Category: BPD/DS
Compounding Pharmacy
March 22, 2017 7:40 pm
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.
Back on Track 2017 Giveaway
January 10, 2017 10:03 am
Let’s get back on track 2017 after the holiday season! The holidays were wonderful but if you find yourself with a few extra souvenirs don’t feel alone. The average American gains between 1-8 pounds during the holiday season and I am no exception. Let’s get back on track 2017 together.
Time to clear out the kitchen! Disposing of temptations and high trigger foods is the first step to getting back on track. If the food isn’t easily acquired then it is less likely to be consumed.
Stock up on high protein and whole, unprocessed foods that are low carbohydrate and nutrient dense. When quality foods are easily available we are more likely to stay on track with the types of foods we should be eating. Simple sugars/carbohydrates are the biggest culprit of holiday weight gain. We need to go back to the basics of hydration, high protein, low carbohydrate/sugar, vitamin/mineral supplements and exercise. Simple sugars and carbohydrates are easy for our bodies to use and absorb and cutting them back can jump start your weight loss. Each individual needs to identify the daily carbohydrate intake that works for them. Some people stay under 50 grams of carbohydrates daily. You may also need to look at your protein and fat intake. All excess nutrients absorbed have the potential to turn into fat mass and inhibit weight loss. Metabolism video.
Hydration is an important ways to start getting back on track. Water is essential to life functions. The brain is 85% water, blood is 80% and muscle is about 70% water. Hydration aids in digestion, eliminating waste, byproducts and toxins. It also can decrease the feeling of hunger. Lack of hydration can increase fatigue which can lead to craving high carbohydrate foods to increase energy.
Protein’s importance in almost every bodily function and muscle mass can not be ignored. High quality complete Protein sustains muscle mass during weight loss, aids immunity, antioxidant function, and enhances leptin and insulin function. Filling up on protein first will help with carbohydrate carvings and give a sustained satisfied feeling. A prior blog post gives additional information on the importance of protein and the effects of protein malnutrition. WLS makes daily protein intake important but especially after Duodenal Switch, protein is a necessity of daily life.
Vitamins, minerals and supplements will ensure the body has the nutrients it needs to function adequately and can keep cravings at bay. Deficiencies in vitamins and minerals can cause cravings for foods. Vitamin and minerals are essential to muscle function, red blood cell production, bone health, and numerous other physiologic functions. We may all slack off on our supplements occasionally but now is the time to get back into the habit of daily vitamins and mineral supplements. A daily vitamin, mineral, and supplement routine is a lifetime commitment after Duodenal Switch or any WLS. Here is a list of commonly used supplements.
Exercise can increase weight loss, overall well being, mental well being, mood, alertness, improve digestion, improve sleep, and increases energy levels. Exercise does not have to be a daunting task. Simply adding 15-30 minutes of activity can give added benefits. Yoga, walking, dancing, lifting weights, hiking, and sports activities can be included or added to more traditional forms of exercise. There are many free online videos for all types of exercise available.
Finding a new hobby can keep both your hands and mind busy, curbing the unconscious eating of foods that are high in sugar and carbohydrates. Adult coloring books, drawing, painting, knitting, crocheting, sewing, dance lessons, gardening, learning to play an instrument and many others are great ways to use your time and expand your quality of life and brain function. New hobbies can also help establish new coping skills. Our previous post on Coping Skills After Bariatric Surgery can be found here. There are a whole host of online videos for “how to” on new hobbies.
Teaming up with others can also help increase weight loss and compliance. Support from friends, family and other groups will assist you. There is a whole gamut of support group online and in person. If you have fallen out of the habit of attending our support group or webinars get back to them. You can find our schedule and announcements regarding webinars here. Our Central Valley Bariatric Facebook page also gives daily inspirational messages, protein recipes and articles and any new information or research available. There is also our Duodenal Switch Facebook Group. Anything that increases accountability is a benefit and motivates us to stay on track.
Experiment with new recipes and flavors that are bariatric friendly and within your dietary needs. There are so many options for quick and easy meals. We have several recipes on our page for all stages following weight loss surgery and Duodenal Switch. However, there are endless option on the internet in Paleo, low carb, and high protein type recipes.
In the spirit of new starts and getting back on track 2017, we are having a giveaway with the basics to get back into the swing of things. This year we are looking for before and after weight loss surgical journeys. Share your weight loss journey! Don’t be shy, your journey can inspire others and/or motivate yourself. To enter the Back on Track 2017 Giveaway, please submit your weight loss surgical journey with before and after pictures to contact@dssurgery.com or you can also post your before and after pictures on our Facebook page. You will also need to sign a release for the use of your story on our website. We will draw 2 names from those that enter by announcing it on our FaceBook page or by e-mail on January 31, 2017. You must submit your mailing information to contact@dssurgery.com in order to claim the prize.
Standard Common Channel In Duodenal Switch Will Result In Weight Regain.
December 16, 2016 1:57 pm
Stéfane Lebel, M.D.*, Geneviève Dion, M.D., Simon Marceau, M.D., Simon Biron, M.D., M.Sc., Maud Robert, M.D., Laurent Biertho, M.D. earlier this year released a research article comparing patients undergoing standard common channel of 100cm and standard common channel 200cm. The conclusion of this article was: “In this population, BPD-DS with a 200-cm common channel offered similar remission rate of co-morbidities compared with standard BPD-DS. It was associated with similar weight loss at nadir, followed by a more significant weight regain. It might yield a lower rate of nutritional complications. Long-term randomized data are needed to detect other potential advantages.”
Our Experience:
One of the most dreaded outcomes of any weight loss surgical procedure is weight regain. This is assuming that initial adequate weight was lost to result in resolution of the co-morbidities in the first place. As the weight loss surgical field has changed over the years so has been the cases of regain that we have seen.
There was a time when Lap bands were being revised for inadequate weight loss and weight regain. Not to mention the complications of reflux, difficulty swallowing and persistent Nausea and vomiting. Then as more Gastric bypass procedures “aged” the number of patients that started looking for revision for weight regain increased. The latest fad is the Vertical Sleeve Gastrectomy that are done with false sense of expectation and results. The long term outcome of Vertical Sleeve Gastrectomy is no where close to that of the Duodenal Switch, independent of the size of the sleeve. In fact, more surgeons are trying to get a little more weight loss by making the sleeve too tight. All they are doing is creating a significant and debilitating set of problems such as reflux, nausea, and solid intolerance.
The ideal revisional procedure for these patients should be the Duodenal Switch. Some surgeons, however, have started advocating “single anastomosis” knock off the duodenal switch. Others do “standard length common channel” rather than a Hess method Duodenal Switch. I have always performed a traditional Hess method Duodenal Switch. The Hess method Duodenal Switch has held the largest and longest excess weight loss maintenance for 28 years, going into 29 years. Here is a past blog regarding small bowel length.
The predetermined standard common channel results in weight regain. Study
Importance of ProteinExclusive Member Content
September 08, 2016 2:43 pm
Review & Update Giveaway!
August 31, 2016 6:27 pm
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.
- 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.
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.
Weight Loss Surgery Effects On Iron AbsorptionExclusive Member Content
June 06, 2016 9:40 am
Minimally Invasive Weight Loss Surgery
May 17, 2016 9:02 am
Minimally Invasive does not mean better, easier, proven outcomes or good excess weight loss. Weight loss surgical patients should be careful of catch phrases such as “less invasive”, “simpler”, “shorter recovery”, “outpatient” and many others that had been used to described procedures with less than optimal outcome. We should not forget the lessons learned from adjustable gastric banding which was also promoted as ” less invasive, simpler to perform, and be done as an outpatient with a short recovery “. We all know how that story has panned out. The overwhelming majority of patients who had an adjustable gastric banding have undergone revision, had it removed or had additional surgeries following the complications which were associated with this simple procedure.
When evaluating outcome data for weight loss surgical procedures, it is important to bear in mind that the long-term success of these procedures will take years to document. More often than not the early weight loss is significantly better than the long-term stable weight loss. This has been clearly documented in the case of the adjustable gastric banding and the gastric bypass and laparoscopic sleeve gastrectomy operation. Duodenal switch , as described by Dr. Hess using the percentage based technique, has the best long-term documented success of all of the weight loss surgical procedures. The scientific data reports 20+ years of successful excess weight loss with a Hess Duodenal Switch procedure. There has been an alternative proposed to Duodenal Switch recently, the SIPS and SADI procedures. As I have already stated in the past, these are not the same as the duodenal switch operation. Any suggestion or innuendos that SIPS/SADI is the same as the Duodenal Switch is deceptive and misleading. We have also seen attempts to use the same catch phrases as described above to promote these unproven procedures. The published data that’s been reported with SIPS/SADI is mostly short-term in small population studies. There are no long-term studies that have documented the efficacy of the SIPS/SADI procedure and “simpler” or minimally invasive does not mean better.
Magnesium QuestionsExclusive Member Content
May 11, 2016 6:07 am
Billroth I or II and Diabetes
March 01, 2016 8:37 am
I have previously discussed the two variations of anastomosis that can be created between the stomach and the first segment of the small bowel. Historically, Billroth I and II procedures were named after Dr. Theodor Billroth who did the first of this type of operation in the 1881 (BI) and then in 1885 (BII).
The following article published in Bariatric Times 2016;13(2);8-10. discusses the resolution of diabetes and its outcomes based on these two types of the anastomosis between the stomach and the small bowel.
Billroth I VS Billroth II
This study concludes that “In summary, we concluded that based on our analysis of the literature, BII reconstruction is more effective than BI reconstruction for achieving postoperative diabetes control.”
Lets remind ourselves that Duodenal switch is a BII reconstruction where as the SIPS, SADI and other lookalikes are BI.
This study only reiterates that these unproven operations need to be studies further and that the patients need to be aware of the consequences of their decisions when choosing a particular operation. Be aware and informed to know the differences between Duodenal Switch and the procedures that are promoted as similar one – which they are not.
Visual comparison of Duodenal Switch and SADI/SIPS/Loop here.
Further description of Duodenal Switch here.