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Month: November 2014

Erosion of Gastric Band

November 30, 2014 5:03 pm

Gastric bands are restrictive rings placed around the top part of the stomach, close to the junction of the esophagus. Their mechanism of action is to create a small tight band to restrict the flow of the food into the stomach. The theory has been that the band will decrease the time food travels down past the narrowing thereby eating less with the end result of weight loss. One of the many complications from the band is erosion of the band into the lumen of the stomach. This results in the patient presenting with nausea, vomiting and some patients develop abdominal accesses. This may present itself with symptoms of abdominal pain, fever, and redness at the port site under the skin.
The treatment for this is urgent removal of the band and repair of the erosion/ulceration. Patients who are contemplating a revision to another weight loss surgical procedure are best advised to stage the procedure because of the potential for leak from the repair site. Almost all of these procedures can be done laparoscopically.

Adjustable Gastric Band Easily Reversible?

November 24, 2014 3:25 pm

The Adjustable Gastric Band  (AGB) procedures have been advertised as “easily reversible” minimally invasive procedures. A point of interest is why doesn’t anyone ask the question, “Why would a successful device and/or procedure need to be revised or removed?” The long term success data shows that the AGB procedure is the most inferior of all bariatric  procedures. It is important, that when looking at the published data,  special attention is given to the definitions in that particular study. An example would be that if a study defines “successful outcomes as weight loss for 30 days!” then all procedure will be successful. The following is an example of a patient who had the Lap Band (R) a several years ago in another institution. She was seen for surgical follow up with minimal weight loss over a short period of time. She then developed the typical complications of the band, namely the upper abdominal pain, reflux, inability to swallow solids, persistent nausea and vomiting. Her symptoms were all “worked up” and  was told that all the studies were normal.  All of her  symptoms were contributed to her eating habits, even though they persisted after the Lap Band (R) was completely empty. The patient then presented n our office for a second opinion. After being seen in our office and having a full work up, she had the Lap Band removed and was revised to a Laparoscopic Sleeve Gastrectomy. She had complete resolution of all of her prior presenting symptoms.
Pictured is the LapBand being dissected. There is significant scarring that has to be dissected to expose the band.
 
The band being unbuckled.
 
With the band removed a very thick band of scar tissue is exposed. This is a typical outcome- and it explains why most patients continue to experience the same symptoms even with the band completely empty.
 
The thick scar tissue must be dissected and removed to allow for the underlying tissue to return to near normal anatomy. The scar tissue act like a restrictive band. If this scar tissue is not removed the patient will continue to have problem after the band is removed.
Hopefully this will reassure patients who are having problems with the band after it’s reservoir is emptied. Scar tissue formation under the band is most likely the contributing factor to the continued and significant symptoms of abdominal pain, nausea, vomiting, and reflux.  If you are having continued symptoms after your band has been deflated seek other surgical opinions.
 

Holiday Survival Tips by: Marylin Calzadilla, Psy.D.

November 17, 2014 8:23 pm

The holidays are almost here, and it’s a time of year that traditionally involves spending much time with loved ones as well as engaging in one of America’s greatest pastimes, eating.  For the most people, holiday memories are strongly tied to traditional dishes and treats – turkey and ham, stuffing, mashed potatoes, and pie.  But for those who have had weight loss surgery, or even if you are simply trying to be conscious of your health and weight, it is important to step back and think about the holidays from a different perspective.  Below are six ideas not only for survival but for success this holiday season.    

 

REFLECT

Think about what the holidays truly mean for you, and take the time to ask yourself what you want from this holiday season. Most of us get caught up in the rat race and never really stop and think what it’s all about. Vast amounts of money are spent on marketing campaigns aimed at luring us into shopping malls and grocery stores to buy the  “indispensable” items of the holiday.  Rather than get caught up in the hustle and consumerism of the season, I encourage everyone to stop and ask themselves what they’re truly wanting from the holidays.  For some it may be spending time with those they care about, for others it may be to take time for oneself.  Write down your goals on an index card and post it in a prominent place at home or at work as a reminder of what your holidays are going to be about this year.

SUPPORT, SUPPORT, SUPPORT

Tap into your support network. We know that strong, available support networks are key to long-term weight loss success. Often we are afraid to ask for help as if requesting assistance were symbolic of weakness.  Often we have a double standard when it comes to support. We like helping others yet dislike asking others for help.  Just as it feels quite rewarding to help someone that you care for, let the individuals in your life be there for you.  Allow yourself to talk about your feelings, share your experiences, both positive and negative.    There is also no better time to attend support group meetings.  You can gain extensive comfort being around those facing similar issues. You can also learn from their mistakes as well as their successes.

ALLOWANCES

It’s difficult to achieve success if you feel deprived all the time. You may want to think about the dishes that are truly special to you and allow yourself to consciously indulge in a treat, if it’s appropriate for your level of post-operative diet. If you look forward to Aunt Marie’s delicious sweet potato pie every Thanksgiving, then allow yourself to enjoy this once-a-year tradition.   Don’t tell yourself you will never be able to eat your favorite foods again. The bottom line is that long-term success with weight loss is about quality and quantity.  Allow yourself to savor each and every bite, and remember portion control.  Also strike a deal with yourself to manage any extra calories you’re taking in with increased exercise or careful eating on other days.

KEEP ACTIVE

Make a realistic exercise plan and stick to it. It’s easy to forego exercise during this busy time of year, but you shouldn’t compromise on your health. You will be spending more time around food and probably consuming a little more than you typically do.  Sticking to your exercise routine will help you to indulge without feeling guilty and will allow you to get through the holidays without losing your hard-won progress on your weight loss.  Plus, exercise will help you keep your energy and endorphins up so you can get everything done and feel good while you’re doing it. 

CREATE

Spend some time researching new bariatric friendly recipes.  You might actually really enjoy the process, and it’s also an opportunity to introduce some healthy alternatives to friends and family. The truth is, everyone is thinking about smart food choices these days, and people will appreciate a tasty, healthy alternative to the usual holiday fare.  At the very least if you prepare a nutritious side or appetizer for a social gathering, you’ll know that there will be at least one healthy dish for you to eat.

PLAN ACTIVITES

Most holiday time is spent around the kitchen and the dinner table, but don’t be afraid to change it up.  Create some fun activities your guests can engage in. Some friends of ours host a karaoke contest after their Thanksgiving meal. Other families go out for a walk, play charades, or even have contests on the Wii, Xbox, or any other home gaming system.  Don’t be afraid to create a new tradition that gets everyone laughing, moving and having a good time.     
Integrating some of these ideas can help keep you, your goals and the holiday season on track, healthy, and happy.  All of the above tips may need to be adjusted depending on your situation and post surgical status.Best Wishes,
Marylin Calzadilla, Psy.D

 

Optimizing Pre-operative Health Status

November 12, 2014 1:23 pm

The outcome of any weight loss surgery is dependent not only on the operation but also the extend and depth of preparation before surgery and adherence to the post operative recommendation. The operation should be considered a planned injury to the body. We should enter the operating room in the best physical and mental condition possible to secure the best possible outcome. Optimizing your Pre-operative health status is the best plan for going into surgery in the best shape possible. Here are some basic steps to maximize the odds for a good outcome. Physical preparation:
  • Maintaining a healthy diet
  • Cessation of ALL tobacco and alcohol use
  • Do not use NSAIDS prior to surgery or after surgery until cleared by surgeon
  • Getting plenty of rest
  • Staying Hydrated
  • Pulmonary embolus prevention exercises such as ankle circles and point and flex toes
  • Maintaining or starting a regular activity level. Any amount of increase in activity will benefit you after surgery. Walking, squats, lifting weights with arms
  • Full laboratory blood studies and vitamin levels as ordered by the surgeon
  • Start and optimize your vitamins, calcium and other mineral and supplements. Vitamin D deficiency increases surgical complications. (Another Vitamin D article)
  • Manage preexisting health conditions (diabetes, sleep apnea, high blood pressure etc..) Follow instruction in regards to what medication to stop or continue before surgery i.e. Aspirin, blood thinners, medications that interfere/interact with anesthesia, etc.
  • Two forms of Birth Control if indicated.

Mental preparation:

  • Have a clear understanding of the procedure
  • Study all information provided to you regarding your surgery
  • Remember that surgery is one of many tools to assist in weight loss and improved health. It does not fix other issues.
  • Realistic expectation of the outcome of surgery
  • The role of family involvement for support
  • Be prepared with all the purchases for the post operative diet, vitamin and mineral supplements.
  • There is also a number of other variables that will improve the long term outcome of the weight loss surgery:
  • Investigate Protein Supplements for the highest bioavailability
  • Try and eat whole, unprocessed foods
  • Read labels on all food items
  • Look for high protein recipes
  • Network with supportive people who will provide a positive influence
  • Long term success also depends on:
  • Maintain daily protein requirements
  • Maintain daily vitamins, calcium, minerals and other supplements
  • Routine follow up with your bariatric surgeon.
  • Routine laboratory studies to surveil vitamin and mineral levels.
  • Get your medical advice from your surgeon.
  • Get suggestions from other patients. Do not confuse this with medical advice.
Weight loss surgical procedures are not an easy way out. On the contrary, weight loss surgical procedures are complex operations, from technical, metabolic, nutritional and psychologic perspective. A patient has to be prepared to deal with all aspect of the surgery for the best possible longterm outcome.