Weight lifted: Town official's slimming continues after surgery

On a recent Monday, he is running nearly 40 minutes late from his 8:45 a.m. doctor's appointment in Worcester. Around 10:40 a.m., Robert Pasquale Jr. enters his flower shop on Water Street and immediately grabs the calculator sitting on the counter next to the cash register.

With his fingers quickly running across the keypad, Pasquale is not interested in how much money he has sold in floral arrangements on Veterans Day, but rather how much weight he has lost since the July 2006 gastric bypass surgery that changed his life.

"Every ounce counts," he said, announcing that he has shed nearly 360 pounds in the past 18 months. "I want to continue to lose more weight."

The 46-year-old and 271-pound Pasquale, chairman of the Clinton Board of Selectmen, once swelled to more than 600 pounds before retaking control of his weight.

"It's nice to be alive again," he said. Before, "I was a train wreck ready to happen. I couldn't walk."

On July 12, 2006, Pasquale underwent gastric bypass surgery known as Roux-en Y procedure at UMass.-Memorial Medical Center in Worcester. Dr. John Kelly, chief general surgeon for minimal invasive bariatric surgery, performed the operation.

"I was determined to do this," said Pasquale. "When you give up everything in life to have life, essentially that's what I have done."

According to UMass.-Memorial's Web site, the Roux-en Y procedure is "<span><span style="color: black;">a surgical procedure that reduces the size of the stomach and attaches it to a point lower down on the small intestine." </span></span>

<span><span style="color: black;">Pasquale said that Dr. Kelly made his stomach pouch, which is about 5 ounces, a little bit bigger than other patients' because of his body size.</span></span>

<span><span style="color: black;">The surgery also helps individuals who have a body mass index (BMI) greater than 40 to control their weight, said the Web site. </span></span>

<span><span style="color: black;">Doctors calculate the BMI by using height and weight. An adult with a BMI of 30 or more is considered obese. Prior to the surgery, Pasquale's body mass index was 81.</span></span>

"My [BMI] is still 38," he said, and it's remained the same for the past 18 months. "It needs to be below 25 to be out of the morbidly obese category."

Staying active

Pasquale, whose doctors have taken him off all his medications - all 32 of them, including the 1,600 units of insulin that he injected into his arm five times each day - said that he enjoys staying active. His exercise routine, which includes walking nearly three miles each day, working out in the gym and swimming, has also helped him trim his once-bulging 78-inch waist into a slender 40 inches.

The once husky kid and caffeine guzzler, who could gulp down 12 two-liter bottles of Coca-Cola a day, said he is looking forward to taking part in many more physical activities that he could not do before because of his weight.

"I'd love to be able to ski," he said. "I used to like to jog. I'd like to do that again instead of walking."

Pasquale's wife Debbie said that she has noticed that her husband is much happier, especially when he steps out in public.

"He's a whole different guy," said Debbie, taking a break from work at the flower shop. "Life has completely changed."

There have even been times when Pasquale's new figure has turned heads.

"[We] go out to restaurants and people think that I'm cheating on my husband and I'm with somebody else," said Debbie.

The completely different guy can now sit at booths instead of tables when enjoying a Saturday night out with his family.

"My whole self image feels 125 percent better," he said. "It's miraculous the new limits life has set."

Pasquale, now calling himself a "label and calorie checker," meticulously keeps an eye on his diet, which consists of angel hair pasta, cranberries, yogurt and protein drinks, just to name a few.

"My days at the diners are long gone," he said, stressing that he rarely visits McDonald's for a fast-food meal.

Pasquale, who describes eating as "scary," said that he does reward himself with tantalizing treats every now and then, splurging on diet pizza, seafood wraps and fried scallops, but there are some foods that he has obliterated from his diet, such as bread, apple pie, chicken parmigiana and most important, anything with sugar.

"Sometime certain foods just don't [digest well] and the experience is horrific," he said. "A simple chicken parmigiana dinner out with your family tastes so good, [then] 20 minutes after, you're on the side of the road hurling."

'Another hurdle'

But his diet is only one of the many obstacles Pasquale has tried to overcome on the road to being thin.

He has faced infections in the first three months after his surgery, had an obstructive hernia in January and has developed autoimmune syncope, meaning that if he bends over too quickly, he can pass out "in the blink of an eye" because he has problems maintaining blood pressure.

"I have to be cognizant that I can't bend over fast to pick something up or else I just black out," he said.

On Tuesday, Pasquale underwent exploratory surgery for an umbilical hernia in his lower abdomen, which was repaired twice, but still presented problems.

"It's another hurdle to go through," he said. "A worthwhile hurdle, I hope."

There is another worthwhile hurdle: Pasquale wants to have surgery that would remove the excess skin that remains on his thinner frame, but his insurance company will not cover the cost.

Pasquale said that Tufts Health Plan has denied payments for the $50,000 procedure because he has not maintained a steady weight.

"They don't feel that it's medically necessary to pay for excess skin removal," he said, explaining that he is current fighting it with an appeal.

Pasquale added that he has visited numerous doctors, including Dr. Kelly and dermatologists and plastic surgeons who have said that it is "medically necessary" to remove his excess skin due to rashes and overall hygiene.

"When you go from 633 pounds down to 273 pounds, the skin's gotta go somewhere," he said. "They want me to plateau and show them that I can maintain weight over a three- to six-month period."

No regrets