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Extreme Measures, Fighting the Obesity Epidemic
By Maria Montoya, Staff Writer/The Times-Picayune
04/07/2003

At home on a Saturday evening, William "Gregg" Steverson sits on his maroon recliner contemplating his own girth. His slender, red-haired wife, Audra, wanders around the house cleaning and chatting with him as he flips mindlessly through the TV channels.

She deserves more, he says, and he wishes he had the energy to get dressed up and take
her dancing, or even go for a walk down by the levee. Instead, they'll spend another quiet weekend here in their Belle Chasse home.

At 317 pounds, the 40-year-old Steverson worries he is not only limiting himself, but taking some of the joy out of Audra's life. He is disgusted with his weight and with himself.

Years ago, he could run two miles in 12 minutes. For six years, he worked the streets as an Emergency Medical Technician. Now he spends 10 hours a day behind a desk as a contract paramedic, giving physicals and treating workplace injuries at the plant where he works.

Giving up the fast-paced work of an EMT left Steverson bored. Over time, he started to use
food and cigarettes to fill the void -- as much as a pack and a half of Marlboro Ultra Lights, three two-liter bottles of Coke and three hearty meals a day.

His new, suddenly sedentary lifestyle started to take a toll on his body -- and his 13-year marriage. Steverson and his wife have tried dieting together. Every time his weight would
start climbing toward 250 pounds, Audra would think of a new way for them to try to get healthy. Each time, she would watch her husband slim down 20 to 30 pounds, only to watch
the weight inch back on.

For the past three years, Steverson has toyed with the idea of having weight-loss surgery,
but he says his primary-care doctor has been hesitant to agree. Recently, however,
Steverson heard from one of his friends that he no longer needs the approval of his
general physician. Perhaps, he hopes, he might be able to lose the weight after all.

"This weight has made a drastric change in how I feel all around," Steverson said. "It's like
with every pound I gain, I am missing out on one more thing in my life."

. . . . . . .

Gregg Steverson is not a desperate man. That fact alone distinguishes him from many of the people in the audience at a weight-loss surgery informational seminar hosted by the Surgical Specialists of Louisiana and Southern Bariatric Associates.

The crowd is largely female, mixed racially, and there are a handful of young people sitting
next to slender individuals who appear to be their parents. And when Dr. Derek Weiss enters the room, briefly introduces himself to the crowd and begins a slide show presentation explaining the dynamics and history of weight-loss surgery, many in the crowd look
prepared to volunteer for surgery tonight, if that were an option.

Steverson is different. He is unhappy with his weight and the way it has more recently
affected his life. But this hasn't been a lifelong battle, and he is fighting for quality of life,
not life itself. Back in 2001, he did have what he would call a "cardiac event," which he describes as "not quite" a full heart attack. Since then, he has followed up with a cardiologist regularly, without further incident.

He just wants to dance with Audra again.

He feels comfortable with his knowledge about the Lap-Band and RNY gastric bypass
surgeries. A friend recently had the Lap-Band operation and Steverson thinks that might
be the right option for him. He likes the idea that the recovery time is shorter than it is
with the bypass and the fact that the banding system is totally removable.

Plus, he says, he only has 120 pounds to lose. The Lap-Band system will allow him to lose the weight slowly and steadily, something that's appealing to both him and his wife. Tonight, he wants to ask other patients how they are doing with their bands and see if their stories are comparable to the positive tales his friend has told him.

As Weiss dives into the details of the Lap-Band surgery, Steverson's decision becomes
even more fixed. During the 90-minute seminar, an actual Lap-Band is passed around to the audience. Steverson takes note of its size and feel. For a minute, he imagines what it just
might feel like to have something so small change his whole life. The idea seems ridiculous
to him.

But then as the doctor finishes speaking, a few bypass and Lap-Band patients are introduced.

A tall man named Gerard stands and tells about his success since undergoing the Lap-Band procedure. Steverson finds him approachable and informative -- so much so that Steverson finds himself repeatedly raising his hand to ask questions. He is eager to find out about
Gerald's experiences and weight loss.

"What are you eating now? How long did it take you to get back to work? Did you have any major pain following the surgery?" Steverson quizzes the group. Their answers are all satisfactory to him.

Within a matter of days, his packet of paperwork is completed and ready to be turned into
the group of doctors. Steverson is ready to go ahead with the surgery. The cost of the
operation is of little concern, because Steverson's insurance policy, American Life
Care/Gilsbar, lists Surgical Specialists of Louisiana and Southern Bariatric Associates
among his covered providers.

. . . . . . .

For Gregg Steverson, the hardest part of the weight-loss surgery is over: making the
decision and getting his general physician to agree that surgery is in his best interest.

He does worry that Audra is a bit unsettled about the operation's mortality rate and
possible complications. Then again, he says, she is a medical professional -- the clinical coordinator of urology at Children's Hospital -- and tends to concentrate too hard on the
risks.

"I am not really scared at all about the complications," Steverson says. "My wife is a little
bit more apprehensive not only about the surgery itself, but I think about me being able to follow the 'rules' afterwards."

That's what today's visit to Ochsner psychologist Robert Baker is about, in part. Steverson's insurer is requiring a psychological evaluation to determine whether Steverson is a good candidate for the surgery.

"Let's see, sir, what brings you here today?" Baker asks Steverson.

"Well, I'd like to have weight-loss surgery because I've gained a good bit of weight in the
last couple years and I can't seem to get it off," says Steverson, as he sits on the sofa in Baker's dimly lit office.

For 20 minutes, Baker and Steverson continue to review Steverson's personal history in
regard to his family, health and emotional concerns. Steverson is his usual warm, jovial, confident self throughout the entire process. There are no deep, dark secrets lurking in his
past. His obesity, he says, is the direct result of one and only one thing: bad eating habits.

And he takes full blame for his unhealthy ways.

"When I was working the streets as a paramedic we would just pick up some fast food, eat
and drive. That's not good at all for someone's eating habits or digestion," Steverson says.
"I am positive I can turn things around. This isn't like another diet. It means a whole different lifestyle choice and I am ready for that. I am tired of living this way, and if that means giving
up all the junk I say let's do it."

. . . . . . .

The last doctor who must approve Gregg Steverson for surgery is his cardiologist,
Dr. Raja Dhurandhar.

This morning he is scheduled for an 8 a.m. stress test.

Wearing his standard gray sweats and polo shirt, Steverson waits in a chilly room with a treadmill and various gizmos he imagines will be attached to him in a matter of minutes.

Normally, most weight-loss surgery candidates don't have to go through cardiac stress tests. Since Steverson did have an incident similar to a heart attack in 2001 and takes medicine for high blood pressure, the doctors want to be certain that his heart is strong enough to endure
the stress of major surgery.

"When I had my cardiac event I thought I was a goner for sure," Steverson says. "It's the
one thing that's been preventing me from going back out and working the streets on a
part-time basis. There's no way I could be out there working under so much pressure.
I'd be worried my heart might just give out on me with all this weight I've gained."

After an hour and a half, Steverson has had his heart monitored twice and been checked by
an electrocardiogram machine twice. He has done his part for the day; now the decisions will
be left up to the doctors. And, as always, Steverson remains optimistic.

"I am sure everything is going to come out just fine," he says. "Now, I just have to focus on
the next step -- surgery."

. . . . . . .

The phone call came just a little after 3 p.m. on a Friday, Steverson's regular day off. The woman on the phone from the doctor's office told him he was approved to have surgery. His operation would be scheduled for March 7 at Memorial Medical Hospital, Baptist Campus.

He and Audra would have two weeks to prepare for the reality of Steverson's new egg-sized stomach.

In the days following the phone call, the couple would schedule time off from work, frantically shop for and test a variety of protein shakes and, more importantly, celebrate with one last "big" meal.

The couple heads to Lido's, a small family-owned Italian restaurant just around the corner
from West Jefferson General Hospital on the West Bank. It's one of Steverson's favorite
places to eat. He'll order his usual: cheese sticks for an appetizer, chicken impanante as an entree with a side salad and plate of spaghetti, and for dessert a piece of sour cream cheesecake.

He is aware that the surgeons don't want him to overdo it. But the way he figures, he has already gone cold turkey on the cigarettes and Coke, so he owes it to himself to have a "last supper" with Audra. Unlike bypass patients, Lap-Band patients are able to resume a full diet much sooner, Steverson knows, but this is goodbye for him and his old ways. After this meal, he doesn't expect to overindulge himself again. There's too much on the line.

"I figure this will add 10 years to my life, and I can't wait to spend that time with my wife,"
says Steverson, sounding as loving as a newlywed. "I want so much for us to have a normal
life again. To go dancing, travel and just do all the things we've been missing out on."

After all the testing and waiting, Steverson realizes as he looks over the remnants of his
"last meal" how fortunate he is to have his surgery covered by his insurer. Over the past
few months, he has met several people whose insurance won't cover any type of obesity treatment. And last week he met someone who paid cash for the surgery.

"If they told me today that I would have to pay for my surgery out-of-pocket, I would try
to find a way to do it. It's worth that much to me," Steverson says. "I am hoping to get
back to where I was years ago -- healthier."

The surgical solution
Gregg Steverson has had a severe weight problem for more than a decade. His doctors will attempt to solve it in 35 minutes.
By Maria Montoya, Staff Writer/The Times-Picayune
04/08/2003

After all the failed diets and aborted exercise plans, the weight-loss workshops and doctor visits, the surgical screenings and soul-searching sessions, the quality of Gregg Steverson's
life is about to be wrapped inside a silicone cord the length of your average necktie.

"Retractor," says Dr. Thomas Lavin.

A nurse in the operating room at Memorial Medical Center, Baptist Campus, hands Lavin a curvy piece of metal resembling a wire hanger, which he inserts into an incision just below Steverson's breast bone. Lavin manipulates the retractor beneath the liver, lifting it out of the way and clearing a path to their surgical destination: Gregg Steverson's stomach.

Steverson, 40 years old and 317 pounds, is putting his hopes for a healthier future on weight-loss surgery, the most drastic treatment currently available to the morbidly obese. He is convinced that surgically shrinking his stomach will give him control of his weight -- and of his life, which has become increasingly limited by high cholesterol, high blood pressure, sleep apnea, heart problems and general weight-induced fatigue.

Lavin will remove no diseased tissue, repair no organ or limb. The procedure calls for him to
tie the silicone cord -- a Lap-Band -- around Steverson's stomach, shrinking it to the size of
an egg and a capacity of one to two ounces. The goal is essentially to do surgically what Steverson has been unable to do for himself: redefine what it means to be "full."

Which is why, when Steverson looks at the Lap-Band, he doesn't see an adjustable gastric banding prosthesis with an inflatable ring. He sees himself wearing a pair of swimming trunks
on his next cruise. Or dancing with his wife Audra to their favorite oldies. Or someday
bouncing a child -- his own child -- on his knee.

Lavin extends his surgical-gloved hand.

"Graspers," he says.

. . . . . . .

It's 5:45 in the morning, but not too early to keep a petite nurse from cheerfully buzzing
around Gregg Steverson's pre-op room.

As she moves, she calmly explains to Steverson and his wife, Audra, what will take place in
the next two to three hours. It's only March 7, but it's a spiel the nurse has already given at least a dozen times this month. Bariatric or weight-loss surgery business is picking up at the hospital; Steverson is one of two patients scheduled today. During a typical week, five to
seven operations will be performed at the hospital by the same group doing Steverson's surgery, the Surgical Specialists of Louisiana.

Steverson is given an IV "to calm his nerves" and taken to the third floor, where a surgical team awaits: Lavin and his associate, Dr. Michael Thomas, an anesthesiologist, a certified registered nurse anesthetist, two scrub nurses, a circulator and a camera technician.

Before the anesthesiologist can put him under, the patient must be moved onto a specially designed operating table, one that's built to handle up to 600 pounds.

Once Steverson has been prepped for surgery, the lights are dimmed in the operating room
so doctors can see the 14-inch TV monitors to their left and right. The pictures on the screen
will be fed from a camera inserted into the patient's abdomen.

In the glow of the camera light, the anesthesiologist can be seen sitting just next to
Steverson's head, carefully monitoring his vital signs and his breathing. Behind Lavin sit the eight to 10 instruments commonly used in laparoscopic surgery.

With everything in order, Lavin and Thomas step onto foot stools at either side of the
operating table to ensure a full view of the patient's stomach.

At 7:35 a.m., Lavin makes the first of six incisions in the middle of Steverson's upper
abdomen. Only about one centimeter long, it will be used to insert a narrow needle that will blow air into the abdominal cavity, so that the doctors will have an unobstructed view of the stomach.

The needle is removed and the camera inserted into the incision. Then the doctors make
the next five incisions, which will be used as ports for the surgeons' instruments.

Once the camera is inserted and the other incisions made, the surgeons will take an
exploratory tour of Steverson's stomach, checking for scar tissue, tumors or other trouble spots. Severe problems are rarely discovered at this stage, but it's not uncommon for
surgeons to find a diseased gall bladder that might need to be removed.

Not today, however. Steverson's stomach holds no surprises.

. . . . . . .

With the retractor holding the liver out of the way, Lavin uses two instruments to make a
tunnel around the top portion of the stomach. He is then handed a reticulating dissector, a
tool that will allow him to loop the silicone Lap-Band around the upper portion of the stomach.

Next, the band is slipped through the port on the left side of the stomach. But before it is
put in place and fastened, the anesthesiologist passes a tube down through Steverson's
mouth to the top of his stomach.

At the end of the tube is a small balloon, which the anesthesiologist inflates by injecting
15 to 20 centimeters of air. When the balloon stops, or gets stuck, the surgeons know they
have reached the top of the stomach.

With the balloon still inflated, the band is placed around the base of the balloon, creating the new one- to two-ounce stomach pouch, after which the anesthesiologist pulls out the tube and the balloon. To ensure that the band doesn't slip, Lavin sews a portion of the lower stomach over the top of the band. Then the end of the Lap-Band is pulled out of the left side of the abdomen.

At this point, all surgical instruments, the retractor and the camera are removed from the
ports. All of the air is then released from the abdomen through valves on each of the ports.
The Lap-Band's access port, which is used by surgeons in follow-up visits to inject or withdraw saline solution from the band to adjust the level of restriction around the stomach, is then
sewn to the abdominal wall in a small pocket. And any extra tubing from the Lap-Band is
placed inside the abdomen.

After this, Lavin uses dissolving stitches to sew up the remaining port sites. Each wound
is dressed, and the patient is steadily awakened. Just before he is fully conscious the
breathing tube is removed.

The entire operation has taken slightly longer than a half-hour.

. . . . . . .

"The operation went fine," Lavin tells Audra in the waiting room just after 8:30 a.m.

Steverson is in recovery and she should be able to see him within the next 20 to 35 minutes. Lavin tells Audra he plans to admit Steverson to the hospital to be observed for the next 24 hours.

But once Lavin returns to the recovery unit, he finds Steverson up and already walking
around. He's also pain-free, thanks to the "On-Q" pain pump that was attached to the same
site as his access port incision. The small, clear ball will dispense two milliliters of pain
medicine for the next 48 hours, ensuring that Steverson won't experience any discomfort.

Eager to avoid an overnight stay in the hospital, Steverson asks Lavin if he can go home.
It is becoming more common for Lap-Band patients to be released the same day if they
are not experiencing fever, pain or nausea and are able to consume liquids. Steverson is released to return with his wife to their Belle Chasse home.

"I feel great. I don't feel any difference at all," Steverson says as he awaits his discharge papers. "I don't see any reason to stick around here if I am feeling fine."

Four days later, Steverson is still feeling fine as he sips juice from a kid-sized squeezie
cup. He has already lost 10 pounds.

On April 10, he is scheduled to see Lavin for his first follow-up appointment. But already he
has made plans to be at the next weight-loss surgery seminar that Surgical Specialists of Louisiana will host on the West Bank. The way he sees it, he may not be that far into his
post-operative stage, but he would like to share his experience with anyone who is interested.

"I am excited about this whole new start," Steverson says. "This is going to be a totally
different lifestyle for me. A better one. A healthier one."

. . . . . . .

Staff writer Maria Montoya can be reached at mmontoya@timespicayune.com or at
1-504-826-3446.


11/14/03

Disclaimer:
As with any surgery, there are specific risks and possible complications associated with
the LAP-BAND System surgery. Talk to your doctor to determine if you are a candidate
for the LAP-BAND System.

For more information about the BioEnterics ® LAP-BAND ® System, please call
1800 801 770.