Office Hours: Monday - Friday 8:00am - 5:00pm

Month: August 2016

Review & Update Giveaway!

August 31, 2016 6:27 pm

Keshishian Giveaway Ticket

The Prize winners are Jo and Kimberly!  Congratulations ladies and enjoy the Obesity Help National Conference!  Thank you to all that participated in the Giveaway!

We are holding a review and update giveaway for two different prizes! Thank you for your participation!

One Prize and One Grand Prize

Prize: two tickets to Obestiy Help National Conference Sept. 30-Oct 1, 2016

Grand Prize: two tickets to Obesity Help National Conference and one night
hotel stay October 1, 2016

Conference: 11999 Harbor Boulevard Garden Grove, California 92840 Event link here

Hotel Prize: SHERATON GARDEN GROVE – ANAHEIM SOUTH HOTEL
12221 Harbor Boulevard
Garden Grove, California

Official Rules:

How to Enter and eligibility: All entrants and winners must be 18 years of age or older at the time of entry. Up to 5 entries per person.

  1. Write a review of Dr. Ara Keshishian on one or all of the sites below or do an update on your profile on Obesity Help between now and Sept. 8, 2016 at 5:00 PM

2. Take a screen shot of the review or update with your username and date.

3. E-mail the screenshot to contact@dssurgery.com with your contact information (name, phone number, e-mail, and mailing address )

4. Entries must be a verifiable patient of Dr. Ara Keshishian in Glendale, CA.

Promotion Timing:

The Review & Update Giveaway begins September 1, 2016 and ends September 8, 2016 at 5:00pm PST

How Winners are Chosen:

Winners will be chosen by random draw.  Odds of winning vary upon the number of entries received for the giveaway.

Winner Notification and the Claiming of Prizes:

Winners will be notified via the email provided at time of entry and also published on our blog comments www.dssurgery.com/blog and on our FaceBook page. The winner will have 72 hours to respond to the winning notification email or the prize will be forfeited.  The prizes have no cash value. The prizes are non-transferable and must be accepted as awarded. No changes may be made to the prizes. There is no cash value for the prizes.

General Conditions:

By entering the Giveaway, entrants agree to abide by and be bound by these Official Rules and the decisions of the Sponsor, which are final and binding in all matters relating to the Giveaway, and release and hold harmless Sponsor and its affiliates, directors, officers, employees and assigns from and against any liability, claims, lawsuits, judgments, losses, damages of any kind, injuries, death, property damage, costs and expenses, arising from, resulting from or in connection with the Giveaway, the participation in the Giveaway, or the receipt, possession, use or misuse of any prize. Sponsor is not responsible for lost, late, incomplete, inaccurate, stolen, delayed, misdirected, undelivered or illegible entries or for lost or stolen entry boxes or other errors or difficulties of any kind whether human, mechanical, electronic, typographical, printing or otherwise relating to or in connection with the Giveaway, including, without limitation, errors or difficulties which may occur in connection with the administration of the Giveaway, the processing of entries, the announcement of the prizes, or in any Giveaway-related materials. Sponsor is not responsible for technical, hardware, software or telephone malfunctions of any kind, lost or unavailable network connections, or failed, incorrect, incomplete, inaccurate, garbled or delayed electronic communications caused by the user or by any of the equipment or programming associated with or utilized in the Giveaway. Persons who tamper with or abuse any aspect of the Giveaway or who are in violation of these Official Rules, as solely determined by Sponsor, will be disqualified and all associated entries will be void. The Sponsor reserves the right, at its sole discretion, to cancel, terminate, modify or suspend the Giveaway if, in Sponsor’s opinion, it is not capable of running as planned, including, but not limited to, due to tampering, unauthorized intervention, fraud, technical or phone line failures or any other problems beyond the control of the Sponsor, and select the winners for affected drawing(s) from among all eligible entries timely received for such affected drawing(s) prior to cancellation.

Ulcer and Stricture

August 29, 2016 5:21 am

A patient was referred to us for second opinion who was experiencing nausea, vomiting, GERD.  The patient had Duodenal Switch procedure many years ago but more recently had developed significant nausea, worsening reflux and solid intolerance. The patient had an endoscopy a few months ago and was only found to have a stricture within the Duodenum, no definitive treatment was offered at the time to the patient. On second examination of this patient with a second EGD the result was development of diffuse Duodenal ulcers  and stricture.
First EGD of Duodenal Stricture
First EGD of Duodenal Stricture
Second EGD with Duodenal Stricture and Ulceration
Second EGD with Duodenal Stricture and Ulceration
                Note that these images are nearly identical positioning showing the stricture at 9 position. The image on the right also shows patchy ulcers. Any changes in GERD, nausea, vomiting, gastric pain or discomfort after weight loss surgery should always be evaluated, treated, and followed. In a previous blog, the effects of GERD have been described.    

Duodenal Switch

August 24, 2016 5:45 am

Buyer Beware ! There are a lot of look alike and counterfeit “Duodenal Switch” procedure being performed. A recent online chat discussion clearly demonstrates the point that just because a patient is told that they had the duodenal switch operation this is not necessarily the case.

In our practice, we always warn our patients of not comparing notes and their outcome to others. I perform the Duodenal Switch procedure  the way it was described by Dr. Hess, making the common and alimentary lengths as a percentage of the total length of small bowel. This is why our patient population has very little nutritional, and gastrointestinal issues compared to others. Unfortunately when a patient is given a disproportionately long Common channel and/or Alimentary channel the patient will have inadequate weight loss. Alternatively, when patients are  given a shorter alimentary channel in proportion to the total bowel length, significant nutritional deficiencies can arise. In a shorter alimentary channel situation patients have to consume higher doses of vitamins and nutrients to keep their laboratory values normal.

I have repeatedly raised the issues to clearly distinguish the single anastomosis procedures from Duodenal Switch operation.

One of the unfortunate problems is the lack of clear guidance given to the patients. It is not uncommon, when I do second opinion consultation with patient who were given generic gastric bypass post op protocol and instructions after their duodenal switch operation. This clearly shows lack of fundamental understanding of the practice performing these procedures and it is carried onto the patient.

 

Let’s Chat

August 22, 2016 8:46 pm

let's chat Keshishian

We are planning on using this blog post to hold routine sessions called “Let’s Chat!” where Dr. Keshishian is available to answer questions online.

This will be more private than some of the social media sites and give more people an opportunity to ask questions.  We will announce when we are going to hold these Let’s Chat sessions on social media, however, the actual chat will take place here on the blog. You will just need to post your comment or question, provide a name (can be initials if you require more privacy) and an e-mail (which is not posted with your question to provide more privacy). If you scroll to the bKeshishian comment boxottom of this page there is a reply box.  Type in your question or comment, enter the other information and click the post comment icon. Your post will not be visible until it is approved by the host.

The Let’s Chat session will be similar to our FaceBook chats.  Here is an example of one of our FaceBook chats.

Exercise Benefits & Events

August 09, 2016 2:25 pm

Exercise and it’s benefits for body, mind and weight loss can’t be over emphasized. Everyone can benefit from some form of exercise whether it be a brisk walk, chair exercises, exercise bands, aquatics, running, hiking or biking. As a family we try to exercise often and attempt to participate in at least one event a month or so.  These types of events tend to keep us more accountable and motivated.  The group atmosphere, energy and vibe only add to the experience. Listed below are some of our favorite exercise events.  We will update this list and add to it.

Physical Benefits:

  • Weight loss and maintenance can be a benefit of exercise. It also improves muscle function and strength.
  • Improves Type 2 Diabetes and Metabolic Syndrome
  • Reduces some Cancer Risk
  • Improved Cardiovascular Health
  • Improved “Good” cholesterol
  • Strengthens and improves Bone Health
  • Living longer
  • Improved Sleep

Mental Health Benefits:

  • Reduce Stress
  • Boosts Endorphins
  • Helps with Anxiety
  • Improved Self Confidence
  • Being in the Great Outdoors and Sunlight (increases Vitamin D)
  • Prevent Cognitive Decline
  • Sharpen Memory and Cognitive Function
  • Help with Addiction
  • Increase Relaxation

One important key note is to pay close attention to hydration with exercise, not only with fluids but electrolytes as well. Exercise increases fluid loss due to sweat and increase circulation to muscle.  You need to increase fluid intake to compensate for these losses.

Exercise events by the month:

June

The Los Angels River Ride is one of our families favorites.  Great ride for a great cause.

August

Luau 5K walk and fun run This is a fun family activity as they have a kids run and lots of activities.  It is also in Griffith Park which is a beautiful and treasured location.

September

The Prudential 401K Run is to promote saving for retirement and is a FREE event at the beautiful Rose Bowl

October

The Aloha Run brings a little Hawaiian feel to the fall.

JDRF One Walk fighting Type I Diabetes

November

City of Hope’s Walk for Hope 

December

Santa to the Sea (must bring a gift for a child)

Varying months depending on location:

Race for The Rescues

Walk from Obesity

Step Out Diabetes Walk

Get your Rear in Gear to fight Colon Cancer

CicLAvia a Los Angeles area quarterly biking event.

Vitamin D status for Infertility Treatment

August 03, 2016 8:02 pm

Many people with obesity face infertility issues and seek infertility treatment or procedures.  A recent article linked Vitamin D status to improved success rate of IVF (in-vito fertilization)  & ICSI (interacytoplasmic sperm injection) in The Journal of Maternal-Fetal & Neonatal Medicine.  It is important to check Vitamin D status for infertility treatment.

Here are the researchers results:

  • Of the 252 females that completed the ICSI cycle, 42% became pregnant (n = 108).
  • The mean vitamin D status was significantly higher in the pregnant group compared to the non-pregnant group (17.74 ng/ml vs 9 ng/ml, respectively; p = < 0.01).
  • Vitamin D status was positively associated with both pregnancy (p = 0.001) and endometrial thickness (p < 0.01).
  • Higher vitamin D levels was associated with a 21% increase odds of clinical pregnancy (p < 0.05).

The researchers concluded,

“Deficiency of 25-OHD in females hinders the accomplishment of optimal endometrial thickness required for implantation of embryo after ICSI.” Keshishian IVF

Following weight loss surgery (WLS) there can be improvement of fertility and for that reason we recommend two forms of birth control methods during the first 18-24 months following WLS or until weight loss has stabilized for several months.  This helps to ensure the best outcome and health for the mother and infant.

In our office we continue to stress the importance of Vitamin D3 for bone and dental health, pregnancy, breastfeeding and several auto-immune diseases. Vitamin D has also been shown to reduce pre-term birth Duodenal Switch patients require a dry water miscible form of Vitamin D3 due to the fat malabsorption of the DS procedure. There are several past blog posts on the topic of Vitamin D and it’s associated nutrients