The Stomach as a Storage Space
& Other Tales of Medical Wonders

The popularity of the gastric bypass procedure, combined with the economic crunch, has produced a curious by-product: restaurant discount cards. For those of lighter body complexion (not our fault, not our fault) and exercise-as-diet proponents (not our type, not our type), the trend does provide a moment of reflection.
But we won’t touch that, are you kidding? Whatever rocks your boat (without sinking it), we’re all for it. Besides, much more impressive is at least two other things doctors have done lately with the abdominal cavity: they’ve used it as a storage space, or forgot things in there.
Before we get to that, though, let’s just say something about the obesity crisis that’s been going on in this country, its possible deep psychological causes, and why it’s so hard for some to lose weight, while absolutely unnecessary for others to go through it: blah blah blah, and this and that, and so on and so forth, plus taxes.
With that out of the way, the number of bariatric surgeries in the U.S.
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has recently plateaued, after an initial surge in the middle 2000s. Seven years ago, the procedure was performed 170,000 times, according to a medical trade group, but now it’s done at an annual average of 113,000, according to the National Institutes of Health.
Both the gastric bypass and the laparoscopic modalities of the surgery can be complex, but complications have fallen since the horror stories of the early 1990s. The costs to the health care industry remain relatively high, at $1.5 billion annually. It’s way less expensive to simply exercise and regulate one’s diet, but apparently not everyone thinks that these can be done by everybody.
Although we disagree with the view that obesity can be equated to race and sexual orientation, for example, as a target for public discrimination, there is indeed a small percentage of purely health-related causes for it, which remain difficult to address with only those common solutions.
PREJUDICE & VICTIMIZATION
Since weight is so intrinsically connected with self-image and social acceptance, its psychological toll to those struggling with it often limit the issue to the realm of personal choice, as smoking and risk sexual behaviors are, away from public scrutiny. Ultimately, though, they affect society at large; it’s hard to determine when privacy ends, and public health concerns take hold.
The recent example of Jennifer Livingston, a Wisconsin TV anchor, who was openly criticized by a member of her audience for being overweight, has unwittingly shed some light on such distinction in unexpected ways. A trained professional, Ms. Livingston immediately gained the upper hand on the discussion, by framing her criticism as being bullied by the emailer (no need to mention his name here).
As such, she’s received praise and showered with invitations for talk show appearances, to discuss the incident. It’s very likely that she’ll successfully navigate the media circuit, by accessing the very much real and worthy subject of bullying, while skillfully avoiding the main question posed by the sender: why she’s not setting a healthier example about personal care to her audience?
As no medical issue has been raised to explain her weight gain (we couldn’t determine exactly how much, but she did use in her defense the sound-bite ready, ‘I’m much more than a number on a scale.’), the critic may have a point: after all, she does have a high-profile job, and her appearance is an integral part of it. Imagine if instead of weight, we’d be talking about personal hygiene here.
It’d also be her right to decline any comment, of course, and accept that people can say or think whatever they will, as long as personal boundaries are respected. It just bothered a few people that she, instead, chose to frame the criticism within a seemingly non-related issue, one that’s real and hurtful mostly to those who do not have the public (bully?) pulpit that she does.

HAD SURGERY? PAY LESS
It’s common knowledge in the hospitality industry that coupons, discount cards, special offers, and all-you-can-eat deals are nothing but misery to servers. For not so hard to figure reasons, that kind of incentive tends to attract a type of ‘entitled’ customer, who truly believes that staff humiliation and a reduced tip are all included in the cut-down price.
We don’t know how it works with those who just had part of their guts either cut off, or sawed on, so to diminish the size of their stomachs, and supposedly prevent them from overeating. Even the notion that you need an expensive operation so to avoid ordering an extra serving of food is one of the things the estimated 800 million hungry people in the world can’t begin to understand.
But never mind that. You had the procedure, for one reason or another, and now it’s time to treat yourself for a sumptuous meal, since ‘you’ve been good,’ right? Well, don’t leave the clinic without your discount card. It’s all the rage in LA, where it all started, and other cities, with a steady ‘reduced-stomach’ community.
The Weight Loss Surgery cards, earlier versions of which have been in effect in places such as Campinas, Brazil, ask restaurants to allow patients to order a smaller portion of food for a discounted price. Naturally, the cheapest U.S. food chains have jumped at the opportunity to increase their bottom line.
UNAVOIDABLE FOOD PICKS
Cracker Barrel, Salt, Golden Corral, Olive Garden and Red Lobster, all eateries known for their rowdy customer base demographics, and the latter two, for being recently involved in labor disputes with their wait staff, accept the cards, offering in many cases their ‘Children’s Menu,’ as an alternative to the special rate.
There are two upsides to this quest for reduced stomachs, prices and portions. According to the New England Journal of Medicine, despite its risks, the bariatric surgery may ‘treat, or even reverse, the effects of type 2 diabetes in overweight and obese patients with high blood sugar levels,’ as reported by NPR’s Rob Stein, who conducted a recent panel discussion on the issue.
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* Tune in tomorrow for the conclusion of this thriller, and find out what Don Corleone’s enemies have to do with it all.

Part II – The Conclusion

Also, it’s about time that food portions served at restaurants and delis across the U.S. get cut in half. Thus, the trend that may be set by patients of the procedure may, hopefully, be extended to the rest of the population, or according to cynics, those who can’t afford to be fat. Or can they?
The cruel irony is that obesity hits the hardest Americans at the lowest income bracket, who simply can’t afford to buy better quality food. So chances are, they will be hardly affected by the trend. It’s still worth the effort, though, if out of the whole discussion, a new consensus may emerge about our relationship with food. In the meantime, would you like another slice?
YOUR PERSONAL STORAGE PLACE
We don’t mean to sound gross, but there’s a lot of stuff that can be found, taken out, or be left in, once someone’s abdominal cavity is sliced open. Mostly benign or necessary, if it’s up to experienced surgeons. Every once in a while, though, along comes someone with a crazy idea, that makes the whole medical establishment scramble to explain, why it hadn’t been thought about it before.
Jaimie Hilton, a former Miss Idaho, was just one of those lucky cases. She was the recipient of a revolutionary procedure that may have saved her cognitive ability, no less. Hilton had a terrible fall in June, while out in the ‘great outdoors,’ and hit the back of her head.
The accident caused her to stop breathing, and hadn’t she been airlifted to a local hospital, she wouldn’t have survived. Not in one piece anyway. While still unconscious, she underwent a long surgery to drain her swelling and bleeding brain. To do that, doctors had to remove some 25 percent of her skull.
And now comes the impressive part: in order to preserve the piece of bone until the pressure on her grey matter would subside, they literally zipped it into her stomach. It remained that for days, protected from opportunistic infections so hard to keep away from living tissue outside the body.

Two surgeries later, it was removed from there and reattached to its proper place. To great relief of her family, community and even the local church, which this devout Catholic has been supporting since childhood, she’s doing fine, with no apparent adverse effects from her ordeal. Not surprisingly, she had no idea where her doctors had stored her skull, nor it occurred to her ask them.
In the race to develop skin and assorted body parts from stem cells or tissue grown in labs, it’s often overlooked the protective and nourishing abilities of the human body. Since such parts are ‘made’ of the same genetic code, there’s no rejection to speak of, or risks of decaying or death. Or rather, if the part dies, scientists can always ‘cultivate’ a new one. Pretty sci-fi, wouldn’t you say?
THE ABSENT MIND RISK
For all the cheery news the case of the beauty queen may represent for future breakthrough in surgery and transplants, there’s always the human factor to, sometimes, screw up everything big time. When the surgeon, for example, forgets sponges, tools, scissors, gaze, and other items, that may go undetected for years, until they cause irreparable damage to the person.
It happens as many as 4,000 times every year in the U.S., and the cause varies, but can always be traced to the medical team’s fatigue and attention deficit. Procedures can sometimes take 20 hours of continuous effort, and doctors, nurses and hospital staff are notorious for being constant in demand and working brutally long overtime shifts.
Tell that to one of the victims, however, and he or she may tell exactly what you should do with your er, insight. And it happens even to members of the medical establishment too. That was the case with Sophia Savage, a nurse, who ‘felt a crushing pain in her abdomen and started vomiting,’ in 2005, according to a NYTimes’ Anahad O’Connor story.
A CT scan showed that she’d a sponge lodged in her abdomen, left there four years ago, from a surgical procedure. It was terribly infected and cost part of her intestines, along with a lifetime of bowel dysfunction. She sued and won a $2.5 million settlement in 2009, for medical malpractice. The hospital however has appealed and Savage’s yet to receive any compensation for her condition.
Sponges account for a third of objects left inside patients, and hospitals contend that, once soaked in blood, they’re easy to miss, in the adrenaline-fueled rush of stitching up a patient. The standard procedure to prevent such a catastrophic slip is to assign a member of the surgical team to simply count them. It’s clearly not working that well to anyone.

PATIENT ADVOCACY & THE BUSINESS
Weary patients are slowly taking a more active role in prevention. Transplant donors, for example, who are offering one of their kidneys to someone they love, have gotten into the habit of using a marker, indicating which one is to be extracted, if that’s an issue. The same for those who need to have a foot, leg, arm or hand removed for whatever reason.
Smart technologies are also being tested, imaging photography, and a variety of other potential solutions that may one day prevent such a terrible mistake from ever happen again. In the meantime, there’s no better method than to name a person you trust, to be there at all times, speaking when you simply can’t.
Let’s face it, for family and friends, is a tremendous pain in the neck. But if you can’t come up with a willing partner for your ‘procedure experience,’ in the sanitized language of medical brochures, then it’s worthwhile hiring someone. Slowly, the presence of non-medical personnel at the operating theater has been gaining a foothold in some hospitals’ rules and regulations.
It’s mainly on the interest of the patient, laying down there, often numbed, defenseless, once the surgery starts. But it’s also for the medical institutions themselves. Even that they’ll wriggle and refuse as much as possible paying for malpractice, there’s always a time when they have no choice. At the end of the day, it’s always about business, too much so to some. But that’s the American way.
Tessio: Tell Mike it was only business. I always liked him.
Tom Hagen: He understands that.
Willi Cicci: [removing Tessio’s gun] Excuse me, Sally.
Tessio: Can you get me off the hook, Tom? For old times’ sake?
Tom Hagen: [shakes his head] Can’t do it, Sally.
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* Quote from The Godfather (1972), used without permission.