Weighing the risks

Barbara VanDyke remembers the day she began considering a gastric bypass. Morbidly obese, she’d been hospitalized in February 2003 for high blood pressure; she suffered from such weight-related conditions as asthma, high cholesterol and diabetes. In April, her cardiologist, Dr. Robert Swackhamer, warned her that if she didn’t change her lifestyle soon VanDyke would die.

“He was harsh, but it was true,” says VanDyke. “Later, I realized that he really cared about me and wanted to get it through to me. But at the time I was taken aback.” A full-figured and attractive African-American woman in her 40s, VanDyke wears little makeup and keeps her hair pulled back tightly. The neckline of her conservative black dress reveals a series of tiny surgical scars at her throat.

As she talks, VanDyke moves around the break room of her office, clearing away snacks brought in by other employees: a bag of popcorn, a bowl of brownies, a plate of cookies. “See all this? Having this food around all the time, it wasn’t helping,” she says, laughing. VanDyke works for CASA—Court Appointed Special Advocates—training volunteers to advocate for abused and neglected children.

VanDyke has struggled with her weight for most of her life. In her 20s, she had her first weight-loss surgery: gastric plication, or stomach stapling. She lost 130 pounds but, by 2003, had gained all the weight back, and more. Diets such as those advocated by Weight Watchers hadn’t worked, and VanDyke’s weight was aggravating her other medical conditions. She wasn’t sure if a gastric bypass was the answer.

“After the doctor left, I had to really think, because with my first surgery, I was in my 20s,” explains VanDyke. “Twenty years later, I’m thinking about having another surgery. Do I really want to do that?”

Gastric bypasses are an increasingly popular option for drastic weight loss among the obese. Some 16,200 surgeries were performed in 1994, says the American Society for Bariatric Surgery. The estimated total for 2004 is 145,000.

Obesity is a significant problem in the United States. According to the Centers for Disease Control and Prevention, 64 percent of American adults are overweight or obese.

That isn’t to say that gastric bypasses are to be taken lightly. The surgery—which involves making the stomach smaller, then rerouting the intestine to attach it to the new smaller stomach—is expensive. Dr. Robert Watson of Western Surgical Group, the only gastric bypass practitioners in the Reno/Sparks area, estimates the average cost at $25,000 to $40,000. And not all insurance providers cover the procedure.

“Most insurance companies do cover it,” he says, “because the benefits are recognized. … But we still have to jump through a lot of hoops, and it’s a long way to getting approved in most cases.”

Swackhamer brought Dr. Kent Sasse, who would perform VanDyke’s bypass, to her hospital bed. Because it was a revision of a previous gastric surgery, Sasse explained to VanDyke that her bypass would require an incision extending from her breastbone to below her belly button. The surgery involved risks such as leakages, infections and even death.

“Like any surgery, especially major abdominal surgery, there is the potential for complications,” says Watson. (Sasse did not return calls for comment.) “The higher your BMI [body-mass index], the more at risk you are. But those are the people who benefit most from the surgery. … Some of [the patients] are concerned about the risks, or occasionally say, ‘I’m scared,’ but all of them who approach me say that this is something they have to do.

“Any patient who’s been through the lifelong struggle with obesity will tell you that the benefits are worth the small risks. We find that more than 95 percent of the patients say that they would do it again.”

VanDyke knew the risks all too well, having lost a friend, Cherise Dwyer, to surgical complications.

“Cherise did not have very much wrong with her,” VanDyke says. “She was overweight, but just a little bit overweight. And she actually got approved by her insurance before I did, so she had her surgery before me. She had her surgery on Oct. 27 [2003]. By Oct. 28—the doctors were going to send her home on the 28th—she was dead.”

The tragedy, says VanDyke, brought the risks of the surgery home. “I had to think again, because I had my family saying, ‘Are you sure you want to do this? Your friend just died, and your surgery’s going to be worse than hers!’ After all of that, I still opted to do it.”

On Nov. 17, 2003, VanDyke had the bypass surgery. The operation took longer than expected because the doctor also had to work around old scar tissue and repair a hernia. Her body didn’t respond well to the invasive surgery, and she was sent to the Intensive Care Unit.

“I remember waking up in intensive care, looking around and going, ‘OK, this isn’t heaven. This is a good thing, I’m alive!'” But VanDyke was a long way from being well. Tubes sprouted from her nose, her neck, her back and her stomach; a feeding tube had been surgically inserted, too. Still, she was determined to will herself back to health.

At first, her positive attitude seemed to help. But complications developed before she left the hospital. The new, egg-sized opening that connected her stomach pouch and small intestine was trying to heal itself and had almost completely closed, a condition known as a stricture. With her stomach effectively sealed off, VanDyke had to take in food and water through her feeding tube.

To repair the stricture, the doctors used a technique called dilation. A small, elongated balloon is introduced into the narrowed stomach opening and inflated to force the walls of the opening back to the correct size. VanDyke has had nine dilations in the five months since her surgery. Initially, she needed the procedure every 10 to 14 days; last time, she made it 24 days. The dilations will continue until the opening heals correctly.

Other complications followed. Soon after being released from the hospital, VanDyke caught pneumonia. The pneumonia medications, in turn, aggravated her diabetes. She developed an ulcer, which is still being treated. A hernia from the open-incision surgery will require another operation.

VanDyke says it’s discouraging to compare her progress with other people who had surgery at about the same time.

“I still can only eat soft foods, whereas they’re eating regular foods,” she says. “Like, maybe they can eat hamburger meat—I can only eat tuna salad from the blender, or mashed potatoes.”

Still, she points out, there are benefits to the surgery. She has lost 108 pounds in just five months, slimming from 367 down to 259. Her blood pressure and cholesterol are down, she no longer suffers from asthma, and she believes her diabetes may be gone entirely.

“Before the surgery,” says VanDyke, “I couldn’t breathe. I used to have asthma attacks all the time. Just to walk from this building to the car, I would be huffing and puffing.” Now, she walks around Virginia Lake several times a week with a friend. Recently, she clocked in with a 19-minute mile.

Although she doesn’t regret having the surgery, VanDyke has mixed emotions about it. “I actually wouldn’t take it back, but if you put me back to Nov. 17 and I had looked into the future and I saw all this stuff, I think I’d say, ‘You know what? I think I’m going to wait.'”

VanDyke hopes to use her experiences to help others who are considering weight-loss surgery.

“I eventually want to write a book about it," she says, "because I think it’s important for people to look at the facts, and I have experience with it—that you can die. I want to talk about the feelings that you have when you still go ahead with the surgery even though your friend died. I want to talk about complications and willpower, and how it’s not that easy, even after you’ve had it done."