Gastric Bypass Surgery
Surgery not a quick fix, but a beginning for weight-loss patients

by Betty Taylor
Photos by Sarah Griffin

“No one knows what it is like to get around in a 546-pound body. My stomach went to my knees,” said Gayle Pfeiffer, who lost 246 pounds after having gastric bypass surgery in 2002.
A recent CNN news report indicated that a new study, conducted by the University of Illinois at Chicago, revealed U.S. life expectancy could fall in the coming years due to obesity. According to the Center for Disease Control, at least 32 percent of Americans are obese. At least 5 percent are extremely obese.
Three local women – Dr. Elizabeth Ritchey, Tammie Gilligan and Gayle Pfeiffer – concerned with their quality of life and the medical conditions brought on by obesity elected to have gastric bypass surgery. While each of their stories shares some similarities, the experience was quite different for the three women.
One thing they all agree on: Gastric bypass surgery is not a quick fix. It does not guarantee a new, thin body. Nor does it guarantee that once weight comes off, it will stay off. For each of these women, however, the surgery has brought an improved quality of life.

Weight Came Off Slowly, but Surely
Dr. Elizabeth Ritchey

“Gastric bypass surgery simply means stapling your stomach,” says Dr. Elizabeth Ritchey, a local endocrinologist. “It means making your stomach smaller. The intestines have three loops. One loop is taken out of the cycle. One area is bypassed. So instead of three miles of road, you have two miles of road.”
Ritchey, who had Roux-en-y gastric bypass surgery nearly two years ago, says the surgery helps with weight loss in three ways.
“You stomach is smaller. There are certain foods that you no longer can eat. And if you do eat something that you’re not supposed to eat, there is something called dumping syndrome in which the body rejects it,” she says.
After gastric bypass surgery, the body can no longer absorb sweets, Ritchey explained. If patients try to eat foods high in sugars or carbohydrates, the body will reject the food.
Ritchey, who considers herself a cheerleader of sorts for the surgery, says it provides some of the most powerful conditioning for changing eating habits.
“You learn very quickly to eat correctly, because otherwise, it is just not worth it,” she says.
Another type of surgery, lap band surgery, involves placing a band around the stomach to make it smaller, Ritchey says.
“Some people are drawn to this procedure because it is completely reversible,” Ritchey says. “But you can also ‘out eat’ the band.”
Ritchey lost 85 pounds after her procedure. She has been overweight all of her life, she says, and although she was not in the morbidly obese category – one of the factors doctors consider when evaluating candidates for the procedure – she has worked with many morbidly obese patients.
“And I had all the symptoms – high blood pressure, diabetes, joint pressure,” she says. “I was tired all the time. I was always short of breath.”
After her surgery, all the symptoms disappeared. She was surprised, however, how long it took for the weight to disappear.
“It came off unbelievably slowly,” she says. “About 10 pounds a month. I really thought it would just fall off.”
Before surgery, it was nothing for Ritchey to eat six doughnuts at a time.
“And here I was eating these virtuous little meals,” she says.
But eventually, the weight did come off.
“It’s the best thing I’ve ever done,” she says. “I do perfectly normal stuff now.”
Not everyone is a good candidate for this type of procedure.
“Some people are truly compulsive/obsessive eaters,” Ritchey says. “They are not going into this with a lifestyle change in mind. They are looking for a mechanical fix.”
Even gastric bypass can fail, Ritchey says.
“The stomach can go back to the size it was before it was stapled,” she says. “The intestine can begin absorbing sugar again, and the dumping syndrome goes away.”
People who are 100 pounds overweight or more are usually considered candidates for the procedure, Ritchey says.
“But if they have psychological problems with food, they are usually not good candidates,” Ritchey says.
There are risks involved in having gastric bypass surgery, Ritchey says.
“They include osteoporosis later on down the line. And gallstones,” she says.
There also is risk of malabsorption (patients who have had the surgery must maintain a daily regiment of vitamin supplements) and general risks of surgery.
“I think lots of people don’t look into it because they are very fearful,” she says. “But they forget how dangerous it is to be overweight.”
Ritchey says some physicians are against this type of procedure because of the disruption to the metabolism. Even some of Ritchey’s friends warned her against having the procedure.
“But I tell them times have changed,” she says. “This is an awesome option.”
She feels her own experience has brought her closer to her patients.
“It’s that whole thing about if you’ve walked in my shoes,” she says.
Ritchey says most insurance companies will pay for the procedure, but Ritchey paid $23,000 in cash for her surgery.
“I drive an old S10 Chevy, and I tell everyone this (the procedure) was my new car,” she says.
Ritchey says she started feeling better the morning after her surgery.
“That need to eat is gone,” she says.

40 is the New 30
Tammie Gilligan

Tammie Gilligan had always been an active person, but at 35, she was suffering from increased blood pressure, sleep disorder, joint pain, acid reflux and borderline Type II diabetes. She had been steadily gaining weight, about 20 to 30 pounds a year, and in 2004, weighed 320 pounds. Her doctor recommended surgery because her health issues were becoming a major concern.
“It was scary at first,” Gilligan says. “But had I not had the surgery, my quality of life would have been just as bad and my conditions could be just as worse.”
Her friends were scared for her, but Gilligan believes it was her positive attitude that helped her through the process. She lost 140 pounds, dropping from a size 22 to a size 12. She now exercises every day.
Gilligan elected for gastric bypass surgery. Her insurance paid for the procedure, but only after she provided five years of medical history with weight-related issues. She warns that deciding to have this type of surgery is not simply a matter of having the surgery and then going home and eating whatever one wants. There is a lot of pre-op and post-op work to do on the patient’s part. Before surgery, Gilligan spoke with a nutritionist.
“And I spoke with a shrink for four months before my surgery to make sure I was ready to change my lifestyle,” she says.
“I highly recommend it,” she says. “I think the biggest misconception about this surgery is that it is a solution. It is not a solution. It is a beginning.”
Gilligan says most people believe that they can go have weight loss surgery and then no longer have to worry about diet, exercise or gaining weight.
“But it is quite the opposite,” she says. “The first 18 months after surgery, food intake starts from about two tablespoons to a kid-size meal.”
Gilligan had been educated about dumping syndrome, but says she experienced few problems after surgery.
“You can introduce a little bit of sugar at a time to your body, and train your body,” she says. “But I live on a high-protein, low-carb diet. And I take vitamin supplements.”
Gilligan continues to go in for regular checkups and visit a nutritionist. She also meets with a support group.
“It’s good to talk to other people who have gone through this,” she says.
She also exercises daily, fitting in an hour of cardio conditioning and a half-hour of circuit weight training each day.
“I’m addicted to working out,” she said. “I have so much energy. That thing they say about the ‘natural high’ is true.”
And what about her health conditions? All gone.
“I don’t take any medicine,” she says. “The first thing I noticed after the surgery is that I wasn’t so tired. I had a lot more energy.”
Today, Gilligan is working toward a goal of losing 25 more pounds to reach her ideal weight. In addition to exercising and watching what she eats, she also has changed how she eats.
“I don’t watch the clock,” she said. “I eat when my body tells me to. I usually eat four to five small snack-size meals a day.”
She says she feels better now at 40 than she did in her 30s.
“Whoever said ‘40 is the new 30’ knows exactly how I feel,” she says.

Being Alive Best Sign of Success
Gayle Pfeiffer

In 2002, Gayle Pfeiffer was told by her doctor that she had fewer than six months left to live. At nearly 550 pounds, the weight of her body was taking its toll on her.
“Just getting up out of bed and dressed took everything life had to give,” she says. “I had to take a nap just to manage to breathe and struggle into my clothes.”
The mother of three was worried. Once before, she had visited with doctors about the prospect of weight-loss surgery, and she didn’t like the news.
“I was scared to die,” she says. “But because I was dying, I had to do what I had to do.”
Pfeiffer had two grown children, a 13-year-old son with special needs and a husband of 34 years. She wanted to be there for her family. In October 2002, she elected for gastric bypass surgery. Before she had her procedure, she lost 100 pounds.
“I was told that if I did not lose a substantial amount of weight that my chances of not surviving this surgery were very high,” she says.
Combined with the 176 pounds she dropped after her surgery, she lost 50 percent of her body weight. And then the weight just stopped coming off.
But Pfeiffer considers herself fortunate.
“On the law of averages, I lost more weight than most folks do that start at 546 pounds. I am grateful,” she says. “While some folks may still see an overweight woman, I know in my heart that I am successful because I made it a point to follow the rules. And the biggest sign of success for me is that I am alive.”
Pfeiffer said she had tried many diets, drugs and ‘remedies’ over the years to try to lose the weight – including Weight Watchers, NutriSystem, Diet Center and the American Diabetic Association Diet (her husband is a Type I diabetic). She also tried drugs including Prozac and Redux (before it was taken off the market).
“When the no-fat ‘fat’ came into being, I wiped every low-fat and every high-fat item from my home,” she says. “I carried only non-fat dressings with me and only stocked non-fat items in my home. I still ballooned to 546 pounds. My skin got so dry from the lack of fat in my diet, it was terrible. This should have told me that fat wasn’t causing my obesity. I was my own study of one.”
Finally, her endocrinologist, Dr. Ritchey, told Pfeiffer that she had a disorder called Polycystic Ovarian Syndrome, known as PCOS. The condition was causing the production of excess insulin, which in turn was causing enlarged fat cells.
During the course of Pfeiffer’s weight gain and subsequent weight loss, she discovered other symptoms that made her all too aware of the importance of patient awareness and research.
A rapid weight gain after surgery occurred after Pfeiffer was given a generic thyroid medication in place of a name brand one. She also discovered she had an enlarged stoma.
“The stoma is the area where the small intestine is attached to the small stomach pouch,” she says. “You lose the ability to feel full. This can be a major problem for most folks.”
Pfeiffer learned to place the amount of food she thought she should eat on a small plate, and when it was gone, she was finished eating.
“I no longer have that burning hunger feeling that I had as a pre-op weight loss surgery patient,” she says. “While it’s true that I do not feel full, I also don’t feel hungry so food no longer rules my life.”
Pfeiffer thought that if she could lose 276 pounds, she could lose all the extra weight.
“But the body adapts to very little food,” she says. “The swelling goes down from the surgery, and the intestines become super efficient at making up for the lack of absorption.”
Pfeiffer wanted to give this interview, she says, because success comes in many forms.
“There are many weight loss surgery patients out there that are true successes in every sense of the word that never get anywhere close to a goal weight,” she says. “In the five years since I have had my surgery, I have watched my oldest son graduate from college, my daughter get married and have children, and have been here to advocate for my youngest son who has many disabilities.”
Pfeiffer has 14 vials of blood drawn every six months to stay on top of malabsorption issues. Once almost bedridden, she is now mobile.
“I still have to use a power chair more often than I’d like,” she says.
Pfeiffer no longer relies on medication or insulin to control her blood sugars, and she no longer suffers from GERD. She also is on much fewer medications now than she was prior to surgery.
She has had plastic surgery to resolve other medical issues and hopes to have another procedure in the future to lose more of her weight. She is glad, though, for what she has right now.
“I have life, and to me, that is the best measure of success,” she said.
Pfeiffer runs an online Internet support group for weight loss surgery patients called San Antonio WLS Friends, http://health.groups.yahoo.com/group/sanantonioWLSFreinds. She is also the moderator of an online Internet support group called Gastric Bypass Info-Central, http://health.groups.yahoo.com/group/GastricBypass-InfoCentral/.