I thought that because of being considered a light weight my weight loss was going to be slower NOT SO!!!I have lost 10 pounds since last Monday. I lost 5 pounds from yesterday to today. I weigh myself 4 times all around the house just to make sure that the scale was correct. It was 192.4 all over the house upstairs bathroom, upstairs bedroom, downstairs bathroom and living room. Down stairs has different floors so just wanted to double check. Yep 192.4.

The upper part of my stomach is still bloated and at night when I turn from side to side you can hear the and feel the gas moving. It is so funny. In the morning when I pee the gas that I have sounds like a bomb. You would think I was dying.all it is air.

One of my incisions is oozing watery liquid with a little blood. I have an appointment with my PCP on Wed. I am going to ask him to take a look at it and take out the last stich from the drain.

I am glad I did the surgery I have only used 5 units of insulin since last Monday as opposed to 170 a day. Amazing. I am still on the heart medication of course. So of course as I was written my last sentence of only using 5 units of insulin I decided to check my BS and yeah a little high compared the other days so I just inyected 8 units. Let me revise my sentence.  I am glad I did the surgery I have only used 13 units of insulin since last Monday as opposed to 170 a day.

I am at work today and feel great. I decided to take my vitamins 2 weeks earlier. My doctor said on week 3 but I think that was too long. Does anyone have any thoughts? Should I stop them? I am not taking the iron yet I don't know if I want to take iron I will be constipated for life. Maybe if I eat a cup of beans a day that can count as my iron supplement.

By the way if anyone reads this post can you tell me if my ticker is on. I don't know if I can't see it but other people can type a thing. I want to be able to see my ticker damn it. I have earned the right to see my ticker I WANT A TICKER!!!

Enough said.

I am home from Mexico. The surgery went wonderful, I am alive. Having heart issues I thought that there was a high risk of not making it. Nothing happened the heart monitor did not even skip a beat.

I have lost four pounds since 06/29/09. I am now post-op I never thought that I was going to write those words.

My liquid intake is not hard I complete it by 5PM or so every day plus about 10 oz more I am really happy about that. I was worried that I was not going to be able to do it.  I can't drink it in one sitting I just sip away.

My surgery recovery has not been bad, a minor discomfort on the stomach as if I did mega crunches .  On the second day I started asking myself what the hell did I do? This is a barbaric operation I am a complete fool in the middle of nowhere with my husband who looks more worried than I do...but then yes I passed some gas  and the pain was gone.

I can't stand the smell of canned tomatoes my stomach contracts and I want to puke, I can't smell most food that is in front of me either. The most amazing thing though I don't want food. I don't know if it is the body saying you can't eat because you are healing or maybe a switch gets turned off. If it is the switch please stay turned off for a while.

My doctor said that I had a stomach on the larger side and that it was very soft. This is not such a good thing after surgery because it is easier for my stomach to expand and gain weight. People with a harder stomach,  the operation is more difficult because it takes longer but post op it's better because it is harder to gain weight (for stomach to expand) I don't know if this is true but the theory makes sense to me.  So I know from the get go that I have to watch what I eat.

OOH the drain hurts like hell. It feels like someone is pumping you with air as they are pulling out. I did not feel the drain move but I did feel air or gas. That has been the worst experience I think.

I went to a 4th of July BBQ today and had Jello and some frozen Popsicles that was lunch and dinner. The whole table was filled with food an none of it was attractive to me. It was pretty looking but I did not want any.

Bariatric patients may be more likely to fracture hands or feet, study says

Updated 3:41 p.m. ET, Mon., June 15, 2009 WASHINGTON - It isn't just the thunder thighs that shrink after obesity surgery. Melting fat somehow thins bones, too.
Doctors don't yet know how likely patients' bones are to thin enough to break in the years after surgery. But one of the first attempts to tell suggests they might have twice the average person's risk, and be even more likely to break a hand or foot.

The Mayo Clinic's finding is surprising, and further research is under way to see if the link is real. But with bariatric surgery booming and even teenagers in their key bone-building years increasingly trying it, specialists say uncovering long-term side effects and how to counter them takes on new urgency.

Simply popping today's doses of calcium supplements may not be enough.

"These procedures are now being sold as a panacea," Dr. Shonni Joy Silverberg of Columbia University told last week's annual meeting of The Endocrine Society, where the fat-and-bone relationship took center stage. "It is of heightened importance to find the answers to these questions."

Obesity actually protects bones
Here's the irony: Obesity actually is considered protective against bone-weakening osteoporosis, possibly the only positive thing you'll ever hear a doctor say about too much fat.

"They're starting better than most of us," cautions Mayo bone-metabolism expert Dr. Jackie Clowes. So the big question is whether they really end up with worse bones, or just go through a transition period as their bones adjust to their new body size.

About 15 million Americans are classified as extremely obese, 100 pounds or more overweight. Dieting alone doesn't make enough of a dent to fend off rampant diabetes and other health problems, so surgery is fast becoming the preferred treatment — from the stomach stapling called gastric bypass to less invasive stomach banding. Patients tend to lose between 15 percent and 25 percent of their original weight, and diabetes dramatically improves.

More than 1.2 million U.S. patients have undergone the surgery in the past decade, 220,000 in the last year alone, according to the American Society for Metabolic and Bariatric Surgery.

There's little data on how patients fare many years later; large National Institutes of Health studies, on both adults and teens, are under way.

But doctors have long noted that the radical weight loss can speed bone turnover until the breakdown of old bone outpaces the formation of new bone. Silverberg cites recent studies showing that a year after gastric bypass, adults' hip density drops as much as 10 percent, raising concern about a common fracture site of old age. (Stomach banding causes less thinning because it doesn't alter nutrient absorption as much.)

Adolescents at greater risk
No one knows if teen bones react similarly, but it's an important issue because almost half of peak bone mass develops during adolescence.

To see if such changes translate into fractures, the Mayo team is comparing the medical records of nearly 300 adults who've had bariatric surgery with similarly aged Minnesotans who haven't.

A quarter of the 142 surgery recipients studied so far experienced at least one fracture in the following years, Mayo's Dr. Elizabeth Haglind told the endocrinology meeting. Six years post-surgery, that group had twice the average risk. But in a puzzling finding, the surgery recipients had even more hand and foot fractures than their Minnesota neighbors, three times the risk.

Those fractures aren't usually connected to osteoporosis. Did the once-obese merely start exercising and just fall down more? Clowes doubts it.

"I was shocked" at the numbers, says Dr. Scott Shikora, president of the bariatric surgeons group, who says he hasn't seen a significant fracture problem in his own practice.

 

 

Surgeons routinely tell patients to take some extra calcium and vitamin D. Shikora estimates about half follow that advice, and other research suggests higher doses may be needed anyway as the obese tend to start out deficient in vitamin D.

A key next step will be to compare the patients who fracture with people of the same weight to see if their bone mass just had to adjust — or if something about surgery alters the complex soup of hormones and other factors that keep bones strong, thus requiring more than extra calcium.

Clowes' advice for now: Don't skip checkups, where doctors monitor bone health, and aggressively treat nutrient deficiencies.

Moral of the story be resposible. I know of someone that does not take their vitamins and drinks her shakes. I would be petrefied something happend.

Jan 5, 2009

Bariatric Surgery: Beware

by Nicholas Yphantides, MD, MPH  

Bariatric (weight-loss) surgery has recently been touted not just as a way to shed pounds, but also as a potential treatment for Type 2 diabetes. In this excerpt from his book, My Big Fat Greek Diet: How a 467-Pound Physician Hit His Ideal Weight and How You Can Too, Dr. Nicholas Yphantides explains why he believes you should think twice before going under the knife.

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My heart always goes out to the morbidly obese patients I see who are hospitalized for complications related to their unhealthy condition: severe diabetes, heart failure, and crippling joint disease, to name a few. Inevitably, I pull up a chair and visit with these hurting folks. When I sense they need a boost of encouragement, I reach into my Day-Timer and show them a picture of me wedged into a seat at a San Diego Padres game.

“Do you recognize that person?” I ask.

“No, who’s he?” is the response I generally hear. That’s probably because I had curly, shoulder-length hair atop a torso brimming with 467 pounds.

“That was me seven years ago,” I say.

The responses range from “No way!” to “You’re joking,” to “I don’t believe you.” After the initial shock passes, they always say, “How did the surgery go?”

How did my surgery go?

The supposition that I could only shed so much weight by having a gastric bypass operation (or what the media often calls “stomach stapling”) is largely based on the waves of publicity given to celebrities who have had the surgery and experienced dramatic weight loss. The number of bypass operations has exploded recently, from 23,100 in 1997 to more than 100,000 in 2003, according to the American Society for Metabolic and Bariatric Surgery — nearly a fourfold increase in just six years.

I did not have surgery to lose weight — I did it the old-fashioned way, through diet and exercise. I can only be happy that this operation has helped hundreds of thousands of people regain some normalcy in their lives. My joy is tempered, however, by the serious health risks associated with this surgery, and these risks should be carefully considered before altering one of the most delicate areas of the body, the digestive system.

Gastric bypass promotes weight loss by surgically restricting food intake and/or interrupting the normal digestive process. Surgeons staple the stomach, or bind it with an adjustable band, to create a small pouch that holds 2 or 3 ounces of food. A normal adult stomach can hold 3 pints of food, or around 24 ounces — the surgery reduces the stomach to one-tenth the size it used to be. It doesn’t take a brain surgeon to figure out that you’re going to feel full very quickly. Eat any more, and you become nauseous.

The surgery is generally reserved for morbidly obese individuals who have made numerous, unsuccessful attempts at losing weight through traditional methods: going on diets, changing eating patterns, working with nutritionists, and increasing physical activity. It’s supposed to be the treatment of last resort, but that’s not how it’s being marketed to — or perceived by — the public. I’ve heard of surgeons promoting gastric bypass surgery for people with only 40 or 50 pounds to lose. That’s not a healthy or appropriate choice for these patients.

The surgery is not cheap. You had better have good health insurance, because the procedure costs around $25,000, and complications, if they occur, will drive up the price even further. Many health plans do not cover the full amount; you could be responsible for up to 20%, or $2,000-$5,000 in out-of-pocket expenses. If you’re poor or uninsured, like most of my patients are, you can forget about gastric bypass surgery. In many states, the overburdened public health system doesn’t pay for this sort of procedure. Medi-Cal patients in my state face a 12-year wait. (Medi-Cal is California’s Medicaid program.)

What many people considering gastric bypass don’t know is that you get a “free ride” only for the first year. In other words, it takes your body about a year to recover from the surgery and to get used to the limitations imposed by the surgeon’s knife. Initially, the weight drops off effortlessly, but after a while your body compensates for the changes in your anatomy — suddenly, you stop losing weight. If you fail to practice the good eating and exercise habits that are the basis of every weight-loss regimen, you will regain some of the lost weight. The only way to lose weight and keep it off is to take in fewer calories than you expend. There are no shortcuts to successful weight management!

Up to 20% of all gastric bypass patients need follow-up surgery to correct a complication such as breakdown of the band, a hernia in the abdominal wall, or a stretched-out pouch. Fortunately, as surgical techniques have improved, adverse side effects are becoming less common — but the risk is not gone. Some potential side effects are the following:

Death. The chances of dying from the surgery are rather high in my book, at around 1 in 200. The risk of dying is dependent on factors such as the kind of surgery and the patient’s medical condition at the time of surgery. There have also been cases of patients dying after binge-eating and rupturing their staples.

Nutrient deficiency. Since food bypasses certain key parts of the small intestine, absorption of essential nutrients is interfered with. Nutrient deficiencies can lead to anemia, osteoporosis, and other bone diseases.

Dumping syndrome. This involves rapid emptying of the stomach’s contents into the intestines, potentially causing nausea, cramps, weakness, sweating, and lightheadedness. Oh, and don’t forget explosive diarrhea.

I’ve met and corresponded with too many people who could not stop overeating despite having a stomach the size of an egg. One woman melted chocolate bars in her microwave and sipped liquefied chocolate all day. Others puréed food that isn’t meant to be puréed: Krispy Kremes, Twinkies, birthday cake. Another woman confessed to me that she ground up pistachio nuts and ate them all afternoon. Although these folks couldn’t eat very much at a time, they were constantly grazing. In each case they regained all the weight they had lost.

I understand why people are willing to have the surgery despite these risks — weight loss can dramatically improve quality of life. Nonetheless, I must say that I’m concerned about all the momentum building in favor of surgical intervention. I may be a voice in the wilderness, but I am a visible reminder that dramatic change is possible without surgery. Sure, I know that the chips are stacked against us, that 90% of people who lose weight put it right back on. But obesity is a complicated issue with no easy answers, and stomach stapling should be a last-resort option. Even for those who have the surgery, it still comes down to eating the right foods in the right way.

Dr. Yphantides (”Dr. Nick”) is the appointed cochair of the San Diego County Childhood Obesity Task Force. His Web site is www.healthsteward.com.

Jun 15, 2009

The Case for Bariatric Surgery

Interview with Dr. Michael Bilof  

Earlier this year, we featured a guest post by Dr. Nicholas Yphantides, a family physician who underwent dramatic weight loss, that was highly critical of bariatric (weight-loss) surgery. This surgery has recently been touted not just as a way to shed pounds, but also as a potential remedy for Type 2 diabetes. For a different perspective, Diabetes Self-Management’s Quinn Phillips interviewed bariatric surgeon Dr. Michael Bilof.

Quinn Phillips: What led you to become a bariatric surgeon?

Michael Bilof: I used to do vascular surgery; I’m a board-certified vascular surgeon. About five years ago, I left my vascular practice and started doing bariatrics. The reason I switched was that most diabetics have, if they’re diabetic long enough, some sort of vascular problems — either in their eyes or their kidneys or their peripheral circulation — and end up needing the services of a vascular surgeon, either for extremity bypass, for dialysis access, or if it really gets bad, for amputation. And it was not the most satisfying practice for me. The analogy I always use is, it’s like closing the barn door after the cow got out. By the time they got to me, my job was not so much to reverse the process but simply to slow the rate of decline. Personally, that’s not what I got into medicine for. Bariatrics gave me a chance to close the barn door before the cow got out, to see patients 20 years before they would end up seeing a vascular surgeon.

QP: What proportion of your patients have diabetes?

MB: I’d say it’s anywhere from a third to 40%. I make an effort to attract diabetic patients.

QP: What procedures do you perform?

MB: I do two types: gastric bypass, which is sort of becoming the gold standard for bariatric procedures, and gastric banding.

QP: How successful is gastric bypass in reversing Type 2 diabetes?

MB: The best published data shows resolution in around 85% of Type 2 diabetics. That’s been a pretty consistent number in different studies. My own practice is pretty similar; it’s about 85% to 90%. And it’s basically a function of how long the patient has been diabetic and whether they’re taking insulin. Patients who have gastric bypass soon after diagnosis have virtually a 100% resolution rate because their bodies are actually making more insulin than they need. So once blood sugar comes down, the pancreas resumes making normal amounts of insulin and their diabetes resolves very quickly — possibly within days or weeks. Whereas for someone who’s been diabetic for five, eight, ten years and is taking 15 units of insulin three times a day, the resolution rate isn’t as good because their body isn’t making as much insulin. Improvement can take months, and they may not resolve their diabetes, but almost all of them get off insulin. When I say resolution, by the way, I mean no medications, normal fasting blood sugar, and an HbA1c level under 6% — biochemically not diabetic.

QP: How much do we know about the mechanism through which gastric bypass does that?

MB: Whoever figures that out goes to Stockholm and picks up their prize. There’s a lot of research going on; my practice is involved with a study looking at something called GLP-1 levels. Other hormone levels are affected too, even independent of weight loss. It’s got to be something hormonal, resulting from diverting food from the stomach and the first portion of the intestines. Because as I’ve witnessed many times in my practice, even before bypass patients lose significant weight, their blood sugar is better. If you compare bands and bypasses, bands actually have a fair amount of diabetes resolution as well — but it only occurs as a result of weight loss.

QP: Have most of your patients been encouraged to lose weight the “regular way” before signing up for surgery? Do you have weight requirements for the surgery?

MB: The vast majority, 80% or 90%, have tried many, many different things. The most common history I get is a patient who’s been overweight their whole life. You need to be at least about 100 pounds overweight to qualify for bariatric surgery, a little less for diabetics. We don’t actually go by weight; we go by body-mass index. For diabetics, a BMI of 35 or higher would qualify you for bariatric surgery; if you’re not diabetic, then it would be a BMI over 40.

QP: How do people pay for the surgery?

MB: The vast majority are covered by insurance. Most are what you’d describe as lower-middle class, typically people who have union jobs with very good benefits, or the relatives of such people.

QP: What complications have you seen in your bypass patients, and how common are they?

MB: There are two categories of risk: immediate and long-term. The most common and dangerous immediate complication is what’s called a leak, which is a life-threatening complication. I’ve had two out of about 600 operations. Probably 50% of deaths after gastric bypass are the result of a leak. I’ve heard numbers like 1% for leak complications, which seems very high to me. I suspect that includes surgeons who don’t do bariatric surgery exclusively. Any surgery has a learning curve, and proficiency increases with the number of cases.

The next most common immediate complication is a pulmonary embolism, or a blood clot that goes to the lungs. And the next most common, which is not that common, would be cardiovascular events, heart attacks and strokes. In my five-and-a-half years of doing bariatric surgery, I’ve only had one postoperative heart attack. That patient was diabetic and had a pretty well known history of coronary artery disease, but had a normal stress test preoperatively. He did fine; it was a minor heart attack.

In terms of long-term complications, there are obviously concerns about malnutrition, which is exceedingly rare — 1% maybe. If a patient is following up, we get blood levels of vitamins and proteins, so if it is happening we can get on it quickly. Ulcers and hernias can also happen, but they’re pretty rare with the laparoscopic form of the surgery. I do laparoscopic procedures exclusively. But I think nationwide a fair number of the procedures are still open surgery, in which the hernia rate is around 50%.

QP: What about dumping syndrome and diarrhea?

MB: Well, dumping syndrome I wouldn’t describe as a complication. That’s a well-known side effect of the surgery; in my opinion, it’s one of the reasons the surgery works so well. It typically will only occur if patients are eating concentrated sweets or concentrated fats, and if you’re morbidly obese you shouldn’t eat those foods. So it sort of forces patients to eat healthier foods.

In terms of change in bowel habits, actually constipation is the most common pattern we see after surgery — mostly because patients aren’t eating as much and they’re somewhat prone to being dehydrated because their stomach is so small. That tendency usually goes away within a month or two.

QP: Do some patients regain significant weight?

MB: Yes; the published number is about 10%. The procedure has about a 90% success rate at ten years, with success defined as losing about 80% of your excess body weight. For diet, exercise, and medication, the published success rate for weight loss is about 10%. Now, a surgical procedure should have a higher success rate than something noninvasive. But compare the two.

What I would say in closing is that people may focus on the risk of the surgery — and that’s appropriate for a surgical procedure — but I always say, what’s the risk of being a diabetic for ten years? Diabetes is the leading cause of blindness, limb loss, and renal failure in this country. I used to deal with dialysis patients, and I’ve never seen an unhappier group of people.

If tomorrow Merck came out with a pill that could resolve 90% of Type 2 diabetes, it would be on the front page of every newspaper in this country. Gastric bypass does that. Not only do a lot of people not know that, but we have to fight a battle to convince people to have it done. I think one reason for this is that people don’t get a lot of symptoms from diabetes — until they do. And then once they do, it’s sort of too late. Once the nerve damage occurs, once the vascular damage occurs, the cow is out of the barn.

Dr. Bilof is the surgeon at Garden State Bariatrics and Wellness Center in Millburn, New Jersey. To read more about the types of surgery he performs, visit www.gsbwc.com

I got an email yesterday from my doctors office saying that they were still waiting for payment. I had sent my payment to then on June 6th. I about died in the middle of my lunch break. I had had issues with getting the rest of the funding and I was stressed about that. I resolved that rather quickly and I thought everything was set to go.

Now I get the email. Completely freaking out went looking for my payment transfers, send them over to Mexico, called administrator and I cannot reach them.  Now I am thinking that the account I sent it to was not my doctor, I just lost $5400 you can imagine the rest.

Well I got an email later yesterday saying that it was an oversight on their part. It looks like two people worked on the account and the other did not write notes on account or something. Everything is fixed. 

I really like the doctor I choose but sometimes they don't pick up the phone. This leads me to think that they are short staff, small office or they are open only certain hours.  This does not however lead me to think that the doctor is incompetent.

How do I change my BMI? I have been looking for this for the past hour or so.

I went to the diabetic nurse yesterday to check things. Well A1C was decent. 8.1 not perfect but better after the stent was put in. the bad news I almost passed out when I saw this weight 201.4 pounds.  I should be loosing weight and I freaking gained 10 pounds WTF???

My so called liquid diet consist of fish at the moment. Have not been able to do liquid diet it is so freaking hard running around. No excuse. I have a surgery twin whom I told I would start the liquid diet with. I have failed. I have liquid for breakfast and lunch then dinner I want, die for fish tacos. I eat the fish and the cabbage no tortilla.

I have to stick to liquid diet!!!!!!

I am getting excited that in 3 Mondays from today I will be in Tijuana getting my VSG. My journey has been really short compared to most.  I am self pay but it felt like an eternity just waiting to get approved from my doctors because of my health issues.

I cannot imagine how some of you felt when doctor's lost information and when you had wait six months for nutrition programs.

For those of us that want WLS, are getting the surgey or have have gotten the surgery I believe that we are very lucky that we are able to get such a procedure that is able to get us to a healthier life. On that note to all the all the beautiful women of OH here is a little morning humor.

So I finally got my 3K. I was beginning to think that I was not going to get the surgery in 2 weeks.
Now I am getting excited. 

I found out today that the doctor in Nicaragua that operated my cousin and who was looking at my case did not feel he could do the job. He never answered the rest of my questions and I just assumed that he was not interested. My cousin went to see for her regular check up and she told him that I was going to Mexico. He said that it was better that I get operated there because my case was very delicate and that Mexico had excellent facilites, he was trainned in Mexico. After this comment from the doctor I feel very comfortable with my choice to go to Mexico.

One thing I am nerveous about is coming back in the plane. I live in the D.C. area and I am going cross crountry then South. I hope that I don't get or have horrible pain. I would think this would suck.