York, PA – Susan Flickinger couldn’t wait until Christmas.

A special gift for her best friend, Melissa Harper, sat among the presents piled in her Red Lion hallway.

When Melissa visited on Dec. 21, Susan handed her the thin package. Katelyn — Melissa’s 4-year-old and Susan’s goddaughter — stared at the shiny paper.

“Mommy, what is it?” she asked.

Melissa unwrapped a photo album that documented the June 10 birth of her second daughter, Kenna.

As Melissa flipped through the pages, Katelyn pointed to the people in each picture.

“Mommy, me and Daddy.”

“Kenna and Susan.”

“Mommy and Kenna.”

Susan’s joy mingled with pain as she watched her husband, Randy, bounce Kenna on his lap.

She wanted her own family but faced medical complications. her weight — more than 400 pounds — was working against her.

—

Randy and Susan are biologically programmed to reproduce, a way in which the human race ensures survival.

Society also expects people to settle down and start a family.

Susan can’t help but flinch when someone asks her when she and Randy are going to have kids.

She tries to play it off with a joke because it hurts too much to tell people the truth: They’ve been trying for more than four years.

Infertility can be emotionally devastating, said Dr. Robert Filer of The Fertility Center in York Township. Patients often feel isolated. They don’t realize one out of six couples has trouble conceiving.

Filer said that can create a disconnect between spouses. Men rarely verbalize the problem. Women are more likely to seek help.

But Susan was hesitant. People always saw her weight first.

One obstetrician/gynecologist told her she was too fat to have kids.

The sting of those words hit her as she watched coworkers get pregnant, attended baby showers and saw Randy cradle Katelyn.

Then came tears.

Then came guilt.

—

Being plus sized is all Susan knows.

She remembers her biological parents being overweight. She remembers classmates teasing her.

At age 7, she was placed in foster care and she bounced from home to home. Two years later she settled with guardians in Red Lion.

“I’m sure that is where some of my eating issues were from,” said Susan, who is now 30.

She avoided eating in public, only to scarf down junk food while alone. despite endless diets, her weight crept higher. At 18, she moved out on her own. her eating problems followed her. Then, she found someone who understood.

Susan — a bubbly, self-described goody-goody — and Randy — a man of few words but several tattoos — met online.

They’ve been together for a decade and wed in 2005. They finish each other’s sentences. and they still flirt as if they’re on a first date.

Randy, 33, who is from Pleasureville, also came from an overweight family. He, too, attempted several diets, and failed.

“If I had taken better care of myself growing up maybe I wouldn’t be the size I am now,” said Randy, who is almost 500 pounds.

Other people, including doctors, didn’t understand Randy and Susan’s struggle. But at their size, they couldn’t avoid appointments.

“I have white-coat syndrome,” Susan joked. She found an ally in Dr. Dale Kresge of Dallastown Medical Associates — her primary care physician of 12 years.

“(Overweight patients) are afraid they are going to get yelled at for not behaving,” Kresge said. “It’s so difficult to lose weight. It doesn’t help to discourage patients.”

He talked to Susan about the importance of diet and exercise to balance her diabetes, hypertension and elevated cholesterol.

Unfortunately, Kresge said, a side effect of hypertension and diabetes medication can be weight gain.

—

People of all shapes and sizes deal with infertility.

But Filer is seeing more and more overweight patients in his office.

Treating obese people presents challenges. Filer said it can be difficult for doctors to read their ultrasounds, which makes it hard to tell if a woman’s eggs are developing properly.

Insulin resistance, which most overweight people experience, drives calories into fat storage. Fat cells produce a weaker form of estrogen, which can disrupt ovulation in women. in men, it can lower sperm count.

Susan, who wasn’t ready to accept her previous diagnosis, went to Filer last year for a pelvic exam. Randy had his semen analyzed.

Filer diagnosed Susan with polycystic ovary syndrome, the most common hormonal disorder among women of reproductive age. Almost half of the women affected, including Susan, are obese and carry their weight through their midsection.

PCOS symptoms include enlarged ovaries containing numerous small cysts, excess hair growth, acne and irregular menstrual cycles. Susan only ovulated two or three times a year, which decreased her chances of conception. She takes Clomid, a prescription fertility drug that stimulates ovulation.

Filer said he can prescribe patients insulin sensitivity medication to regulate estrogen. But, because Susan was taking other medications, he told her to continue to follow a proper diet and exercise regime.

“We can look for hormonal and metabolic solutions, but the patient is still going to need to work,” Filer said.

Weight loss, he added, can usually help or cure most infertility issues, including PCOS.

Susan continued to monitor her diet. She started working out but had to stop after she tore a knee ligament.

Her weight remained stable during the next few months. She didn’t become pregnant. She researched in vitro fertilization, in which an egg and sperm are combined in a laboratory dish. But that procedure wasn’t covered by her insurance.

She felt like she was out of options.

—

Then, Susan thought about her sister-in-law, Michelle Flickinger.

Michelle had been fed up with being 335 pounds. She didn’t want her 12-year-old daughter Brittany Lee to follow in her family’s footsteps.

She opted to get gastric bypass — a type of weight-loss surgery — in 2008. her insurance covered most of the cost.

The first three months after the procedure were torture, Michelle said. But Susan waited for her in the surgery room and helped puree food for the post-surgery liquid diet.

“She pretty much went through it with me,” said Michelle, who now weighs about 190 pounds.

Watching the weight melt off Michelle gave Susan hope. She asked Kresge about the surgery.

Kresge, who had watched Susan try and fail to get healthy on her own, thought she was a good candidate. Gastric bypass could help her drop 100 pounds. With proper diet and exercise the weight would stay off. her health and infertility issues might disappear, too.

“It changes people’s lives,” Kresge said.

Susan told Randy about the surgery and they decided it was something they wanted to do together.

Then, they found out the health insurance plan offered by their employer doesn’t cover any weight-loss surgery.

Susan and Randy couldn’t afford to pay out of pocket for one surgery, which would cost about $25,000, let alone two.

Susan contacted benefits representatives from the company and its insurance provider. She appealed the uncovered claim. her appeal was denied.

She contacted York Healthy Network, which helps local uninsured or underinsured people, but she was told her income is too high.

It didn’t make sense to Susan and Randy. Staying at their size would surely lead to more health problems, which would cost the company more in the future. The surgery could save their lives and maybe help them start a family.

“I think we would be successful,” Susan said. “We have a great support system.”

—

The Flickingers found themselves at another dead end.

They haven’t ruled out adoption, but they will continue the quest to have their own children.

They shared their story on the TLC special “Ton of Love,” which aired in November. Susan hoped someone watching would give her advice. a few women found her on Facebook.

“They told me not to give up,” she said.

In December, doctors told Randy he has sleep apnea, which causes breathing problems when he sleeps.

There will be more appointments. there might be more tears. But they can lean on each other.

“I think this has brought us closer together,” Susan said.

She wants to be a mommy. She hopes her children might learn from her mistakes.

Randy wants to be a daddy, but he knows he has to learn to take care of himself, first.

“We might already have a family,” he said, “if we weren’t the size we are.”

National resources

— The Center for Disease Control and Prevention’s Division of Reproductive Health: cdc.gov/reproductivehealth

— The American Congress of Obstetricians and Gynecologists: acog.org

— The Polycystic Ovary Syndrome Association: pcosupport.org

— The United States Dept. of Agriculture’s MyPyramid for Pregnancy and Breastfeeding: mypyramid.gov/mypyramidmoms

— The American Society of Bariatric Physicians: asbp.org

— The United State Dept. of Health and Human Services: hhs.gov

— The National Women’s Health Information Center: womenshealth.gov

— Health insurance options: healthcare.gov

Local resources

— The Fertility Center, 130 Leader Heights Road, York Township; 747-3099; thefertilitycenter.com

— WellSpan Medical Weight Management, 2339 S. George St., York Township; 851-6207; wellspan.org/body.cfm?id=441

— Pennsylvania Department of Health: portal.health.state.pa.us

Research suggests sensitivity to insulin contributes to infertility in obese women

A Johns Hopkins Children’s Center study revealed a new mechanism that might account for a higher risk of infertility in obese women.

The research, conducted on mice and published in September, showed that the pituitary gland responds to chronically high insulin levels. The gland then triggers several hormonal changes that can disrupt ovarian function and impair fertility.

Scientists traditionally focused on treating infertility by lowering insulin levels. however, the new model suggests that decreasing the pituitary’s sensitivity to insulin could help treat infertility.

Insulin resistance, marked by persistently elevated insulin, usually occurs in people with type 2 diabetes, metabolic syndrome and polycystic ovary syndrome. PCOS is the most common cause of infertility, affecting about one in 10 women.

By deleting the insulin receptors in the pituitary cells of mice, researchers maintained ovulation and fertility even in obese mice with elevated insulin levels. these findings suggest that ovaries, which control ovulation and fertility along with the pituitary gland, might also be affected by high insulin levels.

Source: ScienceDaily

Maternal obesity during pregnancy is associated with complications including:

— Cesarean delivery — a delivery surgery in which a baby is taken out through the mother’s abdomen. in the United States, about one in four women have babies this way. Most C-sections are done when unexpected problems happen during delivery. The surgery is relatively safe but could cause problems with an attempted vaginal birth later.

— Macrosomia — Large body size, often used to describe a fetus. The most common cause of macrosomia is diabetes in the mother. Macrosomia can lead to trauma during birth and a greater chance of a Cesarean delivery.

— Gestational hypertension — High blood pressure during pregnancy can cause low birth weight or premature delivery of the baby.

— Preeclampsia — a sudden increase in blood pressure after the 20th week of pregnancy that can be life-threatening for mother and baby.

— Gestational diabetes mellitus — a type of diabetes that is first diagnosed in a pregnant woman. Usually gestational diabetes goes away after pregnancy, but sometimes diabetes doesn’t. if not controlled before and during pregnancy, type 1 and type 2 diabetes can cause the baby to have birth defects and cause the mother to have problems such as high blood pressure, kidney disease, nerve damage, heart disease or blindness.

— Fetal death

— Birth defects

— Other problems — Children born to obese mothers are twice as likely to be obese and to develop type 2 diabetes later in life. Obesity during pregnancy is also associated with greater use of health care services and longer hospital stays.

Source: cdc.gov/reproductivehealth

Another woman’s struggle to conceive

Eight-year-old Connor-Bryce Miller begged Santa for a brother or sister.

His mother Kymberlee Burks-Miller, 35, of McSherrystown wants to grant her son’s wish. She’s been trying to get pregnant again since he’s been a toddler.

Her weight — 341 pounds — was a complication.

Kymberlee had nine miscarriages before she became pregnant with Connor-Bryce. During her pregnancy she developed gestational diabetes. At 12 weeks, she started bleeding and was monitored closely. She had an emergency Cesarean section weeks before her due date.

“When I look into my son’s eyes, I know that I fought for him,” she said. “I will fight for the next for the one. I’m totally ready to go through it all again.”

Kymberlee and her husband Bryce have tried to conceive again naturally. They decided adoption was too costly.

They tried intrauterine insemination — when a male’s sperm is deposited directly into the woman’s uterus during ovulation — and in vitro fertilization, in which an egg and sperm are combined in a laboratory dish. Both procedures were covered by Bryce’s health insurance.

Once, Kymberlee thought her prayers were answered. Then, she was diagnosed with an ectopic pregnancy — a dangerous condition when a fertilized egg attaches outside the uterus. her fallopian tubes were damaged during emergency surgery.

Exhausted from failed diets, Kymberlee decided to undergo gastric bypass surgery. She gave up holiday feasting for her Dec. 29 procedure, which took place at York Hospital and was also covered by her husband’s insurance.

By Jan. 4, Kymberlee was up and walking. She survived on a liquid diet of clear soup and protein shakes.

Kymberlee dropped to 317 pounds. her goal weight is 172 pounds. Ignoring fast food will be hard work, but the surgery was worth it.

Bryce found his way to the infant aisle — to buy small spoons to help Kymberlee eat her pureed food.

“It’s the first thing we’ve bought for the new baby,” she said.

Weight-loss surgery can lead to pregnancy, but some patients don’t qualify for coverage

More than one couple has come to WellSpan’s Medical Weight Management program with the goal of having children.

But many obese women are so defeated by failed diets and negative at-home pregnancy tests that they doubt weight-loss surgery will help. They are skeptical when clinicians suggest they go on birth control before the surgery.

But for most obese women, losing even 10 percent of their body weight will help or cure their infertility issues.

Post-surgery pregnancies can be dangerous, since patients are on restrictive diets. so doctors ask women to wait 18 months before trying to get pregnant.

One woman who had experienced infertility issues got pregnant 19 months after surgery.

One woman who had been trying to have a child for 17 years became pregnant six weeks after surgery.

Post-surgery pregnancies are rare, but if a patient conceives, she is monitored closely and recommended to gain some weight.

The pregnancy could interfere with the surgery. in extreme cases an internal hernia could develop, which can lead to bowel strangulation and death. Studies have also suggested that ketones — produced by the body while burning fat and during diabetes — can harm fetuses.

In addition to health tests, surgery candidates are required to attend a pre-surgery meeting to determine what their health insurance will cover and what if anything they will pay. It’s a complicated process, which varies by patient, insurance plan and employer.

Employers design their own plans from coverage options offered by insurance providers. Most insurance providers offer weight-loss surgery coverage. some companies opt for plans will full coverage. Others pick plans that cover 80 percent of the cost. still others select plans that don’t include any coverage.

Without coverage, the procedure costs about $25,000, including the hospital stay and physician fees. Most patients are advised against the compulsion to self-pay because complications could increase the bill.

Sources: Debbie Sigel, bariatric care coordinator at WellSpan Medical Weight Management; Sandy Tompkins, coordinator of the WellSpan Medical Weight Management program; Sue Ross of Apple Hill Surgical Associates

Don’t look now, but cold and flu season is right at your door! Every year, it is the same dilemma. Is that nasal congestion and cough due to a common cold, or are they really symptoms of influenza? Sometimes it is indeed hard to tell the difference. A severe cold can cause about as much misery as a mild case of the flu.

The concern is that influenza symptoms can progress to cause more serious medical complications, while colds generally fade away on their own. that is why it is a good idea to learn to make the distinction between whether it is a common cold or a flu bug that is biting you!

What The Flu looks Like

Influenza symptoms generally come on rather suddenly, while colds can take their time making an appearance. A fever is a consistent influenza symptom, and it can spike quite high, making the infected person rather miserable. Fevers can come and go, and measure as high as 106 degrees Fahrenheit, especially at the onset of the illness. Children and younger adults tend to run higher fevers.

Body aches and muscle pain usually accompany the fever, and can become fairly severe. Shaking and chills are another common influenza symptom, as is a headache and pain with eye movement. Most people will feel extremely fatigued and experience a loss of appetite. other influenza symptoms include a dry cough, nasal congestion and a sore throat. Occasionally an upset stomach will accompany the flu, but this is rare and generally found in children.

Home Treatment Of Your Influenza Symptoms

Most of the time your influenza symptoms can be treated in the comfort of your home. Home remedies include plenty of bed rest and fluids. Hot liquids like tea and soup can be very soothing while keeping you hydrated. Over-the-counter medications can be used on influenza symptoms like fever and nasal congestion. A humidifier and an extra pillow under your head at night can relieve coughing and help you sleep. Cough drops or hard candies can also decrease coughing. call your doctor if your influenza symptoms improve but then get worse again, or if you see evidence of an infection such as increased cough, colored mucus or pain in the ears or sinuses. The best remedy for the flu is patience – for most flu sufferers, the influenza symptoms will improve within a week or two.