Category: Obesity
Success Story: Hasmik
January 13, 2016 2:47 pm
Failed Band: My earliest memory of feeling ashamed of being “too heavy” is from kindergarten. For over 30+ years I have struggled with gaining weight, trying to lose weight, or going mad maintaining my weight. There is no shortcut that does not come back to bite you in the butt. There is no diet that effectively changes you permanently. For me exercise is a mindful struggle I sometimes successfully commit to over small periods of time.
I was desperate and ready for a real change. I wanted a genuine difference in the way I consumed and related to food and decided the lap band was the way to go. It was marketed as a “non intrusive, non permanent, easily reversible weight loss tool” and that is EXACTLY what I thought I needed and wanted. I was so very wrong, after my surgery I was considered a “success”. In fact up until the removal of my second slipped failed band, esophagus damage, and poor nutrition; I was considered a success. I look back and think how troubling this was/is. How very damaging to the person struggling and dealing with weight issues. Truly, it messed with my mind and my ability to speak up, admit to myself and out loud the band was NOT working for me. In fact, if I’m completely truthful, it was dangerous and turned me into a residue of the person I once was. I was not able to eat comfortably or eat out any place I happen to be. With the Band, I would need to consider how long I was going to be away from home because I could only eat small bites in small quantities to ensure I did not get stuck or worse vomit what I put inside my mouth. Yes, I had lost almost 100 lbs, but I had given my quality of life as payment. My guilt ensured I would never speak up or complain since I felt “fortunate” and grateful to have had this second chance at life. In my mind, speaking up meant possibly losing the tool (lap band) that allowed me to change my life and reality. Because for the first time in memory, I was the same weight at the start, middle, and end of the year. I did not have to buy different sizes of clothing or underclothing. I could predict what I might wear since my size was stable and my clothes fit. The reality is and was far from this corrupted self truth. I was unhealthy with the restrictive nature of how the lap band worked. In fact my band slipped twice after a severe stomach virus. I later learned of many other symptoms I was making excuses for and quite frankly straight out ignored.
I met Dr. Keshishian (Dr. K) at my lowest weight and at the lowest point in my health. I finally realized, the lap band needed to come out after it had slipped again. It was clear I needed a doctor who would be straight with me and cared for my health and not his/her “success” rates and have the expertise to deal with my failed band. I researched and called several bariatric surgeons then attempted to make appointments with each to discuss the urgent band removal surgery I needed (not as simple as you would think). I was also hopeful I might have the option to undergo the bariatric sleeve surgery because I knew I would not be able to keep my weight under control on my own. I was unwilling to undergo the emotional and mental torment of gaining and losing weight for the rest of my days. I succeeded in making three appointments and truthfully after meeting and speaking to Dr. K and his office staff I canceled them immediately. Let me start with the staff as that REALLY is important; they help you feel comfortable with the doctor, the procedure, and overall experience. They represent and reflect how the doctor you’re about to see will treat his patients. The expected standard within Dr. Keshishian’s office immediately made me feel like I called the right place. I was taken by the knowledgable, kind tone and efficient manner in which they requested the necessary information to effectively help me get from the starting point to the end goal. When I got to my appointment, Dr. Keshishian BLEW MY MIND. He not only presented himself as an approachable person I immediately felt at ease with but also reveal my concerns and questions. He treated me like a person. This may sound strange but this doctor made me feel like a human being with real concerns. He listened to me, asked questions rather than talked at me, and explained how and what was happening to my body and mind. He spent 3 hours with me to answer all my questions (even if I repeated them), draw diagrams, show me video to better help me understand what was happening, and then just sat with me while I cried for a moment. I cried because my 30+ years journey of ups and downs, crazy and insanity finally led me to the door of a man who understood and knew how to help without judgment. WHICH DOCTOR DOES THIS! None that I know.
My life post surgery is what I always hoped it would be. I am able to eat vegetables, leafy greens, fruit, grains and basically a well rounded diet. What’s amazing is that I naturally do not crave sweets, heavy creamy dressings, sauces and fill up quickly. There is after all a difference between the restriction of a lap band and the feeling of being full with the sleeve which Dr. K patiently explained. Today I am able to go any where, at any time, enjoy the moment and the company rather than worry about what I’m not able to consume. My days of scanning to locate the nearest bathroom in case I need to dash to it are over.
As I write this today, I feel like a real person, not some transient hoping to savor my life at glimpses. I am a person that is balanced in my heart with the average person’s anxiety and mindful eating habits. The sleeve is not a magic end to weight gain, it does give you the fighting chance to make choices in life leading up to results you’re willing to work for.
~ Grateful and Mindful, Hasmik (September 2015 Sleeve Op Patient)
Dr. Caya’s Yogurt RecipeExclusive Member Content
December 09, 2015 10:01 am
Acanthosis Nigricans
November 16, 2015 9:28 am
There are a a number of skin conditions that are associated with the disease of obesity. Acanthosis Nigricans is characterized as areas of thickened, dark, velvety discoloration in body folds and creases. Usually seen in the armpits, neck, under the breasts, in the skin folds of the abdomen and groin. The exact cause of it at the molecular level is not clear other than seen frequently with insulin excess in the case of benign conditions. This symptom can give a warning about health conditions that require further investigation.
Patients may assume excessive sweating and poor hygiene are the causes of this condition- both of which are incorrect.
Acanthuses Nigerians is caused by acanthosis and papillomatosis of the epidermis (the outer most layer of the skin) pigmentation is usually not in this area, rather than pigment-producing cells. The skin proliferation abnormalities in acanthosis nigrcans are frequently associated with hyperinsulinemia and insulin resistance. This probably presents the best understanding of the pathology behind it. It suggests that the layer of skin gets thicker probably caused by some stimuli- as indicated above seen with insulin excess.
There are two forms of this condition: Benign and Malignant.
Benign forms are associated with obesity, insulin resistance, and type II diabetes.
Insulin resistance: Insulin is a hormone secreted by the pancreas that allows your body to process sugar. Resistance predisposes to type II diabetes.
Hormonal disorders: Hypothyroidism, Polycystic Ovarian Disease, and other endocrine disorders of adrenal glands are ovaries
Drugs: Certain drugs and supplements such as high-dose niacin, birth control pills, steroids, may cause acanthosis nigricans.
Malignant forms may be an indication of Gastro-intestinal cancer such as stomach, colon, or liver cancer.
Treatment: No specific treatment is available for acanthosis nigricans. Treating the underlying conditions may restore some of the normal color and texture to affected areas of skin.
Shared Success Story- Stephanie U.
September 22, 2015 7:38 am
When I think back as far into my childhood as I can remember my weight was always a problem. I grew up being made fun of and missed out on the simple things that normal kids do growing up because my weight caused limitations.
Even into early adulthood I was still made fun of, but I learned to deal with it. I tried different methods of trying to lose weight. I went to a gym, tried diet pills, followed diets, cut out foods, sodas, alcohol, etc. Sure these things worked (very slowly) for a period of time, but then I would plateau and became discouraged and gain whatever little weight I lost plus some. By the time I was 27yrs old I found myself at my heaviest at 245lbs and I was also pregnant with my first child. I was lucky enough to have a healthy pregnancy. However after I had my daughter, I went up to 265lbs and just couldn’t get it off. I felt the toll the weight was taking on my body. My hips would ache, go numb, my lower back would get stiff, I would become winded just walking upstairs, it was difficult to get up from sitting, my feet would be sore if I was standing too long. I began to realize this was just going to get worse as time went on and as my daughter got older parenting would become more difficult. It became an even bigger concern to be healthier now that I had a little one depending on me and looking up to me.
I decided to explore the option of surgery in late 2013. I knew it was something that my insurance would cover so long as I met the requirements so I set out to find a reputable surgeon in my area.
Surprisingly I reached out into a Facebook group and was overwhelmed with recommendations for Dr. Keshishian (I was originally interested in the DS surgery). I went for my consultation in December of 2013. Upon meeting with Dr. Keshishian I knew I wouldn’t have wanted anyone else to perform this surgery on me. He was very upfront, honest, and straightforward with information regarding what was to come and the effort that needed to be put forth in order for this to work. The Gastric Sleeve was brought up and I decided to go with the sleeve surgery. I pushed forth and the staff at Dr. K’s office began the process of approval which happened to move very swiftly and smoothly.
I ended up having my surgery on 4/11/14 and I weighed 265lbs on the day of. Today, as I write this I am, approaching my 30th birthday healthier than I think I have ever been and I currently weigh 152lbs. The adjustment post-op was not an easy one, but it was well worthwhile. I am much more active, able to keep up and play with my daughter. I feel like I am living a normal life for once. I was scared, nervous, and had so many worries running through my head prior to surgery but now that I have gone through it I would make the same decision all over again in a second’s time.
Shared Success: Kurtis R.
September 08, 2015 5:27 am
For most of my life I had always been on the heavier side of the scale. Since I was a kid I’ve been extremely active with sports and other activities that required me to be running around, but my diet wasn’t on the right track. Even with all the working out or running I did, my diet is what led me to having the body I didn’t want anymore.
I didn’t have the same troubles a lot of bigger or heavier kids had. I wasn’t picked on or depressed. I was liked by just about everyone and had a large group of friends. That part of my life has never changed. What did change was the way I looked at myself in the mirror. I never had confidence in myself when it came to most aspects of life. Sports, I had all the confidence in the world. Nobody could strike me out, or get passed me with a football. The day it really changed for me was about 3 years ago. I was sitting on my bed, about to go to the store and realized I couldn’t bend down far enough to put my socks on without sucking in, holding my breath and leaning my legs out to the side. I got on the scale and realized I had hit 410LBS. 410LBS with a BMI around 50% at 22 years old. A weight I had never thought about, but also a weight I never thought I would be. I was lazy and didn’t care about what I ate. I worked from 7-4 and then played video games until it was time to go to sleep. No exercise and a terrible diet only lead to one result, and that’s a very unhealthy body. I brought this all up to my mom (who had gastric bypass ~15 years ago) and she said if I wanted, we could look into the weight loss surgery options.
She did the work in the beginning, finding out where we needed to go and when I decided I wanted to do this, she was there with me at the group meeting where we first met Dr. Keshishian. I knew from the second I saw his bow tie that he would be a pleasure be around. He brought out pictures and described the differences, pros and cons of each different surgery, I knew Dr. Keshishian was the doctor I wanted. Originally I wanted to just have the Gastric Band, but after hearing Dr. Keshishian go through every option, I ultimately decided to have the Sleeve Gastrectomy done. This was one of the best decisions of my life.
I had the surgery done in March of 2013 (~2.5 years ago) with a starting weight of 410 LBS. Now, 2.5 years later I weigh 250LBS and have lowered my BMI to about 20%, a number that I’m focusing on now. I didn’t have the surgery to become a skinny man. I like being a bigger guy. I just want to be healthy and get my BMI to about 12-15%. With the help and motivation from my parents, friends, family and beautiful girlfriend Kori, there are no doubts in my mind that I’ll be able to reach my end goal and continue on this path of health and exercise for the rest of my life.
Shared Success: Kriston & Shirden
August 27, 2015 5:27 am
My wife, Kriston, and I have struggled with our weights for most of our lives. Over the years we have tried dieting, exercise, medications, and so on….with no luck. A few years ago she started to bring up the idea of weight loss surgery as a possibility. This was an idea that I was dead set against partly for fear of having major surgery and partly because it felt like cheating to me. In my mind, I believed that I should have been able to lose the weight if I really wanted to do so. Kriston continued to bring up the subject. She talked about friends who had had the surgery and how well they were doing with their weight loss. I still resisted the idea until she made the argument that if we didn’t do something about our weight then we might not live to see our daughter grow up and have children of her own someday. That was when I realized that I had to investigate the surgery and what it entailed.
We made an appointment to meet with Dr. Keshishian for an orientation and listened to him as he talked about the problems many people have with weight loss, obesity, genetics, metabolism, what surgeries were available, and the pros and cons of each of them. After meeting him and learning about the surgeries and obesity, I felt very confident that this was the man that could help us with our weight loss struggles. We decided to go with the Duodenal Switch and I scheduled my surgery for June of 2013 and Kriston scheduled hers for November of that same year. We felt this would allow me time to heal and then I would be able to help Kriston after her surgery. I won’t go in to all the details of the surgeries except to say that they both went very well. My recovery was a bit rocky, my wife will say that I was a big baby, but I did recover. I will admit that she was a much better patient than I. Fast forward two years and we are both doing very well. I have lost 180 lbs and Kriston has lost a little over 100 lbs. We look and feel great and we enjoy a much happier and active life style, we even went ocean kayaking last week which is something I could have never done at 370 lbs. This surgery has changed our lives and we could not be happier. We will be forever grateful to Dr. Keshishian, and his incredible staff, for all that they have done to help us become the healthy and happy people we are today.
Vena Cava Filter
July 06, 2015 7:09 am
Example of a Vena Cava Filter Video:
Shared Success Story- Kylie
June 08, 2015 6:29 pm
I never knew how big and unhealthy I was until I decided I wanted a change. My experience with Dr. Keshishian and his staff was nothing less than amazing. He was very informative and made me feel comfortable and safe when undergoing the procedure. Not only did he operate on me, but also my brother, dad, and uncle as well. We are all so grateful for him and his knowledge as a surgeon. My mom had gastric bypass in 2005 by a different doctor and has numerous problems. We are all hopeful that eventually Dr. Keshishian will be able to help her also. Having my whole family’s support and understanding made the experience much easier for me. I am now happier and healthier than I’ve ever thought I’d be.
Before surgery, I weighed 250lbs, and my pant size was a 22. I now weigh 160lbs with a pant size of 8-10. I decided to have surgery because I wanted to be the confident girl who was trapped inside a 250-pound body to be able to shine. I wanted to be active and live a long and healthy life. I also wanted to start this lifestyle now so that when I have children one day, I can be a good example to them on how to be active. Most importantly, I wanted to be comfortable in my own skin. I wanted to feel beautiful. I was always “bigger.” I was a cheerleader from toddlerhood until high school and a swimmer for 12 years. I always stayed very active. Once I graduated high school, I moved out of state to attend cosmetology school and my active lifestyle completely stopped. I ate unhealthy and became very lazy. I wasn’t proud of the person I was becoming and struggled to change my bad habits. My brother had his surgery while I was in Idaho, and when I saw how great he was doing, I was inspired. I decided to fly home and meet these people and then it was my turn.
My Life has changed dramatically since I first met Dr. Keshishian. Working out and eating healthy have become habit. I ran in my first 5k, 10k, and half marathon. I continue to run every day in hopes of running in a full marathon. I LOVE to run, and have made it a way to relieve stress. Running has become good therapy for me. I love cooking and experimenting with foods I didn’t even know existed before I had surgery. It’s been 2 years, and I still haven’t bought or had a soda. I eventually gained what I call my “gym family.” I am there so often, that eventually, most of my friends were from the gym and people who have similar goals.
This surgery affects everyone differently. For me, it was a game I had to play with my mind. Being big, I loved the satisfaction of feeling full after a meal. I would order food and try to decide if it was enough to make me full. After surgery, I would forget that I couldn’t eat that much. I would still want to order the item with the most food. It was almost like the “Old Kylie” was still sitting in the back of my mind telling me what I would have ordered before my surgery. I had to learn to be tough, and ignore her. That was (and sometimes still is) one of the hardest things I’ve had to do. I would look in the mirror and still see a 250 pound girl. I had to have a mental talk with myself, and look at old photos. It was a temporary issue I had with myself. I’ve learned so much about who I am since the surgery, and am so happy with the woman I have become. Having this surgery has made me feel like I can conquer anything I put my mind to. I had no idea how mentally strong I was until I made the choice to have this procedure. This will always be one of the best decisions I’ve ever made for myself, and I’ll always be supportive of others who are thinking of choosing the weight-loss surgery. I owe Dr. Keshishian so much for giving me my life back. Thank you!
Gastro-gastric fistula after gastric bypass operation
May 10, 2013 9:09 pm
One of the complications of gastric bypass is a gastro gastric fistula. This happens when a connection between the gastric bypass pouch develops to the remnant stomach. In a gastric bypass operation, a very small pouch is created from the stomach, and connected to a segment of the small bowel.
The purpose of this operation is to decrease over 95% of the volume of the stomach. In theory, the benefits of this is to reduce the volume of food that can be consumed. Over time, the size of the stomach pouch, and/or size of the gastro-jejunostomy anastomosis might stretch. This result in weight regain that is very commonly seen in about 3 years after a gastric bypass operation.
One of the complications of gastric bypass is a gastro gastric fistula. This happens when a connection between the gastric bypass pouch develops to the remnant stomach. In a gastric bypass operation, a very small pouch is created from the stomach, and connected to a segment of the small bowel.
The purpose of this operation is to decrease over 95% of the volume of the stomach. In theory, the benefits of this is to reduce the volume of food that can be consumed. Over time, the size of the stomach pouch, and/or size of the gastro-jejunostomy anastomosis might stretch. This result in weight regain that is very commonly seen in about 3 years after a gastric bypass operation.
Another possible explanation for weight regain may be an abnormal connection that may develop over time between the bypassed stomach and the small pouch that was created. This abnormal connection is known as a gastro-gastric fistula. In a patient who may have a gastro-gastric fistula, the food can travel down the gastric bypass path or enter the bypassed stomach and go down the path of a normal anatomy.
In these cases, the physiological effect of a gastric bypass procedure becomes ineffective.
The treatment that I favor most for correcting the complication of the gastro-gastric fistula is is to revise the gastric bypass to the duodenal switch operation.
Stages of Liver Failure
January 08, 2013 9:38 pm
The liver is probably one of the most forgiving organs when it comes to recovering from an injury. It can take a significant amount of “non structural” injuries and still be able to carry out its function. It is the only solid organ capable of regenerating its volume after a major resection. When a part of the liver is removed, it is within a matter of months that the size of the remaining liver increases to replace the removed portion.
A liver injury can be caused by a number of elements. In regards to weight loss surgery, these elements include alcohol consumption, high doses of Tylenol, excessive weight loss, and the most significant condition called steatohepatitis, also known as “fatty infiltration”. Steatohepatitis causes structural changes in the liver. Over time, the structural changes cause the liver to progress to an end-stage liver disease that requires a transplant. Structural changes to the liver injury are irreversible.
The healthy liver is normally soft and beefy-red with a very smooth and shiny outer layer.
How does steatohepatitis harm the liver? As the fat concentration of the liver increases, the liver loses its sharp edge and becomes distended with small pockets of fat that are visible as yellow satellite lesions.
The healthy liver is normally soft and beefy-red with a very smooth and shiny outer layer.
How does steatohepatitis harm the liver? As the fat concentration of the liver increases, the liver loses its sharp edge and becomes distended with small pockets of fat that are visible as yellow satellite lesions.
This is gross evidence of steatohepatitis, which is commonly known as fatty infiltration of the liver. The most common cause of this is obesity, in addition to medications such as insulin that are used to treat diabetes. If the underlying cause of steatohepatitis is not addressed, then the liver damage will progressively continue to worsen and eventually be resolved in the structural changes to the liver.
If the physiologic injury to the liver continues unabated, it will develop irreversible cirrhosis. An increasingly continuous insult to the liver will result in sudden liver failure, which will require a liver transplant.