Edmonds surgeons on cutting edge of weight loss

Published 9:57 am Tuesday, December 23, 2008

When Jackie Schmidt moved to Utah from Lynnwood two months ago, her husband carried her over the threshold of their new home.

This was a happy first for Schmidt, who had always been too heavy for her husband to lift. Like many overweight people, at one point in her quest to lose weight Schmidt had lost 90 pounds. She put 70 of those pounds back on.

But two years after having a new weight loss surgery and shedding 84 pounds, Schmidt is happy to try skiing for the first time this year.

At 240 pounds and 44-years-old, on Oct. 7, 2007, Schmidt became the first recipient in Washington of sleeve surgery, a procedure that takes a patient’s stomach from being the size of a small pineapple or gourd to a banana.

Schmidt’s surgery took place at Puget Sound Surgical Center in Edmonds where surgeons Peter Billing and Robert Landerholm have provided the little known operation at their clinic to almost 100 patients.

“People think you are putting some kind of device or sleeve in,” Billing said. “You are not. You are making a kind of sleeve out of the stomach, a tube.”

People have come from Pullman, Washington, Idaho, and Canada to Edmonds to have the sleeve surgery performed by the surgeons, who are the first in the world to offer it as an outpatient procedure.

“It’s fairly new technology,” Landerholm said.

The sleeve procedure has been widely used in Europe, South America and Australia for five or six years. It started out as the first part of an intestinal bypass operation. But doctors noticed patients were losing weight at the same rate as they would if they continued and received the second part of the surgery, which is gastric bypass.

Unlike gastric bypass surgery that requires disconnecting and reconnecting intestines, the sleeve procedure works when food and calories are restricted because 85 percent of the stomach is removed. The idea is that the stomach remains intact and functions as before, while drastically reducing the volume. It is safer for those patients with a body mass index of more than 60 and on some patients can be performed within an hour.

The long-term results of sleeve surgery are not well known as a sole procedure, but weight loss is slightly better than Lap-Band and a little less than gastric bypass according to three-year data.

There is no vitamin deficiency with the sleeve that surgeons know of, Landerholm said. Patients experience satiety in part because the hunger hormone, ghrelim, that secretes into the stomach, is removed when that part is taken out.

Billing said obesity is a multi-factorial disease. It is caused by many problems including hormonal, genetic, metabolic, and anatomic, not just by behavior. The surgeons and their team attack obesity from many different standpoints.

“Here we’ve got everything all together under one roof to address all the issues,” Billing said. “Counseling, exercise, nutrition and surgery. The surgery is one piece. It’s a tool.”

Billing and Landerholm work with Melanie Machado, a medical nutrition therapist at Pacific Nutrition and Wellness. She works with patients who may or may not be thinking about gastric bypass, Lap-Band or sleeve.

Machado works in a comprehensive approach that includes fitness programs, medical nutrition therapy and behavioral coaching as part of her work. There is psychological help, too.

What everyone wants is a high school body, Machado said. “And they want it tomorrow whether it’s surgery or not.”

The psychological component helps with those expectations.

“Sometimes patients are not in a mental state to do surgery,” Machado said. “They are reaching out and grasping.”

If people are not ready for surgery, there are still many other ways Machado can help with their weight issues. Those who do have weight loss surgery meet with Machado for follow up sessions. With sleeve surgery, after care is a two-year process.

“Melanie is one part of this team and further educates people on the lifelong care they need to have for their tool,” Landerholm said.

Schmidt agrees the after care is an important component. She worked with Machado before her surgery and continued to work with her afterward for two years.

Like many others, Schmidt had started to feel the health effects of being obese.

“I had type 2 diabetes and seizures,” Schmidt said.

She also suffered from GERD or gastro esophageal reflux disease. Within three weeks of her surgery in Edmonds her diabetes was gone.

“The procedure can take care of sleep apnea, GERD, diabetes,” Billing said. “Why wouldn’t you want to do that?”

The cultural perception of weight loss surgery in the past is that it is extreme. That attitude is changing with surgeons like Billing and Landerholm performing state-of-the-art procedures.

Billing and Landerholm’s clinic is one of just 16 in the United States that was recently selected to begin trials of another new weight loss surgery, a gastric balloon which will be placed down the throat with an endoscope and into the stomach.

After her sleeve surgery, Schmidt was restricted to liquids, purees, then soft foods for a few weeks. When she progressed to normal foods, she couldn’t even finish a McDonalds snack wrap. She now averages eight to 10 ounces of food five times a day.

“It’s a way of life,” Schmidt said. “I’m eating more often.”

There have been couple of times that Schmidt has eaten until she is so full she is miserable.

“The toughest thing has been not to fall into old habits,” Schmidt said.

But unlike other surgeries where patients can no longer eat carbohydrates or sweets, Schmidt can have those foods but perhaps only one or two, not the whole bag.

“The surgery is not the cure all answer,” Schmidt said. “You have to change your eating habits and develop an exercise plan.”

Insurance plans do not get cover sleeve surgery citing that the procedure is considered investigational. The cost is approximately $19,500.

“I’d do it again and again,” Schmidt said. What she has gained is more than money can buy. “I’m going to be around to see my daughter’s kids.”

Fore more information, call 877-548-2424 or visit www.pugetsoundsurgicalcenter.com.