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Gastric Bypass Patient who Had Her Surgery Performed in Bangkok Thailand Health Care Facilities Safely and Afforadably
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Shedell
Hubbard is outgoing, articulate, intelligent, bright and funny,
exuding good will and interest in life, as if she hadn't a care in
the world. Shedell Hubbard, however, is also, at 146 centimetres and
95 kilograms, classified as "morbidly obese". On January
19, 2004, after years of fighting her weight problem, the
Californian made Thai history as the country's first laparoscopic
bariatric (or "weight") surgical patient.
Laparoscopic surgery is not new to Thailand, but using it for
bariatric surgery is. At Piyavate Hospital, Shedell, 51, underwent
the hour-long operation, also called stomach stapling or gastric bypass
surgery.
Inserting laparoscopes (small optical instruments) through tiny
incisions in her abdomen, the surgeons used equally tiny scalpels to
cut the stomach and form a small pouch, which they connected to a
portion of her small intestine. |
The surgeons conducted the procedures by sight - watching every cut
and snip on a computer screen, through a voice-operated computer
called Aesop (Automated Endoscopic System for Optimal Positioning).
This particular surgery was developed around 10 years ago by a
surgeon who is now with Laparoscopic Bariatric Specialists (LBS), a
clinic at the Garden Grove Medical Centre near Los Angeles.
Throughout the US, other clinics using other procedures are carrying
out laparoscopic bariatric surgery on a growing number of obese
people. In the US alone, more than 103,000 operations were performed
last year.
Along with the growing number of stomach bypasses, the number of
deaths, as well as health problems, has also risen.
According to the International Bariatric Surgery Registry, one in
1,000 patients will die within four weeks of the surgery, and three
in 1,000 will die within three months.
Wound infections, stomach leaks and occasionally life-threatening
blood clots can result, as well as bowel obstruction.
"Any surgical procedure involves risks",
admits Dr. Michael Miller, director of the LBS International
Bariatric Programme and Regional Training Centre in Laparoscopic
Surgery.
Dr. Miller, however, insists that as the procedure has been refined
over the years, health problems resulting from the surgery have been
reduced.
After a career in family and emergency medicine, Dr. Miller joined
LBS five years ago as manager and medical director. On a visit to
Thailand in 2001, he realised that Bangkok could become a
laparoscopic bariatric centre for the region.
"Thailand has good hospitals, the nurses are well-trained and the service is
tremendous", he points out.
Piyavate Hospital provided the best mix, and now Dr. Miller's baby,
supported by the LBS team of surgeons and nurses in the US, takes up
a floor in the hospital. The project is also supported by Dr. Boon
Vanasin, chairman of Piyavate and Thonburi Hospitals, who
understands the financial and social benefits of the procedure only
too well.
Obesity rates in the Asia-Pacific region are rising, along with
additional burdens on the healthcare system. A 2000 World Health
Organisation report, which defines obesity as a condition in which
there is an excess of body fat, blames reduced levels of physical
activity and dietary changes occurring with westernisation.
How much fat is too much? Physicians once thought that Asians were
less likely to be obese than westerners and were therefore less
likely to suffer from diseases such as diabetes or heart disease,
where obesity is a major factor.
"It's sad", says Dr.
Songsak Kornsuthisopon, who is Shedell's doctor-in-charge at
Piyavate. "I attended training courses in Australia six
years ago. At that time, I was invited to observe gastric banding techniques,
but I refused. I thought it was useless because Thai people are so small. Now
the situation has changed."
In 1997, the WHO, recognising that obesity was rapidly becoming a
worldwide problem, established an international standard: The Body
Mass Index (BMI), which is calculated by dividing a person's
weight in kilograms by height in squared metres.
A BMI of 23 to 24 is considered normal, 25 to 30 is overweight and
above 30 is obese or morbidly obese.
The BMI, however, is only one of many measurements of a person's
condition.
"Although the BMI is currently the main tool for quantifying
obesity, it is flawed bcause it doesn't take into account bone
structure, muscle mass or per-cent body fat - let alone
distribution of body fat", says Prof. Philip James,
chairman of the London-based International Obesity Task Force (IOTF). |
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In addition, up to 2000, most studies that examined health risks associated with
obesity - diabetes, hypertension, bone problems and congestive heart failure
- were based on data from Westerners, but these health risks had begun
appearing in people with lower BMIs in the Asia-Pacific.
The WHO report gives one reason: That Asians, with smaller waist circumferences,
"tend to accumulate intra-abdominal fat without developing generalised
obesity". |
Medical Director and Laparoscopic Surgeon with Gastric Bypass Patient After Surgery at Bangkok Hospital in Thailand
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Instead of the WHO BMI standards, different standards need to be developed
according to culture, says the IOTF, which now suggests that the BMI standard
for Asians should be lowered to 23.3 as one means of assessing obesity-related
health risks.
Calling it "a bitter irony that as developing countries continue their efforts
to reduce hunger, some are also facing the opposing problem of obesity", the
IOTF is now evaluating issues of per-cent body fat and waist-to-hip ratios.
With the global obesity epidemic, Dr. Miller expects 20 to 30 patients a month
by the end of this year, and 40 to 50 from all over Asia in two years. The
centre will also eventually act as a centre for training surgeons and nurses
from Asian countries. Whether a gastric bypass or
banding, whether laparoscopic
or traditional, bariatric surgery will not help every obese person.
LBS and other responsible clinics carefully screen potential patients and
eliminate habitual drug users and people with compulsive eating disorders.
Patients must be morbidly obese, at least 45kg over optimum weight, and their
BMI at least 30.
In addition, patients are accepted for surgery only after they've exhausted
all other options. "That stereotype of a lazy, fat person - forget it. These
people are desperate and depressed by the failure of all the other methods
they've tried", says Dr. Miller. "And their life is at
risk."
Shedell easily qualified. "I've always been overweight, say, around nine
kilograms too much", says the nurse, who works in the labour and delivery
department of a hospital near Los Angeles. Her 12-hour shifts should have kept
her active, but her love of sweets did her in.
"Give me candy, cake, chocolates, I'll eat them all. They're my comfort
food", she says.
As the kilograms piled on, she turned to fad diets and pills. Some helped, but
as soon as she stopped, the weight marched right back on. She couldn't even
walk comfortably because her feet hurt all the time.
When her sister had triple bypass surgery at age 38, warning bells rang. "I
knew I had to do something", she says, "and
I began researching options."
Her research led her to nearby LBS and to Dr. Miller, who was looking for
Piyavate's first bariatric patient. Although she had considered other
surgeries and other clinics, Shedell was immediately attracted. She had already
visited Thailand three times.
"It's my favourite country, along with Ireland", she says.
Cost is another consideration. Charges, including medicine, surgery, treatment
and hospital stay, come to US$ 11,500.- (Baht 449,000.-), a third of what
patients in the US pay.
A few hours after surgery, she is sitting up and instructing the nurses on
procedures (a good sign in a recovering patient who's also a nurse).
"I had some mild pain on the first day, but nothing I couldn't handle,"
she reports. After seven days in Thailand, she flew home.
The new Shedell will develop slowly. "I know that the
surgery is not a weight-reduction technique in itself, but a life-long hunger-management
regime", she says.
With her smaller stomach, her food intake will be reduced. Eventually, she'll
be able to eat almost anything, but in much lower quantities. She'll no longer
snack between meals. She'll have to exercise regularly. In addition to routine
physical examinations, she'll take vitamin and mineral supplements for the
rest of her life to avoid deficiencies. She should reach her optimum weight of around 49 kg in a year to 18 months. |
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