We have received notice that the FDA and the compounding pharmacy have changed their regulations for several medications. Unfortunately, this affects our office and Duodenal Switch patients in regards to injectable Vitamin D and Vitamin A. In the past, we have been able to have injectable Vitamin A and injectable Vitamin D in bulk in our office. The new regulations require that a patient be assigned to the medication, so we will be unable to have it on hand in our office. This is out of our hands and control.
We are requesting that if you are anticipating the need for injectable vitamins that you have your laboratory results in our office at least 3 weeks prior to your office visit. This will give our staff adequate time to order your injectable vitamins to be available at your visit.
Injectable Vitamin D may be needed in some cases of Vitamin D deficiency or inability to increase Vitamin D level with oral supplements. Vitamin D is a fat soluble vitamin. It plays an important role in bone metabolism and structure. It has also been found to affect the immune regulation, control off- inflammatory reactions, and also be involved in a number of broad cellular functions throughout the body.
Research and information regarding Injectable Vitamin D.
Thank you for your understanding in this manner.
Fluids and Electrolytes after weight loss surgery are an important part of recovery and lifestyle after undergoing a weight loss surgical procedure. Potassium is an important electrolyte found in higher concentrations within the fluid of the cells. It is important in muscle contraction, heart rhythm, nerve function and co-enzyme function.
Fluids and Electrolytes
The following webinar (link) discusses the balance of fluids and electrolytes with particular attention to post weight loss surgery concerns. Deficiencies can cause heart arrhythmias, muscle weakness and cramping, intestinal paralysis, and neurological deficits.
The Daily Recommended Amount for Potassium is 4,700mg
Here is a list of Lower-carb potassium sources: This is not meant to be in inclusive list. There are many higher carb sources of potassium also.
- Beet Greens- 1/2C 655 mg
- Trout 3oz – 375 mg
- Salmon 719 mg per average filet
- Halibut or Yellowfin Tuna 3oz – 500mg
- Clams 3oz- 534 mg
- Avocados 1 whole- 974 mg
- Squash 1C- 325mg
- Broccoli 1 cup 475m
- Watermelon Radish 3 oz – 233mg
- Sweet Potatoes- one potato 694mg
- Yogurt 1C – 579mg
- Tomato paste 1/4C – 342 mg
- Whole milk 1C – 366 mg
- Chicken breast meat 1 cup chopped – 358 mg
- Cauliflower 1 cup raw– 303 mg
- Peanut butter 2 T – 208 mg
- Asparagus spears 6 – 194 m
- Daikon Radish – 3″ – 280 mg
- Nuts 100-300 mg per 30g / 1 oz serving, depending on the type
- Dark leafy greens 160 mg per cup of raw, 840 mg per cooked
- Kohlrabi 3oz- 98mg
- Mushrooms 1 C- 273 mg
- Spinach – 1 cup 167 mg Potassium
- Walnuts 2 oz-250 mg
Halloween is the start of temptations during the holiday season and surviving Halloween is possible. It’s a time of high carbohydrate treats that can turn into a nasty trick of regain or slowed weight loss. Halloween is a fun holiday that you can participate in with some foresight and planning. Sugar and simple carbohydrates are easily absorbed and can decrease weight loss or regain. The following are some helpful tips to keep you on track.
- Stay steady with high protein, hydration, vitamins and minerals. Protein and hydration will keep you full and help curb the carb cravings.
- Make you own high protein treats. There are so many great recipes out there.
- If you give out candy don’t buy candy that you like. In fact, do the opposite and buy candy you dislike.
- Don’t give out candy at all. Instead opt to do a non-candy type item, stickers, pencils, rings, trinkets, easers, small coloring books, or other small items.
- Keep a list of your goals posted in a visible place.
- Make a picture collage of your goals, achievements you want, and non-scale victories you’d like to achieve posted in a high visibility location.
Stay strong and avoid the pitfalls of temptation.
Dr. Keshishian explaining the different weight loss surgical procedures to nursing students. Including the duodenal switch before cases to a number of nursing students on a board in the operating room. Dr. Keshishian is always willing to educate and draw with a smile but not always with a bowtie!
Cindy Porcell, Surgical tech put the finishing touches on it.
In case you are wondering, surgical scrubs do not have bowties!
In a recent review article published in the September 2015- Volume 42:10 of General Surgery News, the surgical outcomes of different procedures were summarized. There were evaluated based on a number of measures, including re-operation rates. So interesting to note that the re-operation rate of the duodenal switch is the lowest of all surgical procedures.
These are examples of two types of patients referred to us for revision surgery.
The first example is a gastric bypass that we revise to the duodenal switch operation. The upper GI series after the revision, shows a “banana shaped” stomach, the pyloric valve and the duodo-ilesotomy anatomosis component of the duodenal switch.
The second example, images noted below, is that of a sleeve revised to the duodenal switch – both operations done at different institution. Note how the stomach is not a “banana shaped” and more like a funnel with a narrowing at the bottom of the stomach- a stricture.