VSG and HAIR LOSS

***please don't flame me because I have a VSG hair loss blog. Im sure there are others out there. Im only providing VSGrs with some information. I do not claim to be an authority on VSG induced hair loss, Im seriously only trying to help others that follow..understand this common complaint...more than they are being told.  Consider this a starting point to HELP YOU..find your way thru the hair loss maze! 
                                            

Summer 2011:  It bothers me that VSGrs have given up on finding solutions to this huge complaint.  They're told "it will happen or it won't happen", " there's nothing you can do about it", "I didn't have any hair loss (even tho 95% of us DO!!)", "up your protein" use "biotin, nioxin, rogaine, zinc,  hair-nails-skin, use expensive hair shampoo systems," etc...products that do NOT work or may be toxic for WLS induced hair loss, have been used/tried throughout the YEARS by VSGrs in a desperate attempt to prevent, slow or stop this phenomena, have been found to be totally ineffective... yet others keep recommending them anyway, perpetuating the SAME OLD powerful MYTHS...
                                       that do NOT WORK ....NOT FOR THIS!! 
                                              ________________________


Why ?  DIHYDROTESTOSTERONE (DHT), a hormone our bodies produce naturally, and is triggered into overdrive metabolically/hormonally (estrogens/testosterone-aromatase to DHT) within HOURS of VSG  yet does not manifest till ~3months post op  (see timeline below)

DIHYDROTESTOSTERONE is the same hormone that INCREASES as we age...it causes Male Pattern Baldness in elderly men affecting TOP and SIDES of head..
 ......and also observed in Post meno-elderly women- hair thinning TOP and SIDES ! 

in VSG hair loss....what we experience.... TOP n SIDES!!

THE AIM?  to DISRUPT the conversion of hormones to dihydrotestoserone, DHT. 

HOW?  
 DHT BLOCKERS!   DHT Blockers work by inhibiting the 5-alpha-reductase enzyme.  Basically, "a DHT blocker and 5-alpha-reducatase enzyme fit together like a puzzle.  When that happens, the enzyme can’t joint with testosterone to make DHT.  Thus, DHT levels go down, and our hair loss stops".

ESSENTIAL FATTY ACIDS and VITAMIN D3 are DHT blockers-androgen (hormone) inhibitors


Omega 3's: EPA/DHA minimum RDA is 410mg EPA and 274mg DHA please investigate:  1000mg EPA/1500mg DHA  combined with    Vitamin D3 (cholecalciferol) 2-5000 IUs


Americans are usually deficient in both Omega 3s and Vitamin D3 !  VSGrs are no exception!  It is VERY important that IF your raise your Omega 3s you MUST lower your Omega 6s and 9s! as they interfere/cancel each other out. 

Essential Fatty Acids  Krill Oil/Fish Oil Omega3 (EPA/DHA)  interferes with and disrupts the conversion of hormones (estrogens/testosterone to DHT) in acute telogen effluvium... where a  hormonal - metabolic TRIGGER such as VSG causes HAIR LOSS like nothing we've ever experienced in our lives. Would also help with the depletion of hormonal stores (estrogens produced and stored in adipose fat) post op during the rapid fat loss phase, when our hair loss is at its greatest, and we experience increased mood lability/emotional distress

How soon should ya start? the sooner the better !!   vs. AFTER the fact..waiting 3-5months.to see IF you will be one of the very few "lucky" VSGrs that elude hair loss, or chasing your hair loss making up for critical lost time in a panic!
Research hair loss pre-op ...
If considering the above start on your daily regime 2 weeks to 1 month pre surgery up until your told to stop all medications by your surgeon. Post op pick it up asap  Krill Oil (EPA/DHA) is small, Vitamin D3 (must specify cholecalciferol only) is small.  Both come in liquid form... EPA/DHA also comes in liquid form (salmon oil highly recc! is liquid).
 Use in conjunction with required post op vitamins, minerals, and protein intake requirements. Continue into the "critical stage" 0-3 months post op.  

Although there are DHT Blocker systems OTC one can purchase...usually ingredients consist of combinations of selenium, biotin, zinc, silica..we all know these vits/minerals are only worthy at HAIR REgrowth stage (6-7 months out), we get sufficient amounts from diet and daily multi-vit supplementation.


***Do not buy OTC  DHT blockers IF oral HeShouWu is an ingredient 

OTHER DHT BLOCKERS: 


saw palmetto 1500mg per day an essential fatty acid
 http://www.livestrong.com/article/289358-saw-palmetto-hair-loss-in-women/
http://en.wikipedia.org/wiki/Saw_palmetto_extract

GREEN TEA extract  an enzyme 5 alpha reductase to DHT  inhibitor 

Amino Acid  L- Lysine supplementation the most important amino acid in our post op "high protein" diets imo ...and has an effect on VSG hair loss as its another enzyme 5 alpha reductase to DHT  inhibitor 

Topical melatonin hair loss formula/scalp treatments for hair loss  http://www.ncbi.nlm.nih.gov/pubmed/14996107 ,
http://www.livestrong.com/article/292076-melatonin-hair-growth/

Topical only hair loss formulated  He Shou Wu/Polygonum multiflorum http://www.ncbi.nlm.nih.gov/pubmed/21419834 ,
http://www.mendeley.com/research/topical-application-polygonum-multiflorum-extract-induces-hair-growth-resting-hair-follicles-through-upregulating-shh-catenin-expression-c57bl-6-mice/#page-1

I would suggest VSGrs investigate/try these alternative methods..rather than continuing to take or use products that have failed consistently in the past.

Anything you put in your mouth, on yer head to stop hair loss....PLEASE RESEARCH IT YOURSELF!! do not rely on recommendations of others inc. me.... We need to try NEW approaches to this common post op problem!                                                                                           --------------------

 

Although plant sources of Omega3s, are not as bioavailable/absorbable as fish/krill... GLA, ALA are also essential fatty acids that can help with hormonally influenced hair loss. DHA is the most important of Omega3s in hair thinning... so know that  ~10 % of GLA, ALA derived from plant sources convert to omega3 EPA... even less to DHA.

Here's an exerpt from one article on EPO (evening primrose oil) and Hair Loss..thyroid hair loss is also METABOLIC-HORMONAL!! 

 

. . . evening primrose oil (also known as EPO) is a nutritional supplement that is frequently mentioned. In his book, "Solved: The Riddle of Illness," Stephen Langer, M.D. points to the fact that symptoms of essential fatty acid insufficiency are very similar to hypothyroidism, and recommends evening primrose oil -- an excellent source of essential fatty acids -- as helpful for people with hypothyroidism. The usefulness of evening primrose oil, particularly in dealing with the issues of excess hair loss with hypothyroidism, was also reinforced by endocrinologist Kenneth Blanchard. According to Dr. Blanchard:
"For hair loss, I routinely recommend multiple vitamins, and especially evening primrose oil. If there's any sex pattern to it -- if a woman is losing hair in partly a male pattern - -then, the problem is there is excessive conversion of testosterone to dihydrotestosterone at the level of the hair follicle. Evening primrose oil is an inhibitor of that conversion. So almost anybody with hair loss probably will benefit from evening primrose oil."

Evening primrose oil, 1,000 mg thrice daily. Can be replaced with 1,000 mg
borage oil one time daily. 
                                                                       __________


                               The search for that elusive WLS hair loss cure....continues!  
                                                            my original 2009 blog



                                                      
VSG HAIR LOSS
                           ________________________________________________________


PLEASE..read this article on Acute Diffuse Hair Loss/Acute Telogen Effluvium and the importance of PROTEIN and ESSENTIAL FATTY ACIDS  as well as the cycle of events describing VSG hair loss!
    
                                              
http://www.ccjm.org/content/76/6/361.full



  
Use the OH search engine ...sooooo much has been posted on Hair Loss (shedding/thinning) enough to choke a donkey! Its a HUGE post bariatric issue and majority of surgeons NEVER talk to their patients about. Or tell them use zinc, biotin, or increase protein only!  This is a metabolic/hormonal event that begins, is created within hours  of VSG itself .

An interesting article on Acute Telogen Effluvium  http://www.ehow.com/about_5390925_losing-hair-after-surgery.html    following bariatric surgery


Ya never realize how important your hair is to ya.... till yer LOSIN IT!  I don't care who is trying to make light of these times, it IS UPSETTING! Of course it is obvious mostly to the person losing it, and we often exaggerate the loss "coming out in clumps" "bald patches" "Im going bald".
To the men at Male Pattern Baldness forums...its upsetting!! Though their hair loss is genetic-'permanent', are indeed taking perscribed DHT blockers-medications (proscar/finesteride) but  are also supplementing with.....EPA/DHA ( fish oil ) in 3-5000mg range daily to disrupt the androgen conversion in effort ...to stop further hair loss.


For VSG triggered hair loss:

                                KNOW THAT:  THIS TOO SHALL PASS!!!  
                                            
you will NOT go bald!


On a personal note:  I had what only I considered "extreme"  hair loss after having VSG. This is totally ABNORMAL for me despite having gone through stress, trauma, surgeries, pregnancies, crash diets/rapid weight loss, medications,anesthesia at different times throughout my life, then menopause and I have NEVER experienced the amount  or  prolonged hair loss as when I had a VSG.  Hair shed everywhere, brushfuls of hair (my hair is long so looked worse than it was), shower drains n walls, pillow, car head rest, in prepared meals!  


I  tried almost every hair vitamin /supplements, hair products (inc. nioxin) suggestedby members of OH, WLS seminars, my surgeon & nut recs.. since I started losing it at 3 months out,
I tried each product/ supplement, even combined them for at least 30 days. I upped my protein intake to over 90gms protein daily, at the suggestion of my nut and surgeon....TO NO AVAIL!!  NOTHING WORKED to STOP it!  let alone SLOW
 IT DOWN!!

I was desperate! I wanted to believe that what I was taking for it, or shampooing & conditioning with was working, but the truth is...it really was NOT. I only wasted time and money. ...before I summized..the DHT conversion was set into motion the DAY I HAD VSG!!

From what Ive researched,  NUTRITIONAL deficiencies can increase and prolong hair loss ..only  Won't cause it, won't slow it,  won't stop it..... in  Acute Telogen Effluvium. Its the hormonal imbalance triggered by VSG..estrogen/s produced in fat and DHT conversion of hair follicle .... affecting mainly women, but also men  (aromatase) who may not notice / or report  hair loss due to it being normally short, shave their heads anyway,  are not interested in prevention as this temporary phase of hair loss is not as important to them. 

This blog is mostly geared for women! 
 Please consult with your doctor, dietician, endocrinologist re:  contributing factors- supplementation to your diet, secondary illnesses, deficiencies ..i.e.protein intake based on  age, gender and activity (muscle building/strength training), iron intake for menses aged women, medications w/ adverse effect of increased hair loss i.e anti-depressants,  Actigall/Ursodiol, and hormonal disorders such as PCOS, insulin (diabetes), thyroid, menopause which can also exacerbate hair loss. 

 


Things Ive learned along the way:


Hair Loss BEGINS             3-4 months post op
Hair Loss SLOWS              6-7 months post op    (new growth apparent)
Hair Loss STOPS               12- 18 months post op (or when your weight loss stabilizes)


 Just as hair loss slows at ~ 6-7 months, NEW GROWTH makes its appearance. 
Your pubes, armpit, leg hair may be affected as well and may grow back sparsely.


Biotin (Vitamin B7 aka Vitamin H) is great to use at the REGROWTH stage only...as it helps not only with growth but to replenish natural oils helps prevent dried, frizzed, listless hair commonly seen in post bariatric pts. 


1. PROTEIN PROTEIN PROTEIN : One interesting article
                       
http://www.nahrs.org/home/Default.aspx?tabid=66 
**Note 4th paragrah "especially insufficient intake of protein" in ACUTE TELOGEN EFFLUVIUM phase we experience post op.

Hair loss can be related to chronically LOW/er PROTEIN INTAKE during the critical stage (0-3 months post op) Keep protein levels at least 60-70gs DAILY for women. Do not exceed 80gs daily , playing catch up, after this period, thinking you will stop hair loss. Won't happen! Talk to your nut, see your guidelines based on your specific individual protein requirements. Please find a good TRACKING site online to track your protein intake (supertracker, myfitnesspal, sparkpeople, dailyplate, fitday etc). VSGrs that had tracked and got in the necessary protein intake from the get go ...STILL report hair loss, or having some to no effect.

I think it is noteworthy L-lysine an amino acid in protein IS a DHT blocker! Could our reduced protein intake the first few weeks post VSG be an influence? Would supplementing with L-lysine be a 'better' option for us post op to prevent hair loss?  More info on L-lysine from Bariatric Times below



2. SAVE YOUR MONEY on vitamins, hair care products recommended by hairstylists, nuts, surgeons, forum members that claim a product will "save/help your hair" from loss. Either they are toxic, unnecessary / ineffective, must be used for 6 months or more for result$, or claims are unproven! 

Please research any recommendations wellbefore taking them.. to learn the TRUTH about them. You get enough selenium, biotin, zinc, silica from your diet, and daily multi-vit. There has RARELY been an incident of these nutritional deficiencies post VSG. They merely promote hair REGROWTH!. Will NOT do 1 thing to prevent, slow or stop hair loss! ..NOT IN VSG triggered hair loss!! 


****MENSES aged women...PLEASE KEEP YOUR IRON INTAKE AT ACCEPTABLE LEVELS...iron deficiency will exacerbate your hair loss 
****PERI-MENO/MENO women...PLEASE
 KEEP YOUR CALCIUM and VITAMIN D3 at ACCEPTABLE LEVELS. Hair loss in meno aged women is very common...another HORMONAL trigger of acute telogen effluvium. 
**** Hypervitamintosis A has been found to increase hair loss


3. PREVENT BREAKAGE Altho much of your initial hair loss, occurs from the ROOT, at ~7 months out..you will notice numerous remaining hair strands on yer head have a "weak point" of up to ~1/64th of an inch long..where the diameter of each individual hair strand/shaft is THINNER (weak point) between the old hair and new hair growth on that particular strand. PROTECT THESE STRANDS because it is a major HAIR BREAKAGE point. Use a mild protein shampoo and protein conditioner once a week max.

DO NOT use protein shampoos more than 4x a month because they are VERY drying and damaging to your hair. Nioxin or its generic counterparts IS TOXIC! (links towards the end of this blog).

Have you ever noticed post op bariatric patients pics or in real life with DRY,BRITTLE, FRIZZY, LISTLESS hair?
Contributing factors may include: poor protein intake, overuse or too high concentration protein-chemical shampoos/conditioners, main.stylelist.com/2011/01/10/deep-conditioner-how-to-choose/  cotton pillowcases that rob moisture from hair, not to mention hormonal age-related factors when our hair naturally changes (increased DHT), and chemical processing has taken its toll. 


4. CREATIVITY 
Hats, wigs, hair pieces, accessories.
Get creative with styles and parts. 

Camouflage! eye shadow, eye pencils, fillers- tint colored powders, thickeners- hair sprays that match your hair for parts, hair line until regrowth appears.
Great time to go for that shorter hair style! It'll make you feel so much better.

Just as YOU think your hair is paper thin, can see Grand Canyons in yer part, and yer definately going bald..your hair stylist will tell you ~9 months post op...You don't even need a volumnizing cut!...all those little new hair growths will give ya lots of volumn naturally!

5. COOKING HAZARDS:Keep yer hair under wraps or up in a loose bun ..if you insist on maintaining long hair like I do WHILE COOKING and preparing meals!! Talk about losing one's appetite... I can't tell you how many dinner guests have pulled a strand of my hair out of their meal ...my first year post op.

6. AVOID COTTON PILLOWCASEs use a satin/silk pillowcase! handwash/ rinse separately.  Cotton pillowcases.. absorb moisture..natural oils from your hair ... the friction will cause increased hair loss and damages/frizzes hair.  
Your face and your hair pressed against harsh detergent/fabric softeners/chemicals like chlorine bleach for up to 8 hours ...think about this fact not only during the hair loss phase but ... as you age 

 
7. SHAMPOOING/ SCALP MASSAGES:  Do NOT shampoo your hair everyday unless it is very oily. Thin out existing shampoos so less harsh. Look for Keratin or Amino Acid shampoos. AVOID SULFATES in shampoos that rob moisture not to mention color! Use the pads of your fingers to massage yer scalp gently, and stimulate circulation. Protein Shampoos/Conditioners (see above #3) may be needed to prevent breakage when the time comes.

Per Dr. Mercola and Dr. Oz coconut oil ($5 at cooking oils section of Walmart) applied at the root as it does not clog hair follicles, is a NON-TOXIC (unlike Nioxin) DHT inhibitor!...Apply 30 minutes prior to shampooing ..best applied and left overnight (shower cap), shampoo in am. 

Cosmetology schools and hair salons offer Tesla scalp massages for a nominal fee. A neon tube electric 'rake' stimulates circulation & massages the scalp. Per The DRs (television show) rec Tesla scalp treatments to anyone with hairloss.

8. AFRICAN AMERICAN/BLACK HAIR:  Black women please ease up on chemical straightening, weaves, braids/extensions, locs, loc extensions, hot irons anything stressing yer already thinnin scalp the first year unless yer going for the Naomi Campbell look!!
                        
    

See gettin CREATIVE section #4. There are VERY NICE lace-front wigs out now under 100 dollars.  Use combs vs. pins that may pull at root when removing. 

DO NOT USE: Hair growth "potions", Nioxin, Minoxidil, Rogaine products ..research and online reviews claim they will cause your hair to come out in clumps! Check these products out THOROUGHLY before using!
                                       _____________________________


                                                   CONCLUSION!!

SO ..you've gotten in all your protein, all your vitamin and mineral requirements... you may have tried all sorts of OH suggested remedies, hairstylists, surgeon, nut recs.....same old past  FAILS to NO AVAIL we all tried!...you probably have deduced by now.......

NOTHING will SLOW or STOP  this phenomena (VSG-triggered HAIR LOSS)  but ...TIME. (note the timeline above)   As your weight loss stabilizes you may notice your hair loss has completely stopped.  

My weight loss came to a grinding halt at 13 months post op. Coincidentally, so did my hair loss!
All that stressing, money and time popping worthless biotin, hair skin nails supplements, buying & using shampoo systems........FOR
 NOTHING! 

Chronic telogen effluvium occurs after 18 months of hair loss. Other hormonal influences / nutritional deficiencies may contribute to, prolong it. Please see your PCP/surgeon for labwork, endocrinologist, dermatologist if this is the case.

Acute Telogen Effluvium RETRIGGERED? check
Nutritional deficiencies
 
Post VSG  surgeries (
^anesthesia influence):  plastics, revisions, gallbladder surgery..although no where as prolonged or pronounced as in initial VSG. 
Hormonal - endocrine disorders i.e. thyroid, adrenal, menopause 


                                          __________________________________________

NIOXIN:I have many more websites showing very mixed results and also showing people using this system for 5+ years!! and swear by it.. even tho Nioxin website CLAIMS results within 10 days of use. Yes some people do believe it snows in Phoenix, AZ in the middle of summer! I sure did when I used the 3 part system for my hair loss. The tingly sensation from metholation convinced me it must be doing something... until I found out how toxic it is! 

Nioxin website:

http://www.nioxin.com/en-US/the-5-effects-page.aspx
effects#1 
NIOXIN is designed to make hair strong, healthy and thicker-looking

health benefits #2 note  "DENSER-LOOKING" and "APPEARS" as operative words used.
http://www.ewg.org/skindeep/product/272909/Nioxin_Cleanser_System_1/
and


________________________________________________                                                   

   Bariatric Times Articles:


2011  WLS and HAIR LOSS
http://bariatrictimes.com/2010/11/11/hair-loss-among-bariatric-surgery-patients/

2008 Nutrition and WLS INDUCED HAIR LOSS:
http://bariatrictimes.com/2008/09/19/the-latest-on-nutrition-and-hair-loss-in-the-bariatric-patient/

Protein:

Low protein intake is associated with hair loss. Protein malnutrition has been reported with duodenal switch, and in gastric bypass to a much lesser degree. Little is known about incidence, as only around eight percent of surgeons track labs such as total protein, albumen, or prealbumen.3 Limited studies suggest that patients with the most rapid or greatest amounts of weight loss are at greatest risk.4 With surgical reduction of the stomach, hydrochloric acid,5 pepsinogen, and normal churning are all significantly reduced or eliminated. Furthermore, pancreatic enzymes that would also aid in protein digestion are redirected to a lower part of the small intestine. It is thus likely that maldigestion rather than malabsorption is responsible for many cases. Some studies have also implicated low protein intake.6

***Biotin 
Many individuals believe that supplementing with, or topically applying, the nutrient biotin will either help to prevent hair loss or will improve hair regrowth. To date, there is no science that would support either of these presumptions. While biotin deficiency can cause dermatitis, hair loss is only known to occur in experimentally induced states in animal models or in extreme cases of prolonged diets composed exclusively of egg whites.

Other
Other nutrients associated with hair health include vitamin A, inositol, folate, B6, and essential fatty acids. Hair loss can also be caused by systemic diseases, including thyroid disease and polycystic ovarian syndrome (PCOS), and is influenced by genetics.
 

Conclusions:
Hair loss can be distressing to bariatric surgery patients, and many will try nutrition themselves to see if they can prevent it. Unfortunately, there is little evidence that early hair loss is preventable because it is most likely caused by surgery and rapid weight loss. Later hair loss, however, can be indicative of a nutritional problem, especially iron deficiency, and may be a clinically useful sign. Educating patients about the potential for hair loss and possible underlying causes can help them to make informed choices and avoid wasting money on gimmicks that may have little real value.

Research also indicates that low levels of the amino acid l-lysine can contribute to hair loss and that repletion of lysine stores may both improve iron status and hair regrowth. In a study of anemic patients with hair loss who were supplemented with 1.5 to 2g of l-lysine in addition to their iron therapy, ferritin levels increased more substantially over iron therapy alone.
--------- 
An Article on Diet and Hair Loss:
Prevent Hair Loss with Foods: Six Diet Changes to Make

Do you dread trips to the beauty/barbershop? Cringe every time you pass a mirror? If so, you're probably concerned about hair loss. But whether you're starting to see strands of hair in your tub or are just worried that your thick head of hair won't last forever, there are certain foods you can eat that may help. Of course, if you're genetically predisposed to hair loss, there's not much you can do but keep your fingers crossed. But if not, adding these foods to your diet can help keep your scalp healthy, happy and hopefully hairy.

FISH, EGGS,BEANS
Hair is primarily made of protein; therefore, it makes sense to eat a protein-rich diet if you're trying to maintain your healthy hair. However, eating a steak every day isn't going to help you. High-fat diets result in increased testosterone levels, which have actually been linked to hair loss. Stick to leaner proteins such as fish (which has myriad health benefits beyond just maintaining your hair), chicken, calf's liver, brewer's yeast, low-fat cheese, eggs, almonds, beans and yogurt. Soy milk and tofu are also smart to add to your diet because they are high in protein and low in bad fats.

RAISINS
Iron plays a key role in manufacturing hemoglobin, the part of the blood that carries oxygen to your body's organs and tissues. When your hemoglobin is at a healthy level, oxygen is properly dispersed. This means your scalp is getting a good flow of blood, which will stimulate and promote hair growth. Adding more iron to your diet doesn't mean you have to feast on liver day in and day out, but when you're craving something sweet, remember that dried fruits (like raisins) and cherry juice are packed with iron. Eggs; dates; raisins; dark green, leafy vegetables such as kale; and whole-grain cereals are all high in iron. Vitamin C improves the absorption of iron, so fruits such as oranges, strawberries and lemons should also make your grocery list.

BEAN SPROUTS
Silica may not be a word you commonly hear associated with diet (or foods that prevent hair loss, for that matter). But if you're looking to promote hair growth and prevent hair loss, silica needs to be on your menu. The body uses silica to absorb vitamins and minerals; if you're not consuming silica, eating your vitamins might not be helping much. Silica can be found in bean sprouts and the skin of cucumbers, red and green peppers, and potatoes. Remember, when you eat these foods raw, as opposed to cooked, you're getting more nutritional value out of them.

SEAFOOD
Many people who suffer from hair loss are found to have zinc deficiencies. Zinc plays a key role in many of the body's functions, from cell reproduction to hormonal balance, and all of these functions affect hair growth. Perhaps most importantly, zinc manages the glands that attach to your hair follicles. When you're low on zinc, these follicles become weak, causing strands to break off or fall out. To combat this problem, eat zinc-heavy foods such as red meats, poultry, mussels, shrimp, nuts and oysters. Excessive amounts of zinc can eventually lead to hair loss, so it's best to stick to a zinc-heavy diet rather than eat these foods AND take a zinc supplement.

POTATOES
It may be tempting to eat fast food, but greasy foods are among the worst culprits for hair loss. If you have a craving for a burger and fries, your best bet is to cook the burger yourself and dice, season, and bake some potato wedges (leaving the skins on) to go along with it. Try to limit your intake of excessively cold, spicy and sugary foods as well. These can tax your body, and when your body's fighting something unhealthy, it's not functioning at its peak level.

 A BALANCED DIET
Just as your overall health will benefit from eating a balanced diet, so, too, should the health of your hair. Once it's gone, it's gone, so don't put foods in your body that speed up hair loss. You may be experiencing a thinning on top already, but you can counteract this (or at least slow it down) by eating from every food group daily -- concentrating on foods that are rich in protein, iron, silica and zinc.
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VITAMINS and SUPPLEMENTS for HEALTHY
 HAIR 

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HANG IN THERE, HOPE THIS HELPS!! 
                                  IT DOES GROW BACK!


VSG and Dumping Syndrome


Although uncommon, some post VSGrs report episodes of dumping syndrome,called Alimentary Hypoglycemia. Same rapid gastic emptying as seen in partial gastrectomy pertainig more to the liquid/fluid concentration of the intestinal tract. Same rapid gastric emptying seen in people who never had gastro or bariatric surgery also. Current medical data/ literature on VSG procedures do NOT eliminate the occurance of dumping but continue to suggest the occurance as 'minimal' post VSG. You will more than likely never see a stat or data on dumping in VSG it is so uncommon Recent information in dumping in partial gastrectomy shows occurance at 1% of surgeries.  True dumping is NOT the queasy, ick fatigue 'needing to lay down' one gets from eating processed high sugar type foods..on an empty stomach . It is NOT solely diarrhea, or solely nausea/ vomiting associated with eating too fast or overeating. It is a combination of 3 or more symptoms (list below). It is frightening so much so that some VSGrs may be compelled to go to the ER. 
Dumping syndrome in VSG...can occur with simple sugars carbs BUT it can occur with proteins: liquidy creamy, semi-soft proteins..(fluid concentrations of the intestinal tract),  and fats: esp  fried foods as well. 
The belief that dumping syndrome only occurs with high sugar (glucose from simple carbs rapidly emptying into the large intestine ) content foods is erroneous.  That is a reactive hypoglycemia, most common in 33% of RNYrs a reaction to simple sugar/carbs/glucose, and a behavior modification type surgery of choice for "sweet tooth" bariatric candidates. 

 I, personally have experienced dumping syndrome 3x's in 6 months post op. 
The FIRST episode at 2 months post op, then 4 and 5.5 months out. Symptoms  in all episodes inc. heart racing, diaphoresis (sweats), abdominal cramps, dizziness feeling like I was going to pass out en route to bathroom,  severe diarrhea.. food eaten in the toilet..undigested, unabsorbed. Then followed by EXTREME fatigue...needing to "sleep it off'  

2:3 episodes foods I dumped PROTEIN!!  1 cup "canned" 99% FF cream of chicken soup (5g carbs) at 4 months out, and 1/2 cup "canned" ground beef chili no beans (9gs carbs) at 5.5 months out.
These dumping episodes were totally RANDOM!   Ive had those same foods  since 1wk post op (soup) and  then again 2 weeks after dumping on them and NEVER had a problem with them before or after dumping episode. The fluid/concentration of my intestinal tract must have been prime. 


Majority of dumping in VSG forum posts reflect  no episodes of dumping syndrome post 6 months, as the case with me!,..perhaps due to stomach being fully healed, homeostasis  at that time. Important to note that dumping syndrome occurs in people who never had WL or GASTRO surgery. If dumping happens to you, realize: 

                                             THIS IS NOT IN YOUR HEAD.  VSGr's can and do DUMP!

The symptoms will pass depending on severity from 1-12 hours from personal experience which includes the extreme fatigue that follows an episode.  If persists consider seeking medical advice.

Prevention tip: do not eat simple sugars on an empty stomach unless you are at least 6 months out.  
Eat Protein (dense, firm, solids) BEFORE/FIRST!  Combne protein w/ simple carbs i.e. fruit with cheese, nut butters.  


The BEST remedies to overcome Dumping Syndrome: 
1, SOLID proteins  avoid creamy, liquidy protein foods  (decrease fluid concentration of intestinal tract)
2.  SOLUBE FIBER...to soak up excess fluids in the intestinal tract
3. REPLACE ELECTROLYTES lost  ..i.e pedilyte, G2s, Zero sports drinks.

The reason these episodes are called a syndrome is because usually one has 3 or more symptoms each occurance. Here is a list of symptoms:

                               Symptoms

Symptoms of dumping syndrome occur during a meal or within 15 to 30 minutes following a meal, they may include:

Nausea

Vomiting

Abdominal pain, cramps

Diarrhea

Dizziness, lightheadedness

Bloating, belching

Fatigue

Heart palpitations, rapid heart rate

Signs and symptoms may develop after 30 minutes, they may include:

Sweating

Weakness, fatigue

Dizziness, lightheadedness

Shakiness

Feelings of anxiety, nervousness

Heart palpitations, rapid heart rate

Fainting

Mental confusion

Diarrhea

Some people experience both early and late signs and symptoms. Conditions such as dizziness and heart palpitations can occur either early or late — or both.

Some people experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Hypoglycemia is more often related to late signs and symptoms.

Gastrectomy and Dumping Syndrome:
http://emedicine.medscape.com/article/173594-overview

                    Alimentary hypoglycemia

Alimentary hypoglycemia is caused by food being dumped too quickly from the stomach into the small intestine. This causes the carbohydrate to be released too quickly, and this is followed by an over-reaction of the pancreas, and over production of insulin. Alimentary hypoglycemia occurs with an abnormality of the stomach, usually because of stomach surgery. Unlike the normal stomach, which can hold food over a long period, the reduced size of the stomach after surgery makes the holding time shorter. Alimentary hypoglycemia can also occur in some cases of gastrointestinal abnormalities not caused by surgery, depending on where in the system the problem is.

The sudden drop in blood sugar can be very dangerous and, in rare cases, can cause seizures and coma. Usually symptoms will appear a half hour to two and a half hours after eating.

                 Alimentary Hypoglycemia

Hypoglycemia is an affliction common among children and diabetic people, resulting from the body’s natural defense mechanisms reacting wrongly to blood sugar levels that are too high or too low. There are different and varying types of hypoglycemia based on their causes but the most severe type is what they call Alimentary Hypoglycemia.

Alimentary is a word that pertains to or concerns food, and while hypoglycemia itself concerns food and their glucose contents, none is more directly related to actual food than this type of hypoglycemia.

Unlike other forms of hypoglycemia, which result in consumption or lack of blood glucose, Alimentary Hypoglycemia happens when food that you have chewed and swallowed is dumped too quickly from the stomach to the small intestine. This abnormal occurrence causes all the carbohydrates in your food to be released faster than intended, and will immediately prompt the pancreas to overreact, which in turn releases far too much insulin, driving the body’s glucose levels far too fast and too low than your body was designed to handle. This sudden drop in blood glucose levels is among the most severe in all hypoglycemia types, and can cause seizures and even put the patient in a comatose state.

Alimentary hypoglycemia has two subgroups, with the first one occurring to those who do not have any experience with gastric surgery in the past, and the second one being for those who have had prior gastric surgery, either with gastric resection or vagotomy. With the second subgroup, the severest form of alimentary hypoglycemia may occur after subtotal gastric resection, and the constant defecation resulting from diarrhea may further complicate management and treatment. Patients suffering from this irregular digestive system will greatly benefit from a diet rich in soluble fiber while a person with normally functioning digestion should focus more on foods rich in fiber.

Alimentary hypoglycemia tends to happen after mealtime, and is usually caused by excessive moving such as jumping, running or brisk walking. In order to avoid this reactive form of hypoglycemia, it is best to take a few minutes of rest after every meal to ensure that the food you ate has settled down and can be digested thoroughly and properly. Children in particular are very prone to this kind of hypoglycemia, as kids have a habit of immediately running, jumping or playing around after a heavy meal. As such, it is important for the parents to regulate their children’s activities and implementing strict rules regarding behavior after eating.

Alimentary types of hypoglycemia can also be caused by improper administering of medicines that affect the body’s adrenal glands, particularly energy-regulating ones that promote and could result in excessive production of adrenalin, effectively putting the body in a state that digests food faster than normal, and laying havoc to the digestive system.

Always remember that hypoglycemia happens even to people who are not suffering from diabetes, and it is very important to be responsible with your eating habits and daily activities in order to prevent developing or triggering a hypoglycemia attack.


Pre-Surgical Psychiatric Evaluation Criteria


My surgeon gave me the following ASBS psych eval (for interview), I typed it here ver batim in hopes to give pre-surgery candidates a heads up on what to expect, and lessen the fear associated with the interview/testing process. 

Below are links to the ASMBS Psych Eval (for interview) and links to sample questions as well as a synopsis of the MMPI-2 (computer/pamphlet) of how MMPI-2  is rated.

Suggestions for the Pre-Surgical Assessment of Bariatric Surgery Candidates from the American Society for Bariatric Surgery : 


Behavioral
1. Previous attempts at weight management
2. Eating and dietary styles a. binge eating, b. overeating c. grazing d. night eating syndrome
3. Physical Activity and Inactivity
4. Substance Abuse
5. Health Related Risk Taking Behavior a. impulsive behavior b. compulsive behavior c. compliance with medical treatment d. adherence to self management regimens
Cognitive and Emotional
1. Cognitive Functioning
2. Knowledge of Morbid Obesity and Surgical Interventions
3. Coping Skills, Emotional Modulation, Boundries
Psychopathology Specifically the assessment needs to address
1, Whether there is a history of or current self-destructive or suicidal behavior (ideation, plan or attempt), the outcome of this behavior and the resultant interventions, if any.
2. Any history of psychiatric hospitalizations, the circumstances precipitating this, the type of treatment provided and its efficacy.
3. Any psychiatric history including major affective and psychotic disorders. Relevant information should include a thorough history with regard to onset, course, and treatment history. Risk of possible relapse during the immediate and long-term post operative phases. How the patient plans to meaningfully address these issues should they occur, including both professional and interpersonal supports.
4. The possible impact of the surgery both from the standpoint of symptom resolution as well as potential exacerbation. In general, a documented period of at least 6 consecutive months of good stabilization as it pertains to both symptom and medication management is required before the patient is ready for surgery.
5. Outpatient psychotherapy history including recent and current treatments. Information should be obtained from the patient's treating provider(s) regarding the patient's emotional stability, coping skills, psychological resources and ability to manage life stressors, impulse control issues and compulsions, as well as the client's capacity to follow directions and adhere to self-management guidelines. Treating mental health professionals may also provide valuable information concerning what they believe will be the most difficult change or adjustment for the patient during the post operative phase and what reservations, if any, they have about the candidate's decision to pursue bariatric surgery.
6. The history and course of psychotropic medications. If the candidate is stable on psychotropic medication regime information needs to be gathered about the length of stability, frequency of follow-up visits, or the need for possible titration or revaluation of the current medication regimen prior to surgical procedure.
7. The potential medication issues post surgery. Many medications affect appetite and weight gain. Some medications interact with potential posoperative conditions, e.g., dehydration and some no longer appropriate in the same form as pre-surgery, etc.
Developmental History Areas of note to be gathering during the interview should likely include:
1. Patient recollection about the stability of their childhood, any significant adverse events and long-term impact.
2. Parent availability and stability as well as the quality of the bond with the identified parent
3. Degree and quality attachments in social relationships outside the home
4. Any childhood history of weight-related ridicule and its related impact
5. An understanding of the childhood role that food played, along with any attempt to use it as a source of love, comfort, companionship, control or dissociation.
Current Life Situation
1. Stressors The assessment needs to tap information about: a. What significant life stressors have occured in the past year or are ongoing. Stressors might include significant discord with childern or with one's partner, divorce, death of a loved one, loss of a job, buying a home, moving, or starting college. b. What stressors does the candidate expect in the upcoming year. c. How well the candidate is or is not likely to cope in light of the fact that the rapid, widespread post surgery changes.
2. Utilization of Social Support
Motivations and Expectations
Psychological Testing Instruments and Assessments
Summary

In sum, the pre-surgical assessment addresses whether the candidate is adequately prepared--from a psychosocial perspective -- to go forward with bariatric surgery and whether there is evidence of any barriers that may interfere with patient safety and with adjustment to the surgical procedure. 
                   ________________________________________________________

MMPI-2  first 75 questions: antipolygraph.org/cgi-bin/forums/YaBB.pl

synopsis:     www.psychologistanywhereanytime.com/tests_psychological/psychological_tests_mmpi.htm



THE ASMBS  (American Society for Bariatric Surgery) Pre-Surgical Psych Assessment

                                   http://www.asmbs.org/html/pdf/PsychPreSurgicalAssessment.pdf


VSG Leaks and Strictures

Leaks and Strictures are 2 most common complications affecting VSG post ops. They account for LESS THAN 2% of total VSGs done in the U.S. This stat was based on 1-2009 data when this blog was written

New update on leak stats...Dec 2011 incidence of leaks is  2.4% in US, as many more VSGs are being done, stands to reason, leak rate increases.   http://www.ncbi.nlm.nih.gov/pubmed/22179470 
Stricture rate is currently below 1% (link will be provided soon!)

From 3-2011 (international) consensus (of ALL bariatric surgeons)
The total number of LSG cases performed by those panelists who shared data was 12,799. The mean patient age was 42 years, with 26% male and 73% female. The mean body mass index of the patients was 44 ± 4.47 kg/m2. The mean bougie size was 37F ± 5.92F. The average length of hospital stay was 2.5 ± .93 days. The conversion rate was 1.05% ± 1.85%. On average, patients experienced a 1.06% leak rate and .35% stricture rate. The postoperative gastroesophageal reflux rate was 12.11% ± 8.97%.

Even the most experienced bariatric surgeon can cause a leak or stricture, sometimes due to the complexities of the case or history, medical condition of the patient, inc stomach erosion from previous WLS procedures/lapband, 32F bougie/boughie and technique also influence occurance.  They do NOT randomly happen. A VSGr does NOTHING to cause a leak, or stricture. They ARE
 a RISK of surgery. No one is exempt.

This is presented as informational only as told to me by my surgeon, and gathered from posts and articles Ive read. No way is it a replacement for professional medical advice. 

*** PRE-OP: Talk to your surgeon ask how s/he checks for the presence of a leak. Ask how s/he reinforces the staple line to safeguard from leaks.

 

 

LEAKS (gastroesoghageal anamostosis)

When Leak Test Done: Prior to discharge post VSG from the hospital, majority of surgeons have done or will have you do a "leak test". Some surgeons do a leak test after VSG has been completed,  using air pressure/methylene blue, inside the stomach and saline outside the staple line, while in surgery/operating room (OR).  Much like checking for leaks on a bicycle inner tube (bubbles=leak).
~Day after surgery, some surgeons may have you do a leak test with Swallow & Xray. The swallow solution may inc. barium, a contrast gastrogafin white or a stain methylene blue.
Some surgeons will do BOTH leaks tests: one in OR and one after surgery.
Some surgeons 'claim' OR leak tests are 'unreliable', and don't do them. Know that a sole post-op swallow/Xray can also be 'unreliable' as a small leak may go undetected, until swelling/inflammation is reduced. 

Symptoms: unexplained consistent fever 100.5^ , pain: left upper torso shoulder/back, left ribcage, tachycardia (fast heart rate) also increased abdominal pain, shortness of breath, sweating, chills, general malaise.

Occurance: 3 days to 4.5 weeks post op most common. Rarely after 6 weeks post-op, have read of several cases on VSG Forum of leaks discovered at 6 - 7 months post op, VSGrs complaining of symptoms since early on, going to ER and misdiagnosed as kidney infections, or some other malady before discovering/confirming the leak.

At the stomach/esophageal juncture.  A surgeon not getting a tight clean staple line along the top stomach (excised fundus area) because of a "misfire" / angle of the staple gun during the final cut, not using smaller staples due to difference in tissue density from antrum to fundus being the most common, can staple the stomach to the esophagus, knick the esophagus with the stapling gun, overstaple

Diagnosis: Can be found immediately post op doing the leak test barium swallow w/ upper GI Xray, later using CT scan (most effective), GI Xray or ultrasound. May need to be repeated to confirm, as a very small leak due to swelling and inflammation blocking the leak , location of one can go undetected.

Treatment:  hospitalization, leak repair can inc. one or more options:  stent, Jackson-Pratt "jp" drain, fibrin sealant, suture Post op VSGrs w/ leaks report hospitalization 2-60 days depending on severity, where and how soon diagnosed, treatment and its efficacy.  At home recovery may be 2-6 months. Rarely over 1 year.

                          _____________________________________________________

 

 

 

 

Disadvantages of the LSG are: 1) this procedure involves gastric division, and therefore leaks and other complications related to stapling may occur  Obesity Surgery, 15, 2005, pg. 1127

LapSF on 32F bougies in VSG
"Optimal weight loss may require the smallest possible pouch, which may yield the highest leak rate" .




STRICTURES (VSG gastroduodenal anastomosis)

Symptoms: persistent nausea /vomiting, inabilty or gradual inability to keep anything down including liquids. Post-VSGrs w/ strictures also report: liquids backing up in their esophagus, foamies, heaving, fatigue.

Causes: When a surgeon inadvertantly narrows the entrance from stomach to pyloric canal because of misalignment of bougie, "misfiring" of stapler, 
staples your stomach to small intestine (duodenum) 

Scar tissue begins to adhere to staples within 72 hours post op. Scar tissue/adhesions tighten the opening to the pyloric canal/sphincter further. Akin to a clogged drain..over time forcing food/drink to 'back up'.

Occurance: usually from 3-6 weeks post-op, but have read of cases 2-6 months out due to scar tissue build up gradually narrowing the already narrowed opening to the pyloric canal (**see below).

Diagnosis: upper GI, abdominal CT scan , and/or Xray.

Treatment: hospitalization, cleared with endoscopic balloon dilation providing mild stretching at site,  dilation treatments may need to be repeated before resolution.

**We often delay in getting medical help because we think, or are convinced by others that these symptoms are NORMAL. ALWAYS...error on the side of caution!

                         *****************************************
Links that may be helpful:

 Managing Sleeve Gastectomy Complications

Complications of Gastric Sleeve

Europe:VSG leaks
http://bariatrictimes.com/2009/09/23/treatment-of-leaks-after-sleeve-gastrectomy/ .


About Me
Four Corners, NM
Location
VSG
Surgery
09/10/2008
Surgery Date
Mar 09, 2008
Member Since

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