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Catherine O’ Brien
17:55 EST, 28 July 2012
In the months following her surgery, Pauline ‘s weight dropped gradually and she was full of energy. But it wasn’t to last.
Pauline Boyle, right, thought that having weight-loss surgery was the ideal way to end years of yo-yo dieting. But she almost paid the ultimate price for her new slimline frame…
At a family party to celebrate her sister’s birthday, Pauline Boyle found herself being showered with compliments. Relatives who hadn’t seen her for a while did double takes. ‘I barely recognised you,’ said one. ‘You’ve never looked so well,’ said another. Even her teenage nephews teased that Auntie Pauline was looking hot.
Behind her blushes, Pauline was elated. For most of her adult life her weight had hovered around 18 stone. Now she was almost half that. After years of yo-yo dieting, she had finally taken the plunge and had a gastric band fitted to reduce the capacity of her stomach. The pounds had fallen away and, 20 months on, she weighed nine and a half stone.
Her dress size had dropped from 24 to 12 and, with the added help of twice-weekly sessions at the gym, she was fitter than she had ever been.Pauline made no secret of how she had achieved her transformation. ‘I was happy to tell people that having a gastric band had turned my life around,’ she says.
But what she couldn’t have known was that it was about to go horribly wrong. Within weeks of that party, she became desperately sick, her vital organs began to close down, and she was fighting for her life.
Pauline, a 49-year-old nursery nurse from Ruislip, Middlesex, had suffered a rare and little-publicised complication that affects less than four per cent of gastric band patients but can have deadly consequences. Her band had slipped, blocking the entrance to her stomach and making her incapable of digesting any food or drinking water.
A disastrous catalogue of misdiagnoses meant she went into pre-renal failure, and by the time she was admitted for emergency surgery, her stomach had been so badly starved of blood, she was just hours from having to have it removed. ‘I had no idea my health could be put at such risk,’ she says. ‘I don’t want anybody else to suffer in the way I did.’
Like most people who consider weight-loss surgery, Pauline’s decision to have a gastric band fitted was not made rashly. For many years, she explains, she convinced herself that she was not troubled by her size. Growing up, the daughter of a plumber father and housewife mother and the fifth of six children, she was naturally slim and active; it was only when she left school and started work in her late teens that the pounds began to pile on.
‘I worked for a bank and was at a desk most of the day. At night I was out drinking with friends and eating junk food, and by my early 20s I was obese,’ she says. For two decades her weight fluctuated between 16 and 18 stone. ‘Every so often, when my clothes got really tight or I was going on holiday,
I would make the effort to diet. But whatever weight I lost, I regained as soon as the diet stopped. I had friends who were thin and friends who were big like me – although I was always the biggest. But it didn’t worry me, because being big was part of who I was. The most I ever fantasised about was getting down to a size 16. If you had known me then, you’d have assumed I was fat but happy.’
‘I had gone down to a size 16, and for
the first time in my life I was able to buy clothes from normal shops
rather than the outsize chains’
Pauline had several relationships but never married. Then, in her late 30s and early 40s, a series of turning points made her re-evaluate her life. First, her mother died of lung cancer. Then she was made redundant from the bank where she had worked for 23 years. Although she had no family of her own, Pauline had always wanted to work with children. She decided to use her payoff to retrain as a nursery nurse. Before settling into a new job, however, she travelled to India and spent five months working with a rescue organisation in Calcutta – ‘a mind-blowing experience’.
On her return home, she not only felt different, she looked different, and discovered she had lost three stone. ‘I had gone down to a size 16, and for the first time in my life I was able to buy clothes from normal shops rather than the outsize chains.’ She worked with a personal trainer and took up running as well as gym work-outs. ‘I did a five kilometre fun run for Cancer Research and it felt like a phenomenal achievement. I was happier about myself than I’d ever been.’
But the euphoria didn’t last. Pauline’s elderly father was suffering from Alzheimer’s and she became heavily involved in his care. Gradually her weight crept back up, but instead of being able to shrug it off as she had in the past, her confidence plunged. ‘I was eating too much and I felt ashamed for being so out of control. Although I had changed on the inside, outwardly I had gone back to looking like the old me and that left me feeling depressed.’
Aware that the only person who could get her back on track was herself, Pauline researched the options for bariatric (obesity-reducing) surgery. Her doctor told her that she would be eligible for a gastric band on the NHS if she was prepared to wait a year. ‘But in 12 months, I might have put on another three stone, and I didn’t want to risk that,’ she says.
In March 2010 Pauline weighed 18 stone…
And by September 2011 she had dropped to 11 stone
The private clinic that Pauline chose for her operation claims a 99 per cent success rate and celebrities among its clients. A consultant explained the procedure. The band – an inflatable silicone ring – is placed around the upper part of the stomach via keyhole surgery, creating a small pouch about the size of a golf ball. The pouch fills with food, leaving the larger part of the stomach empty. The message sent to the brain is that the entire stomach is full, which helps the patient to feel less hungry, eat smaller portions and lose weight.
Pauline’s band was fitted in March 2010 and required just one overnight stay in hospital. She used her mother’s inheritance to pay the £6,250 bill. ‘Mum had known how I struggled with my weight and she would have been happy to think she had given me a helping hand to sort out my life.’
The surgery went smoothly and the impact on Pauline’s appetite was instant: ‘I didn’t feel so hungry any more.’ The weight loss was gradual – 1lb to 2lb a week. In her first year, she went from 18 stone 1lb to 12 stone 10lb. ‘For months it just seemed as if I was pulling the belt tighter on my jeans, and then, at the 12-month point, I realised I would have to invest in a new wardrobe. Standing in shop changing rooms and having to ask assistants to fetch me smaller sizes was like an out-of-body experience. My self-esteem went back up. I was running around with the children at the nursery and exercising at the gym. I had always had big curly hair to balance my frame, but the curls no longer suited the slender me, so I had them cut off.’
Still the pounds dropped off and by December 2011, Pauline weighed nine and a half stone. But just as she was looking healthier than ever, she started to feel unwell. The first symptoms were intermittent bouts of vomiting. Then one day, while running at the gym, she felt a painful tightening at the top of her stomach where the band was fitted. She immediately made a clinic appointment, during which a nurse suggested that her band may need adjusting – gastric bands are filled with saline, which can be added to or extracted to tighten or loosen the fit. The nurse removed a small amount of saline and arranged for Pauline to have a review appointment in six weeks’ time.
Pauline seemed to recover, but four weeks later, on New Year’s Eve while out for a family meal, she began vomiting again. She went home to bed and assumed she had picked up a bug, but her sickness worsened. As well as being unable to hold down food, she became increasingly unable to drink water either.
‘I feel very let down. My aftercare was disgraceful. No one wanted to take responsibility for me’
After six days of struggling at home, she called the clinic for an emergency appointment. A nurse again tried to take fluid out of her band, but barely any could be extracted. The nurse said she needed an urgent X-ray, which would have to be arranged through another clinic within the same private medical group. Pauline was given a number to phone, but it was the weekend and when she called she was told she would have to wait until Monday. If she was feeling really unwell, the nurse at the second clinic advised her to go to an AE department. Pauline should also have been told that any AE department she went to would need to specialise in gastric-band problems, but this crucial information was not passed on. Her symptoms should have been ringing alarm bells, but no one took her seriously.
By the Sunday, Pauline had been vomiting for seven days and was becoming seriously dehydrated. Feeling too weak to drive, she took a taxi to her local hospital where she was put on a drip and immediately sent for X-rays of her chest and stomach.
The AE doctor told her the X-ray showed no apparent problem with the band, but also stated that they were not experts in bariatric problems. Had she been seen by someone with expertise at this point, they would have picked up the slippage and arranged for immediate surgery before she became any more seriously ill. Instead, Pauline was sent home with some anti-sickness tablets, and the following day she phoned her private clinic, where she was told she would have to pay £250 for an X-ray, which would take two days to schedule. ‘By this time, I was feeling so dreadful I couldn’t believe they were going to make me wait another two days, but I didn’t have the strength to speak, let alone fight for more help.’
The X-ray on the Wednesday finally revealed the full extent of Pauline’s condition. Her band had slipped and was blocking the entrance to her stomach, which explained why she was unable to retain any food or fluids. She was seriously malnourished and her kidneys had begun to fail. She was in grave danger of losing her stomach, and possibly her life, and needed to undergo emergency surgery. Her sister Ann rushed her to London’s Charing Cross Hospital where a senior bariatric team was assembled at 10pm. By now, Pauline was vomiting constantly and her weight had dropped to eight and a half stone.
The surgeons removed Pauline’s gastric band, fortunately without any complications. ‘I was told afterwards that had I come in a day later, they would have been taking my stomach away. The blood supply to it had been cut off by the band and it was beginning to die.’ She spent five days in hospital on a liquid diet while her magnesium and phosphate levels were regulated. It was another month before she was well enough to return to work.
The part-time degree in early-years childcare, from which she was due to graduate this year, has had to be put on hold. ‘I feel my whole life has been thrown into turmoil and it is still not back on track,’ she says. Most worrying of all, with no gastric band in place, her weight has begun to sneak back up. ‘I am 12 stone, but my biggest fear is that it will spiral out of control.’
Pauline is seeking compensation from the clinic that fitted her gastric band, but so far there has been no admission of liability. ‘I feel very let down. My aftercare was disgraceful – no one wanted to take responsibility for me. We read a lot about the “miracle” effects of gastric bands, and they can help achieve dramatic weight loss, but people should also be aware that things can go terribly wrong. When they do, it is vital that those who are responsible for the surgery are made to pick up the pieces before it costs someone’s life.’
Weight-loss surgery: the facts
- Weight-loss surgery has increased 30-fold in the past ten years. More than 8,000 bariatric (obesity-reducing) operations are carried out annually on the NHS and many more through private clinics.
- The two main procedures are the gastric band and the gastric bypass. The band, which costs around £6,000 privately, involves placing a ring near the top of the stomach to create a golf ball-sized pouch. Patients achieve up to 47 per cent weight loss. With a bypass, the surgeon creates a small pouch at the top of the stomach and connects the small intestine to it, so food bypasses the body’s main digestive organs and fewer calories are absorbed. Patients typically achieve 66 per cent weight loss. A bypass costs around £11,000 if done privately.
- Both procedures can cause a number of side effects, but the gastric band is generally considered safer because it does not involve cutting the stomach or the bowel. Another benefit is that it is adjustable — the degree of restriction to the stomach can be varied. Unlike the gastric bypass, it is reversible, as the band can be removed.
- As with all surgery, there are risk factors including infection, blood clots and internal bleeding. A gastric band slippage affects around one patient in 50. Symptoms include heartburn, nausea and vomiting. In severe cases, like Pauline Boyle’s, where the slippage causes a blockage, urgent surgery is needed to prevent malnutrition and death.
- A common complication with bypass surgery — affecting one patient in 20 — is stomal stenosis, in which the hole connecting the intestine to the pouch becomes blocked with food. This can usually be treated by inserting a small flexible tube with a balloon attached, which is then inflated to remove the blockage.
- Those who undergo bypass surgery need to take supplements for the rest of their lives because of the changes to their diets.
- Band patients are initially prescribed a liquid-only diet, but then move on to normal food in smaller portions. They are less likely to need supplements, but should have regular checkups and watch for any deficiencies. Band patients are more likely than bypass patients to need further operations, as the band often requires adjustment.
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