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