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