procedure.

Often performed laparoscopically, the surgeon forms a small pouch, cut from the stomach at the end of the esophagus. Moving down the small intestine, the surgeon “cuts it, and attaches it to the pouch. Then the end of the small intestine that is still connected with the remainder of the stomach is attached to the bottom of the Roux limb,” the OBN described. The step “allows the digestive juices produced by the pouch to meet up with the food in the intestines.”

After three and a half hours in surgery, Dara noted, “I was in recovery for a little longer than expected, about five hours because I had low blood pressure.” Released 24 hours later, she was still unable to eat or drink. Concerned about her inability to eat, she felt that something was wrong but went home as instructed. Dara’s suspicions were right.

Suffering two days of extreme pain and inability to eat or drink, the very sick and distressed young woman returned to the hospital. However, Dara first had to explain and clarify her problem with emergency room staff who on that day had little knowledge about weight-loss surgery. Once the issue was understood, she was readmitted.

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Two days later, Dara “had a scope on the Monday where they discovered a marginal ulcer in the surgical line,” the patient said. The surgeon was surprised. “An ulcer two days post-op is almost unheard of,” because an ulcer “is a complication of surgery but usually it’s much further out.”

Dara was released from hospital within a couple of days with pain medication and instructions for her new routine.

Recovering, Dara will be off work for 12 weeks due to the unexpected ulcer. Without complications, recovery time is estimated at six weeks, and no lifting anything weighing over 4.5 kilograms (10 pounds) until eight weeks have passed. The challenge for the patient now is adjusting to an adjusted lifestyle.

“It’s an overwhelming way of eating in the beginning,” Dara said. “One meal at a time — it’s a process and your body has to relearn how to eat food again.”

The amount of food per meal is severely reduced. Dara’s lunch consists of a quarter cup of protein and a tablespoon of carbohydrates, “so a quarter cup of chicken and a tablespoon of sweet potato.” Another meal could be “half a piece of toast with turkey or chicken, or some oatmeal or some fruit.” Loads of water and lots of vitamins are encouraged.

In a non-COVID-19 year, the Kingston Bariatric Centre of Excellence sees “approximately 250 cases per year,” according to Dr. Boris Zevin, surgeon and medical director of Kingston’s centre. (The statistics were kindly gathered for this author by John Pereira, Kingston Health Sciences Centre’s strategic communications advisor.) Provincially, over 4,000 bariatric surgery cases are seen annually. There is no cut-off age when surgery is contraindicated. Previously, age 65 was the limit, but this has been recently changed, the surgeon stated. About 75 per cent of bariatric surgery patients are women, with men at about 25 per cent.

“It’s hard, but so is being overweight, so you have to pick your hard,” Dara wrote. If others consider bariatric surgery the simple way to weight control, “they could not be more wrong. It’s hard mentally and physically.”

Throughout, the determined Dara keeps a positive outlook. “In the end, all I hope is that the struggle is worth it and I can carry on to live a happy, healthy life with my family.”

Susanna McLeod is a writer living in Kingston.

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