Autumn 2003
When the Yo-Yo Got Stuck in the Up Position

How Gastric Bypass Surgery Changed One Man's Life

Daniel Correia shows off his motorcycle six months after weight loss surgery. For a “before” photo,see below!

“I was overweight as a kid,” 59-year-old Daniel Correia of Stratford recalls. “My mom was a great baker. We always had homemade bread, cakes, pies….”

As a teen, he was a good athlete, but when it was skins vs. shirts, “If I had to take my shirt off, I wouldn’t play,” he says. “Being overweight kept me from doing a lot of things I loved.”

When he graduated from high school, Daniel was 6 feet tall and weighed 225 pounds. When he entered the Army at age 20, he got down to 180 pounds. At the age of 23, he joined the Stratford Police Department, and for the next 15 years, managed to keep a lid on his weight.

But after he retired from the force, the yo-yo started up again. At one point he weighed 250 pounds, and was allowing himself only 500 calories per day. (A healthy diet for a 6-foot adult male is about 3,000 calories.) He got down to 169 pounds—then shot back up again. “I think I’ve lost at least 1,000 pounds in my life,” he jokes.

In the late 1980s he reached 280 pounds—and from then on, no matter how much he starved himself, he couldn’t lose weight. The yo-yo was stuck—in the up position.

The Physical Consequences

Daniel developed high blood pressure. This is common in those who are overweight, simply because the heart has to pump harder to send blood through the excess body tissue. When the heart works harder, that pushes the blood pressure higher.

Daniel also developed arthritis and had to have knee surgery, back surgery, and a hip replacement. “Being overweight didn’t help with that, either,” he points out. The more weight the joints have to bear, the greater the wear and tear they suffer.

Daniel weighed 296 pounds the day his primary care physician, James P. Ralabate, MD, diagnosed him with diabetes—another condition common in those who are overweight. (Nearly 90% of those with type 2 diabetes [non-insulin dependent] are overweight. In fact, a weight gain of just 11 to 18 pounds increases the risk of developing type 2 diabetes to twice that of a person who has not gained weight!)

Daniel with his friend, Jean Mastroni, “before.”

Daniel wasn’t surprised at the diagnosis—“My whole family is diabetic”—but he was certainly dismayed. He knew that both diabetes and high blood pressure increased the risk of heart disease. “I thought, ‘I’m only halfway through my life. Do I want to live the rest of it sick? I am not going die at an early age like my dad and grandma.’”

“Daniel was frustrated by his weight and his progressive arthritis, and was very motivated to decrease his risk of stroke, heart attack, and arthritis pain,” says Dr. Ralabate. “He asked to be referred for weight reduction surgery, and I highly recommended gastric bypass for him.”

Many years earlier Daniel had spotted a New York Times article about gastric bypass surgery—a procedure that reduces the size of the stomach—as a method of losing weight for seriously obese people. So he was delighted when he learned about Bridgeport Hospital’s Weight Management Center and Daniel Tran, MD, who specializes in gastric bypass surgery.

However, “Gastric bypass is major surgery,” says Dr. Tran, “and it requires major, life-long adjustments in lifestyle. It’s necessary to make sure that the patient has not only the physical strength, but also the will and the tenacity to face these changes. So before we could sign Daniel up for the gastric bypass procedure, some tests were required.”

A stress test made sure his heart could take the strain of the surgery. A sleep apnea test, performed in Bridgeport Hospital’s Center for Sleep Medicine, showed that excess weight did not block his throat and cause him to repeatedly stop breathing while he slept. (This is another problem that can be weightrelated —one that can delay recovery from surgery.) And psychological tests demonstrated that Daniel would be mentally able to handle his life after surgery.

Daniel also met with the Weight Management Center’s clinical nutritionist, Laurie Jordan, RD (Registered Dietitian). Reviewing Daniel’s diet history, she saw that he had been able to lose weight on his diets in the past. This indicated that he did have the dedication to stick to a diet. She also learned that Daniel was still making an effort to get some exercise—a good indicator for success after surgery. She discussed his food idiosyncrasies—did he binge on carbohydrates? Drink a lot of juice; eat a lot of sweets? She gave him advice on how to change his eating habits even before he came in for surgery. And because he was diabetic, she put him on a special diabetes diet.

Daniel passed all his tests with flying colors, and in March 2003, Dr. Tran performed minimally invasive gastric bypass surgery. That means the surgery was performed by placing small instruments and tiny lighted telescopes through several 1/2-inch incisions in the abdomen. Compared with the usual long incision, these small ones were less painful for Daniel, and faster to heal. “Eighty percent of the gastric bypass procedures at Bridgeport Hospital are done in this way,” says Nabil Atweh, MD, chairman of the department of Surgery.

Daniel’s stomach was completely divided to create a small working section at the top, called the “pouch,” and a larger, nonworking lower section, which was left in place (see illustration). The pouch was so small it could hold only one ounce of food. (The stomach sends out “I’m full” messages when the pouch is filled, even though the remaining stomach is empty.) Dr. Tran connected the pouch to the small intestine. That way the food could travel from the pouch directly into the intestine for digestion, bypassing most of the stomach and the first part of the small intestine. The connection between the pouch and the intestine was deliberately made small, to slow the time it would take for food to transit, or pass through it. With the small pouch and slow transit time, a small amount of food would make Daniel feel full for a long time.

For his three-day hospital stay, Daniel was closely observed, and his diet was strictly controlled—only clear liquids at first, then a nutrient-enriched liquid. When he went home, he stayed on this enriched liquid diet for the first week. Then he graduated to puréed foods for three months. “And I never felt hungry,” he s

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