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Going under the knife for a new life December 10, 2006 Yet she still smiles. Even now she smiles. And laughs. And makes jokes. Even now, as she lies in a hospital bed, shivering uncontrollably because she's cold, but also because she's afraid. Stacy Adams has wanted to be skinny since she was 12, her mother, Cathy, says. Today, she weighs about 280 pounds. She's wanted to blend in with the people around her, to keep up with her partner, Nicole, at softball, to dance at a nightclub freely, without some guy making fun of the "fat girl" behind her back. But the 29-year-old Valparaiso woman has gone about it the wrong way. She fell victim to an eating disorder using diet pills and laxatives. She gave Jenny Craig a shot, but she didn't stick with it. The depression, and the urges, were just too great. For a period of two years, she would even eat in the middle of the night, still in a trance, almost as if she were sleepwalking. She said she's never even felt full. Stacy is one of the many people increasingly undergoing bariatric surgery when nothing else has worked. Some 171,000 people in the U.S. had the surgery last year. That compares to 47,200 just five years ago. As America grapples with what's been dubbed an obesity epidemic, more people like Stacy are turning to a bariatric operation for help. Just one hour. From incision to completion, an hour. Yet when she awakes, life won't be the same. Dr. Paul Stanish and his team begin digging into the flesh of Stacy Adams. Like dancers in sync, they swiftly move their instruments into Stacy's skin, almost moving to the beat of The Bangles' "Walk Like An Egyptian" playing on the operating room's radio. Watching their progress on a television monitor, they snip and probe and pull and push and rip, their patient in a heavy slumber, unaware of the foreign band about to invade her body. Just one hour. It looks easy. But it's dangerous. Near the site of the operation lurks the spleen and the esophagus. If ruptured, things can go horribly wrong. Things can always go wrong. It's an operation. Complications occur. Many would say, bariatric doctors and patients included, that a gastric bypass operation and the adjustable gastric band surgery that Stacy is undergoing are drastic. Others would say the surgery is too drastic. But many of those critics have never suffered from morbid obesity or eating disorders. It's a surgery with a 0.1 percent to 0.5 percent mortality rate. A surgery that can have serious complications because of patient, and sometimes doctor, error. If a diet isn't followed, if portions aren't maintained, if food is eaten too quickly, if food is eaten while drinking water, if a patient takes up smoking, if a patient drinks alcohol, things can go bad. Sometimes, really bad. But these are operations that can by and large reduce type 2 diabetes, hypertension, obstructive sleep apnea and high cholesterol in a large majority of their patients. And they can lend new hope to people who for years, maybe even a lifetime, have given up on themselves. Best chance Stacy Adams admits she knows the difference between right and wrong. Many of her lifestyle choices have been wrong. Bariatric surgery is her best chance, she feels her only chance, to keep her portions in check, to motivate her to exercise, to live longer, and ultimately, to be happy. Having undergone a liquid diet before the operation last Tuesday, the Valparaiso resident said goodbye to Cinnabon and Oreos. Some day, she may be able to enjoy such delicacies in extremely small portions. But she sees that as a small price to pay for what else she'll lose. She'll lose the stigma of standing out because of her weight. She'll lose the laziness she feels when she plays sports. She'll lose the fear she has of wearing a bathing suit. She'll lose the pain in her knees. She'll reduce her chance to get diabetes, a disease that cost her grandmother both of her legs, as well as her life. She hopes she'll lose her depression, too. Stacy Adams used to perform a little test on the people she'd pass by when walking down the street. She'd look at them and smile, searching for recognition, for eye contact, for acceptance. And over and over again, the eyes she tried to meet would dash away from hers. Sometimes they'd land on the sidewalk, other times on the more slender Nicole, walking by her side. And on some occasions when the glances would meet, Stacy said she would often see disgust staring back at her. But today, all she sees is love, from the eyes of her mother, her father, and Nicole. They're worried too, naturally. "She brings out the best in people," Bob Adams says of his daughter. Now with the surgery, Stacy Adams is hoping to bring out the best in herself. A growing trend In the course of the last five years, the number of bariatric surgical operations has more than tripled, according to the American Society of Bariatric Surgery. But it's not just that Americans are getting larger, but it's also because insurance policies are covering more operations in full than ever before. Bariatric surgery is even covered by Medicare as of last February. And Indiana is prime territory to tackle this trend, as it is among the country's 10 most obese states, said bariatric surgeon Dr. Paul J. Stanish. Stanish and The Methodist Hospitals in Merrillville, where he performs gastric and lap band procedures, are in the final stages to become certified as Centers of Excellence by the American Society of Bariatric Surgery. With that distinction, the operation numbers are expected to grow as more insurance companies will direct obese clients to have their surgeries there. And St. Margaret Mercy in Dyer offers both procedures as well. The ultimate goal is to reach a point where bariatric surgery is not necessary. Stanish believes such a goal is possible, if not soon, maybe some day. But until that day comes, there will be gastric bypass, there will be the lap band operation, there will be ways for people who can't get slimmer themselves to get slimmer with science. These are the stories of four people who have taken such a leap. Taking a chance "I look like a centerfold in this," Bonni Boilek says with a hearty chuckle, as she observes herself wearing a snazzy snug outfit at the Dress Barn in Valparaiso. At first Bonni seems to laugh at the ridiculousness of the situation, as if she, a 62-year-old mother of two, could ever possibly be likened to a Playboy bunny. But there's something more to Boilek's laugh, to her smile, to the way her eyes light up as she looks into her reflection. It appears to be pride. After struggling with weight problems for years, and consequently struggling with her self-esteem, Bonni underwent an adjustable gastric band, or lap band, procedure. She feels like a million bucks, most of the time, whether she's with her family in her dining room or enjoying a shopping spree at a clothing store with a handful of complete strangers. At the home in Schererville she shares with her husband, Ed, and son David, Bonni finds an old photo of herself when she was approaching the 258-pound mark. Bonni stands tall in a red dress on the deck of a boat, her smile spread wide. But in the photo, Bonni is hiding behind a wooden pole, a conscious attempt, she says now, to conceal her body. "I looked as big as the boat," Bonni says. She wasn't proud of her lifestyle: little exercise, bad eating habits, and a treadmill that was used primarily as a coat hanger. She wasn't always like this. In high school, she stayed active as a cheerleader, and she was so thin her mother would joke that she had a hole in her stomach. But when she gave birth to her second son, David, she began to lose the battle with her weight. Again and again she dieted. And again and again she failed. "I thought if I didn't do something pretty soon, I'm probably going to die," Bonni said. "It couldn't be good on the heart, all that gaining and losing." After a three-year search, she discovered that her husband's health insurance would cover her weight-loss surgery at The Methodist Hospitals in Merrillville. Choosing between gastric bypass surgery, en vogue with celebrities such as Carnie Wilson and Al Roker, and the lesser known, less expensive adjustable gastric band operation, Bonni sided with the latter. The thought of gastric bypass, of part of her bowel being cut off, of the pain she could feel, scared her tremendously. And there were the cases she'd heard about of gastric patients sabotaging their own progress. The lap band, placed around the stomach, could be easily adjusted if Bonni felt that she needed more food or wanted to be less hungry. And the entire process is reversible. But Paul Stanish, her doctor, didn't think it was the right decision. "Metabolism is lower (for older patients) so they're not burning off calories as quickly as younger patients," Stanish said. With the lap band procedure, Stanish said, weight loss is typically slower, and positive results can take up to a year to develop compared to a month with gastric bypass. "I don't want to do the surgery ... and have a patient become frustrated," Stanish said. "With frustration, what happens? People start to get angry and they want to eat. That's not a good population to piss off." But Bonni surprised Stanish, losing 60 pounds in four months. She came back from her latest trip to the scale weighing 170 pounds. "It's fantastic," says her husband, Ed. "And it's hard work. It's not just an operation you can walk away from. It's continuous work you have to do." With her centerfold-worthy outfit, Bonni is one of 10 models to hit the runway on a recent November Saturday. The lights from cameras flash all around them, and the music is booming. But this isn't your average fashion show. The models all represent successful weight-loss surgery patients, operated on by Stanish and his colleagues at The Methodist Hospitals. Against the odds Tears well up and applause roars through the banquet room every time a former patient sashays down the runway. But perhaps the most emotional group of all is the group of people sitting at Kim Brakley's table. Today, the tears are from joy. But the 29-year-old Lake Station resident has had a lot of sad days because of her obesity. That shame culminated in a visit to Six Flags Great America. On that day, Kim stood in line with her friends, waiting to ride the Iron Wolf stand-up roller coaster. Yet when it came time to board, she was simply too large, and all the efforts from an employee to push down on her harness didn't work. She walked toward the exit, friends and strangers looking on. Her mother estimates she weighed 185 pounds in seventh grade. Kim estimates she gained about 20 pounds a year. At her heaviest, Kim clocked in at 332 pounds. If she truly were disciplined enough, to have worked out, to maintain a diet, and to never slip up, it could have taken years to get to the weight she reached mere months after her gastric bypass. Now she can fit into a pair of jeans worn by her 13-year-old cousin. And she can fit on the Iron Wolf, too. Kim made a special trip last summer to ride all of the park's roller coasters. She's also enjoying a new romance with an old friend. About five months after the operation, Kim was contacted by her former classmate, Hugo Barajas, through MySpace. The two have been dating since July. The operation greatly worried Kim's stepdad, Keith Soderquist, who again and again asked his stepdaughter if she wanted to go through with it. Kim's mom, Debbie, waited patiently during the operation, praying with all her strength, and recalls thinking, on the day of the operation, how shocking it was that her daughter's weight problems had come to this. Kim says she doesn't miss her old habits or her old life -- but she's afraid at times, that she'll someday stop exercising and eat her old portions. Kim doesn't want to slip up again. She has people in her life who show her why. There's one of her friends, a large woman, who recently had a heart attack. Her friend is only 27. And then there's her father. Once an avid smoker, Kim said he suddenly quit 18 or 19 years ago. But then he started gaining weight. He was about 230 pounds back then. Today, she estimates he weighs about 450 pounds. Kim said she's spoken to her father time and time again about his weight. Her father has been casual about her own operation, and her new lifestyle, and about his own weight problem. Kim asked for her father to be at the fashion show, to see her walking down the stage, slimmer, more fit, happier. To relish in her success. But when the day came, Kim's father didn't show up. Not an easy fix It all came crashing down on Jason Dulla. The sudden weight loss. A new, difficult diet to follow. The stress of quitting his old job and starting a new business. The cravings he had for a cigarette. Something had to give. And it cost him. Dulla was one of the 10 people to participate in the bariatric surgery fashion show where Bonni and Kim were also models. From 342 pounds, he dropped down to 185 pounds thanks to a gastric bypass. A success story. Dulla walked down the runway, visibly a leaner, healthier man, smiling widely, welcoming and deserving of the applause of the audience, and later the hugs of his wife, Stacey, and his 5-year-old daughter, Destiny. But that night, around 11:30 p.m., Dulla suddenly shot up in bed and began coughing up blood. He was rushed to the hospital, for the fourth time in two and a half weeks. By now it was practically routine -- Dulla would get ill, start vomiting blood, and drift in and out of consciousness, covered in a cold sweat. It had to stop. And the way to do it was with another gastric bypass. Jason had undergone his first operation in October 2005 to enhance his life. But when he was home, spewing out blood clots, grappling for consciousness, ghostly white, Jason Dulla thought he was going to die. Jason and his wife believe that something might have gone wrong with the first operation that led to his complications. But Jason admits he may have not helped matters. In addition to quitting his old eating habits, Dulla had another demon to slay: smoking. He has smoked for 12 years, his wife is still a smoker, and he was forced to quit, cold turkey, two weeks before the operation. He is not supposed to smoke ever again, as smoking can cause complications. Late last spring, Dulla gave in. Smoking helped, taking the edge off of his postsurgery stress, and the stress from his new lawn care service. He didn't smoke as much as he once had. But there were days where he lit up 10 or 12 cigarettes. Then in late October, it apparently began to catch up to him. Paul Stanish, Jason's surgeon, believes the cause for the bleeding ulcer and the blood vomiting was the smoking, contrary to the Dullas' opinions. Smoking can often lead to such complications in gastric patients. Jason was opened up, something he longed not to do with the operation in the first place, and fixed up with 20-some staples in him. Back to square one. Back to the liquid diets and pureed foods. Back to quitting smoking, yet again. But Jason said he is coping. His weight is down. His family has been supportive. A gastric bypass operation is not a magic pill. The weight suddenly disappears, but it's up to each patient's discipline to make sure it will stay off, and to generally live a healthy lifestyle. Jason, and the others, will struggle on. Hope wakes Stacy was consumed by fear moments before her operation. Her partner, Nicole, waited anxiously in a nearby room. They grappled onto any small positive omens to get them through the day, to help conquer their fear that Stacy may never wake up. And there were the words of Stacy's nurse, Kathy Duszynski, herself a lap band patient. Telling her story to Stacy and Nicole, Duszynski uttered five simple words that gave them the encouragement to go through with it: "I got my life back." When the operation ended, Stanish came to the waiting room to give Nicole and the Stacy the news. A resounding success. Upstairs, in the hospital room where Stacy will spend the first night of the rest of her life, Stacy wakes, and hears the voice of Nicole talking excitedly in the hallway. It's over, Stacy thought. The operation was finally over. But really, it's just the beginning.
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