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.