Medical assistant Alayna Smith confirms that Kathy Bailey has lost 7 inches in the hips, during a followup visit after gastric bypass surgery at Tampa General Hospital.
TAMPA - Kathy Bailey is working on her relationships.
She is making friends with her new stomach, which now tells her in no uncertain terms what she can eat.
She is reacquainting herself with old clothes, pulled from storage where they were banished when they became too tight to button around her 320-plus-pound girth.
She is playing hard to get with the scale. It calls to her daily - how much have you lost? - but she succumbs only once a week.
Bailey is three months past a gastric bypass at Tampa General Hospital. A surgeon dissected and reassembled her digestive tract and made her stomach the size of an egg. She believes the invasive operation is her last chance to lose the weight she has battled for most of her 53 years. The pounds that bring diabetes, high blood pressure, aching joints, crushed heels, sleep apnea and the prospect of an early death.
But her new stomach has a big voice for such a little thing.
A bite of fatty alfredo? Uh-uh.
A swallow not chewed and chewed and chewed some more? No way.
Something sweet? Back at ya, baby. Her stomach rebels against sugars and fats. It will not accept more than a few bites at a time. Cross me, it says, and your heart will race, you will break out in a clammy sweat, shake, cramp, vomit or suffer diarrhea.
This is a whole new kind of discipline.
Three months into her relationship with the new her, she has lost 54 pounds.
"I can feel jawbones," Bailey says. "My mom says when she looks at me straight on she can see my ears."
A losing battle
The pounds first began to best Bailey's attempts to lose them when she was 19 and could not shed the 60 she put on with her first pregnancy. They outlasted dozens of diets. Under one supervised weight-loss program, Bailey, a computer programmer for a major retailing chain in Largo, dropped 145 pounds. She gained it all back in a year.
Researchers increasingly believe there are genetic, hereditary and metabolic factors that contribute to obesity. For many, the problem is not willpower but plumbing: A dieter's body sabotages success.
One of Bailey's doctors suggested she consider gastric bypass.
The controversial surgery is often viewed as a last chance for the morbidly obese: the estimated 15-million Americans who have a body mass index of 40 or above and are 100 or more pounds overweight. More than 70,000 weight-reduction surgeries were performed in the United States last year, triple the number four years ago.
Bailey's BMI was almost 60. At 5-foot-2, she weighed 327 pounds.
"I just want to walk a block without gasping," she said then.
Bailey had surgery on May 28. Dr. Michel Murr, director of bariatric (from the Greek baros, meaning large or heavy) surgery at Tampa General Hospital, removed her gallbladder, cut her stomach in two, and reattached the small intestine to the upper portion, about one-tenth of the stomach and the size of an egg. The procedure limits the amount of food and liquid a person can ingest and absorb.
Bailey's surgery and recovery were textbook - she suffered no serious complications, which occur in up to 15 percent of patients. She took a seven-week medical leave from her job and lived with her mother in Tampa while she healed.
The most difficult work lay ahead.
"Some people can't make the adjustment from a psychological perspective. They'll find a way to keep taking in calories" despite a minuscule stomach, says S. Curtis Takagishi, a clinical psychologist who counsels trauma and obesity clients. "I try and help them understand the reasons they are using food for other than nutrition.
"People who understand (surgery) is a lifestyle change do the best."
Foodie of a different sort
Bailey's face is screwed into a scowl.
She has brought a sack full of empty wrappers and cardboard containers and her latest medical reports to the Tampa office of bariatric nutritionist Jennifer Broder for a scheduled consultation. She is scowling because Broder says it is time she ate vegetables.
"I hate vegetables," says Bailey.
This is a milestone, says Broder. Three months after surgery, Bailey will no longer be relegated to soft and canned foods. She is moving to the "Crispy and Solid Stage."
On a piece of paper listing goals, Broder writes: Try one new vegetable every week. "We'll do half an entree and add a vegetable or salad for a meal. I want you to eat the entree first. The salad is going to fill you up so much."
With her altered stomach, Bailey finds food to be a not-so-familiar friend. Three weeks after surgery, soft scrambled eggs uncomfortably "sat" in her stomach "forever." Orange juice gave her diarrhea. Too much sugar, says Broder. Leftover alfredo for dinner one night made her so shaky she postponed a planned drive to Orlando until the following morning. Bailey has to chew each small bit of food thoroughly because her abbreviated digestive system can't do as much work as it once did.
"I'm getting much better at knowing when I'm full or if I didn't chew it well enough. It's probably going to take years" to learn, Bailey says.
She is also learning how to deal with questions about how she eats. A co-worker who brought brownies urged her to take one. "I can't eat those, but they look delicious," she replied. A waiter asked why she left most of her food on the plate. "You have to explain to a perfect stranger: I've had surgery that only lets you eat so much."
At today's meeting, Broder is worried that Bailey may be getting into a pattern of grazing. A plateau in weight loss is typical at 12 weeks and Broder wants to prevent backsliding. She tells Bailey she needs to stick to three meals and three snacks per day.
The hourlong meeting is awash in such numbers.
Numbers on packages as Bailey and Broder pore over food wrappers for the fine print on carb, protein and fat grams. Sugar is bad. Protein is good.
Numbers on Bailey's food diary, where each ounce of liquid and morsel of food consumed is recorded along with the time of day.
Then there are the best numbers, the ones lost:
54 pounds.
5 inches on the waist.
7 inches on the hips.
10 points on the BMI.
4 dress sizes.
Broder calculates that Bailey is losing an average of four pounds a week. "Perfect. Exactly perfect!" Broder says, explaining the rate is smack in the middle of the charts and healthy. She pinches the skin on the back of Bailey's hand, which drops when released. "And you're not dehydrated."
Bailey's goal is to weigh 175 pounds.
"If I get that low I'll be wearing a size 16 or 18," she says, "and I'll still have a lot of muscle."
All in the family
More than 160 people are packed into a steamy room at Tampa General Rehabilitation Center this evening in August for the monthly meeting of the weight-loss surgery support group.
"I want to know where Kathy is. I'm here to meet Kathy," says Donna Viduna of Valrico at the beginning of the session. She has followed Bailey's story in the newspaper. Viduna's own gastric bypass is scheduled for Oct. 22. Bailey happens to be sitting beside Viduna.
"That's me!" she says.
Dressed in a too-roomy navy-and-yellow pantsuit, Bailey has come here several times as a "before." Tonight, for the first time, she is an "after."
People pepper her with questions as she rotates from circle to circle. "Did it hurt? Can you eat meat? How do you feel?"
She is feeling like Oprah on tour, with a little less sass.
"There are days when my intestines feel sore," Bailey says, "but for the most part I have nothing to worry you."
Someone asks about her scar. She flips up her shirt to show them the red vertical ridge on her abdomen.
She is honest, but does not mention how she had an allergic reaction to morphine after the surgery, or how her back ached when she tried to rest, or how, to her surprise, her stomach growled for food five days after surgery.
She experienced several weeks of utter exhaustion. Bailey needed the prescribed B-12 shots. She resumed medications for diabetes, thyroid and depression, but some in reduced doses. "Protein! Protein! Protein!" ordered Broder. Protein boosts energy, she says, and keeps patients from losing their hair and their health along with the pounds. Multivitamins with iron and calcium supplements are also required.
"How has your eating changed?" asks a woman at the meeting.
"I eat very small quiches. I had a Hot Pocket, the center part," says Bailey. "I try to stick to chicken but I did have (some) pork roast with juicy gravy. It was faaabulous."
Bailey passes around a scrapbook she made titled My Weight Loss Surgery. Hospital forms, photographs and get-well cards are sealed in its pages, flower stickers positioned just so in the corners.
She is touched, too, by those at the group meeting. "I was so warmed by them. It really made me feel good."
One bite at a time
Bailey is not the type to go on a spending spree for new clothes when the pounds fall away. Losing the weight she has carried around for so long is not about looking good, she says, but living well.
"Being able to go to a restaurant and follow the skinny hostess when she weaves a path through, to sit on an airplane and use a seat belt without an extension and not to say to my fellow passenger, "I apologize for the intimacy we will be experiencing. I have no sharp edges.'
"I want to be able to enjoy my surroundings," she says. "I really couldn't do that. I couldn't be a tourist. I was miserable. I had to stop a lot. I had to get one of those little wheelie cars.
"I will know my life has begun when I can walk around and see things. I want to walk on the beach. I want to play ball with the grandkids."
