tag:blogger.com,1999:blog-52653612999515581572024-03-15T01:15:25.299-07:00Bariatric Surgery BlogInformation Directly from an Experienced Bariatric Surgeon: Suggestions to Achieve Your Best Result from Bariatric SurgeryDr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.comBlogger178125tag:blogger.com,1999:blog-5265361299951558157.post-89427519778515177502013-08-02T10:10:00.000-07:002013-08-02T11:48:24.693-07:00Diabetes can be 'Cured'!<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-gRpW1ggMwjM/UfvuzxzxljI/AAAAAAAAAcc/HSizkReRoXY/s1600/Arms+out+in+joy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="425" src="http://3.bp.blogspot.com/-gRpW1ggMwjM/UfvuzxzxljI/AAAAAAAAAcc/HSizkReRoXY/s640/Arms+out+in+joy.jpg" width="640" /></a></div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<b>Type 2 Diabetes is "<u>CURED</u>" in 24% of patients who have bariatric surgery. </b><br />
<b><br /></b>
<b>These patients have maintained a Hb A1c below 6, a fasting glucose of less than 100 for more than 5 years while being off all diabetic medications. In short, These patients <u>no longer have any evidence of diabetes!</u></b><br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<b><br /></b>
<b>This <u>amazing news</u> was reported in the <i>Surgery News</i> of the American College of Surgeons Surgery in July 2013 by Dr. Brethauer from the Cleveland Clinic. He reported on long term follow up of 217 patients who had had bariatric surgery after years of struggling with obesity and type 2 diabetes.</b><br />
<a href="http://1.bp.blogspot.com/-TH8lD_dNl1M/Ufvu5RCqYlI/AAAAAAAAAco/vRiICAZDyto/s1600/happy_black_woman_211111503.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://1.bp.blogspot.com/-TH8lD_dNl1M/Ufvu5RCqYlI/AAAAAAAAAco/vRiICAZDyto/s1600/happy_black_woman_211111503.jpg" /></a><b><br /></b>
<b>Another 26% of patients were <u>greatly improved</u> off diabetic medicines but dis not meet the more stringent requirements of the first group of patients.</b><br />
<b><br /></b>
<b>A total of 56% of patients where not on any diabetic medications 6 years ofter their operation.</b><br />
<b><br /></b>
<b>Which patients did best?</b><br />
<b><br /></b>
<b>1). Patients who had a <u>gastric bypass</u> operation (instead of a gastric band or gastric sleeve).</b><br />
<b><br /></b>
<b>2). Patients who had diabetes for <u>less than 5 years</u> prior to surgery.</b><br />
<b><br /></b>
<b>3). Patients who <u>lost most weight</u> after surgery.</b><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-jwg0JUpzJW0/Ufvu-AOK6TI/AAAAAAAAAcw/ur1jFlE0XJ4/s1600/smile.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-jwg0JUpzJW0/Ufvu-AOK6TI/AAAAAAAAAcw/ur1jFlE0XJ4/s1600/smile.jpg" /></a></div>
<b><br /></b>
<b>Dr, Brethauer's conclusion: "Bariatric surgery can a significant and sustainable remission of type 2 diabetes and other metabolic risk factors in obese patients and <u>should be considered early in the course of the disease.</u>"</b><br />
<b><br /></b>
<b>I wholeheartedly agree. If you are diagnosed with diabetes your next plan should be to get rid of it as soon as possible. If you are like 90% of diabetics and are at least 50 to 75 lbs overweight you meet criteria for surgery and can often 'cure' the disease before it gets worse! Decide you will not put up with it and contact your bariatric surgeon today. What are you waiting for?</b><br />
<b><br /></b>
<b>If you are one of the very many people that have their diabetes resolved or improved after bariatric surgery please spread the word of your amazing result and to as many people as possible and help me change our country's understanding. Type 2 diabetes is not inevitable but preventable, treatable and often curable. Join me. We have our work cut out for us so let's get to it.</b><b> </b><br />
<br />
<br />
<br />
<br />Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com15tag:blogger.com,1999:blog-5265361299951558157.post-51848020505246193972013-07-28T19:40:00.000-07:002013-10-07T17:37:21.028-07:00Current Thinking Oppresses Patients with Diabetes<!--StartFragment--><br />
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<strong>I am angry with how we think of diabetes. In fact, I am so angry could scream! Type 2 Diabetes is a monster devouring legs, portions of brains, kidneys, eyes and even people’s very lives every day.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>This week I lost another family member that had suffered with Type 2 Diabetes for many years. Two of my immediate family members continue to suffer with diabetes. It is all so unnecessary and it is because our country and our world has the wrong idea about diabetes. We are thinking wrongly and we will not be able to change our world until we change our thinking.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>We believe the projections that 30% of our adult population will have type 2 diabetes by year 2030. We accept this as inevitable because the obesity rates are so high!<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>This is ridiculous. This is unacceptable. We only accept this because we are thinking wrongly. <o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>We do not have to accept this present paradigm. We know that 90% of Type 2 diabetes is related to obesity. Nearly everyone who reaches a BMI of 40, (for instance, five foot five with a weight of 240 lbs.), will develop type 2 diabetes in time. Some have already developed type 2 diabetes even at a lower weight of a BMI of 35.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>For patients with weight high enough to meet criteria for bariatric surgery, sustained weight loss without surgery is very unlikely and therefore dieting and behavior modification is not a solution to this dilemma. In fact, less than 5% of these people will be able to lose significant amount of weight and keep it off long term without surgery. Diabetic medications decrease blood sugar but the glocose is often forced into fat cells increasing weight over time and making diabetes more dificult to manage. It is a viscious cycle of failure and frustration.</strong><br />
<strong><br /></strong>
<strong>However we know that type 2 diabetes can be prevented by the long term weight reduction that occurs after bariatric surgery. Further, we know that most patients that have had type 2 diabetes for 10 years or less will have no evidence of diabetes after having bariatric surgery and be off most if not all of their diabetic medications.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>We need to stop thinking inevitable and start thinking what is possible.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>I am no Martin Luther King, Jr. but I also have a dream.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>I have a dream that as a society we decide that obesity that reaches a BMI of 40 is unacceptable and a person that finds himself or herself in this situation should have bariatric surgery to prevent type 2 diabetes if they have not developed this disease already.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>I have a dream that as a society we will decide that people with type 2 diabetes with a BMI of 35 need bariatric surgery to treat and hopefully resolve their type 2 diabetes.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>I have a dream that thousands of amputations, strokes, patients with kidney failure, blindness and premature death will be avoided as we get angry and say we will not accept the death, destruction and suffering any more when we have the medical know how to prevent and treat this monster we call type 2 diabetes. <o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>I am really angry. Our present way of thinking is wrong and dangerous. Some medical professionals are slowly waking up to the need for some of their patients to have bariatric surgery to prevent or treat this awful disease but we cannot wait. The pace is too slow. Too many are at risk.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>Just like breast cancer. If you have breast cancer it is unacceptable not to have surgery and other treatment for that disease. You can choose not to be treated but as a society we believe it is inappropriate. I am not talking about forcing anyone but we need to bring this problem out into the open and take a stand. Obesity is a killer and it is inappropriate not to seriously consider bariatric surgery if a person reaches a certain level of obesity. Why? Because we know the devastation resulting from diseases such as type 2 diabetes and other obesity related medical problems.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>We must demand a change in thinking now! Too many lives depend on it.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>Will you join me in this righteous anger? Our society needs to change, our insurance companies must change, our government agencies need to change and our medical professionals must change. But this will not happen if you and I do not demand it. <o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>No more amputations.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong>
<strong>No more diabetes related strokes.</strong></div>
<div class="MsoNormal">
<o:p><strong></strong></o:p></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>No more diabetes related heart attacks.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>No more dialysis from diabetic kidney failure.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>No more blindness from diabetic retinopathy.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>No more premature deaths from diabetes.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>Are you fed up with diabetes like I am? Maybe you are so angry you could scream too. Do you have family members suffering from this dreaded disease? Are you one that suffers from diabetes or at risk for this disease? Type 2 Diabetes indeed is a monster devouring legs, portions of brains, kidneys, eyes and even people’s very lives every day.<o:p></o:p></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong><br /></strong></div>
<div class="MsoNormal">
<strong>We must change our thinking and the thinking of others. Pick up your sword with me and together let us strike blow after blow to fell this terrible dragon and warn others of this danger. Let us dream together of a day when diabetes is viewed by everyone as a preventable and treatable disease. It does not take millions. Only a few good men and women of passion and commitment willing to be filled with righteous anger to slay this deadly monster once and for all. </strong><br />
<strong><br /></strong>
<strong>Are you willing to join me in exploring ways to change the way our culture thinks of diabetes? If so please comment or email me to tell me why you are angry with how we think of diabetes and how this disease has affected you or your family members.</strong></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<o:p></o:p><br />
<!--EndFragment-->Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com8tag:blogger.com,1999:blog-5265361299951558157.post-27150753350620111762013-07-12T18:14:00.002-07:002013-07-12T18:21:08.638-07:00Reflux after a Gastric Sleeve Operation<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-IhpnkjhVwng/UeCpk2bqgSI/AAAAAAAAAbc/K0xPmRmOFrg/s1600/Gastric-sleeve.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="http://4.bp.blogspot.com/-IhpnkjhVwng/UeCpk2bqgSI/AAAAAAAAAbc/K0xPmRmOFrg/s400/Gastric-sleeve.gif" width="373" /></a></div>
<b><br /></b>
<b><br /></b>
<b><br /></b>
<b>Most patients do not have problems with reflux after a gastric sleeve operation but reflux can be bothersome for some. Symptoms of gastroesophageal reflux include heartburn or reflux of gastric contents into the throat or mouth especially when lying down.</b><br />
<b><br /></b>
<b>When a patient that has a gastric sleeve swallows food , the food travels down the esophagus past the high pressure zone called the Lower Esophageal Sphincter ( LES) at the lower end of esophagus and enters into new stomach call the gastric sleeve. The outlet of this new stomach is constricted by the circular muscle called the pylorus and food and/or drink stays in the stomach for a time and is released only very slowly. The slow release of gastric contents means food remaining in the sleeve may be under higher pressure is able to reflux up into the esophagus and even up into the mouth as the pressure in the gastric sleeve becomes higher than the pressure of the LES.</b><br />
<b><br /></b>
<b>Patients that are high risk for gastroesophageal reflux after a gastric sleeve operation are those that have symptoms even before surgery. In fact, patients with severe gastroesophageal reflux with pre-cancerous changes in the esophagus called Barrett's esophagus should probably select a gastric bypass instead of a gastric sleeve operation since a gastric bypass is a much more effective way to treat severe reflux.</b><br />
<b><br /></b>
<b>In my practice, if a patient needs to take medication called a Proton Pump Inhibitor, (Protonix, Previcid, Nexium) every day to control reflux I consider them to have moderate to severe reflux. These symptoms are frequently associated with a hiatal hernia since the opening in the diaphragm where the esophagus enters into the abdomen is often larger than normal allowing the upper part of the stomach to slide up into the chest. In this case if the patient prefers to have a gastric sleeve instead of a gastric bypass I will plan to add an additional component to their gastric sleeve operation by approximating the diaphragmatic muscles behind the esophagus with sutures narrowing the diaphragmatic opening for the esophagus called the hiatus making reflux much less likely. Of course since I use the da Vinci surgical robot this additional step becomes much easier. </b><br />
<b><br /></b><b>For those patients having reflux symptoms after a gastric sleeve operation I would suggest the following:</b><br />
<b><br /></b><b>1). For mild occasional symptoms - use Pepcid complete or equivalent when symptoms occur. The antacid will neutralize the acid and the Pepcid will decrease the amount of acid the gastric sleeve is making.</b><br />
<b><br /></b><b>2). For more persistant reflux take a Proton Pump Inhibitor as mentioned above each day.</b><br />
<b><br /></b><b>3). Other suggestions include avoiding eating late into the evening, avoid spicy foods and sleep on more than one pillow if possible.</b><br />
<b><br /></b>
<b>The good news is that the symptoms often improve after the patient loses significant weight and the medications may be able to be discontinued a few months after surgery.</b><br />
<br />
<br />Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com8tag:blogger.com,1999:blog-5265361299951558157.post-8482948708486002032013-06-28T14:13:00.000-07:002013-06-28T14:34:50.246-07:00Iron Deficiency After Bariatric Surgery<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;}
</style>
<![endif]-->
<!--StartFragment-->
<br />
<div class="MsoNormal">
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-XT1rxqVKQes/Uc4BCCGlF2I/AAAAAAAAAa0/eghBrXdMzAw/s1210/colored+pills.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="425" src="http://1.bp.blogspot.com/-XT1rxqVKQes/Uc4BCCGlF2I/AAAAAAAAAa0/eghBrXdMzAw/s640/colored+pills.jpg" width="640" /></a></div>
<span style="font-size: 16pt;"><b><br /></b></span>
<span style="font-size: 16pt;"><b>We need iron to stay healthy. </b></span><br />
<span style="font-size: 16pt;"><b><br /></b></span>
<span style="font-size: 16pt;"><b>Usually the amount of iron we ingest in
our diet is enough to keep up with our needs.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>The iron we ingest as food is absorbed very efficiently by the first
part of our small intestine. <o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>However, gastric bypass patients have reduced ability to absorb iron
since the first part of the small intestine is bypassed along with much of the
stomach.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>Anemia, or decreased red blood cells, may be the result of not absorbing
enough iron. Persons who are anemic often look pale and feel tired. If the
anemia is severe the heart rate may increase to compensate for too few red
blood cells to transport oxygen to the body. In some situations this increased
heart rate can be dangerous.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>Persons who are anemic often crave ice and eat ice frequently.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>To prevent iron deficiency anemia we suggest a gastric bypass patient
consider iron supplementation taken by mouth.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>To check if someone has an iron deficiency anemia doctors check a
ferritin level as a blood test. If this is low we know the person has low iron
storage and iron deficiency is likely to be the cause of their anemia and we
will place them on daily iron supplementation. <o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>This supplement should be Ferrous Fumarate or Ferrous Glucanate since
the usual form of iron supplementation, Ferrous Sulfate, will not be absorbed
well since it needs acid to make the iron available for absorption and the new
small gastric pouch formed at the time of the gastric bypass makes very little
acid, Ferrous Sulfate is likely to pass out in the stool without being
absorbed. <o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>You any need to remind your family doctor about this since he or she are
so used to writing for Ferrous Sulfate and may forget you need a different form
of Iron. <o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>Menstruating women are a particular risk for anemia since they may have
difficulty keeping up with their monthly blood loss. In this situation a woman
with iron deficiency anemia will be referred to her gynecologist for intervention
like hormonal therapy, endometrial ablation or even hysterectomy. </b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>If these
interventions are not acceptable she may need to be seen by a hematologist for
periotic intravenous iron infusions.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="font-size: 16pt;"><b>Of course a thorough evaluation is often in order. This may require a
colonoscopy since patients with a history of obesity have a higher risk of
colon polyps and colon cancer.</b></span><o:p></o:p></div>
<!--EndFragment-->Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com6tag:blogger.com,1999:blog-5265361299951558157.post-41646505104739677852013-06-24T19:36:00.004-07:002013-06-24T19:36:51.929-07:00Avoiding Constipation after Bariatric Surgery<!--[if gte mso 9]><xml>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
<o:PixelsPerInch>96</o:PixelsPerInch>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:10.0pt;
font-family:Calibri;}
</style>
<![endif]-->
<!--StartFragment-->
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-M2IQrLFcy2U/Ucj_oSw3YaI/AAAAAAAAAag/42ik55A27ds/s1600/constipation-2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="172" src="http://3.bp.blogspot.com/-M2IQrLFcy2U/Ucj_oSw3YaI/AAAAAAAAAag/42ik55A27ds/s320/constipation-2.jpg" width="320" /></a></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Patients often
complain of constipation after bariatric surgery. Constipation can happen a few
weeks after surgery or complaints may continue for months or even years. </b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
<b>Why do
people often have constipation following bariatric surgery? This symptom is
usually the result of too little fiber in the diet following bariatric surgery.<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
<b>After a gastric
bypass, gastric sleeve or even a gastric band, patients are asked to take
liquids for several weeks and slowly transition through puree to soft and
eventually to regular foods. However, often these foods are low in fiber. Also
since portion sizes are smaller less total fiber is consumed.<o:p></o:p></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">The solution? <o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>1)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b><u><span style="font-size: 14.0pt; line-height: 115%;">Fiber</span></u> – 25 grams every day.
If you are consistent your stools should be softer and more regular in 2 weeks.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>2)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b>Choose
soluble fiber that dissolves in water and is tasteless such as Benefiber or
another soluble fiber product suggested by your pharmacist.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>3)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b>Avoid
gooey fiber products (such as Metamucil) or tablets (such as Fibercon) since
they may be difficult to pass through the modified stomach.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>4)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b>Make
sure sugar or other calories are not added to your fiber product. You do not
want the extra calories.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>5)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b>Take
the supplemental fiber every day whether you feel you need it that day or not.
This is a long term solution not a quick fix.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>6)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b>Taper
to smaller amounts of supplemental fiber slowly as your regular diet includes
more fiber.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>7)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b>Stool
softeners may help but you need enough fiber to make sure you have stool to
soften.<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
<b>Other suggestions:<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>1)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b>Avoid
narcotic pain meds where possible as all narcotics slow bowel function and
cause constipation.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>2)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b>Discuss
adding fish oil to your medicines with your doctor. Fish oil may improve your
cholesterol and help constipation as well.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;">
<b><br /></b>
<!--[if !supportLists]--><b>3)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;">
</span></b><!--[endif]--><b>For
temporary and rapid relief I would suggest as much Miralax as needed. Other
products such as Milk of Magnesia can provide relief as well.<o:p></o:p></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">Being proactive by taking enough
supplemental fiber soon after surgery can help you avoid this problem
altogether!<o:p></o:p></span></b></div>
<!--EndFragment-->Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com3tag:blogger.com,1999:blog-5265361299951558157.post-34814802462905318192013-06-17T13:21:00.000-07:002013-06-17T13:21:00.958-07:00Doing Great Six Years After Bariatric Surgery<span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px; font-family: Helvetica;"><br /></span>
<span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px; font-family: Helvetica;"><b>I recently received this note from Joanna Baker who had her gastric bypass 6 years ago. She she has some great words of wisdom and encouragement. Here is what she wrote:</b></span><br />
<span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px; font-family: Helvetica;"><br /></span>
<span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px; font-family: Helvetica;"><br /></span>
<span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px; font-family: Helvetica;">Dr. Myers,</span><br />
<span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px; font-family: Helvetica;"><br /></span>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-SfgN6NeeyDg/UbI-vCo65uI/AAAAAAAAAaE/qLQHbbIJV5U/s1600/image.jpeg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="http://3.bp.blogspot.com/-SfgN6NeeyDg/UbI-vCo65uI/AAAAAAAAAaE/qLQHbbIJV5U/s1600/image.jpeg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Now</td></tr>
</tbody></table>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-_utdAebKU-g/UbI_A-dNe0I/AAAAAAAAAaM/6ffO0KtsNuc/s1600/Before+2005.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="250" src="http://3.bp.blogspot.com/-_utdAebKU-g/UbI_A-dNe0I/AAAAAAAAAaM/6ffO0KtsNuc/s400/Before+2005.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Before</td></tr>
</tbody></table>
<span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px; font-family: Helvetica;">I just was having one of those times of reflection, counting my blessings, and you and your program are near the top of my list. I am so grateful at your dedication to good medicine, safe practices, and stellar patient outcomes.<br /><br />I can't believe that it's been 6 years since I started this journey with you! My six-year surgery anniversary is in September, and my BMI is still 25 (down from 45).<br /><br />My best advice for those considering or just having had weight-loss surgery--allow the surgery and recovery to give you the precious gift of the time and physiologically forced discipline you need to recover from dependence on sugar.<br /><br />Patients who are considering or who have just had weight-loss surgery, especially bypass, no doubt understand the need to avoid sugar, particularly processed sugar, and particularly in the absence of fiber (which is why I'm so grateful for fiber-rich fruits)!<br /><br />Don't ever go back! Don't dabble. Don't toe dangle. Read labels. Try not to consume anything with more than 5 grams of sugar per serving. There it is. The rules I live by.<br /><br />Do I miss sugar? No! (Though I'm sure results will vary patient to patient.) I am sure that this is why I have not struggled with keeping the weight off. I'm also sure that if I started playing games with myself trying to find the "safe" amount of sugar I could consume, my body would remember "the good old days" of sugar-coma bliss, start building a "tolerance level" for sugar, and I would end up back where I started more than 6 years ago--a slave to my sugar addiction.<br /><br />I follow the other rules too. I don't use straws, I don't drink carbonated beverages (OK--this one is really hard for me. I genuinely miss Diet Coke, especially on a hot summer day! Still, it's not worth it.), I eat slowly, and genuinely enjoy the colors, flavors, aromas, and textures of my meals, as well as some really good company as often as possible (aka, family dinner)! I eat several small meals a day. (You will rarely find me without a baggie containing a variety of nuts and Kashi Heart-to-Heart cereal in my purse!)<br /><br />I am so grateful for the time and discipline that by-pass surgery gave me. It's the best decision I ever made for my health and quality of life. I would never go back!<br /><br />With warm, fond regards and much gratitude,<br /><br />Joanna Baker</span>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com5tag:blogger.com,1999:blog-5265361299951558157.post-76933362365411750672013-06-11T08:05:00.000-07:002013-06-15T10:23:36.423-07:00Avoiding Skin Fold Irritation<br />
<br />
<br />
<div class="" style="clear: both; text-align: left;">
<b>Avoiding Skin Fold Irritation in Warm Weather</b></div>
<br />
<br />
We have had several very warm days already this Spring. Summer will soon be upon us.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-Gm8GSxxj18c/UbIh5VFeW8I/AAAAAAAAAZ4/r6NgwwNqbEE/s1600/photo-30.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-Gm8GSxxj18c/UbIh5VFeW8I/AAAAAAAAAZ4/r6NgwwNqbEE/s320/photo-30.JPG" width="239" /></a></div>
During warm weather my patients often complain of a rash or skin ulceration especially in the abdominal skin fold or under the breasts. These are areas where skin lies on skin and there is little opportunity for evaporation. As the weather becomes warmer we sweat more. These dark moist, regions are a "set up" for the yeast (or fungus) we all have on our skin to grow much more rapidly. The yeast can be irritating to the skin, deposit a white paste like material and result in a foul smell. The skin becomes red and irritated like a diaper rash and can lead to skin break down bleeding and ulceration.<br />
<br />
If you have this problem and may have interest in having the skin removed by a plastic surgeon I would suggest you take pictures of the irritation and keep the pictures on file to show your plastic surgeon. This may you get insurance coverage for removal of the skin since it would be considered medically necessary and not cosmetic.<br />
<br />
I discussed this with a friend of mine who is a dermatologist and he suggested a great product that I have found works really well. This is a powder that you can purchase at your local drug store over the counter called <b>Zeasorb-AF</b>. This seaweed based powder is excellent for absorbing liquid that can accumulate on the skin and the AF is for the anti-fungal ingredient Miconazol Nitrate that will kill the yeast.<br />
<br />
<b>Here is how I would suggest you use it.</b><br />
<br />
Clean the areas well during your morning bath or shower and gently pat dry with the towel. If necessary dry with a hair drier but make sure not to burn the skin. Apply Zeasorb-AF powder to the affected area. Repeat later in the day if necessary.<br />
<br />
This product is great to prevent groin irritation and athlete's foot as well.<br />
<br />
So stay dry and enjoy your Summer without the skin fold irritation!Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com12tag:blogger.com,1999:blog-5265361299951558157.post-38819103976784951672013-06-07T07:19:00.001-07:002013-06-07T07:19:55.097-07:00Gastric Sleeve: Eating for Success
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:11.0pt;
font-family:Cambria;}
</style>
<![endif]-->
<!--StartFragment-->
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt;">Successful Weight loss
after a Gastric Sleeve Operation<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Remember, for those of you who have had a Gastric Sleeve
Operation, you have asked your bariatric surgeon to reduce the size of your
stomach to only about ¾ to one cup is size.
The outlet of the stomach is restricted by the Pylorus, (the circular
muscle located at junction of the stomach and small intestine). The Pylorus opening is
only about the size of the end of your ring finger. This is what gives you the
resistance to eating too fast and too much at any one time.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Consistently applying the following principles will help.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>1). Liquid calories are not your friend</b><o:p></o:p></div>
<div class="MsoNormal">
Your sleeve
and narrowed outlet from the pylorus is like a funnel. The purpose is to hold
solid food in your pouch for a time, allowing the solid food to slowly leave
the pouch and therefore suppress your appetite by releasing a small amount of
the food over the next couple of hours.<o:p></o:p></div>
<div class="MsoNormal">
I often
hear, “but liquids go down so easily!” but that is exactly the point; too
easily! The restriction caused by your pylorus is not made to hold back liquid
food. All liquids will run straight through the narrow outlet. So take your
calories as solid food not liquids. <o:p></o:p></div>
<div class="MsoNormal" style="text-indent: .5in;">
Avoid milk, (even skim since it has
too many sugar calories), ice cream, cream soup, soda and fruit juices. Fruit
is just sugar water with some fiber. One serving of fruit a day is reasonable.
More fruit may sabotage your goal of weight loss.<o:p></o:p></div>
<div class="MsoNormal" style="text-indent: .5in;">
Get your protein in solid food and
only use protein shakes if you cannot get enough protein in your solid foods. <o:p></o:p></div>
<div class="MsoNormal" style="text-indent: .5in;">
Instead drink water, tea with
sweetener, and Crystal lite or other non caloric beverages. This is an easy way
to reduce your overall calorie intake and help you lose weight.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>2). <u>Minimize</u> crunchy foods</b><o:p></o:p></div>
<div class="MsoNormal">
Crunchy
foods like chips, crackers, pretzels and cookies, after saliva is added, go to
mush and will go into the sleeve and pass through the narrowed outlet too
quickly. One small Ziplock bag a day may be OK but more may sabotage your goal
of weight loss. These types of foods can be your downfall. I am not saying you
should never eat them but when you see them train your brain to flash “DANGER”.
It is a question of portion size. <o:p></o:p></div>
<div class="MsoNormal" style="text-indent: .5in;">
One of my patients did a video on
my blog sharing how she deals with this problem. She swore off ever eating out
of a bag or box again. Now when she brings home the groceries she breaks down
the crunchy foods into small zip lock bags for portion sizes. She no longer
takes the large bag to the TV for her snack but goes to the pantry to get a zip
lock portion size for her snack.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>3). Apply the “rule of 30s” consistently</b><o:p></o:p></div>
<div class="MsoNormal">
Chew 30
times before swallowing<o:p></o:p></div>
<div class="MsoNormal">
Wait 30
seconds before your next bite<o:p></o:p></div>
<div class="MsoNormal">
Wait 30
minutes before drinking<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>4). Avoid feeling chest pressure after eating</b><o:p></o:p></div>
<div class="MsoNormal">
Chest
pressure after eating is a sign that you have eaten too much too fast for the
time it take for your sleeve to empty through the pylorus into the small
intestine and the food, drink or air is backing up into your esophagus. The
esophagus is pressing the food downward but it has nowhere to go so the
pressure just builds up in the esophagus causing the pressure sensation in your
chest or even into your mid back.<o:p></o:p></div>
<div class="MsoNormal">
Instead use
your eyes and brain to determine how much you can eat over what period of time
so you do not cause the chest pressure. This frequently occurs in social
situations when you are distracted and not paying attention.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>5). Establish a “No Fly Zone”</b><o:p></o:p></div>
<div class="MsoNormal">
I want my
patients to establish good boundaries for what comes on their property and tell
their friends and family, “Certain foods just don’t fly here.” We all have what
I would call trigger foods; that is foods that comfort us and when these are
around we have difficulty staying away from them. For me it is cookies, so
guess what? My wife only buys one type of cookies to bring home from the
grocery; Fig Newtons. That is because I really don’t like Fig Newtons much and
they will stay around along time. If she brought chocolate chip cookies they
would be gone in a flash because I have difficulty staying away from most other
cookies. Without fully realizing it my wife has established a “No Fly Zone” at
our home. Cookies just don’t fly at our house.<o:p></o:p></div>
<div class="MsoNormal">
Maybe your
food trigger is pizza or soda or ice cream. Whatever it is you should establish
a no fly zone at your house. You don’t bring these things into your house and
family or friends and not welcome to bring these things as well. Let them know
they are welcome to go out for these things but these foods just don’t fly at
your house.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Applying these principles consistently is the key to
understanding what is going on with your body after having a gastric sleeve
operation. If you are doing these things consistently you are more likely to understand what
is going on if you are having difficulty.</b><o:p></o:p></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
<b>I wish you the very best as you continue on your journey to better health!</b></div>
<!--EndFragment-->Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com1tag:blogger.com,1999:blog-5265361299951558157.post-44603257190031563612013-03-21T16:48:00.001-07:002013-03-21T16:48:22.124-07:003 Suggestions for Transition FoodsThis week I saw a patient of mine, Robert Johnson, who had a Robot Assisted Gastric Sleeve operation just 6 weeks ago. He is doing great and he agreed to have me share about his early weight loss and about some things he has found that may help you as well.<br />
He is right on track and has lost 24 lbs since his operation 6 weeks ago. Thanks to the great nutritional teaching from our dietitians he lost an additional 51 lbs. prior to surgery as he went through the bariatric surgery program at the Weight Management Center here in Reading, Pa for a total of 75 lbs. of weight loss since he entered our program a few months ago. He is feeling great and very happy with his results so far.<br />
He had 3 "finds" that has helped him through the transitions in the first 6 weeks after surgery. Here are his suggestions:<br />
1). He found that putting Progressive Soups in a blender allowed him to have hardy liquids soon after surgery. He could vary the consistency by the time the soup was in the blender. He would heat the soup and separate into two 1 cup containers for 2 servings. Each cup has less than 300 calories.<br />
2). To make sure he got 60 grams of protein each day that we recommend for men, (50 grams for women), he bought New Whey liquid protein at our local Walmart which has 42 grams of protein, 0 carbs and 0 fat per 6 once tube and comes in watermelon, grape or fruit punch flavors. You can buy them individually or as a package of 6. They are a bit pricey at about 2 dollars a tube but the amount needed will decrease as you are able to take more of the 60 grams in other foods.<br />
3). He also found Hormel's pre-packaged Thick and Easy Puree' foods for adults at Walmart and he recommends the homestyle beef with potatoes and corn.<br />
Great suggestions! Hopefully Robert's suggestions will help others as they transition from liquids after surgery to regular food.Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com0tag:blogger.com,1999:blog-5265361299951558157.post-37758940378429264672013-01-24T17:37:00.001-08:002013-10-07T17:20:46.413-07:00Study About Robotic Surgery Published in Obesity SurgeryLast week I heard from the journal <i><b>Obesity Surgery</b></i> that a study I have been working on for nearly 3 years was just published. The article name is <u><b>Robot -Assisted Versus Laparoscopic Gastric Bypass; Comparison of Short Term Outcomes.</b></u> I would like to share its findings with you.<br />
<br />
I compared the short term outcomes of my first 100 gastric bypass operations I performed with the use of the da Vinci surgical robot with 100 gastric bypasses I performed using the more traditional laparoscopic approach. The patients in both groups were very similar in age and weight and most of their medical problems. There was no mortality in either group and complications were low in both groups as well.<br />
<br />
I found that there were two major differences that were statistically significant; 1). shorter hospital stay and 2).less bleeding when the robot was used.<br />
<br />
<br />
<ul>
<li>60% of the patients in the robot assisted group were discharged form the hospital after only one night stay compared to only 4% of patients in the laparoscopic group</li>
<li>Fewer patients in robot assisted group (2 vs 6) required blood transfusion compared to the laparoscopic group</li>
</ul>
<div>
I believe the reason patients left the hospital earlier after a robot assisted operaion is they had less pain because the incisions were overall smaller and the robot "pushes" less on the abdominal wall. I suspect the reason there was less bleeding was because the connection between the gastric pouch and the small intestine was created with a robot assisted hand sewn approach instead of a circular stapling device. In fact no patient in the robot assisted group had gastrointestinal bleeding.</div>
<div>
<br /></div>
<div>
Although it took time for me to become comfortable with the da Vinci surgical robot, I am convinced this is a superior approach for me.</div>
<div>
</div>
<div>
<ul>
<li>I see better with the 3-D high definition view</li>
<li>The instruments have tiny "wrists" that provide much easier and more precise sewing</li>
<li>I am more comfortable doing the operation while sitting at the console a few feet away from the operating table instead of standing to do the operations</li>
</ul>
</div>
<div>
<br /></div>
<div>
I prefer using the robot for nearly all of my bariatric surgery cases including both gastric bypass operations and gastric sleeve operations. It is especially helpful when a patient requires a revision of a previously performed bariatric operation.<br />
<br />
If you want to view the full article please click on the link below. It should be available there for at least a few more weeks.<br />
<br />
<br /></div>
<div>
<a href="http://www.springer.com/alert/urltracking.do?id=Lf055f8Mb7eff6Sb0695ea">http://www.springer.com/home?SGWID=0-0-1003-0-0&aqId=2439249&download=1&checkval=e6832a360938861a0cec2c23c8c2fa7a</a></div>
Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com1tag:blogger.com,1999:blog-5265361299951558157.post-49101774537143239672012-08-18T05:52:00.001-07:002012-08-18T12:16:19.493-07:005 Tips For Success after Bariatric SurgeryAll bariatric surgery patients can benefit from these tips but especially those who have a gastric band.
<br />
<br />
This week I had several adjustable gastric band patients who complained of occasionally vomiting after eating their meals but seemed to have no idea why this was occurring.<br />
<br />
Remember, for those of you who have had a gastric band, you have asked your bariatric surgeon to place a band around the upper part of your stomach to create a gastric pouch and adjust this band so the outlet is only about the size of the end of your ring finger. This is what gives you the resistance to eating too fast and too much at any one time.<br />
<br />
Consistently applying these principles will help.<br />
<br />
<b> 1). Liquid calories are not your friend</b><br />
Your pouch and narrowed outlet from the band is like a funnel. The purpose is to hold solid food in your pouch for a time, allowing the solid food to slowly leave the pouch and therefore suppress your appetite by releasing a small amount of the food over the next couple of hours. I call this “auto-snacking”; giving you the effect of snacking to suppress your appetite with out eating. Them after a few hours the pouch is empty and the person becomes hungry in about 3 hours when it is time for another meal.<br />
<br />
I often hear, “but liquids go down so easily!” but that is exactly the point; too easily! Your band is not made to hold back liquid food. All liquids will run straight through the narrow outlet. So take your calories as solid food not liquids.<br />
<br />
Avoid milk, (even skim since it has too many sugar calories), ice cream, cream soup, soda and fruit juices. Get your protein in solid food and only use protein shakes if you cannot get enough protein in your solid foods.<br />
<br />
Instead drink water, tea with sweetener, and Crystal lite or other non caloric beverages. This is an easy way to reduce your overall calorie intake and help you lose weight.<br />
<br />
By the way, be careful of too much fruit since many fruits like watermelon are really sugar water in disguise.<br />
<br />
<b> 2). Minimize crunchy foods</b><br />
Crunchy foods like chips, crackers, pretzels and cookies, after saliva is added, go to mush and will go into the pouch and pass through the narrowed outlet too quickly. These types of foods can be your downfall. I am not saying you should never eat them but when you see them train your brain to flash “DANGER”. It is a question of portion size. One of my patients did a video on this blog sharing how she deals with this problem. She swore off ever eating out of a bag or box again. Now when she brings home the groceries she breaks down the crunchy foods into small zip lock bags for portion sizes. She no longer takes the large bag to the TV for her snack but goes to the pantry to get a zip lock portion size for her snack.<br />
<br />
<b> 3). Apply the “rule of 30s” consistently</b><br />
<br />
Chew 30 times before swallowing<br />
<br />
Wait 30 seconds before your next bite<br />
<br />
Wait 30 minutes before drinking<br />
<br />
<b> 4). Avoid foods that are likely to be difficult; steak, chicken and bread</b><br />
Steak will not pass through the narrowed outlet of your pouch if the particle sizes are larger than the tip of your ring finger. The stringy fibers you see when breaking open a grilled chicken breast can be chewed all day long but will probably ball into a “twine ball” in your pouch causing blockage of the outlet of the pouch. Doughy bread will become a “dough ball” in your pouch and block the small outlet of your pouch.<br />
<br />
This is a frequent cause of vomiting after a band is placed.<br />
<br />
If one of my patients tells me they can eat these things without difficulty it tells me their band probably needs adjustment. Usually they are gaining wait as well.<br />
<br />
<b> 5). Establish a “No Fly Zone”</b><br />
I want to my patients to establish good boundaries for what comes on their property and tell their friends and family, “Certain foods just don’t fly here.” We all have what I would call trigger foods; that is foods that comfort us and when these are around we have difficulty staying away from them. For me it is cookies, so guess what? My wife only buys one type of cookies to bring home from the grocery; Fig Newtons. That is because I really don’t like Fig Newtons much and they will stay around along time. If she brought chocolate chip cooking they would be gone in a flash because I have difficulty staying away from most other cookies. Without fully realizing it my wife has established a “No Fly Zone” at our home. Cookies just don’t fly at our house.<br />
<br />
Maybe your food trigger is pizza or soda or ice cream. Whatever it is you should establish a no fly zone at your house. You don’t bring these things into your house and family or friends and not welcome to bring these things as well. Let them know they are welcome to go out for these things but these foods just don’t fly at your house.<br />
<br />
Applying these principles consistently is the key to understanding what is going on with your body after having an adjustable gastric band or any other bariatric operation as well. If you are doing these things you are more likely to understand what is going on if you are having difficulty.
<b></b>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com2tag:blogger.com,1999:blog-5265361299951558157.post-88798912100153895272012-04-15T18:41:00.004-07:002012-04-15T19:06:17.759-07:00Diabetes Dramatically Improved-Pat Dittilo Shares in an EmailI received this Email from Pat Dittilo last week and she has agreed to share this with all of my readers. She said would like to encourage as many as possible. Here is what she shared:<br /><br />Dr. Myers,<br /><br />Hope you are doing well in your new position. I wanted to give you an update on my status since you and I have talked several times about the surgery and diabetes. I had a robot assisted gastric bypass by you in October of 2010, about 18 months ago. I was your 13th or 14th robotic case. I had type 2 diabetes diagnosed about 5 years before my operation and was on oral medicine as well as 10 micrograms of Byetta that I had to inject three times a day in addition to injecting 105 units of long acting insulin twice a day.<br /><br />You may remember that my diabetes was out of control – my A1C was 11.7 and while I haven’t had it tested recently, my last A1C was 7.1 six months ago, (i will be having it checked again soon). I wanted to let you know that my sugar level yesterday and today were 94 and 89 and I am not taking any diabetic medication. I am so pleased and happy about my decision to have the surgery and even more pleased that you were here to do that for me. I have maintained my weight at 138 for over a year and I feel awesome. In addition to not taking any medication for my diabetes, I also no longer take medication for my blood pressure like I was before and my sleep apnea is completely gone. I’m 55 (almost 56) and I feel like a kid again. I have more confidence than I’ve ever had in my life. <br /> <br />It’s funny that so many people are more aware of the results of the surgery for those who have diabetes and the media attention it’s getting. Almost weekly I see something in the news about how people with diabetes are no longer dependant on insulin or completely cured. I can’t tell you how wonderful it is to wake up every day and not think about having to take those shots. I can eat without worrying about injecting the Byetta 30-60 minutes before I eat and how it made me sick to my stomach sometimes.<br /> <br />Thank you again for everything you did for me – I never thought I would feel so good again. Living my life without drugs and machines is a blessing, not to mention going from a size 18-20 to an 8-10!<br /> <br />God Bless you and your family. You are truly an Angel in many people’s lives.<br /> <br />Pat DattiloDr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com6tag:blogger.com,1999:blog-5265361299951558157.post-5321207867964148702012-04-11T16:29:00.005-07:002012-04-11T17:58:55.595-07:00Diabetes is Treated Better with Surgery plus Medical Management than Medical Management AloneMany of you may have read or heard about an important study published in the New England Medical Journal on March 26, 2012. Dr. Phil Schaur and his colleagues at the Cleveland Clinic completed a trial that has very profound implications for patients with Type 2 diabetes. <br /><br />They compared 50 poorly controlled diabetic patients who had intensive medical management of their diabetes to 50 patients treated with a laparoscopic gastric bypass plus medical therapy and another 50 patients who were treated with a laparoscopic gastric sleeve plus medical therapy.<br /><br />There was no mortality and complications were low.<br /><br />The primary finding was that at the end of 1 year the patients who had surgery plus medical therapy achieved much better control of their diabetes. In fact, nearly 4 times as many patients in the surgery plus medical therapy group achieved excellent diabetic control than the group receiving only intensive medical therapy.<br /><br />Between the two surgical options, the laparoscopic gastric bypass patients did somewhat better than the laparoscopic gastric sleeve patients.<br /><br />Another important finding was that those receiving only intensive medical therapy increased the number of medicines they had to take over the year while those who had surgery plus medical therapy decreased the number of diabetic medicines and often were on no diabetic medicines at all. <br /><br />Although it will be helpful to continue to follow these patients for several more years to evaluate the long term effects of better control, it is very clear that patients with type 2 diabetes do better if they have bariatric surgery than those who do not choose to have surgery.<br /><br />Several months ago I mentioned that the medical establishment was too slow in accepting the remarkable improvement in diabetes after bariatric surgery. Could there be a sea change coming with this and other studies?Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com6tag:blogger.com,1999:blog-5265361299951558157.post-10694642893101485682012-04-01T18:16:00.006-07:002012-04-01T19:50:16.702-07:00Why Robotic Bariatric Surgery?<a href="http://4.bp.blogspot.com/-ZPP5Ii-DgNc/T3kSOQfT-kI/AAAAAAAAAZU/mZ9pN_qYyBk/s1600/IMG00032-20100922-1041%2B%25282%2529.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://4.bp.blogspot.com/-ZPP5Ii-DgNc/T3kSOQfT-kI/AAAAAAAAAZU/mZ9pN_qYyBk/s320/IMG00032-20100922-1041%2B%25282%2529.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5726628437332064834" /></a><br /><br /><strong>Using a robot to perform a Roux en-Y gastric bypass brings significant value to patients. <br /><br />I had performed at least 800 gastric bypass operations laparocopically without q robot before I began to perform this operation with the help of a surgical robot. The robot does not perform the operation but helps me perform the operation with more precision and with allowing me to see better.<br /><br />I compared the last 100 gastric bypass operations I performed without a robot to the first 100 gastric bypass operations I performed with a robot. I found the following:<br /><br />1). It took more time to perform the robotic operations. On one hand this is not surprising since I had performed so many laparoscopically and had the opportunity to decrease the time it takes me to perform the operation in that way. On the other hand it will take time for me to continue to to improve on the time.<br /><br />2). Most patients in the robotic group left the hospital the day after the operation while most of the patients that had a gastric bypass operation without the use of the robot left the hospital after 2 days.<br /><br />3). The patients in the robotic group had less bleeding. in fact only one patient in the robotic group received even 1 unit of blood whereas 5 patients in the non-robotic group received blood and they each received an average of more that 2 units of blood. I believe this is because I can see better, perform the operation with more precision and with the help of the robot I am able to perform some of the connections with sutures instead of staples.<br /><br />4). There was no increase in complications with using the robot even though these were my first 100 operations.<br /><br />Although it took a lot of patience and effort to learn to perform a gastric bypass with the surgical robot, I believe it was more than worth it.<br /><br />Today most gastric bypass operations are performed laparoscopically without a robot. There is nothing wrong with having an operation in this manner and in fact this would be the choice for most surgeons. However, the robotic approach is being used by more surgeons and in my practice I have shown that I have even less complications when I use the robot.<br /><br />If you have questions please let know and I will be happy to do my best to answer them.</strong>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com3tag:blogger.com,1999:blog-5265361299951558157.post-16731840638996047392012-03-24T19:23:00.006-07:002012-03-25T20:07:42.940-07:00Coughing at Night<strong><a href="http://2.bp.blogspot.com/-kPYQsALwehk/T26GqqC31DI/AAAAAAAAAY8/AIrSkKTBn30/s1600/Lapband.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 178px; height: 206px;" src="http://2.bp.blogspot.com/-kPYQsALwehk/T26GqqC31DI/AAAAAAAAAY8/AIrSkKTBn30/s400/Lapband.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5723660243833443378" /></a><br /><br /><br />This week I saw two patients in the office who complained of reflux and coughing when they laid down at night. Both had had an adjustable gastric band placed a few years ago and had not had a recent adjustment to there band.<br /><br />Their symptoms are related to the band being too tight causing back up of saliva in their esophagus. When they lay down the pooling of saliva can overcome the ability of the muscle at the upper end of the esophagus to keep the saliva out of the throat.<br /> <br />When the contents of the esophagus come up into the throat it they can come in contact with the vocal cords and cause coughing. Occasionally this will aspiration of these contents into the lungs and cause pneumonia.<br /><br />This problem is usually rectified by taking some fluid out of the band. <br />In both cases this immediately relieved the symptoms in both of these individuals and they were able to drink water comfortably.<br /><br />Although this solved the immediate problem, band slippage could be the reason this has only recently developed.<br /><br />If the problem recur rs with or without placing more fluid into the band the patient should be investigated with a special X-ray such as an upper GI or a CT scan to determine whether slippage has occurred.<br /><br />If the band has been forced to slip down further on the stomach the band may have to be repositioned with another laparoscopic operation. Hopefully this will not be the case for either of these individuals and they will be able to avoid another operation. I will be seeing each of them in the office again in a few weeks for follow up.</strong>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com6tag:blogger.com,1999:blog-5265361299951558157.post-74761901306331196442012-03-11T18:22:00.008-07:002012-03-11T19:17:55.807-07:00Managing Nausea and Vomiting after Bariatric SurgeryTwo nights ago I met one of our patients in the emergency room because she was unable to control the sensation of nausea and had been vomiting at home. I had just discharged her from the hospital that very morning after an uneventful time in the hospital following a laparoscopic gastric bypass two days before. Most patients do not complain of these symptoms after bariatric surgery but occasionally nausea is significant problem. <br /><br />Here are three steps to avoiding nausea and vomiting after bariatric surgery:<br /><br />1). Maximizing prevention by medications given prior to surgery. My routine for my patients includes Zofran 4 mg given intravenously by the nurse just before surgery. I also order Decadron 10 mg through IV just before surgery as long as the patient is not diabetic. (This steroid medication will cause a high sugar level in diabetic patient.) Finally, if the patient has had nausea with previous operations or has a history of motion sickness I will prescribe a scopolamine patch to be placed behind the ear starting the night before surgery. This helps to prevent motion sickness but can be very helpful to prevent nausea after an operation as well. This patch can stay on for three days delivering a small amount of medicine slowly during this time. The reason it should go on the night before is to assure an appropriate amount has been absorbed by the time surgery starts. <br /><br />2). After surgery my preferred medication is Zofran if the patient feels nauseated. This can be given through the IV while in the hospital or by mouth in pill form if the patient is at home. The scopolamine patch can be added for more severe symptoms. I prefer to avoid medications such as Phenergan or Compazine since they can cause very bothersome side effects. <br /><br />3). Finally the speed of taking fluids may need to change. If you feel nauseated I suggest you slow down even more taking only teaspoons of fluid at a time and waiting at least 30 seconds between swallows since it takes about that long for the swallow to reach your revised stomach. Sometimes it is helpful to take the fluids at room temperature as well. <br /><br />If the nausea and vomiting persists call your surgeon so you don't become dehydrated. <br /><br />If nausea and vomiting develops weeks, months or years after bariatric surgery consult your doctor or surgeon as this may be a symptom of a narrowing or ulcer.<br /><br />With good preoperatve preparation nausea and vomiting can usually be avoided.. However, if it does occur I hope this posting is helpful to you..Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com4tag:blogger.com,1999:blog-5265361299951558157.post-49589996476659888082011-12-16T19:53:00.000-08:002011-12-16T20:02:16.591-08:00A Very Merry Christmas from Rev. Gary Rode<a href="http://2.bp.blogspot.com/-FGBF5YbY7VM/TuwSvuMtUGI/AAAAAAAAAYM/IAeGVSfnUSI/s1600/gary%2Brode.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 267px; height: 400px;" src="http://2.bp.blogspot.com/-FGBF5YbY7VM/TuwSvuMtUGI/AAAAAAAAAYM/IAeGVSfnUSI/s400/gary%2Brode.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5686941040526577762" /></a><br /><br />Dr. Myers,<br /><br />Just wanted to drop you a friendly hello and wish you a Merry Christmas.<br /><br />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.<br /><br />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.<br /><br />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. <br /><br />Thanks again for your help and best wishes with your changes.<br /><br />Gary Rode<br />United Methodist Pastor <br />Perrysburg, OH<br /><br />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. <br />God bless.<br />Dr. MyersDr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com3tag:blogger.com,1999:blog-5265361299951558157.post-55358569144955820622011-11-23T13:58:00.000-08:002011-11-23T14:21:54.111-08:00A Message of Thanksgiving from Joanna<a href="http://4.bp.blogspot.com/-2aF_8_fTrr0/Ts1uGf5nwJI/AAAAAAAAAYA/nh3Pxux4NLk/s1600/Joanna%2BAfter.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 160px; height: 400px;" src="http://4.bp.blogspot.com/-2aF_8_fTrr0/Ts1uGf5nwJI/AAAAAAAAAYA/nh3Pxux4NLk/s400/Joanna%2BAfter.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5678315763105513618" /></a><br /><a href="http://4.bp.blogspot.com/-PfbEjHFvjoU/Ts1tTcTjbdI/AAAAAAAAAX0/UrgQPHvuQ_Y/s1600/Joanna%2BBefore%2B%25282%2529.JPG"><img style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 224px; height: 400px;" src="http://4.bp.blogspot.com/-PfbEjHFvjoU/Ts1tTcTjbdI/AAAAAAAAAX0/UrgQPHvuQ_Y/s400/Joanna%2BBefore%2B%25282%2529.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5678314885967211986" /></a><br />Dr. Myers—<br /><br />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.<br /><br />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! <br /><br />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! <br /><br />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.<br /><br />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!<br /><br />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. <br /><br />Wishing you all the best this Thanksgiving season and always,<br /><br />Joanna<br /><br />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.<br /><br />Happy Thanksgiving to you and your family and to all of my patients.<br /><br />Dr. MyersDr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com4tag:blogger.com,1999:blog-5265361299951558157.post-86081898315408775342011-10-30T12:48:00.000-07:002011-10-30T13:05:13.129-07:00More from James Bennett<a href="http://4.bp.blogspot.com/-cUv67RwrGXk/Tq2sp0_1FqI/AAAAAAAAAXc/4_IqkkoSIE8/s1600/james%2Bbennett%2Bafter1.jpg"><img style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 400px; height: 300px;" src="http://4.bp.blogspot.com/-cUv67RwrGXk/Tq2sp0_1FqI/AAAAAAAAAXc/4_IqkkoSIE8/s400/james%2Bbennett%2Bafter1.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5669377340530300578" /></a><br /><a href="http://3.bp.blogspot.com/-Gt8Ll3zcnrk/Tq2sU5iEmXI/AAAAAAAAAXQ/haL7a6sIGbE/s1600/James%2Bbennett%2Bafter3.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 326px; height: 296px;" src="http://3.bp.blogspot.com/-Gt8Ll3zcnrk/Tq2sU5iEmXI/AAAAAAAAAXQ/haL7a6sIGbE/s400/James%2Bbennett%2Bafter3.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5669376980970412402" /></a><br /><strong>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: <br /><br /><br /> 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! <br /><br />Sincerely, James Bennett</strong>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com2tag:blogger.com,1999:blog-5265361299951558157.post-55505857960601091572011-10-24T10:25:00.000-07:002011-10-24T11:46:08.959-07:00James Bennett Tells His Story<a href="http://4.bp.blogspot.com/-2vN9xF6A2Pc/TqWqvEgUm2I/AAAAAAAAAXE/M625Rscr8nA/s1600/James%2BBennet.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 279px; height: 336px;" src="http://4.bp.blogspot.com/-2vN9xF6A2Pc/TqWqvEgUm2I/AAAAAAAAAXE/M625Rscr8nA/s400/James%2BBennet.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5667123431755520866" /></a><br /><a href="http://2.bp.blogspot.com/-JRFq7C2SyOc/TqWp6rms1LI/AAAAAAAAAW4/OaupkbJJWCQ/s1600/James%2BBennet%2Bbefore5.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 400px; height: 299px;" src="http://2.bp.blogspot.com/-JRFq7C2SyOc/TqWp6rms1LI/AAAAAAAAAW4/OaupkbJJWCQ/s400/James%2BBennet%2Bbefore5.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5667122531718190258" /></a><br /><a href="http://3.bp.blogspot.com/-OJjfUUpDRCQ/TqWpMLHLFUI/AAAAAAAAAWs/Oe3PW-rXNRI/s1600/James%2BBennet%2Bbefore3.jpg"><img style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 400px; height: 299px;" src="http://3.bp.blogspot.com/-OJjfUUpDRCQ/TqWpMLHLFUI/AAAAAAAAAWs/Oe3PW-rXNRI/s400/James%2BBennet%2Bbefore3.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5667121732722038082" /></a><br /><br /><br /><br /><br /><br /><br /><br /><strong><br /> <br /> <br /><br /> <br /><br /><br /><br /><br /><br /><br /><br /><br />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.<br /> <br />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.<br /> <br />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<br /> <br />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.<br /> <br />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.<br /> <br />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! <br /> <br />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.<br /> <br />James Bennett</strong>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com4tag:blogger.com,1999:blog-5265361299951558157.post-81311167336784537452011-10-08T18:34:00.000-07:002011-10-08T19:24:00.882-07:008 Tips for Fuller, Thicker Appearing Hair<a href="http://2.bp.blogspot.com/-rM6lN8sRJYg/TpEFq5-fg2I/AAAAAAAAAWA/jpluU9ISWQM/s1600/Jake.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 299px; height: 400px;" src="http://2.bp.blogspot.com/-rM6lN8sRJYg/TpEFq5-fg2I/AAAAAAAAAWA/jpluU9ISWQM/s400/Jake.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5661312441257001826" /></a><br /><br /><br /><br /><strong><br />Often my patients ask how they can avoid hair loss and improve the appearance of their hair. <br /><br />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.<br /><br />Here are Jakes 8 tips to make hair look thicker: <br /><br />Talk to your hair stylist about working with your fine hair.<br /><br />1. Create blunt lines to make your hair style look and feel thicker keeping tapering to a minimum.<br /><br />2. Cut bangs deep toward the top of the head for an even thicker look in front bringing more hair forward.<br /><br />3. Shorten fine hair to create fullness.<br /><br />4. Expand the hair shaft with thickening shampoos, conditioners and volumizing tonics.<br /><br />5. Blow dry hair forward and against the usual direction your hair is combed with a flat paddle brush.<br /><br />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.<br /><br />7. Curl with hot rollers or a round brush and blow dryer to create more lift and the apearance of volume.<br /><br />8. Color hair lighter shades to blend with your natural scalp color so the scalp is not so obvious.<br /><br />Jake is even willing to do free consultations for our patients.<br /><br />Jake Miller, Hair Stylist<br />Rafiel's Studio<br />Aveda Lifestyle Salon<br /><br />2927 N. High St.<br />Columbus, Ohio 43202<br />(614) 784-1177<br />www.rafielsstudio.com</strong>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com5tag:blogger.com,1999:blog-5265361299951558157.post-67229989712178569202011-08-04T19:28:00.000-07:002011-08-04T19:33:43.833-07:00Gastric Sleeve Success Story - Jaime Manley<iframe width="560" height="349" src="http://www.youtube.com/embed/3CSE-5iKCCI" frameborder="0" allowfullscreen></iframe>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com3tag:blogger.com,1999:blog-5265361299951558157.post-57159997782136906922011-07-31T17:46:00.000-07:002011-07-31T17:53:27.784-07:00Bowel Issues Following Bariatric Surgery<a href="http://1.bp.blogspot.com/-hCb4IxnSsWg/TjX4FBv1vCI/AAAAAAAAAVo/P-m7UTF7UNs/s1600/myers.jpeg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 79px; height: 107px;" src="http://1.bp.blogspot.com/-hCb4IxnSsWg/TjX4FBv1vCI/AAAAAAAAAVo/P-m7UTF7UNs/s400/myers.jpeg" border="0" alt=""id="BLOGGER_PHOTO_ID_5635683273976167458" /></a><br /><br /><strong><br />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.<br /><br />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.<br /><br />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.<br /><br />Constipation<br /><br />Constipation is a more frequent complaint from bariatric surgery patients.<br /><br />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.<br /><br />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.<br /><br />3) For more immediate relief as the fiber is doing its work you can use the following three over-the-counter preparations:<br /><br /> A). Miralax - You can repeat this several times as necessary until constipation is relieved.<br /><br /> B). Milk of Magnesia<br /><br /> C). Colase stool softener <br /><br />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.</strong>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com2tag:blogger.com,1999:blog-5265361299951558157.post-53542160206160673122011-07-27T18:34:00.000-07:002013-10-07T17:36:08.523-07:00Laparoscopic Gastric Sleeve Operation - Questions Answered<br />
<br />
<br />
<strong>In response to a recent posting on laparoscopic gastric sleeve operations I did in June 2011 I received several questions.<br /><br />Pete S. from Columbus, Ohio asked about outcomes and frequency of the gastric sleeve operation nationally.<br /><br />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. <br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />So Pete, hopefully this helps you to understand what is happening on the national scene.</strong>Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com25tag:blogger.com,1999:blog-5265361299951558157.post-91614753095302211742011-07-23T11:26:00.000-07:002011-07-23T11:43:00.452-07:00Five More Apps for your Smart Phone<a href="http://1.bp.blogspot.com/-yYUyL3pm8Qs/TisWK6rQqFI/AAAAAAAAAVY/_Vay8LHRLao/s1600/133988-iphone3g.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 220px; height: 400px;" src="http://1.bp.blogspot.com/-yYUyL3pm8Qs/TisWK6rQqFI/AAAAAAAAAVY/_Vay8LHRLao/s400/133988-iphone3g.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5632620135762143314" /></a><br /><br /><br />In addition to the free and paid apps introduced on my last blog posting, here are five more paid apps for your smart phone:<br /><br />1). MyFitnessPal<br />This is a calorie counter, as well as a diet and exercise.<br /><br />2). DailyBurn<br />This is a calorie counter as well as a workout and weight tracker.<br /><br />3). Ihourglass<br />Virtual hour glass which allows you to choose multiple time intervals to help you eat slower and clock times between bites.<br /><br />4). Fooducate<br />This application allows you to take a photo of a bar code while shopping to help you make better, healthier choices.<br /><br />5). Meal snap<br />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?Dr. Stephan Myershttp://www.blogger.com/profile/16254828698662676309noreply@blogger.com0