“Besides the obvious benefits of being able to play with my grandson and walk without pain and do Disney and all the rights and privileges thereunto appertaining, the principal way my life has changed is that very small amounts of food go a really long way with me,” Don Aliffi said.
    Since his bariatric surgery at Memorial University Medical Center in Savannah in December 2013, Aliffi has lost 19 inches from his waistline. But his gift for pithy, summative sentences remains plus-sized.
    Minutes before uttering that one, Aliffi, 65, had been tossing and dribbling a basketball with his grandson, who soon will be 7. When they’re not playing with a basketball or football, they go fishing almost daily. And indeed, Aliffi and his wife, Linda, recently had returned to their Claxton home after four days at Walt Disney World with both their grandchildren.
    But prior to the bariatric surgery and a knee replacement about six months later, Don Aliffi had been reduced to near immobility.
    For years, he had worked out five days a week, but degenerative knee and hip joint problems eventually led to intense, piercing pain whenever he so much as walked to the door in the morning. So he settled into a favorite chair after work each day and stopped exercising, until his increasing weight made the knee surgery impossible.
    “My mindset was, I was at a place where I had the willpower to do it on my own, but I needed to get my hip and my knee done,” he said. “I was painted into that corner.”
    Aliffi weighed a little more than 360 pounds when he underwent the surgery that literally reduced the size of his stomach. He had lost 90 pounds by the time he had the knee replacement surgery in May. With increased activity assisting his much-altered appetite and learned dietary changes, his weight loss now totals 120 pounds, and he hopes to lose about 25 more.
    “When I had my surgery, the pants I was wearing were size 58 in the waist, and while I’m sitting here talking to you today, I’m wearing 39s,” he said. “So, I mean, I don’t think I could do Parris Island right now, and I’m not saying I’m ready to be a hip-hop star and take my shirt off, but I’m way, way better off than I was.”

Bariatric surgery: 3 kinds
    Bariatric surgery takes three basic forms, all available through Memorial Health’s bariatrics program.
    A lap-band procedure is the least surgically invasive but can require the most follow-up. The surgeon installs an adjustable cuff around the patient’s stomach to reduce its capacity.
    Sleeve gastrectomy, the procedure Aliffi had done, involves removing the largest part of the stomach, reducing it to a tube or “sleeve” shape.
    Gastric bypass involves both restricting capacity and reconnecting the stomach to a different section of the small intestine so that fewer calories are absorbed.
    Dr. Oliver Whipple and Dr. Robert Kelly do these as laparoscopic procedures, using a scope and small incisions, except when individual circumstances require an open procedure, said physician assistant Jody Hannah, who assists with the surgeries and works with patients before and after.
    Kelly and Whipple are general surgeons with fellowship training in bariatrics and minimally invasive surgery. The operations are performed in Savannah, but Memorial Health has clinics in Statesboro, Vidalia and Brunswick where patients can go for information before surgery and for follow-up afterward.
    Aliffi had hoped to have the lap-band procedure because he liked the idea that it was adjustable. But decisions on the type of surgery are individualized, based on the patient’s weight and other health issues. He took Whipple’s advice and had a sleeve gastrectomy.
    “In retrospect, I’m glad we did what he did ...,” Aliffi said. “It’s completely changed my life.”

NIH guidelines
    Obviously, none of these procedures are for people who just need to drop a few pounds.
    “The National Institutes of Health has very specific guidelines for who can have bariatric surgery intervention,” Hannah noted.
    These guidelines are based on body mass index, a ratio of weight to the square of a person’s height. Under the guidelines, a patient with a BMI between 35 and 40 must have another serious health risk, such as high blood pressure, diabetes or sleep apnea, to qualify for the surgery. But someone with a BMI of 40 or above qualifies for surgery without additional health problems.
    Aliffi is not diabetic, but he was being treated for sleep apnea prior to his surgery. With his weight loss, this problem has cleared up so that he is no longer using a CPAP machine. He also reports that his frequent back pain has largely vanished.
    Before the surgery, he attended an information session and received a preparatory checklist. Aliffi saw his cardiologist and the pulmonary specialist who had treated his sleep apnea and got their go-ahead.
    All patients are also required to see a licensed psychologist.
    Patients who, in consultation with their doctors, choose to go forward receive several hours of preoperative education. As part of this, a licensed counselor who had bariatric surgery more than a decade ago shares her story and offers tips for life after surgery. Dealing with food as a potential addiction is part of the counseling.
    After surgery, follow-up visits with the medical professionals occur every month at first, then less often depending on the patient’s progress.
    “We recommend follow-up for life,” Hannah said.
    Blood lab work to check for problems that can occur, such as vitamin deficiencies, are part of the checkups, Aliffi noted.

Full with less
    A class with an exercise physiologist and classes with a registered dietician are also part of the program. The dietitian “explains the rules of the road” for what is truly a new lifestyle, Aliffi said.
    Now he doesn’t eat “hard carbs,” such as bread, rice, pasta or potatoes. This would seem an almost cruel challenge for a man who grew up in an Italian-American family where food is part of virtually every occasion. But the surgery has made him feel full with less.
    When his family is having pasta, meatballs, bread and salad, Aliffi has two meatballs and a vegetable such as green beans, broccoli or spinach, and this fills him up, he said.
    Breakfast can be an egg or some mushrooms.
    “If you’re full, you don’t miss it,” he said. “You can eat cheesecake in front of me all day long and I’m not tempted by that if I’m full, and that’s the beauty of this is that you stay full and they teach you how to manage your life and how to see the places where you can veer off of the road.”
    Aliffi’s progress involves other factors. Besides the later knee replacement, he had a hip replaced a year before the bariatric surgery, both by doctors from Optim Orthopedics.
    A certified registered nurse anesthetist with 40 years of experience, Aliffi currently works for a firm supplying anesthesia services at Evans Memorial Hospital in Claxton, where he has worked for much of his career but with forays at facilities in Savannah and Reidsville.
    Not all health insurance policies cover bariatric surgery. Finding out whether yours will is part of the info session, and Aliffi learned that his insurance — a state plan from his wife’s previous employment — would pay nothing.
    But the hospital, doctors and anesthesiology provider lowered charges in exchange for payment in advance, Aliffi said, greatly reducing his cost.
    “There is a significant cost reduction if a patient needs to pay cash,” Hannah said.

    Al Hackle can be reached at (912) 489-9458.