Light years ahead

Despite setbacks following gastric bypass surgery, Blount County woman looks forward to a better, healthier future

By KRISTI NELSON, nelsonk~knews.com
May 13, 2003

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Stephanie Bell, 45, stands on the hill that is her front yard looking at four sheep, four lambs, three llamas and four pregnant goats.

"... And that's why I had the surgery," Bell said, only half joking. "This is very uneven ground, and they'll knock you down. At 270 pounds, I couldn't get up by myself."

Bell had gastric bypass surgery at Blount Memorial Hospital on Feb. 18. Four months later, she's steadily shrinking in size.

But her recovery has been something of a rough road - just like the one that led her to the operating room.

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"One of my earliest memories is of going to Sears to the 'chubby' department," Bell said. "I was always the biggest kid in any class, until I got to be a senior in high school, and the only people any bigger than me then were the football team."

As an adult, she tried and failed at several diets, including one during her college days that she now knows was a rip-off: following a 500-calorie-a-day diet while being injected with what she was told was the urine of a pregnant woman.

"It took me a while to realize, hey, stupid, you're paying $17 a day for these shots, and it's the calories," she said, laughing. "Of course, the minute I stopped eating only salad with no dressing, it all came back.

"I've done Jenny Craig. I've done Atkins so many times I could have written it. I was very successful at Weight Watchers - I lectured for Weight Watchers. Once I lost 50 pounds."

At her smallest, after a divorce and two pregnancies but just before she met her current husband, Jack, she was a size 12. Back then, she was 5 foot, 10 inches, although since then her height has "shrunk."

"There were times when I got thin," she said, "but they never lasted very long."

This year, at 55, she was a size 26 - the largest she'd ever been. There were a lot of factors. Bell, who had been burning calories helping her husband build their modest "dream house" in Louisville, took a sedentary job as a bookkeeper for RE/MAX real estate. And all her country cooking and dinners out put the pounds on her at a much more rapid rate than they went on her husband.

"In seven years, I've gone from a 22 to a 26," she said. "I don't eat anything different from what Jack eats, but he's gained maybe 15 pounds in the 20 years we've been together."

It embarrassed her that her husband, who she calls "a handsome man, just gorgeous," had to been seen with her.

"We looked like this horrible ... caricature of the really fat woman with the thin man," she said. "It wasn't fair to him."

Jack Bell said he was less embarrassed about his wife's weight than worried about her feelings - and afraid for her health and safety.

"If she stepped off of a curb, for instance, and twisted an ankle a little bit, if it happened to me, I'd limp to the car and it would be over," he said. "If it happened to her, she might break the ankle. I was always worried about these things ... trying to keep her out of harm's way."

If he confronted her about losing weight, she'd start crying. And he felt guilty, too, telling her to stay on a diet while he ate whatever he wanted. Eventually, he knew, she'd feel the need to hide her eating from him.

"When you are on a diet, and you are morbidly obese, you feel like you are totally deprived," Stephanie Bell said. "I don't know how normal people who only have 5 or 10 pounds to lose, how they feel, but when you are looking at (losing) 120 pounds ... you go, 'This stuff is going on for the rest of my life!'"

When she heard about singer Carnie Wilson having gastric bypass surgery, she saw a possible solution. When she started researching the surgery on the Internet, she realized it was "not the Holy Grail, not the panacea, but a tool." And when she learned she could have the surgery locally, by a surgeon she knew personally, she was ready right then.

Bell's family took her out for a "last supper." They went to Chop House, where she had steak (her favorite meal), appetizers, dessert, wine - all things she might never eat again.


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Stephanie Bell's surgery took about an hour and 45 minutes. Dr. Mark Colquitt, did the surgery laproscopically, making six small incisions and using a camera to see inside her abdomen. During the procedure, Colquitt stapled her stomach to make only a small pouch - about the size of a golf ball - usable, so Bell could take in less food, then rerouted and reconnected her small intestine to bypass a sizeable portion of it, so what food Bell did take in would pass through her body more quickly.

"I came to in my room, and I was amazed at how unsore I was," Bell said. "I felt a little bit uncomfortable, but I didn't feel bad."

After two days in the hospital, Bell went home. The first two weeks she was allowed only clear broth and Jell-O. She noticed that she was hypersensitive to odors; any smell made her sick.

"I could open a bottle of Clorox in the washroom, and she'd be up in the bedroom, and she could smell it," Jack Bell said.

Then she started throwing up - constantly, and violently. She called Colquitt, who told her that wasn't abnormal after the surgery. But after a week of that, she called him back and said, "This is not normal; I'm throwing up a lot more liquid than I'm taking in."

Colquitt looked at her and agreed. He sent her back to the hospital for tests. There she found that during gastric bypass surgery, her bowel had kinked - a complication Colquitt and the Bells had known was possible but didn't expect.

That required a 6-inch incision in Bell's abdomen to repair, and another five days in the hospital. This time, when she went home, she was sore, although she was no longer sick. She was already losing weight, but she felt too bad to care.

A week later, Bell's incisions from both surgeries became infected. One night, the largest incision "exploded," sending pus out with such force that it hit the wall, and sent Bell straight back to the hospital. Colquitt cleaned the wounds, but they didn't heal until Bell visited a wound care specialist.

It was two weeks before Bell got her first meal of solid food: a scrambled egg on a small piece of toast with the crusts cut off. She got two mouthfuls down.

"It's chew, chew, chew, chew, chew, chew, chew, swallow," Bell said. "You take another mouthful, and you chew, chew, chew, chew, chew and swallow. And you go, 'I've had enough of this - I'm full.'"


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Gastric bypass surgery patients must consciously and painstakingly chew every bit of food they put in their mouths. They have to eat in a certain order: protein first, vegetables second. They have to eat chewable vitamins to make up for the nutrients their bodies aren't absorbing, Pepcid to cut the amount of their stomach acid. If they eat the wrong foods, or the wrong amounts, or in the wrong order, their body wastes no time letting them know - with vomiting and diarrhea.

Patients are expected to follow a low-calorie, low-carbohydrate diet. It's possible but not likely that they'll cheat; one bout of being very sick is usually unpleasant enough to avoid a repeat. Sweets, in particular, often cause "dumping," in which the food moves too quickly through the small intestine, resulting in severe nausea, sweating, weakness and sometimes vomiting, diarrhea or even passing out.

"It's very unusual to have (Roux-en-Y gastric bypass surgery) fail from a mechanical or surgical standpoint," Colquitt said. "If they're not losing weight, it's probably something that they're doing to not lose weight. But I've seen patients from surgeries done somewhere else, where they didn't get good instruction on what to eat, or close follow-up. They come in here saying, 'I'm awful sick.' They were never told what to do."

Colquitt will take patients from out of the area only if they commit to staying here for a month after surgery. He wants to see them at the first-week mark, the first month, three months out, six months out and a year out, then yearly after that if they're doing well. But they're still required to attend support group meetings and to keep an exercise and food journal and fax it to his office once a month.

A typical breakfast for Stephanie Bell now is two tablespoons of cottage cheese mixed with a teaspoon of applesauce and a little cinnamon and Sweet'N'Low on a little piece of toast.

"I can eat about half of that," she said.

For lunch, she might have a couple of spoonfuls of tuna, a couple of spoonfuls of Wendy's chili, or part of an apple with peanut butter on it. For dinner, she can eat about six bites of almost anything she wants, as long as it has enough protein and few carbs.

"The first thing I really wanted was sesame chicken," she said. "I wanted it so bad I couldn't stand it."

She ate three bites.

Colquitt gives all his patients a card to carry, asking restaurants to let them order for the children's menu. But the Bells generally just order one dish and share. Bell estimates their grocery bill has been cut in half; likewise, their restaurant dining costs.

Bell has found her tastes have changed, too.

"I used to drink 10 or 15 cups of coffee a day," she said. "I haven't had a cup. I don't want it anymore - I don't even like the smell."

She never liked fish before; she eats it frequently now. Her favorite meal, steak, is a distant memory; even if she could eat red meat, she doesn't really want it. She hasn't craved chocolate, "my downfall," at all. She finds herself wanting citrus fruit for dessert; occasionally, she'll eat a quarter of a sugar-free, almond-flavored cookie. What she does eat has to have a lot of flavor to satisfy her, since she's eating such small portions.

"I'm always amazed that when I eat something, I have this little bit of something, and I'm not hungry anymore," Bell said. But she's learned the hard way not to test that: "That pouch will only hold so much, and if you exceed the 'load limit,' it comes right back up, just the way it went in."

Bell lost 45 pounds and six dress sizes in two months. Colquitt said patients average a 20-to-25-pound-per month loss. Bell might have lost more, but her subsequent surgery and healing slowed her from starting an exercise regimen - the second part of the equation.


* * *
"Do I enjoy exercise? No," Bell said, laughing, but she does it. Right now, she's going to Blount Memorial's Wellness Center at Springbrook three times a week, participating in activities that include aquatics. She stays active outside, too, and is already seeing a difference. She can carry feed for the animals. She can bend over and weed her garden. She can climb stairs more easily, with pain coming from out-of-shape muscles rather than from overtaxed joints. She's getting back some of the energy her bulk sapped.

There's the way she feels, and then there's the way she feels about how she looks. Bell's wearable wardrobe has shrunk with her size, but since she's still losing, it makes no sense to buy a lot of new clothes.

She can cut her toenails. She can shave her legs.

"One of the best things is, I can see my feet," Bell said. "This sounds awful, but when you're really fat, bending over and drying between your toes is really not an option."

Her car is happier, and so is her furniture.

"Sitting in a chair and not having parts of your body fall off the sides" is wonderful, she said. "I can sit in a lawn chair without the fear that when I got up, the lawn chair would come with me."

Most gastric bypass patients' weight loss plateaus in two years. When Bell's does, she may want to consider plastic surgery to "tailor" the excess skin, Colquitt said. Most patients see a plastic surgeon for an evaluation after about 18 months; even after plastic surgery, "they will have some appearance that they were overweight," he said, "but I think you'd have to look close."

Bell sees her relationships with others changing as her body does. She's not as quick to poke fun at herself, quicker to tell people when they've offended her. She notices Jack being more affectionate, more intimate.

"He's always been a loving husband, but I find him being more like he was when we were first married," she said. "Our relationship will change" - for the better, she said, "if we work on it."

Bell worries that she talks about the surgery too much, although she said most people ask her about it out of curiosity. The support group meetings help, especially dealing with the "realism of what happens when you don't sail" through the surgery.

But she has no regrets - about either having the surgery, or becoming its local "poster child" through a News-Sentinel story and a WBIR, Channel 10, series.

"I told (reporter Sara Allen) I didn't care if they filmed the surgery," she said. "I wanted people to be aware that it's available."

"I'm 55 years old. I'm not doing this so I can look good. It's too late for me for that," she said. But when she decided on the surgery, she said, she asked herself, "How do you want to spend those 55 years? Do you want to spend it like some of these women who are on scooters because they're so fat they can't walk?

"I don't."

Kristi L. Nelson may be reached at 865-342-6434. She is health writer for the News Sentinel.