Dr. Myers explains how Gastric Bypass Works

Tuesday, September 28, 2010

Early Results from Robotic Gastric Bypass Operation


“It’s amazing”, Robyn Blake told me in the office today. She is just one week from her robotically assisted laparoscopic Roux en-Y gastric bypass and she is thrilled with her results. ‘I only took one pain pill a day for the first 2 days after I was discharged from the hospital.”

“The results are not subtle,” Mike Palasek, CRNFA who assisted with each of these operations told me today. “The patients who had their operation robotically are having much less pain.”

We have now completed our first four robotically assisted gastric bypass operations. Both are doing very well. Two of these patients went home the day after their operation instead of two days later. The patients appear much more comfortable the day after the operation.

Overall I am very impressed with these very early results. There are only 4 incisions and these are smaller and healing well without a drain or staples.

I agree with Robyn, the results are amazing.

Dressing for Excess Skin

A posting from Stephanie Myers, Dr. Myers' daughter, on 3 problem areas that can be improved by focusing on appropriate wardrobing.

One of the major issues post bariatric surgery is the issue of excess skin. Although the fatty tissue will be gone soon because of the surgery, exercise, and nutrition adjustments, the skin which has been stretched to accommodate that fatty tissue will remain (some to a more severe degree than others, depending on an individual basis). Regardless if you choose to have bariatric surgery or not, I want to give you a few ideas to work around the excess skin in the mean time.

At a recent support group I shared about what clothing to look for in order to resolve the issues of discomfort and embarrassment. Those are both valid issues and the key to solving this issue is having the correct undergarments. Of course, all three can be used at the same time if necessary. Most likely these ideas are not foreign to women, such as Spanx, or control top hosiery. Now, I will explain the three main problem areas, the solutions, (what to look for to work with each area), and styling tips.




1). The problem area: The “Apron” - This is what is known for the the excess skin area of the stomach. Again, once the weight is lost, the skin can still remain.

The solution: A good solution here is to find a very fitted stretch tank top that will help to hold in excess skin. This tank can be a few sizes smaller than you would typically wear so that you get the supporting effect.

This picture is a great example. It is a Spanx for Plus sizes that can be found at Lane Bryant. You could even look for a longer version that will go just below the hips.

How to Style: The key with styling this is that it does not have to show, in fact it really shouldn't. The best idea is to layer and especially going into fall and winter this will be easy to do.



2). The problem area: The “Wings” - This area of excess skin is from any stretched skin that caused by the fatty tissue in the arms.
The Solution: A very fitted three quarters length fitted t-shirt will hold skin in place so you don’t have that 'flapping' feeling. This shirt needs to be more fitted than your usual clothing, again to support your arms.

How to Style this garment: The purpose of this garment is also to be an undergarment, and should be worn with other clothing that fit appropriately.

This example is a top that is on sale at Nordstrom.









3). The problem area: The Inner Thighs - The inner thighs are an area that can be an annoyance.
The solution: Very fitted bicycle shorts or spanx (apparently, these shorts to the left are lined with zebra print. Zebra print is optional when you do your shopping!
How to style: Another great trick is to wear bicycle shorts under your pants or dresses in order to give you a more controlled feeling and therefore, will be more comfortable. This pair is from Lane Bryant.

Again, I am here as a resource for your wardrobing issues now. I also will work with you to create a look that is uniquely yours. Please contact me at Stephanie.Myers1@gmail.com to arrange a meeting to begin!

Get Well Picture for Grandma


Mikey Pyle drew this picture for his grandmother who had her bariatric operation last week and was seen in the office today. Look closely to find the following 4 details:

1). Grandmother's size before and after the operation

2). What is that in Dr. Myers hand?

3). Note the Gandmother + Surgery = Smaller Grandmother format

4). The facial expressions are terific

Great job! Thank you, Mikey, for cheering up your grandmother and bringing a smile to all of us.

Great Message from My Patient, Wendy Hartman. Check Out Her Blog!


My husband and I have been together for 26 years. Married, 19. He met me at about 180 pounds. I was about 250 when we married. I was at 395 when I had surgery.

Scott told me the other day something that had me in tears.

I knew he was worried about me, but we never talked about it. He said: "6-8 months ago, I was crying myself to sleep wondering what I would do when you were gone. How was I going to handle the kids? How was I going to pay the bills when I don't even know where the passwords are for the accounts? I had no idea that our lives could change so much in 6 months. Everything is so much better. You are a better person. We are better." Wow.

Thank you, Dr. Myers!!!

Wendie Hartman

http://margaretandelwood.blogspot.com/

Monday, September 20, 2010

Finding "New" Things after Bariatric Surgery




Finding “New” Things after Bariatric Surgery

Last week one of my patients who had lost a lot of weight after her bariatric operation returned complaining of finding a new mass just below her breast bone. She was obviously very worried.

After I examined her I indeed noted a firm ½ inch hard rubbery mass just as she had described.

I explained that this finding is called the xiphoid process and is a normal anatomic structure. She was just now finding this for the first time because she had lost enough weight it was no longer hidden in the fatty tissue!

This is a very common occurrence. As a bariatric surgery patient loses a lot of weight, say 100 to even 200 lbs or more they are able to “find things” they did not even know they had such as hip bones, back bones, clavicles, tail bones and even ribs that they thought were breast masses!

Of course these patients are often embarrassed when they find out these structures were always there but could not be felt until they lost significant amount of weight but it is just part of discovering themselves anew.

Having bariatric surgery is truly a Fresh Start for many and a new discovery of the new you.

Update on the Use of the da Vinci Surgical Robot


Last Tuesday, September 14, 2010, I was privilegded to perform 2 gastric bypass operations with the assistance of the da Vinci surgical robot. Although it is always challenging to begin to use new technology, both patients did well and one left the hospital after only one night stay.

The following is an exert from an email sent out by a representative of the company that makes the da Vinci robot to some of the Medical staff at our hospital. I thought you might be interested in this anouncement:

"OhioHealth has established itself as a leader in robotic surgery and Dr. Myers has established himself as a leader in bariatric surgery. This is another application where da Vinci is helping surgeons deliver minimally invasive surgery to a broader base of patients every day. Dr. Myers gave the following reasons for using the da Vinci for his gastric bypass procedures:

1. Stronger anastomosis
2. Patients are less likely to bleed
3. Less incisions - reduced from 5 to 4 with about 50% reduction in incisional "footprint"
4. Less pain at trochar sites
5. No need for largest incision to pass circular stapler

Dr. Erik Wilson from the University of Texas Medical School at Houston proctored Dr. Myers with the use of the dual console da Vinci Si system."

This important device will be able to help make this operation even safer and better. I will have the oportunity to use the robot to perform a gastric bypass for three more patients in the coming week.

Learn more about the da Vinci robot at www.IntuitiveSurgical.com

New Video! Dietitian explains Nutrition Facts Label

In this video, You will see Dietitian, Kristi Highley sharing the importance of the Nutrition Facts Label. The photo on top is an image of the exact Label she is refering to but enlarged. One more thing before we get started, Dr. Myers wants to know something about the beginning of the video, "What's up with the tongue Kristi?"





Brian Stinecipher shares his success story after gastric bypass! Part 1

We begin this video with Janet Dearwester, a Fresh Start Bariatrics patient, who went from 200lbs to her current weight of 130 lbs. Then, Brian Stinecipher shares he and his wives' success stories as patients at Fresh Start Bariatrics. He shares before and after stories and pictures.

Brian Stinecipher shares his success story after gastric bypass! Pt. 2

In this part of Brian's presentation, he concludes and then takes questions from perspective patients at a recent Informative Seminar that Fresh Start Bariatrics. and Questions are then answered by both Brian (a Fresh Start Bariatrics patient) and Dr. Myers. The free seminar is the first step in the Fresh Start Bariatric Patients journey.

Preparing to Perform Robotic Assisted Bariatric Surgery




Preparing to Perform Robotic Assisted Bariatric Surgery

My wife and I were at my parent’s home last weekend. Our conversation included my plan to begin performing robot assisted bariatric surgery. They asked a great question, “How have you been training to use the robot?”

I thought you might be interested in my response.



First, it is important to remember that I have been performing the Laparoscopic Roux en-Y Gastric bypass for over 7 years and have performed nearly 800 of these operations.

Second, I plan to begin by performing only a part of the operation using the robot.

Third, using new advanced technology to perform this operation is much like an experienced professional pilot training to use a new airplane to fly a familiar air route.

As you might imagine Riverside Methodist Hospital has a pathway each surgeon is required to complete to become credentialed to perform operations with the assistance of a robot. I have exceeded the requirements and followed the following 10 steps in the path to preparation:

1). Observed two operations performed by Dr. Michelle Toder in Bangor Maine in July 2010 and was very excited by the capability of this remarkable instrument.

2). Informed the hospital of my interest in robotic surgery

3). Reviewed about at least 8 hours of video of the operation performed using the robot

4). Observed an operation with Dr. Burges at Riverside

5). Completed an all day training session performing several operations with a certified instructor

6). Logged at least 8 hours of independent practice on the robot

7). Choreographed each step of the operation with the operation room staff during a mock operation

8). Received temporary privileges to perform robotic surgery from Riverside credentials committee

9). Obtained consent from the first 2 patients to perform their operations using the robot

10). Arranged for Dr Erick Wilson, a very experienced robotic surgeon from Houston, Texas, to be present in the operating room during the first two operations using the robot as my “proctor” or supervisor tomorrow, (9/14/2010)

Now I am ready to get started! Maybe I should watch “Top Gun” once again before we start the operations!

Roller Coasters after Bariatric Surgery?



Yesterday I saw Stephanie, a patient of mine, in the office one week after a laparoscopic gastric bypass operation. I was surprised when she asked if she could ride the roller coasters at Cedar Point amusement park just 11 days after her operation. She said she loved roller coasters and especially enjoyed the rides that make her hang upside down!

I said I was delighted she was doing so well she wanted to ride the rides at an amusement park a week or so after her operation. However, even if it does not injure you, hanging upside down is for bats not humans!

Tuesday, September 14, 2010

How to dress during dramatic weightloss - Dr. Myers' Daughter explains

Dramatic weightloss requires dramatic wardrobe changes. I, Stephanie, (stylist and Dr. Myers' daughter) want to focus on finding a good dress first, because it can be very versatile while you are loosing weight (Sorry Guys! This one is for the Girls!). Especially after surgery, a dress can be a wonderful solution for you while your body is in this very dramatic transitional time period. Here is what to look for while shopping for this must-have fall wardrobe essential: The Dress. Here are five points to guide you to the perfect dress. Let's get started!


#1 What to look for in the perfect dress - Structure


A dress with structure is going to give your body shape, such as this dress from Nordstrom.




I love this dress! The denim is right on trend for this fall. This dress works because of the structure in the bodice which gives the rest of the body a perfect shape. The skirt is full and falls gracefully away from the waist. This is a wonderful solution and a great option for your fall wardrobe. And as the weather changes and cools down, you can switch out the white belt for a nice leather one and pair the dress with an adorable sweater or cropped jacket. Finish the look with a pair of cute boots.

Now, moving right along to the second aspect to look for...


#2 What to look for in the perfect dress - Visual Lines


First of all, can we all just agree that this is a gorgeous dress?! The idea behind a dress like this is that the lines in the garment create a visual trick and elongate the entire body. The draping is also a very current way to look effortlessly glamorous.
Look for these kind of detailing that can quickly update a wardrobe and making you look very modern at the same time.



#3 What to look for in the perfect dress - Necklines


Necklines are an important aspect to look for when you are shopping for the perfect dress this fall. This hot pink dress from Nordstrom is fabulous. It has the best two important key elements when looking at the neckline of a dress. The V-neck is wonderful and creates an illusion of length. Also, the faux-wrap on the bodice can also minimize the chest.




#4 What to look for in the perfect dress - Fit


This specific area of dressing yourself walks a fine line. It is very important to wear a size that is fitted, yet not too tight. However, leave enough room that you can breathe and move easily, and yet is not baggy. If ever you have a question as to if the fit is right on you or not, then try on three different sizes. One that is typically your size, then a size up and a size down from that. Also, because brands can size very differently.

The following two pictures gives two examples of dresses that fit just right.





And now for an ill fitting garment..

The reason why this garment doesn't work is because it hides a figure all together, and what begins as a good intention to hide unwanted weight, actually creates more surface area instead of the desired camouflaging.



#5 - What to look for in the perfect dress - Texture & Fabric


Fabrics are incredibly important aspects of finding a great dress for this season. Look for fabrics that have a certain stiff quality. These fabrics can be forgiving and can camouflage problem areas. Where as a thin jersey (or t-shirt fabric) can cause unwanted hugging. This dress is a fantastic example of almost all of the points we just discussed. I can just see it now with the perfect pair of boots and an adorable jacket for the fall...



And when you are ready to go shopping, Contact me! I would love to guide you through your fall wardrobe and give assistance during the transition time after surgery. We can go to Target or Saks Fifth Avenue and everywhere in between. Contact me at: Stephanie.Myers1@gmail.com

News Release

Columbus, Ohio, September 5, 2010

Free Interactive Bariatric Surgery Course Now Available Online

Prospective weight loss surgery patients can now learn more about bariatric surgery by accessing a new free interactive online course at www.freshstartbariatrics.com. Dr. Steve Myers, a bariatric surgeon in Columbus, Ohio has developed the online seminar in close collaboration with Riverside Methodist Hospital. “This course shares information in plain language for people of size that would like more detail about which bariatric operation would be best for them”, Dr. Myers explains.

This free progressive course includes many videos, drop and drag activities, pictures, information ‘dots’ on diagrams, interactive question and answer opportunities and click for definitions in user friendly terms. Myers says, “This is truly an interactive experience”. Prospective patients unable to attend the live Fresh Start Seminar can now obtain the same information online. For those interested in proceeding in the Fresh Start Bariatrics program, this course can be the first step in the process.

This new course provides clear, transparent information in an easy to learn format and will help persons of size choose the best approach possible when considering bariatric surgery.

Robotic Surgery Holds Great Promise for Bariatric Surgery Patients.


As many of you know, qver the last several weeks I have been observing robotic surgery, logging time practicing on the newest robot and doing a lot of planning for my first robotic gastric bypass operation scheduled on September 14th , just a little over two weeks from now.

Today I spent the entire day training in the robotic laboratory at Good Samaritan Hospital in Cincinnati, Ohio. It was an intense day with many hours in the console of the robot performing several operations, learning to “dock” the robot to the ports and instruments and learning much more about this elegant and sophisticated machine.

The training will continue nearly each day in preparation for the first operations but everything is progressing very smoothly.
I must say, I believe the da Vinci Robot is very likely to bring considerable value to my gastric bypass patients. I am even hopeful that many will be able to go home the day after surgery since I believe I will be able to decrease the incision “footprint” by about 50% and there should be even less discomfort involved with this operation.

Congratulations to Intuitive Surgical, Inc. for many improvements in the newest model of the da Vinci robot!

Posted by Stephan Myers, MD, FACS, bariatric surgeon, Columbus Ohio

An Unusual Way to Keep Weight off after Bariatric Surgery



Last week I saw Peggy Lauritzen, one of my patients, in the office and she told me of the unusual way she reminds herself to eat slowly. She carries chopsticks in her purse and uses them for all of her meals!

Think it is crazy? She has kept her weight off and is doing very well several years after her gastric bypass. It may be a little quirky but it works for her.

Once a friend of hers said "I would lose weight too if I used chop sticks." Peggy said, "so what's your point.

How do slow down your eating? Do you have a quirky way to remind yourself to slow down and chew slowly. Leave a comment and I will share it with the other 750 people that follow this blog each month.

Losing Weight Prior to Bariatric Surgery May Help Obtain Your Best Result

Every week I see patients who have been operated on at other programs only to gain back much of their weight or disappointed with the amount of weight they have lost. Often people had their operation when their weight was considerably more than a BMI of 55. (That would be more than 355 lbs for a person that is 5 foot 7 inches tall.)

This is the message:

Gastric bypass and gastric sleeve operations help people lose weight for only about one year.

After the first year the operation is likely to help the patient to maintain their weight at about the same level but it is unlikely that they will lose more weight from the operation.

Whatever a person’s weight is one year after a gastric bypass or gastric sleeve operation is at 1 year after the operation is likely to be about near their best weight.

That is why we choose to make sure each patient is no more than a BMI of 55 prior to surgery. This can be done with dietary changes, medications and/or a physician supervised very low carbohydrate diet.

Shifting the curve I drew for you downwards, (note the purple arrow pointing down), before surgery is the way to obtain the best result after surgery.



The weight loss curve is about the same regardless of how much excess weight someone has. Although there may be the occasional exception, the most a patient is likely to lose after a gastric bypass or gastric sleeve operation is about 170 to 200 lbs. That means if you have 300 to 400 lbs of excess weight you are still likely to have 200 lbs of excess weight after surgery. This is why we encourage our patients to "shift the curve" downward to a BMI of 55 if their weight exceeds this number. Then after surgery they are much more likely to lose nearly all of their excess weight and approach ideal weight and resolve many of their obesity related medical problems.

These are the benefits of reaching a BMI of 55 or less before surgery.

Better results
Weight reaches near Ideal weight at 1 year
Better resolution of obesity related medical problems
Less complications
Less likely to need a tracheostomy
Less likely to need to need ICU stay
Less likely to have skin or muscle breakdown from being in bed after surgery

This is the bottom line:
Safer operation with better results

Posted by Stephan Myers, MD, FACS, Bariatric Surgeon, Columbus , Ohio

Da Vinci Robot and Bariatric Surgery

I have been pondering the possible place for the Da Vinci Robot in bariatric surgery for a few years. Although it is an expensive device, (about 2.5 Million dollars per robot), I am now convinced there is very real value for bariatric patients and their surgeons.

First, he patient is likely to benefit by having less incisions decreasing from four ¾ inch incisions and one 1 ¼ inch incision to two ¾ inch incisions and two ½ inch incisions. This alone should decrease pain and shorten recovery time. In addition the robot “remembers” the point each device passes through the abdominal wall and pivots at this point decreasing the trauma to the abdominal wall tissues thus decreasing pain even more.

Second, the surgeon can see better since the view is a 3 dimensional view instead of the 2 dimensional view with standard laparoscopy. The better the surgeon can see the safer the operation. Who wouldn’t like there surgeon to see as well as possible during their operation?

Another issue is the reduced wear and tear on the surgeon. Operation on persons of size is physically demanding and allowing the robot to take the physical load while the surgeon is guiding every move of the robot while sitting comfortably at the console may add years to the length of a surgeons career.

Two weeks ago I spent the day in New England with Dr. Toder who performed 2 gastric bypass operations that day. It was clear to me that using the Da Vinci robot would be of benefit to our patients.

Riverside presently has 2 robots and they will be installing the third and most up to date robot in the operating room I usually use to do bariatric surgery operations by the middle of September 2010.

Over the next 6 weeks I will be training on this new instrument. I am hoping the robot will reduce the number of days a patient stays in the hospital from 2 days to one day.

I will post regular updates as we make this transition to this advanced technique to keep you informed.

Antidepressants and Bariatric Surgery


Antidepressants and Bariatric Surgery

Some antidepressants cause weight gain. Others suppress appetite and can help with weight loss. Below is a list of antidepressants that fit into three separate categories.


Antidepressants that may increase your weight:

Paxil - (this is known to be the worst to cause weight gain)
Elavil or other tricyclic antidepressants
Trazadone

Antidepressants that tend to be weight neutral. (After early weight loss patients tend to slowly gain weight over time.)

Prozac
Zoloft
Celexa

Antidepressants that often cause weight loss

Wellbutrin
Cymbalta
Effexor
Prestique

If you are taking an antidepressant that is known to cause weight gain or is weight neutral speak with your primary care physician or psychiatrist about the possibility of changing to an antidepressant that can assist you in losing weight or help you keep your weight off.

Please do not stop any antidepressant without consulting your doctor.

Outcomes of Bariatric Sugery at Fresh Start Bariatrics at Riverside

We continue to be transparent and bring you as much information as possible.

Below you will find the results of 277 bariatric surgery patients operated on by Stephan Myers, MD, FACS at Riverside Methodist Hospital. Each patient was seen in our office in follow up 1 year after their operation where the following information was obtained.

I would like to caution you before you make too much of this information.

First, there are only 25 patients who had a gastric sleeve operation and had 1 year follow up at the time these numbers were tallied. Therefore there is less certainty about the gastric sleeve results. In fact there are so few patients in several categories to make any conclusions. For example note that there are only two patients that had stress incontinence in the gastric sleeve category and both had resolution of this problem. More numbers will undoubtedly show many patients will not resolve this medical problem.

Second, there is a definite bias in these results since patients with diabetes and severe acid reflux most often choose a gastric bypass since this procedure is the most effective operation to resolve these problems. Therefore, patients with less severe diabetes and reflux often choose one of the other operations but since their disease is less severe it is unfair to compare the numbers between operations.
You are welcome to this raw information but please understand that this is not comparing “apples to apples” and this not statistically valid for comparison between the three operations.

Key:
LRYGB ---Laparoscopic Roux en-Y gastric bypass
Sleeve ---Laparoscopic Gastric sleeve procedure
Band ---Adjustable gastric band procedure
N= ---Number of cases in each category


Vitamin D Deficiency and Bariatric Surgery


Vitamin D is very important since it helps to maintain appropriate calcium levels in the blood and keeps helps to make calcium available to strengthen bones.

The vast majority of bariatric operations including a Roux en-Y Gastric Bypass, Gastric Sleeve or Adjustable Gastric Band have little or no effect on Vitamin D absorption. Only the relatively rare bariatric operations that greatly shorten the last half of the small intestine such as a Duodenal Switch, Biliopancreatic Bypass or a Modified Gastric Bypass that leaves a very short portion of the small intestine to absorb nutrients result in inadequate absorption of vitamin D.

Nevertheless vitamin D deficiency is a frequent problem for all patients of size. Although some of the vitamin D we need in taken in as part of the food we eat, some of the vitamin D is formed by sunlight converting colesterol to vitamin D in our skin. Since I am a bariatric surgeon in Columbus, Ohio, 89% of all of my patients are found to be vitamin D deficient even before surgery!

That is the reason each patient that enters our program is tested to determine their vitamin D level. We routinely start our patients on vitamin D when they begin in our program.

Why do our patients often have low vitamin D levels? It is not because of surgery.

Vitamin D deficiency occurs partially because we live in Ohio instead of Phoenix! Ohio is not known for sunny weather. Also people of size often are not out in the sun very much. In addition there is some evidence that Vitamin D is stored in our fat deposits and it may take higher amounts of vitamin D to saturate all of the storage sites.

Vitamin D is converted to an active form as blood is circualated though our kidneys. A normal Vitamin D level is necessary to absorb calcium from the intestine and preserves calcium from being released in the urine.

After absorption, calcium circulates in the serum and is stored in bone. The balance between the amount of calcium circulating in the blood and stored in bone is controlled by a hormone released by four small quarter inch size glands located just behind the thyroid gland in your neck called the parathyroid glands. It is essential to your nerves, heart and other body tissues to have a normal level of calcium in the blood. Therefore if your calcium starts to decrease the parathyroid glands produce more parathyroid hormone which in turn tells some of the cells in the bone to take calcium out of bone and release the calcium into the circulating blood. If this goes on for a long time you can lose so much bone strength that you put you at risk of causing breaks in the bone called fractures. This circumstance is called osteoporosis because the bones, (osteo-), becomes more porous, (porosis).

Therefore, if your vitamin D level is low you will not absorb enough calcium and your calcium level will be low. This will result in higher levels of parathyroid hormone stimulating the bone cells to mobilize more calcium from the bone and make your bones weaker and more prone to break. The bones at most risk are your hips and the bones of your back.

You should take at least 800 mgs of calcium every day, (as calcium citrate for gastric bypass patients) and make sure your vitamin D level is checked yearly. Take Ergocalciferol 50,000 units each week to treat a low vitamin D level. In addition periodic bone density tests will check how much calcium is stored in your bones reflecting how strong the bones are. If you have a mild decrease in bone density called osteopenia, correcting the vitamin D deficiency and taking more calcium may be enough. However, if your bone density is low enough to be called osteoporosis you should speak with your primary care physician about taking a medicine that will reverse the bone loss such as Boniva or Reclast.

From Stephan R. Myers, MD, FACS, bariatric Surgeon, Columbus, Ohio

Dr. Myers, Why do I sometimes feel squeezing pressure in my chest when eating or drinking?


Squeezing pressure in the chest can be a symptom of several problems such as heart disease, gallbladder disease or pressure in the esophagus. If you think the symptoms may be related to your heart call your primary care doctor or go to the emergency room.

However, if this is happening to you several weeks or months after having a bariatric operation it is likely to be esophageal pressure from eating or drinking faster than the pouch or sleeve is emptying thus food, drink and or air is accumulating in the esophagus. The esophagus squeezes the food trying to get it out of the esophagus and into the stomach. However, if the pouch is full the food in the esophagus has nowhere to go. Although there are minimal pain fibers in the stomach, the esophagus is exquisitely sensitive to pressure and will definitely let you know when it cannot move food or drink into the stomach.

This can happen regardless of whether you have had a gastric bypass, gastric sleeve procedure or an adjustable gastric band operation.

In this situation the worst thing you can do is to try to get the food moving by drinking more. This just adds to the problem by adding more fluid into the esophagus and makes the pain more severe. The pain lasts even longer since the additional food or drink also has nowhere to go.

Throwing up what is in the esophagus can give you relief but if you are patient usually the food and drink is likely to pass through the exit of the pouch or sleeve and the pain will be relieved.

After bariatric surgery, eating and drinking too fast should be avoided and may cause squeezing chest pain. When it occurs after eating it may be a possible sign that you may have just eaten too much too fast for the length of time it takes for the food in the pouch or sleeve to pass. In band patients continuing to experience this problem may lead to band slippage. (See band slippage elsewhere in this blog.)Reviewing the “Rule of 30’s” in this blog can help you to avoid this symptom.

Of course, if you have any consern that this is not related to eating too fast call your doctor or go to an emergency room to make sure the pain you are experiencing is not related to your heart.

Video - Dr. Tell Describes Potential Psychological Barriers to Success

Dr. Myers, will I need to use my CPAP machine for obstructive sleep apnea after bariatric surgery?

The short answer is; most likely you will be able to discontinue your CPAP machine sometime after you lose a significant amount of weight from bariatric surgery. In fact over 80% of the time patients with a diagnosis of obstructive sleep apnea will resolve this obesity related medical problem after bariatric surgery.

Let me explain. As our weight increases we see our size become larger. What we do not see is the soft tissue of obesity increasing in our throat making our airway crowded. When we are sitting up and awake gravity brings our tongue down and the muscles of our neck and throat keep our airway open. However, when we lay down on our backs gravity works against us and our tongue falls back into the back of our throat further narrowing the airway that is compromised by the soft tissue of obesity. In addition, when we fall asleep our muscles relax and the airway may become nearly or completely closed. That is why many persons of size are loud snorers! As the air is moving in and out the soft tissue in the airway vibrates making the snoring sound. This may not wake the person snoring but it certainly can keep the one they are sleeping with from sleeping!

But obstructive sleep apnea is not just about sleep. It is mostly about what happens to your heart while you are sleeping. When you are sitting up and awake your red blood cells are likely to be about 98% saturated with oxygen. You need that oxygen for your body' tissues to stay healthy. Your heart especially needs the oxygen to keep beating as well as possible. When a person with obstructive sleep apnea falls asleep and and their airway becomes obstructed their oxygen level decreases since they are not moving air in and out as well as they should. their oxygen level may fall into the 80% range, down to the 70% range into into the 60's and even lower. Our hearts do not like and sometimes your heart will run off a string of irregular beats and the heart will no longer be pumping and the person will be found dead in bed in the morning. Even if your heart does not react in this manner, it will be trying to keep up with the needs by pumping faster and harder. However, since it is starving for oxygen it is often in relative heart failure during the night. That is why people that have obstructive sleep apnea often have to get up at night to urinate since there heart is strained and gives off a hormone that tells the kidneys that you are "drowning" from heart failure and you need to get rid of some of the body's fluid. In addition people of size that have obstructive sleep apnea often wake up in the morning with their ankles still swollen because of the heart failure during the night.

This all can be prevented by using a CPAP machine, (continuous positive airway pressure), that pushes air under gentle pressure into the airway keeping the soft tissue out of the way and keeping the airway open, This allows them to breath normallykeeping their oxygen where it should be.

Since it takes about 3 weeks for the heart to recover from its previous failure we require all of our patients that have obstructive sleep apnea to be using their CPAP machine for at least 3 weeks before their bariatric operation and expect them to continue using it after their operation until they lose enough weight that the machine is no longer needed. This generally takes from 3 to 6 months to lose the amount of weight necessary.

In the hospital our patients may be on pain medicine that could make their sleep apnea temporarily worse so they are continuously monitored for their oxygen level and this information is sent to the central nursing desk for additional monitoring.

At Fresh Start Bariatrics at Riverside we are constantly looking for ways to make bariatric surgery safer for our patients and this includes making sure they are doing everything possible to be as healthy as possible before and after their operation.

Of course there are other reasons people have obstructive sleep apnea and that is why about 15% to 20% of people need to be on CPAP despite loosing their weight. For example, I have a BMI of about 27 but I use CAPAP because I have a palate deformity that narrows my airway.

Fortunately, over 80% of our patients with obesity related obstructive sleep apnea will have resolution of this problem.

Does anyone have any further questions about this? Feel free to post a coment or ask a questiion




by clicking on the word "comment" at the end of this posting.

Dr. Myers, How do you suggest my rheumatoid arthritis medicines be changed around the time of my bariatric operation?

This was a question raised by a woman at the bariatric surgery informational seminar I spoke at today. She has had rheumatoid arthritis for several years and is on methotrexate, an immunosuppressant, and treats flare ups with prednisone. All of these medicines suppress inflammatory activity to keep her rheumatoid arthritis under control but for the same reason they will make healing more difficult.

The overall goal is to allow her to heal normally around the time of her operation but to resume her medications as soon as possible after adequate healing is obtained. We therefore want to stop any medicines that will interfere with wound healing at the right time so the negative effect of the medicines are suspended for about three weeks after her operation since about 80% of healing is completed by three weeks after an operation.

For instance: she takes methotrexate once a week. I would suggest that she take her last dose 2 weeks before surgery so it will be out of her system when she has her operation. She could then resume her methotrexate 3 weeks after her operation.
Similarly for her immunosuppressant, she should discontinue this medication so it’s effect is gone when she has surgery and it could be resumed after 3 weeks of healing assuming she has no infections and all is going well.

I would prefer that she reduce her prednisone to 7.5 mg per day or less but we could use higher doses of steroids in she had a flare up while off of her medications.
To control her joint pain while off of her other medicines we will need to use narcotics such as Percocet and/or she may need to be on a Fentanyl patch for a few weeks.

In this way we should be able to reach the goals of appropriate healing and manage her joint pain. This may sound complicated but it is not an uncommon scenario and patients do well with this approach.

Dr. Myers, am I likely to need to have access skin removed after bariatric surgery?

This is an important question that I have asked of me often at the seminars I give several times each month. Most patients from our practice do not feel they need plastic surgery. However, as a person increases their weight their skin does not just stretch, they actually grow more skin in response to the pressure the increasing weight has on the skin. That means after weight loss there is the same amount of skin but less beneath the skin to fill out the space. Therefore most patients have some excess skin after losing their weight from bariatric surgery. For many patients this is not bothersome and they will not feel the need to have this skin removed surgically.
However, the more weight you have to loose, the more likely you will have enough excess skin that you might like to have removed. Also, aging and a history of smoking seems to correlate with the need for plastic surgery. Finally, if you carry allot of your weight around your abdomen you may want to have the extra skin removed since the fatty tissue will be gone leaving an “apron” of skin.
People have different reasons for having plastic surgery. Some patients have skin irritation or ulceration of the skin. These are medical reasons to have the excess skin removed and usually this will be covered by your health insurance plans. I suggest that you document these problems by taking photos since your plastic surgeon can use this information to request your health insurance company cover your plastic surgery operation.
Sometimes plastic surgery is primarily to look better. This is often called cosmetic surgery and the expense may not be covered by health insurance. Regardless this should be an individual decision. I suggest that my patients wait until they have lost most of the weight they expect to lose before they consult with a plastic surgeon. Usually this is at least one year following bariatric surgery.
But keep in mind that most people have bariatric surgery for their health. I have never had a patient say they wish they had not had bariatric surgery because they have excess skin.
Our program refers patients to 3 or 4 plastic surgeons. I saw Dr. John Wakelin in the operation room at Riverside Methodist Hospital today and asked him to give us his thoughts from the a prospective of a plastic surgeon. This is his response to my request:

“It's very common for people to have Plastic Surgery after losing weight. Skin normally has elasticity, which allows it to shrink back to its normal size and shape after it has been stretched small amounts. This is most noticeable in young people when you pull on their skin and watch it go back to normal. However, when skin is stretched beyond a certain point for a prolonged period, like when someone is overweight, it can lose its elasticity and not spring back to its normal shape.

The excess skin caused by weight loss often sags and hangs, creating an undesirable contour and/or other problems. This is most common on the abdomen. Other common areas of skin excess are the upper arms, thighs, the buttocks and back, and neck. In addition, both men and women frequently have large amounts of excess skin on the breasts after weight loss. Each of these areas can be troublesome for many people. Beyond the cosmetic effects of this excess skin, some people have difficulty with rashes and sometimes even skin infections. Most people also have difficulty managing their excess skin with clothing, since the excess skin might not fit into clothes desirably.

Thankfully there are operations that are designed to remove this excess skin and restore contour to various parts of the body affected by excess skin after weight loss. These operations can remove skin and reshape the abdomen (abdominoplasty), the thighs (thigh-plasty or thigh lift), the buttocks (posterior body lift), arms (brachioplasty), and breasts (mastopexy or breast lift). Some patients also find that a facelift and/or neck lift procedure can restore shape and youth to sagging skin on the face and neck.”

If you would like further information you could contact Dr. Wakelin directly.
John K. Wakelin, M.D., F.A.C.S., Columbus Aesthetic and Plastic Surgery, Inc., 614-246-6900

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Dr. Myers, how do patients that had a gastric bypass do several years after surgery? (Before and After Pictures)




Although it is clear patients lose alot of weight over the first year after having a gastric bypass, I was recently asked how patients do several years after surgery. I recently saw Twila at the time of a routine follow up visit and sh wanted to share her story with patients that are curious about the long term outcome after surgery. I follow our patients for life as long as they are willing to have our practice involved with there care. Each year we make sure they maintaining their weight at a reasonable level and to make sure their vitamin levels and other labs are normal. Twila is doing great and had encouraging lab results. This is what she wanted you to know:

"My name is Twila Senters and I had bariatric surgery Jan 16th 2005
I am doing great keeping my weight off, I started at 273lbs and I now weight 132lbs. I now have more energy, I dont come home and sit in my chair until bedtime now, I dont even have a chair now. I am always doing something, before surgery you could not get me out of the chair until bed time and the next day would be the same , work, home to chair and bed. and all of that has changed for the better. I never stay home if there is something to do, which there always is."

This result is not unusual for patients several years after surgery. In fact it is very unusual in our practice for patients not to do well long term. That is what this blog is really about. I am trying to share with everyone how they can obtain their very best result regardless of where they choose to have surgery. I believe the princilals we are sharing can help anyone be more sucessful. There is alot of noise and errors shared on the internet and although what I say others may disagree with, Our patients are doing extremely well and are very happy with their outcomes. This is not because I am a better surgeon. I believe it is the principals we teach our patients that meke the difference.
I just hope the effort I am making to share this will help more patients to do well.

New Video on Exercise Therapy and Bariatric Sugery



Nicollette Henry explains how important exercise therapy has been for her and her family.

Also, Ask About the Quality of the Program...

In addition to checking out the surgeon to see if he or she is the right one for you like I described in the last posting, spend time evaluating the quality of the program. This can make all the difference in the world in your long term result. For instance our patients lose nearly 20% extra weight after surgery and I am convinced it is because our patients are truly ready for surgery and they receive all the tools necessary for them to get their best result and keep their weight off long term. This is the program that has been built around the operation to meet our patient's needs. Therefore you should ask about program details.

I am convinced that the better the quality of the program the better the results. Ask whether they have the following:

Do they have their own "in house" dietitians doing dietary consultations? How many and by whom. I believe there should be at least 3 before surgery and 3 after surgery by a Registered Dietitian)
Do they have their own “in house” psychologist? Does the program take seriously the psychological readiness of the patient to have surgery and do they have their own psychologist that specializes in bariatric surgery patients?
Do they have their own dedicated internal medicine specialist? A thorough and comprehensive medical evaluation is important to assess your risks and make changes to decrease your risks during surgery.
Do they incorporate a postoperative exercise therapy program after surgery with a exercise therapist to help you return to tour best activity level.
Do they help you with obtaining approval from your insurance company and take the hassle of getting approval as quickly as possible.
Do they expect to continue to follow you medically for the rest of your life to make sure you do not develop vitamin or mineral deficiencies and to help you obtain your very best long term result?
Do they have professionally directed support groups? The groups should be facilitated by a dietitian, Psychologist, or nurse to keep the comments positive and helpful for the entire group.

If the program you select is doing all of this I believe that will translate into a better result for you and you are much more likely to have all of the tools you need to keep your weight off long term and live a healthier and hopefully longer life.

Remember, this is your one time to have bariatric surgery. You want all the help ypou can get to do the best you can. Do not go "cheap". Find the best surgeon and the best program you can find. It"s your life. You deserve the best so investigate both the surgeon and the program thoroughly.

Brian Stinecipher shares his success story! Part 1

We begin this video with Janet Dearwester, a Fresh Start Bariatrics patient (Gastric Sleeve Surgery), who went from 200lbs to her current weight of 130 lbs. Then, Brian Stinecipher shares he and his wives' success stories as patients at Fresh Start Bariatrics (Gastric Bypass Surgery). He shares before and after stories and pictures.

Brian Stinecipher shares his success story! Pt. 2

Friday, September 10, 2010

How will bariatric surgery affect my pregnancy?

The fact is bariatric surgery is likely to make pregnancy safer for both mother and baby. Obesity increases your risks of developing medical problems such as pregnancy related diabetes and serious blood pressure problems. Obesity also increases the likelihood that you will have an abnormally large baby that may make delivery more difficult. There is now good evidence that you can decrease the risk that you will develop pregnancy related diabetes, called gestational diabetes, by about 50% after you lose much of your weight after bariatric surgery. Studies have also shown that you can reduce your risk of developing pregnancy related blood pressure problems by more than 50%. This is great news for both mom and baby!
Also birth defects, problems with the placenta and low birth scores, called Apgar scores, are NOT any more likely after bariatric surgery.
You are also likely to gain less excess weight when you are pregnant and therefor you are likely to get back to the dress size you were in prior to the pregnancy more quickly and easily!
I suggest you do not become pregnant during the first year after bariatric surgery since I would not want you to subject the baby to the weight loss you will experience. Be careful to use adequate birth control measures since it is likely it will be easier for you to become pregnant soon after bariatric surgery since your ovaries will no longer be suppressed from the high amount of hormones your obesity was putting into your blood stream. Of course some women are even referred to me specifically to have bariatric surgery so they are more likely to become fertile.
You should be careful to take care of yourself during your pregnancy by taking the vitamins that are prescribed every day and by gaining the appropriate amount of weight during the pregnancy. Your doctor is likely to check your vitamin levels during your pregnancy and will check your blood count and iron levels.
Finally, it is important that you understand that your pregnancy is likely to be healthier no matter which operation you choose. There is no evidence that any one operations is better than another.

More on the Possible Need for Plastic Surgery After Bariatric Surgery

Often I am asked if people that have bariatric surgery will need skin removed after they have lost weight from their operation. Often this is not necessary since the skin is flexible and can go back into a cosmetically pleasing contour. However, sometimes the excess skin is bothersome. This is most frequent in older patients, those that have been smokers since they have lost some of the flexibility of their skin. Also patients that are heavier than our average patients are more likely to need the help of a plastic surgeon.

If you have skinfold irritation I suggest you take pictures of the irritated skin and keep the photos for your plastic surgeon. This may help the plastic surgeon to get your insurance company to pay for the operation since the condition may be considered a medical condition and the operation may be considered medically necessary.

To care for these irritated skin folds prior to plastic surgery I would suggest using and anti-fungal powder such as nystatin powder for a week or so then change to Zeasorb which is an over-the-counter powder that is made from seaweed and absorbs body moisture well and should keep the skin healthy.

However, sometimes it is best to have the offending excess skin removed. Here is what one of the plastic surgeons at Riverside Methodist Hospital in Columbus, Ohio, Dr. John Waklin, wrote to help you to better understand the most frequently performed plastic surgery operation chosen by bariatric surgery patients:

“Abdominoplasty is the most common body contouring surgery performed for patients after they have losta large amount of weight. Variations of this surgery include a tummy tuck, a panniculectomy, and a circumferential body lift. Abdominoplasty surgery removes excess skin and fat from the abdomen that has become troublesome for patients. The skin and fatty tissue that hangs down is removed and the skin from the upper abdomen is stretched down toward the pubis to make the skin smooth. Often this requires that the belly button be repositioned back to its normal location on the abdomen.

Before surgery fitting this excess tissue into clothing can be uncomfortable, keeping areas underneath the skin folds formed by this tissue dry and free of rashes becomes an ongoing problem, and sometimes keeping the areas underneath this tissue from becoming infected can be difficult for many patients.

This surgery is done under general anesthetic (completely asleep) and can often be performed with other operations at the same time. This allows patients to recover from multiple procedures at once with the benefit of only needing to go under anesthesia once. In some cases, multiple body contouring operations can be performed along with an abdominoplasty procedure. Very often this procedure can be done on an outpatient basis, allowing the patient to recover in the comfort of his or her own home without the added cost of hospitalization.

Some insurance companies will cover the costs of an abdominoplasty procedure. This is highly dependent upon the patient’s symptoms, the insurance company, and the specific insurance plan. Your Plastic Surgeon can usually help guide you through this process.“

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"I have now lost about 90 lbs since my bariatric operation and recently I noticed pain in my tailbone. Could this be related to my weight loss?"


Yes! It is very likely to be a result of your weight loss. Before you lost your weight from bariatric surgery your “tail bone”, which doctors call your coccyx, is protected by the fatty tissue at your bottom. Now that you do not have this protection your coccyx is being irritated by the chair you are sitting on and is repeatedly traumatized day after day. This is like having arthritis of the “tailbone” and is called coccydynia.

This does not happen to everyone because it depends on a person’s anatomy. If the coccyx is high enough to be above the pelvic bones on either side, the “tailbone” is not bothered. However if it is lower than the pelvic bones on either side it is likely to touch the chair or whatever you are sitting on and become uncomfortable.

In my practice I have someone with this complaint about once every other month. Usually they have already tried changing chairs and cushions but continue to complain about the pain. In my opinion the best therapy for this problem is a steroid injection at the coccyx. I use Kenalog and local anesthesia and do the injection in the office. It only takes a few seconds. Patients feel better almost immediately because of the local anesthetic in the injection but the discomfort returns in an hour or so. This shows that the medicine was placed in the correct location. Usually the pain will slowly improve over the following few weeks and will eventially be gone completely. The steroid will continue to do its work for about three months. Often the discomfort will not return after this injection.
I hoe this is helpful.

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Dr. Myers, can you tell me why I sometimes wake up at night sweating and feeling my heart race?

I spoke with a woman in my office today who had a laparoscopic Roux en-Y gastric bypass by me over a year ago. She has lost nearly all of her weight and was very pleased with her outcome. However, she was bothered by episodes that occurred occasionally during the night that were concerning to her. Her symptoms included waking up from sleep wet with sweat, heart racing, feeling light headed, nauseated and mentally foggy.
It is important to explain that she is on no diabetic medication.
These symptoms may sound familiar to some gastric bypass patients since it sounds very much like symptoms they experience after eating too much carbohydrate which is called “dumping syndrome”.
Dumping syndrome is the result of absorbing a lot of sugar from a large amount of carbohydrate that is taken in the diet. With the sugar rise in the blood stream the insulin goes up as well. After the sugar is gone the insulin is still too high and the sugar goes too low which is called hypoglycemia. Low blood sugar causes the same symptoms this woman described.
However this patient stated that she had not eaten since 7 PM the evening before. And therefore could not be related to eating too many carbs.
A gastric bypass operation not only bypasses the stomach but also bypasses some of the small intestine including the first part of the small intestine called the duodenum. In addition the time it takes for food to arrive at the last portion of the small intestine is shortened because of the bypass of the stomach and the shortening of the small intestine. The result of these changes after a gastric bypass is that a patient puts out more insulin after ingesting carbohydrates than they did before the operation. This is because certain hormone like substance are released into the bloood stream from the intestine that causes the pancrease to release more insulin. This is especially important for diabetic patients since it helps them to get off insulin shots and diabetic pills.
This woman also is experiencing symptoms from a low blood sugar. Her difficulty is that she is waiting too long after a meal to have something more to eat. And since she produces more insulin to a carbohydrate meal she is using up her sugar and eventually the blood sugar is so low it caused symptoms. This problem may happen during the day as well if a person that had a gastric bypass waits too long before having another meal or snack. Usually the time between meals should be less than 4 hours while they are awake.
I believe the best treatment for this problem is a series of dietary changes. I suggested that she begin by decreasing the overall carbohydrate intake to smooth out the highs and lows. Second, she should eat later in the evening before going to bed and the meal or snack should have protein as well as carbohydrate to lengthen the absorption. Crackers and peanut butter or cheese would be a good choice. Finally I encouraged her to eat or snack more frequently about every 2 to 3 hours during the waking hours to decrease the likelihood of these symptoms occurring during the day.
It has been my experience that patients respond to these dietary changes very well with resolution of their symptoms. To this date I have not found additional therapy necessary for any of my patients.
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"Am I a candidate for bariatric gastric bypass or other weight loss surgery options?"

People with BMI values over 40 are potential candidates for bariatric surgery. People with obesity-related medical problems such as diabetes, high blood pressure and obstructive sleep apnea may also meet the criteria for bariatric surgery, if they have a BMI between 35 and 40.


Are people right when they say, "You are just taking the easy way out" when I tell them I am planning to have bariatric surgery?

I have often heard my patients explain that when they share that they are planning to have bariatric surgery with a friend or family member they are told, “you are just taking the easy way out”.

I tell my patients that anyone who makes a statement like this clearly does not know what they are talking about.

• There is nothing easy about complying with all of the requirements from your insurance company
• There is nothing easy about completing all of the preoperative workup and consultations to prepare for surgery
• There is nothing easy about recovering from any surgery let alone a life changing operation like bariatric surgery
• There is nothing easy about getting your mind around the changes that need to be made to be successful after bariatric surgery.

Taking the easy way out? I say, “NO WAY!”

My patients who have had bariatric surgery believe bariatric surgery is a reliable way out of a very difficult situation. And I agree. Since a person of size that meets criteria for bariatric surgery has less than a 5% chance of losing significant amount of weight and keeping it off long term with diet, exercise and behavior modification, bariatric surgery is clearly the best option for a person of size to resolve their obesity and keep the weight off.

Said another way, 95% of patients that meet criteria for bariatric surgery that choose to lose weight without bariatric surgery will regain the weight lost within 2 years of the weight loss. Everyone can lose weight. We all know that. The problem is keeping the weight off. Nearly every patient that has come to me for bariatric surgery has been through 10 to 20 weight loss programs and have lost significant 60, 80 or even 100 lbs temporarily only to have gained their weight back and more!

This yo-yo effect of weight loss is very discouraging and people feel that nothing is going to work for them since nothing has been effective long term in the past. Frankly many of my patients feel like a failure and they feel there is no way out. They are even afraid that they will be the one person that surgery will not work for.

It is truly a privilege to share with them that there is hope for them.

In fact about 85% of people that have bariatric surgery are successful long term. In our program the rate of long term success is much better than the average since Fresh Start Bariatrics has a very robust program and our patients are well prepared even before they have bariatric surgery. I do not say this to brag but to share with you that there really is hope for those who chose bariatric surgery.

Is bariatric surgery “the easy way out”? There is nothing easy about bariatric surgery for any bariatric surgery patient but it is a reliable way for people of size to lose most or even all of their excess weight, resolve, improve or prevent many obesity related medical problems and to begin life again without the suffering and despair caused by obesity.

There is hope for those that choose bariatric surgery so do not listen to people that know so little about the subject that they tell you that you are “just taking the easy way out”. They clearly do not know what they are talking about and are not worthy to advise you and are not likely to support you in your quest toward better health.

Take heart. There really is hope for persons of size.

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What implications might bariatric surgery have on my bowel function?

This is a question that is often asked of me. Constipation is most likely to occur in the case of the three most common bariatric operations; Rou en-Y gastric bypass, adjustable gastric band and gastric sleeve operations. This is most likely to happen early after surgery for 2 reasons. First, taking pain meds that contain narcotics such as Percocet or codeine causes the bowel to slow down and stool to become hard and dry. Secondly, soon after surgery you are consuming very little fiber. Treatment is relatively simple.
1). Stop all narcotics if possible
2). Take Miralax for immediate relief
3). Take Benefiber, which can be added to all of your fluids since it is dissoluble. Your goal is to take 25 grams of fiber each day. This may seem to be a truck load of Benefiber but eventually some of your fiber will come from other sources of food.
4). You may want to add over-the-counter Colase 100 mg twice daily.
If you follow this plan you should not have further problems with constipation.
Some other operations such as BPD with or without duodenal swith, long limb gastric bypass and the antiquated JI bypass are much more malabsoptive and will cause chronic diarhea.


New Video - Alcohol and Bariatric Surgery

What suggestions do you have to reduce the risk of blood clots in bariatric surgery patients?

This is a very important question because persons of size are at greater risk for developing blood clots than persons of standard size no matter what operation they are choosing to have. This is true whether they have a knee replacement, hysterectomy or a bariatric operation.
I think persons of size are at increased risk for several reasons. 1). Increased pressure from the weight that is carried in the abdomen places pressure on the blood vessels returning blood from the lower part of the body back to the heart allowing pressure to develop in the veins of the legs and pelvis. This pressure can injure the valves in the deep veins of the legs and make the veins larger slowing the flow of blood and increasing the risk of clotting. This increased pressure is also the reason many persons of size have developed varicose veins since the pressure is transmitted to the more superficial veins of the legs which have thinner and weaker walls resulting in these veins increasing in diameter. The pressure is transmitted to the vessels of the skin causing leakage of red blood cells causing discoloration and irritation of the skin called venous stasis changes. 2). Many bariatric surgery patients have obstructive sleep apnea which causes the right side of the heart to work less efficiently further retarding the blood flow back to the heart making the pressure situation even worse in the blood vessels returning the blood to the heart. 4). Also, the large amount of fat mass causes the increased production of estrogens in both men and women. This is like being on birth control pills all the time and of course this high level of estrogen may increase the risk of developing blood clots. 4). Finally, a bariatric surgery patient is likely to have an increased level of inflammation which may also increase their risk of forming blood clots.

A person that develops a blood clot in the leg, called a deep vein thrombosis, can have significant symptoms like swelling and pain. However, the more serious risk is if the clot is dislodged from the leg or pelvis and travels up to the heart and out to the lungs. At this stage it is called a pulmonary embolus. This blockage can result in keeping the blood that is pumping out of the heart from getting to the lungs. If enough of the flow to the lungs is interrupted the person will not have enough oxygen and may not survive.
To prevent this problem we do several things for everyone that is having bariatric surgery at Fresh Start Bariatrics at Riverside. Many other bariatric surgeons also do the following: 1). Everyone receives blood thinners that start just before surgery and continues through their hospitalization and is continued for 6 days after they are discharged from the hospital. 2). They have sequential compression devices placed on their legs prior to surgery so the blood will be circulating out of their legs back to their heart even while they are on the operating table and while they are asleep. 3). All of our patients are walking in the halls of the hospital just 6 hours after they leave the operating room. 4). Finally, if a patient is at significantly higher risk than normal I request that they undergo placement of a temporary vena cava filter placed by a cardiologist or other specialist into the main blood vessel, called the vena cava, that returns blood to the heart a few days prior to their bariatric operation.
Although some bariatric surgeons are using vena cava filters for high risk patients the following scoring system is unique to the program I have had the privilege of developing at Fresh Start Bariatrics at Riverside. After reviewing the medical literature I have developed a scoring system that identifies patients that are at significant increased risk for blood clots and will need this temporary filter to protect them from a clot reaching their heart and lungs. The cardiologists I work with most frequently here in the Columbus, Ohio call it the “Myers’ Scoring System”. Take a look at the following:

“Myers’ Scoring System for Venous Thomboembolism Prophylaxis”
In the Bariatric Surgery Population

High Risk Score
History of blood clots (DVT/PE) 4
Venous stasis changes, 4
(cellulitis, ulceration, discoloration)
Genetic clotting disorder 4
Immobility, (wheelchair bound) 4
BMI, (Body Mass Index), over 60 4
Moderate increased risk
Obstructive Sleep Apnea 2
Lower increased risk
Male 1
BMI over 50 1
Recent smoker 1
Hormone replacement therapy 1
Total score ___________
Total Score that is equal to or greater than 4 results in a referral for a vena cava filter.

A vena cava filter is generally placed through the groin much like a heart cath is done. After the risk of developing a blood clot is reduced in 4 to 6 weeks the filter is removed. We have found this scoring system and the placement of a vena cava filter in high risk individuals to be very effective in protection patients form this potentially life threatening problem. I believe we have saved several lives with this intervention. This is just one of many ways we work to decrease the risk of bariatric surgery for patients that select our program for their bariatric surgery. I hope this understanding will be helpful to you regardless of where you chose to have your operation.

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