Article in Toronto Star about RNY patient

[Dame J 0]

Interesting article in the Toronto Star today.

BATTLING OBESITY

TheStar.com - Health - `Only way' to freedom

`Only way' to freedom

After desperate bids to lose weight, at nearly 400 pounds Barrie mom took life-saving step

Feb 02, 2007 04:30 AM

Karen Bridson-Boyczuk

Special to The Star

Rating her pain level at an eight out of 10 between morphine shots, Barrie resident Rachel Buttery sits in her Michigan hospital bed and says she doesn't miss food yet.

A day after undergoing gastric bypass surgery, the 33-year-old, 393-pound mother of two says she's just thrilled that she will, no doubt, finally be able to keep her New Year's weight-loss resolution this year.

Ontario's provincial health insurance paid the $24,000 (U.S.) cost of her surgery because of long waiting lists here and the deteriorating state of her health. Buttery's surgery, on Jan. 3, involved creating a tiny pouch out of the top of her stomach and attaching it to her large intestine, completely bypassing the rest of her stomach and her small intestine.

"They keep bringing me different kinds of broth and Jell-O, but I'm partial to the ice chips," says Buttery, who admits it was her addiction to food that led her down the road to morbid obesity.

"I'm sure I will miss food eventually. But there's nothing I can eat that would be better than doing what I'll be able to do when I lose weight."

At five-feet nine-inches tall, Buttery's Body Mass Index is off the charts at 61. A normal body mass index is between 18.5 and 24.9.

A person who has a BMI of 30 or more is considered obese.

Buttery has a degenerating left hip and must undertake more than an hour of walking in the morning to become fully mobile. Her blood sugar levels are at the high normal range – not diabetic, yet, her doctors say, but getting toward Type II diabetes. She has an enlarged spleen and an enlarged and fatty liver and she suffers from sleep apnea, a condition where her airway becomes obstructed when she sleeps, cutting off air flow and periodically choking her.

Surprisingly, her blood pressure and cholesterol levels remain fine. But as her husband Paul Buttery says, that's for now. "She's fairly healthy, but how long will that last?" he says.

Her surgeon, Dr. Tallal Zeni, says Buttery's excessive weight is life-threatening. "If she doesn't lose weight, there's a high risk of other medical problems all coming together to shorten her lifespan."

A person with a BMI of 40, where morbid obesity starts, is more than two and a half times more likely to die than someone with a healthy BMI.

Obesity has been linked to various cancers, heart disease, diabetes, hypertension and depression.

Buttery's fight with weight began in childhood and, after the birth of her first daughter 11 years ago, it slowly climbed, hitting its peak of 399 pounds this September.

Since then, her life has increasingly been affected by her weight.

"If you go to a friend's house, you think, `Okay, what can I sit on that won't break?' You worry about fitting through the turnstiles in stores. At restaurants, you can't sit in a booth. When you get into somebody's car, you pray to God the seatbelt is going to fit."

No longer able to fit into airline seatbelts, even with the belt extension, Buttery turned to bus travel with her family a few years ago. But even that proved uncomfortable. Buttery spent hours unable to urinate on a 13-hour trip to Cincinnati in 2003 because she couldn't fit into the bathroom at the back of the bus.

One option was surgery to reduce her stomach to a pouch that holds just under an ounce of food. But the decision wasn't made easily.

First, she says, she worked very hard to lose the weight on her own.

In the past five years alone, Buttery has joined the Weight Watchers program on four occasions and lost varying amounts each time. With the help of a personal trainer, with whom she worked for a year, Buttery managed to lose 32 pounds.

Lifting weights, walking on the treadmill, counting her points, Buttery was moving in the right direction, says GoodLife Fitness trainer Shelly McNamee. "But her emotional attachment to food and the extreme stress that she was under in her life kept sending things out of whack," McNamee says. She was upset to hear Buttery had gained back the weight she'd lost, plus another 30-odd pounds since they stopped working together a year ago.

Gaining back the lost weight, and then some, is typical for most dieters and often a key factor in how people manage to sink further into obesity, says Zeni, who performed Buttery's three-hour surgery at St. Mary Mercy Hospital.

"With traditional medical weight loss, we see successful, long-term weight loss in just 1 to 2 per cent of patients," he says. "But with this surgery, we have an 80 per cent success rate five to 10 years out."

But there are risks.

The laparoscopic Roux-en-Y gastric bypass – the kind of stomach-reducing surgery recommended for Buttery – has a fatality rate of one in 200, the risk of bowel leakage and potentially fatal blood clots, and a six-week recovery time.

"It's not a surgery one should go into lightly," Zeni says. "But for people who are trying to lose weight and have other medical problems, it's the only way to get the weight off and keep it off."

Zeni stresses it is not a magic bullet. "You've got to be committed to it for the long-term," he says. "Everybody is going to lose weight for the first year and a half (on average, 70 per cent of the excess weight is lost by this point), but you want it to be successful over a lifetime."

For many, Zeni says, dieting and exercise alone just can't get people to where they want to be. "Once you get to a level of morbid obesity, for whatever reasons – genetics, metabolic rate, appetite – maintaining the weight loss is just unsustainable."

That was Buttery's story. Now recovering at home from her operation, she says she saw surgery as her only way out.

After having no trouble sticking to her diet and exercise plans for weeks and sometimes months on end, Buttery would find something in her life would go wrong and her fitness regimen would begin to unwind.

"Any time I get stressed, that's what I do. I eat," she says. "And nine times out of 10, I don't even realize I'm doing it. I'd just go to the fridge and I'd just start grazing."

It also hasn't helped having a husband who is a professional chef and loved to "love her with food," and thinks she looks no different than the day he met her when she was 17, Buttery says.

Food produces a euphoric haze for her, like a drug, she says. "But food is the one thing you can't take away. You don't need alcohol to live, or drugs or cigarettes. But you can't not eat."

Meanwhile, some people in Buttery's life feel she's taking the "easy way out." They point to such high-profile gastric bypass patients, like singer Carnie Wilson, who have gained back a surprising amount of weight given the medically reduced size of their stomachs.

Zeni says this can be a result of the stomach being stretched out again by food, by the connection between the stomach pouch and intestines stretching out to accommodate more food or because of other unknown factors.

"Some people are eating 1,000 calories a day after the surgery and they are still not losing, even when the pouch has not stretched," he says. "So there's more to it than we know at this time."

Ten per cent of patients will gain back about one-third of the weight they initially lost, while another 10 per cent will gain back more than that, Zeni says.

"It's not 100 per cent. But compared to traditional medical weight loss, it's really excellent. Ultimately, those who are successful still maintain less than 1,400 calories a day and (continue to) exercise."

According to a 2004 study published in the Journal of the American Medical Association, gastric bypass surgery cures diabetes in 77 per cent of cases, cures or improves high blood pressure in 78 per cent of patients and ends sleep apnea for 86 per cent of patients, Zeni says.

Buttery approached the Ontario health ministry last fall to get it to pay for her to have the surgery in the United States. Waiting lists to have the surgery in Canada are, for certain surgeries, several years long.

Ultimately, Buttery's stomach will be able to hold about two to three ounces of food at time. But she says she's not worried about how she will cope when life gets difficult and she simply can't eat a whole box of chocolates, as she had in the past. "I've been reading a book on food addiction and I've got a support group I can go to in Barrie," she says.

Between that, the four hours of nutritional counselling she received through Zeni's office and the help of her husband, who has vowed to cook up healthy foods from now on, Buttery says she's got the support she needs. She removed some serious stressors in her life, she says.

Worry that she's set a bad example for her daughters has also fuelled her drive to make this work, Buttery says. "I've got to stop the cycle."

For now, she's focused on how much fun she'll have with her family. "I'll be able to go horseback riding and swimming," she says. "I've got pages of stuff I've not been able to do in years. I haven't been able to go on a roller-coaster ride in years. I used to be a real roller-coaster junkie."

[Dame J 0]

I can totally relate to her love of food.< /p>

[Yoda 0]

It sickens me to no end that OHIP will pay for the gastric bypass yet will not consider paying for a surgery which is almost half the price, is more successful long term, is less invasive, with less recovery time AND is way way way way way way safter (in terms of fatalities).

You'd think I'd be used to this by now...but our gov't still rattles my mind!

[Dame J 0]

Yes exactly!!!!!!!!!!!!!

That is what I thought as well.

OHIP should get with the times and start kicking in for the Lapband. I have no idea what they are waiting for. According to this article the band would cost less, produce the same results (not in the same time frame) but would also be safer and easier to perform.

Very frustrating!

[argon 3]

Wow, yes... $24,000?! That's insane ... $28,000 CDN It really is sad that they'll pay for that, but a lapband is not even partially covered? But to Ontario's praise, at least they DO do that, send waiting people to the US. If only they'd offer more choices... not just RNY or nothing.

[Irishmist 0]

I agree whole heartly, and another thing that bugs me is that they are paying the dollars to American doctors, not even to are Canadian doctors.

Maria

[CLOE 0]

Great article, Dame J, thanks.

Yes, I agree, STUPID, STUPID OHIP!!!!!

[Gaffer 1]

I wonder what she is doing to help her food addication?

This pisses me off too. Why are not more bands covered in Canada. I had a conversation with my mom yesterday that just made me mad. She works with a lady who is having her VGB converted to RNY after she didnt stop eating and ruined it. She is 55, and is does not take care of herself.

So here I am, young, healthy, and cant get one surgery paid for, and she is on her second. :angry

My mom works with 2 people, soon to be 3 who have had RNY covered, and she says they all eat like pigs and are on their way back to pre-op weights.

As a tax payer, I think that people who have thier surgeries covered should be forced in to councilling as well, and have some accountability as to how they are going work with the tool they have been given at OUR cost. Maybe, if they gain the weight back, barring any medical conditions, they should have to pay for the thing. Or make them pay a deducatable they get back after 3 year post op.

People wont work with it if is is free.

A

[angel bear 2]

Exactly! Why won't they LISTEN!

Maybe we'll see it someday???? I agree with the counselling - if we're paying for it from Tax dollars the people who have surgery should be accountable. We're all living proof that the band works but as Gaffer says his mom knows of 2 who are abusing it.

Ok I have to get off the soap box and go get lab work done. Defill coming next Thur (15th) - can't come too soon.

Hugs. Have a great week!

[Yasmina 0]

I wish they had a support group in Thunder Bay for the Lapband, I would be there, I would take the counselling

If you have to work for something it means more, you try harder, you don't abuse it.

It is too bad about OHIP, It is really sad that they would pay U.S. Doctors rather then supporting their own Canadian Doctors.

Hopefully that will soon change. I don't regret spending the $16000, not one penny of it !

I sitll can't believe I have it !

[Irishmist 0]

Well Dame J this is your last Optifast day, tomorrow is the big day for you and then you will be on the band side of life. All the best and good luck :hug:

Maria

[Dame J 0]

Thanks Maria!

Yes I am excited about not doing the Optifast anymore, however I might have some durring the liquid only because I worry about not getting enough nutrients with other products.

Very excited about Surgery. I just keep thinking this time tomorrow my life will be forever changed.

Little nervous but who wouldn't be. Can't wait to come on here after and tell you guys how it all went. Hopefully I will be telling you how easy and pain free it was. :biggrin1:

[Gaffer 1]

Wow, not too much longer for you. That is great, I cant wait to hear how it went as I am due in 6 days and want to know what it is like.

Best wishes for a speedy recovery.

Andrew