Eisenhower's Comprehensive Bariatric Surgery Program

One patient’s life-changing journey

Life had gotten difficult for Julieta Cruz. At 285 pounds, the 28-year-old found it hard to walk any distance. Her lower back and knees hurt. She had trouble breathing at night. She caught COVID-19, which triggered Sjogren’s syndrome, an autoimmune disease that caused muscle pain, fatigue and inflammation — all made worse by her obesity. 

“Everything was just so hard,” she says. “I was tired all the time. I couldn’t catch my breath. I couldn’t even bend over to tie my shoelaces. I hurt so much, I felt like I’d been run over by a car. I was depressed. And I couldn’t keep up with my toddler daughter.”

It hadn’t always been this way. While Cruz admits she had always been on the heavier side and had poor eating habits, she played sports in high school which helped her remain active and lose a little weight. And when she was around 25, prior to becoming pregnant, she became “obsessed” with working out, going to the gym for three hours a day. The weight came off. But then she got pregnant, caught COVID and started feeling depressed, and her workout regimen fell by the wayside. The weight returned.

Marriage, motherhood and working full time as a receptionist for an Eisenhower Health gynecology practice in La Quinta made it unrealistic to resume her previous time commitment to exercise. Her doctor suggested various diets, “but my weight was just not dropping, and I felt terrible all the time,” Cruz says. Finally, her doctor said, “I can send you to see a bariatric surgeon to see if that can work for you,” and referred Cruz to the Eisenhower Bariatric Center, which is accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®), offered through The American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. 

“I was so scared at first,” Cruz confesses. “But I felt like I was losing my life, so I finally said, ‘Okay, I’m going through with it.’”

Cruz met with Board Certified Surgeon Jorge Almodovar, MD, who has completed a minimally invasive surgical fellowship with a focus on sleeve gastrectomy, the most commonly performed bariatric surgery in the world. In this procedure, approximately 70 to 80 percent of the greater curvature of the stomach is removed and the remaining portion is formed into a tube-like structure about the size of a banana. This smaller stomach can’t hold as much food and it produces less ghrelin, an appetite-regulating hormone, which may lessen the desire to eat. For optimal precision, Dr. Almodovar performs almost all of his sleeve gastrectomies using the da Vinci® robotic surgery system.

“There is a stringent screening process to qualify someone for bariatric surgery, based on guidelines from the National Institutes of Health and the Centers for Medicare & Medicaid Services that dictate insurance approval,” Dr. Almodovar explains. 

These guidelines require that eligible patients have a body mass index (BMI) of at least 40, or a BMI of 35 along with comorbid conditions such as high blood pressure, diabetes, high cholesterol or sleep apnea.

And that’s just the beginning.

“To qualify for bariatric surgery, there must also be documented weight-loss attempts during a three- to six-month period during which the patient meets regularly with a dietitian,” Dr. Almodovar continues. “And they must meet with a behavioral health specialist to ensure there are no psychological issues that could prevent them from complying with the pre- and post-surgical recommendations.”

“The American Society of Metabolic and Bariatric Surgery and insurance providers believe that patients are better candidates for surgery if they complete this preoperative regimen,” notes Board Certified Surgeon Bobby Bhasker-Rao, MD, Medical Director, Eisenhower Bariatric Center. “Making it through a six-month program shows their commitment to doing the appropriate things in order to be successful long term.” 
Cruz completed every step she was required to take — including losing about 15 lbs. prior to surgery — and was approved for the gastric sleeve procedure, which she underwent on March 6, 2023. When we spoke in August, she had lost 72 lbs., more than halfway to her goal weight between 150 and 180 lbs.

The process hasn’t been without its challenges.

“Some people think that surgery is an easy choice, an easy process,” Cruz says. “But it’s major surgery and very harsh at the beginning — I couldn’t eat much of anything and you get full drinking just a couple ounces of water. It’s a very drastic change, but this is your new life and this is how you have to manage your food intake.

“But then, after the first month, you start getting the hang of your new eating habits,” she continues. “The second month, you’re saying, ‘okay, now my clothes are fitting looser.’” 

She emphasizes, however, that undergoing bariatric surgery means focusing not just on weight but on the bigger picture.

“My ultimate goal is to be a healthy woman and mom,” she says. “I want to be here for a long time and have the healthiest life that I can, for myself and my family.”

The critical benefits of support
Cruz credits the comprehensive support and education she’s received from the Eisenhower program for helping her get this far. These resources include support groups, guest lecturers, and dietary and exercise counseling.

“Everyone is very knowledgeable, empathetic and nonjudgmental,” she says. “You have an entire support system, including other people who are going through this. They’ve been here for me every step of the way, and I know I can always count on them going forward.”

“Surgery is only a tool to help people get where they need to go,” Dr. Bhasker-Rao says. “These other components must be present in order for them to be successful. In fact, studies show that in programs with this comprehensive approach, patients are forty percent more successful as opposed to having surgery and not having any support.”

“The surgery definitely gives you a head start,” Dr. Almodovar adds. 

Cruz is a believer.

“The gastric sleeve has given me my life back,” she says. “I’m more confident, less depressed, and my pain has completely gone away. I’m able to go about my day like everybody else. I can keep up with my daughter and I love walking outside whenever I get the chance.

“My life has changed completely in just a few months,” she adds. “I’m amazed at how very much my life has improved.”

For more information, visit EisenhowerHealth.org/Bariatric or call 760.834.3796.