“There was no one to do it,” said Kathy Johnson, WMC’s director of surgical services and head of the new bariatric surgery program.

Around that time, the estate of a patient who died after surgery named two local clinics, including Winchester Surgical Clinic, in a $5 million lawsuit. The lawsuit was settled out of court for less than $500,000, according to newspaper reports.

Glembot, previously with Winches-ter Surgical Clinic, insists that the cost of insurance and not the lawsuit was the reason the clinic stopped doing the surgery.

One of the most common side effects is nausea and vomiting for a couple of months after surgery as patients learn the limits of what and how much they can eat.

Men, patients older than 45, and those with high blood pressure are at greater risk for serious complications. And the more someone weighs, the more they are at risk for problems.

A nutritionist and a physical therapist are also consulted. Because even though the surgery helps make weight loss easier, patients must still use old-fashioned tactics to get the weight off: diet and exercise.

Hollywood hype aside, the surgery is reserved for morbidly obese people — defined as more than 100 pounds overweight — who often suffer from higher rates of diabetes, sleep apnea, high blood pressure, and high cholesterol.

But a 2004 study in the Journal of the American Medical Association found that surgery patients show remarkable improvements in such dangerous health conditions as diabetes, high cholesterol, and high blood pressure.

Medicare’s decision may cause private insurance companies that dropped the surgery to reconsider, giving more people help in paying for the expensive procedure.

“[But] every single patient has said to me — every single one of them — ‘This is my last chance,’” Glembot said.

Pugh can now walk up stairs without her knees aching. She works in her garden every night. And last weekend, she did something she hasn’t done in years. She rode a roller coaster.

“This is entertainment,” said their 14-year-old daughter Malissa, smiling as her parents climbed jungle gyms and pushed each other in the swings.

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