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Month: June 2015

Shared Success- Whitney a RNY to DS revision

June 09, 2015 7:43 am

I was always the big girl, pleasingly plump, chubby. I was put on my first diet at age 12. By the time I graduated High School I had yo-yoed up to 200 pounds at College graduation I was up to close to 300 pounds. In 2002 I had RNY Gastric Bypass surgery. I was 39 and weighted 280 pounds. I was told it was the Gold Standard. The Band was still considered experimental and the Duodenal Switch was never mentioned as an option. In fact, I did not even know it existed.

Whitney's Before DS
Whitney’s Before DS

I lost 110 pounds and was considered a WLS success. I did not have any food restrictions and I felt great and maintained the loss for five years. Then I started to slowly gain weight. In little under 5 years I gained 70 pounds. I developed Dumping Syndrome and my Stoma was stretched out. I joined Weight Watchers and lost 5 pounds in a year. Nothing worked. I developed ulcers, osteoarthritis, planter fasciitis and could barley walk a couple of blocks without pain. I was miserable. I felt like a failure

In 2012 started to research surgical options. A local surgeon wanted to “revamp” my already tiny stomach, put a band around my stoma, and “clean up my intestines”. I asked about revision to Duodenal Switch and was strongly discouraged, but I wasn’t going to settle because that was what he was only capable of doing.

Whitney's After
Whitney’s After

I wanted the best. I wanted long term success. So I travelled from Northern CA to Southern CA for a consult with Dr. Keshishian. The only choice for me was to revise to DS. In December of 2012, I had revision surgery of my RNY to Duodenal Switch. One week after surgery, still in the hospital, I went in for a second surgery. Dr. Keshishian found a small leak. I spent an additional two weeks in the hospital. My experience was not the norm and a leak can happen in any surgery involving the stomach.

Recovery was slow but steady. The first 2 weeks Dr. Keshishian called me every three days to make sure I was doing ok. I still have his cell number in my phone. I was back to work 14 weeks after surgery. I could have gone back sooner.

Over the past year I have lost 115 pounds. My BMI is 20, and I feel great. I have my life back. All pre-op issues have been resolved and I am going to start training for a 5K.

My advice for anyone contemplating Weight Loss Surgery is to research all of the options available. Do not settle for a substandard surgery. Get a second or even third opinion. It’s not a decision to be taken lightly. It’s your life fight for it!

Whitney B.

Shared Success Story- Kylie

June 08, 2015 6:29 pm

Screen Shot 2015-06-08 at 7.20.15 PMI never knew how big and unhealthy I was until I decided I wanted a change. My experience with Dr. Keshishian and his staff was nothing less than amazing. He was very informative and made me feel comfortable and safe when undergoing the procedure. Not only did he operate on me, but also my brother, dad, and uncle as well.  We are all so grateful for him and his knowledge as a surgeon. My mom had gastric bypass in 2005 by a different doctor and has numerous problems. We are all hopeful that eventually Dr. Keshishian will be able to help her also. Having my whole family’s support and understanding made the experience much easier for me. I am now happier and healthier than I’ve ever thought I’d be.

Before surgery, I weighed 250lbs, and my pant size was a 22. I now weigh 160lbs with a pant size of 8-10. I decided to have surgery because I wanted to be the confident girl who was trapped inside a 250-pound body to be able to shine. I wanted to be active and live a long and healthy life. I also wanted to start this lifestyle now so that when I have children one day, I can be a good example to them on how to be active. Most importantly, I wanted to be comfortable in my own skin. I wanted to feel beautiful. I was always “bigger.” I was a cheerleader from toddlerhood until high school and a swimmer for 12 years. I always stayed very active. Once I graduated high school, I moved out of state to attend cosmetology school and my active lifestyle completely stopped. I ate unhealthy and became very lazy. I wasn’t proud of the person I was becoming and struggled to change my bad habits. My brother had his surgery while I was in Idaho, and when I saw how great he was doing, I was inspired. I decided to fly home and meet these people and then it was my turn.

My Life has changed dramatically since I first met Dr. Keshishian. Working out and eating healthy have become habit. I ran in my first 5k, 10k, and half marathon. I continue to run every day in hopes of running in a full marathon. I LOVE to run, and have made it a way to relieve stress. Running has become good therapy for me. I love cooking and experimenting with foods I didn’t even know existed before I had surgery. It’s been 2 years, and I still haven’t bought or had a soda. I eventually gained what I call my “gym family.” I am there so often, that eventually, most of my friends were from the gym and people who have similar goals.Screen Shot 2015-06-08 at 7.20.30 PM

This surgery affects everyone differently. For me, it was a game I had to play with my mind. Being big, I loved the satisfaction of feeling full after a meal. I would order food and try to decide if it was enough to make me full. After surgery, I would forget that I couldn’t eat that much. I would still want to order the item with the most food. It was almost like the “Old Kylie” was still sitting in the back of my mind telling me what I would have ordered before my surgery. I had to learn to be tough, and ignore her. That was (and sometimes still is) one of the hardest things I’ve had to do. I would look in the mirror and still see a 250 pound girl. I had to have a mental talk with myself, and look at old photos. It was a temporary issue I had with myself. I’ve learned so much about who I am since the surgery, and am so happy with the woman I have become. Having this surgery has made me feel like I can conquer anything I put my mind to. I had no idea how mentally strong I was until I made the choice to have this procedure. This will always be one of the best decisions I’ve ever made for myself, and I’ll always be supportive of others who are thinking of choosing the weight-loss surgery. I owe Dr. Keshishian so much for giving me my life back. Thank you!

Neuromuscular Disease After Weight Loss Surgery

June 08, 2015 11:30 am

Weight loss surgical procedures  may result in  varying degrees of nutritional deficiencies. Some of these nutritional deficiencies may cause neuromuscular disease if left untreated, these include vitamins, minerals, and protein.  The long-term effect of these deficiencies may presents as neuromuscular conditions including,  weakness, numbness, confusion and all others if not-diagnosed and untreated. It is important to note that all weight loss surgical procedures require lifetime vitamin, mineral supplements and protein monitoring and possible supplements.

The table below outlines some of the specific neurological and neuromuscular disease complications following bariatric surgery.  The most common deficiencies seen with the duodenal switch operation are  fat soluble vitamin deficiencies. These include, Vitamin A, D, E and K. Duodenal Switch patients need oral supplements of Dry “Water Miscible” type of Vitamin A, D, E, and K based on their laboratory studies and needs.

Screen Shot 2015-06-07 at 1.46.20 PM
Click on the picture to enlarge
Click on the picture to enlarge

The neurological deficiencies are manifested much more frequently with the Gastric Bypass than the duodenal switch operation. The most common nutritional deficients are that of B1, B12, Folate deficiencies that are common in Gastric Bypass. A list of possible neurologic deficiencies and there associated symptoms were summarized by Becker (2012). Another article with Nutritional Neuropathies.

Nutritional deficiencies are seen in a number of illnesses including weight loss surgery patients.

Coping Skills after Bariatric Surgery

June 02, 2015 7:23 am

For many people, food can become a coping mechanism and a way to self sooth or comfort themselves.  After weight loss surgery the ability to use food in this manner is disrupted due to the smaller portions and in some cases food intolerances.  Developing alternative and healthy coping skills is an imperative step after weigh loss surgery.

Obesity is a multifactorial process that has many contributing aspects.  Although,  obesity is not entirely the result of poor eating behavior, and lack of exercise. After weight loss surgery, we should  appreciate the importance of healthy dietary choices; being sure that  volume and frequency is not driven by emotion or emotional eating. 

The mental aspect of weight loss surgery should not be ignored. Developing healthy  coping skills can be a large part of dealing with the changes that take place.  Some people go through a mourning period for the loss of the foods that once gave them comfort, made them part of a group, or the feeling of their best friend. In some cases, there may be a need to seek the assistance of a mental health care provider to be able to work through some of the issues and feelings. Never hesitate or be afraid of contact a mental health care professional.

Learning and practicing effective coping/soothing techniques can be started prior to weight loss surgery.  The following are some coping skills that can be effective for some to adopt into their daily lives. nature

1. Nature – Get out into the great outdoors and into the sunlight.  The sounds and sights of nature have a way of energizing  the body and calming the mind.  Sunlight is excellent for increasing Vitamin D levels which can help elevate mood and general well being.

2. Exercise – The mental and physical effects of exercise are paramount after weight loss surgery.  The natural chemical release from exercise is a calming effect and gives a sense of well-being.  In addition, the physical aspects of increase weight loss and change in body contour have positive mental and emotional effects.

3. Music- There are many research articles regarding the positive effects on both metal and physical aspects of music.  Music has a way of soothing or energizing the soul. Turn up loud or keep it soft. Sing along.  Dance it out if you need to.
4. Journaling – We always suggest to people prior to weight loss surgery to start journaling.  It can give you perspective when you look back at entries. We also suggest to journal body measurements, pictures, and weights so that you might look back at how far you’ve come from your starting point.

5. Mindfulness – Using all five sense to experience life and food.  Take your time to take everything in and experience the full effect. Be present in all life experiences. Ask yourself: Am I enjoying this? Does this feel like what I need?  Is this getting me to where I want to be? Is this healthy for me?

6. Support groups of peers- There is nothing like having a group of people who have been there or know exactly how you may be feeling to be able to talk, share or vent. There are so many support groups that can be taken advantage of in either face to face or cyber groups.

7. Treat yourself- Treat yourself and practice self-care by doing  something that you find relaxing, gratifying or energizing.  Massage, manicure, an outfit, shoes, an outing, or a class.

8.  Distraction- Hobbies, new skills, reading, games, bubble bath, or anything that get you out of the same mental spot can help with calming and soothing.

9. Talking- There is great value in having a close friend or trusted therapist to be a sounding board and give you an opportunity to unload some of the challenges you’ve been carrying.

Changing habits and coping skills takes practice and patience.  It is not something that is easily changed over night.  Focus on small steps, goals and achievements. Give yourself time and credit for the accomplishments that you’ve made. Always look at how far you have come and the positive  lifestyle changes you’ve made.  There may be set backs but don’t beat yourself up about it, move on and continue to take steps toward your goal.coping-skills1