Seriously ill after gastric bypass, Turlock mom finds hope

Sandi Krueger feels better than she has in almost seven years.

The 38-year-old Turlock mother lost too much weight after a 2002 gastric bypass surgery.

After surgeons reduced her stomach to a small pouch and bypassed much of her small intestine, every bite of food made her sick, in time causing her weight to drop from 219 to 98 pounds and reducing her to a gaunt shell.

Since her story ran in The Bee in January, a patient from Oakdale who had the same wasting syndrome — and survived — brought Krueger to a surgeon in Delano in Kern County.

Dr. Ara Keshishian implanted a gastrointestinal tube through Krueger's side, so nutrients could be fed into her emaciated body at home. She has gained 30 pounds and tests show the hemoglobin, iron, vitamins and other vital minerals in her blood have risen from dangerous levels.

She's able to take her 13-year-old daughter, Megan, to do volunteer work and cheer for her 20-year-old son, Dustin, at his motocross races.

The tube feedings are intended to build her strength so she can undergo surgery to reverse the gastric bypass. Krueger also awaits an OK from the Medi-Cal program for coverage of the surgery.

"Right now, I am as happy and healthy as I can be," Krueger said. "When I wake up in the morning, I don't have the feeling, 'Is this the day I am going to die.' That has completely gone away."

Krueger is part of the small percentage of weight loss surgery patients who suffer from severe malnutrition. It is a sad outcome for 1 percent to 4 percent of bariatric surgery patients, which can leave them with severe anemia, the inability to walk and difficulty performing simple tasks.

With more than 200,000 of the surgeries performed each year in the United States, doctors are seeing a growing number of these patients.

Problems surface

Keshishian, a bariatric surgeon, said that each month four to six patients come to his office for revision or reversal of gastric bypass procedures. About half complain of weight gain or inadequate weight loss; others have nutritional deficiencies, persistent nausea and vomiting, ulcers, malnutrition or dehydration.

Some, such as Krueger, have struggled for years.

"The question we ask is, 'Are they healthy enough to continue living with gastric bypass and the downside or better off taking the risk of another surgical intervention,' " the surgeon said. "In general, revision or reversal surgeries carry a higher risk than the primary procedure, but for some of these patients the alternative is not an option."

Various reasons are given for poor outcomes: The patient didn't comply with dietary regimens or medical instructions after surgery, the surgeon didn't perform the bypass to specifications or bariatric surgery simply carries the risk of complications.

Physicians across the country are seeing a gap in follow-up care for bariatric patients.

"From talking to patients who have problems, it seems they are afraid to seek follow-up," said Dr. John Husted, a former Modestan and bariatric surgeon in Kentucky who was featured in Discovery Channel specials on bariatric surgery and adolescent obesity. "They felt that being overweight was their fault, and it's their fault they didn't have a successful outcome from gastric bypass."

Husted said he is seeing more bariatric patients with severe nutritional deficiencies, which he attributes to the large number of weight loss surgeries being performed.

Laura Martinez of Modesto had a gastric bypass in 2006 at Memorial Medical Center to address her diabetes and back pain. As she lost weight and her health issues disappeared, she spoke at seminars for people considering bariatric surgery.