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

James Bennett Tells His Story

Having developed degenerative arthrits approximately fifteen years ago, I noticed severe pain and damage in my lower back and both hips. The more pain I was in, the less active I was, and kept gaining weight. In march of 2005, I had emergency abdominal surgery because of severe diverticulitis. I was off my feet for three months, and began gaining weight at a rapid pace.

In April of 2006, I had a full left hip replacement, followed by three months of physical therapy. Off my feet and work for another three months, gaining even more weight, but the pain was no better.

In March of 2007, I had a lumar spinal fusion because I had a disc basically disintegrate and had vertebrae grinding together. When the surgeon opened me up, he discovered one of the affected vertebrae was cracked, and also repaired that. This time, off my feet and work for four months, gaining even more weight. The pain was still severe

Then in January of 2008, I had read about Dr. Myers and bariatric surgery. After going to the seminar in Mansfield, I went home and weighed in at 406 pounds and knew this was the right decision for me. By this time, I was in so much pain I could not walk without a cane or walker, (That is me with the orage shirt sporting a cane in the third picture), and my wife had to push me in a wheelchair when we would go shopping. September 25, 2009 I had a gastric bypass procedure done by Dr. Myers. That day I weighed in at 376, having lost some weight by following the Fresh Start nutrionist diet and changing my eating habits.

The first three months were a little tough, going through the different stages of liquids and soft foods before getting back to a normal diet. The rapid weight loss kept me motivated, losing 80 pounds in the first 90 days. Slowly the pain FINALLY began to wane. Now I was really motivated.

Some things were difficult to adjust to, physically and psychologically, but the fresh start team was right beside me through it all. To date I have gone from a whopping 406 pounds (54 on the BMI chart) to 185 pounds (26 on the BMI chart)! Now instead of buying my clothes at big and tall, I shop in the young mens dept! Instead of laying on the couch in agonizing pain, I am golfing, hiking, camping, canoeing and all the other funs things I used to enjoy doing.My pain and stress level are way down and my attitude and self esteem are way up!

For me, sacrificing 3-4 helpings at dinner, bags of chips and cookies was a miniscule price to pay for the health and happiness I am enjoying everyday. Dr. Myers and the entire Freash Start team are definately the most caring and professional group I have ever met! I owe him my life.

James Bennett

8 Tips for Fuller, Thicker Appearing Hair

Often my patients ask how they can avoid hair loss and improve the appearance of their hair.

You can read further about my recommendations regarding preserving as much hair as possible during the time of temorary hair loss between the fourth and sixth months after bariatric surgery by choosing the subject "Hair" in the index of this blog. However here are important cosmetic tips from Jake Miller, an experienced hair stylist at Rafeal's studio in Clintinville, Ohio. Jake has been my personal hair stylist for the last several years and I recently asked him to share some tips for making our patient's hair look as thick as possible even during the "thin" times.

Here are Jakes 8 tips to make hair look thicker:

Talk to your hair stylist about working with your fine hair.

1. Create blunt lines to make your hair style look and feel thicker keeping tapering to a minimum.

2. Cut bangs deep toward the top of the head for an even thicker look in front bringing more hair forward.

3. Shorten fine hair to create fullness.

4. Expand the hair shaft with thickening shampoos, conditioners and volumizing tonics.

5. Blow dry hair forward and against the usual direction your hair is combed with a flat paddle brush.

6. Part hair on the opposite side you usually part to create fullness. This will lift the hair up further from the scalp giving the apearance of more hair.

7. Curl with hot rollers or a round brush and blow dryer to create more lift and the apearance of volume.

8. Color hair lighter shades to blend with your natural scalp color so the scalp is not so obvious.

Jake is even willing to do free consultations for our patients.

Jake Miller, Hair Stylist
Rafiel's Studio
Aveda Lifestyle Salon

2927 N. High St.
Columbus, Ohio 43202
(614) 784-1177
www.rafielsstudio.com

Gastric Sleeve Success Story - Jaime Manley

Bowel Issues Following Bariatric Surgery

Diarrhea, or loose stools, is rarely an issue after patients have a standard gastric bypass, a gastric sleeve or a gastric band. Occasionally they will experience a few days of loose stools while they recover from surgery but this improves without any therapy.

Diarrea is a side effect of some bariatric operations such as the duodenal switch, biliopancreatic diversion or a gastric bypass that creates a short common channel for absorption of food.

However, if you have several high volume explosive stools a day associated with fever and crampy abdominal pain you should contact your bariatric surgeon’s office since antibiotic use during your hospitalization can change the bacteria in your stool leaving only the C. Diff bacteria to grow and cause these symptoms. A stool test can determine if C. Diff is the cause and treatment with an antibiotic called Flagyl can solve the problem.

Constipation

Constipation is a more frequent complaint from bariatric surgery patients.

1). During the first week after surgery the use of pain medicines such as Percocet or Vicodin that contain narcotics will slow bowel function causing constipation. The solution is straight forward. Stop the narcotic pain medicine and use Tylenol or Tramadol. In a day or two bowel function will return.

2). After the first week or so following surgery constipation is usually the result of inadequate fiber intake. Very little fiber is consumed early after a bariatric operation. Adding 25 grams of fiber each daywill usually correct the problem in a week or so. Many fiber products are difficult for bariatric surgery patients to consume since they often form into a gel after being swallowed. I recommend Benefiber since it is tasteless and dissolves in liquids. Benefiber should be added to nearly all fluids consumed for a total of 25 grams each day.

3) For more immediate relief as the fiber is doing its work you can use the following three over-the-counter preparations:

A). Miralax - You can repeat this several times as necessary until constipation is relieved.

B). Milk of Magnesia

C). Colase stool softener

As you return to more normal foods three to six months after surgery you will be able to decrease the amount of supplemental fiber as long as your stools stay soft.

Laparoscopic Gastric Sleeve Operation - Questions Answered

In response to a recent posting on laparoscopic gastric sleeve operations I did in June 2011 I received several questions.

Pete S. from Columbus, Ohio asked about outcomes and frequency of the gastric sleeve operation nationally.

Pete, I returned from the American Society for Metabolic and Bariatric Surgery in June 2011 and I can tell you that the changes I am seeing in my practice is happening all over the USA and around the world. The frequency of gastric banding has dropped off rapidly and the frequency of the gastric sleeve is increasing rapidly as well. My practice is probably out ahead of the curve somewhat because I have been performing the laparoscopic gastric sleeve longer than many. My first gastric sleeve operation was performed nearly 4 years ago and I have probably performed about 250 of these operations to date.

My practice is now about 50% gastric bypass and 50% gastric sleeve with only one or two gastric bands a month. The gastric sleeve may even be more frequent than the gastric bypass although it may be too early to know for sure. I doubt that this would be the case across the country but the trend is clear.

In regard to outcomes, Across the country there is a range of weight loss from 50% of excess weight lost at 1 year to 80% of excess weight lost at 1 year. As I mentioned in the earlier blog posting I refer to above our average person who has a gastric sleeve loses 78% of their excess weight at 1 year after surgery for those who are at a BMI of 55 or less at the time of surgery. There are several likely reasons for this discrepancy.

1). Technical – Obviously the operation must be performed correctly. The sleeve should be narrow. However, it cannot be so narrow it causes an obstruction along the sleeve. I use a 32 French gastroscope for a sizer and make sure it is not too tight. This allows me to look at the size of the sleeve from the inside of the sleeve before completing the operation to make sure I am happy with the diameter.

One of the most frequent errors that probably contributes to inadequate weight loss is to leave too much room in the top of the stomach called the fundus. When this occurs the fundus is likely to dilate over time making the stomach too large and allowing too much food to be consumed at each meal. This can be corrected but will require an additional operation to remove the excess fundus.

2). Patient must be well prepared – The patient must be ready to make the necessary dietary and behavioral changes to get their best result. This includes being psychologically ready as well. Only participating in a bariatric surgery comprehensive program is likely to do this for most people.

3). Great long term care – It is important to see your bariatric surgeon often after surgery to make sure you are on track. I see my patients at 1, 3, 6 weeks and at 3, 6and 12 months. This allows for mid course corrections if you are not meeting expectations. Ask your surgeon how frequently you will be seen after the operation.

So Pete, hopefully this helps you to understand what is happening on the national scene.

Five More Apps for your Smart Phone

In addition to the free and paid apps introduced on my last blog posting, here are five more paid apps for your smart phone:

1). MyFitnessPal
This is a calorie counter, as well as a diet and exercise.

2). DailyBurn
This is a calorie counter as well as a workout and weight tracker.

3). Ihourglass
Virtual hour glass which allows you to choose multiple time intervals to help you eat slower and clock times between bites.

4). Fooducate
This application allows you to take a photo of a bar code while shopping to help you make better, healthier choices.

5). Meal snap
This app lets you take a picture of your meal and "magically tell you what foods it detects and calculates the estimated calories in each item and meal! How crazy is that?

Nutrition and Exercise Apps for Your SmartPhone

In this era of smart phones there are many apps that can help you on your Journey to better health through the help of bariatric surgery.
Kristi, one of the Fresh Start Bariatrics dieticians, gave me this list and made the following comments on each.

Free Apps:

1). Fresh Fruit
This application contains a description of various fruit, nutritional info. It also explains the country of origin and when they are in season.

2). Nutrition Tips
This contains a collection of 500+ interesting and useful nutrition tips and health facts.

3). Lose It!
You can use your iphone camera to scan barcodes on food packages and track your calories.

4). FoodScanner
This also allows you to scan the barcodes on food packages and track your calories.

Paid Apps:

1). Tap and Track
This is a user friendly calorie/ nutrient, weight and exercise tracker with a built in USDA data base of 7000+ food items.

2). Restaurant Calorie Count for Dummies
This provides nutritional information including calories from restaurant menus.

3). Eight Glasses a Day
This application helps ensure you meet your fluid requirements. The new1.3 version allows you to track from 1 to 12 glasses of water daily. Touch the virtual water glass after drinking an 8 oz. and watch it disappear.

4). Livestrong.com
This is a comprehensive nutrient analysis and exercise tracker.

5). Mealboard
This is a recipe storage app that lets you plan your meals for the week and generates a grocery list.

Hope this is helpful. Thanks to Keisti for reviewing these apps.

Skin Fold Irritation is Worse in Hot Weather

With the heat wave spreading over the United States this summer many of my patients are struggling with the effect of heat and moisture in skin folds such as:

1). Abdominal skin fold

2). Skin folds under breasts

3). Groins

4). In skin folds in the inner thighs

5). Other skin folds

The best treatment for this problem I have ever found is a product you can find at nearly any pharmacy. It is called ZeaSorb-AF. This is a nearly odorless, white powder seaweed product with an added anti-fungal agent.

I think this product is much better than corn starch or baby powder.

After showering, dry the areas well with a dry towel and apply this powder liberally in the skin folds to keep the areas dry and treat any fungal infection that may be starting in these locations.

I hope this helps you stay more comfortable during hot humid days and nights of summer.

Increasing Your Activity of Daily Living to Improve Your Weight

In June I was at the American Society for Metabolic and Bariatric Surgery in Orlando, Florida and had the privilege of hearing Dr. James Levine speak of his research.

Most of the calories we expend are the result of activities of daily living, not from exercise. Exercise is important but we use allot more calories in our activity of daily living.

He explained that people that are lean "automatically" increase their activity of daily living after a time of consuming more than needed. Some of his suggestions include:

1). Walk more and faster all day long.

2). Walk, don't sit, in any meeting of two people.

3). Swear off elevators and escalators.

4). Do not sit while speaking on your cell phone, always walk up and down the hall.

5). Park as far as possible when you drive to work or the store.

6). Move your legs up and down while sitting at your desk at work.

7). Move your chair out of your cubicle and use a fitness ball to sit on.

Even more aggressive options are sometimes suggested including increasing the height of your desk and standing during much of the day, using a stair stepper at your desk during part of the day and even designing a tread mill at your desk!

You may have even better suggestions but each person must design more activity into our daily lives to maintain our weight at a healthy level.

Laparoscopic Gastric Sleeve Operation is Becoming Much More Frequently Performed

An important shift is occurring in our practice. Patients appear to be requesting the gastric sleeve operation more frequently than any other operation. We are much less likely to be requested to perform an adjustable gastric band than a coup;e of years ago.

In my opinion a gastric sleeve is a great operation for many patients. However, a gastric bypass is usually the best operation if you have significant type 2 diabetes or severe gastroesophageal reflux.

A gastric sleeve operation does not change the small intestine and therefore supplemental vitamins and calcium may not be medically necessary.

Also the circular muscle at the outlet of the stomach functions somewhat as the gastric band. In a way this operation is the best a gastric bypass and a band without some of the potential problems of either.

I have now had the privilege of performing over 200 laparoscopic gastric sleeve operations and I have found patients are generally very pleased with their results. In our practice our patients lose about 20 lbs. a month for about three months and they lose an average of 78% of their excess weight at one year after surgery. This is similar to the 80% excess weight loss a year after a gastric bypass in our practice.

Things Randal Hall Learned Before and After Bariatric Surgery

Randal Hall is an engineer who spoke at a recent seminar. He had a gastric bypass operation 10 months ago has lost a total of 200 lbs so far. He did a terrific job sharing many things he learned while proceeding through the process of bariatric surgery and printed his thoughts for us. I think you will enjoy reading them:






Things I Regret:
a.) Nothing!

Three things I wish I would have done differently:
I wish I would have taken more and better pictures and monitored my weight/size loss better.
I wish I would/could have done it sooner
I wish I would have started exercising sooner and stuck with the program better.

Things I didn't expect:
a.) I could have comprehended just how different my life could have been.
b.) My weight loss was very rapid.
c.) My size loss was not as rapid but much more steady than the weight loss.
d.) “Plateaus” are very frustrating but when they end the changes are dramatic.
e.) I became lactose intolerant, no big deal, I hate milk anyway.
f.) Reaction to the new “Me” varies greatly from awkward avoidance to wanting to know every detail.
g.) Size loss does not equal weight loss.

Things I am still learning:
a.) When I look in the mirror, sometimes I still see the “Old Me”, it is kind of weird.
b.) My eyes have not adjusted to my new reality. I see myself as the old size/lifestyle.
c.) Portion selection is still very difficult. I look at a very small portion and think that will never be enough and then I can only eat less than half of that.
d.) Buying clothes is difficult for a few reasons, self awareness of actual size and what fits today may not fit tomorrow.
e.) Chewing is critical, seriously! Few things are worse than getting food backed up, I learned fast to avoid this.

Things that worked out fantastic:
a.) Total lack of hunger (good and bad but the bad is manageable)
b.) Very small portions of food satisfy.
c.) Fluid consumption is not a problem, I can drink water/sports drinks normally as I use to.
d.) I don't notice increased energy levels, just increased endurance.

Things that disappointed me about the process:
a.) Sugar doesn't give me symptoms.
b.) Fats seem to cause mild dumping.
c.) High protein intake means you need to consume some sort of fiber trust me...
d.) While I don't get hungry, I get a feeling like low blood sugar when I need to eat, I try to avoid that.

Things I do different now:
a.) When I eat, I eat quality not quantity.
b.) I don't worry about a clean plate anymore, as a matter of fact, I don't know the last time I cleaned a plate. Wasting food is not good but it doesn't end up on my waist.
c.) I don't take elevators anymore; I don't get winded on the stairs now.
d.) I don't park close to the doors; I walk from the back of the lot now.
e.) I run, I just ran the Komen 5K in 41:00 and I run 4 miles 3-4 times a week.
f.) I can fly coach comfortably now. (This was a primary goal)
g.) I can buy clothes at department stores, non-Big & Tall stores. (This was a primary goal)
h.) I eat slowly, it is not a race and it makes me sick to eat fast now.

Things I recommend doing prior to surgery:
a.) Exercise
b.) Reduce portions
c.) Get use to eating small portions 6-8 times a day, this is critical practice.
d.) Do research. Research your surgeon, hospital, surgery method and every aspect of what you are about to do. I particularly recommend Dr. Myers and Fresh Start, they were absolutely fantastic to me.
e.) Once you start the program take pictures, weighing yourself can cause frustrations but pictures really lets you see your progress.
f.) Develop your story, you will be asked a lot of questions, if there are things you do not want to disclose, formulate your avoidance answers, you will be asked a lot of questions. Prepare for people to say rude things and ask inappropriate questions.
g.) Realize that this is not the easy way out, this is not easy at all. Your life will not be the same after the surgery.
h.) Prepare for post surgery. Have your foods ready and test them prior to make sure what you like, experimenting post surgery can be quite interesting.

Warnings From My Personal Experience:
a.) DO NOT proceed with the program unless you are 100% ready and confident with your choice!
b.) DO NOT think that the surgery is MAGIC!
c.) DO NOT think that you will be happier post surgery!
d.) DO NOT think people will stop judging you post surgery!
e.) DO NOT think that all of your eating troubles will go away post surgery!
f.) DO NOT think that this is the easy way out, while I didn’t find this to be difficult, if this is the easy way the hard way is to do nothing!
g.) DO NOT think the Fresh Start Staff is kidding when they tell you that you have to meet your weight goals before being released for surgery, they are not kidding!
h.) DO NOT think that if you really want to do this, that you CAN’T, you most certainly can!
i.) DO NOT think that my experience will be the same as yours!

Questions you may not be comfortable to ask me:
How much did I weigh before the program?
464lbs was my max weight.
424lbs was my surgery weight.
268 is my weight today.
200-225 is my goal weight.
Max Waist Pant Size: 52” current Pant Size: 38” and shrinking.

Do I have trouble eating anything?
Breads and stringy meats (chicken breast and roast beef) cause me the most issues but if you chew properly and eat slowly they are quite manageable.

Is sex better?
Yes! Very much so.

Do I consider what I did hard?
No, I think in the grand scheme it was pretty easy but there were points where I did ask myself what the heck I had done to myself. If I can do it anyone can do it.

What was the worst part of the whole surgery?
There were two particularly bad points. The first period was the three week period post-op. I was very sore and then one day I woke up and it was totally gone, like magic.
The second period was about 6 weeks out, I had to go back to thin liquids because I couldn't get or keep much down, that lasted for about 2-3 weeks and Dr. Meyers refers to this as the "Misery Window" and he is not joking. Since that period, I have felt fantastic. Other than being sore, I have never felt bad.

Do people treat me different now?
Some do, some don't. I don't let what people think of me effect how I think of me.

Do I tell everyone what I did?
No, not at first, not anymore. I did for a while and the reactions were mixed. I have adopted the "Less History More Mystery" model and it really reduces the drama. It is not that I am ashamed, it is that I prefer people get to know me now before I tell them about my history to avoid the prejudice.

What am I the most proud of?
I started running on October 1st of 2010 at 320lbs. I had not voluntarily run more than a few steps in 20 years. I started a Couch-to-5K program and by March 30th I had ran my first continuous 5 kilometers. I was able to run the Komen race without stopping in 41:00. I am very proud of this.

Can I go out to eat at restaruants?
Of course I do, I just choose much better than I use to but I still enjoy the experience just as much.



Thanks so much for sharing so much of your life with us. I know everyone will really appreciate this.I am also very proud of you. Not only for completing the 5K run but for all the work you are putting into getting your best result!

Best wishes for your ongoing sucess,

Dr. Myers

Blood Clot Prevention before Bariatric Surgery

Martha Pettit explains how the preoperative placement of an Inferior Vena Cava Filter the day before her bariatric operation prevented the development of a pulmonary embolus. Martha was determined to have a high risk of developing deep vein thrombosis and/or pulmonary embolus. She was advised to have the filter placed before surgery and now she is glad she did.

Bowel Habits After Bariatric Surgery

While seeing patients in my office I often hear concerns about constipation. This is a frequent complaint in the early days or weeks after the three most frequently performed bariatric operations; gastric bypass, gastric sleeve, and adjustable gastric band.

Although after surgery patients may be using narcotic pain medicines that slow the intestine that may result in constipation, usually the problem is the lack of fiber in the diet. Since patients are only taking liquids for a time after the operation it is very difficult to consume adequate fiber.

I make the following 4 suggestions to my patients:

1). Stop the use of narcotic pain medicines.

2). Add 25 grams of Benefiber everyday to your drinks or meals. Most fiber products become thick and are difficult for bariatric surgery patients to tolerate. Benefiber disolves in liquids, is tasteless, colorless and is not gritty.

3). Use Miralax as necessary if you have not had a bowel movement for several days.

4). Censider using Colase twice daily until the fiber therapy results in soft bowel movements.

Fiber therapy is not an instant cure for constipation but over a week or so bowel movements will become softer and should stay that way as long a the patient is taking enough fiber. As fiber is added to the diet in other ways the amount of supplemental fiber can be reduced.

Recently I saw Angela McCaulley in my office. When I sat down across from Angella I first told Her,"I might see your name on this chart but I really do not know who you are!" Angela had her laparoscopic Roux en-Y gastric bypass performed by me nearly 18 months ago. She has had an amazing result as you can see.

She now walks or runs everywhere.

To remove some of the extra skin she had a "belt lipectomy" romoving skin from all around her waist about 6 months ago.

I did not feel so badly for not recognizing her after Angela told me even her grandmother did not recognize her!

Congradulations Angela, the great result you have obtained is the result of your exceptional efforts over the last 18 months.

Testimonial Robotic Gastric Bypass

Tom Cocran had a robotic gastric bypass operation 4 months ago. He is 6 ft 4 inches tall and weighed 356 lbs. He lost 60 lbs in the Fresh Start Bariatrics program prior to surgery. He has now lost a total of 114 lbs. He no longer has type 2 diabetes with a normal HbA1c. He is no longer on diabetic or blood pressure medicine. He also no longer is on his CPAP machine for sleep apnea.

Tom shared this at the Fresh Start Seminar on April 16, 2011.

Testimonial Robotic Gastric Bypass

Chest Pain after Gastric Sleeve Operations

Heather explains symptoms of chest pressure just 6 weeks after her gastric sleeve operation.

Testimonial After Gastric Bypass

Jennifer Albalakousy has lost 96 lbs just 8 months after her laparoscopic gastric bypass operation and now wieghs just 175 lbs!

She has two children, Zahn who is two years old and Mazin who is five. "I can now keep up with them and play outside with them. We recently went ot Disney World and I had no feelings that I am too large to ride the rides. I would not have been able to do this before because I was too embarassed.

Congradulations! You should be very pleased with what you have accomplished and it has been great to see how supportive your husband has been throughout this process.

Bariatric Surgery and Kidney Stones

Stephen Vijan, MD, Urologist

I was sitting at the nursing station at Riverside Methodist Hospital today after making rounds on my patients and noticed Stephen Vijan, MD, a urologist, sitting next to me writing a progress note on one of his patients who was on the same nursing floor. I told him I had noticed that not infrequently my bariatric surgery patients have kidney stones in the first year after their operation but I rarely heard about kidney stones thereafter. He thought it was probably because of 2 reasons:


1). They may have more difficulty drinking as much as they should for a few weeks or months after a bariatric operation.

2). They are probably breaking down muscle as well as fat as they lose weight rapidly. Breaking down muscle increases the amount of uric acid in there blood steam and in the urine as it is cleared from their system. Increased uric acid in the urine is known to increase both uric acid stones and more importantly it increases the development of calcium oxalate stones which are the more frequent type of kidney stones.

Dr. Vijan went on to give 5 suggestions for my patients to help prevent kidney stones:

1). Drink as much as possible up to 2 to 2.5 liters. (I am fully aware that this is not possible early after bariatric surgery but do your best.)

2). Take the recommended calcium citrate with meals. This way the calcium will bind the oxalate keeping it in the intestine and away from the urine. Also, the citrate in the calcium citrate will be excreted in the urine and will decrease the acid milieu in the urine making it more difficult for kidney stones to form.

3). When possible avoid oxalate rich foods. This includes cranberry juice, nuts, chocolate, and colas.

4). Be careful not to take too many dairy products such as milk and cheese as they can contain too much protein. (Of course we wnat you to take 60 grams of protein a day for women and 75 grams of protein daily for men. Early on this is challenging and your first priority after keeping hydrated.)

5). Finally, taking other citrate products can help. He suggested that Theralith pills. This is medicine you can order over the internet from Therologics.

A water pill like hydrochlorothiazide can help but since it is likely to cause dehydration in our bariatric patients I would not advise this medicine for most patients.

Dr. Vijan agrees that this problem is likely to be temporary and will not continue to be at risk for kidney stones after they are able to drink 2 to 2.5 liters of liquid a day and after they have lost most of their weight.

Many thanks to Dr. Vijan for taking the time to explain this to me. I am sure it will help many bariatric surgery patients from all over the world.

Testimonial after gastric bypass-Christina Dillman

Before her laparoscopic gastric bypass Chistina Dillman She felt out of control and had difficulty taking nature walks with her students. Now since she has lost 128 lbs she feels much better about herself and she is the one that starts the day by exercising for 10 minutes with her preschoolers!
Shopping is fun again since she has dropped from a 5X to sizes 18 or 20.

She is much happier and her children have lost weight too since mom is making healthier choices.

Great job Christina. You deserve many fun days shopping!

The 7 Steps that Stop Us from Keeping Our Weight Off after a Diet

Why do we seem to always return to our previous body weight no matter how many weight loss programs we try?

The hormone called leptin is the key to this dilemma. At the recent world congress on interventional therapies for type 2 diabetes Dr. Leibel from the Columbia University Medical Center explained that our bodies are programmed to protect themselves from starvation not obesity. The challenge humans have faced throughout history is to survive despite times of famine.

Food being too easily available has not been our problem until the last few decades.
The body is tuned to defend our body weight and preserve our stored calories so we do not run out of energy in times of famine.

Here are 7 steps that keep us returning back to our previous weight each time we diet.

1). The more calories we store as fat in our fat cells the larger the fat cells become. As the fat cells become larger they put out more and more of the hormone leptin.

2). Each time we gain weight the leptin level increases and our brains are reset so our weight setting goes up to a new level.

4). This means our weight settings will go up and up each time we gain weight.

5). Unfortunately, weight setting in the brain only resets upward and does not reset downward!

6). Any fall in the level of fat we have decreases the amount of leptin and our brains will trigger mechanisms such as hunger, delay in satiation of food and decreased muscle activity to preserve our stored calories and restore our weight to the previously set level.

7). When we start to lose weight our metabolism slows down and we use 10-15% less energy so we do not use the stored calories any faster than absolutely necessary.

All of these steps serve to maintain our body fat so we have the energy we need to stay alive as long as possible during times of famine.

Unfortunately, when food is too plentiful such as we see in our time these steps work against us as we lose weight and try to keep it off.

If you have struggled to lose weight and keep it off you now understand why it is so difficult to maintain the lower weight. Fortunately, the surgical procedures we use in bariatric surgery counteracts many of these mechanisms and at least 80% of our patients keep their weight off long term.

Testimonial: Kyle Harrington Shares His Gastric Bypass Results

Kyle Harrington is 34 and a science teacher of 4th, 5th, and 6th graders. He is also a father of twins, Jacob and Lilly, but he weighed 415 lbs and was struggling to do the things he needed to do. Fortunately, his wife and family were very supportive when he decided to have a Roux en-Y gastric bypass by Dr. Myers at Fresh Start Bariatrics at Riverside Methodist Hospital.

He did a great job before his bariatric operation losing 30 lbs so he could have his operation more safely. He weighed 385 lbs. at the time of his operation in December, 2009. He says having his operation was a “God send”. Kyle now weighs only 190 lbs!

He says he had a couple of “bumps” in the road including severe gout as he was losing his weight requiring prednisone and other anti-gout medicines. Also as he lost his weight it became clear he had a deformed coccyx that made it impossible to sit down. This was so difficult he had to have it removed by Dr. Myers surgically.

Now he is off several medicines including Benicar, Allopurinal, Cholchicine, Midrin, and the gabapentin he had been taking for fibromyalgia. He no longer has high blood pressure and is no longer having migraine headaches he no longer needs his CPAP machine for sleep apnea.

Now he is active in Scout’s and can even sit down in a normal position at the campsites!

Congratulations, Kyle, you have worked hard to get your best result from your operation and may God bless you and your family as you enjoy your fresh start life with your wife and twins.

Patient Testimonial Sleeve Gastrectomy

Cheryl Dalton had a laparoscopic gastric sleeve operation only 7 days ago by Dr Myers at Fresh Start Bariatrics at Riverside Methodist Hospital in Columbus, Ohio. She now explains how her postoperative pain has been managed.

Patient Testimonial after Robotic Gastric Bypass on How Her Pain is Controlled

Jill Ehrhart had a robotic Roux en-Y gastric bypass just 9 days ago by Dr Myers at Fresh Start Bariatrics at Riverside Methodist Hospital in Columbus, Ohio. She explains what she experienced and how her pain is controlled after her operation.

Many Paths Before Meeting Criteria for Bariatric Surgery

I have to admit I am somewhat absent minded. On occasion I will be driving along thinking about something else and miss my exit. Before I realize it I have gone quite a distance and when I finally become aware of my surroundings I ask myself, “How did I get here?” I think some of my patients are like that. They are amazed that they have arrived at a weight that is starting to harm their health.
There are many reasons people become over weight. Sometimes I hear someone explain that they had to be on steroids for their asthma and gained a lot of weight. Occasionally I hear the person had a car accident and was immobile for months and gained allot of weight at that time. Others tell of a traumatic episode in their life such as the loss of a child, a parent or even a divorce that led to depression and they started to gain weight while depressed and on antidepressants.

Dr. Tell, the psychologist that works with our program tells me that over 60% of the women in a bariatric surgery practice have been sexually abused as a child or young adult. Sometimes obesity is a way of keeping themselves at a distance from men and keeping themselves felling safe. However by the time they seek help from a bariatric surgeon they have often dealt with the trauma and are married and have healthy marriages and families but they feel trapped in their own body.

Often men tell me they were very active in sports during their teens and or while they were in the military but became much less active as the entered into the work force, found a sedentary job and have gained some weight nearly every year since then.

Women explain they gained weight with each child and now after their last child the weight seems to just keep coming. Or they gained weight during a depression following a miscarriage or stillbirth.

Still others have told me they were always heavier than their peers and cannot remember a time when they were not heavy or that food was used to manipulate them as a child and they just feel driven to eat to prove they are in control of this area of their lives.

Regardless of how a person of size arrived at their weight they usually seek help when their activity level and health are deteriorating. They often feel trapped and desperate and feel their life is slipping away from them.
What is important is that there is hope because with bariatric surgery obesity and related medical problems such as type 2 diabetes can be reversed.

I see it happen every day and I love to hear the stories of how lives are changed and how fun life is again. They tell me of new jobs, having children and having more energy to do the very things they thought they would never be able to do again. I remember John who had not been able to go on the yearly golf trip with his brother for years and the year after surgery he had lost so much weight he was able to take his brother golfing again and oh by the way he is getting married! I remember Molly who was so depressed with her life that she spent most of her time at home in bed but now she has lost all of her excess weight and is salsa dancing again and Sandy who after getting rid of most of her diabetic medicines and losing most of her extra weight took ball room dancing lessons and was recently a champion at a regional competition!

Some of my patients do crazy things like jumping out of perfectly good airplanes, run marathons or going across valleys on zip lines. There are so many stories and so many changed lives. Life can be great again and you can begin to live again. Bariatric surgery can be your fresh start to life. I see it happen every day.

Patient Testimonial / Gastric Bypass / Betty McCauley

See other testimonials on my YouTube channel. Go to Google and enter "DrSteveMyers YouTube".

Obesity Causes Diabetes / Diabetes Causes Obesity

Although Type I diabetes, previously called juvenile diabetes, is a serious problem of inadequate production of insulin, in this posting we will primarily be speaking about type II which is 90-95% of all diabetes. Whereas most Type I diabetics are not obese, Type II diabetes is frequently associated with obesity. In fact, the curve associated with the increase in frequency of obesity parallels the increase in type II diabetes. That makes perfect sense since patients who suffer from obesity develop resistance to insulin resulting in increasing blood sugar levels. Most people understand that they increase their risk of developing Type II diabetes as they increase their weight and the longer they are heavy the more likely they will develop Type II diabetes.

What is surprising to people is that the reverse is also true; the treatment of Type II diabetes causes obesity. When your blood sugar is high we try to lower the blood sugar by taking diabetic pills or insulin to lower the blood sugar. However, the glucose does not just disappear. Many of the medicines drive the glucose into the cells of the diabetic so the glucose can be used for fuel. Unfortunately, many medicines including Insulin, Glyburide, Glucotrol, Amaryl, Pranlin as well as Starlix, Actose and Avandia drive glucose into fat cells increasing the amount of calories stored as fat. As a result the person becomes heavier. This in turn causes more insulin resistance requiring more diabetic medicine to keep the blood glucose down! How frustrating is that; obesity causes type II diabetes and type II diabetes make the obesity worse.

Patient Testimonial Reversing Diabetes with Gastric Bypass

Christopher Anderson had a robotic gastric bypass by Dr Myers just one week ago and now is off of all of his diabetic medicines. Chis shares his story.

Patient Testimonial after lap gastric bypass

John Lyle has lost 143 lbs just 1 year following lap RNY gastric bypass. His knees are much better and he is having a positive effect on his daughter.

Tree Reasons Type II Diabetes is Often Reversed by Gastric Bypass

How a gastric bypass can reverse diabetes Here are thee reasons

1). Early after the operation carbohydrate intake is minimal so the glucose level remains low. In fact in our practice I have patients on a very low carbohydrate diet, (650-800 calories per day), for 1 to 2 weeks before surgery primarily so they have an opportunity to use up the stored calories in there liver, (glycogen), which results in loss of water stored in the liver and the reduction of the size of the liver. This allows me to work more easily under the left side of the liver where the upper part of the stomach lives. This makes the operation easier for me and safer for my patients. What I have observed is that frequently many of my patients no longer need their diabetic medicines even before surgery as long as they continue to consume very few carbohydrates. The reduction in the amount of carbohydrates consumed is clearly an important component in this process that continues even after their operation since it takes several weeks or a few months for the amount of carbohydrate a person consumes increases and stabilizes at a new lower amount.

2). Second, since obesity is the most important reason most of our patients
develop diabetes, losing weight and keeping it off decreases the obesity and the patients lose their resistance to insulin which was caused by their obesity in the first place. Therefore the amount of insulin they are able to make is frequently enough to keep their glucose in the right range. Unlike the previous two components that decrease the blood sugar right after surgery this component takes time to show the beneficial effect of weight loss but by the time the patient is able to consume a more normal amount of starch and sugar he or she has lost enough weight to no longer need their diabetic medicines because of the loss of insulin resistance from the resolution of their obesity. This is why with some patients we need to slowly decrease the amount of diabetic medicine they are on over several weeks or even a few months.
It is important to understand that not everyone will have resolution from their diabetes. About 15 to 20 percent will still need to be on some diabetic medicines after a gastric bypass operation. The longer a person has type II diabetes the less likely it is that they will resolve their disease. However I have seen some patients resolve their diabetes after a gastric bypass operation even after 10 or 15 years of diabetes. Nevertheless even if the diabetes is not completely resolved it is much easier to manage and usually a person needs to be only on a pill they can take by mouth and they will not need to take insulin shots.

3). Finally, of these three most common operations, (gastric bypass, gastric sleeve, adjustable gastric band), the gastric bypass has an additional component that helps the diabetic. It is the hormone change that occurs after a gastric bypass. Probably the most important of these changes is the increase in a hormone like substance from the last part of the small intestine and the first part of the large intestine called GPL-1 (Glucagon Like Polypeptide-1) which increases the amount of insulin a gastric bypass patient sends into the blood stream after consuming carbohydrates.
Instead of giving yourself an injection of Byetta or Symulin, which is the injectable form of GLP-1, after a gastric bypass operation your body produces more GLP-1 on its own in response to ingesting carbohydrates resulting in better production of insulin and improved use of insulin where the insulin does it’s work.
This begins immediately after the operation and is part of the reason that many diabetics that still needed some diabetic medicines before surgery even while they were on a very low carbohydrate diet will leave the hospital after their gastric bypass operation on no diabetic medicines at all and have normal blood glucose.

If a person of size has had diabetes for 10 or 20 years, sometimes the insulin producing cells of the pancreas have been so severely damaged that they are no longer able to produce enough insulin to meet their needs even if they lose their excess weight and therefore lose the insulin resistance that comes along with obesity. Nevertheless I have observed amazing results even when I did not expect them. Even if all the patient who has had diabetes for many years are not able to stop all of their diabetic medicines, generally they are on alot less medicines and their diabetes is much easier to manage. They still should be able to maintain a HbA1c
of 6 or less.

The gastric bypass operation is a wonderful tool for persons of size who want to improve or reverse their Type II diabetes.

Diabetes Reversed by Bariatric Surgery as Viewed by Dr. Myers, Assistant Mike Palasek, RN, CRNFA

Mike Palasek. RN has been working with me as the surgical assistant for over 10 years. He is great help and has helped me with every bariatric operation that I have performed and that is over 1,000 operations. Mike has a “bird’s eye view” of how our diabetic patients do after surgery. He sees each patient after surgery in the office shortly before I see them and records their medicines and how they are doing with their weight and glucose readings. He often speaks to prospective patients who attend our Fresh Start Educational Seminars before I start my part of the presentation. I have heard him say, “I have been a nurse for over thirty years. When I first started nursing I had no idea we would be operating on people to improve their medical problems such as diabetes and high blood pressure. When I was first a nurse I gave insulin for diabetes but no one ever got better and off the insulin injections. We gave pills for high blood pressure but no one ever got off of their blood pressure pills. For me, as a nurse, it is very satisfying because instead of just managing these and other medical problems in our patients we are actually seeing these problems resolve. Now I see people getting off insulin and other diabetic medicines and it is not uncommon for patients to no longer need any medicines for diabetes. Patients who needed 3 or 4 diabetic medicines or are on an insulin pump before surgery are no longer on any of these medicines and they are no longer taking any insulin. It is surprising but we often see patients that are taking 70 or 100 or even more units of insulin every day prior to surgery taking no diabetic medicine or insulin at all with normal blood sugars. As a nurse, that is really rewarding.”

Robotic Gastric Bypass

Gastric Bypass Testimonial Deb Hoffman

Debbie Hoffman explains the results she has experienced 2 1/2 years after her Lap RNT gastric bypass operation. She has lost 131 lbs and kept it off.

For more patient stories from our practice by googling DrSteveMyers and selecting my YouTube channel.

App for a Smart Phone Can Help Bariatric Patients

Jennifer Kanagy was seen in my office this week and explained that she had found a new App that had been helpful to her. It has a name that could insult anyone!

FatSecret.com alows you to manage your calories, protien, fat, calories and exercise.

Download app
Bring up daily food guide
click scan
scan bar graph
Obtain nutrition info
change size of portion
collect info about food consumed
etc.

Jennifer hopes this is helpful for others on their bariatric surgery journey.

Kathy Tells How Her Type II Diabetes was Resolved with a Robotic Gastric Bypass

Diabetes Improvement Barely Mentioned

Recently on a Sunday in late winter I stepped off the escalator on the second level of our local Barnes and Nobles book store at Easton in Columbus, Ohio and my eye caught a large group of books on the medical self just in front of me. I counted 23 books about diabetes and as I looked further no other medical subject devoted so many books to one disease. Not heart disease, not high blood pressure, not even cancer. As a busy bariatric surgeon caring for diabetic patients nearly every day, I was intrigued.

After bariatric surgery amazing things happen to improve the lives of diabetic patients. Usually I see patients with type II diabetes discontinue all of their diabetic medicines soon after bariatric surgery. Less frequently patients who have had diabetes for many many years see improvement in their diabetes, discontinue insulin but still need some diabetic medicines that they take by mouth. In fact, it is extremely rare for a patient NOT to either resolve or improve their diabetes after bariatric surgery.

Filling my arms with a copy of each of these books, I headed for the store’s coffee shop and began to read. I tuned the pages of these books for references to the amazing things I was seeing following bariatric surgery. Surprisingly, I found very little. In fact I found only three books that even mentioned bariatric surgery and only one mentioned bariatric surgery could improve diabetes.

Why is there so little information in most books about diabetes about the amazing improvement for diabetics after bariatric surgery?

I will share more thoughts about this dilemma in postings over the next week.

See patients telling their stories on YouTube by googling DrSteveMyers and selecting my channel.

Follow Up on Chaka, the African Child Who Required Amputations

As some of you will recall, while recently in Africa I had to perform a very sad operation on a one year old baby. The baby had severe malaria and because it took so long for him to recieve adequate care his fingers and feet died and I had to amputate many of his fingers and do amputations of his lower legs. (See postings under African Hospital in the index to the left of this posting and find "The Saddest Operation I Have Ever Performed")


Chaka felt much better a few days after his operation and now has gained weight and will soon recieve the artificial lower legs from a doctor in the USA.

If you look closely at the photo you will note the partial absence of several of his fingers but each is well healed.

I am so pleased he is alive and doing so well. I will be excited to see him next year and see how he is walking with his articicial legs.

Gastric Bypass - Jennifer Pierce Reports 3 Years Later

-----------------JENNIFER NOW-----------------



"Best thing I have ever done for myself!" Jennifer exclaimed. It was my privilege to see Jennifer Pierce in the office three years after her laparoscopic Roux en-Y gastric bypass by me at Riverside Methodist Hospital in Columbus, Ohio.

She was very willing to share some of her journey.

She told me she weighed 267 lbs before surgery and now weighs only 155 lbs. She is near ideal weight and doesn't she look great?

"I now love to work out," Jennifer said when I asked if she is staying active.

She is much happier as you can see from her photos. She has more confidence in herself and is feeling much better than before her operation.

Jennifer's weight loss is a result of her strong effort to get her best result from her operation by staying active and making great choices. She lost nearly all of her excess weight in the first year after her gastric bypass but her weight has remained stable since then.

Great job Jennifer! I am delighted with your result and you should be very proud of yourself for what you have accomplished and how you have kept the weight off.Keep up the good work!

Robotic Bariatric Surgery and Improvement in Pain

The results of our first 50 robotic gastric bypass operations have now been completed. The most dramatic difference we have noted is that our patients who have had robotic operations are much more comfortable following surgery and are leaving the hospital the day after surgery in the vast majority of cases.

At the live bariatric surgery seminar I gave last Saturday,as usual one of our patients volunteered to share her journey through our program. She had lost 135 lbs over the last year and is clearly doing very well. However, one thing she said took me by surprise. She explained that she experienced considerable pain at the one incision in the left side of the abdomen for several days after her operation. The reason this was surprising to me is that I remembered how much discomfort this particular incision caused many of our patients and that I have not heard this at all for the last several months since we have been using the da Vinci Robot.

This is a remarkable change. Previously we made an incision a little over an inch in size that allowed the passage of a fairly large circular stapler into the abdomen. This required the spreading of the muscles at this location which caused much more pain than the small incision we use with the robot.

Using the robot allows me to perform the connection between the gastric pouch and the Roux limb with two rows of stitches instead of using a circular stapling device. Of course the stitches, which we call sutures, are easily passed into the abdomen without any additional abdominal openings. In fact we have been able to decrease the number of incisions from five incisions we previously used and now use only four smaller incisions.

The result is much less pain and the ability to leave the hospital the day after surgery.

It is a privilege to be the only bariatric surgeon in central Ohio using the da Vinci Robot to perform the gastric bypass operation and to be one of the very few surgeons in the country to use the da Vinci Robot routinely to perform a Roux en-Y gastric bypass. It is wonderful to work Riverside Methodist and have the privilege to use today's most advanced technology to improve the lives of so many people.

Gastric Bypass and Smoking

I saw a patient in the office today who was complaining of epigastric pain.

She had had a gastric bypass operation 6 months ago and had stopped smoking as we required prior to surgery. Unfortunately, she had restarted smoking and now presented to my office with worsening pain in her abdomen just below her breast bone which has continues for two days.

The pain is constant and sometimes is felt into her back. It feels worse when she eats or drinks.

This situation is most consistent with an ulcer that develops at the connection of the gastric pouch to the intestine. We refer to it as a marginal ulcer.
This problem is 40 times more frequent in people who smoke after a gastric bypass. That is why at Fresh Start Bariatrics we require that patients stop smoking prior to surgery and we strongly advise that patients refrain from smoking for the rest of their lives.

When necessary an ulcer is diagnosed with an Upper Endoscopy.
Other causes of a marginal ulcer could include:
• Use of alcohol
• Ingestion of non steroidal anti-inflammatory medications such as ibuprofen or naprosyn
• Infection in the stomach from Heliobactor Pylori

A marginal ulcer is treated for several months by:
• Stop smoking and other possible causes of the ulcer
• Start Sucrafate to bring relief from the pain by coating the ulcer
• Start Omeprazole or another proton pump inhibitor twice daily
• Pain medications as necessary
• Adequate protein in the diet

Potential complications could include:
• Bleeding from the ulcer
• Perforation with leakage of gastric contents into the abdomen requiring an emergency operation
• Scarring that will narrow the gastric outlet and require dilation of the narrowing with a dilation balloon or an operation to remove the ulcer and create a new connection between the gastric pouch and the intestine

The message is clear. Do not smoke if you ave a gastric bypass. If you do smoke you are likely to develop a marginal ulcer.

Jeff Howard runs at Walt Disney World Half Marathon!

Dear Dr. Myers,

In January of 2010 my wife Kristie participated in the Walt Disney World Marathon. At that time I promised Kristie that I would participate in the Walt Disney World Half Marathon which would take place in January 2011. It was my hope that this goal would be the incentive I needed to once again try to lose the weight that for so long had been a health problem for me and was only getting worse with time. By May of last year not only had I not lost any weight, I had actually gained a few pounds. I was unable to walk a mile without becoming fatigued and out of breath. I felt that there was just no way I would be able to make good my promise to Kristie to participate in the half marathon or to get my weight under control



On June 12, with the encouragement of my family, friends and my physician I attended a Fresh Start seminar where I first met you and learned about gastric bypass surgery. After discussing the benefits and risks associated with the surgery with my family and personal physician I decided that it was time to get control of my life and my health. At the time of the June 12 seminar I weighed 305 pounds. My daily medications included Lantus insulin each night, Novolog insulin each morning, in addition to an oral diabetes medication. Also I was taking two different blood pressure medicines and two different medications for elevated cholesterol. My daily blood sugars ranged between 200 and 300 hundred each morning.

Only July 1 I completed my first round of testing at Fresh Start and met with the dietitians for the first time. After that first meeting I met with the Kristi Highly for monthly dietitian visits each month through August, September and October. Then on November 2 I had my gastric bypass surgery at Riverside Hospital and was discharged home on November 3. As of my discharge from the hospital I am no longer taking any medications for diabetes or high blood pressure. My daily blood sugars are now typically in the 90 to 100 range and my blood pressure at my last physician office visit was 128/78.

And today I am happy to share with you that on January 8, 2011 I participated with my wife, my daughter in law and her parents and 28,000 other runners and walkers in the Walt Disney World Half Marathon. I completed the 13.1 miles in 3 hours and 17 minutes and averaged a 15 minute mile pace throughout the race. And my weight as of the writing of this email is 215 pounds, a loss of 90 pounds since my first visit.

I cannot thank you and your entire staff for the wonderful care and support you have given Kristie and I throughout this continuing journey. You have given me my life back and I am sure you have added many years to my life with Kristie. I do not have the words to truly express my gratitude and can only say "Thank You and God Bless You" for using the gifts God has given you to help "people of size" like me.

Thanks again and I'll see you soon!

Jeff Howard


Jeff before his operation



Congratulations, Jeff, on a job well done and a promise kept! Thank you for alowing me to share your story on this blog. You are an inspiration to us all.
Dr. Myers