by Margaret Houk, RN, BSN
Margi Houk, RN, BSN, is a case manager with Saint Mary’s Health Plans, Reno, Nevada.
My Journey to Surgery
I have struggled with my weight since my birth. It is a family disease; my older brother has also dealt with a lifelong battle against morbid obesity and all of its associated health problems. In the fall of 2002, my brother nearly died while on a hunting trip to Colorado from complications of being at a high altitude. He was in the ICU on a ventilator for seven days and was the forced to be dependent on a supplemental oxygen tank for a full year following the trip. That development was the slap in the face I needed; I suddenly saw myself going down the same path and realized that with my similar health and weight situation, I was staring at an untimely and young death looming on the near horizon.
In 2003, at the age of 49, my weight topped out at 280 pounds (and may have exceeded that—I was too scared to look at the scale anymore) on my 5’6” frame. My blood pressure was 210/110 with blinding headaches to match. My blood sugars were quickly creeping up into the diabetic range. I was on maximum doses of anti-inflammatory drugs and narcotics for relief of neck, back, and joint pain. I was short of breath with just a few steps. I couldn’t climb stairs because of shortness of breath and knee pain. My cholesterol was sky high. I didn’t fit in airline or movie seats… and forget public (and especially airline) restrooms!
I was forced to examine my quality of life with and without bariatric surgery. At first, I thought that if I decided to pursue this option for weight loss, it would just be another admission of weakness and failure. I soul-searched and studied about the procedure itself. I watched others go through surgery and deal with the positive (and some negative) effects it had on their lives physically, mentally, and spiritually. I stood by and watched morbid obesity take its toll on, and nearly kill, my brother and I saw it starting to personally affect his son. I looked in the mirror over and over and, each time, I saw someone who was on the verge of losing the health battle for good unless she took a step that appeared to some to be drastic (and foolish). I know now that this decision, while not made lightly or on a whim, was not an admission of failure or weakness, but a decision to choose life. So, on April 7, 2003, I had a “date” with Kent Sasse, MD, of Western Bariatric Institute (WBI) for my Roux-en-Y gastric bypass. (See Page XX for Bariatric Center Spotlight on Western Bariatric Institute.)
Now I celebrate two birthdays: My “real” birthday (53 this year) and my bariatric birthday. I’m proud to say that on April 7, 2007, I will be four years old! Every day my heart is filled with deep gratitude and respect for Dr. Sasse and his colleagues. I truly believe that this second chance—this gift—of a new and healthy life is precious beyond words and not to be taken lightly. It requires repayment, and so I’m “giving back” and “paying it forward.”
The Role of Support—Giving and Receiving
Since my surgery, I’ve found that support is just as important to success as they told me it would be. I speak of support from family, friends, medical professionals, and bariatric support groups. I’ve also found that support is most effective if one is more than just a sponge that soaks it up when given by others. Bariatric support is a two-way street that is most effective when it is given back. Once that little piece of enlightenment was realized about a year ago, I became active with WBI as a relief support group facilitator; I became a volunteer Angel Visitor (AUT: is this the “patient advocate” role Carol discusses in the spotlight?); and on occasion I sit in on nursing school classes taught by my friend Carol Bradley as a “ringer” in jogging nursing students’ perceptions of persons of size.
We are lucky in Reno to have WBI as a nationally certified Center of Excellence. They schedule numerous support groups, some comprised of both Roux-en-Y and Lap Band patients (pre- and post-op), some geared specifically to either surgery, and they also reach out to the patients that live in the far-flung rural regions of northern Nevada and northeastern California. WBI maps out monthly topics, schedules guest speakers when appropriate, and provides materials for each meeting. We have quarterly facilitator meetings to keep in touch with other support groups, share successes, problem-solve concerns, and keep current with the latest happenings within WBI’s program. As a facilitator, I find it most enjoyable to meet all the people who attend, hear their life stories and successes, and answer questions and offer encouragement. What little I am able to give to them—knowledge from personal experience, hope, empathy, and encouragement—feels small compared to the huge amounts of the same that they give back to me.
Being an Angel Visitor allows an opportunity, one-on-one, to visit with Roux-en-Y patients and their families while they are in the hospital following surgery. Some visits last 5 to 10 minutes, and some can last up to an hour, depending on the needs of the patients and their support people. These are the times when I feel as though I give and receive the most. We share our life stories, our successes, and our hopes for our futures. Angels share from the perspective of “Been there, done that,” to “Try this, it worked for me,” to “Gee, I don’t know the answer to your questions, but let me find out and get back to you.” We share our “before” photos and delight in seeing hope light up our patients’ faces that “they can do it, too.” We call them at home a day or two following hospital discharge to check in.
I remember after my surgery how alone I felt and am glad that we Angels are able to be there for our patients, to help them understand what they are feeling (physically and emotionally) immediately postoperatively, and to help relieve their fears and anxieties about the future. We always refer them back to the surgeon for medical issues and specifics, but what we are able to give from the heart bolsters them to be successful and encourages and reinforces in us that we, too, made the right decision to have bariatric surgery.
My Role as Support
I am a registered nurse and, in that role, I have spent my career in various stages of weight gain and loss. I have taken care of patients of all sizes. The interesting thing to me, looking back, is that even when I was obese myself, I had a prejudice toward and keen dread of taking care of a person my size or even larger, especially if it involved any kind of moving, lifting, or surgery. The logistics of clinically dealing with a person of size can, indeed, be daunting. My friend Carol Bradley teaches a class for local nursing students titled, “Using Knowledge and Sensitivity in the Care and Service of Bariatric Patients.” As I sit quietly in the back of the room, she starts out, gently, nudging them to acknowledge their preconceived ideas about persons of size (while flashing my “before” picture) and how those ideas and beliefs affect their ability to render effective nursing care. By the end of the class she has brought them full circle to the point that they are able to start shedding some of their preconceived ideas and then… there’s my “after” picture on the screen. Eyes pop and jaws drop as their heads whip around to recognize me as the person on the screen; sometimes blushes of embarrassment can be seen as they remember their thoughts at the beginning of class as they viewed my “before” picture. At that point, Carol invites me to share my story and I do, unabashedly, including 31 years of nursing experience from both sides of the bed-rail. No question is too personal, and no answer is spared. It’s satisfying to receive their acknowledgments and thanks for my experiences, but even more so to know that a new generation of nurses is coming up that, hopefully, will be more sensitive to the unique needs of persons of size, whether or not they are having weight loss surgery or are taking care of some other medical need in or out of the hospital.
Also, in the past year I have found a wonderful fitness trainer who takes great delight in the strides I have made since surgery and the strides that I am continuing to take in my quest for health. He has spoken at our support group about movement and strength and their importance in preoperative conditioning and postoperative recovery, and he has spoken as part of a continuing education offering for nurses about the challenges facing bariatric patients in re-learning how to move and keep moving for health. He seeks me out for my personal experiences as both a bariatric patient and nurse, and I draw great encouragement from him as he gently kicks my butt, tests my limits, and points me in new directions in movement, strength, and health, a mutually supportive relationship.
“Bariatric support” can encompass:
• Personal support persons—
spouses, children, friends, medical professionals
• Someone attending a support group meeting seeking answers while investigating surgery
• Someone who just receive the surgery date and reality (fear) is setting in
• Someone who already had surgery and needs encouragement with the program
• Someone who is there to lead the group or assist the designated group leader
• Someone visiting patients in the hospital as part of a postoperative visiting program sponsored by the local bariatric surgery medical practice
• Patients working with clinicians—medical, dietary, psychology, laboratory, and fitness—in the quest to provide the road map for weight loss
• Anyone working with, and educating, medical professionals—and the general public—on issues surrounding the diagnosis and treatment of persons of size and the impact of bariatric treatment.
But most of all, it is neither a mutually exclusive nor static experience. Bariatric support, when most effective, moves continuously in a never-ending circle through the fabric of the community. It is an essential part of having a successful outcome and keeping the weight off postoperatively. “Giving back” reinforces habits, thoughts, and life patterns learned after surgery, and most of all… It feels good to share success and encouragement with others.
Category: Patient Perspective