By Daniel A. Llobell Maingard

EATING DISORDERS

My name is Daniel A. Llobell Maingard, I am 57 years old. I was born on March 12, 1965, in Mendoza, Argentina. On December 22, 1987, at the age of 22 years old, I moved to Miami, USA, from Mendoza, Argentina, trying to achieve the American dream. At that age, I was working very hard physically on the site from 12 to 16 hours a day, and my physical activity was very intense. I weighed approx. 180 lbs.(kg.82). In 1991, at 25 years of age, I got married. Unfortunately, like many others, I progressively fell into the routine of eating at “junk food chains” and drinking only soda drinks. After working all day, during the evening, at home, I had dinner very late, usually getting double or even more servings of heavy and high-calorie food, such as pasta, meat, etc., and drinking about 2 liters of soda drinks.

 

OBESITY

As a result of my eating disorders, during 1991, in only a few months, my weight increased to 210 lbs. (95 kg.) During that time, I was no longer working physically on the site, but I spent most of my time behind the wheel of a truck, visiting customers, giving estimates, etc. At that time, I didn't eat during lunch anymore because I wanted to lose some weight. So, my eating routine was that at breakfast I would have a couple of black coffees with artificial sweeteners. I would skip lunch, and then at dinner time, I would eat a very heavy meal between 9:00 and 10:00 pm. Then, I would work until 2 o’clock in the morning. Then, I could eat, again, either some leftovers or just a pound of ice cream. Unfortunately, this way of eating took me to 270 lbs. (123 kg.).

 

LOW-CALORIES DIETS

In order to solve my body’s overweight problem, I started trying many different diets, unfortunately with very poor results. Sometimes, I lost 10 lbs.(4.5kg.) in a couple of weeks, and then, in a couple of days, I could gain 15 lbs.(7 kg.)! I remember, as a member of Weight Watchers, buying their boxes and following their instructions. Thus, after losing 20 lbs. (9 kg.) after 2 months of sacrifice, just by stopping the diet for any reason, I would gain 20 lbs. back right away.

 

QUEST FOR MY OBESITY SOLUTION

In 2007, I started visiting some weight-loss medical specialists. They said to me that through my bad eating habits, I had destroyed, over the years, my metabolic system. They suggested that if I tried any other diet, I would fail over and over again. Furthermore, they recommended that I have bariatric surgery. I consulted with a specialist at Mercy Hospital, and as a result of this consultation, which did not last even 4 minutes, I was told that they could perform a Bariatric Surgery on me and that it would cost about $12,500. They did not inform me about any adverse side effects of bariatric surgery. Sadly, I would find out a year later.

 

BARIATRIC SURGERY

We set a date for my bariatric surgery to be performed in March 2008. The hospital medical staff put me on a liquid diet for 10 days before the bariatric surgery. The surgery was performed on March 14, and I was discharged on March 16, 2008. After having some images with contrast taken, there were no leaks in my stomach. A few days later, there was a follow-up visit with the Hospital’s Surgeon and the nutritionist, where I was told I should start eating both blended and liquid soups, avoid fried foods, and eat very small portions of no more than 1/2 cup per intake. This was in order to avoid the dumping effect or discomfort associated with an “abundant” intake.

 

BARIATRIC SURGERY EARLY RESULTS

During 2008 and early 2009 in an 18 months period, I lost approx. 100 lbs. (45 kg.) of overweight, without making any major efforts, and my body weight stabilized at approx. 176 lbs. (80 kg.). Of course, I could not eat greasy or sweet foods because I felt nausea, discomfort and the “dumping effect”. Furthermore, I was having reflux, and was told by my medical team, I had to take antacids for life. Another side effect was my sudden loss of energy while working. My primary doctor ordered full tests, and soon I received the news that my body was depleted of Vitamin B12 and vitamin D. Therefore, I would need to receive vitamin B12 supplementation during my lifetime, to be administered intramuscularly monthly, and a vitamin D capsule orally once a week.

Until then, despite the adjustments, I began to lead a physically active life, biking 5 miles every other day with my youngest son. I was climbing a ladder to clean the gutters at home, taking care of my garden, and enjoying water sports, snorkeling, water-skiing, wind surfing etc. At that time, I felt that the sacrifice and the risk that I took, were worth it, and that it had not been in vain.

In 2008, during the US economic recession, I had a good opportunity to work on a project in the Bahamas. Thus, I was working each month for three weeks in the Bahamas and one week in Miami. Unfortunately, I did not pay a lot of attention to my diet. In the Bahamas, my diet was based on low protein and high carbohydrate intake.

Eventually, on one of those back-and-forth trips, my wife told me, “You are looking emaciated. Perhaps you are losing too much weight”. I checked my weight, and the scale indicated 169 lbs. (77 kg.) Thus, my wife tried her best during the week I was in Miami to nourish me well in order to prevent me from looking malnourished. For me, that was irrelevant since I told myself that, in the next couple of months, my Bahamas project would end and I would have enough time to gain back some weight. What a paradox, then, that my main concern was being underweight!

 

THE BEGINNING OF MY LIVING HELL

My first hospitalization: One Saturday afternoon, during February 2010, I started having a fever and abdominal pain. I called my general practitioner, and he recommended I go right away to Mercy Hospital's Emergency Room. I thought perhaps he wanted to be sure that while I was working in the Bahamas, I did not get any kind of infection. Once I got to the Emergency Room, they did a scan and analysis, and they discovered that I had had bariatric surgery. Although there were no leaks, the blood tests indicated that there was an infection. They kept me hospitalized for 5 days for antibiotic therapy. On the fifth day, they discharged me. I had no fever or pain, so they suspected that I perhaps had gastroenteritis.

My second hospitalization, which included my first surgery: A few months went by, and on a Sunday during the month of May, 2010 at 11:00 p.m. I was watching TV when suddenly I felt a stabbing pain in my abdomen. I couldn't take a deep breath, and my abdomen was completely hard and rigid. Furthermore, I did not even know how I could get to my bedroom, so I crawled. My voice was not strong enough to call my wife or my children. When I finally got to my bedroom, I asked my wife to call 911 since I thought I was having a heart attack. In a few minutes, the paramedics arrived, tried to stabilize my pulse and blood pressure, and rushed me to the Doctor’s Hospital since my heart rate was over 150 bpm.

Once I was admitted to Doctor’s Hospital, they did a CAT scan. They found I had a high fever, my abdomen was full of liquid and gases, and my blood test indicated that I was becoming septic. A surgeon came, I was admitted and they took me immediately to the operating room.

I woke up 6 hours later, and the surgeon came to explain that they rinsed my abdomen with 10 liters of serum and that he did not find any leak due to gastric surgery or any other source of infection. They kept me hospitalized with antibiotic therapy for a week. Then, I was discharged, and everything passed like another nightmare.

My third hospitalization: During the month of June 2010, after only 10 days after my second surgery, I had the same symptoms, and this time, my son took me to Doctor’s Hospital Emergency Room. There was the same surgeon, this time alone. Again, he gave me antibiotics and recommended that if I presented these symptoms again, I should go directly to Jackson South Hospital, where I could count on the specialized team in Bariatric surgery and the experience of Dr. Jacobs.

My fourth hospitalization, which included my second surgery: The Doctor Hospital surgeon's advice was not in vain; on July 1, 2010, I ended up in the Jackson South Emergency. My health had already deteriorated, and I had lost more than 15 lbs. (7 kg.). Once again, they did an abdominal lavage, and they discovered a small leak or fistula in my stomach. They informed me that they tried to close it with no success. They explained to me, in their words, that "sewing on your stomach is like sewing on a wet paper napkin that is macerated". “Momentarily, we are going to feed you with tube feeding, thus controlling the infection.” In addition, they also put a stent in my esophagus, passing through the area of the fistula, so my saliva was not going to stop at my stomach and cause a new infection.

Eventually, in the first week of August 2010, they sent me home with parenteral nutrition. In the following weeks, I continued with pain and fever; however, my Jackson South account balance was already reaching $540,000, and my Doctor's Hospital account balance reached an additional $200,000. Unexpectedly, the health insurance company flatly refused to pay these costs because they considered that this was a pre-existing condition and would not cover a penny of my past or future Medical and Hospital costs. Thank God, at least, that my good friend and surgeon at the Jackson South Hospital continued to take care of me in the Emergency Room every time I had a high fever or pain.

My fifth hospitalization: At the end of November 2010, and seeing no way out of my health problem, my family decided to send me for a month to Mendoza, Argentina, where my father's cousin, Dr. Balaguer, was a Medical Director at a well-known hospital, and his colleagues would study my case. And so, it was. I arrived in Argentina on December 2, and they did several studies on me, including contrast studies, and they did not find any leaks, but they did detect an abnormality (a fluid collection) the size of an egg lodged between the pancreas and the spleen next to the stomach. The medical group decided to treat it only with antibiotics, since it was very dangerous to remove that fluid collection because it could end in a hemorrhage or damage to my pancreas. I was treated for the next 3 months, only with antibiotic therapy for a period of 10 days every 3 weeks.

In May 2011, after returning to Miami, I once again had unbearable pain and a fever. Therefore, Dr. Balaguer, in Argentina, drew the conclusion that the fistula was still open, so he ordered me to have some images taken in the Trelleborg Position at 45 degrees inclination. The images showed that my stomach was leaking more than the Mississippi River. I had a fever and was in pain again. My parents came from Argentina to join me in Miami. When they arrived, they were concerned that if I remained in Miami, I would take the risk of dying little by little, and that even just a couple of months, would be too much. Therefore, they suggested, without any delay, that I go back to Mendoza (Argentina), where a team of doctors at the Spanish Hospital were waiting for me. They also thought that, in this way, my wife and children would have an almost "normal life".

Without further setbacks, they bought a ticket to Mendoza, Argentina. My friend Dr. Eddie Gómez warned me that I was not in any condition to travel, and if I had an emergency, there would be no way to save me

My mother told me, "We trust in God, and we will go anywhere needed for you to be healed". And that's how it was. The trip lasted a never-ending 9 hours to Santiago de Chile. I had a high fever, and I could not stand the pain in my shoulder and my abdomen. I worried about how my elderly parents would be able to face this matter. I had to take painkillers, to be able to arrive in Santiago de Chile and wait another 2 hours for the connecting flight to Mendoza.

My sixth hospitalization, which included my third surgery: We eventually arrived in Mendoza on May 24, 2011, at 10:30 a.m. The air was cold and dry, and I was finally going to rest a bit, but it wasn't like that. On the way home in a taxi, we stopped at the lab test analysis office of biochemist Martha Bertetto, Dr. Balaguer's wife. They took several samples of my blood. Finally, at 12:00 pm, I was sitting in the living room of my parents’ home. Not even 15 minutes had passed, when Dr. Balaguer called, and told my father, that he had seen my blood test results, they were not good, and, we needed to rush to the intensive care unit.

Since, we arrived at the Spanish Hospital, I could feel the admiration and due respect of the Hospital personnel for the Llobell and Balaguer families. At the hospital reception, without any further questions, they proceeded immediately, to take me to intensive care. There, they promptly provided me with oxygen and IV fluids; they drew my blood for testing, and they started their battle against the sepsis. Later, Dr. Balaguer joined his friend, a pulmonologist, who ordered x-rays and told me, "Kid, you have a tremendous pleural effusion; now we are going to have to put drains in to try to stop the infection.”

On May 25, 2011, they did an endoscopy on me. Thus, they managed to find the fistula, and through it, they reached the fluid collection. They did an aspiration and managed to extract around 70 cubic centimeters of pus.

While taking me back to intensive care, they told me that the infectious focus had already been controlled, and from now on, they were going to feed me with a nasogastric tube. The doctor informed me that the tip of the tube had been inserted, beyond the end of the stomach, where the duodenum is, hoping that my medical condition would improve. After 7 days, the improvement was miraculous, the infection was controlled, and the CT images did not show any new collection. Thus, the medical team decided to send me home, to be more comfortable, continuing my nasogastric feeding.

My seventh hospitalization, which included my fourth surgery: During the first week of June 2011, meanwhile, the medical team was looking for a final solution to my fistula. After taking into consideration other specialists’ opinions, they concluded that, the best-skilled medical team that could perform surgery on my fistula, was at the Hospital Austral in Buenos Aires.

We made the arrangements and took the advice that the best hospital was the Favaloro Hospital in Buenos Aires. Everything was arranged, with reservations made for the hospital and my companions (my parents).

The day before the trip to Buenos Aires, I was receiving my nasogastric feeding ration at 11:00 a.m. when I felt the stabbing pain again. I couldn't breathe; my abdomen was hard, my heart was exploding, and I told my mother, "Please let's go to the Spanish Hospital immediately."

As soon as I arrived at the Emergency Room, I was sent immediately to their Intensive Care Division. They gave me oxygen; suddenly I had a burning fever. They did TAC images, and again, they found an infectious fluid collection. Furthermore, they immediately performed a laparoscopy to extract the infectious fluid.

On a cold and gray Saturday morning, they performed an endoscopy after the procedure. While I was still on the stretcher, I woke up, and the doctor told me that they had extracted 100 cc of pus.

At that moment, I felt nauseated, so I asked the nurse, to bring me something like, a container because I felt I was going to vomit, and after a few seconds I started vomiting. In an alarmed manner, the doctor said to his colleagues, I was vomiting blood... and there was my uncle, Dr. Balaguer looking for the surgeon on duty, and I heard behind the scenes, he said I was bleeding internally.

The doctor approached, and they took me immediately to the operating room. And so, they operated on me for 9 hours and gave me 12 blood transfusions. They found that my spleen was necrotic. As a result, they performed a splenectomy.

An hour later, I woke up in intensive care, and I found myself with sutures from my sternum to my pelvis. In addition, I had a fever and excruciating pain. And there, in the solitude of the intensive care room, I regretted, over and over again, why I had chosen to have gastric bypass? Why, did I not try with more discipline or non-invasive methods to solve my overweight problem? Thus, I realized I had made the worst mistake of my life, going against Mother Nature’s wisdom. Unfortunately, after seven days in the recovery room, I was still septic!

My fifth surgery: The surgeon, in his last round at 12:00 a.m., took a sample from my drains to be tested. After half an hour, the results came out, and they were not good. They showed that my abdomen was infected with both Candida and E. coli. Thus, they transferred me immediately, again to the operating room. I woke up 10 hours later. I was informed that my large intestine had been perforated and that they had performed a colostomy. Besides that, I had another episode of pleural effusion, and they had to do a scraping of the ampulla that was stuck between the pleural tissue. It was a long procedure, and the post-operative recovery was the most excruciating pain I had ever experienced in my life.

I plunged into a dark stage in my life where I did not want to live anymore. Not only because of my own pain, but also because of the additional pain it caused my family and close relatives. Weeks passed, and in a lot of solitude, I devoted myself to my Saint, Judas Tadeo. I asked him, to intercede with God to let me return to Miami and leave things at least in order for my wife and my children. After 2 months in recovery, they sent me to a common room, where, at least, I enjoyed receiving a few visits and could watch television. During the next few weeks, my sepsis went away, and I was able to interact with my family and friends.

My sixth surgery: One day, a surgeon told me that if I wanted tea, I could have it. I accepted it, and I was so pleased to drink it! Unfortunately, not even 3 minutes had passed, and my abdominal sutures began to leak what I had just drunk. Later, radioactive iodine images confirmed that my small intestine had been perforated.Again, a new surgery was arranged to stop the leak and make an anastomosis.

The surgery was successful; however, my crater-like open abdominal wall, surgery after surgery, reached a diameter of approx. 25 cm. (10 inch.)

As a result, my intestines were exposed. At the same time, I was enduring a very painful healing process. I was told by my medical staff that they would control my abdominal discharges of bile and drainage, in order to prevent my body from self-digesting those growing skin and tissue cells necessary to cover my open abdominal cavity. For that purpose, they used an ancient vacuum pump technique that accelerated blood circulation and collected waste and bile acids. After 4 months of recovery in the hospital while receiving parenteral feeding, eventually my vital signs achieved some stability. By then, my mind and soul wanted to abandon this nightmare. Sharing my feelings with Dr. Viotti, he told me, “In my opinion, you are developing hospital depression; I suggest you to continue your recovery at home, before you undergo your next surgery."

A few days later, on September 21, 2011, I was discharged and Dr. Viotti and his assistants took me home. My father rented a hospital bed, and the surgeon and his team brought a surgery kit and all the accessories they might need for my home treatments. Every day, they came to change my colostomy bag and replace the dressings on my open abdomen.

At home, I was calmer, I could communicate with my family, and my parents would not have to make the sacrifice of going back and forth to the hospital every day.

On September 22, 2011, Sandra Serer, a friend of my mother who is a physiotherapist, like an angel from heaven came to me. Despite the fact that I did not want to receive many visitors, she insisted to my mother that she wanted to meet me, and so she entered the room and we met. We introduced ourselves, and only with her look did she understand my situation. I had terrible pain in my back, especially in my left scapula. She told me without qualms, "Don't move," and with her angelic hands running under the pillow, she touched my upper left side, and I felt intense pain. Thus, I began under the professional supervision of Sandra Serer to do isometric exercises to avoid cramps in my lumbar area and exercises to strengthen my legs and arms, thus being able to walk to go urinate alone, in addition to taking a shower without the help of my dear father.

 

At that time, the scale indicated my weight was only 105 lbs. (48 kg.), and it was obvious that with the enteral feeding, I was only surviving. Unfortunately, there was no progress in the granulation tissue formation in my abdominal area. At that time, my abdominal crater (ulcer) reached a dimension of 25 cm by 20 cm. Weeks passed, and I was getting weaker and weaker.

 

Meanwhile, far away in the USA, during the month of March 2012, my older brother met with Dr. Maurizio Lucà-Moretti at the International Nutrition Research Center (INRC) to talk about my complicated health status. According to INRC scientists, the main reason for most of my malaise was that my body was in a chronic negative nitrogen balance due to chronic malabsorption due to my bariatric surgery. In their opinion, under these circumstances, it was impossible to maintain my body’s nitrogen balance in equilibrium only by providing current oral or enteral nutrition. They recommended the use of SON Formula, an unprecedentedly effective medical food, to be incorporated into an adequate oral or enteral diet.

Thus, the SON Formula was sent immediately to me in Argentina. My mother, without hesitation, pulverized 30 tablets of SON Formula and added the resulting powder to my daily enteral nutrition.

Thank God, only a few days after taking SON Formula, my abdomen showed the beginning of granulation tissue. Eventually, during the first few weeks, I began getting out of bed in good health, and progressively, with the help of my dear physiotherapist, I was able to walk again a few blocks. Thus, I progressively recovered my resistance and endurance to walk while doing some therapeutic exercises. My doctors, with great surprise, saw for the first time that my health status was improving dramatically after being stagnant without any improvement for over six months.

My seventh surgery: After seeing this miraculous progress and accepting my request in April 2012, my doctors felt confident enough to perform a colostomy reversal surgery. That was a blessing, taking into consideration that my colostomy was something that made me extremely upset and, at the same time, deeply depressed. The reversal of my colostomy was a complete success; the wound closed satisfactorily, like in a healthy person. In my opinion, everything was a great success. Then, the only thing still to be done was an additional surgery on my intestine that could close my current two fistulas.

My eighth surgery: The surgeon very cautiously told me that if we continue like this, soon we are going to do a new surgery since my blood tests and my general condition had improved dramatically, and I had managed to gain weight, thus reaching 114 lbs. (52 Kg.)! In June 2012, I went back to the operating room, and they performed surgery on me in order to cut about 30 cm of duodenum, where the fistulas were located. Fortunately, again, the closure and scars healed immediately, and I required only one week of hospitalization. Unfortunately, during that period, the hospital did not let me take the SON Formula medical food.

 

 

Once I was discharged from the hospital, they sent me home with home hospitalization. A few days later, I noticed two small rashes where the scar was exposed. They began to leak bile again, and if I drank water, it came out of the wound. Again, the anastomosis was successful, but two new fistulas had formed in the duodenum. Soon I realized, according to my own conclusions, that the lack of SON Formula during 10 days, at the moment that my body needed it the most, had caused a Body’s Negative Nitrogen Balance, which in turn caused an insufficient Body’s Protein Synthesis (BPS).

We immediately started to add SON Formula to my enteral feeding. Although those fistulas were not as serious as the previous ones, they continued to appear without explanation. Once again, the Surgeon told me that we would have to wait until they could perform a new surgery on me.

I followed the surgeon's instructions; my fistulas were exposed, and my abdominal wall did not finish closing. The doctors and surgeon came to the conclusion by just looking at my small intestine that it was still perforating. So again, I waited another year until my general condition was better, and I gained weight. We continued with the physiotherapy treatment, adding SON Formula to my daily enteral feeding.

 

 

 

My ninth surgery: In June 2013, they again performed surgery to cut the fistulized section of the intestine. Everything went well, but 3 weeks later I had 2 fistulas again, although these were low flow. At least I could use absorbent gauze and move freely, and only at night did I connect to the vacuum machine to collect bile and thus not damage the skin around the fistula.

My physical condition was excellent. I walked 7 km with my physiotherapist three times a week. Although I had leaks from the fistulas, the doctors suggested that if I could now add regular food, although a small

part of what I ate came out through the fistula, 95% of what I ate would pass through the rest of the digestive system.

We came to the conclusion that we should think about continuing to improve my general physical condition with weight gain, and later in a few months we could take another approach to see how we could avoid repeating surgery that would end up in fistulas.

 

 

The doctors were attentive to my family situation. I was going through 28 months of hospitals and surgeries away from my family in Miami. The surgeon told that if I wanted to go to Miami to be together with my children and wife, I could use a few months to be with them. So, on September 5, 2013, I began my return to Miami.

Unfortunately, my reunion with my wife and children, which started being very goo

d in the first few weeks, later become uncomfortable, for me and my wife, due to our different opinions about how to educate our two children. By March 3, 2014, sadly, my wife had left our home, taking our two children with her to the other end of the city. Given the circumstances and the start of the divorce process, I had a relapse. My emotional stress increased, my fistulas got bigger, and my financial position went from bad to worse.

 

Then, in 2014, Obama made it possible that no hospital could refuse me treatment and/or surgery within the USA. As a result, I followed the advice of my parents to have my next surgery done in Miami. Regrettably, by then, I had lost contact with the International Nutrition Research Center because I took it for granted that I could have a normal life without taking SON Formula.

 

My tenth surgery: I managed to contact a University of Miami surgeon, and after numerous studies. Finally, on February 1, 2015, they performed the surgery and a new anastomosis. In order to improve the granulation and healing for the next 30 days, every morning I received a 4-hour session in the hyperbaric chamber with a pressure of 2-1/2 atmospheres and pure oxygen. Eventually, the fistulas did not come back; however, my abdominal wall did not generate any skin. Now again, I realized, according to my own conclusions, that the lack of use of SON Formula during a long period, when I needed it the most, caused my body to have a Negative Nitrogen Balance. This led to an insufficient Body Protein Synthesis and, therefore, an insufficient cellular turnover.

After 2 months of hospitalization, I was discharged. A skin transplant was scheduled for May 2015. And so it was, I spent a week in the University of Miami Hospital. Only 70% of the skin transplant was positive. The following month, again, a new transplant to cover the remaining 30% was done successfully.

However, as the years went by, I could not gain weight, and weakness had a bad effect on me, although I tried to eat high-calorie foods, I did not gain weight and my general condition was poor, as I suffered from back pain and did not have the strength to be away from home for more than a couple of hours.

Always remembering SON Formula, Dr. Lucà, and the International Nutrition Research Center, in July 2021, I managed to contact them. They asked me why I didn't continue taking the SON Formula, and I really had no logical answer to give them. They recommended that I start taking 10 tablets of SON Formula three times a day, along with any food that I felt comfortable eating and digesting. Eventually, thank God, my life took another 180-degree turn. I began to feel, to look, and to be stronger and stronger, and much more physically active.

For the first time since 2014, I reached a 132 lbs. (60 kg) body weight! My body's flaccid skin and weak muscles began to take back the shape and muscle tone that I had progressively lost since I received bariatric surgery in 2008. The speed with which my hair and nails were growing was also remarkable.

I thank God that back in 2012, I had the opportunity to meet Dr. Maurizio Lucà, at the International Nutrition Research Center. Perhaps, without having their professional and personal support and their SON Formula, I would not be here to tell my story.

So, I hope, God willing, that my testimony and the use of the SON Formula, under medical supervision, will be of great benefit to those people, who, like me, have had bariatric surgery; or to those suffering from eating disorders, overweight, malabsorption, and/or malnutrition. As a consequence of my bariatric surgery, I have been in a living hell for the last 15 years of my life, and paraphrasing John Lennon's words, “I was not the only one.” Therefore, based on scientific evidence and my own experience, I will always strongly recommend that anyone considering bariatric surgery should never have it. No matter what!

Daniel A. Llobell 2023