ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Sunday, April 20, 1997 TAG: 9704180044
SECTION: BUSINESS PAGE: 1 EDITION: METRO
DATELINE: LOW MOOR
SOURCE: SANDRA BROWN KELLY THE ROANOKE TIMES
SURGEON JANN Holwick hit age 40 and decided she'd had enough of California's hustle. But when she moved to a farm in Greenbrier County, W.Va., she brought along more than furniture and cats.
Holwick is experienced at performing operations, called gastroplasty and gastric bypass, that help severely overweight people become thinner. She did gastric bypasses regularly at a clinic in California.
After Holwick began practicing as a general surgeon at Columbia Alleghany Regional Hospital in 1993, word got around that she knew the bypass procedure, which shuts off most of a patient's stomach and brings about rapid weight loss.
Holwick has about 600 of the surgeries to her credit, most from her years in California. She now averages four a month at the Alleghany hospital.
Bariatric surgery - surgery to control weight - has been around since 1967 and has gone through several procedural changes as problems were discovered with the previous ones. It was quite popular in body-conscious California, Holwick said. She operated on 10 to 20 patients a month there, and, with more promotion, she probably could get 10 a month here.
But the doctor said she doesn't want that much business, because it would take away from her new lifestyle driven by a 1,000-acre farm, five cats and other assorted animals.
The weight-loss surgery can take several forms, but Holwick uses two. They are stomach stapling - using vertical stapling to close off part of the stomach - and gastric bypass, which involves closing off most of the stomach by stapling and then connecting the small intestine to the newly designed pouch.
The surgery is viewed, even by insurance companies, as a life-saving procedure for people who are more than 100 pounds overweight and who have other health problems. And even though there's been no big push to publicize the surgery, the hospital has promoted it regionally in newspaper advertisements and on television.
Especially in Virginia's non-metropolitan areas, doctors have been slow to publicize their talents, which makes Holwick's "poster" patient ads stand out.
They feature before and after photographs and the patient's "story."
And they do bring in business, Holwick said.
Her patients have come from the Covington-Clifton Forge area, the Roanoke Valley and from West Virginia and several other states.
Lately, a number of patients have been from Franklin County.
A current ad features Debbie Meeks of Rocky Mount, a 45-year-old school bus driver for Franklin County.
Meeks jokes that she's Holwick's "poster girl" and said she considers the doctor to be "fantastic." But Meeks says she always tells people who call her when they're considering the surgery that it's not just an operation, but a drastic lifestyle change.
Meeks doesn't glamorize the surgery, and neither does Holwick. "It's a major change, not something to be taken lightly," Holwick said.
In 600 gastric bypass surgeries done during her career, Holwick said she has had only one patient die. "But even that one makes me wonder if I should do it at all," she said.
Holwick uses a tough set of guidelines, established by consensus during a 1991 National Institutes of Health conference, in selecting patients for the procedure.
A person must want the surgery to improve his or her health. "Not to wear a two-piece bathing suit, but to live longer," she said.
The person should diligently have tried nonsurgical ways to lose weight and must realize that the surgery is a lifestyle change and should not be considered reversible (although it is). It means a lifetime commitment to taking multiple vitamins.
Some people can't handle the change in eating habits the surgery causes, and some can't even handle being skinnier, Holwick said.
Counseling of prospective patients is always recommended and is required by some insurers, but even Medicare will pay for the gastric bypass surgery if it can be established that it would prevent later health problems.
Most insurers won't consider it, though, unless the person is 100 pounds overweight, she said.
"People with 100 pounds to lose have a dismal chance of succeeding," Holwick said.
Food choices after surgery aren't restrictive, but it does take trial and error to establish the foods a person can eat. Too many sweets will cause a person to become ill, Holwick said.
"You can have a brownie, but not three," she said.
The surgery reduces the stomach size from about 40 ounces to about a cup's worth, which means eating half a sandwich can make a person feel full.
The average bypass surgery patient is female, about 35, who has tried three to 10 diets and lost from 20 to 100 pounds per diet, but regained the weight.
Holwick is a graduate of the University of California, Los Angeles, School of Medicine and a fellow in the American College of Surgeons. She is licensed in Virginia and West Virginia.
Her practice remains mostly traditional, general surgery - hernias, gallbladders, hysterectomies and cancers. In addition to surgeries, she operates a Tuesday clinic in Marlinton, W.Va., where she sees the usual "lumps, bumps and scrapes" of emergency patients and also meets with patients scheduled for or recovering from surgery.
Holwick might not be able to stop the momentum generated by her reputation and skills, though.
Even if the hospital has been slow in pushing the elective surgery, Chief Executive Officer Ward Stevens doesn't rule out more aggressive promotion later.
From January 1996 through March of this year, Holwick did 31 bypasses, which brought in $400,000 before expenses, Stevens said. The average cost per patient is about $13,000.
Net income to the hospital from the surgeries will amount to about $240,000. The weight-loss operations still represent a tiny portion of the hospital's surgeries, which numbered 4,800 procedures in 1996.
Stevens said the hospital would "be foolish not to let that surgery grow here."
Holwick's gastric bypasses and some of the follow-up surgeries, such as tummy tucks and thigh reductions that newly thin patients have requested from her have established a trend at Alleghany.
Recently, a second surgeon, Dr. Michael Breiner of Roanoke, formerly with Lewis-Gale Clinic in Salem and now in private practice, began offering cosmetic and reconstructive surgery at Alleghany one day a week. His services include liposcution.
The hospital hasn't promoted Breiner's specialty, either, but the surgeon on his own is talking with The Homestead resort in Hot Springs and The Greenbrier in White Sulphur Springs, W.Va., exploring ways patients could combine a resort stay with their surgeries, Stevens said.
Both resorts are within an hour's drive of Alleghany Regional.
"We feel that we can draw people from out of area to have surgery here," Stevens said. "If there's surgery to be done, we can grow."
On some days, the surgery department stays busy beyond eight hours, but there are other days "when little is done," Stevens said.
He said he's made no effort to market the lifestyle surgeries through the nationwide Columbia/HCA Hospital Corp. network.
LENGTH: Long : 134 lines ILLUSTRATION: PHOTO: (headshot) Dr. Holwick. color. 2. Newspaper ad featuresby CNBDebbie Meeks of Rocky Mount. Meeks says she is Dr. Jann Holwick's
"poster girl" and considers the doctor to be "fantastic." Graphic by
RT. color.