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Weight loss surgery no quick fix
Yumimi Pang
reporters@nsnews.com
THOSE close to Erin Madsen say she's smiling a lot more these days.
She hasn't won the lottery, but the Seycove secondary English teacher has had another lifelong dream come true.
Madsen's done what the likes of Al Roker, Carnie Wilson, and Randy Jackson all did - in March 2004, the 32-year-old had her stomach stapled. The result of the drastic procedure is a 92-kilogram (200-pound) weight loss in just 16 months.
Madsen is literally less than half of her former 168-kg (371-pound) self, and now packs a svelte 75 kg (166 pounds) on her five-foot-10-inch frame.
She considers herself athletic now and is in such good shape that she participated in the Victoria Times Colonist 10 kilometre race this past April, running half of it. This fall, she plans on running all of the eight-km Royal Victoria Marathon in Victoria, where her weight loss surgeon is based. One day soon, Madsen, who has lived in North Vancouver her whole life, will also attempt the Grouse Grind for the first time.
The path hasn't been anywhere near easy though.
Madsen started to notice a weight problem when she was just seven years old. It took her about 20 years to become 45 kg (100 pounds) overweight, but only about three or four years to become 90 kg (200 pounds) overweight.
Like an estimated 23 per cent of Canadians, Madsen was obese. Worse, Madsen was morbidly obese.
"When you watch TV and see someone weighing 700 pounds (317 kg), most people say, 'Oh, how could somebody let themselves get that way?'" said Madsen. "I don't say that. I know that that was my future."
She has no illusions why she became overweight. From an early age, Madsen learned to use food to deal with emotion - to celebrate with food when she was happy, and to drown her sorrows in food when she was sad. Madsen also knows that she was eating the wrong foods: like whole bags of Doritos, countless doughnuts, cakes, and other goodies.
She's a perfectionist, but weight loss was her one failure, even though she'd tried "every diet in the book," including the cabbage diet, diabetic diet, and doctor-supervised weight loss. "When I do something, I like to succeed," she said. "This is the one thing I could not do; I could not lose weight."
According to Madsen's surgeon, Dr. Bradley Amson, who is one of only a handful of weight loss surgeons in British Columbia, the weight loss success rate with conventional therapies like medical therapy, intensive psychotherapy, exercise, group therapy, or medication for the morbidly obese is just two per cent. With weight loss surgery, patients have a 50 per cent to 75 per cent success rate. Amson defines success as a patient losing half of their excess weight and maintaining that weight loss for a year. For example, if a 135-kg (300 pound) person who is 68 kg (150 pounds) overweight loses 34 kg (75 pounds) and maintains that weight loss, the patient has succeeded.
Soon, the health effects of obesity began to catch up to Madsen. Diabetes was just around the corner. She was having problems sleeping and was diagnosed with sleep apnea. She also had leg ulcers, painful back aches, and needed to take medication to control acid reflux.
Madsen even had to take disability leave from teaching because dealing with sleep apnea and backaches had drained her of energy. Loss of productivity through disability leaves contributes to the $730 million to $830 million estimated total economic cost of obesity to British Columbia, according to a 2001 GPI Atlantic study.
The idea of stomach stapling came to Madsen as a result of the media coverage of singer Carnie Wilson's successful surgery.
It was a very difficult decision for Madsen to make, but after a year of thinking about it, she finally asked her doctor for a referral to a bariatric, or weight loss, surgeon.
"It was so freeing to take away the burden, the sense of failure," she said. "It was purely a health decision. It's too much to go through just for vanity."
She is among an increasing number of Canadians who choose bariatric surgery and, according to the March issue of the Canadian Medical Association Journal, the number of bariatric surgeries has increased from 78 procedures in 2000-2001 to more than 1,100 procedures in 2002-2003. In 2004, Amson performed about 75 bariatric surgeries in his clinic, which include gastric bypass and other weight loss surgeries. There have already been 100 surgeries so far this year.
British Columbia's Medical Service Plan (MSP) covers the cost of certain medically necessary bariatric surgeries, like the gastric bypass that Madsen had.
Madsen waited 17 months after her first appointment with her surgeon before her procedure. She had ample time to implement lifestyle changes and to learn about the surgery and what to expect.
Prior to surgery, Madsen embarked on an exercise regime of walking three kilometres four times a week to strengthen her lungs and heart and to prove her dedication to weight loss. Her diet changed little during that time, but she did switch to diet soft drinks.
She also became involved in weight loss support groups and has since become a contact for the West Coast Vancouver Weight Loss Support Group, which meets once a month.
"You get the best advice from someone who's been through it," said Madsen.
Madsen had her surgery on March 8, 2004. The procedure, called Roux-en-Y gastric bypass, basically involved making a small stomach pouch, which greatly decreased the amount of food that she could eat, and reducing the length of her intestine so that fewer calories could be absorbed.
Like all major surgery, bariatric surgery is not without risk. Although the death rate is low at less than 0.2 per cent, complications include gallstones, bowel leaks, stomach ulcers, and blockages in the stomach. Vitamin deficiencies are also common because a section of the stomach and intestine is bypassed in surgery. Multivitamins are usually the norm post-surgery.
For Madsen, recovery from surgery was far from easy. Because of a genetic condition called protein C deficiency, two weeks after surgery, her blood got dangerously thin. Madsen had to be re-hospitalized and received two blood transfusions.
She also encountered the "usual" discomforts including muscle pain related to knife incision points and dumping syndrome - which occurs when food passes too quickly from the stomach into the intestines, and can result in nausea, vomiting, bloating and diarrhea. Even now, Madsen experiences "dumping" when she eats sugar or fat.
"It's not a decision that anyone should make lightly," she said of the surgery.
Madsen will never eat "normally." Eliminated from her diet are sugar, bread, and fibrous foods like pork, pineapple, and oranges. Gone too are the sinful favourites like fried food, cakes, cookies, pie, chocolate, and ice cream. She spent months surviving on liquids and soft foods like yogurt, well-cooked veggies, fruit, cheese and eggs. It took her a whole year to be able to tolerate meat, brown rice, whole wheat tortillas and whole wheat pasta.
Madsen now follows a low-fat, high-fibre diet which includes whole grains, fruits and vegetables. While others who've had bariatric surgery occasionally indulge in a doughnut or chips, Madsen won't touch the "garbage" food that she once used to love so much. She doesn't want to open a Pandora's box. Temptations still abound though and the end of school this past June, with all the barbecues, cakes, and other treats, was especially hard for Madsen.
Madsen lost 19 kg (41 pounds) the first month after her surgery, 45 kg (100 pounds) in the next four months, and then 4.5-7 kg (10-15 pounds) a month until she lost all her excess weight. Typically, there is a more gradual weight loss after this type of surgery, but Madsen's weight dropped rapidly until she hit a weight-loss wall.
The thrill of weight loss became so intoxicating that about eight months ago Madsen was worried that she might have been developing anorexic habits, so she saw a psychologist. That has been resolved now, and she credits her love of food and self-awareness as being her best defence against anorexia.
Madsen's challenge now is weight maintenance. Even though her stomach pouch is small, it can stretch. She has also become more tolerant of fat in her diet, so she has to be very careful of her food and exercise regimes so that she keeps her newly acquired size eight figure.
"The more (patients) exercise and the more they eat appropriately, the better it is," said Amson. "Surgery's a little tool that helps them to get there, but it's really the (efforts of the) patient. If they think that surgery is a magic cure, then they're wrong. . . . The patients have to really work hard to be successful. Madsen's a real example of someone who's really done well."
On the health front, Madsen has freed herself from almost all of the old hazards including diabetes, sleep apnea, and acid reflux.
The damage to her legs has been done though, and some swelling remains. Madsen also has some gall bladder problems directly related to the procedure, but while she hasn't reached the point of gallstones, she has what she calls gall "sludge." Other than that, her health has never been better.
As a result of her dramatic weight loss, skin that once stretched to accommodate increased fat stores now hangs loosely on Madsen's body. She estimates that the excess skin weighs about 3.5-4.5 kg (eight to 10 pounds).
"I can't wear a bathing suit. I don't feel comfortable dating. I don't feel normal," she said. "I feel less comfortable with my body now than I did when I weighed 370 pounds (168)."
Madsen has already got a surgery date this September for a breast lift and arm lift. Later this year, perhaps in December, she will have a tummy tuck.
These plastic surgery procedures are not covered by MSP, although many, including Amson, think that it should be. He believes that patients who have successfully lost weight should have excess skin removal partly or fully covered. MSP does cover tummy tucks for medical complications like chronic skin rashes or infections, but many patients practise impeccable hygiene for their excess skin. "The fee code is grossly inadequate," he said, referring to the codes that doctors use to bill MSP.
Madsen is trying to plead that her case is similar to breast reconstruction after tumour removal for breast cancer - not medically necessary, but still a case of reconstructive surgery.
If Madsen is unsuccessful, the $14,500 plus GST price tag will fall on her own shoulders.
"Here I am trying to get out of my student loans still, hoping to one day own a home. So that's pushed back a few more years," she said.
"But the way I look at it, I've come this far, I owe it to myself to finish it off - and I can't wait for the results."
posted on 07/19/2005
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