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Taking an alternate route
Pinned to a black curtain at the Weight Loss Surgery Center of Hampton Roads on J. Clyde Morris Boulevard in Newport News, are dozens of before-and-after pictures of the center's patients.
In one photo, a woman stands with arms so thick her hands flop far away from her sides. In her after photo, she is beaming and sports a new hairdo, lipstick and a slim-fitting, red leather suit. A sticker on the photo said she lost 185 pounds.
A young man in an oversized black shirt looks sullen in his photo as his double chin touches his collar. His upper body is shaped like a half donut. In the after photo, he is 314 pounds lighter and is wearing a sleeveless shirt that reveals his muscles.
Dr. Anthony Terracina, one of the doctors at the center, has performed gastric bypass surgery on some of those folks. He moved to Virginia from Florida in June. A general surgeon for 10 years, Terracina said there was such a need for weight loss, or bariatric, surgery, that it started to take over his Florida practice. For the past five years, he has focused on bariatric surgery.
"I've never been on a diet in my life, but these patients have been on all of them," Terracina said. "This is the next step for them."
Monday, Terracina performed a newer kind of weight loss surgery for the first time on the Peninsula. He completed the first laparoscopic adjustable gastric band, or Lap-Band, surgeries on the Peninsula at Sentara CarePlex Hospital. He did three Monday and he'll do another Thursday. Drs. Stephen Wohlgemuth and James Snyder have done two procedures at Sentara Norfolk General Hospital in the past six weeks, but Terracina is the only doctor on the Peninsula trained to do them.
The surgery lasts about 30 minutes and requires an overnight stay in the hospital. The stomach is not stapled and the small intestine is not cut and rerouted. The banding procedure also eliminates "dumping syndrome," the sick feeling associated with eating sweets or drinking alcohol after gastric bypass surgery. The surgery can cost patients more than $15,000, but that's less than gastric bypass, which can cost another $3,000 or more.
BioEnterics Corporation in Carpinteria, Calif., created the Lap-Band device. It's been around for about 10 years, but it didn't get approval from the Food and Drug Administration until 2001. While gastric bypass is still the gold standard for weight loss surgery, Terracina said there has been increasing interest in the Lap-Band.
The procedure has its problems. According to studies completed by BioEnterics for the FDA, the band can have side effects like nausea and vomiting, heartburn and abdominal pain. Sometimes patients need another operation to correct a problem with the device. While gastric bypass patients can lose 75 percent of their excess weight within in a year, Lap-Band patients typically lose about 55 percent of their excess weight within two years, Terracina said.
But both operations improve or eliminate diabetes, hypertension and other illnesses associated with obesity.
In the operating room, a member of Terracina's surgery team flipped through his CD case, decorated with stickers for the hard rock band Godsmack, while Static X, a gothic techno band, spun on the Bose CD player at the front of the room. Terracina and his surgical team nodded their heads to the aggressive guitar playing, but their hands were steady and they paid meticulous attention to the surgery.
Terracina cut one small incision near the patient's belly button to insert the camera instrument that allows him to see the stomach and other organs on two, flat panel TV screens. He cut another incision for the instruments that will hold the liver up and away from the stomach. A few other incisions were for the instruments the team used to introduce the band. After Terracina marked off a portion of the stomach about the size of a golf ball, he snapped the band around it. He implanted a tube leading from beneath the skin of the abdomen. Later, Terracina injects saline solution into a port beneath the skin leading to the tube to make the band tighter and the stomach section smaller. He also can remove saline to make the band looser.
Like after a gastric bypass, the banded stomach can hold about two ounces of food. That's equivalent to a piece of cheese the size of your index finger or a cut of meat smaller than a deck of cards.
But Debbie Smith of Hampton can deal with that. She was Terracina's second patient Monday. She said Terracina made her comfortable about the surgery.
"I like him a lot," she said. "He's such a small, little guy and you wonder how did he get in this field?"
Smith, 47, and her husband had done research on Lap-Band surgery for years. Smith thought it might be safer than a gastric bypass.
"I liked the idea that we're not cutting stomach or intestine," she said before her surgery.
Smith is about 5-foot-3 and has a body mass index, or BMI, of 49. BMI is calculated from a person's height and weight. According to the National Institutes of Health, a person with a BMI of 30 or more is obese.
The strawberry blond hair stylist said she had tried Weight Watchers, liquid diets and specialized nutrition plans. At one time she even joined Overeaters Anonymous. Whatever weight she managed to lose, she gained back and then some.
"You just get to a point when things are not moving in the right direction," she said.
Smith forked over $15,750 for her surgery and an overnight hospital stay, but she said it will be worth it. For one thing, she wants to go on the roller coasters with her 10-year-old son at Busch Gardens.
"I'm looking forward to having more stamina," she said. "I'm also looking forward to buying myself a new wardrobe."