For this couple, gains came from loss

Bariatric surgery, triggered by tragedy, has changed their lives
January 26th, 2017

Sit down with Diane and Dan Hopmann and there’s a sense of completeness. The Aurora couple have been married 42 years with two grown kids and grandsons ages two and five. He works as an IT manager at Visa; she has a home-based business selling LuLaRoe clothing. He possesses a dry wit; her soft-spoken sincerity complements it.

These are good people, the kind other people just feel comfortable being around. But as with any pair having spent 64 years on this Earth, there has been loss, too. In the case of the Hopmanns, one loss led to another which, in turn, has brought them immense rewards, both anticipated and otherwise.

Diane and Dan Hopmann at UCH for their one-year checkup after bariatric surgery. Dan has lost 114 pounds, Diane 104. Those pants don’’t quite fit anymore.

The triggering loss was of Diane’s brother, who died of pancreatic cancer in May 2015. She called it a family tragedy.

“My brother was taking care of himself,” Diane said. “I was the obese sibling.”

Dan was similarly struck.

“It just reminded us of the value and the preciousness of what we had and the desire to make it better,” he said.

Diane was five-foot-two and weighed 263 pounds at the time. Dan was a foot taller and weighed 330. Both were thin when they were younger – Dan even described himself as having been “a beanpole in high school and college.” But, as he put it, “You start in the workaday world flying a desk eight hours a day and it packs on after a while.”

By 2015, neither moved well. They loved the mountains, but Diane was short of breath at altitude. Dan couldn’t make it up the four floors of stairs to his office without stopping to pant. They had a harder time keeping up with their young grandsons than they imagined they might. Both were pre-diabetic and had high blood pressure. Dan had restless leg syndrome. Their sleep apnea meant continuous positive airway pressure (CPAP) machines at night.

Taking it off

They knew that losing weight would help, and they tried many times. Diane recalled going on a 500-calorie-a-day diet at one point, which is ample sustenance only if you happen to be a hamster. They knew of bariatric surgery, but didn’t know insurance companies backed it. Their primary care doctors Katie Suddarth, MD (Diane), and Laurence Williams, MD (Dan), and their other health care providers were at University of Colorado Hospital, making the Surgical Weight Loss Center the obvious choice for weight loss procedures.

In summer 2015, they started the process by attending an information session led by Jonathan Schoen, MD, who with fellow University of Colorado School of Medicine surgeon Kevin Rothchild, MD, performs the center’s bariatric surgeries. Their insurance company gave the go-ahead provided they start the bariatric diet (high protein, low carb) and lose weight before the surgery.

There’s also a psychological evaluation. The point isn’t to slim down or determine sanity so much as to demonstrate that the bariatric surgery candidate has the stability and willpower to ensure the surgery’s long-term success – which is far from guaranteed.

“The surgery is a tool,” Dan said, repeating what is the center’s guiding mantra.

That tool, in the Hopmanns’ case, would be a vertical sleeve gastrectomy. This involves removing more than half the stomach, leaving not much more than an esophagus-width pouch and a slew of staples behind. That such a major – and irreversible – procedure can be called a tool is a testament to the importance of the ecosystem of Surgical Weight Loss Center support surrounding the surgery itself, including support group meetings, exercise programs, dietary and psychological counseling and medical visits. That support goes on “forever,” as dietitian Lisa Kassel, RD, CNSC, put it.

“The preparation and the follow-up are critical,” Dan added.

Under the laparoscope

The vertical sleeve gastrectomy, which the Hopmanns had three weeks apart, removed about 85 percent of their stomachs. It’’s an irreversible process, and that was part of the appeal. ““I didn’t want to leave myself with an escape hatch,”” Dan said. “”I didn’t want a way out.””

Diane’s surgery happened first, in late October 2015, with Dan following three weeks later. Diane’s recovery from the laparoscopic procedure went more quickly, in part because Schoen had to deal with scarring from a gallbladder surgery Dan had done 20 years ago.

For both, there were weeks of adjustment – from consuming only clear liquids before advancing to full liquids to purees to soft foods. An in-depth preoperative nutrition class prior to surgery and a detailed nutrition book from the center provided guidance.

“You go through a lot of yogurt,” Dan said.

They avoided complications associated with bariatric surgery and they started living a different dietary life. Breakfast consists of protein shakes. Carbohydrates largely disappeared from the house, and pasta and pizza are indulgences of the past as is Diane’s swooning for McDonald’s fast food. She said she doesn’t crave it, or carb-heavy foods in general, anymore. A carb splurge, she said, might come in the form of a small piece of birthday cake, a thin slice of pie or a dinner roll. Dan admits to a lingering weakness for oatmeal raisin cookies, but comes across one rarely.

She and Dan continue to eat out. But they exercise portion control to the point that they tend to get two additional meals out of their doggie bags. They take “bariatric vitamins” three or four times a day to counteract the lessened absorption in the stomach. Their alcohol tolerance is way down.

“We make for a really cheap date night,” Dan said.

A year later

On Nov. 30, just over a year after their surgeries, they were on the sixth floor of the Anschutz Outpatient Pavilion for their one-year post-surgical appointment. It started with a weigh-in and, a bit later, a waistline check. Jamie Brave, the center’s senior medical assistant, did the honors. Brave said that even from her seasoned perspective, the changes are “amazing to see, especially when we have patients who have lost 300, 400 pounds. They’re unrecognizable.”

Dan produced his work ID card. The photo was taken before the surgery. There was a jowly roundness now absent. His colleagues worried that he had cancer, he said, and his younger grandson, on their recent visit in Kansas, was at first skeptical of his true identity.

The numbers showed why. Dan had lost 114 pounds since surgery; Diane had lost 104 pounds. They have shed, respectively, the mass of more than a dozen gallons of milk each. Those changes manifest in volume, too. Diane has shed 15 inches from her waistline. Dan’s beltline is a foot shorter. He had to buy new business suits because taking them in enough would have overlapped the back pockets.

Schoen entered the exam room, pulled up medical records, and said, “Looking at the numbers, you both have done very, very well.”

A good weight

The average bariatric patient loses 60 percent of his or her excess weight. Diane had lost 75 percent of hers; Dan 70 percent of his. Schoen did some calculations on his smartphone and concluded that, if they wanted to, he would sanction either of them losing a few pounds more. But from a medical perspective, they were already in good shape.

“I’m actually very happy with you at this weight, provided you are,” Schoen said.

While Diane aims to lose another eight pounds or so, they are happy with how things are turning out. Several pleasant surprises have tagged along with expected benefits such as much-improved mobility and energy.

Diane Hopmann talks with Jonathan Schoen, MD, as Diane’s husband Dan looks on during their appointment a year after bariatric surgery, which Schoen performed. Both lost more than 100 pounds.

“With the grandkids, we can take them to places and not tire out,” Dan said.

Diane’s difficulty breathing at altitude turns out to have been weight-related, so they’re back in the mountains. Her blood pressure is down. She’s no longer pre-diabetic. She hasn’t caught a cold since the surgery either, she said. Her knees are better.

Dan is off blood pressure medication; like Diane, he’s no longer pre-diabetic, either, and his restless leg syndrome disappeared. His cholesterol numbers are much better. Both he and Diane still use CPAP machines for sleep apnea, but Schoen said they may not need them anymore, pending another sleep test. There are also psychological benefits.

“Our overall view of life is better,” Diane said.

“It’s just a more positive outlook,” Dan added. “Plus, you can look back at this and say, ‘We succeeded.’”

More to do

That said, they’re not done, they both know.

“You still have to be vigilant,” Dan said. “It’s a lifetime story now.”

Schoen said that vigilance is merited. Their bodies want to return to their heavier selves because of some combination of energy balance and hormonal regulation that still flummoxes medical science. He then brings up exercise. Diane aims for a one-hour Curves session three times a week but doesn’t always get there. Dan said he has never been a big exerciser, but is making a point of walking more and taking the stairs up to his fourth-floor office at work, which he now conquers without a problem.

“You could both stand improvement there,” Schoen said. “Exercise is very important in maintaining the weight that you’ve lost. It increases your metabolism and rebuilds the muscle.” Shoot for seven days, he added, though five days a week will work as well.

As Schoen departs, Diane tells him, “Thank you so much – this is a fantastic program.”

They will be back in six months. Until then, they plan to come in for monthly support group meetings that helped them so much as they mulled and then prepared for surgery. They enjoy them, they say, and it gives them a chance to pay forward their good fortune born of very different sorts of loss.