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Nov 11
My mother-in-law took me shopping on friday and bought my Christmas gifts, clothes from Coolwater, I went down a size , now wearing a size 12 (skin room), they fit me perfectly and I also got into some Md tops too.

Nov 04

I haven't made a new post in a while and there has been a lot going on.

My dad isn't doing so well, his health took a big turn to the worse. He is now totally bed bound and has no strength. He is fighting a huge golf ball sized pressure sore that is just as deep. The nurse came in and put a catheter in, it is making it much easier for him and my mom. My short visit went well, he had his good days and bad days. It was good to see him, even though I was shocked on how much he has gone down hill. My mom, sister and I had some pretty frank and difficult conversations. I think that they were good for all of us. Mom is starting to make finale prepreation for him as we don't know how much time he has left, which is numbered in weeks to months. I just want whats best for my dad not just whats best for me. He has been living with his disease for over 5 years and I think he is at peace with himself. My sister sent out a family email to let everyone know how dad is doing and to come to see him sooner rather then later. We had some beautiful pictures taken of my dad when I was at home. 

On the happer side, I saw some realtives that I had not seen in a year and they didn't recognize me. When they figured out who I was they said I looked fantastic.

101107

Hernia: http://www.medicinenet.com/hernia/article.htm

Here is what I found at www.mayoclinic.com

Myth #15
Muscle weighs more than fat.  

Truth:  Muscle is more dense than fat, therefore taking up LESS room.  

One pound of muscle weighs the same as one pound of fat.  Just as one pound of feathers weighs the same as one pound of bricks.  The difference is in the VOLUME.  Fat will take up A LOT more space than muscle.   
--------------------------------------------------------------

Plateaus/Stalls:

Here is some good information I found on plateaus/stalls, everyone goes though periods of stalls which are not plateaus. The body going through an ajustment period and is loosing inches. We have stalls throughout our weight loss journey, first one ususally is about 3 weeks out. Here is a great detailed artical on the subject:
www.weightwatchers.com/util/art/index_art.aspx?abnum=1&art_id=23561

Gallbladder  

http://www.sensiblehealth.com/gallbladder.html 

http://www.mamashealth.com/organs/gallbladder.asp 

http://health.ivillage.com/digestion/digallblad/topics/0,,4v25,00.html

 -------------------------------------------------------------------------------
  

http://www.mtxeconditioning.com/kettlebells/fitnessmyths.html

Signs and symptoms Dehydration:     

 

   : Here is what I found at

Mild to moderate dehydration is likely to cause:

• Dry, sticky mouth
• Sleepiness or tiredness — children are likely to be less active than usual
• Thirst
• Decreased urine output — fewer than six wet diapers a day for infants and eight hours or more without urination for older children and teens
• Few or no tears when crying
• Muscle weakness
• Headache
• Dizziness or lightheadedness

Severe dehydration, a medical emergency, can cause:

• Extreme thirst
• Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
• Very dry mouth, skin and mucous membranes
• Lack of sweating
• Little or no urination — any urine that is produced will be dark yellow or amber
• Sunken eyes
• Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold
• In infants, sunken fontanels — the soft spots on the top of a baby's head
• Low blood pressure
• Rapid heartbeat
• Fever
• In the most serious cases, delirium or unconsciousness

Unfortunately, thirst isn't always a reliable gauge of the body's need for water, especially in children and older adults. A better barometer is the color of your urine: clear or light-colored urine means you're well hydrated, whereas a dark yellow or amber color usually signals dehydration.

When to seek medical advice

If you're an adult, call your doctor if:

• You're not able to keep liquids down for 24 hours.
• You've been vomiting for more than two days.
• You're vomiting blood.
• You're dehydrated. Signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness.
• You notice blood in your bowel movements.
• You have a fever above 101 F.

Plateaus:

Here is some good information I found on plateaus, everyone goes though periods of stalls which are not plateaus. The body going through an ajustment period and is loosing inches. We have stalls throughout our weight loss journey, first one ususally is about 3 weeks out. www.weightwatchers.com/util/art/index_art.aspx?abnum=1&art_id=23561

Weight-Loss Plateaus   

• ·                                  Article by: The Weight Watchers Research Dept

   Plateaus are a common part of the weight-loss process. A plateau happens when the scale is at a standstill for several weeks—if weight stays the same for one or two weeks or the rate of weight slows but doesn't stop, it's not a true plateau. The progression from initial weight loss to hitting a plateau follows a typical pattern.

   The Predictable Cycle of Weight Loss
  During the first few weeks of losing weight, a rapid drop in pounds is normal. When calories from food are reduced, the body gets needed energy by releasing its stores of glycogen, a type of carbohydrate found in the muscles and liver. Glycogen holds onto water, so when glycogen is burned for energy, it also releases the water—about 4 grams of water for every gram of glycogen—resulting in substantial weight loss that's mostly water.

   Once the body uses up its glycogen stores, it starts to burn fat for energy. Unlike glycogen, fat does not store much water and each gram of fat releases more than twice the amount of energy (i.e., calories) than a gram of glycogen. The result is that weight loss slows down substantially. At this point, the recommended rate of weight loss is no more than an average of 2 pounds per week. Losing weight faster than this is generally a sign that amounts of lean muscle mass, which like glycogen is largely water, are being broken down for energy.

   As the body's glycogen stores are replenished by increased carbohydrate intake, there is a corresponding retention of water. During this time, weight stabilizes or may temporarily increase.   

   

   

   

   

•  Why Weight Loss Plateaus Happen
  By 6 months, a weight loss plateau is likely to occur.¹ While plateaus are an almost inevitable response to losing weight, the physiological reasons for why they occur is not well understood.

   One area of current research involves a possible link to reduced levels of leptin, a hormone produced by fat cells that is involved in the regulation of appetite. Research has shown that weight loss causes a marked decrease in serum leptin levels, which may, in turn, increase appetite.² Based on evidence from an animal study, scientists have suggested that a reduction in leptin may contribute to a weight-loss plateau.³ However, more research on leptin's role in human weight regulation is needed before conclusions can be drawn.

   Metabolic processes during weight loss may also impact plateaus. Losing weight can lower metabolism since a smaller body carries less lean muscle mass and burns fewer calories to move it around. Additionally, lower calorie consumption means it takes fewer calories to digest and absorb food. Taken together, a state of energy equilibrium could result, with weight remaining steady for a period of time.   

   

   

•   
  Galbladder

• How Do I Know If I Have Them?

  If your symptoms suggest a gallstone-obstructed duct, your doctor might first examine your skin for jaundice, then feel your abdomen to check for tenderness. A blood test may reveal evidence of an obstruction.

  Because other digestive problems, such as an infection of the duct, can produce symptoms similar to those of a gallstone attack, the doctor may also run other tests to determine if gallstones are in fact the culprit. The most common technique is an ultrasound examination. This quick, painless procedure uses high-frequency sound waves to create pictures of the gallbladder, bile duct, and their contents. CT scans are also sometimes done to look at the anatomy of your internal organs.

  A more complicated test may be used if the doctor suspects that a gallstone is lodged in the bile duct. Commonly known by the acronym ERCP, this test allows the physician to look at the bile duct through a small flexible tube called an endoscope. The doctor sprays the back of the patient's throat with an anesthetic drug to prevent gagging, then passes the endoscope into the mouth, through the stomach, and into the area of the small intestine where the bile duct enters. Dye is injected through the tube and into the bile duct, then X-rays are taken. The procedure takes about an hour.

  What Are the Treatments?

  In most cases, treatment of gallstones is considered necessary only if they are symptomatic. Of the various conventional treatments that are available, surgical removal of the gallbladder is the most widely used. Some alternative treatments have also been found to be effective in alleviating the symptoms of troublesome gallstones.

  Conventional Medicine

  When deciding what course of action to take for symptomatic gallstones, doctors usually choose from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical removal of the gallbladder.

  Watchful Waiting

  Though a gallstone episode can be extremely painful or frightening, almost a third to half of all people who experience an attack never have a recurrence. In some cases, the stone dissolves or becomes dislodged and thereby resumes its "silence." Because the problem may solve itself without intervention, many doctors take a wait-and-see approach following the initial episode.

  Even when the patient has had repeated gallstone episodes, the physician may postpone treatment or surgery because of other health concerns. If your surgery has been delayed, you should remain under a doctor's care and report any recurrences of gallstone symptoms immediately.

  Nonsurgical Therapy

  If you are unable or unwilling to go through surgery for a gallstone problem that requires treatment, your physician may recommend one of several noninvasive techniques. Note that though these methods may destroy symptom-causing gallstones, they can do nothing to prevent others from forming and recurrence is common.

  Some gallstones can be dissolved through the use of a bile salt, although the procedure can be used only with stones formed from cholesterol and not from bile pigments. The drug ursodiol (Actigall) is taken as a tablet and the salt dissolves the stone by increasing the level of bile acids in the gallbladder. Depending on its size, the gallstone may take months or even years to go away and often people need to take this medication indefinitely.

  Another nonsurgical technique, shock wave therapy, uses high-frequency sound waves to fragment the stones. Bile salt is administered afterward to dissolve the small pieces.

  A method called contact dissolution can also be used to dissolve gallstones. The doctor inserts a catheter through the abdomen, then injects a special drug directly into the gallbladder. In many cases, the stone disappears within a few hours. Contact dissolution and shock wave therapy are still considered experimental.

  Doctors can also attempt to remove gallstones during an ERCP. During the procedure a cutting instrument is inserted through the endoscope to attempt removal of the stone

• Here are some things you might want to do before surgery:
  get a comprehensive list from surgeon on the do and don't meds
  get a list from nut/surgeon on what you diet is at the different stages
  check with hospital to see what they provide you during you in hospital stay
  shop for staples for the family and yourself after surgery 
  (you might want to make sure you have at least a few weeks worth so you don't 
  have to shop real soon after surgery)
  
  some suggestions for different eating stage:
  clear liquid stage: clear broth, clear juice, clear soup, sf jello, sf popsicles 
  full liquid stage: cream soups (strained), sf yogurt (strained), milk, soy milk, sf pudding, protein drinks 
  purer: anything that can be blended to baby food consistancy 
  soft foods: things easy to chew like soft cheeses and ground meats
  full foods: foods cut up to about the size of a pencil eraser  and chewed up finely
  
  things to bring to the hospital:
  loose clothing to go home in
  pillow for the car ride (makes it more comfy)
  slippers
  toiletries  
  flushable wet wipes
  long handled tongs (to use with wipes to keep you clean after the bathroom)
  through away camera for before and after pics

  Dumping: Patients may develop loose stools and/or abdominal cramps shortly after eating certain types of foods. These symptoms can be avoided by not eating the offending foods. Diarrhea is uncommon after gastric restrictive surgery and can be successfully treated with medication. Dumping is occasionally associated with brief periods of light-headedness, sweating or heart palpitations due to low blood sugar. These symptoms can usually be reduced by drinking a sweet liquid like fruit juice.  

  Obstruction of the opening of the stoma: This rare complication occurs in less than 1 out of 100 gastric bypass patients and can occur when a piece of food becomes lodged in the stoma. When this happens, the piece of food is removed through a tube (endoscope) passed from the mouth into the stomach.

   

   

  http://som.umdnj.edu/departments/clinical/bariatric_surgery/specificrisks.html

  Vitamin and/or iron deficiency: This may occur in a mild form in as many as 40 percent of patients after gastric bypass. Iron and some vitamins, most notably Vitamin B-12, are primarily absorbed in the stomach and upper part of the small intestine which is bypassed. Both the vitamin and iron deficiencies are easily treated by either oral supplementation or injections. Women who are regularly menstruating will need additional iron supplements.
  
  Vitamin and iron deficiencies are uncommon after stapled gastroplasty because, with this operation, the food passes through the stomach and small intestine in the normal way.
  
  Low calcium and protein levels and deficiencies in fat soluble vitamins (A,D,E) are known to occur after distal gastric bypass. Gas, flatulence and diarrhea may be more prominent after distal gastric bypass.
  
  

  HAIR LOSS: Hair loss may be a temporary problem for some patients within the first six to twelve months after the operation. This is largely due to vitamin deficiency. There is no specific remedy other than proper nutrition and multivitamin supplements.  

   

• Plastics

• Saralicous came across this document on the web. It's the American Society of Plastic Surgeons...it has codes to use for your documentation and for your procedures.  Diagnosis CODES are good!!!

  ASPS Recommended Insurance Coverage Criteria

  for Third-Party Payers

  http://www.plasticsurgery.org/medical_professionals/health_p olicy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID =18091   

   

   

   

HAIR LOSS: Loosing hair sucks but unfortunatly its pretty normal occurance for people who have had WLS. We tend to start loosing hair about 3 months out and it might continue until around 10 months. Malnutrition and aneshesia are some of the causes. Make sure you take your vitamins and get your protein in (these will help, but won't stop it). The good news is that new hair growing in is whats pushing the old hair out and it will be much healthier because of our new eating habbits. Don't waste your money on expensive hair products that reduce hair loss it won't work for our problem. Use a good shampo and don't wash you hair everday. Some people say Bioteen helps (not proven) but it can't hurt and it is really good for you neils.

SKIN ARTICLE: http://weightloss.about.com/od/obesityhealth/a/blexcessskin.htm

links to: weblinks with information on dizzyspells, hope they help.
http://www.drmyhill.co.uk/article_l.cfm?subject=Neurological +problems

http://health.yahoo.com/ate/drdonnica/allqa/00026723

092007
I have decided to change my goal weight to what I was thinking a good one would be for me pre skin removal. Some one else who is the same height as me and she wears a size 8 and has maintained that weight for a year 148.

091907
The scale is finaley moving again, granted it was only one pound but I will take it since it hasn't moved that way in a while.

091607
I'm still at a stall, its really frustrating, but the good new is that I can get into 14 pants and a size large top. My baby won his first school football game on tuesday, 7-0, he plays defensive back on the A team. He was so exicted.

082807

Had a few great WOW moments yesterday, I saw someone who hasen't seen me in a while she said I looked great and have lost a lot of weight, since she last saw me . I also tried on one of the pants my mother-in-law gave me I was so excited that the 14 went on !

082707
Here is that website you'll asked for at the Terrall Support meeting.   http://www.shrinkpictures.com/create-avatar/resize.php

082107

For adults, fewer calories are needed at older ages. For example, an active 31-year-old man should aim for 3,000 calories, but an active 50-year-old man should aim for 2,800 calories.

061807

Just thougth I would give you an update on my issue. I really don't know if this is all related but this is when it starts. I was 2 week late (had tuble ligation11 years ago) then I finally started, was pretty heavy and crampy, stopped 5 days latter as normal for me, I started having right abdominal pains on my right side, something that has happened to me when ever I have ovulated from that side so I blew it off. Then 2 week after that I started again (it was the normal time of the month for me) was heavy and crampy again, stopped after 5 days. I continued to have the minor abdominal pains (deep feeling so of pain and sometimes burning, I have a high pain thresh hold) off and on then this weekend it started hurting (not enough to go to er) and not stopping. I was able to get a dr appointment this moring and got back a not that long ago. He did a urin sample to check for blood, there was none, he is running my normal blood work and he said since I have had that pain for a while and doesn't know the cause he is getting ct scan set up for my for upper and lower abdomin. He gave me some sample packs of something to decrease my stomach acid so we hope this might help.  So for now I'm sitting here back at work waiting for that call, I hope it comes today and I can get this done before my trip. 

Dr called me last night my CT scan is wed at 945.

061707

Weight loss Obsession By Heidi
Am I truly positively obsessed with weight loss, will I ever be happy with the size I see my body in the mirror or is it true that I think the only size that is right is zero.  I know I am not anorexic because I do like to eat and have no desire to look like a walking skeleton but at a loose size 8 I still feel fat, I don't see anything thin about me at 140lbs and 5'5.  What size is right, what weight is right, where does it end.  I feel so much better in my body now, but now the numbers on the scale possess me.  I want to see 130 something but when I reach it will I want to see 120 something.  Probably, then will it be 110.  Ugghhh I don't know.  Its scary in a way, I never thought I would feel this way and now that I am here all I see is thinner womyn and I want to be there too.  Our society shows size 2 as the ideal, and anything over 10 as a plus size.  Where did this crap come from, I know its all perception but realistically we are now chasing something thats nearly impossible to achieve yet I can't seem to let go of the idea of being truly thin.  I guess some day soon I need to take a few pics of myself and really see how I look. Hugs Heidi

My respons
Todays society is so weight obsessed, how can we possible not think about it all the time. Our perception of what is a healthy weight (number is so scud) we see these overly thin girls on ads and we are told that this is normal and the body type we should all be. The fashion world needs to wake up and open their eyes to what a normal person should look like, I can't remember the place but I read an artical about not letting models who are two thin be in a fashion show (yea). The average size women is a 12-14 and the fashion industry says a 8-10 is a large size model .  I think we get so obsessed with the number are scales say and our brains have been so messed up on what size we should be. I am going to try to go by what the BMI says (at least thats is done by the medical industry and not fashion) and be happy with a healthy one and not worry weight the number on the scale says or what size my clothes are. When I was younger there was no such thing as a zero or a size 2 in reality today those sizes are childrends 12-14 just longer and I'm an adult so why should I be wearing kids sizes. I checked your BMI out and your within a healthy normal zone (5'5 140 bmi 23.2, 130 bmi 21.6, 120 bmi 19.9 and anything lower is under weight). So as long as your stay healty and feel good what does it matter what that scale says as long as we are at a healthy BMI.  When everything is said and done I want to look like a women not a kid. I hate this mind game we keep playing with ourselves .

Hernia: http://www.medicinenet.com/hernia/article.htm

Here is what I found at www.mayoclinic.com

Myth #15
Muscle weighs more than fat.  

Truth:  Muscle is more dense than fat, therefore taking up LESS room.  

One pound of muscle weighs the same as one pound of fat.  Just as one pound of feathers weighs the same as one pound of bricks.  The difference is in the VOLUME.  Fat will take up A LOT more space than muscle.   
--------------------------------------------------------------

Plateaus/Stalls:

Here is some good information I found on plateaus/stalls, everyone goes though periods of stalls which are not plateaus. The body going through an ajustment period and is loosing inches. We have stalls throughout our weight loss journey, first one ususally is about 3 weeks out.
www.weightwatchers.com/util/art/index_art.aspx?abnum=1&art_id=23561

Gallbladder

 

 

 

http://www.sensiblehealth.com/gallbladder.html

 

 

 

http://www.mamashealth.com/organs/gallbladder.asp

 

 

 

http://health.ivillage.com/digestion/digallblad/topics/0,,4v25,00.html

 

-------------------------------------------------------------------------------
 

 

http://www.mtxeconditioning.com/kettlebells/fitnessmyths.html

Signs and symptoms Dehydration:  

 

 

 

   : Here is what I found at

Mild to moderate dehydration is likely to cause:

• Dry, sticky mouth
• Sleepiness or tiredness — children are likely to be less active than usual
• Thirst
• Decreased urine output — fewer than six wet diapers a day for infants and eight hours or more without urination for older children and teens
• Few or no tears when crying
• Muscle weakness
• Headache
• Dizziness or lightheadedness

Severe dehydration, a medical emergency, can cause:

• Extreme thirst
• Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
• Very dry mouth, skin and mucous membranes
• Lack of sweating
• Little or no urination — any urine that is produced will be dark yellow or amber
• Sunken eyes
• Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold
• In infants, sunken fontanels — the soft spots on the top of a baby's head
• Low blood pressure
• Rapid heartbeat
• Fever
• In the most serious cases, delirium or unconsciousness

Unfortunately, thirst isn't always a reliable gauge of the body's need for water, especially in children and older adults. A better barometer is the color of your urine: clear or light-colored urine means you're well hydrated, whereas a dark yellow or amber color usually signals dehydration.

When to seek medical advice

If you're an adult, call your doctor if:

• You're not able to keep liquids down for 24 hours.
• You've been vomiting for more than two days.
• You're vomiting blood.
• You're dehydrated. Signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness.
• You notice blood in your bowel movements.
• You have a fever above 101 F.

Plateaus:

Here is some good information I found on plateaus, everyone goes though periods of stalls which are not plateaus. The body going through an ajustment period and is loosing inches. We have stalls throughout our weight loss journey, first one ususally is about 3 weeks out. www.weightwatchers.com/util/art/index_art.aspx?abnum=1&art_id=23561

Weight-Loss Plateaus   

• ·                                  Article by: The Weight Watchers Research Dept

   Plateaus are a common part of the weight-loss process. A plateau happens when the scale is at a standstill for several weeks—if weight stays the same for one or two weeks or the rate of weight slows but doesn't stop, it's not a true plateau. The progression from initial weight loss to hitting a plateau follows a typical pattern.

   The Predictable Cycle of Weight Loss
  During the first few weeks of losing weight, a rapid drop in pounds is normal. When calories from food are reduced, the body gets needed energy by releasing its stores of glycogen, a type of carbohydrate found in the muscles and liver. Glycogen holds onto water, so when glycogen is burned for energy, it also releases the water—about 4 grams of water for every gram of glycogen—resulting in substantial weight loss that's mostly water.

   Once the body uses up its glycogen stores, it starts to burn fat for energy. Unlike glycogen, fat does not store much water and each gram of fat releases more than twice the amount of energy (i.e., calories) than a gram of glycogen. The result is that weight loss slows down substantially. At this point, the recommended rate of weight loss is no more than an average of 2 pounds per week. Losing weight faster than this is generally a sign that amounts of lean muscle mass, which like glycogen is largely water, are being broken down for energy.

   As the body's glycogen stores are replenished by increased carbohydrate intake, there is a corresponding retention of water. During this time, weight stabilizes or may temporarily increase. 

   

   

   

   

   

   

   

   

   

   

   

   

•  Why Weight Loss Plateaus Happen
  By 6 months, a weight loss plateau is likely to occur.¹ While plateaus are an almost inevitable response to losing weight, the physiological reasons for why they occur is not well understood.

   One area of current research involves a possible link to reduced levels of leptin, a hormone produced by fat cells that is involved in the regulation of appetite. Research has shown that weight loss causes a marked decrease in serum leptin levels, which may, in turn, increase appetite.² Based on evidence from an animal study, scientists have suggested that a reduction in leptin may contribute to a weight-loss plateau.³ However, more research on leptin's role in human weight regulation is needed before conclusions can be drawn.

   Metabolic processes during weight loss may also impact plateaus. Losing weight can lower metabolism since a smaller body carries less lean muscle mass and burns fewer calories to move it around. Additionally, lower calorie consumption means it takes fewer calories to digest and absorb food. Taken together, a state of energy equilibrium could result, with weight remaining steady for a period of time.  

   

   

   

   

   

   

•   
  Galbladder

• How Do I Know If I Have Them?

  If your symptoms suggest a gallstone-obstructed duct, your doctor might first examine your skin for jaundice, then feel your abdomen to check for tenderness. A blood test may reveal evidence of an obstruction.

  Because other digestive problems, such as an infection of the duct, can produce symptoms similar to those of a gallstone attack, the doctor may also run other tests to determine if gallstones are in fact the culprit. The most common technique is an ultrasound examination. This quick, painless procedure uses high-frequency sound waves to create pictures of the gallbladder, bile duct, and their contents. CT scans are also sometimes done to look at the anatomy of your internal organs.

  A more complicated test may be used if the doctor suspects that a gallstone is lodged in the bile duct. Commonly known by the acronym ERCP, this test allows the physician to look at the bile duct through a small flexible tube called an endoscope. The doctor sprays the back of the patient's throat with an anesthetic drug to prevent gagging, then passes the endoscope into the mouth, through the stomach, and into the area of the small intestine where the bile duct enters. Dye is injected through the tube and into the bile duct, then X-rays are taken. The procedure takes about an hour.

  What Are the Treatments?

  In most cases, treatment of gallstones is considered necessary only if they are symptomatic. Of the various conventional treatments that are available, surgical removal of the gallbladder is the most widely used. Some alternative treatments have also been found to be effective in alleviating the symptoms of troublesome gallstones.

  Conventional Medicine

  When deciding what course of action to take for symptomatic gallstones, doctors usually choose from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical removal of the gallbladder.

  Watchful Waiting

  Though a gallstone episode can be extremely painful or frightening, almost a third to half of all people who experience an attack never have a recurrence. In some cases, the stone dissolves or becomes dislodged and thereby resumes its "silence." Because the problem may solve itself without intervention, many doctors take a wait-and-see approach following the initial episode.

  Even when the patient has had repeated gallstone episodes, the physician may postpone treatment or surgery because of other health concerns. If your surgery has been delayed, you should remain under a doctor's care and report any recurrences of gallstone symptoms immediately.

  Nonsurgical Therapy

  If you are unable or unwilling to go through surgery for a gallstone problem that requires treatment, your physician may recommend one of several noninvasive techniques. Note that though these methods may destroy symptom-causing gallstones, they can do nothing to prevent others from forming and recurrence is common.

  Some gallstones can be dissolved through the use of a bile salt, although the procedure can be used only with stones formed from cholesterol and not from bile pigments. The drug ursodiol (Actigall) is taken as a tablet and the salt dissolves the stone by increasing the level of bile acids in the gallbladder. Depending on its size, the gallstone may take months or even years to go away and often people need to take this medication indefinitely.

  Another nonsurgical technique, shock wave therapy, uses high-frequency sound waves to fragment the stones. Bile salt is administered afterward to dissolve the small pieces.

  A method called contact dissolution can also be used to dissolve gallstones. The doctor inserts a catheter through the abdomen, then injects a special drug directly into the gallbladder. In many cases, the stone disappears within a few hours. Contact dissolution and shock wave therapy are still considered experimental.

  Doctors can also attempt to remove gallstones during an ERCP. During the procedure a cutting instrument is inserted through the endoscope to attempt removal of the stone

• Here are some things you might want to do before surgery:
  get a comprehensive list from surgeon on the do and don't meds
  get a list from nut/surgeon on what you diet is at the different stages
  check with hospital to see what they provide you during you in hospital stay
  shop for staples for the family and yourself after surgery 
  (you might want to make sure you have at least a few weeks worth so you don't 
  have to shop real soon after surgery)
  
  some suggestions for different eating stage:
  clear liquid stage: clear broth, clear juice, clear soup, sf jello, sf popsicles 
  full liquid stage: cream soups (strained), sf yogurt (strained), milk, soy milk, sf pudding, protein drinks 
  purer: anything that can be blended to baby food consistancy 
  soft foods: things easy to chew like soft cheeses and ground meats
  full foods: foods cut up to about the size of a pencil eraser  and chewed up finely
  
  things to bring to the hospital:
  loose clothing to go home in
  pillow for the car ride (makes it more comfy)
  slippers
  toiletries  
  flushable wet wipes
  long handled tongs (to use with wipes to keep you clean after the bathroom)
  through away camera for before and after pics

  Dumping: Patients may develop loose stools and/or abdominal cramps shortly after eating certain types of foods. These symptoms can be avoided by not eating the offending foods. Diarrhea is uncommon after gastric restrictive surgery and can be successfully treated with medication. Dumping is occasionally associated with brief periods of light-headedness, sweating or heart palpitations due to low blood sugar. These symptoms can usually be reduced by drinking a sweet liquid like fruit juice.  

  Obstruction of the opening of the stoma: This rare complication occurs in less than 1 out of 100 gastric bypass patients and can occur when a piece of food becomes lodged in the stoma. When this happens, the piece of food is removed through a tube (endoscope) passed from the mouth into the stomach.

  Vitamin and/or iron deficiency: This may occur in a mild form in as many as 40 percent of patients after gastric bypass. Iron and some vitamins, most notably Vitamin B-12, are primarily absorbed in the stomach and upper part of the small intestine which is bypassed. Both the vitamin and iron deficiencies are easily treated by either oral supplementation or injections. Women who are regularly menstruating will need additional iron supplements.
  
  Vitamin and iron deficiencies are uncommon after stapled gastroplasty because, with this operation, the food passes through the stomach and small intestine in the normal way.
  
  Low calcium and protein levels and deficiencies in fat soluble vitamins (A,D,E) are known to occur after distal gastric bypass. Gas, flatulence and diarrhea may be more prominent after distal gastric bypass.
  
  

  HAIR LOSS: Hair loss may be a temporary problem for some patients within the first six to twelve months after the operation. This is largely due to vitamin deficiency. There is no specific remedy other than proper nutrition and multivitamin supplements.  

   

   

   

   

   

   

   

• Plastics

• Saralicous came across this document on the web. It's the American Society of Plastic Surgeons...it has codes to use for your documentation and for your procedures.  Diagnosis CODES are good!!!

  ASPS Recommended Insurance Coverage Criteria

  for Third-Party Payers

  http://www.plasticsurgery.org/medical_professionals/health_p olicy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID =18091