500-Pound Man Fights For 'Lifesaving' Surgery

[The Straight Story]

500-Pound Man Fights For 'Lifesaving' Surgery

POSTED: 5:44 pm EST February 12, 2007

A 500-pound man in Central Florida who claims his weight is killing him is fighting for surgery that he believes could save his life after his insurance company refused to pay for it, according to a Local 6 News report.

Neal Pittard, who said he is easily pushing 500 pounds, said he has tried twice to get gastric bypass after his doctors said his obesity may soon kill him.

Doctors said the best chance of preventing possible death is gastric bypass.

With doctors on record, Pittard's insurance company told him he was on his own and it would not pay for the weight loss surgery that could save his life.

Pittard's insurance is through Florida Hospital, where his wife is a nurse.

http://www.local6.com/news/10992476/detail.html

[bigscott]

1. not sure how i feel about this

article does not mention whether he has tried other means of losing weight, is this his last resort?

[Bluebear]

2. At 500# it probably is his last resort

I don't think taking a ballroom dance class and watching his snacks is going to help the guy. Give him the surgery so he can become mobile again.

[boston bean]

3. I agree. Give the man a chance for goodness sakes. I hate insurance companies. nt

[wicket]

5. The sick thing is - it'd probably save them money in the long run

Being that heavy surely comes with many other health ailments.

[SmokingJacket]

8. Maybe, maybe not.

This surgery causes lots and LOTS of complications that can require tons of follow-up care.
And if the guy dies of a heart attack, it won't cost them much at all.

This surgery is not always a quick fix. That said, I think the insurance company should pay for it -- they took the guy's payments, after all.

[elehhhhna]

13. The longer he lives, the more he'll cost the insurance company. Period.

Whether there are complications to his surgery or not.

Face it: they want him gone.

[wicket]

20. True

He's better off dead to them.

[terip64]

4. you are so right! n/t

[Horse with no Name]

16. What does that matter?

He is in a crisis NOW. At that weight, he wouldn't be able to do exercise and his body would require more than you or I just for homeostasis.

[benEzra]

6. The insurance company is being a bunch of idiots...

not only are they making themselves look ruthless, but if they succeed in denying him the surgery, they will end up paying a lot more for his heart disease and diabetes related care...

[RebelOne]

7. My daughter had gastric bypass surgery and her

insurance paid for it. But she was one of the lucky ones because almost immediately after her procedure the insurance company stopped paying for those operations.

[Vinca]

9. He should be able to get the surgery, but I've always wondered.

If, instead of the surgery, a person went on the miserly diet associated with bypass surgery, would they eventually lose the same amount of weight? Or does the bypass surgery literally bypass the calorie-absorbing part of the intestine? Just wondering.

[woodsprite]

10. It bypasses alot of the area that absorbs nutrients, fat, etc.

After you have the surgery you have to be on all sorts of supplements to get your level up high enough that the proper absorption takes place. It also physically makes the stomach smaller - I think the pouch they leave will allow 1/4 cup. For awhile after surgery, you usually can't eat and drink together because it would fill the pouch up too much. Really fatty or sweet things can make you have the runs or throw up. Your hair comes out because you're weightloss is so fast. It's hard to get enough protein at the beginning because your stomach can't hold much. If you eat too much, your stomach pouch will expand and you will gain weight. After you lose the weight, you usually need to have excess skin removed. This surgery is not usually covered by insurance.

It is not pleasant by any means, but I know 3 people who have gone thru it. My SIL who did it to get down to a healthy weight so she could be put on a liver transplant list if needed. She contracted HepC when she was ambulance attendant. She is down to 165 from 360 and still losing. She has also had the skin removal surgery.

I also have a friend who has been doing well. She had tried everything, and at 320 lbs. decided that this was a last ditch effort. She's doing great (down 120 lbs in 10 months), but she said that she is still hungry, still craves things she now cannot eat. She has put things in her mouth and chewed them, then spit them out just to get rid of a craving.

I met another friend when we were in the hospital together. Several years back she had gastric bypass surgery to try to avoid developing diabetes (runs rampant in her family). I met her when she had been admitted because she had an ectopic pregnancy and they had to do an emergency hysterectomy on her. She looked wonderful outside, but the docs were going to have to go in another time for more surgery because her insides were a mass of scar tissue from the bypass surgery.

None of these seem pleasant, but I guess if you're looking down the barrel of a gun, you do what you feel you must do.

[Vinca]

21. Thanks for the info.

Fortunately, although overweight, I wouldn't qualify for this surgery. It sounds absolutely horrible, but those willing to go through with it should have it covered by insurance. For me, if I ever get that heavy, I'll have my husband lock me in a closet for a few months and push Slim Fast through a crack in the door.

[auntAgonist]

23. It's not horrible, it is however life changing.

NO one should even think about surgery if they are not willing to adhere to strict life style changes. I take my supplements and vitamins regularly/religiously. I have my blood drawn and I continue to have regular checkups with my Dr.

My only regret is that I didn't do this sooner.

I've lost 162 lbs! I now weigh LESS than that at 137 lbs.

aA

[Vinca]

25. Congratulations! nt

[auntAgonist]

22. I had bariatric surgery.

Here is a link to the surgery I had
http://www.duodenalswitch.com/procedure/procedure.html




Public release date: 22-Sep-2006


Contact: John Easton
[email protected]
773-702-6241
University of Chicago Medical Center
For super-obese patients, duodenal switch beats gastric bypass

In the first large, single-institution series directly comparing weight-loss outcomes in super-obese patients, researchers from the University of Chicago found that a newer operation, the duodenal switch, produced substantially better weight-loss outcomes than the standard operation, the Roux-en-Y gastric bypass.

In the October issue of the Annals of Surgery, the researchers report that the duodenal switch (DS) produced greater weight loss than the Roux-en-Y gastric bypass (RYGB) by all measures in patients with a body mass index (BMI) of at least 50. These patients typically carry at least 150 pounds more than their ideal weight.

In this study, patients undergoing duodenal switch were significantly more likely to achieve and maintain successful weight loss--defined as losing more than half of their excess weight--at one year (DS 83.9% vs. RYGB 70.4%) and three years (DS 84.2% vs. RYGB 59.3%) after surgery.

"While there is no single ideal bariatric procedure that can be applied to all severely obese patients, we have generally recommended the duodenal switch for those with a BMI greater than 50," said study author Vivek Prachand, M.D., assistant professor of surgery at the University of Chicago. "This study confirms that approach. Both procedures appear to be reasonably safe in the hands of an experienced team, but the duodenal switch appears to offer a considerable advantage in terms of the amount and possibly the duration of weight loss."

The super obese make up only a fraction of the U.S. obesity pandemic, but their ranks are increasing faster than any other group. When the term was coined in 1987, fewer than one in 2,000 adults in the United States met the criteria of a BMI greater than 50. (A normal BMI is 18.5 to 24.9. From 25 to 29.9 is considered overweight. Thirty or above is considered obese; 40 and above is morbidly obese.) The prevalence of the super-obese has quintupled since then, to one in 400 U.S. adults in 2000, which adds up to more then 50,000 people in the U.S.

At the same time, bariatric or weight-loss surgery has increased from about 16,000 cases in 1992, to 63,000 in 2002, to 171,000 in 2005. The most common surgical procedure for these patients--more than 80 percent of all bariatric operations in 2002--is the gastric bypass, which involves stapling off a large portion of the stomach to make overeating difficult, and rerouting the intestines to reduce the absorption of calories. The duodenal switch--fewer than eight percent of all bariatric procedures performed nationwide--leaves a slightly larger stomach pouch but makes even more drastic alterations to the intestines to limit absorption, particularly of fats and starches.

This study involved 350 consecutive super-obese patients who underwent weight-loss surgery at the University of Chicago Hospitals between Aug. 5, 2002, and Nov. 10, 2005. One hundred ninety-eight patients underwent duodenal switch and 152 had a gastric bypass. More than 80 percent of both groups were female. The average age was 40, but that ranged from 18 to 68. About 92 percent had the surgery performed laparoscopically, through small abdominal incisions.

The duodenal-switch patients were slightly heavier. Their average weight before surgery was 368 pounds, compared to 346 for gastric-bypass patients. Average BMIs were also higher: 58.8 for the duodenal-switch patients (up to 96.3), compared to an average BMI of 56.4 for gastric-bypass patients (up to 84.2).

On average, patients who had a duodenal switch stayed in the hospital one day longer, four days instead of three. About 24 percent of DS patients stayed more than four days and about 20 percent of RYGB patients stayed more than three days. There was one death among the 198 duodenal-switch patients within 30 days of the operation and no deaths before 30 days among 152 gastric-bypass patients.

The duodenal switch produced greater weight loss. DS patients lost more total weight and a larger percentage of excess body weight and consequently had a bigger decrease in BMI. When they were weighed one year after surgery, DS patients had lost an average of 149 pounds compared to 121 pounds for RYGB patients. After three years, DS patients had lost 173 pounds, but average weight loss for RYGB patients had decreased to 118 pounds.

"Every one of these patients had significant weight loss," Prachand said, "but the duodenal-switch patients had greater weight loss and seemed to keep the weight off longer."

"There has been a perception amongst bariatric surgeons that the duodenal switch might provide better weight loss than gastric bypass in super-obese individuals," said Prachand. Several studies have demonstrated higher rates of weight-loss failure and weight regain following gastric bypass in these patients.

But surgeons have been hesitant to adopt the duodenal switch for several reasons, he said: "greater technical complexity of the operation, particularly when performed laparoscopically; greater potential for nutritional deficiencies; and need for life-long medical follow-up."

"Given these concerns," he said, "it would be difficult to recommend duodenal switch without demonstrating a significant advantage over the gastric bypass, which is generally a very effective operation in severely obese patients. Our study demonstrates an advantage with regards to weight loss."

"We still need longer-term data on these patients," he added. "We are currently comparing nutritional outcomes and improvement in obesity-related medical problems, including type 2 diabetes, high blood pressure, elevated cholesterol levels, acid reflux, and obstructive sleep apnea in these patients. We don't know yet how much weight loss we need to get those health benefits, but losing more of the excess weight certainly seems to be better."
###

Additional authors of the study were John Alverdy and Roy DaVee of the University of Chicago.

[Coventina]

11. For a family friend, it really was a life saver

He was going to die if he didn't drop the weight.

Going ahead with the surgery was a gamble, because of the possible complications, but he really had no other choice. As other posters have pointed out, there comes a point when diets and exercise just are not an option.

[dogday]

12. If this surgery were for some cosmetic reasons, I might

could understand, but this is a life saving procedure to help the really overweight individual shed the weight.. Their heart and lungs can't take all the weight....

[bleedingheart]

14. First insurance companies are money making outfits

I know people forget this with regard to health insurance..but all insurance is a money making business.

In cases like Mr. Pittard, there are other options. Gastric bypass has a great deal of risks and if his health insurance gives him the go ahead and he ends up with a myriad of complications then they lose money.

Do I think it is right? No...but that is the nature of our current health care system.

The sad fact is that the other options for Mr. Pittard are also probably not covered by insurance because they would involve his admission to weight loss clinics.

[Horse with no Name]

15. He is the candidate that gastric bypass was made for

Not the women who don't want to diet...yet more often than not, well-insured women that weigh between 200-250 are the ones who take advantage of this surgery.

[bleedingheart]

17. you are correct...

but also remember this...

surgeons like when the risks are in their favor and a lot of surgeons are focusing on the group who weigh between 200-300lbs..
however my cousin who is outide that range can not get the surgery because the bariatric/gastric surgeons tell her she must lose some weight first because her risk of dying under anesthesia are too great.

They told her that her losing the weight to have the surgery would also prove that she was committed to the surgery and the lifestyle she would have to lead.

Meanwhile she broke her hip twice and even then the ortho's would not operate due to her weight...tell me that isn't horrifying...a heavy woman who can't move very well due to her improperly healed hips...

[Horse with no Name]

19. I have seen that more than once

Hip surgery has a high risk of morbidity/mortality in the "ideal" candidate--they are always reluctant to do it in the "not-so-ideal" candidate.
However, on the GB, I guess it depends where you go to do the surgery.
I have known people outside that range that have had the surgery in Dallas. One of the surgeons there will not do it on the 200-250 group because he says that the complications/risks of the surgery outweigh the benefit. I have actually seen patients GAIN weight to meet his weight range.
And then you have docs there that will operate on anyone that has insurance, I have seen someone under 200 lbs get this surgery.
Interestingly, I had a discussion with one of the surgeons about the surgery. It was after I had a patient that started projectile vomiting bright red blood. Asked if he would recommend it for his family. He said, unequivocally, no. His theory is that the surgery hasn't been around long enough (modified Roux-en-y) to know the long term effects of it.
He said that it would be interesting in 30 years to see if the nursing homes were full of s/p gastric bypass patients that were feeding tube dependent.
Indeed. That is an eye-opening prophesy.
Good luck to your cousin.

[auntAgonist]

24. a LOT of the women

on the bariatric surgery lists I belong to 'self paid' for their surgeries. Many go to Brazil to have it done. Many need plastic surgery to remove excess skin and pay for all of that themselves. I had excellent insurance coverage. I had my surgery here in the USA.

aA

[yasmina27]

18. I know 3 people who've had this surgery

The first was my BIL. A great guy - nearly 500 pounds (maybe more) who did not follow order post-op and now weighs - my guess - 300/400 lbs. An improvement ? Yes. Healthy? No.

Another is the mother of my daughters friend. She really didn't need it, IMO. She was overweight, but not grossly obese.

The 3rd is a colleague at work. She actually had to GAIN weight in order for our insurance to cover it. According to what she said, her dr. said she had to be 100 lbs. overweight in order to have the surgery.

Both of these ladies look great now - but at what cost? This is not something I would consider unless I was morbidly overweight.