I remember clearly the day that one of my office staff members told me about Warren Kushnick. He had already obtained his insurance authorization for gastric bypass surgery at another facility. He was continuing to research where to have his surgery since he was told that he was high-risk and he felt the other facility was “taking their time” with scheduling his surgery.

After talking with my staff and attending a lecture, Warren had decided to have his surgery with us.  While reviewing his health questionnaire, I learned that Warren was 63-years-old, weighed 365 pounds, had severe sleep apnea, hypertension, and chronic heart rhythm problems secondary to coronary artery disease for which he had open heart surgery and bypass grafting. Wow! I had to admit, to undertake a laparoscopic gastric bypass on a patient who brings all this to the table (literally), was more than a little concerning to me.

After meeting Warren and his wife in consult, there was nothing, within my best medical judgement, that was going to prevent me from performing his surgery. Why? Simple – Warren reminded me so much of my own father who had struggled with obesity for years.

Growing Up With Obesity

My Father, Jack Nease

My father was a Judo Instructor in the military and in relatively good physical condition. I remember him lifting weights routinely. Five years after he was discharged from the Army, he began to gain weight quite rapidly. This is where genetics, lack of exercise and good home cooking come into play. At the age of 36, he developed Rheumatoid Arthritis, and was placed on steroids, another weight gain factor, along with many other types of medications for two years. All this weight gain made the joint pain even worse. My dad missed many of my ballgames, which was such a big part of my life growing up. I was involved with several organized sports, but my father rarely was able to toss a football or throw a baseball to help me practice. It was even difficult for him to be a spectator at my games, because he gained so much weight he avoided being in crowds.

Me, in my younger times.

When I was 12 years old, my mom and dad brought lawn chairs to one of my games because it had become too difficult for him to climb the bleachers. He weighed 300 pounds at that time. As luck would have it, he exceeded the weight limit of the lawn chair and it collapsed beneath him. My mother tried to help him up from this terrible and embarrassing position, but she could not do it on her own and enlisted the help of two men in the crowd. Despite the laughs of some of the people, my dad pretended that it did not bother him but I knew differently. I was very protective of him and couldn’t do much about the adults who were laughing, but I could do something about the one kid on the opposing team whose laughter seemed to never end. Let’s just say it ended quite abruptly after being introduced to his first black-eye. (Here’s one for you Dad!)

I Can Do It On My Own

As I grew up, I found myself drawn to medicine for many reasons. As a third year medical student at Ohio State University, I had heard about the disease of obesity during my surgery rotation. I talked to my dad about considering gastric bypass surgery. He was now 350 pounds and had developed sleep apnea, hypertension, diabetes and severe problems with degenerative joint disease of his knees. His response to me was, “Once I get my knees replaced, I’ll get around much better and lose this weight.” Well, he had both knees replaced shortly thereafter and you probably can guess – he did not lose any weight. In fact, he gained more weight and four years later he needed one of his knees replaced again. By this time, I was at the University of South Florida for my surgical residency, where bariatric surgery was an integral part of my training. My dad was now 400 pounds. I tried to convince him that the operation he really needed was a gastric bypass and not another knee replacement. But dad said this time he could do it on his own. If only his knees would hang in there long enough for him to lose the weight.

Dad, in his heavier times.

Over the next few years, he continued to battle the weight and related health problems, and I began to see a dramatic decrease in the quality of his life. His highest weight was just under 500 pounds. He had become oxygen dependent, and required assistance of a ventilator at night. He never complained and rarely asked for anything. My dad was truly one of those rare people who gave more than he received or expected back in life.

Bitter Sweet

Early in 2000, my wife, Sheila, and I were expecting our second child, but since it was early in the pregnancy, we did not announce it to anyone and told our 2-year-old son Garrett, to keep it a special secret. Well, as you can imagine, it was not a secret for very long and on Easter Sunday, Garrett informed my parents of our own bit of Easter “Good News.”  My dad, who was a “kid magnet,” was so thrilled to be a “Paw-Paw” again and couldn’t wait for the day to arrive.

Sadly, the day never arrived for my dad. Two days after Easter on April 25, 2000 he was defeated by the devastating diseases process called morbid obesity. I no longer could call or go visit him. He would never know my children who are now forever deprived of his unconditional love as I had growing up. I was angry and hurt to be robbed of such a wonderful friend and father, but much as I knew he silently suffered, I also knew he was now at peace.

To Be or Not To Be

Even though I saw what bariatric surgery could do to help achieve long-term weight loss surgery in my training, I had no plans of making it part of my medical practice. There was no immediate gratification knowing that the surgery went well. In general, most surgeons are of the mentality of, “Have surgery and fix the problem.”  If someone has a bad appendix, you remove it and it takes care of the problem. If it’s a tumor, remove it and your job is done. Albeit, there may be further treatment necessary, but the surgeon’s job is generally complete and there is satisfaction knowing you are aiding in the recovery.

However, bariatric surgery is just not that way. There is nothing immediate that tells you whether the risk was worth it because results are not instant (this is where a surgeon has trouble dealing with delayed gratification).

And since you get to know the patient on a more personal level than with other types of surgery, you worry even more so and really feel it when there is a complication. This factor, along with an overall higher risk groups of patients, continued insurance coverage and reimbursement problems, high malpractice costs for this specialty and a new baby on the way — I just wasn’t sure. Not to mention, my anger at such a disease that took my fathers’ life. I didn’t think I could deal with it on a daily basis.

The road leading to bariatric surgery as my specialty was not as simple or a clear path from the beginning. I’m not sure I actually chose this field or whether it chose me. Dealing with obesity was certainly not new in my life, but to dedicate my whole practice to it was not an immediate or easy decision. Over time, however, the pain and anger of my father’s death seemed to have lessened and after a few years of advanced laparoscopic general surgery, I decided to consider adding bariatric surgery to my practice. I first implemented a program that would provide proper support, and after the first few cases I was hooked. I got such a unique satisfaction that I could help those who undoubtedly faced similar health problems and social situations as my father. And it wasn’t hard to get used to that delayed gratification after the first few “success stories.”

Back to Warren

Dr. Nease talks with Warren about his progress.

I was determined to not allow my father’s fate with obesity to be that of Warren and his family. Despite the high risk involved, Warren went on to have a laparoscopic gastric bypass in October of 2003. To date, he is proud to tell anyone who will listen that he has lost over 100 pounds and his health has dramatically improved.

For all the Warrens out there and in memory of my dad, Jack Nease, this is how and why I have chosen to fight the battle against obesity. I am truly blessed to be a part of this specialty and am thankful to all those who have had the courage to make a difference for themselves, their family and friends.

For the Love of My Father originally appeared in ObesityHelp Magazine Summer 2004. To see the full pdf version, please check out Dr. Nease’s website.

Dr. Blaine NeaseBariatric Surgeonhttp://www.yourwls.com/ – Center for Surgical Weight Control

QHow old were you during your WWII military service, and what was your rank?

I was about 26 years old, and a Navy medical officer and photographer on two ships: the LST-6 (landing ship tank) during the Normandy invasion and the AKA-103 (attack cargo ship) at Okinawa. I was initially an Ensign, on LST-52 on the Atlantic crossing from Boston to England, and later I was promoted to Lieutenant [Junior Grade], and then full Lieutenant. I made five trips across the English Channel from Portsmouth to the Normandy coast of France.

QWhat was your set-up for emergency triage on the tank deck off of Normandy?

On the LST-6, our tank deck was converted into an emergency and hospital room after all the heavy military equipment (tanks, trucks, etc.) had been discharged to the beach. The stretchers holding the wounded served as hospital beds. There were three doctors on our ship including myself. We had adequate quantities of IV solutions, ten or twelve bottles of type-O blood, ample vials of morphine sulfate for pain, and sulfa drugs for infection. The surgical equipment was quite good—we kept what was needed for major surgery on one of the mess hall tables. In addition to the tank deck set-up, we had first-aid stations scattered about the ship, where emergency equipment such as bandages, antiseptic and so forth could be used by the personnel top-side in case our ship was hit.

QDid you perform surgery as the medical officer on the ship?

During the Normandy invasion there were three doctors, one a qualified surgeon from Kentucky. We did one abdominal exploration for a shrapnel perforation and completed an arm amputation on a severely torn upper arm. We used the mess hall dining table for the surgery.

QWhat was the environment that led to your development of weight loss surgery?

I had always been interested in research, and during the last year of my residency in 1953 I devoted my time and effort, along with Drs. Arnold Kremen and Charles Nelson, to a small bowel absorption study in dogs to evaluate the absorption characteristics of various segments of the small intestine. After completing my service and going into private practice, one of my patients, R.D., of Savage, Minnesota, who weighed between 275 and 385 pounds at various times, complained that she could not maintain her weight loss and, no matter what she did, she would always regain the weight she had lost. I told her about our experiment in dogs and that although the malabsorption did result in weight loss, it had never been performed on humans. She told me that she wanted the surgery no matter what. In those days, we did not have the [Institutional Review Board] regulations nor the litigation that we have today, so after consultation with Dr. Kremen, we decided to perform the first surgery in April of 1954 at Mount Sinai Hospital in Minnesota.

QWhat was the initial reaction of the medical community to weight loss surgery?

The paper with our results and the R.D. case report, published in the Annals of Surgery, was received enthusiastically at the American Surgical Association meeting in Cleveland in 1954. Shortly thereafter, a number of surgical groups began to do variations of the JIB (jejunoileal bypass), but I decided not to perform any more procedures until I had a chance to see the results of our case and the operations that were being done by others.

As far as the general medical community goes, however, there was a lot of resistance to weight loss surgery, especially amongst internists, as well as some surgeons. They thought it was crazy to treat obesity with surgery. In an interview with Dr. Ancel Keys, an internationally known nutritionist, he said with a slight smile, “what you should do is to sew the patient’s mouth shut!” That shook me a bit, but did not deter me and I decided to perform the surgery anyway.

QWhat type of weight loss surgery did you perform?

I performed JIBs at first, but because of the problems associated with that procedure, I switched to the Gomez horizontal gastroplasty, then Mason’s vertical banded gastroplasty, and finally the Roux-en-Y gastric bypass (GBP). I did a few gastric banding procedures but found the weight losses were not as significant as with the gastric bypass. I used the open method exclusively, but today our group does it primarily laparoscopically, tailoring the choice of operation to each patient. There are certainly going to be other technologies down the road, but the most important thing is that these procedures pass the test of time and prove to be as safe as possible.

QWhat were the disadvantages of gastroplasty?

It was not as effective as gastric bypass, and, in trying to improve the results, the stoma was often made too small, resulting in stomal obstruction. The adjustable band improved that situation considerably, but, in our experience, was not as effective as the GBP. We later found that the GBP was a more effective way of treating Type 2 diabetes as well.

QWhat role did aftercare play in your early experience with weight loss surgery?

Lifetime follow-up is vital to achieving good results and evaluating long-term success. This often requires telephone contact or mail response.

QWas a psychiatric evaluation necessary for having weight loss surgery in the early years?

We did not believe that formal psychiatricevaluation was necessary in every case. If we felt, based on a good history and physical examination, that a particular patient needed to have a psychological evaluation, we recommended it, but certainly not for every patient.

QWhat advice would you give to surgeons new to this field?

Get the best training in current techniques at Centers of Excellence, attend national meetings, and keep abreast of all the new changes in this dynamic field.

QWhy do you think weight loss surgery has gained such prevalence?

Obesity has grown to epidemic proportions in our country, and at this time there is no effective medical treatment for the morbidly obese. We need more effective preventive measures on a national level.

QWhat do you see as the next frontier of bariatric surgery?

There will be growth of robotic-type approaches and transluminal endoscopic procedures.

QTell us about the book you have written on weight loss surgery, and about your inspiration for your most recent book.

I wrote my first book, Surgery for Morbid Obesity, which was published by Springer-Verlag in 1984. It was a standard textbook for a number of years. When the newer approaches appeared, there were some discussions about a second edition, but, unfortunately, I was too busy to get into it.

My most recent book, Normandy to Okinawa, is a combination of my diaries as a Navy medical officer aboard LST-6 during the Normandy invasion and the AKA-103 at Okinawa and an abridged history of WWII. I had kept a daily diary and I was also a photographer on the ship. When I came back from duty and began my practice, I put the diaries and the photographs in the closet where they resided for fifty years. I have five daughters, and a few years ago my wife and my daughters encouraged me to start working on my diaries and ultimately publish them. It took me ten years to put everything together, but it was finally accomplished.

This interview with Dr. Linner appeared in ObesityHelp’s magazine Bariatrics Today, Issue 1 2008. Dr. Linner  was a pioneer in bariatric surgery, his groundbreaking research led to the world’s first published account of a weight-loss operation. For 40 years, he dedicated his life to the study and treatment of obesity. He served as the former ASMBS president, published several articles and a book on bariatric surgery, served as a consultant to the U.S. Department of Health and Human Services, and won awards from the American Society for Metabolic and Bariatric Surgery. Dr. Linner passed away November 8, 2013 at age 95, Family members say Linner was most proud of being remembered as a doctor who was dedicated to his patients and who kept up with them long after they left the hospital. “Patients showered him with thank-you notes”, his wife said.

Dr. John H. LinnerFormer President of the ASMBS