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Weighing the risks: Complications

Despite many warnings, gastric bypass is growing more popular. Now, even teens are having the surgery. If your teenager wants to do it, should you allow it? NBC’s Al Roker decided to look at the pros and cons himself.

The before and after comparisons -- we can't seem to get enough of them. Irrefutable proof that something close to a miracle is at work. People who have struggled for years with obesity are now dramatically slimmer thanks to gastric bypass surgery. This year alone, an estimated 145,000 people will have the procedure.

Well-known folks like "American Idol's" Randy Jackson, singer Carnie Wilson and myself, have become virtual poster-children for the surgery. I told the story of my experiences before, during and after the operation here on Dateline NBC two years ago. I discussed my decision to finally get the surgery. But even as I shared my story I was conflicted about being perceived as a role model for the surgery. I knew how dangerous it could be. 

Still, I know it's natural for people to look at my results and expect that for themselves, people like Mike and Jennifer Butler from Georgia. But given the risks, I’ve learned that not everybody will get what they want.

In August of 2000 just before I went public, Mike Butler sent me an email asking about the surgery:

I heard a rumor that you might have some info on weight loss procedures. I am going for gastric bypass surgery next Tuesday and would appreciate any information you may offer.

Because I was still keeping quiet about my surgery at the time, I wrote back:

I'm really not talking about my health issues, however I wish you luck and am sure you'll be pleased with the results.

So what ever happened with Mike Butler? Well, his story begins much the way it does for countless others who decide to go for gastric bypass surgery. Jennifer met her husband at a college fraternity party. At 5-foot-11 inches, he was a big guy but by no means obese. They soon married and had two sons. Their days were filled with Little League outings, family trips and music recitals. But their charmed life became burdened by Mike's struggle with his weight. Jennifer says she watched him balloon from about 220 to 350 pounds over a five year period.

Jennifer: "You go to a restaurant, you can't sit in a booth because it's no longer comfortable. Working in the yard is exhausting. It was beginning to take a physical toll on him."

In fact, 43-year-old Mike, who worked as a facility manager for General Electric, NBC's parent comapny, began to suffer from sleep apnea and diabetes. And despite countless diets and exercise, he was losing the obesity battle.

Jennifer: "And he did like everybody else, he tried everything… The weight wouldn't come off.  It kept coming on."

Mike was concerned that his health would continue to go downhill, and with good reason. The dangers of morbid obesity  -- high blood pressure, diabetes, heart disease -- are profound. The latest statistics say it's the second biggest cause of preventable death. Only smoking kills more. 

So Mike began exploring gastric bypass. He decided to have his surgery at Northeast Georgia Medical Center through a surgical practice called Obesity Solutions. He and Jennifer were invited to a reunion seminar where former patients gave vivid testimonials about how the surgery had improved their lives. Photos of the event are featured on the surgeons’ Web site.

Jennifer: "It was very positive. I mean just miraculous stories. These people looked great. They stressed that it wasn't an easy surgery, but look at us now, our life is so much better. I mean when I came out of there, I wanted to have the surgery. Like I'm ready! He was certainly after that reunion ready to go. Pumped up."

Roker: "Was there any note of sobriety about you know, the risks of the surgery?"

Jennifer: "Not for the one that I went to."

Jennifer says Mike did attend other informational meetings where he was told that as with any surgery there were risks. But she questions how much he actually absorbed.

Jennifer: "I mean here's the key to a better life. And you want it really bad and you're working toward it. So I think you hear it but you don't really understand what it means."

In fact the mortality rate for the surgery is about 1 in 200, although some studies say the rate is as high as 1 in 50 with less experienced surgeons. Compare that to a mortality rate of 1 in 700 for an appendectomy.

In August of 2002, Mike was ready for the surgery that he and Jennifer hoped would finally give him back his life. He yearned to be the active person he once was, to be a healthier husband and a more active father to their two teenage sons.

Jennifer: "He really, I think, was very nervous, but excited too."

Mike's operation was done in two steps. First, a tiny section of his stomach was stapled off. Next, part of his small intestine was cut, then re-attached to his new smaller stomach. The weight loss happens because this tiny new stomach can't hold much food, and since food bypasses part of the intestine, not as many calories are absorbed.  

As expected, Mike's surgery lasted about an hour and a half. 

Jennifer: "He looked great. Seemed to feel fine. He was very coherent when he talked to me."

Particularly about why he chose to do the surgery.

Jennifer: "He said, I did this for you and the boys. So I think he was really, really trying for a better life for all of us."

Two days after the surgery, Jennifer brought Mike home so they could begin that better life together. But just four days later what started out as a routine recovery period became mired in problems. It started with a sharp and relentless pain in Mike's side, and an emergency trip back to the hospital.

Jennifer:  "He was sweating so profusely that I was changing his bed every five minutes. Everything would be completely wet."

It turned out that Mike had a leak where his intestine was reattached to his new stomach.  This is one of the most severe complications of gastric bypass surgery. It meant that Mike would be hospitalized with no food or liquids for possibly weeks until the leak healed. But Mike’s problems didn't end there. Over the next two weeks he would suffer from a severe infection from an I.V. line and major internal bleeding.

Jennifer: "I can remember him, leaving in the ICU bed with his hands on the rail just kind of worried but really so sick that he couldn't verbalize much to me."

Mike had to take to writing notes to Jennifer because tubes in his mouth prevented him from speaking. Despite being critically ill his thoughts still clung to the intended goal of the gastric bypass surgery. He wrote: "Do you think my new stomach will ever work?"

But a week later Mike died from what doctors say was the dire combination of a bleeding ulcer and blood clots in his lungs.

Jennifer: "It was devastating. I don't think anyone is prepared to lose a spouse at this age."

Despite this tragic outcome, Jennifer says she never heard from Mike's surgeon, Daniel Procter, who was out of town when Mike died.

Jennifer: "He has never called. He sent flowers the day after Mike died. But I have not heard from him."

Roker: "Are you disappointed that you haven't heard from him? Angry that you haven't heard from him?"

Jennifer: "I am a little bit angry that I haven't heard from him."

Jennifer believes that Mike's gastric bypass surgery three weeks earlier directly triggered the conditions that led to his death. That had he not gotten the leak, he would not have had to endure a lengthy bed rest which caused the blood clots.

Dr. Procter: "I can’t tell you you're not going to have a complication, but I'm going to tell you that I'm going to make every effort for you not to have a complication."

Dr. Procter acknowledges that bed rest could have caused Mike's blood clots, but he maintains that because obese people are vulnerable to blood clots, it could have happened after any kind of surgery. Either way, Jennifer says she and Mike were not forewarned enough about this possibility or other risks he faced.

Roker: "In talking with Mike's widow, Jennifer, she said she went to this seminar and felt that it was more of a cheerleading session, that there was almost no discussion or virtually no discussion about the risks."

Dr. Procter: "I think maybe people that come to it hear what they want to hear a lot of times. And certainly if I'm thinking about having this procedure I may not want to hear about the complications. But yeah, we have a slide program and we go through the operation itself."

In fact we attended one of Dr. Procter's informational meetings and heard him mention risks. But Jennifer believes that the emotional testimonials from those who'd been through the surgery overshadow the information about the hazards.

Dr. Procter also pointed out that Mike Butler followed instructions and wrote a "letter of understanding" before his operation as is required of all of Procter's patients. In it Mike listed several possible risks of his upcoming surgery including blood clots and leaks.

Roker: "Do you think that maybe doctors should hit the negative parts of it or at least the potentially problem causing parts of it a little harder because you've got to cut through a euphoria and a desire for this operation that whatever we hear we're going to minimize?"

Dr. Procter: "You need to do that with any operation, minor or major. But how do you tell a person that yes, you can die from this operation but you're dying from the disease as it is, and not scare them to death?"

Of course that's the frightening reality about being morbidly obese -- it is a life-threatening illness. Not doing the surgery can pose a substantial health risk, one that can be far greater than the risk of the surgery itself.

Even Jennifer Butler believes the operation has merits. She just wants to make sure people actually process information about the risks. To that end she sent a letter to about 25 surgeons in the Atlanta area asking if she could tell Mike's story to prospective patients, to put a face next to a statistic. She says she got zero responses.

Jennifer: "I want people to go into it as a consumer and shop for the best. Evaluate the program that they want to go to and make sure it has all the parts they want. Go to the courthouse and see if your physician has been sued. Don't be surprised if they have. But put your doctor on the spot. You need to ask, doctor, how many patients have died?”

As for Dr. Procter's record, in the 26 years he has been doing weight-loss surgery, he says he's performed thousands of gastric bypasses and has lost four patients due to complications, far below the average mortality rate of 1 in 200.

Roker: "How does it affect you when a Mike Butler happens?"

Dr. Procter: "Oh, it's devastating. You know, you get to know these patients better than any patient that you've taken care of."

Roker: "Jennifer told us that she was upset, angry even that she never heard from you after Mike died. How come?"

Dr. Procter: "You know, what do you say, you know, that's not been said? I would love to talk to Jennifer. But I think, you know, you say, well, by talking to then am I going to bring up some bad feelings? And it's hard to know what to do."

Jennifer never bargained on becoming a widow at the age of 44 or a single mother of two teenage boys, but that's her life now. She says she's coming to terms with the unexpected events that have unfolded, but it's a process and a slow one at that.

Jennifer: "It has taken me almost two years to be able to watch you do the weather, not because I hold you responsible or blame you, but it's just hard for my mind and heart to understand why Mike didn't have the same result you had."