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When Should I Have My Gallbladder Removed with Weight Loss Surgery

2011-06-24T02:27:00Z

There are definite times when you should have your gallbladder removed. If you have gallstones and are having a gastric bypass you should have the surgery either before your bypass surgery or about three months after your bypass.

If you have a lap band you only need to remove your gallbladder if you are having symptoms, i.e. pain, infection.

If you develop gallstones after bypass surgery, you should have the gallbladder removed. The main reason to remove the gallbladder is if a stone should get into the common bile duct it will be difficult to remove with out major surgery. Normally you can get a procedure called an ERCP( a gastroscope goes down you throat passes into the duodenum to allow for access to your common bile duct). Since you stomach is stapled there is no way for the scope to pass into the duodenum without a surgeons assistance.

How to choose between a Lap Band and a Sleeve Gastrectomy

2011-06-22T01:25:57Z

I will give you a short review of each procedure and then compare the pros and cons of each. The lap band is a restrictive weight loss procedure. The band divides your stomach into two sections, a small top stomach and a larger lower section. If you compare a hour glass to what the band does to your stomach, than you will have a better understanding of how it works. Just like putting water in an hour glass allows the fluid to quickly empty from the smaller section into the lower larger section, if you drink sweets they will quickly empty into the larger portion of your stomach and you will not feel full very long. And if you eat a large piece of meat, and don't chew it well it will get stuck like rocks in an hour glass. The band is adjustable so it can set for each patient at a different fill level.
The sleeve gastrectomy is also a restrictive procedure that makes your stomach into a tubular structure. It also has the same problems as a band in that sweets go down easily and if you eat too large a piece of meat it may get stuck.

I believe that the sleeve does not offer much of an advantage over a band but has a significant increased risk of complications. The main advantage of the sleeve is that there is not an implant. But the procedure is permanent and if the sleeve stretches there is no way to adjust it.

In my practice I prefer banding over sleeve gastrectomy because I believe it offers an excellent chance for long term weight loss with the least risk. As stated in other articles whether to have a bypass or a band depends on many patient factors.

What can cause pancreatitis in patients who have had a gastric bypass?

2011-04-22T00:54:00Z

The most likely cause of pancreatitis in bariatric patients are gallstones passing into the common bile causing an increase in pressure in the pancreatic duct. Even when an ultrasound does not show stones in the gallbladder, there is a possibility that there are small stones that can pass into the common bile duct, Rapid weight loss or multiple diets over your life can put you at increased risk for gallstones. When these stones pass out of the gallbladder they can get stuck in the duct that takes bile from the liver to the bowel. This duct also empties enzymes from the pancreas. The pancreas does not like increased pressures and sometimes the enzymes become active in the pancreas instead of the bowel. This results in pancreatitis.

Other causes could be medications, alcohol, viral illnesses, elevated triglycerides and idiopathic pancreatitis( not a clear cause).

It is always important to contact your bariatric surgeon is you have pancreatitis.

How to manage your lap band diet.

2011-03-22T12:48:00Z

Every physician has different programs for post banding diets. I will outline what I find works well with my patients. Initially I do not fill the band with much fluid at the time of surgery. This reduces the chances of vomiting and therefore the risk of having the band slip.

The day of surgery you stay on clear liquids. The day following surgery starts a soft diet consisting of foods like oatmeal, soups, soft fish, cottage cheese. After one week the diet changes to regular food for lunch and dinner but the amount should be 3-4 oz of your protein, i.e. meat or fish, and 1/2cup of salad or vegetables. Breakfast should be a protein drink with at least 30gms of protein and no more than 200 calories.

At the one month visit the band is usually adjusted unless you feel full with the present amount of food and you have lost at least 4 lbs in a month. The key to success is filling the band to allow the small meals to fill you up. If you always over eat with every adjustment, you will have excessive nausea and vomiting. This leads to constantly adding and subtracting fluid from the band which reduces weight loss over time.

Remember the band acts as a restriction device only. It makes your stomach into an hour glass. Just like an hour glass liquids always pass easily, and rocks do not. Chew your food well and eat slowly. Avoid high calorie liquids or foods that become liquid once eaten.

A new method to treat Heartburn.

2011-02-27T17:18:00Z

Heartburn affects a lot of people, especially those with weight problems. The first thing to do is get off some pounds. But even then there are those who continue to have heartburn and require medications to treat the symptoms. There is a new endoscopic procedure called esophyx that allows the physician to tighten the valve at the bottom of your esophagus. This is done using an instrument placed down your mouth while you are asleep. If you want to see what the procedure is like the company has a web site, www.endogastricsolutions.com ,that shows the procedure. If you have any questions about the procedure just email me at davidswardmd1@gmail.com.

How to get back on track if you gained weight after Bariatric Surgery. Use the 2+2 Diet!

2011-02-27T16:49:00Z

The best way to start if you have gained some weight after either your banding or your bypass is to pick a simple way of eating that is not too extreme. My 2+2 diet works well with my patients. The diet consists of drinking a protein shake for breakfast and as a snack at around 3pm in the afternoon. Costco sell a premade shake that has 160 calories and 30 gms of protein called premier protein. It has 4 points if you use the weight watchers system. For lunch include a salad and fish or chicken. At dinner time have salad, vege and a meat or fish. Most people do well with a total of 1000 to 1100 calories per day. This will allow you to drop about a pound per week. You can eat around 700 calories for lunch and dinner together. Good luck.

What is new with the Lap Band?

2011-02-27T16:33:00Z

Just recently the FDA approved the lap band for people who have a BMI of 30 or above. That means that a 5 foot six inch person weighing 180 lbs can be a candidate for the band. This is the most successful population of patients with the band because loosing 50-60 lbs and maintaining that weight loss is the area where the band is very effective.

The weight loss should be able to be accomplished in about 6-9 months. The hardest thing will be having the insurance companies agree to pay for the new guidelines. For patients that can not get their insurance companies to pay, there are cash pay options with physicians across the country. At our office in NJ, Allied Surgical Group, we offer lap banding and a year of followup for $12,000. That includes the band which cost $3200, anesthesia, the OR fees and all the surgeons fees. It is on pare with a year of nutrisystem.

It is important for you to have your banding with a physician that you can visit at least once a month for the best results. Most of my patients visit me monthly for the first 6-7 months and some once a month for the first year. Than the visits can be individually set based on your success and comfort.

If you want more information about paying out of pocket for the band email me at davidswardmd1@gmail.com

Update progress of phentermine and topamax for weight loss.

2010-09-05T04:09:00Z

I would like to give you an update on how my patients have been doing on phentermine and topamax. Almost 90% of the patients found that they did as well by just taking the phentermine. The weight loss benefit of the topamax was small and did not justify the side effects of the drug even at a low dose. Patients have lost an average of 10 lbs per month with the amount greatest the first month on the medication and trailing off by month three. The phentermine needs to be stopped for 4-6 weeks every three months so that the appetite suppressant effect returns. This program has been the most successful with both banding and bypass patients.

Update on patients who have had a lap band after having Gastric Bypass Surgery in the past.

2010-09-05T03:41:00Z

Over the past three years I have surgically treated patients who have gained weight after having gastric bypass surgery. Options for these patients had been limited to medical therapy and dieting. About two years ago a procedure called Stomaphyx was being offered to patients who had gastric bypass and had gained back weight. The procedure entailed endoscopically suturing the stomach to try to make it smaller. Unfortunately this procedure provided good results only in the short term. Over time the stomach began to enlarge again and patients did not continue to have much benefit.

Also around the same time I began to place lap bands in patients who have had laparoscopic gastric bypass and have gained weight back. These patients have done very well and have lost a significant amount of weight and have been able to keep it off. I have not had any complications in these patients but the number is limited (10) and the longest patient is now two years post banding. I must say that the patients are happy and they feel the sense of fullness that had gone away with bypass.
Out of all the procedures being offered, I feel that the band offers the best results. The hardest part of the procedure is getting the patients insurance to pay for the procedure. My suggestion to people who are looking to go down this pathway is to start documenting any medically supervised weight loss programs that you are trying. This will help with the process.

How are my patients doing with medical treatment for weight loss?

2010-02-27T00:10:00Z

It has been a year since I started treating people with and without surgical weight loss procedures. My program includes daily to weekly email followup, monthly office followup and cycling medications for optimal effect. People who have approximately 60 to 80 pounds to lose can drop 30 pounds in the first three months of the program. When they are off medications the goal is slow loss or maintainance.
I try to encourage exercise after the first month of weight loss. Exercise will always enhance weight loss but mainly helps with weight maintainance while off medications.

A new tool to help with weight loss. Phentermine and topamax

2010-01-11T16:26:00Z

There has been increased evidence that the combination of phentermine and topamax have an additive effect on weight loss. The phentermine helps with appetite suppression and the topamax has an effect on your taste buds that reduces the appeal of the food you are eating. Like all medicines for weight loss there is a decreasing effect over time but it seems that the combination of the two drugs has a longer effect than other medications alone. Medications have side effects and you should always discuss taking medications with your doctor and understand when you should stop them if side effects occur.

How to manage and use your Lap Band for the best result.

2009-04-21T02:29:00Z

The best way to lose weight after you have your band surgery is to eat a meal that will eventually be the maximum amount of food that will fill you once your band is completely adjusted. I tell my patients that it is better to fill your band into your diet rather than eat into your band fills. If you watch what you eat during the period of band fills you will lose more weight and not have as many episodes of vomiting or feeling nauseous.
Normally about 3-4 oz of your protein and 4 oz of vegetables will fill you once your band is adjusted properly.

HERE ARE SOME CHOICES FOR PROTEIN SUPPLEMENTS

2008-11-20T02:17:00Z

Patients who have had weight loss surgery need to maintain their protein intake. An intake of about 60-80 grams of protein daily is a good goal. Most of the supplements are whey protein based which is milk protein. Some examples of products are the following: (Note I do not recommend any specific product, you should sample different types and see which one you like)

IDS whey liquid protein bullets: 3.1 oz   42 gms of protein   176 calories

Isopure whey protein drinks: 20 oz    40 gms of protein     170 calories

EAS whey protein products   1 scoop of powder    23 gms of protein    120 calories

There are many other products on the market and most are similar with different additives to change flavor or consistency. Most powders taste better if mixed in skim milk and this adds some calories about 90 for 8 oz of skim milk and some more protein.

Do not buy large quantities until you taste each product.

WHERE TO FIND INFORMATION ON GASTRIC BYPASS AND GASTRIC BANDING.

2008-11-11T01:31:00Z

For almost ten years I have been presenting information on weight loss surgery at monthly seminars. For many of those years there was not complete and accurate information about the procedures and about the complications and risks of having surgery. Now there are many sites on the web but just a few offer easy to understand information that is accurate and easy to understand.

The following sites are good places to start: 1. www.sages.org and on the home page in the right side of the page is a link to morbid-obesity info. On this site click on presentation and a power point presentation will be opened. This site offers a nice over view on the back ground and basis of obesity. It gives you information on banding and gastric bypass. 2. www.bariatricedge.com is a site that is sponsored by Ethicon who is owned by J&J. The site offers comparisons of banding and bypass and allows you to watch an animated video on each procedure.

The other important points that are not on any websites is how you get to have surgery and what is the process. The following is the best information for the majority of people who have private health insurance. First almost all of the insurers require a nutritional consultation and a psychological consultation. Second the majority of insurance companies require 6 months of medically managed weight loss within the past two years. This means seeing your primary care doctor for six visits, one per month for six months, just for weight loss. Only a few companies do not require this. Always check with your insurer about there requirements.

Once you have completed these requirements the remaining things like labs, tests will be determined by your doctor.

Which procedure you choose depends on your preference and a open discussion with your physician. I always respect my patients wishes and at the same time will give my opinion on what I think will work best.

WHAT ABOUT FRUIT IN MY DIET?

2008-10-30T01:30:00Z

My patients can be my best source for writing about relevant topics. Today a patient who had bypass surgery about 4 years ago was in the office to discuss revisional surgery. I always make a point to include an examination of what has been going on with someones diet over the past year as part of the solution to weight regain.

What was interesting in the conversation was that overall her diet was not bad however on looking into the diet further she was eating a lot of fruit. Fruit in small amounts is fine but fruit has a lot of sugar. Of course fruit has vitamins and fiber. But you can get all the vitamins you need in your multivitamin and your fiber by eating leafy green vegetables that have no calories.

When you are trying to lose weight is important to look at all aspects of your diet to find areas where you can get the same nutritional value of a food without of all those calories. Always be careful of eating any food in excess. And what I say in almost every topic is it is all about total calories!

EXERCISE: THAT'S WHAT HELPS YOU MAINTAIN YOUR WEIGHT

2008-10-28T23:59:00Z

When you finally get to your goal weight its time to celebrate. How do you maintain that weight? Of course you must watch what you eat but the most essential thing is exercise. Exercise will allow you to eat more calories and maintain your weight. The problem with weight maintenance is that you have been denying yourself those foods that put those pounds on and now that you have got to your goal weight those foods look even better. If you exercise that will allow you to eat those calories without putting on pounds.

And of course on the flip side if you exercised the entire time you dieted and decide that once you reach your goal weight you can cut back on your exercise routine, you will be sorry. The pounds will come back.

Remember your weight will always be about total calories consumed minus total calories spent.
Anything that upsets the equation can lead to weight gain.

DIET INFORMATION FOR PEOPLE WHO HAVE HAD A STOMAPHYX PROCEDURE

2008-10-28T00:12:00Z

For people who have gained weight or have not reached their goal weight after bypass surgery there is a procedure called Stomaphyx. The procedure is also for patients who have developed dumping syndrome after stretching their connection between the stomach and small bowel, i.e. gastrojejunostomy. There are two aspects to have a good result from the procedure. First the procedure needs to be performed well and second the surgeon needs to have a nutritional plan for the patient after the procedure.
I put emphasis on the post operative diet. I want my patient's to understand that there is an opportunity after the procedure to re-learn how to reduce your calories and maintain a satisfying diet. The first week after the surgery you should stay on a liquid to puree high protein diet. Foods for this week include various protein drinks, low salt soups, yogurt, cottage cheese and pureed meats. The second and third week your food should be solid but soft and moist. Foods like soft and moist fish, mashed potatoes and tomatoes. And by the forth week you should be eating regular food.
The key to successful weight loss is to keep track of how many calories you are eating each week so that as your meal selection changes you continue to maintain the same amount of calories and protein. This gives you an understanding of how your weight loss is related the amount of calories you are eating. I have created a free web site call www.myphonediet.com which can help you with tracking and recording your foods, calories, protein, fat and carbs as well as weight. The site will also help with calculating a calorie goal for daily calories.
The more you understand how your weight changes as your calorie intake varies the more control you will have in keeping your weight off and reaching your goal weight.

HOW TO KEEP WEIGHT OFF AFTER GASTRIC BYPASS.

2008-10-23T00:54:00Z

Every week I see patients who I have operated on many years ago and they are coming back to my office after having gained some weight. Most of them admit that the weight came back as a result of going back to the foods which caused them to gain the weight in the first place. How can that be? Didn't you believe that after the surgery you would never be able to eat those foods? What tends to happen is that you can not eat as much of those foods at one sitting, however if you begin to graze or eat little amounts at multiple times than you get in a lot of calories which leads to weight gain. These habits creep up slowly and the weight comes on slowly. Weight gain after bypass surgery is slow but hard to remove because your body is very efficient and to get those pounds off you really have to reduce your total calories.

That is why I created a free website for my patients to help with calorie counting and understanding how your weight is effected by total calories. The site is www.myphonediet.com.

HOW AND WHAT DO I EAT IF I HAVE A GASTRIC BAND?

2008-10-20T00:11:00Z

I like to use the analogy of a hour glass to help people understand the way a gastric band works. The gastric band creates an hour glass effect in the stomach. Where the band goes across the stomach it creates a small upper stomach. The outlet of the small stomach is small and the size of the outlet is adjusted by placing sterile water into the port of the band. Just like an hour glass if you drink high calorie liquids, i.e. milk shakes, ice cream, alcohol, the fluid will empty quickly. There is no sense of fullness and the effect of the band is lost. At the other extreme if you do not chew your food well, it is like putting stones in an hour glass. The food just won't go past the band and you end up throwing up the food.

The way to use the band for the most weight loss effect is to chew your food well to the consistency of thick sand. Then the food will empty slowly and you will feel full for a longer period of time but not have any nausea.

There are three goals that you should meet to use the band successfully: 1) If you eat 3 oz of a protein that is meat, fish, or poultry, with a small amount of vegetables and feel full, 2) you should be satisfied with that meal for 3-4 hours and 3) your weight should drop by 1-2 pounds per week during your weight loss period.

The foods to eat should always be moist and be high in protein and low in fat and carbs. Examples of this are fish, poultry, meats, whey protein based foods and supplements, and soy or tofu. If you eat lentils and beans you must be careful about how many carb calories you take in everyday. Once again weight loss will only occur when your intake of calories is less than you needs.

WHAT SHOULD YOU DO ABOUT VITAMINS DURING A DIET?

2008-10-15T23:48:00Z

While dieting it is important to maintain not only protein intake but mineral and vitamin intake. There are two classes of vitamins water soluble and fat soluble. Water soluble vitamins like vit C taken in high doses are excreted in the urine and if you take high amounts the excess is not stored for a long period. Fat soluble vitamins are stored in fat cells and in the liver. Taking too much fat soluble vitamins can be unhealthy and unnecessary.

Most people who have normal gastrointestinal tracts only need to take a multivitamin with iron and a calcium with vit d supplement usually 600mg tablets. There are many good cheap vitamins available. I don't have any favorites. If you have had gastric bypass surgery you need to take extra vitamins everyday and it is important to have vit B12, vit D, Iron and Vit A levels measured at least 2 times during the first year after surgery and than every year after that once per year.

When you take fat soluble vitamins it is important to have some fat in the food taken at the same time. This will help with absorption.

There have been changes in the amount of Vit D that people should have stored. The recommendation is to take two calcium and vit D supplements 600mg per day. It is also important to get sun exposure even during the winter.