Surgical Weight Loss Program offers options for patients

by Alyssa Harvey, The Daily News, originally published on 11/5/2011

Keri Clark hadn’t always been overweight.

“I gained a little bit after getting married and having kids,” she said.

In 2001, she had twins and nearly died.

“I had high blood pressure issues. They were premature,” she said. “I was going into kidney failure. I stayed in the hospital for almost a month.”

Her metabolism changed and Clark said she “really blew up,” going from 180 pounds to 269 pounds from 2002 to 2003.

“I didn’t exercise,” she said. “I never did when I was younger.”

After having the twins, Clark became a labor and delivery nurse, often working 12-hour shifts.

“My knees and back were hurting. It was a very demanding job,” she said. “It’s what made me want to do it.”

“It” was weight loss surgery. Clark had a duodenal switch, which involves making the stomach smaller and rerouting the small intestine. She had the surgery in March 2010 in Nashville.

“I don’t think it’s for everybody, but I think everybody should have the option,” she said of weight loss surgery. “You have to do your own research. Be honest with yourself. Is this surgery right for me?”

Clark is now helping others have the option as a bariatric nurse liaison for The Medical Center’s new Surgical Weight Loss Program. Located on the first floor of Riverside Professional Center, the program offers support for patients before and after their operations, which will be done at The Medical Center. The service offers everything a patient may need, including a seminar to help potential patients learn more, insurance specialists, a nurse practitioner, a psychologist and a dietitian. There is also a support group that works in conjunction with the program.

“We do laparoscopic surgery. It’s minimally invasive,” said Dr. John Oldham, who, along with his partner, Dr. Derek Weiss, will do the operations. “It’s much better for patient outcomes. We’ve done 6,000 procedures and haven’t had to convert anyone to an open procedure.”

Oldham and Weiss are bariatric surgeons with Bluegrass Bariatric Surgical Associates in Louisville. They will perform different types of surgery, including the adjustable gastric band, which is placed around the top part of the stomach to reduce food intake; sleeve gastrectomy, in which the outer 85 percent of the stomach is removed, making it the size of a banana; gastric bypass, in which a pouch for food is made at the upper end of the stomach and the pouch is connected to the upper small intestine; and the greater curvature plication, which is new.

“No insurance covers it yet. It’s an investigative procedure,” he said. “You fold the outer portion of the stomach in and make it smaller.”

Patients usually have to have a body mass index of 35 or greater and some related condition such as sleep apnea, diabetes or heart disease, in order for insurance to cover surgery, Oldham said. Those with a BMI of 40 and up don’t have to have a health condition for insurance to cover it. Gastric band surgery is available for those with a BMI of 30 to 34.9, but insurance does not cover it.

Each surgery is a tool designed to help the patient get to a healthy weight, and each one is different, Oldham said. Gastric bypass and sleeve gastrectomy patients lose the majority of their weight in the first year – 60 percent to 70 percent of excess body weight. The gastric band procedure is the safest because there is no cutting the stomach or rerouting the intestines.

“There is no magic procedure. They have to commit to do this,” he said. “There is a lot of education involved. A lot require a six-month diet before they have surgery.”

There is also more education after the surgery, including time with an exercise physiologist and support group meetings, Oldham said.

“They commit to being patients for the rest of their lives. Once a year, we check their vitamin levels and make sure their bodies are doing what they should be doing,” he said. “Exercise has to become an important part of their lives as well. You have to be committed to make changes in your lifestyle to do it.”

Clark said she started thinking about weight loss surgery in 2007. She had family members who were obese and wanted her life to be different.

“I worked with people who had it done,” she said. “It’s scary because you’re choosing to have surgery. What kind of life am I going to have if I don’t?”

After her surgery, Clark was in the hospital for five days. Her surgery was not laparoscopic. She understands that people worry about the possibility of complications, but today’s surgeries are more advanced, she said.

“We have to overcome ’70s and ’80s surgery,” she said. “People died during those surgeries.”

Clark has made some lifestyle changes since her surgery and is about 8 pounds from her goal weight.

“When you start to feel full, you stop,” she said. “If you try to stuff yourself, for me it really hurts. It’s not just an uncomfortable feeling.”

Clark said her feelings about food have changed. Some people feel as if they should have an entire cake after they have had one piece.

“I had a piece of cake, and it was really good, but I don’t have to eat the rest of it,” she said. “I’ll get cravings, but it’s not like I have to go eat all of it.”

She eats a high protein, low carbohydrate diet and no longer craves empanadas, which was her favorite food.

“It changes your taste buds,” she said. “You’ve got to change a little bit.”

Clark said weight loss surgery is a tool, not a cure.

“You can gain it back,” she said. “It’s a tool, like you would use health equipment at BAC.”

Copyright 2011 News Publishing LLC (Bowling Green, KY)

'Winter blues' hitting again: Steps urged to fight seasonal disorder

by Alyssa Harvey, The Daily News, originally published on 11/5/2011

Some people find no joy in the end of daylight saving time.

It brings shorter days with less sunlight. For some people it’s the beginning of the “winter blues,” or Seasonal Affective Disorder, a type of depression that occurs at the same time every year.

“People with SAD have symptoms that start in the fall and may continue through the winter months. Reduced sunlight can drop serotonin levels in people with SAD,” said Dr. Mrinal Mullick, a psychiatrist at The Medical Center. “The biological internal clock of the Circadian rhythm tells when we’re asleep and when we’re awake. It’s the destruction of the Circadian rhythm. It’s a combination of genetics and brain chemistry.”

SAD is different from general depression, Mullick said.

“It’s mostly associated with oversleeping and a craving for high-carb foods,” he said. “They have a feeling of hopelessness, a loss of energy and a loss of pleasure in activities.”

Greenview Regional Hospital respiratory coordinator Tuyen Trinh said some of the symptoms of SAD include depression, sleep problems, a tendency to overeat, loss of concentration, anxiety, mood problems and lowered sex drive.

“Four to 6 percent of the population suffer from SAD. Adults, teens and children can have it,” she said. “A lot of people have it but don’t know they have it. It happens in females four times more than in males.”

When men have SAD, though, their symptoms are more severe, Mullick said. Other risk factors for SAD include having certain other mental illnesses and how close one lives to the equator.

“The further you live away from the equator, the prevalence increases,” he said. “If you already have depression or bipolar disorder, it can make it worse.”

Although SAD can’t be prevented, there are ways to ease the symptoms, including using light therapy, Trinh said. People should be cautious with it and consult their doctors because UV lights can be damaging to the eyes.

“You can use a light box. It emits enough light for the body to soak up or you can sit near a window,” she said. “Take walks in the afternoon. Do things outdoors.”

People can use light therapy for an hour or two daily, Mullick said.

“It starts working quickly, in two to four days with very little side effects,” he said.

Some people may need antidepressants such as Paxil, Zoloft or Prozac, Mullick said.

“If people have typical SAD, they start taking it before the symptoms start,” he said. “They generally continue for a couple of months after the symptoms resolve.”

Psychotherapy can also help, Trinh said.

“It can help identify negative thoughts and changes,” she said. “Once you understand it, you won’t feel as bad.”

Mullick and Trinh encourage lifestyle changes to help ease symptoms.

“Trim branches at your home so you can have more sunlight. Sit next to the windows at work. Take a walk outside,” Mullick said. “If you are eating lunch in the office, sit in the park and eat it if it’s not very cold. Physical exercise helps relieve stress and anxiety.”

Developing healthy sleeping and eating habits and having a strong support team of family and friends can help, Trinh said.

“Socialize,” she said. “One of the symptoms of SAD is being withdrawn. Take trips where there is more light and come back when winter is over.”

Students should ask for help if they have SAD and lose concentration in class, Trinh said.

“During that time you may not have focus like you would another time,” she said.

Be patient, Trinh said.

“Don’t expect symptoms to go away immediately,” she said. “Don’t be too rough on yourself.”

People should not view SAD as a weakness, Mullick said.

“You should not just ignore it if the symptoms are persistent,” he said. “Get help, especially if you have suicidal tendencies.”

Trinh agreed.

“People often disregard. They just go on through the winter like that,” she said. “There’s less light. We can’t stop that. We can only prepare ourselves. Talk to your doctor on recommendations on how to treat it.”

Copyright 2011 News Publishing LLC (Bowling Green, KY)