Obesity deaths prompt surgeries
by Sheryl Kornman on Jan. 13, 2007, under Body, Family, LocalBariatric procedures quadruple from ’04 to ’05
At 18, Clyde Brown was a professional wrestler known as Buddy Boy Brown.
By 24, he was pulling in the crowds here as Little Gorgeous George.
But at 67, Clyde Brown is pinned to an easy chair as his health deteriorates while he waits for stomach surgery he hopes will help prolong his life.
Brown, who weighs 384 pounds, is diabetic, has kidney problems, congestive heart failure and sleep apnea. He “needs” three of those medical conditions to be eligible for bariatric (weight-loss) surgery.
Weight-loss surgery is growing in prevalence here as the number of morbidly obese adults continues to rise.
Just 320 bariatric surgeries were performed in 2004 in Arizona, according to a report, “Obesity in Arizona: Prevalence, Hospital Care Utilization, Mortality,” published in September 2006 by the Arizona Department of Health.
By 2005, the number of surgeries for obesity nearly quadrupled here to 1,130.
About a dozen hospitals in Arizona, including two in Tucson, provide the surgery. They are Northwest Hospital and Carondelet St. Joseph’s.
Tucson Medical Center doesn’t provide it nor does it cover bariatric surgery under its employee health insurance plan, according to spokeswoman Julia Strange, who said the procedures are still considered somewhat experimental.
The American Society for Bariatric Surgery sets standards for bariatric surgery programs in the United States. It requires a facility to have at least two surgeons experienced in weight-loss surgeries.
For Brown, bariatric surgery could save his life.
He has been disabled for years by an industrial accident that damaged his spine. His surgically repaired knees can’t support his weight for long, so he can’t exercise to lose weight.
On Jan. 7, Brown, a Medicare patient, went to Phoenix to begin a six-month intake process at a hospital there that will lead to Medicare-approved stomach-banding surgery.
Medicare covers bariatric surgery, but only after a six-month waiting period in which the patient is expected to diet and exercise to lose weight.
And it covers only facilities with high success rates and low death rates in bariatric surgery.
Only three facilities in Arizona – two in Phoenix and one in Scottsdale – provide Medicare and Medicaid-covered bariatric surgery.
No facility in Tucson has been Medicare approved.
Brown heard about the bariatric surgery program at Carondelet St. Joseph’s Hospital here and had been meeting with its bariatric surgeon but could not wait for it to become a Medicare-approved Center of Excellence in bariatric surgery.
As his health worsened, Brown and his wife Joanne, who helps care for him around the clock, chose to get help from the surgeons at the Medicare-approved Scottsdale Bariatric Center, who operate at Scottsdale Healthcare Shea Campus Hospital in Scottsdale.
Brown said his cardiologist has given her approval for non-invasive (laparascopic) surgery that will insert a band to reduce the size of his stomach but leave his small intestine intact.
The stomach band can be adjusted externally with a saline-pump device inserted in the abdomen, Joanne Brown said.
More invasive bariatric surgery cuts out part of the small intestine and surgically reduces the stomach. It requires cutting open the abdomen, a riskier procedure for obese people with multiple medical issues.
Brown said he is eager to undergo surgery and begin “to get my life back.”
He wants to be able to walk easily next door to visit his granddaughter.
“If I could just get rid of this,” he said, placing his hands on his belly.
While Brown’s surgery will be covered by Medicare – most such procedures are not.
In Arizona in 2005, 66 percent of bariatric surgeries were paid for by private insurance, 9 percent were paid by Medicare and 4 percent were paid by the Arizona Health Care Cost Containment System (AHCCCS).
The cost of the surgery, an estimated $18,000 and up, depending on the type of surgery, is a fraction of the lifetime cost of ongoing care for diabetes, kidney failure and chronic heart disease, the common complications of morbid obesity. The “Obesity in Arizona” report details the high cost to hospitals that provide general medical care for men and women with diseases associated with obesity.
In 2005, the gross charges for all inpatients with a mention of morbid obesity in their diagnosis exceeded $320 million.
More surgeries are expected as the number of clinically obese adults (at least 100 pounds over what doctors consider an ideal weight for a person’s height) continues to rise.
That number in Arizona is up 31.5 percent from 2000 to 2005 – from an estimated 644,333 adults to 847,266 – according to Brian Bender, survey center manager for the Arizona Department of Health Services.
Pima County also has seen an increase in clinically obese adults of 3.5 percent from 2000 to 2005 – from 114,000 adults to 118,000 – according to a 2006 state health department report.
As more Arizonans become obese, the death rate rises as well.
A total of 262 deaths in Arizona in 2005 were related to obesity, according to the report. In 2000, there were just 24.
Yet, the risk appears acceptable for many. Tucsonans Allison Johnson and Augustine Villaseñor had surgery for obesity last year and are thrilled with the outcome.
Johnson, 46, said she struggled with weight her whole life. The 5-foot-4-inch computer technology analyst had high blood pressure and “a lot of aches and pains from being so overweight.”
She decided on bariatric surgery instead of another failed diet. Her employee health insurance didn’t cover weight-loss surgery but she was able to pay the $18,000 herself.
“It’s simply an investment in my health,” she said.
Johnson weighed 244 pounds when she had weight-loss surgery at Carondelet St. Joseph’s on July 18, 2006. She is already down to 183 pounds.
She had a Roux-en-Y procedure, which reduces the size of the stomach and the small intestine. Now she goes to the gym a couple of times a week and walks twice a day.
“I feel like a completely different person and I’m not done yet,” she said. “It’s amazing how wonderful I feel. It has given me my life back. I want to get out more. Before, I just sat at home.”
At 5 feet 6 inches tall, and 300 pounds, Villaseñor, a police officer, said he was borderline diabetic, had sleep apnea and was at high risk for a cardiac event before he had weight-loss surgery.
“I was disgusted with myself for the way I was,” he said.
His therapist suggested weight-loss surgery. He contacted the bariatric surgery program at Carondelet St. Joseph’s and had the Roux-en-Y procedure Aug. 4, nine days after his internist referred him to a bariatric surgeon. The operation was covered by insurance.
A surgeon reduced the size of his stomach and removed 11 inches of his small intestine to reduce the absorption of food.
Already he is down to 229 and has 40 more pounds to lose. It’s much easier for him now to chase criminal suspects, he said.
“I feel 20 years younger. I have so much more energy,” Villaseñor said.
This winter he was able to keep up with his son on a hunting trip. “I was ecstatic.”
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ARE YOU OBESE?
Doctors calculate body fat using a standardized body mass index (BMI) based on weight and height. If your BMI is 30 or more, you are obese by clinical standards. A normal BMI is 18.5 to 24.9.
Doctors consider a person to be clinically obese if he or she weighs at least 100 pounds over what is considered an ideal weight for a person’s height
Source: Centers for Disease Control and Prevention and National Heart and Lung Institute
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www.nhlbisupport.com/bmi/
www.asbs.org
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TUCSON HOSPITALS PROVIDING BARIATRIC SURGERY
Carondelet St. Joseph’s Bariatric Surgery Program
Contact Karen Bauman, R.N., at 873-5472
Northwest Hospital Surgical Weight Loss Program
Contact Gayle Duke, R.N., at 742-9000
Phoenix-area hospitals approved by the Centers for Medicare and Medicaid Services for bariatric surgery
Banner Good Samaritan Bariatric Center
(602) 239-5000
St. Luke’s Medical Center
(602) 251-8100
Scottsdale Healthcare Shea Campus and its
Scottsdale Bariatric Center
(480) 860-3000
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> The most common, according to the Mayo Clinic, is gastric bypass surgery, the Roux-en-Y technique. The surgeon staples the stomach across the top to create a pouch the size of a walnut and adds a bypass around the small intestine. This technique limits the amount of food that can be eaten and reduces absorption of food.
> Also common is the adjustable gastric banding technique, which uses an inflatable band that partitions the stomach into two parts. This technique limits the amount of food that can be eaten at one time.
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By SHERYL KORNMAN
Clyde Brown’s legs are swollen.
“I had this knee replaced three times and this knee once. They just wore out in there. My left shoulder I’ve had done twice. I got spurs there and it cut the tendon loose from the bone. The first guy didn’t put it back up there right. It got that way when I was a carpenter building houses. I lifted a lot of board.”
Joan and Clyde Brown will have been married 30 years next year. Most of their time together has been a challenge.
Clyde’s most recent injury took place 27 years ago. Clyde wore a morphine pump for nine years for the pain.
This is how it happened:
“I worked at a hydroelectric plant in Ohio. I had a hold of a four-by-four, 12-foot long, up seven stories in the river.
“I was up on a scaffold, a catwalk. I had this piece back here, sliding off from the steel. The crane operator kinda tightened up on it, I had to swirl around to catch it.”
That’s the move that permanently injured his back. He had two surgeries to try to repair it.
“I was 40 years old. That’s when I started falling apart. I just started putting this weight on and I just couldn’t stop. I’ve tried and tried to get it off.”
Chicken fried steak, once his favorite, is now a memory.
Joan had her own back surgery in 2006. She recovered from a spinal fusion while still caring for Clyde, helping him with the dozen or so medications he takes each day to control his various symptoms.
He’s also had a triple coronary bypass operation and suffers now from congestive heart failure. He takes a diuretic to eliminate the excess fluid, but his legs still swell after he’s been lying down.
The Browns were hopeful that a surgeon at Carondelet St. Joseph’s would do Clyde’s weight-loss surgery.
Clyde said he went to meetings there once a month for a year, staged by the hospital’s weight-loss surgery program to help potential patients understand the challenges of weight-loss surgery.
The meetings also provide pre-op and post-op patients an opportunity to share their struggles with obesity.
“When I first heard about (the surgery), I was pretty excited. I thought it was a good thing,” he said. “But then after I heard the people who had it talk about it, I got kinda scared. But it’s the only thing I can do.”
By December, St. Joseph’s bariatric program was not yet Medicare approved and Brown’s condition continued to decline.
So the Browns decided to travel to the Phoenix area, where three hospitals are Medicare approved for bariatric surgery.
Brown said he’s been told he will be able to lose two pounds a week after his surgery, once doctors place an adjustable band around his stomach to reduce the size of the pouch.
Clyde still faces a mandatory six-month wait before he can have surgery. Medicare requires him to try to diet and lose some weight before surgery will be scheduled.
Most days, Clyde sits in his chair in the living room, watches TV, talks with Joan and other family members and plays with Bowser, the family dog.
And accompanied by Bowser, he takes day naps in the bedroom, his nose fitted with an oxygen tube to make sure his chronic sleep apnea won’t damage his heart.
A motorized scooter – and the family van driven by Joan – gets him to his doctor’s appointments.
Clyde says he misses the things he used to do frequently, like camping and fishing.
“I can’t walk,” he said. “I used to fish and hunt and everything.”
Since 1980, he’s only been out fishing three times.
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KINDS OF WEIGHT-LOSS SURGERIES
