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Sherry Crossno of Prospect is no longer ashamed to be seen in a bathing suit—as long as it’s a one-piece. She enjoys being active: playing golf, riding horses, kayaking, riding her bike, and taking walking tours of cities—something she was unable to do just two years ago due to her weight.
Crossno struggled with being severely overweight. Maine leads New England as the heaviest state and the Centers for Disease Control and Prevention estimates that two-thirds of the nation’s adult population is obese.
“When I started gaining weight at the age of 24, I didn’t pay much attention to it,” Crossno says. “I was healthy, athletic, and had what I thought was a pretty good figure. But over the years the weight started creeping along.”
At 60, Crossno, 5 feet 10 inches tall, weighed 297 pounds and was suffering from high blood pressure, high cholesterol, sleep apnea, low kidney function, and type II diabetes that required three to four high-dose injections of insulin a day—all due to her weight. She had tried various diets over the years—the Zone, Nutrisystem, Atkins—with no success.
“I was tired all the time and had no energy,” she recalls. “I didn’t want to die in five or six years, so I began researching weight loss surgery as an option.”
After proposing the idea to her primary care physician, she was referred to Eastern Maine Medical Center’s surgical weight loss program, where she was accepted for gastric bypass surgery. The accredited program offers a unique multidisciplinary approach that includes dieticians, physical therapists, nutritionists, counselors, psychologists, surgeons, and a reconstructive plastic surgeon.
EMMC also has the ability to do robotically-assisted, minimally-invasive gastric bypass surgery. It’s one of the only programs in the nation to offer this type of surgery, which uses wristed robotic instruments that articulate the same way hands do, allowing surgeons a full range of motion and unimpeded fine motor skills with a three-dimensional view and magnification.
“Surgical teams come from Japan, Australia, and all corners of the U.S. to learn the robotic technique from us,” says Dr. Michelle Toder, medical director of EMMC’s surgical weight loss program. “Mainers are getting state-of-the-art care for a life-threatening medical problem right in their backyard.”
In order to qualify for gastric bypass surgery, patients generally need to be 75–100 pounds overweight, between the ages of 18 and 65, have a significant health issue, and have exhausted all other means of shedding the pounds. The program screens about 500 candidates for surgery a year and performs approximately 300. Since June 2002, they have completed over 2,000 surgeries.
“Gastric bypass surgery is covered by most insurers in Maine, including MaineCare, if patients meet medical eligibility criteria,” says Lynn Bolduc, clinical coordinator for EMMC’s program. “We are a preferred provider with most insurance groups here—something that requires a yearly report of our outcomes in order to maintain this status.”
It takes about six months from acceptance into the program to surgery. In a gastric bypass procedure the stomach is divided into two parts—a larger lower portion, called the distal pouch, and the smaller upper portion, called the proximal pouch. The proximal pouch is generally the size of an egg and will serve as the new stomach. A portion of small intestine is then connected to the proximal pouch, bypassing the distal pouch and approximately five feet of intestine. A smaller stomach makes you feel full more quickly and bypassing part of the intestine results in fewer calories being absorbed. This leads to weight loss.
But this operation isn’t a quick fix. Studies show that in the two months following gastric bypass surgery, 15% of patients will have minor to significant problems like hernias, staple line rupture, blood clots in the lungs, and infection that will require surgery. And patients aren’t even guaranteed to lose weight—about 10% of patients who have the surgery don’t lose any significant weight at all.
Patients also have to worry about malnutrition due to the size of their new, smaller stomach. About one-third of people who undergo gastric bypass surgery develop a nutritional deficiency condition like anemia or osteoporosis. An iron and vitamin B12 deficiency occurs about 40% of the time.
The risk of mortality is primarily contingent on the patient’s relative obesity, age, and health. The most common life-threatening complication is the leaking of gastrointestinal fluids from sutured or stapled surgical lines, which, if not immediately addressed, may cause an infection leading to death. According to Toder, the risk of death at EMMC’s program is one in 700, less than the 2% national average for these surgeries. The risk of infection at EMMC is less than 1%.
“We have a very low complication rate because we spend so much time preparing patients for surgery and work with them to lower the risk,” Bolduc says. “We do this by getting their diabetes in control, screening and treating for obstructive sleep apnea, requiring smokers to quit, and having patients lose weight before surgery. Our patients are highly educated by the time they get to surgery.”
It’s been found that in the first two years of a successful gastric bypass surgery, a patient will lose, on average, two-thirds to three-fourths of their excess weight. In the five to 15 years after the surgery, the patient will keep off half of that weight.
An integral part of the program is dedication to long-term care with support services. Surgery is only part of the equation; committing to a lifestyle change is another.
Becky Felker of Jackman had gastric bypass in 2004. This past May, she completed something she never thought she could do before her surgery—the 26.2 mile Sugarloaf Marathon.
“It was really awesome,” Felker says. “I had regained my health after losing the weight. I was stronger and healthier.”
She credits the nutritionists and dieticians for helping her understand her metabolism, caloric requirements, and the importance of eating a balanced, nutritious meal. Although the program gives patients the tools they need to succeed with nutritional counseling and in-depth monitoring and support services, it is, ultimately, up to the patient to follow through in order to achieve success.
“They really lay it down for you, right from the first meeting,” says Felker. “I truly don’t know where I’d be today if I wouldn’t have had this surgery or the guidance they provided. I feel like I’ve lived more in the past five years after surgery than I had before.”
Crossno, too, feels like she has been given a new lease on life. She is now a healthy 173 pounds.
“My only regret is that I didn’t do this for myself 10 years earlier,” she says. “It totally changes your life for the better.”
