|A measuring stick for life By Erica Stacy
Most of us take the little things for granted.
Things like taking a walk in the park. Or
buying a new shirt off the rack from a local
store. But for individuals who are obese, these
simple acts are challenging if not impossible.
Today, the morbidly obese have access to bariatric surgical
procedures, medical techniques that can help them lose
weight and improve quality of life. But does losing pounds
and inches really change lives?
For Curt Shelvey and Jeff Rogers, the answer is a
Curt Shelvey’s story
Curt Shelvey’s daughter, Trinity, is 4 years old and the
apple of her daddy’s eye. His love for her has been lifealtering.
Now 46, Shelvey had struggled with obesity since he was
10. He had tried exercise and diets and, unsure of what his
next step should be, had attended an informational meeting
about bariatric surgery. Still he was hesitant to undergo the
complex procedure— until he saw the future reflected in his
“I was a borderline diabetic,” Shelvey says. “I had high
blood pressure, sleep apnea and was always fatigued. My
knees, hips and feet hurt all the time. I practically ate Tylenol
like candy to take the edge off.”
Because Shelvey was so overweight, his open gastric bypass
surgery was especially complicated. Recovery was not easy.
For six weeks, he received nutrition through a tube as his
body adjusted to the change.
But, he says, the results have been worth the effort.
The Italian chef who once weighed more than 400 pounds
is now 200 pounds lighter. “I dropped from a 64-inch waist
to a 38,” he says. “I wore a 6X shirt, and now I can wear an
XL. Before the surgery, I was taking five medications. Today,
I am prescription-free.”
Best of all, Shelvey now has the energy to enjoy life. “I
used to watch from the sidelines. Now, my wife Stacie and
Trinity have a hard time keeping up with me.”
Jeff Rogers’ LAP band surgery
A teacher by profession, Jeff Rogers recognizes the value
of education. Two years after his LAP band surgery, he is an
advocate for those who may be on the fence.
Go to an informational session,
he advises. Read everything you can,
and ask questions.
“I was tired of getting out of
breath and breaking a sweat just
tying my shoes,” Rogers says. “I
knew I needed to do something
about my weight. Diets hadn’t
helped. I saw an advertisement
for an educational session, and I
went. After about six months of
preparation, I had the procedure. I
would do it again tomorrow.”
Rogers, who has lost 123 pounds
and counting, is overjoyed with the results. “I am off all
prescription medications,” he says. “I have more energy. My
joints don’t hurt. I was using a cane; now, most of time, I can
stay balanced without it.”
He also goes to the gym six days a week. “It’s a pleasure
not having to shop in the Big and Tall section of clothing
stores anymore,” he says, “because I have lost eight pant sizes
and three shirt sizes.”
“Bariatric surgery is a tool,” says bariatric
surgeon Raymond Washington, M.D., of
Pinehurst Surgical. “It is used in combination
with changes in diet and exercise to improve
health. It is a life-changing event. A lot of
these patients are either intentionally or
unintentionally discriminated against, and
there are a lot of things they can’t do. By
having the surgery and losing the weight, they
are often able to get off their medications.
They can exercise and lose more weight. They
get a new outlook on life.” Bariatric surgery
involves several procedures designed to help
the excessively obese live healthier lives. It can
be a safe and effective method for promoting
weight loss and treating sleep apnea, diabetes,
high blood pressure, joint pain and various
other illness associated with morbid obesity.
However, experts caution that it is not a quick
fix. Achieving success through bariatric surgery
requires lifestyle change. The procedures are
complex, and serious complications can result
if patients are not 100 percent committed.
Recognized as a Center of Excellence by the
American Society of Metabolic and Bariatric
Surgery, the Bariatric Center at FirstHealth
Moore Regional Hospital offers Roux-en Y
divided gastric bypass surgery, the adjustable
gastric band and revisional bariatric surgery.
Performed by way of either a traditional
“open” incision or a laparoscopic (minimally
invasive) approach, the Roux-en Y procedure
reduces the stomach to a small pouch that
holds about an ounce of food. The pouch
is connected to the small intestine so it can
Limiting the amount of food a patient
can eat and the number of calories that the
patient’s body is able to absorb promotes
dramatic weight loss while often controlling
type 2 diabetes, high blood pressure, sleep
apnea and other health problems. Patients who
have gastric bypass must remain in the hospital
for a few days and have
During this procedure, surgeons typically
use laparoscopic techniques to implant an
inflatable silicone band into the abdomen.
Like a wristwatch, the band is fastened
around the upper stomach to create a
tiny new stomach pouch that limits and
controls the amount of food that is eaten.
It also creates a small outlet that slows the
emptying process into the stomach and small
intestine. As a result, patients are satisfied
with smaller amounts of food.
Hospital or the
M.D., click here or call (800) 213-3284.
Gastric band surgery is reversible, and
the band can be tightened or loosened as
necessary. Most patients will experience an
overnight stay in the hospital after surgery and
are able to resume work and other normal
activities within two to four weeks
Revisional bariatric surgery alters or repairs
a previous operation for treatment of morbid
obesity. There are two reasons for revisional
bariatric surgery: poor weight loss or weight
regain, and complications of the original
Surgeons at Moore Regional also perform
gastric sleeve resection procedures—often as a
Roux-en Y staging procedure for certain highrisk
patients. During a sleeve procedure, a large
portion of the stomach is removed and the
remainder is converted into a tube that restricts
“Although patient preference does factor
into the decision, we carefully evaluate every
individual and make recommendations on
what is best for their specific situation,” says
bariatric surgeon C. Kenneth Mitchell Jr., M.D.,
also of Pinehurst Surgical. “The methods we
use to prepare our patients set us apart from
other hospitals and surgeons. We approach
each case individually and customize the care
for the patient. Our goal is to help each one
achieve his or her desired results. In essence, the
procedure is just one ingredient in an overall
new recipe for life.”
Raymond Washington, M.D. (standing) and Kenneth Mitchell Jr., M.D., perform bariatric surgeries at FirstHealth Moore Regional Hospital.
Media attention is at an all-time high. Patients are
evaluating their bariatric surgical options now more
than ever, and the number of surgeons performing
bariatric surgery continues to increase. The choices
for obese patients have never been more plentiful.
Some would say they have never been more difficult.
Bariatric surgery was once a club, if you will, of
dedicated surgeons who had great interest in the
treatment of the morbidly obese. Over the last 10
years, bariatric surgery has developed into a society
and, more recently by necessity, has evolved into an
industry. With more and more surgeons claiming
their “bariatric expertise,” patients now have more
choices regarding bariatric surgeons.
How does the patient choose a bariatric surgeon?
Here are some questions to consider:
1) What are my
surgery? This is one of
the most basic questions
you should ask yourself
and your surgeon. In this
time of new technology
and innovative techniques,
almost anyone can claim to be a bariatric surgeon.
So know how your surgeon became interested in
bariatric surgery, and ask what proportion of his
practice is involved with bariatric surgery. I feel a
dedicated bariatric surgeon should devote at least 50
percent of his practice to bariatric procedures to be
considered a specialist by his peers.
Did my surgeon receive special training in
bariatric surgery within his residency program? Did
my surgeon complete a bariatric fellowship? Is my
surgeon board eligible/board certified? All of these
questions are important, and should be asked early on.
2) What is my surgeon’s reputation in the medical
community? This will tell you a lot about your
surgeon, because one physician cannot do it all.
Bariatric surgeons should work closely with other
physicians in their community when caring for
bariatric patients. What does your family doctor
think of your bariatric surgeon? Your cardiologist?
Any inside information from the medical community
could be very helpful.
3) Are other patients satisfied with my surgeon? Any
Internet chat room can help you with this process, but
beware. Not everyone who is obese is a candidate for
bariatric surgery. Be on the lookout for the disgruntled
patient who had a bad experience with a particular
surgeon and spends his/her free time trying to trash
that surgeon or that surgeon’s office and staff. Pay most
attention to the majority, not the exceptions. Attend
a support group meeting and ask other patients their
opinion of their surgeon.
4) What are my surgeon’s complication and mortality
rates? This can be difficult information to obtain, but
the best way is to ask. Any respectable bariatric surgeon
will be honest and open with you regarding these issues.
Remember, some bariatric patients are quite ill prior to
surgery, in essence making them great candidates for
bariatric surgery. With pre-existing co-morbidities comes
increased risk. However, this is not a license for higher
complication rates or high mortality rates. The accepted
mortality rate (chance a patient will die within 30 days
of surgery) is roughly 1 percent. The accepted morbidity
rate (chance a patient will experience a complication
in the immediate post-operative period) is roughly 15
5) What is my surgeon’s office like? This is a very
important observation that all patients make. Start
with the waiting room. Are there chairs that you can
sit in comfortably? Is the waiting room cramped? Are
the examination tables big enough for large patients?
Are there scales for weighing patients in excess of 500
pounds? Does the surgeon have a bariatric coordinator
who can be contacted easily?
6) Is my surgeon offering an operation or a program?
Some bariatric surgeons pride themselves on the ability to
operate, and measure the success of their patients by the
immediate post-operative course. Once a patient recovers
from his surgery, the bariatric surgeon may dismiss him to
follow up with his family doctor. This leaves the patient
with little surgical follow-up in the weeks, months and
years to come. Most dedicated bariatric surgeons spend
most of their practice in bariatric surgery educating their
patients before and after surgery. Most of their operating
time is spent performing bariatric surgery, not just doing
a gastric bypass or LapBand if there are too few hernia
repairs or gallbladder excisions to do. Truly dedicated
bariatric surgeons see this specialty as demanding of their
time and resources. Their program starts with education
and evaluation prior to surgery and leads to lifelong
follow-up after surgery.
7) What does my surgeon expect of me before and
after surgery? This is tied into the operation vs.
program question. My feeling about bariatric surgery is
that the operation itself is about 10 percent of the entire
package, but a very important 10 percent. Information
sessions are a great way to learn about the options for
bariatric patients, and some surgeons require prospective
patients to attend a free information session prior to
an office consultation. This gives the patient, and the
patient’s family or loved ones, a chance to learn about this
exciting opportunity at no cost and in a non-threatening
What about post-op? Long-term follow-up is
necessary and, in most elite bariatric practices,
mandatory. In my experience, the success of a post-op
bariatric patient depends on four major points:
- Completing a successful bariatric procedure
- Taking daily supplements for the rest of your life
- Adherence to an exercise regime with a strengthtraining
- Compliance with a strict post-operative diet and
commitment to long-term follow-up and support group
If one of these elements is missing, the post-op patient’s
level of success will be limited.
8) Is the hospital specially equipped for the bariatric
patient? This assessment begins in the admissions
department. Don’t be afraid to ask questions; without
questions, you won’t get answers. Are there special
wheelchairs, stretchers and hospital beds? What about
reinforced toilets or extra-large bedside commodes?
Is there specialized equipment in the operating room,
specifically an operating room bed that can accommodate
a person greater than 500 pounds? Is the anesthesia
department specially trained to care for the bariatric
9) Is my surgeon a member of the American Society
of Bariatric Surgeons? This is the most important
question you should ask of your bariatric surgeon.
Involvement in this society is considered mandatory for
the true bariatric specialist. Members evaluate current
research, discuss new techniques and set standards for the
society to follow. If you had a bad heart, would you seek
the consultation of a cardiologist who was not a member
of the American Heart Association? I rest my case.
These are just some suggestions. Consider them and
remember: Choose a surgeon and a program you feel
comfortable with, even if you have to drive an hour or two
out of you way. It’s your choice, and you are the customer.
C. Kenneth Mitchell Jr., M.D., is a general and bariatric
surgeon with Pinehurst Surgical and medical director of the
bariatric surgery program at FirstHealth Moore Regional
Hospital. For more information on the bariatric program at
FirstHealth Moore Regional Hospital, call (800) 213-3284.