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Gastric bypass surgery
| Date: |
06 August 2006 12:00 |
| Producer: |
Sophia Phirippides
Jonathan H Pienaar
Sophia Phirippides
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| Show: | Carte Blanche |
Charmaine (30 years old, 135kg): 'There is a lot that I have missed out on because of my weight.'
Ansha (34 years old, 146kg): 'You cannot swim in public. People are always staring. People are always talking.'
Izak (27 years old, 200kg) and Pieter (27 years old, 212kg): 'The names they called us, 'Lard-ass'... 'Heavies'.'
Elmien (31 years old, 194kg): 'You see small children passing you and they look and they stare. It's like carrying another person around with you the whole time.'
These people have all been overweight for most of their lives. They have all reached a stage the doctors call 'morbid obesity'. Simply put, they are walking time bombs. For Charmaine, her weight is more than an aesthetic consideration.
Charmaine Schwenn (Attorney): 'If I look in the mirror, I don't like what I see. I try to make the best of what there is.'
At 135kg, her weight has reached a point where it is life threatening.
Charmaine: 'My Body Mass Index is about 47, which is really dangerous. There's a severe cardiac history in my family. My father recently died of a heart attack; my mom had a heart attack at the age of 50. I have started to experience some mild chest pains, and it's a bit scary.'
Ruda Landman (Carte Blanche presenter): 'In 2002, the World Health Organisation declared obesity a disease, and a major cause of other life-threatening diseases. But the problem has continued to escalate, with more and more people getting more and more overweight. The answer seems simple: diet and exercise. But the fact remains that in the long term, diet and exercise will work for only five percent of seriously obese people.'
Charmaine: 'I've tried every single diet that there is, without a doubt, and I've experienced moderate success, I've lost 20 kilos - 10 kilos at a time. But as soon as I returned to normal life, I just piled back on all that weight plus about 10 kg more.'
Elmien, too, had lived a life of yo-yo dieting. 18 months ago she weighed 194kg. Since then she lost 106kg - almost two thirds of her weight. It was the end of a long, hard struggle.
Elmien Pieterse (Events Co-Ordinator): 'I was in primary school and I remember my mother taking me to a doctor, and he prescribed this diet, and she had to inject me every morning. I am talking about standard two.'
As much as she tried to diet, Elmien couldn't beat her eating problem, and she got fatter and fatter. The final straw came when she and her husband bought a new, double storey home.
Elmien: 'And to climb these stairs, I'm telling you now, was effort. I am telling you now, if I came home and forgot something downstairs it would stay downstairs because I was out of breath by the time I got upstairs. I just realised that I cannot continue on like this. I am going to be dead before the age of 35.'
Elmien is not exaggerating. Obesity is one of the modern world's biggest killers. Amongst others, it can cause heart disease, hypertension, Type-2 Diabetes and certain cancers. At almost 200kg, Elmien was a prisoner of her own body, preferring to vegetate in front of the TV. Ironically, it was a TV programme on gastric bypass surgery that offered her a solution.
Elmien: 'I think the first thing that you need to do is realise: look I cannot do this by myself. When you get to a certain weight it is just impossible. And I decided that I needed to do something radical. And that is why I went for the surgery.'
Over the years, various methods of weight-loss surgery have been developed, which aim to restrict food consumption, or bypass parts of the digestive system. One of the most successful has been the Roux-en-Y procedure, which cuts the stomach down into a 50ml pouch, limiting the amount of food the patient can ingest at any one time. The intestine, or small bowel, is cut and joined to the pouch, so that food bypasses the part of the digestive system that handles the absorption of sugars and carbohydrates.
Ruda: 'People will do anything to lose weight, and the fatter you are, the more extreme the things you may try in desperation. But gastric bypass surgery - having your stomach stapled - still sounds radical.'
Weight-loss surgery, of one form or another, has been popularised by celebrities like comedienne Roseanne Barr, singer Carnie Wilson of Wilson Phillips, footballer Maradonna and music producer Randy Jackson. Is it just another fad, or does it offer real hope?
Prof. Tessa van der Merwe (Centre for Obesity Research & Education): 'For now, this is the most sophisticated, the most successful and the most sustainable form of therapy that we've got for the morbidly obese, given it's in safe hands.'
Endocrinologist Professor Tessa van der Merwe, of the International Association for the Study of Obesity, says that this surgery forces the patient to comply with a long-term healthy eating regimen.
Tessa: 'This is not a simple question of, 'Am I going to go to gym today, yes or no,' which remains a choice for the patient; what we are doing is performing a surgical procedure that enables them to go along with a certain way of behaving afterwards.'
But not everyone qualifies: patients are screened according to their Body Mass Index - or BMI - and state of health. BMI is a factor of height and weight, and the 'normal' range is 20 to 24. Once an obese patient reaches a BMI of 35 or more, and has developed life-threatening weight-related health problems, they may be considered for surgery. Charmaine, who has a BMI of 47, has been accepted for treatment at the Bariatric Centre of Excellence in Pretoria.
Charmaine: 'For me, I always say that an alcoholic can go and give up alcohol. A person that has a weight problem you tell them to still have what is their weakness and their downfall, but only so much of it. I don't see myself as a weak willed person at all, but everybody has got their Achilles heel, and this is mine.'
Tessa: 'This is not for the faint-hearted. You have got to prepare the patient very carefully. You have got to have a dietary preparatory phase of about ten to twelve weeks prior to surgery, teaching the patient what to expect after the surgery.'
Ruda: 'Is this an easy quick fix?'
Elmien: 'No. It does give you a jump-start. The after care is what really makes it a success. And you cannot just eat right; you need to exercise. To make it a success it will take willpower.'
Prof van der Merwe has joined forces with internationally renowned laparoscopic surgeon and gastro-enterologist Prof Heine van der Walt. Together they started the Bariatric Centre of Excellence, where he performs the Roux-en-Y procedure that has been tried and tested for many years. He stresses that this is not an operation to be undertaken lightly.
Prof Heine van der Walt (Bariatric Laparoscopic Surgeon): 'This is not a slimming clinic. We operate on patients who come in on oxygen masks, blue in the face; they can't move, they can't stand up, they can't move out of the chair, they can hardly breathe, they can hardly talk, they are so ill.'
Twins Pieter and Izak both weighed over 200kg when they were accepted for the surgery by Prof van der Walt. Now, seven months later, Izak has lost 70kg and Peter 50kg. But at the time, even they did not know how sick they were.
Tessa: 'Both of them were in very grave heart failure, suffering from hypertension with a lot of osteo-arthritis. But I think my main concern was that we were dealing here with two very young men who had now been diagnosed with diabetes and were literally deteriorating in front of my eyes.'
Izak Voormolen (Stock Controller): 'I would be sitting chatting with people and just fall asleep. I couldn't sleep at night - I would sleep for 20 minutes, then wake up struggling for air. My blood pressure was very high... blood sugar. My heart almost gave in.'
For Izak and Pieter, the surgery was a life-saving intervention. Prof van der Walt performs this procedure laparoscopically, through four small holes cut in the abdomen. In experienced hands, it has a very low risk of mortality - 0.5% - and there is some risk of post-operative complications, which can usually be managed. But the long-term effects are still uncertain, and patients need to be monitored for nutritional deficiencies.
Heine: 'This operation has two components. It has a restrictive component where the size of the pouch limits the amount of food that the patient can eat. It also has a mal-absorptive component. The length of the small bowel actually causes your digestive juices and your food to join up a bit later, then your digestion actually starts a bit later.'
Tessa: 'There's a third element. Certain chemicals in the stomach that, under normal circumstances, send a signal back to the brain: I am hungry and I need to eat - and they are quite potent ones, located in the stomach - to a large extent are eliminated.'
This procedure originated from a peptic ulcer operation, when doctors noticed that patients lost weight, and it was then modified for weight-loss surgery. And a remarkable thing happens within 72 hours: patients' insulin levels suddenly start to normalise. It's something doctors are unable to explain. When we met Pieter and Izak, seven months after their operations, they told us that they haven't looked back to their days of braaivles, brandy and Coke.
Pieter: 'After the operation I didn't really feel like eating; you didn't fell like drinking that little bit. My mother forced us to do it. Even now, you just don't feel like eating.'
They are now at the halfway mark. By this time next year, they should be close to their ideal weight. But such radical surgery is not without risks if doctors' orders are not followed. Elmien neglected her diet, and fell ill with Guillain-Barré syndrome.
Elmien: 'I became obsessed with losing weight and didn't eat for three weeks. I was eating half an apple and a can of Coke light a day, so my immune system was completely dilapidated. That is how I picked up the virus, and I realised when I woke up in ICU that this is not the way. There is a way of healthy living, and that is what makes the difference.'
Weight loss surgery has evolved over the years; in the past, procedures were risky and often resulted in death. Ansha has had two different types of weight-loss surgery in her life. The first time she nearly died.
Ansha Visage (Admin Supervisor): 'I had liver problems afterwards because of the food going straight through - there was no vitamins being absorbed. I didn't have energy for anything; I felt like I was dying. In the end I wanted to die.'
Ansha had opted for a cheaper operation that simply shortens the small bowel from seven metres to 40 centimetres. But within days she was critically ill.
Ansha: 'I went back to the same doctor asking him to reverse it for me and he said no he can't because it is too early.'
Professor van der Walt says that Ansha's operation was abandoned in America in the early '80s.
Heine: 'It was actually so bad that the American College of Surgeons in 1982 made a statement that if this operation is done, they consider it unethical; it is undesirable. And a surgeon will be medically and legally liable if he should operate on a patient and the patient develops any complications or side effects from the operation.'
Ruda: 'Is it still done?'
Heine; 'Unfortunately yes. And we often admit these patients with liver failure, kidney failure, and they are on the verge of death.'
With this operation there are no dietary restrictions, but Ansha found she was ill-prepared for what followed.
Ansha: 'Afterwards, you have constant diarrhoea, because anything that goes into your mouth comes basically directly out.'
In five weeks Ansha lost 23kg, but she was so ill that she tracked down a surgeon who would reverse the operation. Even now, she admits she hadn't researched her options properly.
Ansha: 'I think at that stage you're so desperate, it sounds like such a way out. If a doctor tells you: you can eat anything, you are still going to lose weight and you are going to be healthy, you will believe it.'
Two years later she heard of the Roux-en-Y procedure and, despite initial misgivings, she decided to go for it. In just over a year she lost 76kg.
Ansha: 'It's dramatic how healthy I am - I don't have high blood pressure anymore. I can walk around the block without getting tired or feeling like I need to lie down. It's just fantastic.'
On TV and on the Internet a whole host of alternative treatments are advertised - often with glowing testimonials - which claim to have the same effect , without the pain and cost of surgery.
Ruda: 'There is something advertised which I have seen on the Internet called a gastric bypass pill. And it actually swells up and fills the stomach to a certain extent.'
Heine: 'All methods work; whether it be the ones that gives you the shakes or gives you diarrhoea. Everybody loses weight for about a month and then it [tethers] out and that's the end of it.'
The Roux-en-Y gastric bypass can cost between R60 000 and R120 000 for the entire process, and in South Africa, where obesity is a growing concern, it is out of reach for most people.
Elmien: 'I had to take a second bond on my house. My husband was very supportive.'
Charmaine: 'I'm going to be drawing money out of my bond in order to fund the surgery. It is going to take me a long time to pay it back.'
Ruda: 'With people coming off medication, getting sick less, and generally enjoying a better quality of life, one might expect the medical aid societies to be enthusiastic, but it seems that most of them have yet to discover the long term benefits.'
Heine: 'Obesity has been classified as a disease, and these are ill people. And medical aid must not [shy] its responsibility in looking after these patients. They are not offering cosmetic surgery to these patients, they are offering health.'
Ruda: 'It's not a cheap option, and the expenses don't end with this operation. If you lose as much as 80 to 100kg, you're left with layers and layers of excess skin.'
Elmien: 'I went to a very good plastic surgeon and both operations together came to about R110 000.'
Elmien had a tummy-tuck and breast reconstruction. Her arms and legs also had skin removed, and she had a mini face-lift.
Heine: 'You have to cut away the skin because otherwise you get these skin folds, where you get this fungus overgrowth. And it is just impossible to look normal in clothes. And, once they have stabilised their weight, that is when we send them to the plastic surgeon. A number of these patients actually have their skin shrinking with them and they don't need plastic surgery.'
Ruda: 'So after a lifetime of being the cuddly fat friend, the one you could trust with your husband or your girlfriend, playing the mother figure to all and sundry, you are suddenly given a new body and everything... literally everything... changes?'
Elmien: 'I've lost friends; I've lost some of my best friends.'
Ruda: 'Why did you lose friends?'
Elmien: 'That role that you play within a group of friends.... Now you are not the mother any more, so you need another role, but that role has already been filled. I used to be 'one of the guys', so when you are in a conversation and they speak about stuff that men speak about when they are alone, stuff that is usually offensive to women, and I am like: guys, I am right here. And they were like: you are one of the guys, so that is fine. And that has changed hugely. And for my husband - it never used to bother him that I had male friends, but that has also changed.'
Ruda: 'What's the best moment for you?'
Tessa: 'Without a shadow of a doubt the four week post-op visit.'
Ruda: 'Why? What happens?'
Tessa: 'The person that walks through that front door is a totally different person. They have a renewed self-confidence, they have hope; their eyes change.'
Heine: 'I've seen big smiles. I've seen patients that walk into my rooms after one year that I do not recognise. I've seen divorces, depressions, new marriages. I've seen numerous new sets of wardrobes. Some of these patients are too scared to go outside and be ridiculed by society and, for the first time, they actually have the self-confidence to be part of society again, and that's a wonderful thing to see.'
Ansha: 'Sometimes I feel it wasn't me. Most of the time I don't look at the photos. I get cross with myself for doing that to myself.'
Elmien: 'When you shed the weight, you shed the person that you used to be. You feel lighter in your soul. You feel lighter in your heart. You feel that you can achieve pretty much anything. It is exhilarating... that's the right word.'
IMPORTANT DISCLAIMER:While every attempt has been made to ensure this transcript or summary is accurate, Carte Blanche or its agents cannot be held liable for any claims arising out of inaccuracies caused by human error or electronic fault. This transcript was typed from a transcription recording unit and not from an original script, so due to the possibility of mishearing and the difficulty, in some cases, of identifying individual speakers, errors cannot be ruled out.
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