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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.

Adjustable Gastric Band Easily Reversible?

Pictured is the LapBand being dissected. There is significant scarring that has to be dissected to expose the band.

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

Shared Success Story: Krystal U. Had a LapBand to Duodenal Switch Revsion

November 13, 2014 6:23 pm

Another amazing and emotional success story by Krystal Unruh. Krystal we celebrate you and your successful LapBand to Duodenal Switch revision. Thank you for sharing with us all.

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.

Shared Success Story: Patricia Y. Had a LapBand to Duodenal Switch revision

November 04, 2014 3:16 am

Patricia’s success story is truly inspiring and emotional. Please take a moment to celebrate her success by watching video about her journey and revision from LapBand to Duodenal Switch. Thank you Patricia for sharing you journey with us.

Patricia Y.

Laboratory Blood Specimen Collection Change

October 30, 2014 5:20 pm

picture of blood specimen tubes — Older and Newer Blood Specimen Tubes

No one likes surprises at the lab when you are about to get your blood drawn. The picture above is of the older vacutainers blood specimen tubes and a new type of tube that is being introduced. There is currently a change over of blood specimen tubes in laboratories across the country. Locally we are seeing the use of SARSTEDT tubes/syringes. This change over is for several reasons. First and foremost is to reduce blood bourne pathogen exposure due to needle sticks and tube breakage. However, these blood specimen tubes offer some additional benefits, especially to people who frequently have lab draws. One of which is the ability to use aspiration of the specimen to decrease the incidence of hemolysis. Hemolysis skews laboratory studies and damages the red blood cells in the collected specimen causing the need for repeated testing. Aspiration is also easier on fragile veins due to the decrease pressure versus vacuum. The SARSTEDT tubes are versatile in that they can also be used as a vacuum tube if needed.

Hope this knowledge will alleviate at least some anxiety on your next trip to the lab for your blood draws. Remember that follow up laboratory studies after weight loss surgery is a lifetime commitment that ensures your health and adjustment of vitamins and supplements.

Weight Loss before Weight Loss Surgery?

October 19, 2014 2:54 pm

I am frequently confronted by the question “Are you going to make me lose weight before I have weight loss surgery”? My answer is no, for several reasons, it makes little or no sense and there is scant scientific data to support it.

1-Anatomical and 2-psychological-behavior related variables have been suggested as the reasoning for the recommendations for diet before weight loss surgery.

Let’s see what the scientific evidence says about this.

1-Liver can be divided into two anatomical lobes. The tail end of the left lobe may extend all the way to the upper left side of the abdomen covering the upper 1/3 of the stomach, the gastro-esophageal junction (GEJ) and the esophageal hiatus. It was suggested that the access to the GEJ could be made easier, if the left lobe of the liver was smaller.

“A decrease in the size of the liver by 18% was shown in patients who were subjected to a very low-energy diet for 12- weeks.” This was published by Colles et.al in a small study of 39 subjects.

It is important to appreciate that this reduction in liver size meant that a patient would have to tolerate an ultra low caloric diet (less than 500/day) for 12 weeks. The interesting observation was that even with this reduction in the size of the liver there was “… no difference shown in morbidity, mortality, hospital stay, and decrease in morbidity- associated diseases whether there is preoperative weight loss or not.”

2-Behavior modifications have been entertained as a necessary element to the success of adjustable gastric banding. Numerous studies have shown that there is no predictive value of preoperative weight loss in relation to the weight loss after surgery.

The overwhelming scientific data suggest that there is no value to subjecting a weight loss surgical patient to a pre-surgical ultra low caloric diet.
“The California Department of Managed Health Care recently conducted a review of weight loss prior to bariatric surgery and concluded that “there is no literature presented by any authority that mandated weight loss, once a patient has been identified as a candidate for bariatric surgery, is indicated. This comprehensive review states that mandated weight loss prior to indicated bariatric surgery is without evidence-based support, is not medically necessary, and that the risks of delaying bariatric surgery are real and measurable.” Published by the American Society for Metabolic and Bariatric Surgery in March 2011.

Dental Issues after Weight Loss Surgery

October 13, 2014 10:53 pm

Please click the link to view the webinar on Dental Issues after Weight Loss Surgery. A special thank you to Armen Mardirossian, DDS, MS Diplomate for his contributions to this article.

Update for Feb. 2017 Dental Resources here.

Dental Issues after Weight Loss Surgery Webinar here.

This is a review of data regarding weight loss surgery and dental health. I am not a Dentist so please follow up with your Dental Health Care Providers if you are having any issues. Always keep your health care providers informed of your overall health status.

Angular Cheilitis

October 04, 2014 2:35 am

Cracked corners of the lips is know as Angular Cheilitis (AC). This is a condition that is not uncommon. It has been contributed to a lowered immune state caused by multiple factors. The underlying lowered immune state may predispose a patient to an infection which can cause the AC. These infections can be caused by bacteria or fungus that is normally present in healthy individuals, but with any level stress placed on the immune system, they are able to spread.

This condition can surface with minimal weakening of the immune system. Possible contributing factor of weakened immune system may be stress (physical and psychological), trauma, malnutrition, and extreme fatigue. Vitamin B and Iron deficiency was also suspected to be a cause of AC. The Vitamin B or iron deficiency may be contributing factor of weakened immune state and not directly causing AC. It is however important to correct all possible contributing causes including Iron and vitamin B deficiency.

Controversies of Duodenal Switch -Staged or Single Stage

September 27, 2014 5:29 pm

There is almost no science supporting the two staged duodenal switch. The “theory” advocated was that one can try a less invasive procedure and then if it does not work, proceed with the more complex operation. This was also advocated as a risk reduction tool for patient to have the sleeve component done as a planned first stage to reduce the operative and the anesthesia risk of the full duodenal switch operation. The “DS” surgeons soon recognized that the weight loss after sleeve is limited and not long lasting.

Laparoscopic Sleeve Gastrectomy has received a great deal of attention in the last few years. Most of this attention is contributed to the almost universal failure and high complication rate of the adjustable gastric banding (AGB) procedures. Since some practices and surgeons promised a low risk, minimally invasive procedure with the AGB procedures, they had to find an alternative as the complications and the failure of the AGB procedures mounted. This is when the Sleeve Gastrectomy started gaining more acceptance by surgeons who previously had performed AGB. Sleeve Gastrectomy is becoming one of the most commonly performed weight loss surgical procedure in several areas in the country and world.

It is worth mentioning, that Sleeve Gastrectomy is nothing new to the surgeons who perform Duodenal Switch procedures. Duodenal Switch has been performed as a single stage procedure since it’s inception.In fact every classical Duodenal Switch procedure is a Sleeve Gastrectomy with two small bowel anastomosis, first described by Dr. Hess in 1988. Duodenal Switch surgeons were also first to offer Sleeve Gastrectomy as the first stage of a two staged procedure.

BiliopancreaticDiversion-Duodenal Swtich: Independent Contributions of Sleeve Resection andDuodenal Exclusion, Marceu P, Biron S, Marceau S, et al. Conclusion: SG and DS independently contribute to beneficial metabolic outcomes after BPD-DS. Long-term weight loss and correction of metabolic abnormalities were better after DS favoring its use as first stage in BPD-DS; one-stage BPD-DS outcomes were superior to two-staged.

Other than some extreme cases, there is no indication to offer the sleeve as a staging operation since in vast majority of the cases the patient will require to have an alternative procedure done when the weight loss stops, and in some cases weight gain is experienced.

The reasons one should avoid a staged procedure is the evidence in the research data does not support that staging a procedure benefits the patient. There is also consideration for two general anesthesia exposures. Anesthesia time is based on surgical experience, technique and past patient surgical history. The argument that a patient should have the Sleeve Gastrectomy, to improve the risk for Duodenal Switch has almost no support in the peer-reviewed literature. One should also consider that a patient having had a Sleeve Gastrectomy may not qualify for the second stage Duodenal Switch procedure due to lower BMI or the insurance benefits mandating only one weight loss procedure in a lifetime.

There may be patients who may benefit from the Sleeve Gastrectomy long term, but in my opinion to offer Sleeve Gastrectomy as a planned first phase of the the duodenal switch is not indicated in majority of the cases.