"Making the connection with patients and finding ways to improve the program are the best parts about this job," said Debbie Spamer, a bariatric specialist at Northside Hospital in Atlanta.
The before-and-after photos of patients who have undergone bariatric surgery are often dramatic, but they fail to tell the whole story of the risks, hard work and emotional changes that people go through before, during and after the procedures.
"Weight-loss surgery is not a quick fix," said Debbie Spamer, RN, BSN, CPAN, and bariatric specialist at Northside Hospital in Atlanta. "These people [patients] should be commended for doing something to better their lives and health. It takes a lot of courage."
The hospital was one of the first in Georgia to begin performing weight-loss surgeries in 1983. Northside doctors perform about 130 surgeries a year, including the Roux-en-Y gastric bypass and the less-invasive Lap-Band surgery, both of which reduce the size of the stomach.
When hospital administrators decided to form a bariatric program four years ago, they asked Spamer to head it. A post-anesthesia nurse, she had been coordinator of the recovery rooms for eight years and taking care of gastric-bypass patients since 1989.
"I said yes, because I really enjoyed taking care of these patients and I have learned a lot from them," she said.
Spamer gives preoperative instructions to each patient, makes rounds on the post-surgical floor, helps gather outcome data and facilitates the patient support group. She also provides education and training to the staff.
"Some patients are still coming to the support group six years after surgery, so I get to know them very well," Spamer said.
Weight-loss surgery patients have to be thoroughly committed and screened. Doctors will only take patients who have been trying to lose weight on doctor-prescribed diets for at least five years. They must be at least 100 pounds over their ideal weight and have a body mass index (BMI) of 40 or greater. Those with a BMI of 35 who also have other serious health conditions, such as diabetes, severe joint stress, sleep apnea or hypertension, are also considered for the surgery.
Patients undergo nutritional counseling and extensive medical and psychiatric testing before doctors will accept them as surgical candidates.
"Surgery is a last resort to losing the weight that will improve their health and add 10 years to most people's lives," Spamer said. "While the procedures are not considered dangerous, the patients are at higher risk because of the weight which puts an extra burden on their heart and lungs."
Postoperatively, patients must walk every four hours in the hospital.
"We don't take no for an answer, and patients know that going into surgery. They're willing to comply because they know the complications that can happen," Spamer said.
Blood clots, peritonitis, infections, bowel obstructions and hernias are some of the complications that can develop, even a year, five years or 10 years after surgery. Doctors follow their patients very closely for at least two years.
"The good news is that they lose weight — over 100 pounds for most patients," Spamer said.
She has one patient who used a scooter because she couldn't walk. She lost 245 pounds and is now walking and working again. Another is running marathons.
Spamer gets to hear abouth patients' excitement and successes in the support group, as well as the enormous emotional changes, the fears of acquiring other addictions to take the place of food, the struggle to stay on diet and exercise plans and physical complications of the process.
"I never know what is going to come out of someone's mouth, whether it's talk of bodily functions or relationship changes, but I enjoy watching them support each other," Spamer said. "Even those who have had rough times with the surgery say that they would do it again, because they can't believe the changes in their lives. They're much more active and healthy and doing things they couldn't do before, like riding on airplanes or roller coasters. It's amazing to see the improvements.
"Making the connection with patients and finding ways to improve the program are the best parts about this job."