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For obese teenager, surgery worth risks

By NICK WALTER THE GAZETTE Everywhere he went, Ryne Clarke felt the eyes. In the hallways at Harrison High School, they gawked. In any sport he tried, they disapproved. In class, when Clarke rose from his seat, they stared, just in case he’d bump into something. Ever wonder about a life at 483 pounds? “If someone really wants to know,” Clarke said, “try walking around with a full book bag and school supplies all day, 24-7, and see how hard it is to move and how hard your heart has to work.” Weight-loss pills, exercise and dieting wouldn’t counteract Clarke’s extremely low metabolism. Gastric bypass surgery — a risky, lastditch method for weight loss — seemed to be the only option that could rescue Clarke from his solitary and unhealthy life. A moment before he was wheeled through the door of the Penrose Main operating room on June 4, 2003, the 483-pound Clarke leaned his head up and glanced at his father, Adrian. His dad’s face was stone-cold still. But his dark brown eyes were different. They indi- cated something to Clarke — something more than worry or fear. “That’s when it hit me,” Ryne said. “Like, ‘Wow. He fears that I won’t come back OK.’ That’s when I started to get a little nervous.” Adrian Clarke has a different image burned into his mind. “It was after one of his final (freshman football) practices,” Adrian said. “He was so heavy and out of shape, when I came to pick him up from school, I’ll never forget his face. He said, ‘I can’t make it.’ The practice was too tough on him and the drills . . . he couldn’t handle them.” Gastric bypass surgery has increased dramatically in recent years. “Today Show” weatherman Al Roker told viewers about his surgery. Still, it remains rare for young people to have such surgery, even if obesity puts them at risk for complications and death. Clarke underwent the 90-minute procedure. Doctors split and stapled Clarke’s belly, rearranged his abdominal parts, and reduced his stomach to the size of an egg. Clarke awoke afterward and felt overwhelming pain. Doctors wanted Clarke awake for two minutes to check his vital signs. “It felt like there was a cut down my stomach and someone took a semi and lodged it into the raw stuff inside,” Clarke said. BECOMING MORE COMMON The procedure, which eventually would help Clarke lose 222 pounds, is complex. First, the top of the stomach is cut and stapled to form a pouch, which will become a new stomach that can hold, on average, 2-4 tablespoons of food. The small intestine is cut and sewn to this pouch. Eventually, food will bypass a part of the small intestine and reduce the amount of nutrients that can be absorbed. Gastric bypass and gastric banding are the main forms of bariatric surgery practiced in the United States. With gastric banding, a band is placed around the stomach to create a small pouch and a restricted passage to the larger remaining part of the stomach. Bariatric surgery is becoming increasingly common. The American Society for Bariatric Surgery estimated that 140,640 Americans underwent gastric bypass surgery in 2004, compared with 103,200 in 2003, and 16,200 in 1992. ASBS executive director Georgeann Mallory estimated there will be more than 170,000 this year. Furthermore, the ASBS membership has increased from 258 in 1998 to 1,070 in 2003. The numbers have increased despite serious risks. According to the Mayo Clinic, one patient in 200 to 300 on average die from the procedure. It also presents potential psychological concerns and health problems such as bleeding, perforation, or leakage where some staples are dislodged by overstretching the pouch. Also, ulcers and narrowing of the passage can result if the staple line does not heal properly. Dr. Thomas Sachtleben, the Clarke family physician, said Clarke’s weight problem, which already had caused high blood pressure, headaches and stress on his joints, could put his life in danger at a young age. Once the surgery was complete, Clarke faced a different sort of challenge. “Besides the pain after surgery that lasted for a brief two minutes,” Clarke said, “the next three or four months was the hardest thing I’ve had to deal with.” Clarke’s brain was still in munch mode, but his stomach could hold only six tablespoons at a time. Over a year it would expand to hold about one cup of food. Because his stomach lining was thinner after surgery, spicy foods and sweets caused stomach pain. Clarke once tried Cajun rice and felt nauseated. Two years before surgery, Clarke hired a personal trainer at 24-Hour Fitness. But when he worked out, his immense weight began to punish his body. Shortly before the operation, Clarke developed a stress fracture in his right ankle. Nothing worked. And the humiliation began to take a toll. “People in school never took a chance to get to know him,” Adrian said. “They just saw a big person and judged him from that. He was just looked at as a fat boy.” In middle school, when he weighed well over 300 pounds, Clarke hid from the world “because of the way I looked.” He was isolated in class, seated in a chair behind a table because he couldn’t fit in a standard desk. “It was hard to move around the desks in the classroom,” Clarke said. “Every time I got up I felt like someone was watching to see if I was going to knock something over. But no one really paid attention to me. They just looked through me.” Clarke’s biggest gain in weight was during a six-month span from the summer after eighth grade to that December, when he went from 375 pounds to 420 pounds. He could benchpress no more than 95 pounds. “Being that heavy, I felt like there were cement bricks on my legs and arms and I had to work real hard to do something simple that others do easily,” he said. Clarke tried playing football in high school but couldn’t. “I tried everything else and the surgery option showed promise with people much older than me,” Clarke said. “My doctor said because I’m younger I could bounce back faster.” RARE FOR YOUNG PATIENTS Until Clarke, Dr. Scott Fisher never had performed gastric bypass surgery on anyone younger than 20. Before agreeing to perform the surgery, Fisher was concerned that Clarke, like any patient, would not lose weight or adjust to new eating habits. Fisher insisted on four sessions of psychological testing. “The patient has to be able to deal with what follows the surgery,” said Fisher, who wrestled at Amhurst High School and Hamilton College in New York. Fisher earned his medical degree from Syracuse University. “The surgery has caused suicide in cases I’ve read nationally, but certainly not in my case.” The ASBS lists 13 doctors statewide — two in Colorado Springs — who perform gastric bypass surgery. An informal survey of the 13 showed that only two other doctors have performed a gastric bypass surgery on a patient under 18. Dr. Michael Johnell of North Colorado Medical Center in Greeley said he has performed the surgery on a 17-year-old. Dr. Frank Chae of SkyRidge Medical Center in Lone Tree said that in the past 10 years he has done close to 1,000 gastric bypass operations. Of those, 14 were on adolescents. Dr. Harvey Sugerman, a retired bariatric surgeon and current ASBS president, knows bariatric surgery on teenagers is rare and not encouraged, but sometimes necessary. “I think it’s becoming more common in adolescents because there’s nothing else that can be done,” Sugerman said. Clarke’s family and doctors felt surgery was the only option, but the Clarkes did not receive coverage from their insurance company, Kaiser Permanente. According to Clarke’s mother, Emma, they wrote to the company “begging” for coverage but received only a letter suggesting Clarke make weekly appointments at a weightwatchers group for teenagers in Denver. Emma said Fisher and Sachtleben wrote letters to Kaiser Permanente that explained the necessity of surgery. “I said, ‘We can’t drive all the way to Denver every Wednesday,’” Emma said. “And with his blood pressure, Ryne needed help quick.” C.J. Moore, Kaiser Permanente’s public affairs director, said the company has approved insurance for 14 gastric bypass surgeries this year. She also explained the company’s process of approving coverage for such a procedure. “If it is not a medical necessity, Kaiser does not cover a gastric bypass,” Moore said. “Medical necessity means that (the surgery) is what’s needed for that particular condition. There are a lot of things that go into this, such as high blood pressure and the patient’s age.” Because their insurance company didn’t cover the surgery or the six-day hospital stay, the Clarkes still are paying off a $40,000 bill, plus occasional visits to Fisher and a nutritionist. The bill takes up a large chunk of the Clarkes’ budget. Emma and Adrian work in child care and have about $22,500 left to pay. “It was worth it,” Emma said. “It saved his life.” ‘ IS THAT HIM?’ During four months of ad- justing to his new eating habits — Clarke acquired a genuine liking for fruits and vegetables and turned his nose at sweets — he essentially had to reconnect his brain to his stomach. More importantly, he experienced a dramatic weight loss of 133 pounds in three months. He settled in at 350 pounds at the start of his junior year when he made the football team as an offensive lineman. “Three months after surgery, when I went back to school as a junior, people would look back and say, ‘Who’s that? No . . . is that him?’” Clarke said. “It felt weird. At first I was so used to people looking past me and now people are looking at me.” Clarke shed an additional 30 pounds by the end of the season. In the spring, he was on the wrestling team but couldn’t compete because he wasn’t close to the maximum weight of 275. “He’d never wrestled a day in his life,” Harrison wrestling coach Doug Moses said. “But he never missed a practice and did everything all the other kids were doing.” Clarke was named “Most Dedicated Athlete” by Moses. He also filmed the varsity wrestling matches. In doing so, Clarke saw his ultimate goal. “I told coach, ‘My only wish is to be on the opposite end of the camera,’” Clarke said. Soon, Clarke would have the camera’s attention. During his senior year, after being chosen captain of the football team, starting on the offensive line, and dropping his weight to the wrestling maximum of 275, Clarke got his chance. It was Chance Torres who had to take the fall. One month before a regional wrestling tournament, the Harrison heavyweight injured his knee. That meant Clarke would have a wrestle-off with Ryan Johnson for Torres’ spot. Clarke won a 3-2 decision. At the regional, with his mother, grandmother and aunt present, Clarke lost his first and last matches. “I was crushed,” Clarke said. “I thought I wouldn’t make it to state after all that hard work.” The top four qualify for state. As it turned out, Clarke tied Cheyenne Mountain’s Dale An for the fourth spot. Fortunately for Clarke, he had defeated An during the season. “Then my teammate Iavor Kostadinov came running up to me and said, ‘You’re going to state!’” Clarke said. “I couldn’t believe it at first. It was unbelievable. My tears of sorrow became tears of joy. I didn’t think I’d ever be able to make it to state.” Although Clarke lost his two matches at the state tournament, he had arrived, his life suddenly full of purpose. A leaner, more confident person, he found a flock of new friends and is attending the University of Colorado at Colorado Springs, where he’s studying engineering. Some of the drawbacks: Clarke must take two pills of multivitamins, calcium and iron, and three pills of B-12 daily because he can no longer absorb sufficient nutrients from food. Clarke also must undergo another surgery when he is 21 to remove excess chest skin. Still, the weight loss has allowed Clarke to do things that are trivial to most: drive any car, walk comfortably between rows of school desks and fit in movie theater seats. Clarke reported to his twoyear check-up April 5, weighing 261 pounds. The nurses and assistants were shocked, not having seen Clarke in a year. “The end results,” Fisher said, “were better than I ever expected.” The weight continues to plummet. On Monday, Clarke stepped on the scale and weighed 250 pounds. “I’m still the same person inside for the most part,” said Clarke, who thanked the Harrison football and wrestling staffs for their support. “The only thing I changed was my outside appearance. Now I’m more outgoing and I’m a lot more positive. There’s no doubt that, overall, I’m a better person for having the surgery.” CONTACT THE WRITER: 636-0250 or sports@gazette.com