Wednesday, December 22, 2010

Laura England Loses 100 Pounds in Five Months!


BEFORE

Laura England had a laparoscopic gastric bypass five months ago and was seen in my office for her five month follow up visit today. She has lost 109 since her operation and only has 68 more pounds to lose by the end of her first year.

She says she has 100% more energy and looks forward to exercising. She even went shopping on "Black Friday".

She no longer needs to sit down while singing in the church chior!





Recently others living in her comdominium suprised her by celebrating with this sign:

Tuesday, December 21, 2010

Robotic Surgery Update


We have now completed our first 44 robotically assisted gastric bypass operations. I am pleased to report that our patients are doing well. We have had no leaks and no transfusions. Most patients are now going home the day after surgery. Surgical pain is much less and patients seems to be pain free on their first office visit after surgery at 1 week after the operation.

We have needed to dilate one patient who developed a narrowing between the gastric pouch and the Roux limb of the small intestine.

We now are completing the operations in 2 hours.

Saturday, December 18, 2010

Call for Recipes


Have a favorite recipe(s) that has helped you in your bariatric surgery journey? We would love to hear from you! Sharing with us can help others in their journey.Feel free to share about your weight loss or other items that might be helpful to others.


Appetizers
Drinks
Salads
Vegetables
Soups or Stews
Fish and Poultry
Meats
Pastas
Casseroles
Desserts


Just send them to Kristi, one of our dietitians, at Run4sanity@yahoo.com. Kristi will do the nutritional analysis and we will share the recipes with our patients.

We would especially like to know your ideas of how to improve protein intake and use of non-calorie sweeteners!

Thursday, December 16, 2010

Anthem Medical Insurance Company Approves the Gastric Sleeve

Today we noted Anthem changed their policy and will now approve a gastric sleeve for bariatric surgery patients who would prefer to choose this procedure.

Blue Cross/Blue Shield companies usually follow the recommendation of Anthem.

This ruling reverses the previous policy that stated a "Gastric Sleeve is an experimental procedure".

A gastric sleeve is now the second most frequently performed operation in my practice after a gastric bypass.

I have had the privilege of performing about 150 Gastric Sleeve operations. Our patients lose 78% of their excess weight at one year on the average and it is not medically necessary to take a multivitamin and calcium after this operation although it is still encouraged.

This operation is best considered for patients who do not have significant diabetes since a gastric bypass is more likely to improve or resolve diabetes.

Thursday, December 2, 2010

A Bag of Calcium Chews Cost Grace $500!


I saw Grace Sexton in the office today and was startled when she told me a bag of chocolate calcium chews cost her $500. This is the story she said I could share with you.

Grace recently bought a bag of chocolate chews for calcium supplementation and placed it in a drawer at home. The chews must have smelled irresistible to her dog since he opened the drawer and proceeded to eat all 50 of them, wrappers and all!

That amount of calcium is toxic and chocolate is dangerous to a dog as well so off to the veterinarian they went. The dog was hydrated with IV fluids and his stomach was pumped. Five hundred dollars later the dog recovered.

This could be the most costly bag of calcium chews ever.

Friday, November 19, 2010

A Heavy Load for a Little Boy




Kimberly Foley was seen by me in the office this week for her 1 year visit. She has had an amazing result! She has lost 97% of her excess weight. In fact she lost even more if you count her weight loss before her operation. She said she was willing to share her information with you.

5/21/09 Intake visit 384 lbs
11/9/09 Pre-op visit 356 lbs
11/18/10 1 yr Post-op 166 lbs

Her Body Mass Index dropped from 59 to 25.






Even more important, Kim shared a story that nearly brought tears to my eyes. Kim has a son Trevor who is 8 years old and a sister, Barbara, who is a funeral director.

One day Trevor said to Kim, “Mommy, I’m so proud of you for getting “thinny” so we don’t have to call Auntie Barb to get your funeral ready”.

Whew! What a heavy load this little one was carrying without anyone knowing it. You never know what kids are thinking.

How did Kim get such a great result? She said she had positive support from friends and family, she exercises 4 days a week and gave up elevators for lent!

Monday, November 15, 2010

Gastric Band and Autosnacking


"Autosnacking" is a word I invented to explain one of the reasons that patients who have a gastric band are not hungry for about 3 hours after eating. This term refers to the slow release of solid food from the gastric pouch as it passed through the area of narrowing created by the adjustable gastric band.

If the band is adjusted properly solid food will be held up by the band and allowed to reach the rest of the gastrointestinal track over the next couple of hours after eating. This suppresses the patients appetite just like snacking but without eating. after the food has passed the hormone, Ghrelin, will again begin to rise making the patient feel hungry about 3 hours after eating.

We use this time interval to determine whether someone needs a fill. If the patient is feeling hungry just an hour or so after eating a meal of solid food the band may need to be adjusted with more saline injected to make the band tighter and therefore narrowing the restriction slowing release of food from the pouch.

I emphasize solid food because the band is not designed to hold back liquids.

Other indicators for needing a fill include losing less than 1 pound a week and the ability to eat foods such as bread, chicken breast and / or steak.

Sunday, November 14, 2010

Update on Robotic Bariatric Surgery at Fresh Start


This is just a quick update on our robotic gastric bypass operations. We have now completed 23 Laparoscopic Roux en-Y Gastric Bypass operations with robotic assistance. We have had no complications from the robotic portion of the operation and the only complication was the infection from the non-robotic small intestinal connection that we reported in the previous update. The robotic portion has reduced in time from 2 hours to 45 minutes and most patients are now going home on the day after surgery. Overall I am delighted with our progress to date.

Saturday, October 23, 2010

Diabetes May Double by 2050, Bariatric Surgery Can Help!



Front page news in the USA Today and the Columbus Dispatch newspapers this week reported the most recent CDC prediction for diabetes in America.

1). Diabetes may increase from the present rate if 1 in 10 to 1 in 3 persons over the next 40 years.
2). Presently there is about 200,000 diabetics in central Ohio
3). It is estimated that the number of diabetics in central Ohio will increase by 13,000 every 2 years




Most of the increase will be in Type II diabetes. Why?

1). Improved diabetic care is allowing diabetics to live longer
2). Earlier diagnosis
3). Growing minority populations
4). Increasing frequency of obesity

How can bariatric surgery help?

For those persons of size who develop type II diabetes, their diabetes is resolved 84% of the time after bariatric surgery. For those who were diagnosed with diabetes within the last 5 years the results are even better: 95% of patients will resolve their diabetes.

Although all bariatric operations can help to prevent diabetes, the best operation to resolve diabetes is a Roux en-Y Gastric Bypass. A Roux en-Y Gastric Bypass is the only operation that changes to patients hormonal situation to increase the amount of insulin the pancrease produces in response to carbohydrates.

Learn more about diabetes and bariatric surgery on other posts on this blog.

Our practice is available to help as many persons of size with diabetes who want to be helped.

Tuesday, October 19, 2010

Bariatric Surgery Decreases the Risk of Breast Cancer

A recent study showed that the risk of developing breast cancer over the 5 years after bariatric surgery is decreased by 80%.

Nicolas Christou at McGill University in Montreal, Quebec, Canada compared a group of bariatric surgery patients with a group of people of similar weight over a 5 year period of time.

Only 2% of those who chose bariatric surgery developed breast cancer over the subsequent 5 years compared to 8.5% of people of similar size that did not have bariatric surgery.

This is the first study that clearly shows the risk of developing breast cancer is decreased by 80% over the next 5 years after bariatric surgery.

Baraitric surgery could be the most important choice some women make.

Thursday, October 14, 2010

Results of the First Eleven Robot Assisted Gastric Bypass Operations at Fresh Start



Left: Dr. Myers, Right: Mike Palasek, CRNFA, Robot, named "Bow Tie" center





Over the last few weeks I have been privileged to several Robotic Assisted Laparoscopic Gastric Bypass operations. I am very pleased with the initial results and I would like to share them with those who follow this blog.



Number of operations performed 11

Converted to open operations 0

Number of incisions required 4, which is 1 or 2 incisions less (2 5 mm ports and 2 12 mm ports)

Total lentht of incisions decreased by 50%

Discharged day after operation 50%

The length of time required to perform the operation has improved from 3 hours 30 minutes to 2 hours 20 minutes.


In addition, we have noted the patients have much less pain in the hospital and denies any pain at the 1 week visit.

One patient was rehospitalized for an infection not related to the robotic assistanc and they are improving nicely.

Overall patients are doing very well. I will keep you informed of further progress.

Ramona Fleming and daughter Mellisa Hume share their success stories

Tuesday, September 28, 2010

Consignment Clothing For Weightloss Wardrobe Changes






During the stages of weight loss, it is hard to imagine purchasing a whole new wardrobe in the size that your weightloss takes you each month or so. My best suggestion is to go consignment shops that specialize in Plus Sizes. Also, Thrift stores are a great place to go hunting for a few pieces to get you by while you are loosing the weight. Here are a five in the Columbus, Ohio area.



Go Figure Consignment
988 N. High St.
Columbus, OH 43201
614.297.8070

One More Time – Grandview
(Men’s and Women’s Consignment)
One more time plus
614-486-3728
1515 West Fifth Avenue
Columbus, OH 43212

JustPlus
6042 E. Main St Columbus OH
614-759-PLUS (7587)
Monday - Saturday 10 - 8
Sunday 12 - 6

Miss Chrissy’s
3058 W Broad St
Columbus, OH 43204-1302
(614) 351-7253

And My personal favorite (which is my own happy hunting grounds) is
Gabriel Brothers in Mansfield or Zanesville


Where have you had success?

Early Results from Our First Robotic Gastric Bypass Operations


“It’s amazing”, Robyn Blake told me in the office today. She is just one week from her robotically assisted laparoscopic Roux en-Y gastric bypass and she is thrilled with her results. ‘I only took one pain pill a day for the first 2 days after I was discharged from the hospital.”

“The results are not subtle,” Mike Palasek, CRNFA who assisted with each of these operations told me today. “The patients who had their operation robotically are having much less pain.”

We have now completed our first four robotically assisted gastric bypass operations. Both are doing very well. Two of these patients went home the day after their operation instead of two days later. The patients appear much more comfortable the day after the operation.

Overall I am very impressed with these very early results. There are only 4 incisions and these are smaller and healing well without a drain or staples.

I agree with Robyn, the results are amazing.

Saturday, September 25, 2010

Great Message from My Patient, Wendy Hartman. Check Out Her Blog!


My husband and I have been together for 26 years. Married, 19. He met me at about 180 pounds. I was about 250 when we married. I was at 395 when I had surgery.

Scott told me the other day something that had me in tears.

I knew he was worried about me, but we never talked about it. He said: "6-8 months ago, I was crying myself to sleep wondering what I would do when you were gone. How was I going to handle the kids? How was I going to pay the bills when I don't even know where the passwords are for the accounts? I had no idea that our lives could change so much in 6 months. Everything is so much better. You are a better person. We are better." Wow.

Thank you, Dr. Myers!!!

Wendie Hartman

http://margaretandelwood.blogspot.com/

Thursday, September 23, 2010

Dressing for Excess Skin

A posting from Stephanie Myers, Dr. Myers' daughter, on 3 problem areas that can be improved by focusing on appropriate wardrobing.

One of the major issues post bariatric surgery is the issue of excess skin. Although the fatty tissue will be gone soon because of the surgery, exercise, and nutrition adjustments, the skin which has been stretched to accommodate that fatty tissue will remain (some to a more severe degree than others, depending on an individual basis). Regardless if you choose to have bariatric surgery or not, I want to give you a few ideas to work around the excess skin in the mean time.

At a recent support group I shared about what clothing to look for in order to resolve the issues of discomfort and embarrassment. Those are both valid issues and the key to solving this issue is having the correct undergarments. Of course, all three can be used at the same time if necessary. Most likely these ideas are not foreign to women, such as Spanx, or control top hosiery. Now, I will explain the three main problem areas, the solutions, (what to look for to work with each area), and styling tips.




1). The problem area: The “Apron” - This is what is known for the the excess skin area of the stomach. Again, once the weight is lost, the skin can still remain.

The solution: A good solution here is to find a very fitted stretch tank top that will help to hold in excess skin. This tank can be a few sizes smaller than you would typically wear so that you get the supporting effect.

This picture is a great example. It is a Spanx for Plus sizes that can be found at Lane Bryant. You could even look for a longer version that will go just below the hips.

How to Style: The key with styling this is that it does not have to show, in fact it really shouldn't. The best idea is to layer and especially going into fall and winter this will be easy to do.



2). The problem area: The “Wings” - This area of excess skin is from any stretched skin that caused by the fatty tissue in the arms.
The Solution: A very fitted three quarters length fitted t-shirt will hold skin in place so you don’t have that 'flapping' feeling. This shirt needs to be more fitted than your usual clothing, again to support your arms.

How to Style this garment: The purpose of this garment is also to be an undergarment, and should be worn with other clothing that fit appropriately.

This example is a top that is on sale at Nordstrom.









3). The problem area: The Inner Thighs - The inner thighs are an area that can be an annoyance.
The solution: Very fitted bicycle shorts or spanx (apparently, these shorts to the left are lined with zebra print. Zebra print is optional when you do your shopping!
How to style: Another great trick is to wear bicycle shorts under your pants or dresses in order to give you a more controlled feeling and therefore, will be more comfortable. This pair is from Lane Bryant.

Again, I am here as a resource for your wardrobing issues now. I also will work with you to create a look that is uniquely yours. Please contact me at Stephanie.Myers1@gmail.com to arrange a meeting to begin!

Monday, September 20, 2010

Get Well Picture for Grandma


Mikey Pyle drew this picture for his grandmother who had her bariatric operation last week and was seen in the office today. Look closely to find the following 4 details:

1). Grandmother's size before and after the operation

2). What is that in Dr. Myers hand?

3). Note the Gandmother + Surgery = Smaller Grandmother format

4). The facial expressions are terific

Great job! Thank you, Mikey, for cheering up your grandmother and bringing a smile to all of us.

Sunday, September 19, 2010

Finding "New" Things after Bariatric Surgery




Finding “New” Things after Bariatric Surgery

Last week one of my patients who had lost a lot of weight after her bariatric operation returned complaining of finding a new mass just below her breast bone. She was obviously very worried.

After I examined her I indeed noted a firm ½ inch hard rubbery mass just as she had described.

I explained that this finding is called the xiphoid process and is a normal anatomic structure. She was just now finding this for the first time because she had lost enough weight it was no longer hidden in the fatty tissue!

This is a very common occurrence. As a bariatric surgery patient loses a lot of weight, say 100 to even 200 lbs or more they are able to “find things” they did not even know they had such as hip bones, back bones, clavicles, tail bones and even ribs that they thought were breast masses!

Of course these patients are often embarrassed when they find out these structures were always there but could not be felt until they lost significant amount of weight but it is just part of discovering themselves anew.

Having bariatric surgery is truly a Fresh Start for many and a new discovery of the new you.

Saturday, September 18, 2010

Update on the Use of the da Vinci Surgical Robot


Last Tuesday, September 14, 2010, I was privilegded to perform 2 gastric bypass operations with the assistance of the da Vinci surgical robot. Although it is always challenging to begin to use new technology, both patients did well and one left the hospital after only one night stay.

The following is an exert from an email sent out by a representative of the company that makes the da Vinci robot to some of the Medical staff at our hospital. I thought you might be interested in this anouncement:

"OhioHealth has established itself as a leader in robotic surgery and Dr. Myers has established himself as a leader in bariatric surgery. This is another application where da Vinci is helping surgeons deliver minimally invasive surgery to a broader base of patients every day. Dr. Myers gave the following reasons for using the da Vinci for his gastric bypass procedures:

1. Stronger anastomosis
2. Patients are less likely to bleed
3. Less incisions - reduced from 5 to 4 with about 50% reduction in incisional "footprint"
4. Less pain at trochar sites
5. No need for largest incision to pass circular stapler

Dr. Erik Wilson from the University of Texas Medical School at Houston proctored Dr. Myers with the use of the dual console da Vinci Si system."

This important device will be able to help make this operation even safer and better. I will have the oportunity to use the robot to perform a gastric bypass for three more patients in the coming week.

Learn more about the da Vinci robot at www.IntuitiveSurgical.com

Thursday, September 16, 2010

New Video! Dietitian explains Nutrition Facts Label

In this video, You will see Dietitian, Kristi Highley sharing the importance of the Nutrition Facts Label. The photo on top is an image of the exact Label she is referring to, but enlarged. One more thing before we get started, Dr. Myers wants to know something about the beginning of the video, "What's up with the tongue Kristi?"





Tuesday, September 14, 2010

Brian Stinecipher shares his success story after gastric bypass! Part 1

We begin this video with Janet Dearwester, a Fresh Start Bariatrics patient, who went from 200lbs to her current weight of 130 lbs. Then, Brian Stinecipher shares he and his wives' success stories as patients at Fresh Start Bariatrics. He shares before and after stories and pictures.

Brian Stinecipher shares his success story after gastric bypass! Pt. 2

In this part of Brian's presentation, he concludes and then takes questions from perspective patients at a recent Informative Seminar that Fresh Start Bariatrics. and Questions are then answered by both Brian (a Fresh Start Bariatrics patient) and Dr. Myers. The free seminar is the first step in the Fresh Start Bariatric Patients journey.

Monday, September 13, 2010

Preparing to Perform Robotic Assisted Bariatric Surgery




Preparing to Perform Robotic Assisted Bariatric Surgery

My wife and I were at my parent’s home last weekend. Our conversation included my plan to begin performing robot assisted bariatric surgery. They asked a great question, “How have you been training to use the robot?”

I thought you might be interested in my response.



First, it is important to remember that I have been performing the Laparoscopic Roux en-Y Gastric bypass for over 7 years and have performed nearly 800 of these operations.

Second, I plan to begin by performing only a part of the operation using the robot.

Third, using new advanced technology to perform this operation is much like an experienced professional pilot training to use a new airplane to fly a familiar air route.

As you might imagine Riverside Methodist Hospital has a pathway each surgeon is required to complete to become credentialed to perform operations with the assistance of a robot. I have exceeded the requirements and followed the following 10 steps in the path to preparation:

1). Observed two operations performed by Dr. Michelle Toder in Bangor Maine in July 2010 and was very excited by the capability of this remarkable instrument.

2). Informed the hospital of my interest in robotic surgery

3). Reviewed about at least 8 hours of video of the operation performed using the robot

4). Observed an operation with Dr. Burges at Riverside

5). Completed an all day training session performing several operations with a certified instructor

6). Logged at least 8 hours of independent practice on the robot

7). Choreographed each step of the operation with the operation room staff during a mock operation

8). Received temporary privileges to perform robotic surgery from Riverside credentials committee

9). Obtained consent from the first 2 patients to perform their operations using the robot

10). Arranged for Dr Erick Wilson, a very experienced robotic surgeon from Houston, Texas, to be present in the operating room during the first two operations using the robot as my “proctor” or supervisor tomorrow, (9/14/2010)

Now I am ready to get started! Maybe I should watch “Top Gun” once again before we start the operations!

Friday, September 10, 2010

Roller Coasters after Bariatric Surgery?



Yesterday I saw Stephanie, a patient of mine, in the office one week after a laparoscopic gastric bypass operation. I was surprised when she asked if she could ride the roller coasters at Cedar Point amusement park just 11 days after her operation. She said she loved roller coasters and especially enjoyed the rides that make her hang upside down!

I said I was delighted she was doing so well she wanted to ride the rides at an amusement park a week or so after her operation. However, even if it does not injure you, hanging upside down is for bats not humans!

Wednesday, September 8, 2010

How to dress during dramatic weightloss - Dr. Myers' Daughter explains

Dramatic weightloss requires dramatic wardrobe changes. I, Stephanie, (stylist and Dr. Myers' daughter) want to focus on finding a good dress first, because it can be very versatile while you are loosing weight (Sorry Guys! This one is for the Girls!). Especially after surgery, a dress can be a wonderful solution for you while your body is in this very dramatic transitional time period. Here is what to look for while shopping for this must-have fall wardrobe essential: The Dress. Here are five points to guide you to the perfect dress. Let's get started!


#1 What to look for in the perfect dress - Structure


A dress with structure is going to give your body shape, such as this dress from Nordstrom.




I love this dress! The denim is right on trend for this fall. This dress works because of the structure in the bodice which gives the rest of the body a perfect shape. The skirt is full and falls gracefully away from the waist. This is a wonderful solution and a great option for your fall wardrobe. And as the weather changes and cools down, you can switch out the white belt for a nice leather one and pair the dress with an adorable sweater or cropped jacket. Finish the look with a pair of cute boots.

Now, moving right along to the second aspect to look for...


#2 What to look for in the perfect dress - Visual Lines


First of all, can we all just agree that this is a gorgeous dress?! The idea behind a dress like this is that the lines in the garment create a visual trick and elongate the entire body. The draping is also a very current way to look effortlessly glamorous.
Look for these kind of detailing that can quickly update a wardrobe and making you look very modern at the same time.



#3 What to look for in the perfect dress - Necklines


Necklines are an important aspect to look for when you are shopping for the perfect dress this fall. This hot pink dress from Nordstrom is fabulous. It has the best two important key elements when looking at the neckline of a dress. The V-neck is wonderful and creates an illusion of length. Also, the faux-wrap on the bodice can also minimize the chest.




#4 What to look for in the perfect dress - Fit


This specific area of dressing yourself walks a fine line. It is very important to wear a size that is fitted, yet not too tight. However, leave enough room that you can breathe and move easily, and yet is not baggy. If ever you have a question as to if the fit is right on you or not, then try on three different sizes. One that is typically your size, then a size up and a size down from that. Also, because brands can size very differently.

The following two pictures gives two examples of dresses that fit just right.





And now for an ill fitting garment..

The reason why this garment doesn't work is because it hides a figure all together, and what begins as a good intention to hide unwanted weight, actually creates more surface area instead of the desired camouflaging.



#5 - What to look for in the perfect dress - Texture & Fabric


Fabrics are incredibly important aspects of finding a great dress for this season. Look for fabrics that have a certain stiff quality. These fabrics can be forgiving and can camouflage problem areas. Where as a thin jersey (or t-shirt fabric) can cause unwanted hugging. This dress is a fantastic example of almost all of the points we just discussed. I can just see it now with the perfect pair of boots and an adorable jacket for the fall...



And when you are ready to go shopping, Contact me! I would love to guide you through your fall wardrobe and give assistance during the transition time after surgery. We can go to Target or Saks Fifth Avenue and everywhere in between. Contact me at: Stephanie.Myers1@gmail.com

Gastric Sleeve Surgery Performed by Dr. Myers



This video contains the Gastric Sleeve Surgery procedure. It is not for the weak stomached. However, the video will give you a good idea of what the procedure looks like.

Sunday, September 5, 2010

NEWS RELEASE

Columbus, Ohio, September 5, 2010

Free Interactive Bariatric Surgery Course Now Available Online

Prospective weight loss surgery patients can now learn more about bariatric surgery by accessing a new free interactive online course at www.freshstartbariatrics.com. Dr. Steve Myers, a bariatric surgeon in Columbus, Ohio has developed the online seminar in close collaboration with Riverside Methodist Hospital. “This course shares information in plain language for people of size that would like more detail about which bariatric operation would be best for them”, Dr. Myers explains.

This free progressive course includes many videos, drop and drag activities, pictures, information ‘dots’ on diagrams, interactive question and answer opportunities and click for definitions in user friendly terms. Myers says, “This is truly an interactive experience”. Prospective patients unable to attend the live Fresh Start Seminar can now obtain the same information online. For those interested in proceeding in the Fresh Start Bariatrics program, this course can be the first step in the process.

This new course provides clear, transparent information in an easy to learn format and will help persons of size choose the best approach possible when considering bariatric surgery.

Thursday, September 2, 2010

Walk from Obesity!




Walk from Obesity is happening again in Columbus, Ohio!

Columbus, OH
Walk from Obesity
Register today - Early registration for adults (12+) is only $25.00.

Children under the age of 12 are FREE!

Register online at: www.walkfromobesity.org

Walk Date: Saturday, October 30, 2010

Registration will open at 9:00AM
The Walk will begin at 10:00AM

Walk Location:
Fred Beekman Park / The Ohio State University
Southwest Corner of Lane Avenue and Kenny Road

Presented By: The Ohio State University Medical Center Bariatric Surgery Center, Dr. Bradley Needleman and Dr. Dean Mikami

Event Leaders: Shannon Hall and Andrea Hansen

Walkers: You may seek pledges using the online tools after registration. To collect pledges in person, a printable pledge form is available here.

Event Sponsors: Please contact Shannon Hall or Andrea Hansen directly for local Walk sponsorship information and opportunities.

For more information, or to volunteer your services for the Walk, please contact:

Shannon R. Hall
redheadedshannon@yahoo.com
614-595-1492
3555 Rangoon Drive
Westerville, OH 43081

Andrea Hansen
aniahansen@hotmail.com
614-451-6510
3558 Rangoon Drive
Westerville, OH 43081

Friday, August 27, 2010

Robotic Surgery Holds Great Promise for Bariatric Surgery Patients.


As many of you know, qver the last several weeks I have been observing robotic surgery, logging time practicing on the newest robot and doing a lot of planning for my first robotic gastric bypass operation scheduled on September 14th , just a little over two weeks from now.

Today I spent the entire day training in the robotic laboratory at Good Samaritan Hospital in Cincinnati, Ohio. It was an intense day with many hours in the console of the robot performing several operations, learning to “dock” the robot to the ports and instruments and learning much more about this elegant and sophisticated machine.

The training will continue nearly each day in preparation for the first operations but everything is progressing very smoothly.
I must say, I believe the da Vinci Robot is very likely to bring considerable value to my gastric bypass patients. I am even hopeful that many will be able to go home the day after surgery since I believe I will be able to decrease the incision “footprint” by about 50% and there should be even less discomfort involved with this operation.

Congratulations to Intuitive Surgical, Inc. for many improvements in the newest model of the da Vinci robot!

Posted by Stephan Myers, MD, FACS, bariatric surgeon, Columbus Ohio

Friday, August 20, 2010

Six Stages of Eating After a Gastric Bypass



You are likely to pass through 6 separate stages of eating after your gastric bypass operation.

Recently I saw a patient who had a laparoscopic Roux en-Y gastric bypass by me a few months ago who was quite frustrated that she could not eat and drink what she wanted to consume. She wanted to eat a regular diet but was not yet able to eat as much solid food as she had expected. She seemed to be someone who could not allow the process to proceed in the usual fashion.

The fact is you cannot rush the healing process and trying to speed things up will only make a person frustrated and could be harmful. After performing several hundred of these operations there is a natural progression I have observed after a gastric bypass operation and it usually goes like this:



1). FIRST WEEK

It seems almost impossible to get as much liquid down. The only way to stay hydrated is to sip very small amounts every 15 minutes or so all day long.

2). WEEKS 2 THOUGH 5

Slowly liquids become somewhat easier to go down. This is when a patient starts learning how much they can swallow at one time. If you drink faster than the pouch can empty fluids will back up in the esophagus and cause a pressure sensation in the chest. Slowing down even more will relieve this unpleasant sensation.

3). WEEKS 6 THROUGH 9

The patient often feels they are having more difficulty eating and drinking than they had over the previous few weeks. This is because the connection between the gastric pouch and the intestine is healing and the scar is becoming thicker resulting in a narrower outlet to the pouch. Just as you have observed when you have cut yourself the scar is relatively smooth for the first few weeks but it becomes thicker and more angry looking at about 6 to 9 weeks. As the scar is remolded the scar will slowly become softer over the next several weeks and months. The scar at the connection between the gastric pouch and intestine goes through this same process and the thickened scar is the reason that it takes more time for the food and drink to pass out of the pouch into the small intestine. We frequently call this the “window of misery” and you will find a posting by that name elsewhere in this blog.

4). WEEKS 10 THROUGH 12

The scar that I mentioned above softens and the opening between the gastric pouch and the small intestine starts to slowly open up more and food and drink passes through more easily.

5). BETWEEN 3 and 6 MONTHS Although things continue to improve, usually meat and bread is still difficult unless the meat is ground and the bread is toasted to make the fragments and particles smaller.

6). BETWEEN 6 MONTHS and 1 YEAR Things continue to Improve and sometime during this period patients begin to have less and less difficulty swallowing meats and bread. By this time the diet has returned to normal although many people tell me there food choices have changed considerably and they eat much healthier.

Hopefully this week by week description will help you as you go through the various stages and you will be more patient with yourself since you know better days are coming.

By Stephan Myers, MD, FACS, bariatric surgeon in Columbus, Ohio

Wednesday, August 18, 2010

Gastric Sleeve Operation



Recently we have noticed that more and more patients are choosing to have a laparoscopic gastric sleeve operation. I have now performed over 80 of these operations and patients seem to be generally very pleased with the results. Their weight loss is quite good having lost an average of 87 lbs in the first year which is 78% of their excess weight. The range of weight loss is between 41% and 102% of their excess weight.

The weight loss appears to occurring in a very similar fashion to the weight loss from a gastric bypass. nearly all of the weight is lost in the first year.

There is no rearranging of the small intestine and therefore vitamins and calcium are not medically necessary although still a good idea.

A gastric sleeve operation is likely to improve or resolve many obesity related medical problems such as sleep apnea, urinary stress incontinence and high cholesterol but it is not as good as a gastric bypass to resolve type II diabetes or severe gastroesophageal reflux.

The complication rates are low and the two most frequent problems have become even more infrequent in our practice over the last year. Fairly early in our series we had two people who had leaks along the staple line and two patients had narrowing of the sleeve which was treated with revision to a gastric bypass. Neither of these problems have occurred since we have gained more experience with the procedure but they are still a possibility.

All operations have been able to be performed laparoscopically with no conversion to open operation.

All commercial insurance companies in our area cover a gastric sleeve except Anthem/Blue Cross and Blue Shield companies.
I feel a gastric sleeve operation is an excellent option for patients who do not have severe type II diabetes or severe gastroesophageal reflux disease.

Saturday, August 14, 2010

An Unusual Way to Keep Weight off after Bariatric Surgery



Last week I saw Peggy Lauritzen, one of my patients, in the office and she told me of the unusual way she reminds herself to eat slowly. She carries chopsticks in her purse and uses them for all of her meals!

Think it is crazy? She has kept her weight off and is doing very well several years after her gastric bypass. It may be a little quirky but it works for her.

Once a friend of hers said "I would lose weight too if I used chop sticks." Peggy said, "so what's your point.

How do slow down your eating? Do you have a quirky way to remind yourself to slow down and chew slowly. Leave a comment and I will share it with the other 750 people that follow this blog each month.

Wednesday, August 11, 2010

Losing Weight Prior to Bariatric Surgery May Help Obtain Your Best Result

Every week I see patients who have been operated on at other programs only to gain back much of their weight or disappointed with the amount of weight they have lost. Often people had their operation when their weight was considerably more than a BMI of 55. (That would be more than 355 lbs for a person that is 5 foot 7 inches tall.)

This is the message:

Gastric bypass and gastric sleeve operations help people lose weight for only about one year.

After the first year the operation is likely to help the patient to maintain their weight at about the same level but it is unlikely that they will lose more weight from the operation.

Whatever a person’s weight is one year after a gastric bypass or gastric sleeve operation is at 1 year after the operation is likely to be about near their best weight.

That is why we choose to make sure each patient is no more than a BMI of 55 prior to surgery. This can be done with dietary changes, medications and/or a physician supervised very low carbohydrate diet.

Shifting the curve I drew for you downwards, (note the purple arrow pointing down), before surgery is the way to obtain the best result after surgery.



The weight loss curve is about the same regardless of how much excess weight someone has. Although there may be the occasional exception, the most a patient is likely to lose after a gastric bypass or gastric sleeve operation is about 170 to 200 lbs. That means if you have 300 to 400 lbs of excess weight you are still likely to have 200 lbs of excess weight after surgery. This is why we encourage our patients to "shift the curve" downward to a BMI of 55 if their weight exceeds this number. Then after surgery they are much more likely to lose nearly all of their excess weight and approach ideal weight and resolve many of their obesity related medical problems.

These are the benefits of reaching a BMI of 55 or less before surgery.

Better results
Weight reaches near Ideal weight at 1 year
Better resolution of obesity related medical problems
Less complications
Less likely to need a tracheostomy
Less likely to need to need ICU stay
Less likely to have skin or muscle breakdown from being in bed after surgery

This is the bottom line:
Safer operation with better results

Posted by Stephan Myers, MD, FACS, Bariatric Surgeon, Columbus , Ohio

Saturday, August 7, 2010

Robot and Bariatric Surgery



When using the Da Vinci Robot to perform bariatric surgery I begin the operation at the operating table placing the robotic scope and instruments as I would in a standard laparoscopic operation. I then sit at a consol in the same operating room and thereafter all robotic movements of instruments are controled by me.

The veiw is much better because I can see in 3-D since the scope is a binocular scope. Also most of the instruments are "wristed" alowing me to reach angles that are not possible with standard laparoscopic techniques. If I need an instrument to be changed the first assistant and scrub nurse are continuously at the side of the patient and they will remove one instrument from the robot and attach another at my command. Interestingly, the robot "remembers" exactly where the previous instrument is located within the abdomen and placed the instrument in the same location only a short distance from the previous point to protect the patient from any possible injury.

The placement of stitches is more exact and I am able to see much better with the robot than with other techniques.

I am very pleased Riverside Methodist Hospital presently has 2 of these advanced robots with a third to be installed by mid-September.

Written by Stephan Myers, MD, FACS, bariatric surgeon in Columbus, Ohio.

Monday, August 2, 2010

Da Vinci Robot and Bariatric Surgery

I have been pondering the possible place for the Da Vinci Robot in bariatric surgery for a few years. Although it is an expensive device, (about 2.5 Million dollars per robot), I am now convinced there is very real value for bariatric patients and their surgeons.

First, he patient is likely to benefit by having less incisions decreasing from four ¾ inch incisions and one 1 ¼ inch incision to two ¾ inch incisions and two ½ inch incisions. This alone should decrease pain and shorten recovery time. In addition the robot “remembers” the point each device passes through the abdominal wall and pivots at this point decreasing the trauma to the abdominal wall tissues thus decreasing pain even more.

Second, the surgeon can see better since the view is a 3 dimensional view instead of the 2 dimensional view with standard laparoscopy. The better the surgeon can see the safer the operation. Who wouldn’t like there surgeon to see as well as possible during their operation?

Another issue is the reduced wear and tear on the surgeon. Operation on persons of size is physically demanding and allowing the robot to take the physical load while the surgeon is guiding every move of the robot while sitting comfortably at the console may add years to the length of a surgeons career.

Two weeks ago I spent the day in New England with Dr. Toder who performed 2 gastric bypass operations that day. It was clear to me that using the Da Vinci robot would be of benefit to our patients.

Riverside presently has 2 robots and they will be installing the third and most up to date robot in the operating room I usually use to do bariatric surgery operations by the middle of September 2010.

Over the next 6 weeks I will be training on this new instrument. I am hoping the robot will reduce the number of days a patient stays in the hospital from 2 days to one day.

I will post regular updates as we make this transition to this advanced technique to keep you informed.

Saturday, July 31, 2010

New Mobile Service for This Bariatric Surgery Blog


To make this blog more friendly for smartphone users we have developed a mobile website that can be accessed here: http://freshstart.m77950.com/blog



We welcome you to bookmark this site for quick access to future posts and explore the expanded mobile site for more information. In the comments below, we invite you to tell us what else you would like to see on the mobile site.

The mobile site has been designed for Dr. Stephan Myers MD. by Monarch Mobile Web Solutions (www.monarchmobile.org)

Thursday, July 29, 2010

Weight Loss in the First Year after Bariatric Surgery




There is a “Magic Year” after a bariatric operation is your year to get your weight off.

Gastric bypass and gastric sleeve patients will lose nearly all of the excess weight that they will lose from their operation by the end of one year after the operation. (Gastric band patients also lose most of the weight they will lose in the first year but their weight loss is usually slower and it takes about 3 years to reach a stable lower weight.)

In our practice it is common that patients lose about 20 lbs a month for 2 or 3 months then 15 lbs for a couple of months then 12 lbs for a couple of months and so on slowly decreasing the amount of weight they lose over the first year until their weight is stable. Our patients lose about 80% of their excess weight at one year for both of these operations. The most frequent BMI I see from patients having these operations a BMI of 28.

After the one year time period the operation will help the patient to keep the weight off but is unlikely to cause very much more weight loss.

Do not miss your year of opportunity! This is your year to get your weight off.

The weight loss stops because after one year a patient is able to consume enough food to meet their caloric needs and weight loss will probably soon come to a halt.

This is why it is so important to do everything your bariatric surgeon ask of you especially during that all important first year after the operation.

In our practice we ask patients to start their exercise program at 3 to 4 weeks after the operation and avoid liquid calories whenever possible and keep the portion size of each meal at an appropriate level and follow the directions of the dietitian. Other suggestions to lose or maintain weight loss can be found on the June 4, 2010 posting on this blog: “8 Rules for Long Term Success after Bariatric Surgery”.

We want all bariatric surgery patients to obtain their best result so make sure you are determined to make the most of your “Magic Year” after bariatric surgery.

Remember, where your weight is at 1 year is probably where you can expect it to stay if you do what is asked thereafter.

Advice from Steve Myers, MD, bariatric surgeon in Columbus, Ohio

Friday, July 23, 2010

Antidepressants and Bariatric Surgery


Antidepressants and Bariatric Surgery

Some antidepressants cause weight gain. Others suppress appetite and can help with weight loss. Below is a list of antidepressants that fit into three separate categories.





Antidepressants that may increase your weight:

Paxil - (this is known to be the worst to cause weight gain)
Elavil or other tricyclic antidepressants
Trazadone

Antidepressants that tend to be weight neutral. (After early weight loss patients tend to slowly gain weight over time.)

Prozac
Zoloft
Celexa

Antidepressants that often cause weight loss

Wellbutrin
Cymbalta
Effexor
Prestique

If you are taking an antidepressant that is known to cause weight gain or is weight neutral speak with your primary care physician or psychiatrist about the possibility of changing to an antidepressant that can assist you in losing weight or help you keep your weight off.

Please do not stop any antidepressant without consulting your doctor.

Thursday, July 22, 2010

Outcomes of Bariatric Surgery at Fresh Start Bariatrics at Riverside

We continue to be transparent and bring you as much information as possible.

Below you will find the results of 277 bariatric surgery patients operated on by Stephan Myers, MD, FACS at Riverside Methodist Hospital. Each patient was seen in our office in follow up 1 year after their operation where the following information was obtained.

I would like to caution you before you make too much of this information.

First, there are only 25 patients who had a gastric sleeve operation and had 1 year follow up at the time these numbers were tallied. Therefore there is less certainty about the gastric sleeve results. In fact there are so few patients in several categories to make any conclusions. For example note that there are only two patients that had stress incontinence in the gastric sleeve category and both had resolution of this problem. More numbers will undoubtedly show many patients will not resolve this medical problem.

Second, there is a definite bias in these results since patients with diabetes and severe acid reflux most often choose a gastric bypass since this procedure is the most effective operation to resolve these problems. Therefore, patients with less severe diabetes and reflux often choose one of the other operations but since their disease is less severe it is unfair to compare the numbers between operations.
You are welcome to this raw information but please understand that this is not comparing “apples to apples” and this not statistically valid for comparison between the three operations.

Key:
LRYGB ---Laparoscopic Roux en-Y gastric bypass
Sleeve ---Laparoscopic Gastric sleeve procedure
Band ---Adjustable gastric band procedure
N= ---Number of cases in each category


Tuesday, July 20, 2010

Video of Gastric Bypass Performed by Dr. Myers

This is Part I of a Laparoascopic Roux en-Y Gastric Bypass Performed By Dr. Myers. See Part II immediately below this posting.

Video of Gastric Bypass Performed by Dr. Myers

This is Part II of the Roux en-Y gastric bypass. Find this on YouTube as well at "Gastric Bypass Myers" and share with others if you would like.

Wednesday, July 14, 2010

Hair Loss and Bariatric Surgery

Causes of Hair Loss: This general overview of all causes of hair loss from the Mayo Clinic is the best I have seen. In our patients hair loss occurs between months 4 and 6 and then regrows. This is because the shock of sudden weight loss. This puts hair into the "resting phase" called, telogen, for 2 to 4 months before the "growth phase" called anagen begins again. This means your hair will grow back again! This is described in the first 2 paragraghs of this article.

Also note the section labled "Telogen Effluvium" as this section further describes the hair loss that comes with weight loss.

If you stay on Biotin 3-5 mg per day, make sure you get enough protien and iron your are doing the best you can to blunt the hair loss that you can expect. I hope this information is helpful to you.


Causes
By Mayo Clinic staff

Due to hormonal changes, irritation or damage, some hair follicles have a shorter growth phase and produce thinner, shorter hair shafts. Your hair goes through a cycle of growth and rest. The course of each cycle varies by individual. But in general, the growth phase of scalp hair, known as anagen, typically lasts two to three years. During this time, your hair grows just less than 1/2 inch (1 centimeter) a month. The resting phase is called telogen. This phase typically lasts three to four months. At the end of the resting phase, the hair strand falls out and a new one begins to grow in its place. Once a hair is shed, the growth stage begins again.

Most people normally shed 50 to 100 hairs a day. But with about 100,000 hairs in the scalp, this amount of hair loss shouldn't cause noticeable thinning of the scalp hair.

Gradual thinning is a normal part of aging. However, hair loss may lead to baldness when the rate of shedding exceeds the rate of regrowth, when new hair is thinner than the hair shed or when hair comes out in patches.

Causes of specific types of hair loss

■Pattern baldness (androgenetic alopecia). In male- and female-pattern baldness, the time of growth shortens, and the hairs are not as thick or sturdy. With each growth cycle, the hairs become rooted more superficially and more easily fall out. Heredity likely plays a key role. A history of androgenetic alopecia on either side of your family increases your risk of balding. Heredity also affects the age at which you begin to lose hair and the developmental speed, pattern and extent of your baldness.
■Cicatricial (scarring) alopecia. This type of permanent hair loss occurs when inflammation damages and scars the hair follicle. This prevents new hair from growing. This condition can be seen in several skin conditions, including lupus erythematosus or lichen planus. It's not known what triggers or causes this inflammation.
■Alopecia areata. This is classified as an autoimmune disease, but the cause is unknown. People who develop alopecia areata are generally in good health. A few people may have other autoimmune disorders, including thyroid disease. Some scientists believe that some people are genetically predisposed to develop alopecia areata and that a trigger, such as a virus or something else in the environment, sets off the condition. A family history of alopecia areata makes you more likely to develop it. With alopecia areata, your hair generally grows back, but you may lose and regrow your hair a number of times.
■Telogen effluvium. This type of hair loss is usually due to a change in your normal hair cycle. It may occur when some type of shock to your system — emotional or physical — causes hair roots to be pushed prematurely into the resting state. The affected growing hairs from these hair roots fall out. In a month or two, the hair follicles become active again and new hair starts to grow. Telogen effluvium may follow emotional distress, such as a death in the family or a physiological stress, such as a high fever, sudden or excessive weight loss, extreme diets, nutritional deficiencies, surgery, or metabolic disturbances. Hair typically grows back once the condition that caused it corrects itself, but it usually take months.
■Traction alopecia. Excessive hairstyling or hairstyles that pull your hair too tightly cause traction alopecia. If the pulling is stopped before there's scarring of your scalp and permanent damage to the root, hair usually grows back normally.
Other causes of hair loss

■Poor nutrition. Having inadequate protein or iron in your diet or poor nourishment in other ways can cause you to experience hair loss. Fad diets, crash diets and certain illnesses, such as eating disorders, can cause poor nutrition.
■Medications. Certain drugs used to treat gout, arthritis, depression, heart problems and high blood pressure may cause hair loss in some people. Taking birth control pills also may result in hair loss for some women.
■Disease. Diabetes and lupus can cause hair loss.
■Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. Under these conditions, healthy, growing (anagen) hairs can be affected. After your treatment ends, your hair typically begins to regrow.
■Hormonal changes. Hormonal changes and imbalances can cause temporary hair loss. This could be due to pregnancy, childbirth, discontinuation of birth control pills, the onset of menopause, or an overactive or underactive thyroid gland. The hair loss may be delayed by three months following a hormonal change, and it'll take another three months for new hair to grow back. During pregnancy, it's normal to have thicker, more luxuriant hair. It's also common to lose more hair than normal about three months after delivery. If a hormonal imbalance is associated with an overproduction of testosterone, there may be a thinning of hair over the crown of the scalp. Correcting hormonal imbalances may stop hair loss.
■Hair treatments. Chemicals used for dying, tinting, bleaching, straightening or permanent waves can cause hair to become damaged and break off if they are overused or used incorrectly. Overstyling and excessive brushing also can cause hair to fall out if the hair shaft becomes damaged.
■Scalp infection. Infections, such as ringworm, can invade the hair and skin of your scalp, leading to hair loss. Once infections are treated, hair generally grows back. Ringworm, a fungal infection, can usually be treated with a topical or oral antifungal medication.
■Trichotillomania (hair-pulling disorder). Trichotillomania is a type of mental illness in which people have an irresistible urge to pull out their hair, whether it's from the scalp, their eyebrows or other areas of the body. Hair pulling from the scalp often leaves them with patchy bald spots on the head, which they may go to great lengths to disguise. Causes of trichotillomania are still being researched, and no specific cause has yet been found.

Copied from a Mayo Clinic posting on weight loss and hair loss by Stephan Myers, MD, Bariatric Surgeon< Columbus, Ohio.

Saturday, July 10, 2010

Vitamin D Deficiency and Bariatric Surgery


Vitamin D is very important since it helps to maintain appropriate calcium levels in the blood and keeps helps to make calcium available to strengthen bones.

The vast majority of bariatric operations including a Roux en-Y Gastric Bypass, Gastric Sleeve or Adjustable Gastric Band have little or no effect on Vitamin D absorption. Only the relatively rare bariatric operations that greatly shorten the last half of the small intestine such as a Duodenal Switch, Biliopancreatic Bypass or a Modified Gastric Bypass that leaves a very short portion of the small intestine to absorb nutrients result in inadequate absorption of vitamin D.

Nevertheless vitamin D deficiency is a frequent problem for all patients of size. Although some of the vitamin D we need in taken in as part of the food we eat, some of the vitamin D is formed by sunlight converting colesterol to vitamin D in our skin. Since I am a bariatric surgeon in Columbus, Ohio, 89% of all of my patients are found to be vitamin D deficient even before surgery!

That is the reason each patient that enters our program is tested to determine their vitamin D level. We routinely start our patients on vitamin D when they begin in our program.

Why do our patients often have low vitamin D levels? It is not because of surgery.

Vitamin D deficiency occurs partially because we live in Ohio instead of Phoenix! Ohio is not known for sunny weather. Also people of size often are not out in the sun very much. In addition there is some evidence that Vitamin D is stored in our fat deposits and it may take higher amounts of vitamin D to saturate all of the storage sites.

Vitamin D is converted to an active form as blood is circualated though our kidneys. A normal Vitamin D level is necessary to absorb calcium from the intestine and preserves calcium from being released in the urine.

After absorption, calcium circulates in the serum and is stored in bone. The balance between the amount of calcium circulating in the blood and stored in bone is controlled by a hormone released by four small quarter inch size glands located just behind the thyroid gland in your neck called the parathyroid glands. It is essential to your nerves, heart and other body tissues to have a normal level of calcium in the blood. Therefore if your calcium starts to decrease the parathyroid glands produce more parathyroid hormone which in turn tells some of the cells in the bone to take calcium out of bone and release the calcium into the circulating blood. If this goes on for a long time you can lose so much bone strength that you put you at risk of causing breaks in the bone called fractures. This circumstance is called osteoporosis because the bones, (osteo-), becomes more porous, (porosis).

Therefore, if your vitamin D level is low you will not absorb enough calcium and your calcium level will be low. This will result in higher levels of parathyroid hormone stimulating the bone cells to mobilize more calcium from the bone and make your bones weaker and more prone to break. The bones at most risk are your hips and the bones of your back.

You should take at least 800 mgs of calcium every day, (as calcium citrate for gastric bypass patients) and make sure your vitamin D level is checked yearly. Take Ergocalciferol 50,000 units each week to treat a low vitamin D level. In addition periodic bone density tests will check how much calcium is stored in your bones reflecting how strong the bones are. If you have a mild decrease in bone density called osteopenia, correcting the vitamin D deficiency and taking more calcium may be enough. However, if your bone density is low enough to be called osteoporosis you should speak with your primary care physician about taking a medicine that will reverse the bone loss such as Boniva or Reclast.

From Stephan R. Myers, MD, FACS, bariatric Surgeon, Columbus, Ohio

Wednesday, June 30, 2010

Dr. Myers, Why Do I Sometimes Feel Squeezing Pressure in My Chest When Eating or Drinking?


Squeezing pressure in the chest can be a symptom of several problems such as heart disease, gallbladder disease or pressure in the esophagus. If you think the symptoms may be related to your heart call your primary care doctor or go to the emergency room.

However, if this is happening to you several weeks or months after having a bariatric operation it is likely to be esophageal pressure from eating or drinking faster than the pouch or sleeve is emptying thus food, drink and or air is accumulating in the esophagus. The esophagus squeezes the food trying to get it out of the esophagus and into the stomach. However, if the pouch is full the food in the esophagus has nowhere to go. Although there are minimal pain fibers in the stomach, the esophagus is exquisitely sensitive to pressure and will definitely let you know when it cannot move food or drink into the stomach.

This can happen regardless of whether you have had a gastric bypass, gastric sleeve procedure or an adjustable gastric band operation.

In this situation the worst thing you can do is to try to get the food moving by drinking more. This just adds to the problem by adding more fluid into the esophagus and makes the pain more severe. The pain lasts even longer since the additional food or drink also has nowhere to go.

Throwing up what is in the esophagus can give you relief but if you are patient usually the food and drink is likely to pass through the exit of the pouch or sleeve and the pain will be relieved.

After bariatric surgery, eating and drinking too fast should be avoided and may cause squeezing chest pain. When it occurs after eating it may be a possible sign that you may have just eaten too much too fast for the length of time it takes for the food in the pouch or sleeve to pass. In band patients continuing to experience this problem may lead to band slippage. (See band slippage elsewhere in this blog.)Reviewing the “Rule of 30’s” in this blog can help you to avoid this symptom.

Of course, if you have any consern that this is not related to eating too fast call your doctor or go to an emergency room to make sure the pain you are experiencing is not related to your heart.

Friday, June 4, 2010

8 Rules for Longterm Success After Bariatric Surgery


1). NO FLY ZONE
Identify your food triggers. Those foods that are very difficult for you stay away from. If you are like me it is the cookies. For others it may be pizza or soda. These foods should not be brought you’re your home or onto your property. Your property should be a NO FLY ZONE for these foods; “they just don’t fly here “ Find suggestions like these in the great book, Exodus from Obesity.

2). PLAN BEFORE YOU ATTEND
Before attending a wedding or another special event where you know food will be a major part of the event make sure you plan ahead. Plan what you will eat and drink and what you will stay away from.

3). SOLIDS FIRST
Start with solids, especially protein, before you move on to other foods. This will make sure you get the most important foods in first and there will be less room for high calorie carbohydrates.

4). AVOID CALORIE CONTAINING LIQUIDS
Cream soups, ice cream, milk, soda and other high calorie liquids should be avoided. Regardless of which operation you choose, liquids will move through the pouch, band or sleeve without resistance and all those calories will be absorbed very quickly. These high caloric liquids can blunt your weight loss and keep you from reaching your goals.

5). RULE OF 30’S
Chew 30 times before swallowing, wait 30 seconds between bites and wait 30 minutes after completing a meal befor taking most of your liquids.
6). SMALL PLATES DEVIDED IN 4 QUADRANTS
Choose a small plate for your meals and visualize the plate being divided into 4 quadrants. One quadrant for protein, (fish, meat or beans), One for starch, (bread, rice, potatoes, corn or carrots) and then the other two quadrants should be for green vegatables.

7). STAY ACTIVE
Make arrangements for 30 to 60 minutes of vigorous exercise 3 to four days per week.

8). WEIGH YOURSELF AT LEAST EACH WEEK
Those who weigh themselves frequently are more likely to keep their weight off long term.

Thursday, June 3, 2010

Difficulty Eating During the” Window of Misery”



I had a patient in the office today about 8 weeks out from her laparoscopic Roux en-Y gastric bypass. She had lost about 50 lbs and was concerned about having more difficulty eating some solid foods than she seemed to have just a few weeks ago. I explained the symptoms she is experiencing are fairly common for people 6 to 9 weeks after a gastric bypass. Some people call this time “the window of misery”. Although most patients will not be bothered by symptoms during this period of time, others will experience temporary difficulty.

When a gastric bypass operation is first performed I use a 25 mm circular stapler to make the connection between the gastric pouch and the small intestine so the outlet size is consistent. Initially the connection is about the size of your thumb and there is minimal resistance to food and drink. The connection heals by the body laying down scar tissue. As the healing process continues over the next several weeks, more scar tissue forms and the scar contracts making the outlet of the pouch become smaller. Eventually between 6 and 9 weeks, during the “window of misery”, the size of the outlet is only the size of the tip of your little finger or even less.

Because the outlet is so much smaller there is more resistance to the food passing through the new opening. Therefore to get food to pass it takes longer and the particle size may need to be reduced. In fact if a patient continues to try to eat and drink as they have in the first few weeks after their operation they can make themselves miserable. If they eat faster than the pouch can empty, the food and drink will back up into the esophagus and the will experience a squeezing pressure in their chest from the contractions of the esophagus trying to push the food through the smaller opening. This pain in the chest after eating means the patient is eating faster than the food is able to leave the pouch.

Fortunately, after about 9 weeks the scar will slowly mature. As the scar softens the outlet will become larger again allowing more food to pass more quickly. Over time the symptoms will become less frequent.

Nevertheless, even at 6 months it is likely that a patient will occasionally have difficulty with some foods such as bread, chicken or steak. Sometime between 6 and 12months even these foods will pass more easily.

About once a year in our practice the narrowing becomes so small it is difficult for anything to pass. This is called an anastomotic stricture meaning there is a severe narrowing or stricture at the anastomosis or connection between the pouch and intestine. If this happens the patient should have an upper endoscopy and a special balloon is passed to dilate the opening. After this is done the patient will be able to eat and drink normally the same day. This procedure can be performed without the patient staying in the hospital overnight.

But for most people if they are patient and take liquids with small particles until after 9 weeks following surgery they will not need a dilation and will get through this time without difficulty.

Tuesday, June 1, 2010

Dr. Myers, What Standards Help to Make Bariatric Surgery as Safe and Effective as possible?


We have designed standards into our bariatric surgery program that generates exceptionally low complication rates and outcomes that are about 20% better than reported averages. Some of these standards are listed below:

Since the risk to the patient increases with a BMI over 55, patients must be at a BMI of 55 or less prior to operation. If a patient’s weight exceeds this they should be treated medically to assist them in losing weight to reach a BMI of 55.

A Very Low Carbohydrate Diet is started several days before operation in non-diabetic patients and 2 weeks prior to operation is diabetics to decrease the size of the liver making it easier and safer to perform the bariatric operation.

We prevent blood clots from forming by using Lovenox, (a blood thinner), while in the hospital and for 6 days postop. We also require early walking the night of the operation and use compression garments to keep circulation flowing even while patients are resting in bed. For patients of higher risk they will be asked to have a special temporary filter placed in the vein returning blood from the lower half of the body back to the heart to prevent blood clots from reaching the heart and lungs.

Patients with a diagnosis of obstructive sleep apnea must be compliant with their CPAP for at least 3 weeks before their operation to alow their heart to become stronger and the CPAP level is adjusted where necessary to no more than 10 cms of H2O after surgery to prevent excess air in the gastrointestinal tract.

Blood pressure medicines called ACE inhibitors and ARBS are discontinued or decreased several days prior to surgery to make sure the patient’s blood pressure does not become too low during surgery.

Patients must stop smoking at least 6 weeks prior to operation. This decreases their risk of ulcer formation and decreases the risk of blood clots as well.

Patients must agree to participate in all of the components of Fresh Start Bariatrics and pay for the program prior to surgery. This helps to motivate them to complete the exercise and dietary portions of the program.

The patients proceed to insurance approval and on to surgery only after the dieticians, psychologist and medical personnel all agree that they are ready to proceed.

All of htese standards help to decrease risks and inprove longterm results.

Monday, May 31, 2010

A Memorial Day Tribute



I friend of mine told me this true story yesterday and I wanted to share it with you as a tribute to all the men and women who have served in our armed forces and have fought and often died for the freedom we continue to enjoy in America.


My friend was teaching in the Ukraine several years ago while it was still part on the Soviet Union. It was very cold that February day and several street musicians and homeless people had taken refuge from the cold in the subway. As my American friend and his Ukrainian guide entered the subway one of the street musicians began to play the Star Spangled Banner.

My friend was shocked that he was so easily recognized as an American so he asked his guide, “If I changed into Ukrainian clothes do you think I would still be recognized as an American?” The guide quickly responded ”Yes, of course.” When he was asked why the guide said, ”Because you walk like you have had 200 years of freedom.” My friend will never forget that reply. It brought tears to his eyes even as he shared the story with me.


I what to thank my father, Dan Myers, for serving in the Navy during the Korean Conflict and my nephew, Jordan Boucier, for serving in Afghanistan and all of the wonderful men and women that serve in our military. Today I would especially like to remember all those that have given their lives that we may continue to walk like we have had “200 years of Freedom”.

On this memorial day let us not forget the immeasurable cost of that freedom.