Managing Nausea and Vomiting after Bariatric Surgery

Two nights ago I met one of our patients in the emergency room because she was unable to control the sensation of nausea and had been vomiting at home. I had just discharged her from the hospital that very morning after an uneventful time in the hospital following a laparoscopic gastric bypass two days before. Most patients do not complain of these symptoms after bariatric surgery but occasionally nausea is significant problem.

Here are three steps to avoiding nausea and vomiting after bariatric surgery:

1). Maximizing prevention by medications given prior to surgery. My routine for my patients includes Zofran 4 mg given intravenously by the nurse just before surgery. I also order Decadron 10 mg through IV just before surgery as long as the patient is not diabetic. (This steroid medication will cause a high sugar level in diabetic patient.) Finally, if the patient has had nausea with previous operations or has a history of motion sickness I will prescribe a scopolamine patch to be placed behind the ear starting the night before surgery. This helps to prevent motion sickness but can be very helpful to prevent nausea after an operation as well. This patch can stay on for three days delivering a small amount of medicine slowly during this time. The reason it should go on the night before is to assure an appropriate amount has been absorbed by the time surgery starts.

2). After surgery my preferred medication is Zofran if the patient feels nauseated. This can be given through the IV while in the hospital or by mouth in pill form if the patient is at home. The scopolamine patch can be added for more severe symptoms. I prefer to avoid medications such as Phenergan or Compazine since they can cause very bothersome side effects.

3). Finally the speed of taking fluids may need to change. If you feel nauseated I suggest you slow down even more taking only teaspoons of fluid at a time and waiting at least 30 seconds between swallows since it takes about that long for the swallow to reach your revised stomach. Sometimes it is helpful to take the fluids at room temperature as well.

If the nausea and vomiting persists call your surgeon so you don't become dehydrated.

If nausea and vomiting develops weeks, months or years after bariatric surgery consult your doctor or surgeon as this may be a symptom of a narrowing or ulcer.

With good preoperatve preparation nausea and vomiting can usually be avoided.. However, if it does occur I hope this posting is helpful to you..

The Patient First and Foremost

Shown here is the original "clock tower" building of the Reading hospital and Medical Center. It has now grown to a large full service 650 bed regional medical center. I have only been on staff here for about 10 days but I am very impressed by two major focuses of this hospital:

1). A deep commitment to provide for the medical needs of persons of Berks County and the surrounding counties of Pennsylvania.

2). Provide the best possible quality care to each person.

"Of course!", you say. "doesn't every hospital try to do the same?"

Maybe most hospitals say they do but often their actions tell another story.

As hospitals proceed down the road to function as a multimillion dollar corporations, they begin to develop a corporate mind set and incentivize the administrators to produce more profits in each part of the hospital. This can squeeze each area so much that the quality of service to the patient begins to suffer. Less nurses, less helpers and less resources can and do produce more short term "bad" profits. But who really pays the price? Cost effectiveness is very important but it can not be at the expense of patient safety or patient lives. "Good" profits flow from great care, great patient satisfaction and patients that want to come back when they have additional medical needs. Patients want to know the hospital is there to serve them and provide for their needs not to make the hospital more financially successful.

Hospitals are not just businesses. There are lives at stake. Hospitals should not be incubators for administrators to climb the "corporate ladder". They should be places where the patient and their needs truly come fist. Administrators should come along side of the doctors and nurses to provide the resources necessary to provide the very best quality of health care.

Financial security of hospitals is important but should not become the driving force at the expense of the reason hospitals are here in the first place: to provide the best possible care for their patients.

Long ago we resigned ourselves to the fact that health insurance companies in the United States do not do what is in the best interest of the patient but they primarily are there to make profits for their shareholders and provide high incomes for the officers of the health insurance company. Sometimes this occurs by limiting access to care for patients. However We do not want our hospitals to go down this same road...but many are. Service to their community becomes an after thought and quality is felt to be the responsibility of the doctors and nurses no matter how little is provided to them in resources.

How refreshing it is for me to now be in a hospital system that has rejected the pathway of corporate greed in favor of a patient centered philosophy. Service to the community and providing the best possible care to each patient are goals I can really embrace. I congratulate The Reading Hospital and Medical Center board and administrators for a job well done. It is a pleasure to be here and to do all I can do to contribute to accomplish these goals.

Dr. Myers Starts at the Reading Hospital and Medical Center

Josh, Beth and Steve in frozen Toulouse. France
















Aaron, Elodia and katerina (Elodia's mother} in Africa














My wife, Beth, and I arrived in Reading, Pa just over a week ago. Whew! What a whirlwind of travel the last month before coming to Reading. Before I settled into my new position we wanted to visit our family who are spread thoughout the world We traveled to see our son, Aaron, who is an investment banker in Kinshasa, Congo, Africa. We had a great time visiting with him and meeting the young woman from Belgum who he plan on marrying. As we were ready to leave we were imformed Air France was on strike! Instead of a direct flight to Paris we were rerouted to Nairobi, Kenya then Amsterdam and finally to Paris before traveling to Toulouse, France to visit our other son, Josh who works for Airbus in sales and marketing. The trip from Africa was 36 hours in travel instead os an 8 hour trip straight to Paris. No matter. We were delighted to be met at the airport in Toulouse by Josh. It was a wonderful time with Josh and his wonderful girl friend, Melitza. Just as in Kinshasa we enjoyed remarkable restaurants and thoroughly enjoyed exploring the city. After several days with Josh, we traveled to Paris. Although we had not planned to be in Paris on Valentines day it was such a treat. We stayed at St. Jaque.s Hotel as we have many times on our trips back from Africa. We walked around the city seeing Notre Dame lit up at night, visited our friend Tim Meier who now lives in Paris and enjoyed time sitting in a cafe and talking. On return to our hotel we watched Midnight in Paris on my iPad. It was a very memorable Valentines night together.
In the morning we were off to the airport and on our way Bach to Columbus, Ohio.
We had only 10 days before leaving for Reading. Many wonderful good byes, and much time with family as our daughter, Summer, Andrew her husband brought our three grandchildren, Caed, Maddy, and Xavier for a wonderful few day visit. My other daughter, Stephaie, also became engaged that same weekend to a great young man, Matthew Catania. We even was able to meet Matt's family who are from Knoxville, Tenn before leaving for Reading.
Our road trip to Reading included a visit with my parents in Akron and time with Beth's ailing father near RochesteR, NY. We finally arrived at our temporary apartment late in the evening.
After a couple days of rest I started working at the Reading Hospital and Medical Center. I am truly delighted to be here and am so encouraged by their commitment doing the very best for their patients and their community. As Director of Weight Loss Services including bariatric surgery, it is a privilege to work along side Dr. Fred Ceppa, another experienced bariatric surgeon and a great team at the Reading Hospital Weight Management Center.
The Reading Hospital has two surgical robots with of most advanced technology in the world. It will be a privilege to continue my work in robotic bariatric surgery. I will update my readers with the results of my recent research in robotic bariatric surgery in a posting within the next few days. It is great to be here although I certainly miss all of my friends, many patients and colleagues from the great state do Ohio. Thanks to all of you for the many wonderful years my wife and I enjoyed there.

Dr. Myers Signs Contract with The Reading Hospital and Medical Center

I am now able to announce that I have agreed to become one of the bariatric surgeons at The Reading Hospital and Medical Center and the Medical Director of the Weight Management Center of the Reading Hospital beginning February 29, 2012. The Reading Hospital and Medical Center is a 650 bed hospital that serves a large area just west of Philadelphia. After much careful consideration I have selected this new location near Philadelphia, Pa for the following four reasons:

1). The Reading Hospital has had a decades long track record of deep commitment to persons of size with a large program performing over 400 bariatric operations per year.

2). The Weight Management Center is a comprehensive approach consistent with my core values for caring for persons of size

3). It will be my privilege to work along a bariatric surgeon, Fred Ceppa, MD, who demonstrates deep empathy for patients who are suffering with the medical, social and psychological difficulties brought on by obesity. Dr. Ceppa has excellent outcomes and a very low morbidity and mortality rate.

4). I will be able to continue perform surgery with a surgical robot, continue to do research to profect robotic bariatric surgery further and provide the highest quality of care for my patients.

Although it is difficult for my wife and I to leave our many friends in Ohio, I would be honored to care for patients from all over the United States or from around the world if they chose to travel to Reading Hospital and Medical Center.

I will continue to contribute to this blog as frequently as I can to help as many bariatric surgery patients as possible obtain their best possible results no matter where they chose to have their operation.

A Very Merry Christmas from Rev. Gary Rode

Dr. Myers,

Just wanted to drop you a friendly hello and wish you a Merry Christmas.

I received the letter this fall announcing that your were making some changes in your professional life. Hope that is turning out well for you. I know that I really appreciate the care and skill that you and your staff demonstrated in my surgery and in our doctor/patient relationship.

I wanted to give you an update on how things are going for me. Last May when I came in for my one year check-up for my gastric by pass surgery, lab tests showed that my A1C was 7.3 At that time you recommended that I begin taking Metformin. I went home and thought about it. One of the reasons that I had the surgery was to get off of diabetes medication. So I decided to try an alternative treatment. Something really radical. I started to exercise. Yes, I know that everyone on your staff reminded me over and over again about the importance of exercise. But the weight was rolling off without the exercise, so I just ignored it.

Finally in mid-June I began a program of walking/running for 30 minutes per day. Eventually I arrived at the point where I could run the full 30 minutes. Finally in early September I ran in my first 5K, a fund raiser for a local ministry that provided housing and care for the Mentally Retarded ( I have two adult sons with Downs Syndrome). In mid-October I saw my local family doctor, and by adding "running" to my treatment regime, my A1C dropped from 7.3 down to 6.6. I am thrilled. He seems to think that if I continue this the A1C will drop even further. Since then I have ran in two more 5K races -- one to support Special Olympics, and another to support Hospice of Northwest Ohio (My mother died in March 2011 and received Hospice care.) Even though the temperatures are dropping, I have bought the necessary clothing and I am hitting the streets at about 6:15 am, 4-5 times per week running 3+ miles. I look at it as my diabetes medicine. Before having bariatric surgery, I sometimes thought about running. In fact during part of my pre-surgery goal setting, I had running as a potential future activity. I find that I am really enjoying doing it. My health is great, my weight is staying down, I have lots of energy, and my diabetes is under control.

Thanks again for your help and best wishes with your changes.

Gary Rode
United Methodist Pastor
Perrysburg, OH

Thank you Gary for allowing me to share this with everyone. This should be an encouragement to all of us to work hard at staying active. Great job and congratulations! Merry Christmas to you and yours as well.
God bless.
Dr. Myers

A Message of Thanksgiving from Joanna

Dr. Myers—

I hope this finds you well and moving forward. I think of you often and wonder where you have decided to practice, but I am especially thinking of you this week as I am reminded by this season to ponder all the things for which I am grateful.

You and your work, Dr. Myers, are near the top of the list, behind only God’s gift of a relationship with Him and the gifts he’s given me in my family and friends. Because of your work, you have helped to give me a life I thought I would never have. I am still surprised when I walk by the mirror at my new body, and it’s been four-plus years since surgery!

I have no pain in my joints and back because I don’t carry the extra weight that was previously putting stress on them. I have more energy to keep up with my disabled daughter and my teenagers. I no longer fear the blood-pressure cuff, which previously revealed increasing numbers. I enjoy shopping, and rather than worry about finding something that I feel comfortable in, I have to worry about spending a little bit too much money!

My husband, who has always been a loving, generous man, and claims he always found me beautiful, can’t stop telling me what a beautiful woman I am. I am more comfortable moving toward people and getting to know them and allowing myself to be known. I can’t think of any aspect of my life that having this surgery hasn’t touched. I feel that I have freedom to be the woman that God created me to be—a freedom that I’m sure that I had as a larger woman, but didn’t realize, didn’t grasp hold of.

I continue to meet people who have had bariatric surgery, and I am always glad to meet them and eager to share my story. I am increasingly shocked when I find out that many of them had little or no preparation in changing their eating habits, dealing with their emotions, and increasing their activity prior to surgery. I am even more shocked when I learn that some of these people are chewing food at 6 weeks! So, I’m not surprised, but definitely saddened, when I find out that these same people are returning to some of their old habits—particularly eating sugar—just months after their surgery! It is so sad!

I am so, so grateful to you Dr. Myers that you have refused to water down your standards and that you’ve chosen to stand by what you know is true about what is best about your patients. I wish you and your family only the best as you move forward in your career. I hope that wherever you have chosen to practice, that you will invite me sometime to speak at one of your seminars. I love to share my story, love to travel, and welcome the chance when I am able to get coverage for my special needs daughter Jessica.

Wishing you all the best this Thanksgiving season and always,

Joanna

Thank you for such a special Thanksgiving message. I am so pleased you are doing so well four years after your operation. I am in discussion with a hospital in Reading, Pa and Grand Rapids, MI. I will certainly let you know when we have made a final decision.

Happy Thanksgiving to you and your family and to all of my patients.

Dr. Myers

More from James Bennett

James Bennett recently sent me more information and postoperative pictures to add the story he recently shared on the blog. Here are his additional comments:


My total weight loss I measure from the night I went to your seminar. I weighed in that night at 406 lbs. I now weigh between 182 and 185! From size 56 jeans to 34 slims! From big and tall to the young mens dept! Instead of being parked on the couch I now re-enjoy camping, hiking, lifting weights, fishing, golfing, and so on! personal physician doesn't think my idea of skydiving is safe because of my artificial hip and spinal fusion, but he may okay zip lining, which I am looking forward to! Jen and I would still be more than willing to speak for you wherever you move your practice to!

Sincerely, James Bennett