After Assisting in Bariatric Surgeries, O.R. Nurse Chooses It for Herself
With a sleeve gastrectomy, Mandy Pate, R.N., has lost more than 50 percent of her body weight. Still, the operation is not a decision to be taken lightly, she says.
It wasn’t long into her tenure as an operating room nurse that Mandy Pate, R.N., realized the same type of bariatric surgery she helped doctors perform on others could benefit her as well.
Despite countless efforts to lose weight, insatiable cravings left the 36-year-old unable to shed pounds.
“All I could think about was food; it was like a junkie needing their fix,” says Pate, who, at her heaviest, had 333 pounds on her 5-foot-3-inch frame. “If all of a sudden a brownie sounded good, I would have to go to the store to get one. The urge was that strong.”
It’s why Pate, a Michigan Medicine employee since 2008, sought out more information about receiving a sleeve gastrectomy herself.
In the surgery, about 80 percent of the stomach is removed, greatly reducing its storage capacity and, as a result, limiting production of the hunger-producing hormone ghrelin. Unlike a gastric bypass, in which the stomach is divided in two and the small intestine is rearranged to connect to both parts, a sleeve gastrectomy is less likely to cause “dumping syndrome” — a condition where food moves into the small bowel too fast after eating.
Both surgeries are permanent and have a one-year mortality rate of 0.1 percent.
At Michigan Medicine, sleeve gastrectomy has surpassed gastric bypass as the most common procedure for patients seeking weight-loss options. Gastric bypass was the subject of an extensive New York Times story last year that focused on two Michigan patients.
Like those featured in the Times, Pate’s decision was a big one.
“If you’re going through something that’s changing your body, it’s obviously scary,” she says. “But I was really excited because I thought, ‘This is going to be what I need; this is going to work.’ If I’m positive, I’m going to have a positive outcome.”
Now at 160 pounds and with a new attitude toward food and fitness, the Ann Arbor resident is happy to share her experience with patients at Michigan’s Adult Bariatric Surgery Program.
But she’s quick to emphasize that the surgery “is not some magic cure.” Lifelong lifestyle changes are necessary. Emotional reactions to a new body and relationship with food must also be addressed.
Still, “I tell people it saved my life,” says Pate, who recently spoke more about her journey.
As an adult, how did your weight affect you?
Pate: I had a lot of joint pain standing on my feet all day. It would be hard to stand and move around in the operating room. I really loved my job; it was creating an issue.
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I would come home and I couldn’t even walk. I would have really bad reflux at night where I would aspirate and choke. I was getting concerned I would end up dying of a massive heart attack if I didn’t get my weight under control.
How did you move forward with getting the surgery?
Pate: You don’t just make an appointment. There’s a lot of work patients go through. I had to go to an information session and see a physician’s assistant. I had a three- to four-hour psychological exam to ensure I understood the changes I had to make — and to make sure I didn’t have any other eating disorders that would eliminate me from surgery. I also had to attend two support group meetings.
Some insurance companies require months of documented attempts at weight loss to prove you’ve done everything else you can do. My body mass index was almost at 60, which was high enough my insurance company said I didn’t need to.
Finally, I had to have a sleep study done because they thought I had sleep apnea, which I did. Once my case was submitted and reviewed by everyone who saw me, I scheduled my surgery. I started the process in December 2013 and had surgery that April.
What did surgery preparation involve?
Pate: Once I got my surgery date, I had to go to a four-hour nutrition class. Two weeks before the surgery, I went on a high-protein liquid diet. It was very strict — no fruits, no vegetables.
The purpose is to shrink the liver and make it flexible so they can move it out of the way to operate on the stomach. It also shows the team you’re committed to making dietary changes.
Could you describe your operation and recovery?
Pate: Basically, they’re removing about 80 percent of a stomach to restrict how much you can eat. It was laparoscopic surgery with six small incisions. In the end, the stomach kind of resembles the shape of a banana. You feel fuller faster and you’re not eating as much.
The operation took less than two hours, maybe an hour and a half. I was in the hospital for two nights, and I went home on the third day. I was on a liquid diet for two weeks, then a puree diet for two weeks, then a soft-food diet for a month. I had a very smooth surgery and recovery.
How did you feel?
Pate: Right away, I had a lot of energy. They tell you to start walking 30 minutes a day after surgery. About six weeks later, I committed myself to going to the gym for an hour each day after work, really doing cardio and weights.
And I wasn’t hungry at all. I didn’t believe people in the support group who said that. But I could have gone all day without eating or drinking anything. It’s important for post-op patients to keep drinking fluids or they can become dehydrated quickly.
Still, for me, it was calming to not have food on my mind all the time.
How did surgery change your diet?
Pate: Because I didn’t have a lot of the cravings, I started making changes to my diet. I didn’t bring anything sweet into the house that would be a trigger. I would get creative, making spaghetti squash instead of noodles. My tastes changed. I ended up craving things like fruits and vegetables. I don’t even want the pasta anymore.
One-half to a cup of food is as much as I can handle. I usually do 2 ounces of meat — protein first — and then vegetables. We’re taught not to eat rice, pasta, crackers, pretzels or bread. They balloon in the stomach and you can’t get the other nutrients you need.
What downsides have you experienced?
Pate: Because you lose weight so quickly, you have a lot of excess skin. Also, I wouldn’t always see the weight loss like other people saw it. I would think I looked exactly the same.
In the past year, I’ve had three plastic surgeries to remove excess skin from my arms, legs and abdomen. That’s been a tremendous help. Now, I can see my hard work and I look how I should after losing 170 pounds.
At your day job, what do you tell others considering bariatric surgery?
Pate: A lot of patients are afraid they’ll break the bed or fall off the table or people will make fun of them. I always try to reassure my patients that we’re going to take good care of them, that I’ll be with them, the beds will hold them and all that stuff.
I also tell them it’s OK if you have weight-loss surgery; it’s nothing to be ashamed about. It doesn’t mean you’re any less of a failure than someone who does it with diet and exercise alone. There’s nothing wrong with going to an informational session and seeing if it’s right for you.
If you’re interested in learning more about weight-loss surgery, call 734-647-6685 to schedule an informational meeting with Michigan Medicine.