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Q. Hi Dr. C,
First thank you for taking your time out. I was banded on 11/18/08, and lost 14 lbs about 10 days after. Since then I have been gaining. I pretty much follow the 60 60 60 rule, eating way less than I did before surgery and I am gaining. It?s still a struggle to keep the weight off. I do suffer from PCOS/Insulin Resistance and I was on meds for that. But since losing weight on my own, I was taken off of the meds and had to completely stay away from any kind of carbs. Realizing I couldn?t lose any more weight on my own, I decided to have the LapBand. Is it common to gain weight after you lose the water weight and before your first fill or is it my insulin resistance creeping up on me again? When questioning my Dr. about my insulin resistance and having me retested (GTT) he just looked at me funny. I know many Dr.?s don?t quite understand this, but he told me that is not the problem. The Dr. that treated me for my insulin resistance is my GYN Dr. and he doesn?t want to touch me with a 10 ft pole. Any suggestions for me? And once again, is it common to gain weight? I am feeling a bit discouraged here...Thank you! -tonirose25
A. I have seen this allot - usually it takes a few fills especially in PCOS patients to get some weight loss going. It is my impression that PCOS patients have to exercise more as well, to keep the scale moving. That would probably be my main recommendation. The take home here is that it takes some work to get the weight off, but you already know that!
Good luck!
Trace Curry, MD
Bariatric Surgeon
http://www.TheBandDoctor.com
Did you know?
In his spare time, Dr. Trace Curry plays the mandolin and fiddle in an Ohio bluegrass band called The Grasstains, giving his moniker ?The Band Doctor? a dual meaning! Dr. Curry is a regular contributor to the ObesityHelp LapBand Forum and has been readily available to answer member questions and answers. Click on the link below and look for the "Ask Dr. Curry" post: http://www.obesityhelp.com/forums/LapBand/
Q. Hello, I had gastric by pass in 04. I never did obtain my goal but was happy with the weight I did lose. About a year into it, I had pain on the left side under my breast bone but it came and went so I thought nothing of it. Then one year ago, I awoke one night in tremendous pain in the same left side area. My husband rushed me to the hospital and I had a perforated stomach. I had to have emergency surgery by a general surgeon. He said the perforation was next to the stoma. Well, I have gained about 35 lbs this past year and I am wondering if there may have been a malfunction. I now also have several abdominal hernias that I was looking into getting repaired but now I am thinking that maybe I should see a bariatric surgeon to see if maybe there was failure. Could there have been one with my history? -Elizabeth
A. Dear Elizabeth,
From what you are describing you had a perforated marginal ulcer. A marginal ulcer is an ulcer that is just distal to the connection between the small gastric pouch and the connection to the small intestines. It is thought that patients who have a larger gastric pouch produce more acid which can lead to a marginal ulcer. Marginal ulcers can cause bleeding, pain, nausea, and perforate. You would need to get a copy of your operative report to see what was done by the general surgeon. Most surgeons would usually just patch the ulcer with a piece of abdominal fat but maybe he revised your gastrojejunostomy (connection between stomach pouch and small intestine) and made it too big. I would definitely recommend that you see your bariatric surgeon and bring copies of your operative report. Once you develop a marginal ulcer you should be placed on a proton pump inhibitor medication like Nexium or Protonix for the rest of your life to prevent a recurrence and have an endoscopy as some point. There are many reasons for weight gain after gastric bypass surgery. If your stomach pouch was only stapled and not divided by your original surgeon there is about a 50% failure rate of the staple lines. Other problems include the gastric pouch can stretch out and get larger and the connection between the stomach pouch and small intestine can get larger so that the stomach pouch empties faster. There are two new endoluminal procedures to correct these problems; the Stomaphyx and the ROSE procedure. These are done completely through the mouth with no incisions and no recovery. I definitely recommend following up with your bariatric surgeon life long to address your needs.
Shawn Garber, MD, FACS
Bariatric Surgeon
http://www.stopobesityforlife.com
Did you know?
Dr. Shawn Garber has performed more than 2500 laparoscopic gastric bypass procedures and 800 LapBand procedures. He has been featured on ABC news, NBC news, NY55 news and featured in the New York Times as the premiere bariatric surgeon on Long Island. He was been on many talk shows discussing obesity surgery, including Montel Williams with Carnie Wilson. Dr. Garber is on the medical editorial board of ObesityHelp.com.
January 2009