A Member’s Perspective

We recently lost a friend and long time OH member to a condition known as “intestinal blockage.” Her loss is absolutely heartbreaking for the many OH members who knew her. However, her tragic situation also presents us with an opportunity to become better informed about a risk that any of us can face—a risk that doesn’t always have to have such a tragic outcome. I know it was a wake-up call for me, because I have spent time in the emergency room with severe abdominal pain, cramping and vomiting. My diagnosis was simply gas. If there is a next time, I will be more vocal and more insistent about my treatment.

The definition of intestinal blockage is an obstruction of the small or large intestine. It may occur after weight loss surgery. We need to be aware of the symptoms, and we certainly need to be proactive in the emergency room. According the Merck website, 85% of partial small bowel obstructions will be resolved without surgery, but 85% of complete small bowel obstruction will require surgery to repair. We need to know what it is and what causes it and we must take a proactive stand if we suspect we have it.

The onset symptoms of a blockage are cramping, vomiting, and constipation, the inability to pass gas, abdominal distention and tenderness. The most common causes of small intestine obstruction are adhesions, hernias and tumors, but also may include intussusception, volvulus and stricture. Common causes of obstruction of the colon are cancer, diverticulitis and volvulus but may also include intussusception, impacted feces, and stricture. It is important to understand these causes and to recognize the symptoms. If strangulation occurs, the blood supply to the intestine is cut off and gangrene may occur in as little as 6 hours. If the bowel ruptures, peritonitis will result.

Adhesions are scar tissue bands that may bind organs together and may be the result of any abdominal surgery. Intussusception is when the intestine or colon folds in on itself like an accordion. Volvulus is a twisting of the bowel and a stricture is the narrowing of the outlet to the stomach or a narrowing of the colon. With so many OH posts about constipation, this should be a concern for those who suffer from it since constipation may also cause it.

What should you do if you have abdominal pain? Go to the Emergency Room, immediately. You must make it clear that you have had gastric bypass and that you suspect intestinal blockage. Demand x-rays. CT scans and MRI often do not show a blockage. X-ray is the best way to show the location of a blockage and air around the intestine which may indicate rupture.

If you would like to read more about intestinal blockage, here are two trusted websites with excellent information.

http://www.mayoclinic.com/health/intestinal-obstruction/DS00823

http://www.merck.com/mmhe/sec09/ch132/ch132g.html#sec09-ch132-ch132g-1050

- Charlotte Carlile (http://www.obesityhelp.com/member/charlie/)

A Surgeon’s Perspective

Small bowel obstruction can happen after any operation. Some obstructions resolve without surgery – but determining whether it is likely to resolve without intervention is a surgeon's call, based on their judgment and experience. It would not be in the patient's best interest to have every bowel obstruction taken back to the operating room, and would lead to many unnecessary operations. Complete or partial bowel obstructions cannot always be judged by any given x-ray, CT scan, or other test. More than a test, it would be important to have a surgeon examine the patient, and make a determination.

Some patients have warning signs: they get partial obstructions periodically, get better, and are fine for a period of time. If you are having these symptoms, talk to your weight loss surgeon about the symptoms: when they occur, how long they last, whether the pain is constant, or whether it is colicky. Note what things you have eaten before you get the pain; is it vegetables, is it dairy products, is it anything with gluten in it? Also tell the surgeon whether food helped the pain, or made it worse. Let the surgeon know if you have had nausea and vomiting with the pain, whether you had diarrhea, and whether you developed a temperature. Learn how to take your own vitals—your pulse, your temperature—even your blood pressure. Clearly, you should not try to diagnose yourself, but learning all you can to present a coherent picture to your surgeon will be helpful. Some may have lactose intolerance, which can be very painful, or gluten intolerance, or be developing gallbladder disease, or a partial obstruction. If you have a number of these episodes your surgeon may want to take you to the operating room when you are feeling okay, just to explore you and see if there are any adhesions; we would much rather take care of the problem in an elective manner, when you are well and healthy, than when you are very ill in an emergency room.

Small bowel obstructions leading to death of the small bowel and, ultimately, to the death of the patient happen far too often. Weight loss surgeons are very familiar with this, and take weight loss patients back to the operating room much faster than other surgeons might. CT scans can and do show blockages, and are helpful—but it is going to the operating room that is far more helpful than any particular scan. It must be remembered, however, that even if a surgeon is notified, and takes a patient back as soon as possible, some patients may die.

The bottom line: if you are in pain, go to the emergency room where you had your surgery, or notify your surgeon and find out where he or she would like you to go. If you are in a strange city and are having pain, it is best to go to a hospital where they have weight loss surgeons on staff.

-Terry Simpson, MD, FACS

Terry Simpson, MD, FACS, is medical editor for ObesityHelp and has been doing weight loss surgery since 1991. He has written several books about weight loss surgery, including Weight Loss Surgery: A Lighter Look at a Heavy Subject. His second edition of The Road Kill Diet: Recipes from the Journey of Alaska to Arizona will be published shortly by Amazon.

http://www.obesityhelp.com/morbidobesity/bariatric+surgeon+profile+Terry+Simpson+fnd.html

By Michelle May, M.D.

Do you allow a number on your bathroom scale to make or break your day? Wouldn’t it be absurd to let the temperature, the date or the Dow-Jones determine how you feel about yourself or how your day will go? They’re all just numbers but for some, weight has the power to change a mood and ruin a morning.

The scale does not measure your self-worth. It simply measures the weight of your tissues (including your bones, muscle and fat) and substances that are just passing through (like water, food and waste). Your weight can fluctuate dramatically depending on time of day, hormones, when you last ate and other factors – none of which have anything to do with your value as a person.

Weight a Minute

When you’re losing weight gradually (clearly the best way), you may not see significant changes in your weight day to day, and perhaps even some weeks. Further, when you exercise you’ll build muscle and lose fat so although the numbers might not change, your body composition is improving. If you’re depending on a needle on a scale to tell you how you’re doing, you may feel discouraged and tempted to give up even though great things are going on inside.

Weighed Down

Have you ever said to yourself…

• I did so well this week. I deserve a treat!
• I was so good but I didn’t lose any weight. I might as well eat.
• I don’t have to weigh in until next week so I’ll splurge now and make up for it later.
• I was terrible this week and I still lost weight. I guess I don’t need to be as careful.
• I only lost a half a pound. It wasn’t worth it.

These thoughts are counter-productive to weight management. Further, although it can be motivating, losing weight can also be scary. Maybe a part of you doesn’t believe you deserve it or that you’ll gain it back so you sabotage yourself.

Weigh to Go

Some people weigh because they want to be held accountable. Accountable to a metal rectangle on the floor and a three digit number?
The goal is long term weight management without restrictive dieting – not answering to a judge and jury. Focus on the process not the outcome.

Why Weight?

Your weight is a surrogate measurement of your body fat so it’s helpful for monitoring long term changes. Newer body fat scales are helpful but are only useful over time.

Your weight can also be used to calculate your Body Mass Index (BMI) which is a measure of your weight in relation to your height. (Caution: BMI can be misleading in highly muscled individuals.) Check the easy BMI calculator at http://www.nhlbisupport.com/bmi/. BMI can help you and your health professional assess your risk for common conditions associated with excess weight. Even though BMI is widely used these days, it is only one piece of information.

Weight Around

Your waist circumference is another number your doctor might want to measure. A waist circumference over 40 inches for men and 35 inches for women is associated with metabolic syndrome and may increase your risk for certain diseases including diabetes and heart disease.

Take the Weight Off Your Shoulders

• Be honest about how the numbers affect you. If knowing your weight tends to backfire, put your scale under the sink or out in the garage.
• Decide how often you need to weigh yourself. Some people prefer to be weighed only when they go to the doctor but for most people once a week or even once a month is a good.
• You never need to weigh yourself more than once a day; if you do, you’re playing games by measuring meaningless physiological fluctuations.
• Let go of old benchmarks. You may never again reach your wrestling or wedding day weight but you can live an active lifestyle and make conscious choices that will serve you now.
• Don’t weigh yourself to confirm what you already know. When you’ve been mindful of your choices, don’t take a chance that the scale will give you an answer you didn’t expect and derail your confidence.
• Don’t use the scale to punish yourself. When you know you’re off track, focus on the changes you’ll make rather than beating yourself up.

No Weigh

A man I met at a conference recently said, “I don’t need a scale; I have pants.” I smiled at the simplicity and accuracy of his method of monitoring himself. A few ounces won’t make a difference but a few pounds will determine how comfortable he feels. Look for other ways to assess your health and progress too:

• Resting heart rate, blood pressure, cholesterol or fasting blood sugar
• Minutes of walking, steps on your pedometer or pounds of weight you’re able to lift
• How do you feel? Tune in to your energy level, mood and stamina

Weigh Your Options

A scale is an external device that doesn’t accurately measure what’s going on inside your body or your head. If you’re been consumed by the numbers, skip the scale for awhile, set new goals – and remember, meaningful change can only take place from the inside out.

Michelle May, M.D. is a recovered yoyo dieter and the award-winning author of Am I Hungry? What to Do When Diets Don’t Work. Find additional articles and resources at http://AmIHungry.com/.

Copyright Michelle May MD. Reprinted with permission.

Your BMI and Weight Loss Surgery Success - What New Research Suggests

In his research at the University of Texas-Houston Medical Center, Brad Snyder, MD, reviews data on weight loss surgery outcomes every day. When he wanted to isolate the factors leading to success or failure after bariatric surgery, the data led him to an intriguing conclusion. Dr. Snyder recently shared his findings about starting BMIs with ObesityHelp.

What sparked your interest in considering starting BMIs in weight loss surgery outcomes, and what did your research uncover?

I wanted to define what might predict a person’s outcome after weight loss surgery. When I looked at the gastric banding patients, one significant difference between those who failed and those who succeeded was their starting BMI. The people who failed to lose more than 15 percent of their excess weight had an average BMI of 49. The people who lost more than 30 percent of their excessive weight at a year out had an average BMI of about 43.

I looked at about 600 gastric band patients a year out from surgery. I stratified their BMIs, charting patients with BMIs in the 30s, the 40s and the 50s while noting their excessive weight loss over a year. It was very clear that people with a BMI of 30 lost considerably more weight over that year than people with BMIs in the 50s.....read more here.

Not a member of ObesityHelp yet? Get access to all of ObesityHelp's great features by joining today!

You are not the number on your bathroom scale. Yet for too many people, this number or judgments surrounding this number can cause pain and inner conflict. Letting go of judgments during the weight loss process can release you from this internal battle and bring you more peace. This, in turn, enables you to choose proper foods and exercise with greater ease. Now that’s a new thought: peaceful weight loss!

Click HERE for a short, relaxing video clip to help you focus on peace.

Denna Shelton, cPT, inspries others in the field of health and fitness, focusing on wellness in body, mind and spirit. For more information, visit www.twentygems.com. 

By Michelle May, M.D.

Diets are filled with dogma about when, what and how much to eat. Certainly “the rules” are usually based on observations that make sense, but unless you understand why you do certain things, you’ll break the rules as soon as the temptation is greater than your motivation.

Let’s examine some of these myths, where they come from and how to make long term changes that will work for you.

Myth: Don’t Eat After 7pm

Your metabolism doesn’t shut off at 7:01 pm so why is this rule so common? It’s based on the observation that many people who struggle with their weight overeat in the evening. Most have already eaten dinner so they aren’t snacking because they’re hungry. They snack because of boredom, television, loneliness and other triggers.

Rather than creating a rule to address those habits, ask yourself “Am I hungry?” whenever you feel like eating in the evenings. If you truly are, eat, keeping in mind that your day is winding down so you won’t need a huge meal. If you aren’t, consider why you feel like eating and come up with a better way to address that need. Ken, a man in one of my workshops, realized he was just bored so he started doing stained glass in the evenings to entertain himself. Whatever works!

Myth: Eat Small Meals Every 3 Hours

This rule is based on the fact that many thin people tend to eat frequent small meals. However, most of the thin people I know don’t check their watch to tell them it’s time to eat – they eat when their body tells them to. They eat when they’re hungry and stop when they’re satisfied. Since that tends to be a small meal, they get hungry again in a few hours.

Instead of watching the clock, begin to tune in to the physical symptoms of hunger to tell you when to eat. And remember, your stomach is only about the size of your fist so it only holds a handful of food comfortably. By learning to listen to your body’s signals, you are likely to follow a frequent small meal pattern naturally.

Myth: Don’t Let Yourself Get Hungry

This one is based on the belief that overweight people are incapable of controlling themselves when they’re hungry. In my experience with hundreds of workshop participants, once they learn to tell the difference between physical hunger and head hunger, the opposite is true.

Think about it. When you’re hungry, food tastes better and is more satisfying. My grandmother used to say, “Hunger is the best seasoning.” Besides, if you aren’t hungry when you start eating, what’s going to tell you to stop? Of course, you also need to learn to recognize hunger and make time to eat before you’re too hungry since it’s harder to make great choices when you’re starving!

Myth: Exercise More When You Cheat

I hate this one because it has caused millions of people to equate physical activity with punishment for eating. As a result, many people either hate to exercise or use exercise to earn the right to eat.

While it’s true that your weight is determined by your overall calories in versus your calories out, exercise is only part of the equation and has so many other important benefits. Instead of using exercise to pay penance, focus on how great you feel, how much more energy you have, how much better you sleep and how much healthier you’re becoming. In the long run, you are more likely to exercise because it feels good than because you’re forced to.

Myth: Follow Your Diet Six Days a Week Then You Can Have a Cheat Day

This is absurd! What if you were a harsh, overly strict parent six days a week then completely ignored your kids every Saturday? How would this approach work for your marriage or managing your employees?

It just doesn’t make sense to try to be perfect (whatever that is) Sunday through Friday while obsessing about everything you’re going to eat on your day off. Then on Saturday you overeat just because you’re allowed to so you end up feeling miserable all day. Huh? Personally, I’d rather enjoy eating the foods I love every day, mindfully and in moderation. I call this being “in charge” instead of going back and forth between being in control and out of control.

Myth: Eat X Number of Calories a Day

Does it make sense that you would need exactly the same amount of fuel every day? Aren’t there just days when you’re hungrier than others, maybe because of your activity levels or hormonal cycles?

Rather than setting yourself up to “cheat” on those hungry days and forcing yourself to eat more food than you want on your less hungry days, allow yourself the flexibility to adjust your intake based on your actual needs rather than an arbitrary number. Important: for this to work long term, you also need to learn to tell the difference between physical hunger and head hunger.

Myth: Carbs are Bad (or Fat is Bad)

This “good food-bad food” thinking makes certain foods special. As a result, you may feel deprived and think about them even more than you did before. Worse yet, healthy foods become a four-letter word.

The truth is all foods fit into a healthy diet. Since different foods have various nutritional qualities and calorie content, you can use the principles of balance, variety and moderation to guide you without trying to restrict an entire food group.

Truth: You Are In Charge

I assume the rule-makers are well-intentioned and don’t realize that they’ve created a tight rope that most people fall off sooner or later. It’s time to give yourself the flexibility to make decisions that both nourish and nurture you.

Michelle May, M.D. is a recovered yoyo dieter and the award-winning author of Am I Hungry? What to Do When Diets Don’t Work. Find additional articles and resources at http://AmIHungry.com/.

Copyright Michelle May MD. Reprinted with permission.

by Ronda Einbinder

Each day is the same for Joyce Holloway. She lies in bed in her small trailer, unable to get up to use the bathroom. Her fiancé, Ray, serves her every need. She watches life through her television set, unable to use the computer because it sits on a desk. She tells people she weighs 650 pounds, but she has no way of knowing if she actually weighs more. She has a large tumor growing on her stomach, but the doctors say they will not touch it before weight loss surgery. No surgeon she has reached has been willing to perform weight loss surgery on a woman her size.

Joyce has spent her entire 41 years in Newport, a small town in southeastern Tennessee. The only child of a mom who worked long hours and a dad who was her harshest critic, Joyce turned to food when no one was around. “I remember when I went to get my shots before entering kindergarten and they were concerned about my weight,” Joyce recalled. “At the age of five, I was weighing 100 pounds. My mom bought me Ayds, which were supposed to suppress my appetite. She said two would fill me up, but they were like caramel, so when she would lay down before her midnight shift was going to start as a nurse, I went into the kitchen and ate four or five.”

Always the largest student in class, Joyce began diet pills at an early age. “Mom has always been upset about my weight and tried to get me to take better care of myself and try not to get big but I did,” said Joyce. “It was always a problem in our home. I was a brat and an only child, so they felt sorry for me and gave me whatever I wanted. She was giving me diet pills while my dad was giving me candy bars.”

Joyce describes her parents’ marriage as dysfunctional and says her mom’s help would also hinder her. “My dad did not want children before I was born and he would pick on me. My dad’s sisters would tell him to leave me alone. They would say, ‘She is just little and she will grow out of this.’ This is really a sore spot with me because I loved my daddy and I thought maybe he didn’t love me because he talked to me the way he did, yet he would give me anything I wanted. He would compare me to my cousins, saying I wasn’t as smart or pretty as they were. He said no man would ever want me and before I got married, he said he didn’t see why my husband would want me.”

After graduating high school, Joyce walked away and never looked back. “I did not go to the graduation,” she said. “I just went straight to work at the healthcare facility because I would rather be at work than at graduation. I worked there for five months before hurting my back.”

After breaking up with her high school boyfriend of five years, 21-year-old Joyce met Gerald through a friend, and they were married. Joyce weighed 300 pounds at the time of the marriage, and she and Gerald desperately wanted a baby. “I took fertility drugs and soon they discovered I was pregnant with twins. When we made an appointment for the sonogram, they did not hear the heartbeats. They think I was five months pregnant. I was 28 years old at the time.”

Joyce says Gerald did not allow her to work and she found herself bored with no hobbies. “He was a mechanic and worked on cars, and I tried crafts but did not really get involved in anything,” she said.

What began as financial problems for the pair would ultimately end in divorce in 2003. With her weight up to 400 pounds, Joyce moved into an apartment in her mother’s apartment complex after the foreclosure of her trailer. She had been living on disability since 1996.

Some time later, Joyce went to the BBWRomance website and met an Alabama man named Ray. Ray, who is also on disability, moved to Newport, and the two set up home in a new trailer.

While she has found happiness in her relationship with Ray, fear for her health and future are constant. “No one wants to help me,” Joyce said through her tears. “I have gone to different surgeons in Tennessee. I went to the ER so many times and then was sent to the University of Tennessee in Knoxville. The surgeon that was there just lifted the sheet up and said the tumor was clearly cosmetic. After I tell doctors about the tumor, they don’t want to lay a hand on me. I haven’t been to the doctor since April 2007.”

Joyce receives regular check-ups at home by a nurse from Dr. Lawrence Mathers’s office, but that is all the medical care she has received. She feels she is running out of options, but desperately wants to begin living her new life with Ray. “We will get married after my health is taken care of,” she quietly said. She is just hoping that someone will hear her cries for help and find a way to save her.

Contact ObesityHelp at editor@obesityhelp.com.

with OH Member Charlotte Carlile

Imagine yourself sitting in a restaurant. You just finished eating spicy steamed shrimp. You feel like the Sahara Desert after a sandstorm. Your tongue feels like it is stuck to the roof of your mouth. You want to drink some water, but you know you are not supposed to drink with your meal or soon after. What do you do?

This is a dilemma we face quite often. I follow the no-drinking rule after Roux-en-Y (RNY) gastric bypass, but every now and then, I find I need to drink after a salty or spicy meal. When that happens, I take a few sips of water until that dry uncomfortable feeling abates. It usually takes no more than two small sips. Often, just crunching a small piece of ice will help. Also, drinking a glass of water about a half hour before a meal will keep thirst at bay.

During the first six to twelve months, we must sip water all day to stay hydrated, so the pouch stays full and we do not get hungry. After that, for most of us, our sense of hunger returns and the stoma relaxes. Because of this, we must work at staying full as long as possible. Having a sense of satiety is the basic premise of weight loss surgery.

Have you ever eaten something like nuts or a dense protein followed by a big gulp of water? Then all of a sudden it feels as though you have a boulder in your chest and you feel a bit green around gills? That is another reason to avoid drinking with meals. There is nothing worse than excusing yourself in a restaurant and running like a gazelle to make it to the bathroom in time.

Most of us tend to eat too fast, which leads to overeating, but, according to Terry Simpson, MD, FACS, not drinking with meals may help us to slow down. He also says that “eating and drinking forces food out of the pouch and into either the lower stomach (for the Lap-Band) or the small bowel (for the RNY),” and that it “may also cause the stoma to dilate for those with RNY,” all of which can lead to weight gain.

We will face many challenges with weight loss surgery, and not drinking with or after meals is one of the most difficult. It is important that we make every effort to follow the protocol given to us so we can be compliant and successful. As always, eat protein first, eat healthy and exercise.

Visit Charlotte’s profile at www.obesityhelp.com/member/charlie/ to learn more about her and her weight loss journey.

Check out ObesityHelp's Nutrition Forum for product reviews, informative articles and more.

PRIMARY MUSCLES INVOLVED: Middle and Lower Trapezius; Rhomboids (which are located in your back)

Beginner Level: Seated Resistance Band Row

Preparation/Setup: Wrap your resistance band around a strong and stationary object. You may also choose to use a door attachment specifically for use with resistance bands. You want the band attached at or near chest height. Where you position the band will depend on how you choose to sit (in a chair or on the floor); you may also stand if you wish. Sit in a chair or on the floor with your back straight. With the palms of your hands facing each other, grasp the handles of the resistance band. Your arms should be extended out in front of you.

Movement/Execution: In a controlled fashion, pull the handles of the resistance band toward your torso until your hands come near or in contact with your rib cage. Then, extend your arms, returning to the start position. Repeat.

Notes: If you choose to sit in a chair with a back, you may want to scoot up slightly to allow room for your elbows to move as you pull on the resistance band. Make sure to keep your back straight even though you are not against the back of the chair....Click here to learn about several different variations of The Row.

Not a member of ObesityHelp yet? Get access to all of ObesityHelp's great features by joining today!

There's a story in the Clarion-Ledger this morning about a 37-year-old woman, Ann Beauchamp, who is stuck between the proverbial rock and the hard place, and her life is in danger as a result. The complete story is here, but we have summarized some of the key points below.

While the Mississippi woman and her family and friends were saving the money to fund her WLS that wasn't going to be paid for by her insurance, she gained enough weight so that now the doctors won't operate on her. She has to lose 72 of her 572 pounds first. However, without a job, and with her 19-year-old daughter Amanda as her caregiver, Ms. Beauchamp simply doesn't have the resources she needs to pay for professional help in dropping those 72 pounds, and anyone who has struggled with weight knows how hard it can be to make it on your own -- especially when your weight limits your mobility, as 500+ pounds is certain to do.

In yet another cruel twist, Amanda reports that a doctor told her that she might as well "kiss her mama goodbye," because her mother wouldn't live until she turns 20. Her 20th birthday is coming this January.

The good news is that a Mississippi non-profit, the Mississippi Against Obesity Foundation Fitness Clinic, has agreed to work with Ms. Beauchamp. It funds its programs through donations. Perhaps the agency's help will allow her to get back to a less risky weight for surgery so that she can finally have the surgery she has struggled to find funds for since 2004 -- the surgery that may save her life.

While this article focused on the struggles of one person, that one person, Ms. Beauchamp, is far from the only one stuck in a similar situation. She's been fortunate enough to have an organization offer help, but is this a case of too little too late? What do you think? Is there a solution? What can be done, and whose responsibility is it to do it?

Many of his colleagues recognize Dr. John H. Linner as a founder of bariatric surgery—one of the two surgeons to perform the very first weight loss operation. His close circle of family and friends know that he also served our country as a Navy medical officer during WWII in both the Atlantic and Pacific theaters. In fact, Dr. Linner’s experiences during WWII were so profound and life-changing that he recently devoted nearly a decade to recounting those early experiences in a book.

A 26-year-old doctor and ship photographer aboard the LST-6 during the Normandy invasion and the AKA-103 at Okinawa, Dr. Linner made five trips across the English Channel from Portsmouth to the Normandy coast of France. “On the LST-6, a landing ship tank, our deck was converted into a hospital emergency room after all the heavy military equipment had been discharged to the beach,” Dr. Linner said. “There were three doctors including myself.....click here to read more!

Read more about Dr. Linner here.

Not a member of ObesityHelp yet? Get access to all of ObesityHelp's great features by joining today!