Category: Duodenal Switch
Bloating and Excessive Gas
April 17, 2012 7:36 am
The relationship between the consumption of food, bloating, and excessive gas is a subject that comes up frequently. In our practice, this is a complaint usually raised 3 or 4 years after receiving the duodenal switch operation. It appears that patients eventually disregard the recommendations made for a healthier diet of low carbohydrate, high protein, hydration, supplements, and then everything else.
In general, carbohydrates, carbonated drinks, artificial sweeteners (such as Splenda®, sugar alcohols, etc.), vegetables, excessive amounts of food, and an intake of fat will cause significant gas and bloating. This is not to be taken out of context and assumed that one cannot consume any of these products. However a diet that has fruits and vegetables will cause significant gas and bloating. These can not be controlled by probiotics, antibiotics, or other products such as Beano.
Simple carbohydrates/sugars (sugar, candy, cakes, cookies, pies, regular soda pop, jelly, jam, syrup, ice cream, sherbet, and sorbet, etc.) are easily absorbed. Simple carbohydrates/sugars can increase diarrhea due to the Duodenal Switch allowing more undigested sugars/fuel for intestinal bacteria to feed upon, multiply and form gas. The end result can be gas, bloating, and diarrhea.
Complex carbohydrates have more structure than simple carbohydrates/sugar which are harder for the intestinal bacteria to break down and may cause less bloating, gas and diarrhea. Also, complex carbohydrates usually contain higher fiber content. The fiber in the colon will help to absorb water from the stool and can reduce diarrhea. However, this is not the case for all Duodenal Switch patients.
When a patient reports these problems, I recommend that the consumption of all carbonated drinks should be stopped. No patient should consume carbonated drink of any sort. Artificial sweeteners should also be avoided all together. A good alternative would be honey, maple syrup or Stevia. Minimize or reduce the carbohydrate intake.
It has been our experience in the majority of cases that excessive gas and bloating is a result of dietary indiscretion. In some patients, once the dietary sources have been ruled out, it should be further evaluated by a barium enema to rule out the diagnoses of a redundant colon.
The best approach would be to first go back to a high protein and low carbohydrate. This should allow a patient to rule out any dietary sources for the bloating and excessive gas. It is recommended to next be seen by your physician for a further workup.
To summarize, when a patient has excessive amount of gas, diarrhea and bloating, the first line of treatment is elimination of all of the possible causes. These include carbohydrates, fruits, vegetables, artificial sweeteners, carbonated drinks and milk products. I can not overemphasize the importance of this step prior to anything else such as antibiotics or probiotics.
Feeding Jejunostomy TubeExclusive Member Content
February 06, 2012 3:38 am
Gastric Emptying after the Duodenal Switch and the Sleeve Gastrectomy
January 19, 2012 1:10 am
How do different medication that treat constipation work?
December 26, 2011 9:27 pm
|
Treatment option |
Pros |
Cons |
|
Lubricants (Mineral Oil) |
Facilitated bowel movements
Promotes soft bulk |
Limits fat soluble vitamin absorption
Interaction with Birth control pill and Coumadin |
|
Emollients (Colace, Docusate) |
Penetrates stool
Effective for painful anal fissure |
May cause increased gas and bloating |
|
Hyperosmolar Laxatives (Miralax) |
Promotes water retention in stool |
May cause increased gas and bloating |
|
Saline Laxatives (Fleet, MOM, Mag. Citrate) |
Rapid acting |
May cause electrolyte imbalances |
|
Stimulants (Dulcolax, Senekot, Ex-Lax) |
Increased water in stool |
Prolonged use can cause dependence of the GI track |
|
Herbs (Green Tea) |
Natural in origin |
Prolonged use can cause dependence |
|
Bulking agents |
Absorbs water, softens, and bulks the stool |
May cause increased gas and bloating |
Yearly lab and medication requests
October 17, 2011 5:28 pm
As a practice matures and evolves, decisions are made and changes are instituted to ensure that the delivery of quality care is not compromised. Most of our decisions are driven by factors (medical, regulatory, and legal) that are out of our control. There are two significant changes that we have had to make to our laboratory ordering process.
First, we now have preferred laboratories that have partnered with us. The laboratory results are expected to be sent to us electronically, which should cut down on the time between the blood draw and when the results are available to us. The information on the preferred labs is located at: https://www.dssurgery.com/lab. Needless to say, there are no financial incentives for us. You should also check with one of the labs, as well as with your insurance company, to make sure that they are a contracted facility and that the order is covered under your policy. It is your responsibility to make sure that your insurance company will pay for the labs ordered. We are in no way responsible for the verification of benefits for the laboratory services that we order.
Second, we have had to change the way we order our yearly lab work. As most of you are aware, it is critical that weight loss surgical patients have continuous yearly follow-up care and monitoring. It is critical that the patients continue to receive yearly follow-up care, not only by doing their scheduled laboratory studies but also by a yearly follow-up in-office exam. We provide a comprehensive follow-up plan to patients who have had the Duodenal Switch or Revision from other failed weight loss surgical procedures. This includes ordering the laboratory studies, reviewing and interpreting the results, as well as office visits as frequently as required or deemed necessary.
Vitamin D supplements
August 01, 2011 1:12 am
Vitamin A
May 17, 2011 7:20 pm
Vitamin A occurs in animal tissue as retinol. There are a number of different provitamins in food of vegetable origin. Disorder yellow and red carotenoid pigments can be changed to vitamin A in the liver.
A number of functions for vitamin A have been found, including defense mechanisms, maintenance of healthy epithelial tissues, and most importantly, a function in the visual system. A deficiency may manifest itself by: 1.) A scale-like appearance in the skin and occasional acne, 2.) A failure of growth in young animals, including C. station of skeletal growth, and 3.) A failure of reproduction associated with atrophy of the epithelial cells of the testes and interruption of the female sexual cycle. A deficiency may also represent a decreased visual acuity, and more specifically, night blindness. This was found in a patient who complained that they were unable to read a particular sign at night while driving, but was able to read it during the day
Vitamin A Deficiency Treatment
When a patient is diagnosed with a deficiency, the treatment will require aggressive oral supplementation. For cases in which vitamin A levels do not respond to “Dry” Vitamin A oral supplementation, intramuscular injections may be required. The usual injected dosage is between 25,000-50,000 international units. Repeated injections in a 3-month interval have been required in some patients to normalize their level, as well as resolving the symptom of night blindness.
“Common bile duct is dilated”
March 10, 2011 8:16 am
Duodenal Switch and Distal Gastric Bypass (ERNY)
December 04, 2009 7:24 pm
On 10/28/2009 I had a variation of the RNY gastric bypass (Distal Gastric Bypass) known as the Fobi pouch. I lost over 270 pounds, but I had debilitating complications of dumping syndrome, reactive hypoglycemia, acid reflux and vomiting.
My entire day was pretty much controlled by dumping syndrome. Due to the hypoglycemic episodes that resulted from dumping syndrome, I was constantly in a binge cycle, because I constantly needed to stabilize my blood sugar. I would eat breakfast and need to lay down. Once I started having hypoglycemia, I would get up and splurge on carbohydrates.
Note that my dumping syndrome was not caused by poor food choices. I only splurged off carbohydrates in a desperate attempt to quickly get my glucose levels up. This did work, but it lead me to dumping syndrome again. I then had another episode of hypoglycemia, which lead to more binging which resulted in more dumping, more binging and weight gain. Here is a diagram of the cycle I was constantly in:
Eat –> dump –>hypoglycemia –> binge –>redump –> more hypoglycemia –> binge –> dump
This was a constant cycle I was in, and as you can see here, my entire life became controlled by dumping syndrome, and it eventually caused me to become disabled. I am a full time student and was not able to go to school in this state. I would eat lunch and then go to class only to start dumping ten minutes into lecture, and I ended up dropping my classes for the semester.
I went to my bypass surgeon and told him of the problems I was having, and he told me that I was anorexic. I was also told that it was “…all in my head.”
After doing much research, I consulted with Dr. Keshishian. I handed him a list with the problems I was having and asked if revision to the duodenal switch would resolve these problems. Dr. Keshishian drew out a diagram of the anatomy of my surgery and showed me exactly why I was having these complications. I remember him saying, “There is a physiological explanation for why you are having these problems. It is not in your head. Yes, revision will resolve these complications.”
I had my revision on 4/11/2011, and all the complications I had with my bypass have been resolved, and I have had no complications with my duodenal switch. Now that my pylorus is working again, I can eat without becoming ill. I have now gone back to school, work, and have resumed back to a normal life.
YG
Obesityhelp.com revision Forum information
November 08, 2009 9:00 am
I am not sure what has happened over the past two weeks or so, but I have received a number of inquiries from patients who have had questions about the revision of RNY or Lap Band® for weight regain, inadequate weight loss, or other complications. I finally had to ask one of the patients where he got his information and heard about our practice. His source of information was the obesityhelp.com website.
I have spent some time looking over and responding to several postings on the forum sites. I have referred to a number of publications in some of my postings on obsityhelp.com.
Nishie et.al. (Obesity Surgery, 17, 2007 1183-1188) reported:
“Pouch size area, measured by routine UGI on the first postoperative day does not influence short term postoperative weight loss. “
Cottam et.al. (Obesity Surgery 2009, 19:13-17) concluded:
“The level of restriction or the presence of stenosis achieved by different stapler sizes does not have a significant role in weight loss.”
O’Connor et.al. (Surgery for Obesity and Related Dis. 4(2008) 399-403) summarizes:
“With construction of divided, vertical, lesser curvature based small-volume (less than or equal to 20 cm gastric pouches, the actual size of the gastric pouch did not correlate with the %EWL at 1 year laparoscopic GB.”
I am a firm believer that the best patient is the most knowledgeable patient. It is always safer to spend as much time as needed to ask questions and investigate all options. If I can provide any information, please contact us at [email protected]