Edith Reyes wants to cure her diabetes.
The 246-pound Ventura woman dreams of a body and life that will propel her and her four children away from drive-thru cheeseburgers, insulin and cardiology tests. Now in size triple-extra-large, she aspires for large, maybe medium.
Her hopes pushed her into a Ventura operating room recently. A surgeon stapled her stomach, shrinking it from a football to an egg in a gastric bypass that will be funded by taxpayers. If she can keep off the weight that should melt from her body, her diabetes, asthma and worries about future heart problems may disappear.
"I stopped my medicine already," she said, remembering her mounting fears at the desperation of her act. "I was very worried because of my kids. I didn’t want to go into a lot of complications. Thank God everything went fine."
Weight-loss surgery is rippled with controversy and growing medical promise — issues that stretch from life to death.
A Simi Valley man is suing the 1-800-GET-THIN marketing campaign, a surgery center and others allegedly associated with a Lap-Band and hernia operation that he claims resulted in his wife’s death. The defendants say the claims are false.
A Moorpark woman suffered a heart attack that doctors said could have been fatal. She says surgery that helped her lose 104 pounds has delivered new life.
In Ventura, a county hospital designed for people who can’t pay for care elsewhere began offering weight-loss surgery this month. Doctors say the value in the procedures, covered by Medi-Cal, comes not only in the weight shed but also in the money saved through care that won’t be needed for disease linked to obesity.
"We can continue and continue and continue to pour medication on these diabetics, and the reality is we can only control one out of five," said Dr. Barry Sanchez, the surgeon leading the program at Ventura County Medical Center. "With bariatric surgery, we can do a procedure where we can control their diabetes within a year without medications."
The face of weight-loss surgery was plastered on freeway billboards that delivered a similar message as the commercials and the jingle John Faitro heard often. "Let your new life begin," the song started.
The 55-year-old Simi Valley man sat in dark glasses in an easy chair, a Bible in front of him, a lawyer to his side. Diagnosed with diabetes as a child, he’s been without sight for 26 years, dependent on his wife, Laura. Now she smiles at him from a photo above the fireplace.
Laura Faitro worked in customer relations for a software company, taking care of people at work and home. She took medicine for diabetes, high blood pressure and high cholesterol. She tried different diets but couldn’t control her weight. A friend from Bible study went through Lap-Band surgery and it worked.
She decided to do the same thing.
"I thought my wife was beautiful the way she was," John Faitro said. "This was the first thing she wanted to do for herself. It sounded good. It sounded like an easy operation."
Lawsuits allege 1-800-GET-THIN was an arm of a weight-loss business operated in part by Michael and Julian Omidi, physician brothers from Los Angeles. Doctors performed thousands of the adjustable banding operations at surgical centers, using inflatable silicon bands — Lap-Bands — to restrict the flow of food into the stomach. People could eat less and still feel full.
Now, the Omidis, other doctors and surgery centers face allegations that the surgeries were run as a mill with ill-trained physicians, patients unaware of risks and screening procedures nonexistent.
"The pre-screening was, ‘Do you have insurance and will they pay?’ " said John Walker, a Woodland Hills lawyer who represents Faitro.
But the Omidis have no role in the case because they never treated Laura Faitro and never saw her, said Konrad Trope, a lawyer representing Valley Surgical Center, where she received her Lap-Band. The brothers don’t own the surgery centers or 1-800-GET-THIN. He also said Faitro’s allegations against the surgery center and 1-800-GET-THIN are false.
"It does not provide health care," Trope said of the marketing campaign. "It’s separate and apart."
In the lawsuit that targets the Omidis, weight-loss surgeons, the surgery center and surgeon Michael Drucker from Simi Valley Hospital, John Faitro alleges the Omidis and others were engaged in a joint venture. His lawyers said his wife never should have received the Lap-Band because her liver was too large. They said a last-minute change in surgery centers meant she was operated on by a surgeon she never met until the day of the procedure.
Faitro said his wife’s liver was lacerated during surgery, leaking blood into her abdomen. She came out of the surgery in excruciating pain. Two days later, she was admitted into the emergency room at Simi Valley Hospital.
She struggled, nearly dying, and then seemed to bounce back, John Faitro said. He was sleeping during dialysis for his failed kidneys on the morning of July 26, 2010, when his sister-in-law and niece tapped him on the foot.
"They said, ‘Laura died,’ and then they had to hold me down," he said. "I went to the hospital and kissed her. She always kissed me back. I used to go to the gym really early in the morning. I’d kiss her when she was sleeping and she always kissed me back. It was the first time she didn’t."
Laura Faitro is one of five patients who died in surgeries allegedly linked to 1-800-GET-THIN. After a warning about misleading advertising by the U.S. Food and Drug Administration, the billboards have been removed. The commercials and the jingle have been silenced. The company that makes the Lap-Band stopped selling it to centers linked to the marketing campaign.
Trope contends Faitro’s death had nothing to do with the Lap-Band surgery, saying she was stable when discharged from Valley Surgical. He said blaming the surgery center or the Omidis is misplaced, and that much of the blame instead rests with Simi Valley Hospital and its staff.
"Had the hospital appropriately diagnosed her, she would have been alive today," Trope said.
John C. Kelly, a lawyer representing the hospital, disagreed. Kelly said the hospital was once being sued by Faitro but has been dismissed from the litigation.
"Frankly, the hospital didn’t have any exposure in this case," he said.
Faitro said he blames the death on greed. He has told his story on network television, in depositions and newspaper stories, usually with a lawyer monitoring every word.
"I do these interviews because I want people to know these surgeries aren’t as easy as they appear to be," he said, explaining he thought the operation alone would make his wife thin. "I totally believed that. I believe people think it’s an easy way to lose weight."
NO MAGIC PILL
In a different procedure, the gastric bypass, the stomach is stapled and the path food takes through the body is rerouted so less fat is absorbed. In a procedure called sleeve gastrectomy, part of the stomach is amputated, leaving a strip of the organ — a sleeve — to digest food.
Federal guidelines suggest surgical options be limited to people with a body mass index of 40 — for example, a 5-foot-6-inch person who weighs 248 pounds. The standards are lower for people with a health condition or for those considering a Lap-Band.
Weight-loss by scalpel, known generally as bariatric surgery, was pressed into public consciousness in part by Carnie Wilson. The daughter of Beach Boy founder Brian Wilson, she’s a singer with Wilson Phillips and a reality television regular.
Once nearly 300 pounds, she lost half of it after a 1999 gastric bypass surgery broadcast on the Internet. She told her story on the cover of People magazine. She posed nude in Playboy. Bariatric industry leaders pointed to the exposure as a landmark, part of a surge in celebrity bypasses that included Roseanne Barr, author Anne Rice and "American Idol" judge Randy Jackson.
The publicity helped open a door to surgeries that grew from 29,000 procedures in 1999 to 220,000 a decade later. That growth has been stalled by the recession, insurance coverage and, some say, the controversy surrounding things like 1-800-GET-THIN.
Earlier this year, Carnie Wilson went to St. John’s Regional Medical Center in Oxnard for a second surgery. The pounds had come back, with People magazine reporting her weight exceeded 200 pounds. At St. John’s, Dr. Helmuth Billy fitted a Lap-Band around her stomach.
To critics and advocates, the up-and-down scale is the epitome of weight-loss surgery. Research suggests as many as 20 percent of gastric bypass patients regain much of the weight, some fooling their bodies by drinking water with their meals and flushing food through their rebuilt stomachs.
Dr. Geoffrey Drew, a Thousand Oaks family doctor who specializes in weight management, said weight-loss surgeons don’t focus enough on the behavior changes people need to keep weight off. Instead, they focus on their ability to rebuild the stomach.
"They’re engineers. They’re like car mechanics," said Drew, who fights to keep his patients from going through the procedures. "I think there’s a huge scientific blindness going on right now."
Surgeons said a focus on aftercare, nutrition, portion size and exercise separates the good programs from the not-so-good. They allege some programs push people in and out of surgery centers as quickly as possible.
"If it sounds like you’re going through a turnstile, you probably are," Billy said.
A first-generation American with parents from Austria and Iceland, Billy started doing weight-loss surgery at tiny Santa Paula Memorial Hospital a decade ago while larger hospitals decided whether to establish programs.
He launched programs at St. John’s in Oxnard and Community Memorial Hospital in Ventura. Now, he performs about 400 surgeries a year.
Before surgery, patients have to go through a psychological evaluation, orientations and screenings that include heart scans, lung exams and bone density tests. Afterward, there are support groups, exercise classes and years of aftercare, much of it not covered by insurance, Billy said.
Risks of the surgery include internal hernias and leaks in the rebuilt part of the intestine or at the stapled part of the stomach. Lap-Bands can slip and erode into the stomach. A stapled-off stomach can stretch, reducing its effectiveness.
Almost all surgeries are done with a fiber-optic device called a laparoscope that means smaller incisions and lower risks. But because the patients are obese, they run higher-than-normal odds of complications that include heart attacks on the operating table.
"We operate on the most unhealthy people in society," Billy said. "The risks are there."
Two days before a Thanksgiving that was going to double as an engagement celebration for her son, Jackie Clifford woke up covered in sweat. She couldn’t breathe. Her heart stopped and then started. Two of her arteries were plugged.
It was a heart attack, a type that is especially fatal.
"It was called the widow-maker," she said.
Clifford was 62 then. She stood 5 foot 2 inches and weighed 256 pounds. She suffered from diabetes, high blood pressure and collapsed arteries in each of her legs.
After heart surgery, her doctor said the only way to survive was to lose weight and keep it off. He recommended surgery.
After a yearlong dance with an insurance company that ended when her husband found a new job and new coverage, she underwent a gastric bypass. The family paid about $6,000 toward total costs that exceeded $70,000.
Now her stomach is 2 inches long and 1 inch wide. Dinner is half a pork chop, a small potato and broccoli the size of a half-dollar.
Some patients complain certain foods, ranging from canned fruits to pancakes with syrup, trigger nausea, cramps or diarrhea. Clifford can eat anything, but there is a price.
"I’ll get horrible stomach pains and it will go away in an hour. … It’s pain enough that I double over," she said, adding that she’s been told to eat more slowly.
In about a year, she has lost 104 pounds. She rides her bicycle half an hour a day. Her diabetes and hypertension are gone.
"I’m a completely new person. I can do anything," she said, thinking of her old life. "My heart doctor said that within a year, I would have been dead."
But ask her if she would recommend surgery to her friends and she thinks of the pain when she eats and the changes in her food and her life. She thinks of the $6,000.
"It has its place," she said. "If you can lose weight any other way, try that first."
BREAKING A CYCLE
Four of 10 Americans will be obese by 2030, according to a study funded by the U.S. Centers for Disease Control and Prevention. One in three adults will have diabetes by 2050, the agency says.
The numbers help explain why administrators and doctors at Ventura County Medical Center have been quietly preparing a weight-loss surgery program for more than a year.
But the main reason surgeries began early this month is people like the Ventura woman who was dancing to Wii with two of her daughters two weeks before her gastric bypass.
Edith Reyes is unemployed. Her husband works at a car shop, washing vehicles and chauffeuring customers home. They live off Ventura Avenue, the children sharing a bedroom and their parents sleeping in the living room.
Reyes has asthma and heart issues but worries most about the diabetes that grew worse as she gained weight.
Always heavy, she tried programs that range from injections of B-12 to a weight-loss product called Phentermine. Pounds came off but always returned.
"I think it’s like an alcoholic trying to give up their beer," she said. "I think food is the same way. It’s really hard to give up."
It’s a pattern entrenched in communities throughout Ventura County, particularly in areas where culture reinforces huge meals and income is a barrier.
"Their money sources are low," said Sanchez, the surgeon leading the county program. "What are the foods they can afford? It’s high-fat and high-cholesterol."
Sanchez came to the county more than a year ago, piecing together a county weight-loss program aimed at people who have few other options. In March, he started seeing patients who also met with psychologists, internal medicine doctors and lung specialists.
The focus rests on using weight loss to stave off diabetes, heart disease and other conditions linked to obesity. Two studies published in April in the New England Journal of Medicine contend gastric bypass surgery is a much more effective treatment of diabetes than medication and other medical treatment. One of the studies said the surgery pushed as many as 75 percent of the patients into remission.
"We know morbid obesity contributes to some of the major chronic disease of our time," said Dr. Stan Patterson, medical director of the Magnolia Family Medical Clinic in Oxnard that houses the weight-loss program. "We’re talking about reduction in deaths."
Others, however, question society’s growing emphasis on surgery.
"We’re not going to find the answer to obesity in surgery," said Art Caplan, director of the Center for Bioethics at the University of Pennsylvania. "It’s a place to turn for the desperate and those who are really facing life-threatening risk. It’s a solution for some but not for most."
Reyes is desperate. She thinks she has to change her life so her children won’t end up on a path that leads to health problems, doctors and immobility.
Her surgery on Monday was a beginning. Even before, she started the changes, dancing in a Zumba class four days a week, exercising to Wii and serving her family some vegetables for the first time she can remember.
Now, she’ll segue from a post-surgery water diet to protein shakes to blended foods and finally to solids.
"It’s like starting like a baby," she said. "It’s like: What’s my stomach going to handle?"
Before the operation, Reyes didn’t want to think about people who die in surgery or the chance of complications. Now she said the risks were worth it. She thinks surgery brought her a chance to live longer and ride bicycles with her children.
Will it make her happy? The question stops her.
"You don’t change," she said, "just your body."
(c)2012 Ventura County Star (Camarillo, Calif.)