A bariatric patient wants other women to know…

A young nursing assistant had sought help for a back injury five years ago, and her doctor recommended bariatric surgery. She lost 120-pounds, but it has not been a happy ending. Looking shockingly decades older than her real age, malnutrition has cost her her health, her job, and most of her hair and teeth. She and other women around Modesto believe that more attention deserves to be given to the long-term complications of bariatric surgeries and bravely shared their stories with the Modesto Bee this weekend.

These are the truer pictures of the pain and complications of bariatric surgeries that those of us who’ve cared for these women see far more often than those glowing before-and-after stories in the media.

These women showed tremendous courage in opening their hearts and going public, hoping to help other women. Their stories deserve to be heard. Please be sure to watch Sandi’s touching video interview [halfway down the page]. As reporter Ken Carlson wrote:

Weight loss surgery's complications devastate some patients

Sandi Krueger of Turlock dropped 120 pounds with weight-loss surgery, but she is hardly a success story. The 2002 surgery led to chronic malnutrition and anemia. As the pounds melted away, so did her life. With a sunken face and protruding collar bones, she is too weak to work and spends most afternoons on the couch wrapped in a blanket. She has thoughts of giving up, but wants to be there for 12-year-old daughter Megan and 19-year-old son Dustin. "It's not acceptable leaving me like this," said the 103-pound Krueger, who at 38 looks closer to 50...

Krueger's options appear to be running out… "This isn't a life," said Robert De Kasha, her brother. "If she doesn't find an answer, she is just going to fade away."..

She had what's called a Roux-en-Y gastric bypass …[and] lost weight quickly as dumping syndrome made her sick for months. When she went to the doctor with complaints, he urged her to stick with the dietary instructions and take supplements, she said….

After a second surgery attempting to correct the complications, she gained 22 pounds, only to plummet down to 98 pounds and be hospitalized for severely low blood sugar.

Tests have shown that her pouch no longer holds food but dumps it directly into the small intestine. Even if she eats five times a day, she doesn't get the protein and other nutrients she needs… Krueger said it's heartbreaking for her daughter to see her tired and faint all the time. She has lost hair, her teeth are decaying and she's often out of breath. To treat her anemia, she's had a blood transfusion and three rounds of iron infusions. A reaction to the last infusion caused her blood pressure to plummet and nurses to come to her aid. Last year, she was considered for having the gastric bypass reversed at UCSF, but doctors told her in December that it was too dangerous. They were concerned that her remaining stomach would have inadequate blood flow and would rot, she said…

If they would put me on the operating table to take me back to 250 pounds, I would do it."

Two other Modesto-area women came forward to describe their situations. Donna also suffered from dumping, malnutrition and dehydration, as Carlson wrote:

Attempts to eat made her feel sick and sweat profusely, even though she followed the guidelines to eat pureed food and take small bites, she said. She went from 246 pounds to 123 in six months and landed in the emergency room, where she was treated for dehydration for several hours, she said… Five years after the surgery, she still is forcing herself to eat... She said one of her daughters had the same post- surgery troubles, as well as a calcium deficiency resulting in dental problems.

Another young mother told the paper that she’s had two hernia surgeries since her bariatric procedure and suffers from severe iron deficiencies and has had to have a port inserted into her chest for iron infusions. She faces yet another hernia surgery and has lost her hair. “I still get dumping syndrome,” she said. “If I don't chew my food 50 times, it collects at the bottom on my esophagus and I throw up.”

The strength of this newspaper article was in the reporting from original sources: the women telling their own stories. When the reporter moved away from original sources and attempted to balance this story by reporting the research, he didn’t go to the original studies himself. He went to bariatric surgeons and the information became confusing and contradictory, and the women’s situations were downplayed. In fact, it was falsely implied that they were to blame and complications could be avoided if patients are simply “responsible for complying with the recommendations for follow-up, nutrition, exercise and behavior change.”

The reporter cited unnamed studies and unnamed sources purportedly finding patients with long-term complications are the minority and such outcomes are rare. “[Bariatric surgery] has improved the lives of people who suffered from diabetes, high blood pressure, sleep apnea and other issues, experts say.”

Readers didn’t learn that these promotional claims have not been soundly supported in the medical literature. The Mayo Clinic also reported that 20-25% of gastric bypass patients develop life-threatening post-op complications and even the recent Lap-Band U.S. clinical trials done to earn FDA approval had reported 89% of patients had at least one adverse event, one-third of them severe. A recent study by researchers at Virginia Commonwealth University found that 56% of bariatric patients had 62 different gastrointestinal complications and abnormalities. The surgical complications and failures of bariatric surgeries are so significant, according to bariatric surgeons with Tampa General Hospital in Florida, that revisional (second) surgeries are required in up to 23% of gastric bypasses and in 5-36% of vertical banded gastrophy cases. Vomiting after gastric bypass procedures occurs in up to 68.8% of cases and can become chronic, resulting in severe malnutrition, according to Brazilian surgeons in a 2005 study published in Obesity Surgery. The long-term nutritional complications are even more extensive.

In fact, the complication rates are so high and the complications so severe that even Dr. Edward Eaton Mason M.D., Professor Emeritus of General Surgery at University of Iowa Hospital and inventor of gastric bypass, cautioned: “For the vast majority of patients today, there is no operation...without introducing risks and side effects that over a lifetime may raise questions about its use for surgical treatment of obesity.”

Concerning the risks and benefits, the reporter said “a 10-year Swedish study found many patients kept the weight off and had increased longevity.” Neither claim had been credibly demonstrated in that study, as we’ve learned. “The benefits by far outweigh the risks that are associated with the procedure,” another bariatric surgeon was quoted as saying. But the largest and strongest study to date on every bariatric surgery done on Pennsylvania residents during the entire decade from 1995 through 2004, revealed that by best estimates, bariatric surgery likely increased the actual mortality risks for these patients the first four years post-op by 363% to 250%.

When patients bravely come forward to share stories that confirm what the soundest studies show, their voices deserve to be heard. Most patients are experiencing complications, yet we almost never hear those stories in the news.

This article provided a rare attempt to offer that balance.