Northampton Press

Saturday, May 30, 2020

Editor's View

Thursday, January 24, 2013 by The Press in Opinion

Surgery offers new hope for diabetics

I started the new year without diabetes.

What makes that remarkable is the fact that I had diabetes in 2012.

I literally walked into St. Luke's Hospital's Allentown campus Dec. 31, 2012, with diabetes and walked out on New Year's Day without the disease.

The reason for the overnight turnaround is metabolic surgery. Specifically, I had gastric bypass, which is a form of bariatric or weight loss surgery. It's important to note, however, that not all weight loss surgeries are metabolic surgeries.

"Metabolic surgeries ... are so called because they cause changes in connections between your gastrointestinal tract and brain and help your brain 'want' to go to a lower weight," says the book "The Complete Idiot's Guide to Eating Well After Weight Loss Surgery" by Margaret Furtado, M.S., R.D., L.D.N., R.Y.T., and Joseph Ewing.

The reasons it works are complicated and, according to my research, have to do with the role of amino acids and hormones called incretins that dramatically increase after surgery.

"The American Diabetes Association currently recommends considering bariatric surgery for people with type 2 [diabetes] who have a body mass index (BMI) of 35 and over. Both expert and published research are divided when it comes to people with lower BMIs and people under the age of 18," says an article dated Feb. 22, 2010, on the American Diabetes Association website.

I've had issues with blood sugar and high blood pressure since I was in my early 20s. Diabetes runs rampant in my family and, by age 21, I had what today would be called prediabetes. At that time I weighed 92 pounds and was a competitive distance runner, having been a member of Penn State's varsity track and cross country teams. I mention this to dispel the myth that diabetes and high blood pressure happen only to sedentary people. Neither poor diet nor a lack of exercise were contributing factors in my case.

Two car accidents 11 months apart ended my running career but I stayed active, mostly by hiking. It's not unusual for my husband, Sean, and I to go out and hike 6 or 8 miles at a clip. Still, high blood pressure persisted and, five years ago, I was finally diagnosed with type 2 diabetes. Sean also had developed diabetes by that time.

Our exercise regimen didn't change much but we found ourselves taking medications, needing regular blood work and watching our diets with even greater intensity. We assumed this is how we would spend the rest of our lives.

I learned the benefits of gastric bypass for diabetics from a colleague. Diabetes does improve with weight loss and diabetes patients are urged to try to lose weight – although diabetes itself can make that rather difficult.

But no, she said, these patients weren't getting rid of diabetes through weight loss; they were literally walking out of the hospital without the disease.


I mentioned it to Sean and, during a doctor's visit for another reason, he brought up the subject.

Our doctor was downright enthusiastic. Because we had followed his recommendations to the letter, he felt we would be excellent candidates for bariatric surgery as a treatment for diabetes.

By early September, we were enrolled in an informational class on bariatrics at St. Luke's. This set in motion the series of events that would lead to both of us having gastric bypass. Sean's procedure was scheduled for Dec. 26, 2012, and mine was New Year's Eve day.

The St. Luke's pre-op program takes three to six months and I'm told the program at Lehigh Valley Hospital is similar. Candidates meet with a dietitian and social worker, attend various informational sessions and have tests done as recommended by the medical team.

With both Sean and me, an endoscopy showed that, because of the diabetes, our stomachs were not pumping food out to the intestinal tract as quickly as they should. This was a revelation. No wonder we didn't feel good half the time. The discomfort itself was never enough to spur a doctor's visit but it was enough to be annoying.

Immediately after the surgery, which was performed laproscopically, we started the "sippy diet," which involves sipping liquids in small amounts throughout the day in order to avoid dehydration. From there, you move up to a blenderized diet which includes items such as scrambled eggs and yogurt or foods run through a blender. Meals consist of a quarter cup of food and your main nutritional goal is to make sure you get enough protein.

Next comes the soft diet, which includes fairly normal foods such as hamburger, chicken and beans. These must be added gradually as they can be tolerated. After about six weeks, you begin to gradually increase the amount of food eaten at one time. After 18 months, your meals will consist of 1-1/4 cup of food.

Eventually Sean and I will be able to have dessert. Right now, though, such a concentration of sugar would make us sick. My colleague, who had the surgery a year and a half ago, says she can now really enjoy a single cookie.

Am I hungry? No. Will I become hungry again over time? Yes. How will I deal with it?

First, I've been taking the time to savor my food. I never thought a single scrambled egg could taste so good! Our first meatloaf – which was the size of a fist – was also delicious. I even really enjoyed the leftovers. This enjoyment of what I do eat helps lessen the desire for foods in greater quantity.

Do I want food even though I can't eat it? Sometimes. It's not overwhelming, though. In fact, I've been amazed at how much more time we have since we don't have to prepare big meals or go out to restaurants. And despite having to buy and take vitamins and supplements, we're saving an awful lot of money – which is good because we're both going to need an entirely new wardrobe.

Will diabetes come back in the future?

"It's unlikely," said my surgeon, Dr. Maher El Chaar. "I've never seen it."

In addition, not being diabetic increases my life expectancy by as much as 10 years, according to the St. Luke's bariatric program.

I won't kid you. Surgery is no picnic. The first three days you wonder what you were thinking when you decided to do this. But each day gets easier and both Sean and I could see improvement in how we felt even over the course of a single day.

Now as I write this, just three weeks after surgery, I feel great. Despite seven small incisions, some of which are still a little sore, I feel even better than I did before the procedure. Since the date of surgery, I've lost 21 pounds. Sean has lost close to 40.

And the benefits don't stop there.

Sean and I hiked 5-1/2 miles on the D&L Trail Sunday. In addition to enjoying time out in nature, I noticed my feet and lower back didn't hurt like they always had before.

Less pain. More energy. More time. More money. And no diabetes.

I definitely made the right choice.

Johanna S. Billings


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