1-818-812-7222 Office Hours: 8:00 AM to 5:00 PM
10 Congress St., Suite #300
Pasadena, CA 91105

Results for : "vitamin d"

Parathyroid Scan

July 09, 2018 11:48 am

A Parathyroid scan or Sestamibi scan may be needed if the typical weight loss surgical reasons for elevated PTH levels have been addressed. Sestamibi is a small protein which is labeled with the radio-pharmaceutical technetium-99. This very mild and safe radioactive agent is injected into the veins of a patient with overactive parathyroid and is absorbed by the overactive parathyroid gland. If the parathyroid is normal it will not absorb the agent. The scan below shows the uptake of the agent.

Calcium, Vitamin D and Parathyroid hormone are routinely measured on yearly follow up for most post weight loss surgical (WLS) patients. Elevated parathyroid hormone (PTH) may be caused by Vitamin D deficiency or calcium deficiency (most common in post WLS) or by over active parathyroid gland(s). In the latter case, if one of the four glands is overactive then this is knows as a parathyroid Adenoma. If all 4 are over active and are secreting too much PTH, this is known as hyperplasia. Ultrasound of the neck, may identify an enraged parathyroid gland (adenoma) which is located behind the thyroid gland. Given the large area where the parathyroid gland may be located, additional tests are needed to not only identify the location of the gland(s) but also to distinguish between single gland (adenoma) or multiple glands (hyperplasia) cause for the elevated PTH. It is important to investigate all avenues and testing in parathyroid hormone elevation and in some cases, not to rely on one test for your diagnosis. It is also imperative that weight loss surgical patients take their supplements routinely and consistently and have their laboratory studies followed at least yearly.

Parathyroid Scan

Calcium Lab Results

June 05, 2018 3:26 pm

Calcium is measured to evaluate function and adequacy of a physiologic processes. Calcium plays a critical role in several body functions such as, coagulation pathways, bone health, nerve conduction, and other functions. It is important whenever you are evaluating laboratory results that you look at the whole picture of the person, including medications, other laboratory studies and health history. One value is not a stand alone result. There are many factors that effect calcium results.

Factors that effect calcium results: (not an all inclusive list)

pH

Albumin

Lactate

Heparin

Vitamin D deficiency

Magnesium depletion

Anticonvulsants

Renal Disease

Pancreatitis

Parathyroid

Thyroid

The two most common issues following Weight loss Surgery or Duodenal Switch may be albumin level and Vitamin D level. Please see past blogs on Vitamin D. Magnesium may also play a role in a Duodenal Switch patient.

The most common calcium result drawn is the total calcium level. Laboratory results may not explicitly label it as such, however, it measures the calcium that is bound to protein. Ionized calcium is the free calcium that is representative of the true total calcium. Ionized Calcium can be measured by ordering specific lab. Alternatively, the Ionized calcium can be calculated by the following formula: Corrected calcium mg/dL = (0.8 * (Normal Albumin – Pt’s Albumin)) + Serum Ca ) or use the calculator at the bottom of this post.

Calcium bound to albumin Keshishian
calcium metabolism
Duodenal Calcium Metabolism

The low Albumin level accounts for the low calcium level. This may be the reason for a patient with a low albumin/protein level, also having their calcium level reported as low. However, when adjusted for the protein deficiency the corrected calcium comes into normal range. Video of Trouseau’s sign of a patient with calcium deficiency.

The first step in a patient who has low calcium reported, is to make sure their protein and albumin levels are normal, along with Vitamin D.

Calcium levels are managed by two processes major regularly hormones and influencing hormones. Controlling or major regulatory hormones include PTH, calcitonin, and vitamin D. In the kidney, vitamin D and PTH stimulate the activity of the epithelial calcium channel and the calcium-binding protein (ie, calbindin) to increase calcium absorption. Influencing hormones include thyroid hormones, growth hormone, and adrenal and gonadal steroids.

Further information on protein.

Further information on calcium.

Videos/Webinars on several of the above topics.

Corrected calcium = 0.8 * (4.0 – serum albumin) + serum calcium

Compounding Pharmacies

January 22, 2018 2:38 pm

New FDA regulations for compounding pharmacies has spurred changes in our pricing and ability to provide injectable Vitamin A and Vitamin D.  The compounding pharmacies are no longer compounding injectable Vitamin A and there is a nationwide shortage of the national brand of injectable Vitamin A.  We have a tentative date of February 2018 when we may be able to obtain injectable Vitamin A. We won’t be able to quote pricing on Vitamin A injections until we are able to orders.

We are able to obtain and supply our patients with injectable Vitamin D but with a price increase.

The following is the letter we received from our compounding pharmacy.

“The healthcare industry has continuously undergone changes in regulations and legislation. The compounding industry is no exception and has faced rigorous regulatory requirements this past year such as new testing specifications and compliance standards.

We are set on facing these demanding challenges by meeting and exceeding these new regulatory requirements. We want to assure you we will continue to provide the best products on the market for you and your patients. Quality and safety remain a top priority. We understand that our pharmacy plays a vital role in providing care to your patients. The increase in pricing is a reflection of the additional cost in producing and testing the product based on regulatory specifications.”

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.

Exercise Benefits & Events

August 09, 2016 2:25 pm

Exercise and it’s benefits for body, mind and weight loss can’t be over emphasized. Everyone can benefit from some form of exercise whether it be a brisk walk, chair exercises, exercise bands, aquatics, running, hiking or biking. As a family we try to exercise often and attempt to participate in at least one event a month or so.  These types of events tend to keep us more accountable and motivated.  The group atmosphere, energy and vibe only add to the experience. Listed below are some of our favorite exercise events.  We will update this list and add to it.

Physical Benefits:

  • Weight loss and maintenance can be a benefit of exercise. It also improves muscle function and strength.
  • Improves Type 2 Diabetes and Metabolic Syndrome
  • Reduces some Cancer Risk
  • Improved Cardiovascular Health
  • Improved “Good” cholesterol
  • Strengthens and improves Bone Health
  • Living longer
  • Improved Sleep

Mental Health Benefits:

  • Reduce Stress
  • Boosts Endorphins
  • Helps with Anxiety
  • Improved Self Confidence
  • Being in the Great Outdoors and Sunlight (increases Vitamin D)
  • Prevent Cognitive Decline
  • Sharpen Memory and Cognitive Function
  • Help with Addiction
  • Increase Relaxation

One important key note is to pay close attention to hydration with exercise, not only with fluids but electrolytes as well. Exercise increases fluid loss due to sweat and increase circulation to muscle.  You need to increase fluid intake to compensate for these losses.

Exercise events by the month:

June

The Los Angels River Ride is one of our families favorites.  Great ride for a great cause.

August

Luau 5K walk and fun run This is a fun family activity as they have a kids run and lots of activities.  It is also in Griffith Park which is a beautiful and treasured location.

September

The Prudential 401K Run is to promote saving for retirement and is a FREE event at the beautiful Rose Bowl

October

The Aloha Run brings a little Hawaiian feel to the fall.

JDRF One Walk fighting Type I Diabetes

November

City of Hope’s Walk for Hope 

December

Santa to the Sea (must bring a gift for a child)

Varying months depending on location:

Race for The Rescues

Walk from Obesity

Step Out Diabetes Walk

Get your Rear in Gear to fight Colon Cancer

CicLAvia a Los Angeles area quarterly biking event.

Fat, Protein – Post Duodenal Switch Diet

May 23, 2016 6:43 am

Fat and Protein after weight loss surgery…. This is a subject that seems to come up all the time.

What I recommend is “…Water, protein, vitamins, supplements and every thing else….”

Dehydration can cause a lot of problems, stay hydrated.

Weight Loss Surgery (WLS) is a surgically imposed catabolic state (surgical induced starvation).  The weight is lost by not allowing enough caloric intake/absorption and forcing the body rely on stored sources of energy, mostly fat mass.  The rationale for the high protein intake is to minimize net muscle mass loss during the catabolic state.   Low carbs and low fat further push the body into catabolizing the fat mass, and reducing the net loss of protein content. As the fat mass is broken down it will release hormones and other byproducts that the body will eliminate. Hydration is crucial to every bodily function and even more so in the weight loss phase to allow for elimination of some of these byproducts.

The mechanism by which Duodenal Switch works during the weight loss phase is by limiting the caloric intake.  Long term  Duodenal Switch keeps the weight off due to the malabsorptive component as the caloric intake increases. Protein intake, Vitamin/Mineral supplementation and diligence in surveillance of vitamin/mineral levels is imperative and a life long commitment after WLS.

There are a number of different types of  Fatty Acids.  Our bodies naturally produce, from other components,  all but 2 essential fatty acids: Omega 3 and Omega 6.  Most fatty acids require bile salts to be absorbed within the small intestines.  Those are the fatty acids that are absorbed to a lesser degree after Duodenal Switch.  Medium chained fatty acids do not require bile salts and can be absorbed into the blood stream from the small intestines. Medium chained fatty acids are used for energy as they are processed in the liver. Medium chained fatty acids are actually given to patients with Short Bowel Syndrome to decrease fatty stool and increase their body weight.  This is also a possible reason some fats cause DS patients more loose stools and others do not (medium chained fatty acids). Adding fats is a purely individualized process.  Each person has a different length of small bowel, alimentary limb, common channel, percentage of excess weight to lose and metabolism. Patient’s tolerance for fat in regards to vitamin/mineral levels, stool consistency and frequency is completely individualized.

Fats and Fatty acids can be divided according to their structure in groups:

A) Saturated  Fat (animal fats, butter, lard- solid in room temperature)

B) Unsaturated Fat (liquid in room temperature)

           1-PolyUnsaturated Fats
                    a)Omega 3-fattty acids (fish, shellfish, soybean, walnut, flaxseed)
                    b)Omega 6-fatty acids (corn oil, sunflower oil)
            2-Monounsaturated fats
                    a)Omega 9-fatty acids (olive oil, avocados, peanuts, almond

The main focus in the weight loss phase should be hydration, hydration, hydration, protein, low carb, low fat and vitamin/mineral supplementation (page 22).  Rest is key in the early post op phase but gradually adding exercise is also important in ensuring the body does not breakdown muscle mass.  Adequate intake of protein and use of muscles diminishes the bodies natural response of breaking down muscle mass in a low caloric intake state.

Post Surgical Needs for the first 90 days in order of importance:
This is to allow healing to take place before adding additional stress on the body and surgical sites.
Minimum of 64 ounces of fluids daily
Minimum 80-100 grams of protein daily (protein requirements are based on ideal body weight)
30 gms by 30 days post-op
60 gms by 60 days post-op
90 gms by 90 days post-op
Vitamin/Mineral Supplements
Low carb
Low fat
Rest (early Post-op)
Exercise

Proteins are important, not only for structure (muscle) but for functions. We know that proteins and amino acids are involved in all aspects of our body’s function. This is even more critical during the rapid weight loss phase. Protein needs may increase and change based on health status, pregnancy, surgeries, healing, etc.

When it comes to fat, I do not recommend patients consuming excessive amounts of fat- At the same time I do not recommend patients go on a low fat diet.  There is this misconception that since DS is causing fat and fat soluble vitamin malabsorption, then taking more fat (in excessive amounts) can solve the problem of vitamin deficiency. How about the possibility that some patients are causing their own vitamin deficiency by taking large volumes of fat which may results in more frequent bowel movements and decreased vitamin absorption.

It is not to be forgotten that each patient will respond differently with dietary changes after duodenal switch. Some patients may tolerate more and some less fat in their diet.  After the initial 90 day post op phase I recommend that patients go slowly in adding new food items by giving it several days before adding another food item. i.e.; add carrots for 3-5 days to see how your body handles it before attempting to add another new item.  The above is not the entire weight loss process or education and is only a small portion of the education needed before undergoing any WLS procedure. These recommendation are my recommendations for my patients with the Hess technique for Duodenal Switch.

SupplementsExclusive Member Content

March 19, 2016 11:16 pm

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FAQ

March 19, 2016 10:38 pm

We have compiled a list of frequently asked questions. Please view the questions below or click on a link to jump to the section.

Pre-Operative (Before Surgery) Questions

Will my insurance pay for the surgery?

Your surgery may be covered depending on which insurance you have. We will contact your insurance company and obtain detailed information on the “Coverage and Benefits”. To do this, we ask that you complete the information on our New Patient Inquiry page, as well as fax us a copy of the front and back of your insurance card. We will then verify the coverage and contact you.

How long does it take before I can have surgery?

It usually takes 4 weeks between the time of the initial consultation in the office and the surgery.

Are there any other fees that are not covered by my insurance?

Yes, you are responsible for Copay, deductible, and share of costs. Additionally, you may be required to pay a program fee for a particular type of surgery with services provided that is not covered by your health insurance plan. This will all be discussed with you in detail after your insurance coverage has been verified.

How long do I have to stay local to the hospital?

10-14 days. Some patients may be released back home sooner, while others may need to stay longer.

How often do I have to come back for follow-up?

If you have the Duodenal Switch operation, you are required to follow up with us in months 1, 3, 6, 9, 18, and 24 after surgery (post-op). You are also recommended to follow up afterwards on a yearly basis. This schedule is also the same if you are having another weight loss surgery revised to the Duodenal Switch.

Do I need to keep my follow up appointments? Can’t my primary doctor do the follow ups closer to home?

Yes, it is very important to keep your appointments. We need to know that you are effectively absorbing your nutrients and are not losing the weight too fast or too slow. We can also evaluate to make sure that the weight loss is mostly fat and not muscle. Failing to keep your appointments puts your health at risk. While your primary doctor will play a big role in your follow up, we also need to see you and will send requests for the necessary lab tests.

If you are having adjustable gastric banding, or Lap Band®, you will then be expected in our office 7 to 14 days after surgery. The first adjustment will take place 4 weeks later. Different patients require different numbers of port adjustments to optimize the size of the band. The average patient may need 4 to 9 adjustments.

Are the surgeries done open or Laparascopically?

The Duodenal Switch operation is done both open and Laparoscopically. The majority of the revisions are done with open surgery. Lap Band® is performed with laparoscopic surgery

How do I decide if I should have the Duodenal Switch or the Lap Band®?

We do not recommend the adjustable gastric banding procedures for anyone. It has shown to have high complication rate and a very poor long-term weight loss.

Will I have saggy/extra skin after my weight loss surgery?

You may or may not. It will depend on a number of factors, such as your BMI, age, or the presence of another disorder or disease.

How much protein should I take every day?

An individual’s protein intake is based on his or her weight in Kilograms. The requirements are also dependent on the needs of each patient. Additional protein is needed for healing after surgery. Most patients should aim for 1 Gram of protein for each Kg of their lean body weight. This may be difficult to calculate precisely, so the average patient may safely aim for 80 to 100 grams of protein every day.

How do I convert pounds (lb) to kilograms (kg)?

1 lb = 0.453 kg or 1 kg = 2.2 lb
Example: 5 kg equals 5×2.2=11.0 lb
Example: 5 lb equals 5×0.453=2.27 kg

What is Sugar alcohol?

Sugar and sugar alcohols are each considered nutritive sweeteners because they provide calories when consumed. Sugar alcohols, or polyols, contain fewer calories than sugar. Sugar provides 4 kcal/gram and sugar alcohols provide an average of 2 kcal/gram (a range from 1.5 kcal/gram to 3 kcal/gram). Contrary to the name, sugar alcohols are neither sugars nor alcohols. They are carbohydrates with structures that only resemble sugar and alcohol.

Foods that contain sugar alcohols can be labeled sugar-free because they replace full calorie sugar sweeteners. Sugar alcohols have been found to be a beneficial substitute for sugar for reducing glycemic response, decreasing dental cavities, and lowering caloric intake.

Sugar alcohols naturally occur in many fruits and vegetables, but are most widely consumed in sugar-free and reduced-sugar foods. The sweetness of sugar alcohols varies from 25% to 100% and is as sweet as table sugar (sucrose). The amount and type that is used will be dependent on the food. The following table lists the details of each of the sugar alcohols.

sugar-alcohols

How do I make an appointment?

Appointments can be made by contacting our office at 818-812-7222. A new patient inquiry can also be submitted online and our staff will contact you to schedule a consultation.

How much am I looking at spending out of pocket?

This varies depending upon your insurance benefits. These can be determined by faxing your insurance card front and back to 818-952-0990 or e-mailing a copy to contact(at)dssurgery.com

Why do I have to see a psychologist?

Most insurance companies require that a psychological evaluation be performed prior to weight loss surgery based on the recommendation of the National Institute of Health (NIH). A psychologist is usually available for consultation at the time of your initial appointment with us. His fee of $200.00 is not included with the cost of your consultation.

If I go to my own psychologist, what do I tell him? Is there a guideline I can take to him?

We do not have a specific guideline that must be followed. Most psychologists are aware of the type of evaluation required for weight loss surgical patients.

What room and board accommodations are available in Glendale?

What does the program fee cover?

The program fee covers two years of follow-up care, workbook and education on topics critical to the patient’s health, nutrition, and weight loss, as well as support group meetings and the completion and processing of one’s disability/leave form.

What is the Duodenal Switch and how is it different than the Gastric Bypass?

The Duodenal Switch operation is restrictive as well as a malabsorptive, which makes the stomach less absorbent of food. Gastric bypass operation is only a restrictive procedure. The mechanism of action, safety profile, short and long term complications, short and long term success between the two procedures are different. It is our opinion that the duodenal switch operation is a far better procedure compared to the gastric bypass surgery. It is very important, however, that patients educate themselves about all the surgical procedures prior to making a decision.

Does my insurance usually approve the surgery?

We can’t give a general answer to this question. There are thousands of insurance policies, each with their own requirements. Even if weight loss surgery is a covered benefit of your plan, this does not guarantee that your surgery will be approved. Each patient’s case requires individual review, at which time coverage will be determined.

How long does it take to get an approval?

This depends on how quickly the patient completes his or her work-up. Once the work-up is complete, authorization is requested by your insurance. The waiting period for approval depends on the type of insurance you have. It can take anywhere from 5 to 45 working days

Post-Operative (After Surgery) Questions

I have been having diarrhea since my surgery. What causes that?

An increased number of bowel movements are normal shortly after the Duodenal Switch operation. Some patients will also experience very loose bowel movements. Excessive diarrhea can lead to dehydration. You need to look at the amount of fats in your diet, as well as the type of protein you are consuming. Whey proteins can cause diarrhea because of the milk products content. Other dairy products, such as milk, cheese, sour cream, etc., may also cause diarrhea, as well as fried or fast foods, and need to be avoided. Artificial sugars can also cause diarrhea. Try keeping a food diary in order to recognize trigger items. If your bowel movements continue to be excessive call the office for a follow up appointment.

Should I avoid all fats to help me lose weight?

This will depend if you have had the Duodenal Switch or the Lap Band® operation. It is generally okay to consume some fat after the Duodenal Switch operation, since you will only be absorbing a small portion.

Why do I need to drink so much fluid following surgery?

In addition to nausea, vomiting, weakness, and confusion, dehydration can also lead to blood clots, as your blood becomes thicker and stickier. You can get into a vicious cycle with the loss of fluids, as the more dehydrated you get, the less you may be able to take in by mouth. This may require hospitalization so that Intravenous hydration can be provided. Drinking a lot of fluid is a top priority and it is important not to fall behind in this regard.

I cannot take much in by mouth. What is the most important for me to take?

Water is by far most important to take in, as you need to avoid getting dehydrated. At times, this may result in nausea or dark infrequent urine. The surgeon will make specific recommendations depending on each case.

I am constipated, should I take a laxative to help me go?

The first step is to make sure that you are drinking enough water. No laxative is needed or recommended. After the Duodenal Switch operation, a patient will absorb far less amounts of ingested fats. Increasing your fat intake in moderation will sometimes help with constipation. Call our office if the problem persists.

Is drainage from the incision normal? How do I care for it?

Some patients have some drainage from the top or bottom of the wound a few days after being discharged from the hospital. This is expected because of the poor healing properties of the fatty layer under the skin. In some patients, other conditions may contribute to this. These include diabetes, a history of smoking, etc.

Keep the area clean and dry by showering 1 to 2 times daily. Wash the area with soap and water and remember to dry well. The drainage should subside after a short time, but varies from patient to patient. If the wound or drainage changes in any way, such as pain, redness, warmth, color, thickness, smell, etc., call the office immediately.

Is it normal to feel hungry after surgery?

Yes, you should still be able to tell when you are hungry, but need to learn to the difference between mental hunger and actual hunger. This is hard to do in the first few weeks as you learn to cope with the separation from food and allow yourself time to get through the situation. Most patients after the Duodenal Switch may not be able to tell the difference between feeling full or hungry. The safest approach to this is to err on the side of having small frequent meals rather than large meals to satisfy “hunger.”

For the past two weeks I have been having episodes of nausea and vomiting, is that normal?

No. It does not matter if days, weeks or months have passed since the operation. Whether you had the Duodenal Switch or the Lap Band®, persistent episodes of nausea and vomiting should be evaluated by a doctor.

What happens if I lose too much weight?

We can usually stop excessive weight loss with prescription supplements that allow you to absorb more of the food that you eat. This process will generally slow or stop the weight loss and prevent you from needing surgery to correct the problem. Call us if you are concerned that you may be losing too much weight. The treatment for excessive weight loss after Duodenal Switch includes enzyme supplementation and possible surgery to lengthen the common channel. With Lap Band®, it may be as simple as taking the fluid out of the band and making sure there are no other issues.

The health food store has Enzymes that the clerk says would be good for me, should I take them?

No. Enzymes will “undo” the malabsorbtion component of your surgery, which means you will absorb much more of what you eat and begin regaining weight. You must take the supplements recommended by your surgeon. If you have any questions regarding any product or supplement, contact your surgeon.

Why can't we take Iron and Calcium together?

Calcium inhibits Iron absorption. This blocking effect of iron absorption is dose independent, meaning that even a very little amount of Calcium may block most of the Iron absorption.

How far apart should we separate taking Iron and Calcium?

60 minutes or so will provide adequate time for the stomach to empty.

Can we take Iron with other Medications?

No. The best way to take Iron is on an empty stomach with some orange juice.

What is ADEKs?

ADEK stands for the fat-soluble vitamins, A, D, E and K.

Others are taking ADEKs, should I be on ADEKs?

No. ADEK is prescribed to patients after the Duodenal Switch operation and only after their lab results demonstrate deficiency of one or more of these fat-soluble vitamins.

Calcium Citrate Vs. Calcium Carbonate is always a hot topic. Which is better. Why?

calcium-citrate-vs-calcium-carbonate

The above table indicates that Calcium Citrate is absorbed easier, but more is needed for the same amount of elemental calcium. Less Calcium Carbonate is needed to get the same amount of elemental calcium, but the absorption is less efficient. Medical literature provides supporting data for recommending either one. We believe that at least in the beginning, most people could take either type. The decision of which one to take should be based on which is tolerated better. Later recommendations for changes will be made.

I have received a letter from your office about a Vitamin D3-50 prescription and I am unable to have it filled at my local pharmacy. What do I do now?

Vitamin D3-50 is vitamin D3, 50000IU. There are a number of places that you can get it from. The letter sent to you had one of the sources. Another place where you can get it from is here.

What is dry vitamin A? why can I not have regular vitamin A? Where do I get dry vitamin A from?

Vitamin A is fat soluble. After the Duodenal Switch operation, you may not absorb adequate fat and vitamin A (which is fat soluble). To resolve this problem, vitamin A is formulated to become “water soluble”. “Dry” or “water soluble” vitamin A does not rely on fat absorption to be absorbed.

Hernia Questions

What is a hernia?

A hernia is a weakness in one of the layers of the abdominal wall. This allows for the content of the abdominal to be displaced and move closer to the skin.

How do I get my hernia removed?

A hernia is repaired surgically, but not removed.

How can I tell if I have a hernia?

A hernia may show itself in the form of an asymmetrical “bulge” around your incision. The best way to know, however, is to ask your physician.

What does it feel like?

Depending on the location, size, and content of the hernia, the feeling may be different for each individual. Some patients may only have the protrusion under the skin, while others may get very sick with nausea and vomiting. As previously indicated, the best way of identifying a hernia is to be seen by your physician, who can provide the correct diagnosis and treatment options.

Why is a small hernia more dangerous than a large one?

Small hernias have a much higher chance of trapping their content, which is called an incarcerated hernia. A large hernia has such a large opening that it would be less likely for its content to not reduce back.

Should I wait to have my hernia fixed?

This is a very complex question and depends on the size and location of the hernia, as well as the presence or absence of any symptoms; based on this information, your surgeon’s recommendation will differ. Please be seen by your physician for an evaluation.

What is a mesh?

Some hernias are large enough that the two edges cannot be secured together without tension. In those cases a mesh is used. A mesh can either be a synthetic or natural product. The synthetic mesh materials are permanent. The surgeon may choose which type of mesh to use depending on the details of each particular case.

Can I feel the mesh?

Most patients are unable to feel their mesh. Some will feel the edge where it is secured to your natural tissue.

Why do some people keep getting hernias?

The causes of hernias are multiple. A number of factors may cause recurrent hernias, including patient related conditions, such as the presence of infection, diabetes, smoking, etc. Large hernias in active males are also more prone to recurrences.

Can I prevent getting a hernia?

You can probably significantly reduce the chance of recurrence by following your surgeon’s recommendations. There is no sure way to prevent a hernia. Wearing an abdominal binder does not prevent a recurrence.

Can my hernia and a tummy tuck be done at the same time?

In most cases, two operations can be done at the same time. There are instances, however, in which each procedure needs to be done separately.

Lap Band

How much weight will I lose after Lap band?

The amount of weight loss varies from patient to patient and depends on lifestyle and eating habits. A weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less.

What is placed inside of the Lap Band®?

Sterile Saline (salt water) is used to adjust the Lap Band.

Does my insurance company pay for the adjustments?

This will depend to your insurance and the health plan.

On average, how much is spent on adjustments?

It only takes a few minutes to adjust the band, which is done in the office.

How many adjustments will I need?

This varies from patient to patient. The goal for each patient is to stay in the “green zone.” For some patients, this may require more frequent adjustments, but less for others. It is very important to appreciate that a close follow-up is imperative for the successful weight loss after an adjustable gastric banding procedure.

For the Lap Band, what does the insurance cover?

Most insurance, if they cover weight loss surgery, will cover the cost of the operation and the follow up for a period of 30 to 90 days.

Does the gastric banding system limit any physical activity?

No, the gastric band does not affect or hamper physical activity including aerobics, stretching, and strenuous exercise.

Can the band be removed?

The band and the port can both be removed if there is a medical reason for it. Weight regain is almost certainly expected after band removal.

Do I have to worry about the access port? How do I care for it?

There is nothing you have to do for the access port. The port is placed in the fatty tissue under your skin. If there is any persistent discomfort, redness, or discharge from the port area, talk to your doctor as soon as possible.

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