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Tag: BPD

Staying on Track and Surviving Halloween

October 27, 2015 6:07 am

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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.

Teaching Nursing Students about Duodenal Switch!

October 19, 2015 11:34 am

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!

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Cindy Porcell, Surgical tech put the finishing touches on it.

In case you are wondering, surgical scrubs do not have bowties!

Internal Hernia And Bowel Obstruction

August 21, 2015 7:49 pm

Whenever there is a bowel resection with anastomosis made there will be a defect in the mesentery (the tissue that holds the blood supply and the nerves etc going to and from the bowel)  that needs to be closed. In this particular case, the stitches that were used to close the defect were intact and yet the tissue had separated from it. The result is an internal hernia. This can cause bowel obstruction, where by a loop of the bowel can go through the defect and kink the bowel causing the blockage. In some cases, the internal hernia may reduce itself with intermittent symptoms of the bowel obstruction and in other cases it may require immediate emergent surgery.  A CAT scan with oral and IV contrast is needed after Duodenal Switch to visualize the alimentary and bioliopancreatic limbs.

Symptoms may include but are not limited to:

  • nausea
  • vomiting
  • abdominal bloating
  • abdominal tenderness
  • cramping abdominal pain
  • diarrhea, constipation
  • feeling of inability to completely empty bowels
  • fever
  • severe abdominal pain.
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Mesentery Defect site of Internal Hernia

Informed Surgical Consent

July 18, 2015 9:39 pm

Surgical informed consent is the document that summarizes the discussion that has been carried out between the treating physician and the patient. It also outlines the expectations as well as the potential complications of the treatment being proposed.

An informed consent should mean that the patient is absolutely clear as to the procedure agreed upon and that is reflected on the consent. No abbreviations are allowed on the consent forms. Clearly, there are instances when a physician or surgeon providing service may have to deviate from the proposed plan and agreed upon procedure on the consent because of unexpected findings in the operating room.

Any patient undergoing surgery should be acutely aware of the terminology and the language used. With regards to weight loss surgical procedures, RNY and GB is not acceptable because they are both abbreviations.

Duodenal Switch is a distinct well described procedure with its unique identifiable code (43845 for open procedure) that is recognized by hospitals, insurance companies and the surgical societies.

Duodenal Switch operation is not SADI, SIPS nor a loop Duodenal switch. Any attempt to interchanges these terms or operations is inaccurate the say the least.

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A surgical informed consent is signed by the patient ( or the guardian) and the treating physician. This document however is reviewed and confirmed by all those involved in the patient’s care delivered in the hospital. The consent is reviewed by the admission staff when taking the patient for surgery, preoperative nursing and administrative staff, operating room circulating nurse as well as the anesthesia staff. One step most patients may not be aware is initiated after the general anesthesia is induced. The operating room staff, anesthesia staff and the operating physician all go through a set of checklist known as “Time out”.

“Time out” involves confirming the patient’s identification as well as the proposed procedure as the patient had discussed with the staff and confirming the consent.

It is imperative that a patient have complete understanding of their surgical options available to them and critical that they have full knowledge of the type of surgical procedure that has been consented to and performed.