Patient Perspectives: Sleeve Gastrectomy for a Heart Transplant

Podcast Transcript

Dr. Scott Steele: Butts and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Dr. Scott Steele: Hi again everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the chair of colorectal surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. Today, super excited to have a three person panel, if you will. We have Karen Schulz, who's a certified nurse specialist in the Bariatric and Metabolic Institute here at the Cleveland Clinic. Diane Harris, who's a patient navigator here at the Cleveland Clinic. And we're always looking forward to when we can have a patient on. We are very pleased to have Paul Beatty, who's a sleeve gastrectomy patient here at the Cleveland Clinic. Everyone, welcome here to Butts and Guts.

Karen Schulz, CNS: Thanks.

Paul Beatty: Thank you.

Diane Harris: Thank you.

Karen Schulz, CNS: Good to be here.

Paul Beatty: It's good to be here.

Dr. Scott Steele: So today, we're going to talk about, well Paul, let's face it. We're going to talk about you.

Paul Beatty: Oh.

Dr. Scott Steele: And we're going to talk about a very interesting sleeve gastrectomy for a heart transplant patient. But for the longtime listeners of Butts and Guts, we first want to hear just a little bit more about your background, where you're from, where'd your train, or how did it come to the point that you were here at the Cleveland Clinic, or here came to the Cleveland Clinic? So Karen, let's start with you.

Karen Schulz, CNS: Okay, thanks. So, I'm a west sider of Cleveland, born and raised here. Only left to go to college and came back as an advanced practice nurse. I was fortunate enough to work with the first and founder of bariatric surgery in Cleveland, Dr. Helmut Schreiber. And that was back in the day when they thought bariatric surgery was sort of voodoo medicine. Nobody really believed in it, but he had a vision. He knew that obesity was a metabolic disease. We need more than diet and exercise and that's really what sparked my interest. I moved into bariatrics in the early 90s and just kind of was hooked and has stayed in it ever since.

Dr. Scott Steele: That's awesome. Diane?

Diane Harris: Born and raised in Cleveland, as well. Started my bariatric interest at St. Vincent, where I met Karen. And she decided to bring me over to the Cleveland Clinic, which I've been a patient navigator for the last seven years and totally enjoy my job and plan to stay here for a while. So, I really love helping patients to a healthier, happier lifestyle.

Dr. Scott Steele: And Paul, we're going to talk a little bit more about your journey later, but just give us a little background about yourself. Where are you from.

Paul Beatty: Sure.

Dr. Scott Steele: Where'd you grow up and give us a little background.

Paul Beatty: I grew up in Northeast Ohio over in Geauga County, and I ended up after college, I was a senior pastor in West Virginia. And for 20 years, I did a lot of public service. I was on town council, sat on a lot of different boards. But probably one of my greatest achievements was I started a fire department through the town council and ended up in the fire service because of that. And so, we've done a lot of different things. But life is good, and I've just had a good time, and we're always looking for the next adventure.

Dr. Scott Steele: Fantastic. And we're so glad to have you here. So Karen, I'm going to start with you. So again, we want to just, we have a lot of different listeners out there who have a lot of different medical expertise, but let's start big. So, what is a sleeve gastrectomy and how is this surgery performed?

Karen Schulz, CNS: Yeah, the sleeve gastrectomy is a form of bariatric or weight loss surgery where you take the stomach, which is about the size of a football, you remove 80 percent of it, left with a small sleeve-like stomach. And it really helps patients with that smaller stomach to feel full with a smaller amount of food.

Dr. Scott Steele: So, there's a lot of different type of surgeries. Is this surgery common for patients seeking to lose weight for, versus another procedure?

Karen Schulz, CNS: Yeah, the sleeve is very popular because it's the simplest form of weight loss surgery. I think that in what's very common as a prelude to other surgeries especially. We see a lot of orthopedic doctors now referring their patients prior to joint replacement. We see patients coming prior to hernia repair; infertility specialists send their patients to us to lose weight for that reason, and also for transplants. So, sleeve is the simplest surgery, can maybe be done in about 30 to 60 minutes, fairly low risk laparoscopic, which is why we chose that operation for Paul.

Dr. Scott Steele: Yeah, so you mentioned a little bit is that we try to individualize some of the different procedures to our patients. So specifically, why was sleeve selected for Paul? And you mentioned the weight loss, obviously one thing, but what are the other benefits to a sleeve gastrectomy?

Karen Schulz, CNS: Well, for him, because of his severe congestive heart failure, we wanted to get him in and out of the operation as quickly as possible. He had a left ventricular cyst device and we knew that every minute counted. So, his surgery was about 60 minutes, and then he tolerated that very well. We knew that he would base on the basic simplicity of the sleeve gastrectomy, just having one step instead of some of the other procedures with several steps.

Dr. Scott Steele: So obviously you see a large amount of patients for being a certified nurse specialist in the Bariatric and Metabolic Institute. So, can you give us a couple of the common questions that you might hear more frequently from patients regarding the sleeve?

Karen Schulz, CNS: Yeah, I think patients really want to know how this is going to help them when everything else has failed. I think there's a certain fear that they're going to have the weight loss surgery and then they're going to potentially not do well because they've tried and failed so many other programs before. So, what I tell them is really the surgery's a tool, just like any other tool, in the toolbox to lose weight; it's going to help you. But really working with those other things that you're familiar with: good food choices, physical activity, all of those things together, along with some changes in your eating habits, that will be lifelong.

Dr. Scott Steele: Yeah. That's fantastic. And so we're going to switch gears now to you Diane. And so I had knee surgery, I didn't have a patient navigator, I can tell you that much. So, what is a patient navigator and kind of tell us a little bit about your role within the Bariatric and Metabolic Institute and how did they decide what patients you need to navigate in?

Diane Harris: Okay, so we have a team of navigators. We currently have five. And what our role is to help the patient through the process, to help motivate, help inspire, help keep them on track. And if they have questions, they can contact their navigator. They're assigned by alphabet, so they're easily identified.

And so, they complete an online seminar, and we verify their insurance to make sure they have coverage for bariatric surgery, especially the commercial insurances. Some of them, employers do cover it, some of them don't. And we try to help make that simple for them. If they're a candidate, we send them a welcome letter, and we get them set up with a series of appointments, and we try to streamline the process for them. And so if they have questions, they know who to reach out to and just help them through the process.

Once they've completed the program based on their insurance requirements, we help get their insurance approved for them. Some are easier than others, some are not. Sometimes you got to file an appeal and go through the process, which we had to do for Paul. Paul's insurance took me probably about a good nine months to a year because I had to fight for him, but it was worth fighting for. So yeah, so the navigator is there to help them through the process.

Dr. Scott Steele: Well, that's awesome and I'm so glad that we have members like you and your team available to navigate this journey, if you will, to use a little bit pun on that word. But I can tell you that I tell a lot of my patients that this is a behemoth of an organization, but we do individualize the care and you make that happen, so we much appreciate it for that. So, walk me through it. So, Paul's your patient or let's say I'm your new patient. How do you connect with me and kind of how does that relationship evolve over time?

Diane Harris: So, we do a lot of email with our patients because we all have a big caseload. So, once you become a patient and you qualify for bariatric surgery, you're sent a welcome letter and you're given an email address. But, we do reach out to our patients on a regular basis if they decide they need some extra handholding; we email a lot back and forth. They're given a team of caregivers between medical, surgical, psych and nutrition. There's a lot of requirements they must meet based on their insurance requirements, and we're there to inspire and motivate on a daily basis if they need us.

Dr. Scott Steele: And that's fantastic. So what do you personally find most rewarding as a patient navigator?

Diane Harris: Helping the patients to a happier, healthier lifestyle and getting their insurance approved. It's a challenge, but we love the challenge of getting them approved. And once they're approved, it's like an accomplishment for us because the insurance companies are challenging.

Dr. Scott Steele: Yeah. Absolutely. So Paul, we're going to switch to you now and we've had the honor of taking care of you at the Cleveland Clinic, and you've had the benefit of having specialists and the expertise of the two women sitting right here. So, can you explain to the audience a little bit your medical situation that brought you here to the Cleveland Clinic?

Paul Beatty: Sure. I'd had a heart attack on a fire scene, and at that time I found out that I had major damage to my heart. And, I think the doctor said at that time he'd get five years out of my heart. At the end of five years, almost to the day, I ended back in the hospital. They knew that things were rough so they'd give me two choices. I picked the Cleveland Clinic. They transported me from Charleston, West Virginia to the Cleveland Clinic. And to say things were dire would probably be really minimizing it. But, it wasn't long after I was here that I went into renal failure. They'd tried different things, put a balloon in my heart, different things like that. I ended up where I got LVAD, left ventricular assist device, and it gave me a new chance at life.

And so, I was in the hospital for quite a while, finally got out and started getting my life back together again at that point, looking at whether the LVAD was going to be destination or a bridge. And I definitely wanted to go forward and be a bridge. And I had some doctors that really helped me. Dr. Gorodeski was the one that pushed me then in a direction and advised me to look at getting the gastric sleeve. And so, that was the beginning of my journey to do that. At that point, I believe at my highest point I weighed 358 pounds. I had diabetes, I had just all kinds of problems that were associated with being overweight like that. So, it was something that I really wanted to do, and so we went forward.

Dr. Scott Steele: Oh, that's fantastic. So, you received your sleeve gastrectomy in preparation for a heart transplant. Can you touch a little bit about your journey receiving care here? What was it like?

Paul Beatty: Well, I remember on the ambulance ride up here, I mentioned to my wife, Twila, that I said, I don't want caregivers taking care of me, I want friends. And I said, we're going to make friends here. And we really have. I can look back over the experience and the journey, and I can say that at the Cleveland Clinic, it just wasn't about caregivers, but it was about people that were really concerned and cared. And I felt like everybody that had a hand in our care, that took care of us, became friends. I have lifelong friends to this day that I met here. And to me that's what it's about. It was more than a job; they cared.

Dr. Scott Steele: That's incredible words to hear. It's also incredible; I'm sitting here looking at you. It's hard for me to picture you at 358 pounds. You look fantastic. And all the things that you've been through that literally we could take a day going through, and then more. Tell us a little bit about what you found beneficial, to have a patient navigator and to have the expertise of having a certified nurse specialist just guiding your care along this way, in addition to all the healthcare providers that kind of touched your life.

Paul Beatty: Well, I can't say enough about my navigator, Diane. She fought for me, and I knew it from the beginning. She went above and beyond. I think that most other people would've said, man, this is too rough and quit. But she continually, against that evil giant, the insurance companies, fought them and called them and there were times that I would call them. But, she didn't quit and I wouldn't be here today. I can say I would not be here today if it wasn't for Diane. I don't think, I know, I couldn't have navigated that myself. And she means the world to me and always will. And just the care that I got was amazing.

I had a three-part kind of thing that I went by, and it was one that in my care that I was going to ask the doctors to do everything that they could, and all the people that took care of me. And then second of all, I was going to do everything that I could. And lastly, I was going to ask God to do what only He could. And I felt that that three-part system just came together for me and everybody did their part and I wouldn't be here without any of it.

Dr. Scott Steele: I have to ask you, in terms of a transplant, and as well as the sleeve gastrectomy. What was your recovery like for each of those? Was one harder than the other or for different reasons?

Paul Beatty: The recovery was different for all of them. I'll start backwards. Probably the transplant was in the middle. I think the average stay in the hospital was 43 days. I ended up getting out in eight. And so, I went into that getting stronger. I'd been going to the gym, working out. I got vertigo from it. And that was a little rough. The gastric sleeve, I really didn't have hardly any side effects. Or the one that I had was I end up with gout, and that was because my body was processing all of that weight loss back through my system again in reverse. And so, I ended up with a gout a couple times and that was the roughest thing. I really didn't have, I hear people talk about all the different things that they go through. But for me, I listened to what they said. I made some pledges, I'm not eating this, I'm not drinking this, I'm not doing that. And I think in sticking to that, it really helped me. I really didn't have bad recovery at all.

The LVAD was rough. It brought me from death’s door. I remember I'd been opened up three times I believe in that whole process, and I had to learn to walk again. I just didn't have any strength. And so that was a hard one. That was probably the worst of the recoveries. But, you just got to fight through those things. You got to reach down inside and have some fight. And I can remember when I played high school football, my dad never missed a game. And if I could remember him saying anything, if I got hurt, he really didn't care. But if I got knocked down, he cared about one thing and that was I got up and I could hear him from the stands and he would say, get up, get up, get up. And that served me my lifelong. Every once in a while I hear that voice. And when you get knocked down, you got to get back up.

Dr. Scott Steele: What courage and just inner strength and commitment that you have. It's amazing to me that all you've been through, one of the things that comes up is that darn gout.

Paul Beatty: Yeah.

Dr. Scott Steele: That kind of stands out to me. So, what stood out to you most when you were a patient at the Cleveland Clinic?

Paul Beatty: The care. The care. I noticed that a lot of times, even just my nurses would touch my hand or touch my arm, and I felt like they were touching me in a whole lot of ways. But the care was phenomenal. It just wasn't a job. And I could see that. You could tell when to some people it was. But for the majority of my caregivers, that stands out for me, that they cared.

Dr. Scott Steele: It's amazing because I came out of the operating room the other day and the family said to me, they said, I just need a hug. And I turned to them, and I said, I need a hug, too. So sometimes, we forget about that personal touch.

Paul Beatty: Right.

Dr. Scott Steele: What would you say to somebody that's considering weight loss surgery, but maybe is still uncertain. You've been through this, obviously you're a little bit unique in the fact that you've been through weight loss surgery and so much more. But what would you tell the listeners out there?

Paul Beatty: Well, I guess when I think about what I would tell somebody is that this is something that can help you. It's not something that's going to do everything for you. It reminds me of the guy, he come out and seen a bunch of people. They were at an alligator farm and they were looking at this pond of alligators, and he said, hey guys. He said, I own this. He said, you have any questions? One lady said, I was just wondering, are these friendly or are they really wild and dangerous? He said, well, let me put it to you this way. He said, if anybody could jump in that pond and swim across and make it to the other side, I'd give them 50,000 dollars. They heard a splash. And all of a sudden, they see this guy just swimming like crazy and he gets to the other side. They all run over there and said, man, I can't believe you took him up on that. What are you going to do with the 50,000 dollars? He said, 50,000 dollars? I just want to find the guy that pushed me in!

And sometimes, we just need that little push. And to me, that's what the surgery was for me. It was that push. It was that help. There was still, you got to swim hard, you got to fight yourself. And I would say if anybody's expecting that this is going to do everything for them, they have the wrong expectations. But they need to see it as something that's going to come alongside them and help them achieve things that they never thought they could have done.

Dr. Scott Steele: Oh, that's absolutely inspiring. So, it's time for our quick hitters where we get to know each of you just a little bit better. We'll do it kind of in a shotgun, random style. So, we'll going to go back and forth. So the first question, what's your favorite food? Karen?

Karen Schulz, CNS: Yeah, that's kind of embarrassing because I'm a bariatric surgery nurse, but I love pizza.

Dr. Scott Steele: Fantastic. Diane?

Diane Harris: I'm going to say lasagna.

Dr. Scott Steele: Paul?

Paul Beatty: Oh, I love butter and cheese.

Dr. Scott Steele: And now we're going to go back the other way. So, what's your favorite sport to play or watch Paul?

Paul Beatty: I played high school, college and semi-pro football. But, I love basketball.

Dr. Scott Steele: Fantastic. Diane?

Diane Harris: Baseball.

Dr. Scott Steele: Karen?

Karen Schulz, CNS: I don't know if this counts, but I like to ride my bike.

Dr. Scott Steele: No, there's nothing wrong with that. Absolutely. And so what's a place that you've either traveled to or want to go to one day on your bucket list? Karen?

Karen Schulz, CNS: Down to the Florida Keys.

Diane Harris: Italy. Bucket list.

Dr. Scott Steele: Paul?

Paul Beatty: Man, I travel a lot and I enjoy every place that I go whether it's the desert, the islands. I went to Alaska this last year. I find there's beauty everywhere.

Dr. Scott Steele: Yeah, absolutely. I normally ask a different question about Northeast Ohio, but since you're from West Virginia, I'll ask you each a different question. You could go back in time to that, let's put it in that high school graduating senior self of yours, and you can give yourself maybe just a word of advice or something that you just want to whisper in your own ear back at that stage, what would it be? Paul?

Paul Beatty: Probably you can achieve more than you could ever think you can.

Dr. Scott Steele: Diane?

Diane Harris: Dream big.

Dr. Scott Steele: Karen?

Karen Schulz, CNS: Don't worry about it so much. It's all going to be fine.

Dr. Scott Steele: Yeah.

Paul Beatty: That's a good one. That's a good one.

Dr. Scott Steele: All great words of wisdom. Karen, are there any advancements on the horizon for sleeve gastrectomy here at the Cleveland Clinic? And again, what's a final take home message that you can share with our listeners about sleeve gastrectomy?

Karen Schulz, CNS: Yeah, advancements in the field of bariatric surgery have just been incredible. I think with improved technology, we're seeing these procedures, especially the sleeve being done laparoscopically for small incisions in the 30 minutes, and people are going home in one day. And I think eventually it's going to be same day. We're now introducing the robot, which makes the surgery more efficient and a little less painful. So, I think that's really on the horizon.

If I could give a final take home message to patients, I would say if you've been struggling with your weight for a long time and several health issues and you can't seem to keep the weight off, you're not alone. This is a metabolic disease, and surgery is safe and effective. It's not just for those people on My 600 Pound Life, it's for the average American that has significant amount of weight to lose.

Dr. Scott Steele: And Diane, for you, what’s a final take home message to share with the listeners regarding patient navigation?

Diane Harris: Our navigation team is there to help each patient like they're the only patient to reach their ultimate goal of having surgery. And they fight hard for each patient every day.

Dr. Scott Steele: Fantastic. And Paul, final takeaways for our listeners about your experience here at the Cleveland Clinic?

Paul Beatty: Yeah, I would have to say one of the biggest things that stops any of us from doing anything is fear. And sometimes we have to look at the goal instead of the journey. Where do you want to be? What do you want to do? I remember after losing weight, being able to go out and work in my garden and bend over. And I stayed bent over for a long time because I could. I hadn't been able to do those things for a long time. And sometimes we get afraid, and we're fearful of what's going to happen and what could happen. And sometimes we have to look at what we really want to be. And I would also say this as being a pastor for 20 years: cling to your faith.

Dr. Scott Steele: Fantastic advice. And so, to learn more about the Bariatric and Metabolic Institute here at the Cleveland Clinic, please call 216-445-2224. That's 216-445-2224. You can also visit clevelandclinic.org/bariatrics for more information about bariatric surgery here at the Cleveland Clinic. Again, that's clevelandclinic.org/bariatrics. To the three of you, thank you so much for taking the time out and joining us here on Butts and Guts.

Paul Beatty: Thank you.

Karen Schulz, CNS: Thank you.

Diane Harris: Thank you.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.