Thursday, August 28, 2008

Gastric bypass surgery patient story: The road to recovery continues

Columbia, TN
here are very few times when I am driven to tears.

However, sometimes there are instances that a person can’t control their emotions.

That happened to me this morning when my little brother Ben called to tell me that Wednesday was a special anniversary.

He reminded me that it has been exactly one year since he underwent gastric bypass surgery.

As I chronicled in a column last year, Ben has struggled with his weight for many years before finally reaching his breaking point.

Ben weighed in at a debilitating 452 pounds and was literally struggling with nearly every breath.

After trying and failing with several different weight loss methods, Ben made the difficult decision to undergo gastric bypass surgery.

The results have been nothing short of amazing.

Ben’s latest weigh-in had him coming in at a svelte 260 pounds. That means that he has lost 192 pounds since that momentous day last August and I couldn’t be more proud.

The before and after pictures of him are so startling that I was glad I was sitting when I first saw them.

There’s no way to accurately describe the difference in his appearance that has taken place in just a year.

In addition to his physical appearance, Ben’s mental health has also improved. He realizes that he has a new lease on life and expects to take full advantage of it. As Ben put it, he was once dying from obesity, depressed and feeling hopeless, but now he is full of joy with renewed hope.

That’s what this crazy world is all about, isn’t it?

People somehow finding the strength to battle through adversity to better themselves.

With the high stress, non-stop lives that most of us lead, sometimes it’s hard to keep things in the proper perspective.

Ben’s struggle has helped me to do just that.

He is an inspiration to me and a constant reminder to not take for granted those things which I cherish in my life like my beautiful wife and son.

In a world where sometimes we put an unhealthy emphasis on sports, it’s good to be reminded there are also other things to be concerned about.

Don’t get me wrong, I’m still sports-crazed.

Trust me — new perspective notwithstanding — I will be on the edge of my seat Sunday afternoon watching my Kentucky Wildcats battle loathsome Louisville.

But while my love of sports will never lessen, I’m going to try and not let it dominate who I am.

Sports are great and serve as a wonderful diversion from the struggles that so many people face.

However, sports are just that, a diversion.

I truly hope that is the lesson I can take from Ben’s journey that only has 60 pounds remaining.

I know 60 pounds seems like a lot, but it is nothing but a final bump on Ben’s remarkable road to recovery.

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Wednesday, August 27, 2008

What Are The Risks Of Lap Band Surgery?

Best Syndication
No doubt you've been reading a lot more about lap band surgery, adjustable gastric band surgery and gastric bypass surgery in the past few years than ever before. Although weight loss surgery has been around for many years, newer procedures and techniques have made it safer and more common. However there are many risks of lap band surgery, complications and side effects to be aware of.

If you've been thinking about a gastric banding procedure to lose weight, such as lap band surgery, which is a safer alternative than permanent gastric bypass surgery, you may be wondering what the health risks are or what possible complications can develop from this procedure.

When doing your research online you'll no doubt read on the lap band websites that are promoting lap band surgery some of the risks and complications but you need to find out all of the risks and possible complications. You'll also want to know what side effects to expect and if you can handle these. And will you lose weight and if so at what pace?

Of course one of the best ways is to read articles like this and to go to lap band forums where you can discuss your concerns. You particularly want to find forums that are comprised of people who have had lap band surgery and see what they have to say, good and bad, and what testimonials you can find.

Any surgery can be risky and many have more risks than others. In any event elective surgery is always something that should not be taken lightly. As a nurse I've been present at many surgeries and although most of the surgeries go well, there are those that have complications. If a patient is obese or overweight or are carrying a lot of extra fat tissue, there can be some serious health problems present that may or may not be evident or known about and may have serious health consequences regardless of the type of surgery the patient is having.

Some of the risks to be concerned about are those that are general to any surgery and are influenced by your age, weight, how you react to the anesthesia and what diseases you may have and whether they're related to your weight problem or not. I won't go into all the risks of general surgery here but focus on the specifics risks and complications for lap band surgery.

The biggest risk of lap band surgery is the possibility of gastric perforation during the surgery, which happens in about one percent of the surgeries. Gastric perforation is a tear in the wall of the stomach.

Following lap band surgery there are numerous complications that can develop over the next few months or so. These can range from the lesser mild to more serious. Directions after surgery must be followed closely, as solid food eaten too early can cause a medical emergency. This mistake is made if the weight loss surgery patient eats solid food in the day or two after surgery or if they have traveled to Mexico or another country and fly home soon after surgery and think it's okay to indulge a little. Make sure you understand the lap band diet and understand liquid food and solid food restrictions.

Side effects can affect many patients such as nausea and vomiting and some will experience regurgitation. Some patients will find that the band has slipped and it'll need to be adjusted and some find that the passage is blocked between the two sections of the banded stomach.

The extended list of risks include ulceration, gastritis, which is irritated or inflamed stomach tissue, GERD (gastroesophageal reflux), which is regurgitation, heartburn, bloating from flatulence (gas), difficulty swallowing, dehydration, constipation, regaining of weight and rarely death but needs to be mentioned. If the surgery is done laparoscopically rather than a full open surgery then there are other problems that can develop such as liver damage or spleen damage (requiring removal of the spleen), damage to the blood vessels, lung problems, blood clots, the rupture of the incision and perforation of the esophagus or stomach during surgery.

Following surgery there are problems that can develop with the lap bad system type of gastric banding and they include: a deflating of the band causing leakage, which can come from the tubing band or the reservoir, slippage of the band or stomach, an enlargement of the pouch and the stomach outlet can be blocked, or the band can erode directly into the stomach.

Be aware that the cost of lap band surgery may rise if you have after-surgery and ongoing complications that are not fully covered under your health insurance plan or affect your pocketbook if you are paying cash out of your pocket. So you want to research this also.

Although lap band surgery is typically done laparoscopically, in some cases the surgeon may have to switch to a more open method of surgery, which has happened in about 5% of the cases as reported in a U.S. clinical study.

Make sure that you completely understand all the risks of lap band surgery and adjustable gastric banding and discuss them fully with your bariatric or weight loss surgeon before undergoing this surgery. Although safer than the more permanent gastric bypass surgery it does come with risks, possible complications and side effects. What is not known are the long term effects of this surgery. This is true whenever you tamper with nature. So it's better to be safe than sorry. Make sure you do plenty of research before you commit.

By: Helen Hecker

No doubt you've been reading a lot more about lap band surgery, adjustable gastric band surgery and gastric bypass surgery in the past few years than ever before. Although weight loss surgery has been around for many years, newer procedures and techniques have made it safer and more common. However there are many risks of lap band surgery, complications and side effects to be aware of.

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Saturday, August 23, 2008

Gastric band weight-loss surgery can boost reflux

From U.S. News & World Report

Obese patients with GERD may choose gastric bypass instead, experts say
Gastric banding, a surgical procedure designed to combat obesity, appears to boost the risk for developing or exacerbating symptoms of gastro-esophageal reflux disease (GERD).

The finding stems from a review of research on the link between obesity and reflux. The experts concluded that gastric bypass may help reduce GERD, but gastric banding does not -- a finding patients may want to consider when choosing one form of weight-loss surgery over another.

"For people with obesity and reflux together, the gastric bypass procedure appears to be effective not only for weight loss, but also for the control of reflux symptoms," concluded the review's lead author, Dr. Frank K. Friedenberg, an associate professor in the section of gastroenterology at Temple University School of Medicine, Philadelphia. "Because in this case, most of the acid from the stomach is being partitioned away, so it doesn't have exposure to the esophagus," he explained.

"However, with gastric banding, the problem is that you actually create a pocket which acid has the ability to fill from the remainder portion of the stomach," Friedenberg said. "And this acid can just sit there above the band, and make its way back up to the esophagus. This can cause reflux disease to develop, or make it worse than it had been if it was a problem before the procedure."

Friedenberg and his colleagues published their findings in the August issue of The American Journal of Gastroenterology.

Gastroesophageal reflux disease (GERD) occurs when a muscle at the end of the esophagus does not close properly, allowing irritating stomach contents to leak back into the esophagus. Symptoms include heartburn and acid indigestion.

According to the new analysis, involving numerous studies, a high body mass index (BMI) and/or high amounts of abdominal fat does appear to raise the odds for significant acid reflux.

The researchers also found that diet-induced weight loss can help minimize GERD symptoms.

However, not all weight-loss surgeries were equally beneficial with respect to GERD, Freidenberg's team found.

Across several studies, a procedure known as Roux-en-Y gastric bypass -- which involves the creation of a small gastric pouch walled off from (or bypassing) the rest of the stomach and intestinal track -- consistently appeared to help patients shed pounds and eliminate or reduce GERD symptoms.

However, laparoscopic (gastric) banding was found to be less helpful in tackling GERD.

The popular surgery, which involves the placement of a band to divide and reduce the size of the stomach, initially debuted in 1993. It has proven effective in helping patients feel satiated earlier, spurring weight loss.

Patients often did lose weight after banding, the researchers found, and this reduction in weight did not immediately encourage GERD. In fact, in some cases, post-procedure weight loss appeared to moderately reduce some reflux disease symptoms, the researchers said.

However, the inserted gastric band often seems to shift in place over time, they said, leading to a reversal of any initial benefit and a gradual worsening of GERD symptoms.

Based on these findings, Friedenberg and his team concluded that gastric bypass may be "the preferred surgical technique" with specific regard to GERD risk. But they also pointed out that more rigorous studies need to be conducted to better understand the how's and why's of reflux disease in the context of weight-loss surgery.

One expert said the current work highlights the need to carefully assess the pros and cons of each weight-loss procedure.

"Gastric bypass is the most common and the most successful of the surgical procedures to deal with obesity," noted Dr. Anthony A. Starpoli, an attending gastroenterologist at Lenox Hill Hospital and director of gastro-esophageal research and endo-surgery at St. Vincent's Hospital, both in New York City. "But the advantage to the banding procedure is that, although it will not be an effective option for all patients -- depending on the level of obesity -- it's a lot less aggressive than bypass and has a lot less morbidity associated with it. And it's much more reversible. So, there are reasons some patients might choose that option."

Read more Gastric band weight-loss surgery can boost reflux

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Gastric bypass surgeon and hospital face wrongful death medical malpractice lawsuit

Danbury, CT
The husband of a 39-year-old Ridgefield woman blames her surgeon and Danbury Hospital for her death on Christmas Day 2004.
Anthony Cataldo is suing Dr. Keith Zuccala, a Danbury doctor, and Danbury Hospital, claiming, among other allegations, that she was "improperly identified" as a candidate for gastric bypass surgery and that she wasn't properly cared for or monitored during a later hospital stay.

Lisa Ann Cataldo, a mother of two, had gastric bypass surgery Sept. 17, 2004, and was discharged three days later. One week later, she returned to the hospital, complaining of general abdominal pain, weakness and fever, and was seen in the emergency room, according to the complaint.

On Dec. 13, she had severe abdominal pain, the lawsuit says, and two days later she went to the emergency room, reporting her pain on a level of nine out of 10. She got there about 11:25 a.m. according to the lawsuit, which was filed in Superior Court in June.

She was moaning and appeared uncomfortable, and said she had been unable to eat or keep down fluids for two days.

About 2:30 p.m. that day she had a CT scan of her abdomen, and about 4:50 p.m. the films showed at least a partial small-bowel obstruction, according to the lawsuit.

Zuccala examined her in the emergency room and agreed to admit her for overnight observation on Dec. 15.

In the early morning of Dec. 16, she suffered from nausea, vomiting, dry heaving and increasing abdominal pain, the suit alleges. About 10:44 a.m. Zuccala performed a laparotomy to repair a perforated bowel.
Cataldo died on Christmas Day from sepsis caused by the perforated bowel, according to the lawsuit.

Hospital spokeswoman Andrea Rynn said there would be no comment.

Zuccala could not be reached.

Nor could Anthony Cataldo, who was appointed as executor of the estate on Jan. 12, 2005, be reached for comment.

Betty Ann Rogers, the plaintiff's Fairfield lawyer, declined to comment.

Cataldo time line Sept. 17, 2004 -- Lisa Ann Cataldo undergoes gastric bypass surgery. Dec. 16, 2004 -- she has surgery to repair a perforated bowel. Dec. 25, 2004 -- she dies. Source: a lawsuit filed in Superior Court by her estate

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Saturday, August 16, 2008

Former 1,100 pound man loses more than half his weight after gastric bypass surgery, now ca driver car and ride bike

Omaha, NE
Times are tough for the Nebraska man who once weighed more than 1,000 pounds, but Patrick Deuel says he's trying to stay positive.

Deuel weighed almost 1,100 pounds in 2004, and he had to have his bedroom wall cut open so he could be hospitalized for lifesaving gastric bypass surgery.

By late 2006 he was down to 370 pounds, but when he stepped on a scale in May he was back up to 540.

His wife says none the less, Deuel is able to go out and do the things he wants to do. His surgeon says his health is generally good, noting he can drive a car and ride a bike.

The former restaurant manager is now looking for a new line of work, while he and his wife survive on a Social Security check of less than $600 a month.

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Friday, August 15, 2008

Can gastric bypass cure diabetes?

San Francisco, CA

A new study is trying to learn whether a surgery meant to cure obesity, could also cure the symptoms of diabetes, even if the patient isn't overweight. It's a strategy that's not without controversy.
Pat Prescott is fighting to control her type 2 diabetes. She carries her blood glucose meter, a cooler for her insulin and gets regular exercise through ballroom dancing.

Still she says her symptoms have been getting worse.

"It just doesn't work anymore," said Prescott.

So when she learned that a surgery used to treat obesity has the side effect of improving diabetes, she approached her doctors, but was told she wasn't overweight enough to qualify.

Now, she's hoping to join a new clinical study, headed by surgeon Francesco Rubino. He is testing whether that same surgery, similar to gastric bypass, can improve diabetes in people who aren't obese.

"We're shifting towards a new concept, which is using surgery to intentionally treat diabetes," said Dr. Francesco Rubino from Weill-Cornell Medical School.

As he documented in the Journal Diabetes Care, when obese patients have surgery that bypasses part of their small intestine, their symptoms often disappear within days, long before they begin to lose weight.

"With some operations like gastric bypass or similar procedures, the remission of diabetes symptoms is very quick after surgery, which even precedes the weight loss," said Dr. Rubino.

In fact, researchers have known about those effects for several years. But offering gastric bypass to non-obese diabetics is controversial.

"I think it has no place outside of obesity surgery," said UCSF professor of endocrinology Dr. Robert Lustig.

Dr. Lustig says diabetes can be caused by combination of factors, including the health of beta cells, the agents in the pancreas that produce insulin.

"Diabetes is a complex disease. If you have a problem with your beta cells, then doing a bariatric surgery isn't going to rescue you," said Dr. Lustig.

Still, patients like Pat Prescott may have a part in testing the theory. Recruitment for the study begins this fall.

"I want to live long enough to enjoy my grandchildren. I want to keep dancing, I like to dance," said Prescott.

It's significant to note that the type of gastric bypass being tested in the study is performed on the small intestine, which has a complex role in how the body processes food.

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Wednesday, August 13, 2008

Are you a candidate for gastric byoass surgery?

The option of surgery to treat obesity has gained in popularity over the past several years. As the techniques and knowledge regarding the subject have improved, so too have the results. However, not everyone is a candidate for surgery when it comes to their weight. Moreover, one must be sound psychologically as well as physically to undergo either of the two most common procedures, Rous-En-Y gastric bypass and adjustable gastric banding.

Generally speaking, one must have a body mass index (BMI) greater than 40 to be considered for surgery, or have a BMI greater than 35 with one or more obesity related co-morbidities such as diabetes, obstructive sleep apnea, hypertension or the metabolic syndrome. In addition, it is rare that a physician or other healthcare provider will move right to the surgical option without first exhausting all the non-surgical options. Usually, both the surgeon who will perform the procedure and the individual's insurance company will want to see that the patient has truly "failed" diets, exercise, and group programs such as Weight Watchers, Nutrisystem and others, before agreeing to go ahead with surgery.

Both Rous-En-Y gastric bypass procedure and adjustable gastric banding are very effective at helping people lose weight. One study, which looked at any type of weight loss surgery, showed maximal weight loss at 1-2 years with a 32% drop for the gastric bypass procedure and 20% with the gastric banding procedure. The loss at 10 years post surgery was more modest but rather significant nonetheless with gastric bypass at 25% and gastric banding at 14%.

If you are an individual with the above mentioned criteria for severe obesity (a.k.a morbid obesity), and you have indeed failed many attempts at sustained weight loss over a period of a few years, weight loss surgery may certainly be an option, and you are encouraged to speak with your primary care provider about the subject. Be cautious though.

Firstly, by its mere nature, obesity, especially with co-morbid conditions such as diabetes, hypertension and high cholesterol, will put you in a higher surgical risk category with potential for more complications. Your surgeon and primary care provider will most likely want you to undergo a battery of tests to ascertain your overall health and suitability for the procedure as well as assess your perioperative risk for complications.

Also, often overlooked, is the psychological trauma for patients, many of whom have been heavy their entire lives and are not fully prepared for the change they will experience after surgery. For instance, some patients have battled depression and anxiety having come to identify themselves as obese, but now are no longer. They can have difficulty adjusting their psyche to a new body image. Moreover, the individual's relationship with food can change dramatically, especially after gastric bypass surgery, an added trauma. Often, one cannot eat as much post surgery and patients can find that an unusual issue to deal with having not anticipated this before the surgery. In all likelihood, one will most likely be required to undergo a psychological evaluation in addition to the physical one.

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Saturday, August 9, 2008

Gastric bypass alternative: Lap band procedure

Texoma, KS
We continue our Special Report on Fighting Obesity with a look at Laproscopic Adjustable Gastric or Lap Band Surgery. This operation does not interfere with the normal digestive process, but doctors say it's not for everyone because it does require a higher level of self discipline.

It's performed by placing a hollow band around the stomach. A small pouch is then created along with a narrow passage into the rest of the stomach. The band can be loosened or tightened over time by injecting saline into a small port placed underneath the skin. After the operation, patients can no longer eat large amounts of food at one time. At first, the pouch holds about 1 ounce of food, later most patients can eat about a cup of food without feeling sick.
"Some patients will say you know doctor that's really all that I need is to reduce the volume that I'm eating. And that will be adequate and indeed it does for some patients it will work very satisfactory." said Bariatric Surgeon Dr. Kenneth Warnock.
With any Bariatric Surgery comes the concern of life threatening risks. But Dr. Warnock says the reality is, the problems are often highlighted more than the success.

"Large studies show if compared to patients who have had surgery to those who have not at the end of approximately 8 years the mortality rate goes down 50% and that number includes all the risks and side effects of the operation itself." said Warnock.
In fact the medical risks of not having the surgery often far outweigh any concerns of having surgery! Both the Lap Band and Gastric Bypass are reversible but as you can imagine most patients never want to look back. In fact to keep from gaining the weight back, many join support groups.

"If they are going to do well they need life long professional support by someone who really understands."
Patients also get check ups from Dr. Warnock every six months for their rest of their lives. Patients say it's just another way to help hold them accountable.

"They say the doctor knowing I'm going to be back to see you in some fixed time helps me stay on the straight and narrow!"
The cost of the Lap-Band Procedure runs around $16,000. That price includes doctor and hospital fees.
We will continue our look into Bariatric Surgery every Wednesday at Five, Six and Ten through out the month.
Next week we take a closer look at two women who had Bariatric Surgery and how it's completely changed their lives.

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Tuesday, August 5, 2008

Workers' compensation insurer must cover obese worker's gastric bypass costs

Portland, OR
A 350-pound worker in Oregon injured his knee while on the job. But treatment for the injury wouldn't be effective because of his weight, and the physician recommended gastric bypass surgery. A lawsuit was brought and an appeals court sided with the state's Workers' Compensation Board, saying SAIF, a state-chartered workers' compensation insurer, had to cover the cost because the "injury was more than a minor cause of the claimant's need for gastric surgery and was therefore compensable."


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