Monday, 20 May 2019
BREAKING NEWS

Bariatric surgery helps with more than weight loss – Jacksonville Daily News

The turning point for Scott Nunn came when he was at an event with his daughters and seated on the floor at the YWCA in Wilmington. When it came time to leave, he couldn’t stand up.

Nunn always had been a big kid, but he didn’t play organized sports. At 175 pounds and 6 feet tall in high school, he instead enjoyed the less-formal fun of pick-up basketball games, tennis with his friends, swimming and riding his bike.

In his college years – with its accompanying bad diet and too much beer, Nunn saw his weight climb to 240 pounds, not yet alarming, but something he noticed.

“The next thing I know, I’m 350. It really had a way of sneaking up on me,” he said.

Years passed and with them came a journalism career, marriage to fellow journalist Cece Nunn and the birth of their two daughters.

When he was in his 40s, Nunn kept his weight at 335 to 340 pounds, though he sometimes dropped to 310. Still, it wasn’t enough. He was taking five costly medications for diabetes and couldn’t keep up with the kids running around in the backyard.

“I was uncomfortable with the way I looked. I can’t get around well,” he said. “I was actually to the point in my life where I didn’t actually give a crap what anyone thought. It wasn’t about that. It was about this is bad – this needs to change.”

His general practitioner, Dr. Frank Snyder, urged Nunn to look into bariatric surgery, mostly to help get his diabetes under control. He was at a point where the surgery was his only option.

“I won’t say I didn’t do it to lose weight or to look better or feel better or whatever in that way, but the main reason I did it was primarily to cure my diabetes, which it more or less has,” Nunn said.

“I think it used to be viewed as sort of an extra – something you can live without. But it’s not anymore, and the way I know that it’s not is that the insurance companies are so quick to pay for it now because they know that it works,” he said.

After seeing the good results in a couple of acquaintances, Nunn started the process of becoming qualified for gastric bypass surgery, one of two types of common weight-loss surgeries. The other is known as sleeve gastrectomy.

After consulting with a surgeon, he went to a support group meeting at New Hanover Regional Medical Center and heard story after story from people who lost 150 to 200 pounds after bariatric surgery and had their diabetes treated.

Issues with insurance coverage delayed his surgery by years, but eventually he was able to schedule a March 15, 2017, date with surgeon Dr. David Miles.

Preceding surgery he had to undergo months of weight-loss counseling, evaluation by a psychologist and guidance from a dietician.

“I had to make up my mind that I wanted the surgery. I had to find the surgeon that was going to be a practical possibility with my situation,” he said. “That was such a disjointed mess for so long, then it all came together, and it was, ‘God, here we go.’”

He went into surgery early in the morning, stayed that night in the hospital and was home the next day by noon. He had to be able to walk and urinate before he could leave.

Now, two years later and at age 54, Nunn’s stomach has gone from the size of an eggplant to the size of a pool ball.

“There’s nothing really that I can’t eat,” he said. “I can only eat very limited amounts because there’s not room for it. “

He’s down to about 220 pounds now and hopes to get down to 180. He’s off most of his diabetes drugs, no longer has sleep apnea and he has graduated from walking short distances to running a mile and a half.

His waist size dropped from 50 inches to 36, just a bit above his high school size of 32.

Also gone for the most part is his appetite.

“I don’t care about food anymore,” he said. “It’s amazing the small amount of food that goes on my plate, especially compared to what a plate would have looked like of mine several years before that.”

His doctor still wants Nunn to stay on low doses of two medications, to potentially correct some of the damage caused by diabetes. He also takes vitamins daily, too.

“I think it’s important for people to start thinking about it as not some bizarre way to lose weight. It’s another treatment method.”

Sherry Jones of Jacksonville, operations coordinator for the Onslow Water and Sewer Authority, had sleeve gastrectomy in July at Carteret Health Care in Morehead City.

Jones said the surgery had benefits for her beyond losing weight, though she weighed 285 pounds just months before.

“I’m pre-diabetic and also had high blood pressure,” Jones said. “I’ve got neuropathy and I’ve got artificial knees, so I needed to lose the weight badly to prolong these knees – to work for me as long as I can get them to work.”

Three months after her surgery, she was able stop taking medications for diabetes and blood pressure.

Jones said she lost 25 pounds in preparation for surgery and another 45 pounds since, for a total of 70 pounds, bringing her down to 215 pounds. Her goal weight is 175 pounds.

She said her weight loss has slowed, though there are days when the scale needle moves down.

“I have learned to look for what we call NSVs, non-scale victories, which could be how your clothes feel, energy level, blood tests, being able to fit in the seat belt easily or just being able to exercise easily – just being able to do things you hadn’t been able to do before,” Jones said. “When you see those changes, you know your body is still changing even if the scale isn’t saying so.”

Dr. James Harris, a gastrointestinal and bariatric surgeon with Coastal Carolina Surgical Associates in Wilmington, said he does about 120 bariatric surgeries a year at New Hanover Regional Medical Center. The hospital itself does about twice that number of the surgeries, he said.

Before a person can be considered for weight-loss surgery, the patient’s body mass index – a formula using height and weight – must be determined, Harris said. Typically, that index must be 40 or more.

“You have to understand that the surgery alone does not necessarily work in a vacuum without other things like lifestyle changes, diet changes, exercise, participating in support groups and follow up to surgery,” he said. “You have to go through pre-operative nutrition classes to learn what the diet is before surgery, as well as the phases of diet afterward and ultimately the rest of your life.”

A visit to a psychologist is scheduled mainly to screen out people with certain eating disorders who need treatment other than surgery.

Patients are put on a low-carb diet before surgery to make it easier to do the surgery and to decrease the medical risk during laparoscopic surgery.

Initially pre-surgery visits with Harris would make sure patients are candidates for the surgery. Other visits are to give instructions and post-operative expectations.

“Then they have to go off and they see the psychologist and the dietician. They come to the support group,” Harris said. “They usually have to go see their medical doctor for a visit or two, depending on which policy they have.”

After a final visit, the patient’s information is submitted to the insurance company for approval. The whole process takes three to six months, depending on insurance.

As with Nunn’s experience, the surgery is a treatment for diabetes, Harris said.

“The surgeries in most situations can get type 2 diabetics off all their medications,” he said. “Not only do the surgeries usually cause pretty significant weight loss, which helps diabetes, but the surgeries also have this metabolic effect where as soon as the surgery is performed, the diabetes is partially treated.”

In a gastric bypass, the majority of the stomach is bypassed, Harris said.

“You make a very small stomach pouch out of the top of your stomach and the rest of the stomach is excluded,” he said. “You take some small intestine up to that pouch. So, food goes to the esophagus, pouch and right straight into the small intestine.

“Both surgeries that are commonly done these days – the gastric bypass and the sleeve gastrectomy –have some metabolic effect for diabetics. Gastric bypass has maybe a little more, so if someone has a bunch of medications for diabetes, we tend to favor the bypass versus the sleeve.”

The surgeries take an hour and a half to two hours. Usually the patient has a one-night stay in the hospital, going home the next day. The average length of stay for the surgery at NHRMC is 1.1 to 1.2 days.

“We tell people, depending on what they do at work, they’re going to take a week, maybe two, off,” Harris said. “They can’t do anything strenuous for four weeks. So, if they can go back to work light duty, they can go back in a week or so.”

Most patients are up and walking in the halls the same day of surgery and drinking liquids that night.

“Since they’ve been educated so rigorously pre-op, they know everything along each step of what they have to do,” Harris said. “That’s part of the success of the surgery. You’re not going into anything blindly. You know exactly what you have to do every step of the way. And we make sure of that.”

Patients are seen by Harris on a regular basis after surgery to make sure they’re getting the nutrition and vitamins they need.

“It’s fun to see them post-op,” he said. “They lose a lot of weight. They feel great. And they’re very appreciative.”

Dr. Charles Moore of UNC Surgical Specialists at Lenoir in Kinston is part of a team that started doing bariatric surgery at UNC Lenoir Health Care in early 2017. Since then, he and partner Joel Rose have performed about 50 weight-loss surgeries and have another 35 or 40 in the pipeline, Moore said.

“If we can do 50 in a year, then our national accreditation gets going and then it will open up to even more insurances,” he said. “As the program matures in time, our expectation is going to be in the hundreds.”

Both Moore and Rose are fellowship trained in metabolic and bariatric surgery. Moore has been in Kinston for five years and Rose has been there four years.

“Our personal mission of this program is to take care of the people of Eastern North Carolina,” Moore said.

“If we were to take away essentially Raleigh and Charlotte, we would be the highest obesity and one of the highest diabetes rates in the country,” Moore said. “We live in an area that is endemic with those two disease processes.”

Moore and Rose perform the sleeve gastrectomy and gastric bypass surgeries laparoscopically at UNC Lenoir.

Megan Daniels, bariatric coordinator at UNC Lenoir, said the pre-surgery requirements usually depend on the patient’s insurance plan. That testing and preparation typically take two to three months, though it could take as long as six or 12 months, Daniels said.

“The nice thing about our program is, because a lot of times those benefits are so opaque in a way for patients, we have our own referral coordinator that helps navigate any patient in our program through the process,” Moore said.

In addition to patients with health insurance, the UNC Lenoir program also accepts TRICARE for uniformed service members, retirees and their families; Medicare; and select Medicaid patients deemed appropriate, he said.

“In the last 10 to 15 years, modern bariatric surgery – because of the workup, because of the fellowship, because we’ve really started to hone in on some of these different nuances – has become as safe or safer from a mortality rate as gall bladder surgery,” Moore said.

“If your gall bladder was diseased, you’d think nothing to come to either myself or Dr. Rose to have your gall bladder out. The funny thing is I think there’s this overall perception, especially with obesity, that it’s an easy way out or that it’s just for weight loss.”

In fact, bariatric surgery has demonstrated benefits for patients suffering from diabetes, high cholesterol, hypertension and obstructive sleep apnea or facing knee replacement, he said.

“We’ve actually even found that people that struggle with fertility with polycystic ovarian disease, by losing the weight and going through with surgery, increases their fertility,” Moore said.

Source: https://www.jdnews.com/news/20190325/bariatric-surgery-helps-with-more-than-weight-loss

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