Debra Poetter seemingly had tried everything to lose weight, at times dropping as many as 50 pounds, but was never able to keep the weight off. Driven by concern that her weight was causing serious health problems, including high blood pressure, two knee replacements, and sleep apnea, the 55-year-old Spokane woman sought a more aggressive solution.


In January, surgeons at Holy Family Hospital installed whats called a Lap-Band in her abdomen. The device, sold by pharmaceutical giant Allergan Inc., reduces the size of the opening to a patients stomach, drastically curbing the amount of food the patient can consume and creating a sensation of fullness when the patient eats small amounts of food, says Dr. Lee Trotter, the Spokane surgeon who did Poetters surgery.


Trotter says use of the Lap-Band is gaining momentum as a tool in treating obese patients. Its employed along with a highly restrictive and specialized diet that Trotter says patients would be too hungry to withstand without the surgery. Patients who have the so-called bariatric surgery can eat only about 1,000 calories a day, he says.


What the band itself does is fairly simple, Trotter says.


The surgery helps tone down those hunger feelings. It fakes your brain into thinking you are full, he says.


His patients who have had the procedure typically were between 100 and 125 pounds overweight, and generally have lost about 70 percent of their excess weight after the surgery.


Holy Family Hospital began offering the procedure in August in its new surgical bariatrics program. So far, Trotter has performed about 25 of the outpatient procedures there. The surgical bariatrics program coordinator facilitates monthly support groups and answers questions for patients before and after they have their surgery.


In addition to his Holy Family cases, Trotter has performed about 20 of the procedures at Valley Outpatient Surgery Center over the past year. That center is owned jointly by Empire Health Services, of Spokane, and Birmingham, Ala.-based HealthSouth Corp. Also, Post Falls surgeon John Pennings has been emplacing the devices for about the same amount of time at his Surgical Bariatrics Northwest Clinic, in Post Falls.


A bariatric surgery program operated jointly by Rockwood Clinic PS and Sacred Heart Medical Center & Childrens Hospital has started seeing patients for the Lap-Band procedure and expects to begin placing the device in patients this summer, says Dr. Mathew Rawlins, a surgeon who directs that program. Rawlins and Dr. Andrew Bright have been performing another form of bariatric surgery, called Roux-en-Y gastric bypass, through that program since 2000. Deaconess Medical Center currently doesnt have a surgical bariatrics program, hospital representatives say.


The Lap-Band and Roux-en-Y gastric bypass are becoming more accepted as solutions to a host of obesity-related health issues, and studies are beginning to show that the procedures are effective to address those issues, Rawlins says. He says he performs the gastric bypass surgery to address the health problems his patients have as a result of being obese, and not just to address their weight issue.


About 85 percent of patients (who have Roux-en-Y) have their diabetes go into remission and have normal blood sugars after surgery, he says. The other 15 percent generally see a significant improvement in their blood sugars.


Poetter says she believes the Lap-Band will change her unsuccessful track record with weight loss. Since having the device implanted, Poetter has lost 56 pounds, and says shes already experienced significant health benefits from the weight loss. Poetter, who had other breathing problems besides sleep apnea, says those problems have been largely resolved, and she also has been able to cut back on her blood pressure medications.


Poetter, who now weighs about 220 pounds, says she will be happy if her weight falls below 200 pounds, though she says Trotter would like to see her reach 150 pounds. Mostly though, she just feels better overall, she says.


It rocks for me, Poetter says. Im going to try to get on my bike this summer.


To be a candidate for bariatric surgery, a patient must be clinically obese, meaning they have a body mass index of 40 or higher, or a body mass index of 35 or higher accompanied by other weight-related health problems, such as diabetes, says Linda Cox, surgery coordinator for the Holy Family surgical bariatrics program. A woman who is about 5 feet 6 inches tall and weighs 245 pounds would have a body mass index of about 41 and could be a candidate for the surgery, Cox says.


In the Lap-Band procedure, a surgeon makes several laparoscopic incisions in the abdomen, through which surgical tools and the Lap-Band device are inserted. The device includes a hard plastic band, which is attached around the upper part of the stomach, and a small tube with an injection port at its end. The injection port is implanted just beneath the skins surface, and is used to adjust the Lap-Band later after surgery. Trotter says the surgery takes about an hour, and the patient normally spends another hour in recovery.


Typically, the band is tightened after about two months, Trotter says. To do that, a physician injects saline through the skin and into the injection port. The fluid runs through the tube to the Lap-Band, and partially fills a balloon around the inside of the band, making the opening to the stomach smaller. Trotter says some patients may have their Lap-Bands adjusted several times the first year, while others dont need any adjustments.


The Roux-en-Y is a more aggressive surgery. Doctors here say they typically perform that surgery with laparoscopy as well, but it involves reducing the size of the stomach to a small pouch and bypassing the main part of the stomach by attaching that pouch directly to the small intestine. Patients who have Roux-en-Y have a slightly higher risk of developing ulcers than they did before the surgery, but tend to lose weight more quickly than those whove had the Lap-Band procedure. Over time, however, the results from the two surgeries are similar, Trotter says.


Cost is a factor. Trotter says the Lap-Band costs about $17,000, while a Roux-en-Y procedure, which typically involves a hospital stay of several days, costs about $30,000.


Trotter and Rawlins both say the key to success in bariatric surgery, whether its Lap-Band or Roux-en-Y, is support for the patient before and after surgery to ensure the patient makes lasting lifestyle changes. Both Holy Family and Rockwood Clinic offer pre- and post-surgery support programs, and Lyndee Chatterton, administrator of Valley Outpatient Surgery Center, located at 1414 N. Houk, says that facility also is developing a support program for its Lap-Band patients.


Trotter and Rawlins both say that while the surgical treatments are tools to help their patients lose weight, the surgeries themselves dont solve the obesity problem. Patients who dont follow through on the diet restrictions can get sick, overstretch their stomachs, or end up suffering from malnutrition.


Thats why surgical patients must first go through psychological testing to determine if theyll be able to handle the rigorous lifestyle changes they must make following surgery. Both doctors put their patients on diets before the surgery, and their patients meet with dietitians.


Trotter says patients who have the surgeries can eat so little that what they eat becomes extremely important. He says such surgical patients typically must consume 60 grams of protein daily, some of which comes from a protein shake he designed with Metagenics Inc., a San Clemente, Calif.-based medical food company. Patients also take a quickly absorbed multivitamin daily, which Trotter says he also developed in collaboration with Metagenics. The other main dietary element is vegetables, and Trotter says that beyond vegetables and protein, there isnt much more such patients can eat.


Trotter says he discourages patients from eating anything processed or that has so-called empty calories, which basically add calories but no nutrients, to the diet. He coaches patients on grocery shopping, telling them that when they enter the store, they should bypass the bakery, then everything around the perimeter of the store is pretty much their safe zone, including the produce, dairy, and meat sections.


Within those guidelines, Trotter says he encourages his patients to devise their own meals, adapting things they ate before the surgery. He says, however, that theyll eat much less of whatever it is theyve eaten in the past.


Trotter sees his patients once a month for at least 12 months following the surgery. He never uses weight as a measure of success. Instead, he checks the patients body composition, and if he or she hasnt lost fat, or has lost muscle, he helps them hone their diet and lifestyle choices until they get it right.


Trotter says his patients through Valley Outpatient Surgery Center have had such good success that HealthSouth is considering instituting similar programs at its surgery centers throughout the country.


Contact Jeanne Gustafson at (509) 344-1264 or via e-mail at jeanneg@spokanejournal.com.