Gastric bypass gives patient new 'After' life
Bariatric surgery transports a Bend man and his doctor to the top of Kilimanjaro
The Oregonian - April 04, 2007
JULIE SULLIVAN
Tony Randazzo (left) and his surgeon, Dr. Marinus "Dick" Koning, stand at the summit of Mount Kilimanjaro. "Glaciers in all directions," Koning wrote in his diary. The views, the achievement, I am elated."
BEND -- Hours before the surgeon sliced and stapled his stomach into a thumb-size pouch, Tony Randazzo posed for his "Before" picture. He did not smile.
Folds of flesh drooped onto his belly, which bulged over his size 50 slacks. His chin and cheeks spread out around his goatee. With 350 pounds packed onto his 5-foot-7-inch frame, Randazzo threatened to burst the seams of his pants while he was sitting and destroyed couch armrests as he struggled to his feet.
That he would one day race stairs seemed a fantasy. That he would climb Mount Kilimanjaro with the man who changed his life was a world beyond that.
He and his new wife, Lori, both now 33, were California hairstylists who moved to Bend in 2001 with plans to open a salon. But the Bend market was saturated, and work was spotty. Randazzo was obese most of his life, but in Bend he cooked for therapy and ate to relieve stress: homemade pepperoni pizza, rigatoni with his Italian grandmother's red sauce, double batches of chocolate-chip cookies. By 30, he carried twice his ideal body weight.
Even after finding a vigorous job at a Central Oregon wilderness therapy school, he still registered a body mass index of 52 -- and 40 is morbidly obese. He had an inflamed prostate, urinary problems, borderline diabetes and sleep apnea. He got serious about surgery.
Since 1998, the number of bariatric procedures has jumped ninefold. Researchers concluded such operations are more effective than diets or pills for patients more than 100 pounds overweight and suffering related health problems.
Randazzo underwent blood, heart, sleep and psychiatric evaluations. His parents agreed to pay $30,000 for the surgery. Early on March 5, 2004, he checked into the hospital.
Gastric bypass would forever change his digestion and diet, cutting full meals to a few mouthfuls. Death rates for bariatric procedures are less than 1 percent, but they often involve rehospitalizations. One in five patients has complications such as internal bleeding or infection. The procedure has emotional side effects as well -- many patients have divorced their spouses.
But Randazzo could no longer tie his own shoes. "There was no way this body was going to sustain life," he says. "I felt I had maybe a year left to live."
Doctor as patient
The operating table for gastric bypass surgeries can withstand 1,200 pounds while tilting a patient nearly upright. The table allowed Dr. Marinus "Dick" Koning to move as much as 50 pounds of fat in Randazzo's abdomen out of his scalpel's way.
Raised in the Netherlands, Koning had gone to medical school in Amsterdam and did his residency in New York. He was traveling when he met Patricia O'Neill in Taiwan, where she was studying Chinese history. The couple toured Oregon in a Volkswagen bus and discovered Redmond in 1978. They decided to marry and raise their family in the town.
While they raised three children, Koning practiced general surgery; his wife taught college history and served on the Redmond City Council. They helped establish one of Central Oregon's first hospices.
In 1997, when Koning was 50, he discovered a tumor on his testicle. The next morning, after completing his scheduled surgeries, he asked the operating room nurses to stay over and called in his urologist to remove the malignant mass. A week later, he threw "The Testicular Ball," inviting 100 friends who "had a fabulous time and showered me with support." He blustered through the next month, too, until he woke up and "it was like someone hit me with a bat -- I had cancer."
He re-evaluated, realizing that after time with family, his most meaningful moments occurred helping patients. In 1998, Koning flew to Europe for training, and in 2002 he added laparoscopic bariatric procedures to his repertoire. Since then, he and his partner, Dr. Stephen Archer, have conducted 400 bariatric surgeries at St. Charles Medical Center in Bend.
Randazzo's laparoscopic bypass took less than two hours. Twenty-seven hours later, he went home.
Who is that?
The July 2006 gala for bariatric patients took place in a large tent near Mount Bachelor. Part prom, part wedding reception, it was a black-tie and bared-shoulder affair that doctors host each year for their newly thin patients. O'Neill spotted a man in a white linen shirt, his black hair brushing his shoulders, his tanned skin aglow. "He looked like a movie star," O'Neill recalls thinking. "Wait, that's Tony!"
Randazzo's metamorphosis began as he left the hospital. Living on sips of liquid, then high-protein drinks, he lost ounces by the hour and, at one point, 5 pounds overnight. Within a year, he'd lost 100 pounds and over the next year another 65. He filled 10 garbage bags with piles of size XXXL Hawaiian shirts and specially tailored Armani suits.
He was working as an assistant field director at SageWalk, the Bend wilderness program, when a production company began filming "Brat Camp," the ABC reality show. Randazzo became the liaison to the producers, then appeared on the show and narrated episodes.
Suddenly he was working until 11 every night. His wife noticed other changes. As Randazzo lost weight, he needed smaller wedding bands, then stopped wearing a ring altogether. He put his fat photographs away. Women ogled his Italian good looks. "Your husband is so hot," a woman told her. Then Randazzo started receiving television fan mail.
"You catty little women didn't think he was so cute when he was 350 pounds," she recalls thinking, shocked at her own reaction. "All of a sudden I was this jealous person I'd never been before." The 5-foot-9 redhead poured her feelings out in a letter to her husband. Randazzo -- "who had no idea" -- reassured his wife. Both knew more had changed than just his appearance. Their sex life had become more adventurous. They rode Harley-Davidson motorcycles.
Then, last year, Koning asked Randazzo to climb Mount Kilimanjaro. The surgeon was nearing the 10th anniversary of his cancer diagnosis and his 60th birthday, and he wanted to celebrate "an epic adventure" with the people he loved -- his family, friends and any patients who wanted to go.
The final group included four doctors, a physician's assistant and a paramedic, ages 24 to 61. But the climb was still riskiest for Randazzo, whose limited digestion heightened the threat of dehydration and diarrhea. But Randazzo didn't hesitate. He wanted to climb with his doctor -- and his wife.
A fight to the summit
Mount Kilimanjaro, Africa's tallest peak, rises 19,340 feet above northeast Tanzania. At midnight on Feb. 7, three days before Koning's 61st birthday, the party awoke and prepared to summit.
They'd trained for months. Koning and O'Neill rode their tandem bike at 5:30 a.m. and worked out with a personal trainer. Lori, "an inside girl," quit smoking and eating fast food, and "got crazy" about getting in shape. The team hiked Mount Bachelor, took cardiac tests and swallowed malaria pills.
Kilimanjaro is wildly popular as a nontechnical climb. But the quick ascent risks altitude sickness. The lack of oxygen causes headache, vomiting and, in extreme cases, death.
The climbers chose a route that allowed time to acclimate. They rose steadily, through cold rain and sleet. On Day 3, Lori sprained her ankle badly. Randazzo wrapped her leg and coached her every step. They pushed on, through air that was thinning to half the oxygen available at sea level.
At 15,000 feet, O'Neill began coughing, and by 17,500 feet, she was wild-eyed and ill. She returned to a lower camp. "We take three breaths now for each step," Koning wrote in his diary.
As the remaining climbers neared the summit in the dark, they walked in single file. Koning had terrible cramps. Randazzo kept moving, his eyes locked on the doctor's yellow jacket. He'd stayed remarkably strong. All the couples had grown closer -- and the Randazzos felt like part of Koning's family.
Sunrise ribbons of pink and purple streaked the sky as the group labored through snow. As they neared the summit, the Randazzos walked side by side. She would count 20 steps and then stop. Then they'd start out again. The couple stepped onto the summit. Pictures show the group embracing, laughing -- healthy.
"For me, it was the culmination of this whole undertaking," Randazzo said, "the highest point so far."
A sign on the summit identified it as Uhuru, Swahili for "freedom."
____________________________________________________________________________
The Oregonian
Julie Sullivan: (503) 221-8068
juliesullivan@news.oregonian.com
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