More than anything, wanting to give her daughter another sibling is what led Tessa Fautherree to her doctor's exam room to talk to him about surgery.

Living with polycystic ovary syndrome required that Fautherree seek out an infertility clinic if she wanted to conceive again. Being above the weight guidelines for the treatment, a struggle that PCOS added to, required that she seek help from a professional.

"I've been overweight all of my life and I wanted to have more kids… the only other thing I could potentially control is weight loss," said Fautherree, a military spouse whose husband serves in the 62nd Airlift Wing here. While she and her husband hope for five kids altogether, she says that even just one more would be a success.

When she talked to her primary care manager about the idea of weight loss surgery, he said, "I'm not going to tell you that you can't do it on your own, but you can't do it on your own."

Getting approved for bariatric surgery (most commonly a gastric bypass or a sleeve gastrectomy) comes with different requirements depending on each person's body mass index, said Col. Matthew Martin, Madigan's Trauma Medical Director and Bariatric Surgery Director. Any patient with a BMI of 40 or above could be considered for the surgeries, while patients with BMIs of 35-40 may be considered if they have at least one obesity-related disease; those with a BMI between 30 and 35 may be considered if they also have significant metabolic diseases. The surgeries are only available to family members and retirees, and not to active duty service members.

"We don't do any of it for aesthetics," said Martin, who shared that common weight-related conditions which can be alleviated include joint health, type II diabetes, high blood pressure, sleep apnea, reflux, and liver conditions.

"The majority of patients' (conditions) can be cured after bariatric surgery, or definitely improved," he said.


Entering the pathway

After Fautherree's PCM referred her, she joined the Madigan Bariatric Pathway program in October 2015 -- the first step towards growing her family. While the program which prepares patients to be successful after surgery usually runs six months, she opted to attend the program for four more months to be even more ready for life after surgery.

About 20 to 25 patients join the pathway each month to learn about nutrition, health psychology and behavior modifications, and to get support from others who are on the same journey, said Kandace Dennison, the pathway's case manager assistant.

They learn about healthy eating, meet with dietitians one on one, and keep food journals. They also sit down with health psychologists to learn about the relationships they have with food.

"They delve into people's pasts… is it past history, was it trauma or was it just because life took over and you just forgot about yourself?" said Laura Sage, the case manager for the Bariatric Pathway.

Even post-surgery, patients still get nutritional help while they meet quarterly with the surgery department for follow-up. Joining in the Bariatric Pathway before and after surgery is critical to patients' success, said Martin.

"It's such a huge lifestyle change. It impacts every aspect of their life… if they are not 100 percent on board and able to do all of the right things, they could hurt themselves after surgery or they'll have a much higher risk of the surgery failing," he said.


Life after surgery

For Fautherree, it was the pathway's support group that helped her through the massive emotional and mental changes that accompany the surgery. Once a month, before and after her surgery, she met with people who embarked on the same journey for different reasons: to improve their health, to literally breathe easier, to travel again, to keep up with their children.

"Oh my goodness, people who understood your fears… you get to see people who've done it and learn from their experiences and you get to see people who are doing it with you and that they experience the same fears, the same struggles," said Fautherree. "You don't realize the mental changes that are going to happen… and when you go you realize that this happens to everybody."

She said that she feels her brain changed after her operation; she hasn't felt hunger since it, and now she has to remind herself when to eat, and to eat healthily.

"Before, you ate because you're hungry… now, I have to eat to live," said Fautherree.

While immediately after her surgery nearly six months ago she had to go on a liquid diet, she slowly introduced new foods since then to learn what her body can now tolerate. With the nutrition changes before the surgery, Fautherree lost 18 pounds; she's now lost a grand total of more than 100 pounds.

Although the weight loss is significant, it's not what people notice the most about Fautherree these days.

"The biggest compliment that I get … is your smile is bigger, you always seem happy," she said. "I have a more positive outlook on life."

She has to wait 12 to 18 months after her surgery to return to the infertility clinic, and she needs to build up to eating a little bit more in order to be able to have the nutrients to sustain a pregnancy.

Fautherree suggests others who are considering bariatric surgery to pursue it.

"I would recommend just doing it; just go for it," she said. "It's life-changing but in the best way."