For Linda Nelson, the difference between weighing 280 pounds and 177 pounds is much more than physical.
“I feel more feminine. Does that make sense?” she says. “I feel more like a lady than what I did.”
Linda, 66, is 103 pounds lighter thanks to stomach-reduction surgery she had last January. She and her husband, Adrian, traveled from their home in Harlan, Iowa, last week to the Omaha office of her surgeon, Dr. Gary Anthone, for Linda's one-year, post-surgery checkup.
Even though Linda is happy with how she looks and feels, the past year hasn't been trouble-free. Getting used to smaller food portions took a while, and when Linda would eat a little too much, she would throw up.
The vomiting stressed her incision and led to a hernia, which required surgical repair and about a month of being attached to a wound VAC. That surgery was performed at the same time Anthone removed an 8-pound apron of abdominal skin that was left behind after Linda lost all the weight. She missed six weeks of work after those procedures after missing 3½ weeks because of the initial surgery, called a duodenal switch.
Anthone said he performs hernia surgeries on his duodenal-switch patients more than half of the time.
“Since I'm one of the last of the guys that does really open surgery rather than the smaller laparoscopic surgery,” he said, “I probably do more hernia repairs than anyone I know. The tension on the incision is pretty great.”
Linda allowed a World-Herald reporter and photographer to observe her stomach-reduction surgery last year. Anthone removed 80 percent of her stomach, took out her gallbladder and disconnected, rearranged and reconnected her intestines. Her doctor had recommended the surgery after diets, weight-loss programs and exercise had failed to help her keep weight off.
(Photo gallery: Linda's surgery and transformation)
Linda had Type 2 diabetes for four years before the surgery, and developed a severe blood infection about a year before the procedure. She would become winded walking up the couple of steps into her house. She bent over when she walked because of the abdominal weight she carried.
“A couple years back, she fell down in the yard one time,” Adrian said. “Because of it being a little slick and her being so overweight and that, she couldn't get up.”
“And I fell a lot more when I was heavy,” Linda said. “I haven't fallen since.”
She also hasn't had to take any diabetes medication since the surgery. Pre-surgery, she gave herself twice-daily insulin shots and took two different pills twice a day.
Anthone said the latest statistics show that 90 percent of duodenal-switch patients don't need diabetic medications two years after the surgery. The percentages are 50 percent for sleeve gastrectomy and 60 percent for gastric bypass, he said.
“If you have diabetes, that requires insulin,” Anthone said, “that's why patients generally choose DS.”
Linda's A1C, a measure of a person's average blood-sugar level over a two- to three-month period, is 5 percent. Normal is 4.8-5.9, Anthone said. Her level used to be 8.4. Her triglyceride level, which measures fat in the blood, is 71. Normal is under 150. Her total cholesterol level is 175. Doctors generally like it to be under 200.
Those are the good numbers. Her ALP, used to help detect liver damage or bone problems, is 118, which Anthone said is above the normal level. “Sometimes, when we remove the gallbladder, the level goes up,” he said. And her vitamin D3 level is 24, which Anthone said is low. Linda takes a vitamin D supplement.
A couple of months ago, Linda started to have foul-smelling gas. “That is the worst side effect for a duodenal switch,” Anthone said. “We ask patients to take a probiotic. Linda's already on a probiotic called Align. Then there's some other products, (one is) called Devrom. It's like an internal odor neutralizer.” Linda will start taking that.
Consuming milk products bothers her, and if she forgets to take an anti-heartburn pill in the morning, heartburn will wake her up at night.
Linda said the positives outweigh the negatives. Her oldest grandson, who saw her on Thanksgiving for the first time in months, didn't recognize her. “He walked right past me and didn't even notice me,” Linda said.
She has gone from a size 22/24 pants and shirt down to a 12/14. The clothes she buys today, she said, cost less than the ones she used to buy.
The bill for the two surgeries was $100,000 combined, but because of insurance, Linda has had to pay only $4,000. Not all insurers cover the procedure.
Anthone said Linda has done a good job handling everything post-surgery. “Linda is what we call a 'Cadillac patient,'” he said. “You sort of do the surgery and it's low maintenance after that.”
Adrian said he used to have to wait for Linda to catch up with him when they shopped. Now, he said, he must pick up the pace to keep up with her.
“She's just more fun to be around.”