From Bariatric Patient to Bariatric Nurse Practitioner: My Journey to Health, Wellness, and a New Career Trajectory
by Heather R. Baum, MSN, RN, BA, CRNP, NP-C, AGACNP-BC CCRN
Ms. Baum is with Weight Loss Surgery and Wellness Center, Reading Hospital, Tower Health System in Reading, Pennsylvania.
Funding: No funding was provided for this article.
Disclosures: The author reports no conflicts of interest relevant to the content of this article.
Bariatric Times. 2023;20(2):8–9.
I did not have obesity as a child or teen, but now, looking back, I can see the patterns of emotional eating. Of course, with a good metabolism, back in the day I could handle eating Nutty Bars for breakfast, a salad with bacon bits and ranch for lunch, and then whatever my mom cooked for dinner. It was a typical American dinner of a meat, starch, and vegetables, and we never had dessert. When I think back to my childhood, even fast food was a rare, maybe yearly, treat! As I grew into early adulthood, I was free to eat “whatever I wanted” and that “freshman 15” was more like 30. I remained active after high school, but never had a set fitness routine. Routine, habits…what was that?
At 21 years of age, I became pregnant with my son (he is one amazing young man who is now 19 years of age himself and rocking the college life) and that was the point my weight really started to pack on. Between the pregnancy, full-time school and working basically full-time, I didn’t have much time to focus on me. And you can eat whatever you want when you’re pregnant, right? Well, now I know that was wrong! After he was born, I went back to college full-time and finished my degree in psychology. While my dreams of going into the Federal Bureau of Investigation (FBI) were not going to come to fruition, I started working at the hospital because I needed health insurance for me and the baby, and I fell in LOVE with the surgical intensive care unit (SICU). Thus, I stayed a fifth year at college to complete the science requirements and then completed a two-year diploma program in nursing.
I was blessed to be able to do well in school, even with a baby and a now full-time nurse aide job, and started in the SICU as a graduate nurse. This is where I was meant to be, but I knew I wanted to continue to grow my career through education. During this time, I tried to focus some time on myself by trying different gyms and probably just about every diet in the book! I would lose maybe 30 pounds or so, but it never stuck. I got down to a size 16 for our wedding (blessed to have married my high school sweetheart), but that was the smallest I was able to get into at the time. After we were married, we were again blessed to become pregnant with our beautiful baby girl (now a sassy pre-teen). And my weight ballooned up to its highest at 260lbs. I knew I couldn’t keep going this way.
Knowing that diets and attempts at exercise hadn’t worked for me in the past, I sought out help at my hospital’s weight loss surgery center. Working in the SICU, I was afraid of the gastric bypass (this was 2010 and so much in the world of bariatric surgery has changed since then), and the sleeve gastrectomy was just coming back into popularity. I figured the band, being reversible, was the “safest” way to go. There are known long-term complications that can come from the band, but in the short-term, it seemed safer, as there are no associated absorption issues, no dumping syndrome, and a shorter recovery time. Long-term complications that came to light over the years included gastric perforation, slippage, erosion, and need for revision.1
While I lost 90lbs with it in place, after five years, I developed an esophageal stricture, and the fluid needed to be removed. At this time, I was working full-time, had two young children, and was in my master’s degree program (I had gotten my BSN while I was pregnant with my daughter) to become a family nurse practitioner (FNP). So, of course, on the back burner my health and wellness went again, and with the stress of all I was doing, I ate. I ate a lot. And I regained weight, back up to 270lbs.
Why was I hesitant to get gastric bypass surgery? Unfortunately, being a longtime nurse in the SICU, I saw the worst of the worst when it comes to complications of any surgery, and in particular both short-term and long-term complications of gastric bypass. Any surgery carries a risk of complications, and with the gastric bypass in particular, those complications include anastomotic leaks (seen in about 1.5–6% of all cases), which can occur within days to weeks after surgery.2 I also knew this was a more complex surgery compared to the gastric band, with a prolonged recovery time, vitamin and mineral malabsorption, risk of stomach ulcer formation (prior to working with neurology, I was using nonsteroidal anti-inflammatory drug [NSAIDs] for weekly migraines; now on a preventative medicine, I have not had migraines in three years), and dumping syndrome.3
After graduating with my FNP, I started working for a hospitalist group and found myself dealing with many physical manifestations of my obesity. Throughout all of this, I was lucky to never have developed hypertension, high cholesterol, diabetes, or other comorbidities, but I did have plantar fasciitis and Achilles tendonitis, and my lungs were so deconditioned I became short of breath just walking a small distance. I knew I had to do something. I had tried some prescription medications after the fluid came out of my band. (I also was completing a postmaster’s NP in adult-gerontologic acute care at the time.) At that time, the medications that were offered were not as expansive as today, with the development of the glucagon-like peptide-1 (GLP-1) medications. I tried phentermine/topiramate. I tolerated the phentermine very well; however, due to the fogginess that topiramate can cause,4 I almost failed an exam for my NP program, and I have never failed an exam in my life—I knew this option was not ideal for me! Knowing that the band, a surgical weight loss tool, had worked well for me before, I wanted to explore other surgical options.
In March 2020, yes, the week COVID-19 hit the United States (US), I had my sleeve conversion done. My band was finally removed, and I did well to start. However, after four months, I developed severe reflux. I was taking omeprazole daily, then twice daily, then other medications were added. I then tried six small meals a day and sleeping upright. Despite all of those interventions, I was having nightly volcanic eruptions of pure stomach acid—even though I stopped eating seven hours before bed! I ended up having an upper gastrointestinal series, which revealed 90 percent of the barium that went down came right back up again. This was followed by a Bravo study, and my pH was off the charts. My esophagogastroduodenoscopy (EGD) revealed inflammatory changes that were not there previously. They found that my lower esophageal sphincter (LES) wasn’t closing (I am curious to know if this could have been related to the years of vomiting, sliming, and the stricture, but we might never truly know). So, my options were: 1. medications (well, those weren’t working), 2. try to tighten the LES (which might work about 50% of the time), or 3. permanently fix the issue by converting to gastric bypass. Yes, the surgery I tried to avoid from the beginning.
By this point, I had lost 94lbs with my sleeve, and at 18 months, I converted to gastric bypass. My reflux was immediately resolved! It was amazing. When I had the consult with the surgeon prior to the gastric bypass, I was worried about continued weight loss in that I didn’t want to lose too much weight. His thoughts were that I would get down to maybe 150lbs, as this was the typical projected weight loss after conversion.
Luckily, prior to my sleeve conversion and even despite COVID-19, I had kept up with my basic habits of fuel, fluid, and movement! I started working with a trainer in 2019 to prepare for my sleeve gastrectomy and get myself moving in a way that was safe for all of the physical limitations I had at the time. When the gyms reopened, I was right back at it, even with the reflux issues I was having. I was not giving up. This program continued after my revision. I stuck with monitoring my food and fluid intake and made sure I was doing a physical fitness program that made me stronger, leaner, and more flexible. So, with the conversion, my weight went down to 120lbs. I have muscular definition. I have strength and flexibility. I have been able to maintain this weight, and just celebrated my one-year post-revision-surgiversary!
As far as my career, I had left the hospitalist group after one year to work in neurocritical care. Working with trauma and neurology as a bedside nurse, I was a self-proclaimed “neuro nerd.” I loved it. It was challenging and interesting, but I knew I couldn’t hack the night call/24-hour shift life forever. I am in my 40s at this point, so those shifts can be left to the young advanced practice providers! I started a health coach certification course hoping to help other bariatric patients like myself. I mentioned this to my surgeon at a postoperative visit, and this led to me interviewing and transitioning to an NP position in my very own weight loss surgery and wellness center!
I have now been there for eight months, and I am loving how I can meld my love for healthcare with my bariatric journey. When it fits the conversation, I tell my story to my patients, I share my own experiences and knowledge at our support group, and I have also started to help with our medical weight loss program. To use my knowledge, my passion, and my success to help inspire our patients’ journeys means so much to me! I often say, if I can change one life with my story, my journey was well worth all of the ups and downs.
References
- Eid I, Birch D, Sharma A, et al. Complications associated with adjustable gastric banding for morbid obesity: a surgeon’s guide. Can J Surg. 2011;54(1):61–66.
- Johns Hopkins Medicine. Risks of gastric bypass surgery: anastomotic leaking. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/risks-of-gastric-bypass-surgery-anastomotic-leaking Accessed 30 Nov 2022.
- Public Education Committee. Bariatric surgery procedures. American Society for Metabolic and Bariatric Surgery. Updated May 2021. https://asmbs.org/patients/bariatric-surgery-procedures. Accessed 30 Nov 2022.
- Sommer B, Mitchell E, Wroolie T. Topiramate: effects on cognition in patients with epilepsy, migraine headache and obesity. Ther Adv Neurol Disord. 2013;6(4):211–227.
Category: Past Articles, The Wise Provider
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