i\lEDIC\L H.\LL {)F Fvxn: I:\LH'CTI-T Life Transformer By CHRISTOPHER JOHNSTON W hen Dr. Helmut Schreiber joined MetroHealth Medical Center as an attending surgeon in 1975, he could have easily entered a distin- guished career in gastrointestinal surgery. Instead, he chose to pursue a little-known, barely respected specialty called bariatrics, a surgical procedure that shrinks the stom- achs of morbidly obese people. It was a lonely choice. Soon after his arrival, the doctor who drew him into the field left Cleveland. Schreiber became a minority of one, promoting these opera- tions to radically improve lives of individ- uals suffering under the severe physical, emotional and societal pressures that accompany obesity. Three decades later, Schreiber is recog- nized as a pioneer in an exploding field that has hospitals throughout the country scrambling to accommodate the demand for bariatric surgery. Today, morbid obe- sity is second only to smoking as the lead- ing cause of preventable death in the United States, killing more than 250,000 people annually. Almost 59 million adult Americans (31 percent) are obese, which is double the number from two decades ago, according to a study by the Centers of Disease Control and Prevention. Moreover, the number of bariatric proce- dures performed rose by 40 percent last year, to 80,000, and is expected to reach 120,000 this year, according to the con- sulting firm Frost & Sullivan. At St. Vincent Charity Hospital, where Schreiber is director of surgery, his team performs approximately 100 bariatric procedures each month. For Schreiber, validation is sweet. "I am deeply gratified that the things I have talked about for 28 years have come to fruition with the data that's appearing allover the country to validate what I've been working on," he says. 10 NOVEMBER 2003 Schreiber adds that the recent discov- ery of ghrelin, a hormone that causes hunger, lends additional credence to the procedure from a scientific perspective. A study published last year in the New England Journal of Medicine proved that bariatric or gastric bypass surgery signifi- cantly reduces the hormone's production by shrinking the stomach to the size of a thumb, thus reducing stimulation of the hormone through the stomach lining. "The surgery has gotten a lot of public- ity lately as a physiological operation, not. just a mechanical operation," he explains. "Now, we can show that it doesn't just force you to eat less food because you have a small pouch for a stomach." Schreiber compares the impact of bariatric surgery to that of the coronary bypass 40 years ago. Similar to the people saved from heart disease since then, this surgical option offers a weapon to fight obesity and the diseases such as diabetes, sleep apnea and high blood pressure that accompany it. "For the first time, there is a viable, legitimate procedure that can help some of these people who would otherwise have no options," he says. Schreiber's family immigrated to America from Germany in 1956,when he was 14. In Europe, they had bounced among five different displaced-persons camps for two years after fleeing the Communist regime of their home country, Yugoslavia. As a student at Kent State University in the early 1960s, Schreiber loved the sci- ences and math, but soon found them to be "somewhat dry." So, to fulfill his desire to help people, he switched to pre-med. He was accepted into The Ohio State University's medical school in 1966. There, he met the late Dr. Robert M. Zollinger Sr., considered one of the fathers of modern surgery. Zollinger helped shape Schreiber as a surgeon and drove him to achieve an award for distin- guished services as a student, he says. Yet, Zollinger, renowned as a tyrant to his res- idents, also prompted Schreiber to depart Columbus and take a residency position at University Hospitals of Cleveland. At UH, Schreiber met pioneering bariatric surgeon Dr. Walter Pories, who was chairman of surgery during his residency. Pories drew him into the spe- cialty and invited Schreiber to stay at MetroHealth Medical Center as an attending surgeon and faculty member, which he did from 1975 until 1981.When Pories departed to become chairman of surgery at East Carolina Medical School, Schreiber remained as the only faculty member promoting bariatric surgery. Another of his mentors at UH, the late Dr. William Holden, inspired Schreiber's love for teaching, which led him to accept the task of resurrecting a struggling resi- dency program at the then Huron Road Hospital in the 1980s. Schreiber left to assume a similar role at St. Luke's Medical Center until 1997, when he became med- ical director for the Cleveland Center for Bariatric Surgery at St. Vincent. Schreiber recently debuted an innova- tive stomach-marking procedure for bariatric patients so that, should they ever require other abdominal surgeries, the surgeon would know that their anatomy had been altered by the gastric bypass. Additionally, he recently received a com- mendation from Mayor Jane Campbell for his tireless efforts to promote having two fully trained surgeons in the operat- ing room during a bariatric procedure, a safety practice that more hospitals have adopted as the field continues to expand. He is also an adamant proponent of providing bariatric patients with a com- •