Ask the Expert: With Dr. Mitchell Roslin

June 26, 2013

Bariatric surgeon Dr. Mitchell Roslin answers the questions that are important to you. Do you have a question you would like to ask of a plastic surgeon, bariatric surgeon, fitness expert, dietician, psychologist, or other bariatric professional? Send your questions to [email protected].

Deb. O:  I had RNY in August of 2008.  No complications at all, all these years, and a few months ago I started getting heartburn regularly. I take OTC Zantac for heartburn one in the morning and one in the evening and then it's OK.  Is that OK that I do that?  I have not seen the doctor that did my surgery in 3 years. I moved out of state and have not found a new one yet.

Dr. Mitchell Roslin: ObesityHelp is a wonderful resource, but not a substitute for quality follow up.  Blood levels need to be take to make sure your micronutrients are replete.  A recent change in symptoms also means that an investigation of the anatomy is in order.  RYGB is used to treat reflux, as the pouch is constructed above the area where acid is usually produced.  Thus new onset reflux could be indicative of an enlarging pouch, marginal ulcer, or even gastric fistula.  It also could be none of these things.  If you cannot find a bariatric surgeon, any capable primary care doctor in combination with gastroenterologist should be able to provide the care you need.  But, you need care from a physician, not online.

Melinda G.:  As part of my 'healthy movement" my PCP has recommended I have a routine colonoscopy.  The prep is my problem.  The Colon Doc wants me to drink 64 oz of Gatorade with a laxative in it.  64 oz of a sugary drink?  Who is he kidding?  I can't drink 64 Oz's of water and all that sugar would make me sick.  Any suggestions?

Dr. Mitchell Roslin: You need to speak to your doctor, but a good prep is important for a good result.  There are now a variety of 1 liter preps, such as MoviPrep, that can be used.  In 20 years of practice, we have had no difficulty getting colonoscopies for our patients.  Also, there is the standard GoLytely and Pedialyte and numerous other supplements.  Additionally, typically RYGB patients require less volume to clear out.  Finally, with lap-band and plication, you just need to take it slower.  Your pyloric valve is intact and you should not be as sensitive to sugar as a gastric bypass patient.

Betty O.: Ten years ago I has a gastric bypass surgery. As a result I lost ninety pounds. The last few years have been a struggle with diet and exercise. I am about sixty five to seventy pounds still down. At present my weight is 210 on a 5'4" frame. I wonder what the best surgical options to consider.

Dr. Mitchell Roslin: Weight regain is common and I believe under reported following gastric  bypass.  I believe that what happens is that the bypass circuit empties rapidly and people get very hungry shortly after eating.  This is exaggerated with simple carbohydrates.  The problem is there is no great solution. The first step is avoid simple carbs and to go on a low glycemic index diet.  Endoscopic suturing works for as long as you are on the post procedure diet.  Banding the bypass works similarly to primary band.  Meaning it works for about half of the patients and it does seem to prevent further weight regain but has all the long-term issues of a band.  Converting to duodenal switch works real well if done well, but this is very complex operation and probably not needed with a BMI of around 38.  People are investigating doing a sleeve on the jejunum, but you really have to have the right anatomy to try this experimental option.  Meaning an ante-colic laparoscopic bypass.

 Do you have a question to Ask The Expert?  Email us at [email protected]!

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