by Mike Liguori
The specially trained nursing staff of Swedish Medical Center’s bariatric surgery center has a lot of admiration for patients.
"It’s a pretty huge decision to make that type of change," said charge nurse Donna Thompson.
Some estimates say as many as 10 million Americans are morbidly obese, a condition generally defined as more than 100 pounds over ideal body weight or having a body mass index of 40 or higher.
Bariatric procedures were first performed in the 1950s, and many advances and improvements have been made through the years. For patients, however, it remains a drastic step.
"They’ll never be able to go out and eat a whole bunch for the rest of their lives," Thompson said. "We admire them for making that decision and being willing to stick by it. These people are very motivated. They have a huge support system. They have studied a lot and they don’t make the decision overnight."
Swedish maintains a medical team and dedicated unit focused exclusively on two types of bariatric procedures, Roux-en-Y gastric bypass and Lap-Band.
Patients have to go through a complex preparation before the surgery. They learn about the surgery and are evaluated for mental and physical fitness for the procedure.
"They have to clear psychologically for the huge change coming in their lives," Thompson said.
Thompson said patients having the Roux-en-Y are usually at the hospital two to three days, while the banding patients usually stay only one night.
"Some of those [Lap-Band] patients go home the same day," she said. "We’re doing more of the bypass surgeries than bandings, but we’re seeing more bandings now, too."
The eighth floor bariatric unit has specialized equipment for obese patients, and the unit’s team is continuously trained in the latest weight-loss science and support for the special emotional needs of patients.
The procedure has a larger mental and psychological component than other types of surgeries, Thompson said, and there are many issues that come up afterwards. Patients second-guess their decision to have the surgery. Some worry about losing a significant other because they’re afraid they will become a different person.
"You have to have a pretty supportive family behind you, because much of our lifestyle is built around food. That is a big change in their lives," Thompson said.
The average length of stay at Swedish after bariatric surgery is 2.3 days compared to the national average of 3.4 days, according to hospital officials. Bariatric procedures are not always fully covered by patient insurance, so efficient care helps make the surgery a more affordable option.
After surgery, bariatric patients can only ingest 2 ounces of clear, sugarless liquid at a time.
"You need to keep reminding and teaching them about the new diet," Thompson said, adding that patients generally begin by taking one two-ounce cup of juice or broth every half hour or so.
"They don’t get very much," she said.
"Most of them are pretty astonished to find out that one of those little cups makes them feel full. They have to learn what it feels like to be full with the little pouch. They can get nauseated very easily," she said.
She explained that when patients come back from surgery, they all experience a different level of pain depending on the type of procedure and other factors. All patients are encouraged to get up and sit in a chair on the first day.
"It’s important to get up and get moving quickly," Thompson said.
She explained that patients, who are often around 300 pounds but can be as heavy as 500, are at tremendous risk for blood clotting after surgery, and most are put on anti-coagulants.
She said big people have problems breathing in bed, which can raise their temperature and cause other problems.
Thompson said most patients have significant secondary problems related to obesity, including diabetes, high blood pressure and sleep apnea. Many of the secondary issues are resolved pretty quickly after they start losing weight, she said.
She said getting patients to understand that improvements will come quickly is among the more challenging aspects of bariatric procedure nursing.
Thompson has many years of experience in general surgery, but said she and other nurses were a bit leery at first when told about the hospital’s new bariatric treatment.
"When you think of a 300- to 500-pound person having surgery, you think, ‘How are they going to get out of bed?’ But most of these patients are very motivated to make a change in their life," Thompson said.
"It’s pretty rewarding, actually. A few people come back to see us afterwards. They’ve lost 100, 150 pounds, and you don’t even recognize them."
The hospital’s bariatric surgery center has been recognized, however.