Friday, April 24, 2009

Gastric bypass: One man's journey

Baltimore, MD
Obesity is a condition that can cause all sorts of serious health and social problems, and they're all too familiar for an 11 News photographer who decided to have gastric bypass surgery.

Obesity can affect many things in life, including fitting into a movie seat, traveling on an airplane or going to a baseball game. They were problems long-time photographer Howard Melnick has been familiar with his entire life. 11 News decided to follow him on his journey through gastric bypass surgery.

Howard Melnick's Interview
Dr. Thomas Magnuson interview

Melnick has struggled with his weight all his life. He said it's tough carrying around heavy equipment, especially when he weighs more than 400 pounds.

"I was the fat kid who was about 10 minutes behind everybody else on the track. I was the fat kid who couldn't do chin-ups," he said.
Howard Melnick
Photographer Howard Melnick chose to get gastric bypass surgery.

His obesity has led to hypertension, sleep apnea and serious knee problems.

"My knees are shot -- just shot, and I need my knees (for work)," he said.

Finally, Melnick and his wife, Debbie, decided he would have bariatric surgery, or gastric bypass.

"It's the curse of my life. With Debbie, we love our lives today ... except for the weight," Melnick said.

Melnick's wife said she was fully supportive of his decision, but still worried because it was a big surgery.

"I'm very nervous, probably more than he is," she said.

Dr. Thomas Magnuson, the chief of general surgery at Johns Hopkins Bayview Hospital, said the surgery would take about three hours to complete and told Melnick the procedure has come a long way since it was first developed.
"Twenty years ago, people would lose weight then gain it back in two years (after gastric bypass). Now, they're more durable," said Dr. Thomas Magnuson

"They're a lot safer and they work better and last long-term. Twenty years ago, people would lose weight then gain it back in two years. Now, they're more durable -- a lifetime," Magnuson said.

Melnick could eventually lose many of the medical conditions caused by his obesity, Magnuson said.

After extensive counseling on nutrition, lifestyle and exercise, Melnick had his surgery.

"It hurts when I sit up and lay back down, but when I'm walking, not so much. They had me up last night," Melnick told 11 News the day after his surgery.

One week later, doctors said the surgery went well, and Melnick said he had already lost about eight pounds and was feeling great.

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Tuesday, April 21, 2009

Healthy Weight: Malabsorption makes vitamins necessary for gastric bypass

Billings, MT
Dear Dr. Baskett: Is it true that you have to take vitamins after weight loss surgery and that you have to do this for the rest of your life?

Actually, yes, that is true. After you have had bariatric surgery, regardless of the procedure - adjustable gastric banding (AGB) or Roux-en-Y gastric bypass - you are able to take in fewer calories. You are eating smaller amounts of food at any one time and you should not be snacking between meals. Therefore, you are at risk for nutritional deficiencies.

For example, after you have gastric bypass surgery, you often are able to eat only about a 1/2 cup of food at mealtime.

If you have had AGB, your capacity is also restricted to 1/2 cup to a cup of food at mealtime. Certainly, the decrease in calories leads to weight loss. This is your desired outcome. However, you are not able to get in all of the various nutrients that you need - such as calcium, iron, vitamin B12, and folate. Remember, that if you have had gastric bypass surgery, there is also a component of malabsorption. This can lead to further lack of essential nutrients.
Fortunately, this problem is readily resolved by taking a vitamin and mineral supplement on a daily basis. What is of most importance, though, is that you use a high-quality bariatric vitamin and mineral supplement.

There are several different brands that can be used and your bariatric team can make a recommendation for one that is suitable for you. These supplements have been designed specifically for the person who has had bariatric surgery and they provide the needed vitamins and minerals.

More common vitamins such as Flintstones or Centrum do NOT provide the essential nutrients that a bariatric surgical patient will need.

In addition, these products are not well absorbed. Although the bariatric supplements may cost a bit more, they are well worth the investment.

If your supplement is inadequate, long term nutritional and metabolic problems can occur.

Again, because you are eating less food, you are taking in less of the healthier fats called essential fatty acids - the omega 3's and 6's. Therefore, it is also important to supplement with fish oil capsules, flaxseed oil, or essential fatty acids (EFA).

Daily supplementation with bariatric vitamins/minerals and EFAs will help you to stay healthy after bariatric surgery. Don't shortchange yourself in this area.

Dr. Kathleen T. Baskett is medical director of the St. Vincent Healthcare Weight Management Clinic and author of "Moving Forward: The Weigh to a Healthier Weight."

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Tuesday, April 14, 2009

Hospital criticized over death of 420-pound woman after gastric bypass surgery

Manchester, UK
A 420 pound woman who had a gastric bypass operation died at a hospital where staff hadn't been properly trained to care for obese patients.

Janice Barnardo, 46, was the first patient to undergo the weight-loss surgery at Tameside Hospital and was taken back in to repair problems with the surgery five days later.

A Stockport inquest heard staff were not trained to operate adapted beds for patients recovering from the surgery.

Miss Barnardo's bed - specially designed to provide support for overweight patients - had been left unplugged for two days. It was called a bariatric bed after the branch of medicine that deals with obesity.

Sections of the beds can be raised and lowered automatically to keep patients comfortable and prevent bed sores. Pathologist Andrew Yates said the cause of death was heart failure, gross obesity, high blood pressure, diabetes, asthma and pressure sores.

Jane Doyle, surgical ward manager, said staff had not been trained to operate bariatric beds. She said: "The hospital's bariatric policy was in draft form and had not been finalised."

Elaine Hughes said when her sister, Miss Barnardo, was put on a ward after leaving intensive care she felt unhappy.

Mrs Hughes said: "When she came back from the intensive care unit at Tameside, Janice was put in a bed at an angle at the end of a long ward.

"The first thing you saw coming on to the ward was Janice in a huge bed. She felt like she was in a freak show.

"We asked that she be moved to a side ward. That was so cramped we could not get around the bed." Miss Barnardo, from Mossley, had the operation in February 2007 and required surgery to repair a leak five days later. By the end of the following month, surgeon Abduljalil Benhamida discharged her to Shire Hill, Glossop, for rehabilitation.

But Miss Barnardo later developed deep bed sores and in May 2007 she returned to Tameside with septicaemia and later died.

Coroner John Pollard recorded a verdict of misadventure. He criticised nursing notes and said he would write to the chief executives of the local NHS trusts highlighting his concerns. After the inquest, Mrs Hughes said: "Janice's problems started on ward 15 at Tameside Hospital. Staff were not trained to care for bariatric patients."

A spokeswoman for Tameside Hospital Trust said: "This case highlights the complex medical and psychological rehabilitation needs of patients undergoing surgery of this nature and the need for careful assessment, planning and co-ordination of services to minimise the risk of similar problems in the future."

Jill Pinington, of Tameside and Glossop primary care trust, said: "Since Miss Barnardo's death an audit has shown a significant improvement in standards of documentation and note-keeping."

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Friday, April 3, 2009

Family demand answers after gastric bypass death

Macclesfield, UK
The family of a woman who died following a gastric bypass are demanding answers into her death.

Suzanne Wrighton, aged 59, died on May 30, 2008, less than 36 hours after having three operations at The Regency Hospital in Macclesfield.

Mrs Wrighton, who lived in Moreton Road, Crewe, decided to go in for the surgery paid for by the NHS at the private hospital because she was overweight and suffered from back pain.

Her husband Brian, aged 64, yesterday told an inquest into her death at Macclesfield Town Hall that he and his wife had been to two consultations prior to the operation and had been told there was a one per cent chance of fatality.

He said: "Suzanne had suffered from back pain for a long time. It started after she had a car crash in 1987. She had two operations on her spine but she still suffered from pain and she put on weight because she couldn't exercise.

"She decided on a bypass rather than a band. We know there is a risk with any operation but the risks we were told about weren't enough to worry her."

The inquest heard that after the first operation on May 28 Mrs Wrighton was in severe pain.

The following day consultant surgeon William Brough decided to perform a second operation to find out what the problem was but it wasn't until May 30 after the third operation that he found Mrs Wrighton had suffered a bleed.

Mr Brough said: "This was a rare complication that could not have been seen beforehand.

"It is the first time I have heard of a bleed from the staple line."

Mr Brough said that since Mrs Wrighton's death the hospital has altered protocol to ensure that all patients no matter how ill they are will have blood tests the day after the operation.

Mrs Wrighton died from adult respiratory distress syndrome (ARDS), which is when the lungs become filled with fluid and can't function properly.

Deputy coroner for Cheshire Janet Napier recorded a verdict of death due to complications following an operation for weight loss.

After the inquest Mr Wrighton, said: "We will be speaking to our solicitor and launching a complaint against the hospital. We are not happy with how Suzanne was treated. She was screaming out in pain most of the time she was in the hospital."

Suzanne's daughter-in-law Tammy Buxton, from Burslem, said: "The inquest hasn't really answered our questions.

"We still don't know why they failed to find the bleed until after the third operation.

"We have got to the bottom of the reason why she died. We don't want other families to go through the same pain and trauma we've been through."

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