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Incisional Pain After Gastric Bypass Surgery

by DrCurry Leave a Comment

pain

Pain after surgery is expected, particularly with the gastric bypass. This is a bigger, more involved surgery than the sleeve! Setting realistic expectations after surgery is important–you should expect to have some pain after surgery. 

 

We always inject local anesthetic in each incision, however the effect of this is only temporary. This can make it seem like your pain is getting worse, but it’s actually just the numbing medicine wearing off.  

 

Most of the discomfort in the gastric bypass there is one incision on the far left side of your abdomen.  This will commonly cause complaints such as: sharp or intense pain, dull cramping pain, burning, tugging, and pulling sensations. These are sometimes worsened by movements, or certain positions and the pain is not always felt directly underneath this incision.   These types of symptoms are normal and expected after bypass surgery. 

 

This incision is necessary in order to safely complete the surgery. Because of the size and depth of this incision, a suture is placed through the deep muscle layers to help prevent a hernia. This suture is almost always the cause of the symptoms described above. This pain will commonly last for 3-6 weeks and perhaps longer in some situations. 

 

We always do our best to minimize the discomfort associated with this incision, but we cannot completely eliminate this pain all together. Patients will be prescribed a narcotic pain medication, a muscle relaxer, and a pill which helps with neuropathic (nerve) pain. In addition to the medications, we recommend using ice packs over the incisions, 20 minutes on and 20 minutes off several times per day. This will help with the inflammation. After 2-3 days you may get better relief with a heating pad as the pain becomes more muscular in nature. 

 

This same far left incision can also be prone to infection, as at the end of the procedure we pull a little piece of small intestine out through it.  This can sometimes contain bacteria which can lead to infection, despite the fact that we place it in a sterile pouch before pulling it out.  Some of the first signs of infection are: fever, swelling at the incision site, redness around the incision, or drainage at the incision )particularly yellow thick foul smelling drainage).  Occasionally a clear or pale-red drainage will be present–this does not necessarily mean there is an infection. If you have concerns with your incisions, please contact us to have your incisions evaluated by our staff! 

Go back to the post-op navigator

Filed Under: Education, Post op, Uncategorized

How To Achieve Success After Weight Loss Surgery-The Three “M’s”

by DrCurry Leave a Comment

By Dr. Trace Curry

Patients always want to know what they need to do to be successful after weight loss surgery, it’s one of the most common questions I’m asked.  In my experience treating thousands of patients over the past 20 years, it all boils down to the three M’s:

  • Motivation
  • Menu
  • Movement

Motivation

I listed motivation first as it is the key.  If you are not motivated to lose weight and improve your health, even the most powerful weight loss procedure will not work in the long run.  Weight loss surgery can be life saving, by reducing or eliminating current or future medical issues such as diabetes, heart disease, high blood pressure, and high cholesterol.  You must have the motivation to make permanent lifestyle changes that include the changes listed below.  It’s worth the effort!

If you feel like you motivation is fading, even if you are 10 years out from surgery, reach out to us so that we can bring you in to meet with the team and formulate a plan to get you back on track.

Menu

Menu is the second item in the list because if you are not eating the right types of foods, you simply cannot move enough to burn off the excess calories.   First off, you need to “get the white out” of your diet!  White food refers to foods that are white in color, meaning that they have been processed and refined.  Things includes things like table sugar, flour, pasta, rice, bread, crackers, and cereal.  Secondly, eliminate liquid calories from your diet.  Everything you drink after surgery, with rare exception, should be zero (or very low) calorie.

Keep in touch with our expert registered dietitians for suggestions on healthy substitutions for these items in your diet.

Movement

It’s very difficult to be sedentary and maintain your weight loss in the long run.  These operations frequently have enough power to provide significant short-term weight loss without exercising at all.  However, once you reach your nadir (your lowest weight achieved after surgery) if you are not active AND exercising you will regain weight.  In some cases you could regain all your weight, especially if your motivation and menus are lacking.  No matter what your physical condition is, you must start somewhere!  Everyone’s definition of exercise is a little different, so just pick something you can do and build on it from there.  I highly recommend getting a good fitness tracker so that you can make sure you are reaching your move goals and modifying them as your health improves.  I’m partial to the Apple Watch as it does a good job not only to encourage you to exercise, but also not to be sitting for the rest of the day!

If your mobility is significantly limited, check out these low-impact exercise options for overweight patients.

overweight person exercising

If you keep the 3 M’s in mind, you will be successful in your weight loss journey.  The sky is the limit!

Other Posts From Dr. Curry

  • pain

    Incisional Pain After Gastric Bypass Surgery

    Pain after surgery is expected, particularly with the gastric bypass. This is a bigger, more involved surgery than the sleeve! Setting realistic expectations after surgery is important–you should expect to have some pain after surgery.    We always inject local anesthetic in each incision, however the effect of this is only temporary. This can make [...]
  • overweight person exercising

    Low-Impact Exercise For Overweight Patients

    Movement is one of the critical keys to success after weight loss surgery. For some of our patients though, exercise (or even walking) can be a challenge.  Once the weight starts coming off however, patients will see a dramatic improvement in weight-bearing joint pain.  Even so, it's important to start some form of exercise as [...]
  • Stop weight gain after bariatric surgery

    Breaking A Plateau After Weight Loss Surgery

    Breaking a Weight Loss Plateau Weight loss is a journey, and with that journey will come many struggles! A common discussion we have with patients is overcoming a stall or “plateau” in weight loss. Below are some tips to help break out of a weight loss plateau. First of all, consider how far you have [...]
  • SGLT2 Inhibitors

    Diabetes, weight loss surgery, and SGLT2 inhibitors

    Diabetes management is a rapidly-changing field.  It seems like every few days there is a new medication being advertised.  If you are a diabetic, it's important to understand how to manage your medications before and after surgery. SGLT2 (sodium-glucose transport protein 2) inhibitors are a new class of medications used to treat type 2 diabetes.  [...]
  • sleep apnea

    Negative Sleep Apnea Test

    Among the variables measured during sleep testing, the AHI (apnea-hypopnea index) is one of the most important.  The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (episodes of shallow breathing) that occur each hour, on average. In patients with an AHI below 10, the test is considered negative (or normal) and no [...]

Gastric Sleeve

vertical sleeve gastrectomy

Gastric Bypass

gastric bypass anatomy

Filed Under: Education, Post op

Low-Impact Exercise For Overweight Patients

by DrCurry Leave a Comment

Movement is one of the critical keys to success after weight loss surgery. For some of our patients though, exercise (or even walking) can be a challenge.  Once the weight starts coming off however, patients will see a dramatic improvement in weight-bearing joint pain.  Even so, it’s important to start some form of exercise as soon as possible after surgery.  The definition of exercise can vary from patient to patient.  For some just walking out to get the mail and back can be very challenging.  Below are some very low-impact exercise routines that nearly any patient can do.  Just start off slow and start building your tolerance, even before surgery!

All of these workout routines require no special equipment and can be done at home!

Low Impact Exercise Routines For Overweight Patients

Plus Size Full Body Workout

Low Impact Home Cardio Workout

Low Impact Overweight Cardio Workout

One Mile Happy Walk

Low Impact, Beginner, Fat Burning Home Cardio Workout-All Standing!

Also check out Joyn – it’s a free site with all sorts of options for patients with any kind of mobility issue. There is even have a section for chair exercises!

joyn icon

Filed Under: Education Tagged With: exercise

Breaking A Plateau After Weight Loss Surgery

by DrCurry Leave a Comment

scaleBreaking a Weight Loss Plateau

Weight loss is a journey, and with that journey will come many struggles! A common discussion we have with patients is overcoming a stall or “plateau” in weight loss. Below are some tips to help break out of a weight loss plateau.

  • First of all, consider how far you have come!
    • Before you hit your plateau, you were most likely experiencing successful weight loss for quite some time.
    • Remember your non-scale victories! This can include feeling better, having more energy, clothes fitting better, being able to do things you haven’t been able to in a while, and feeling more confident! Success is not always measured by the amount of weight that you lose!
  • Work with a dietitian to reassess caloric needs.
    • Based on the amount of weight you have lost so far, your calorie needs may have changed and will need to be adjusted. This can include changing the amounts of protein, carbohydrates, and fat in the diet as well, which all contribute to calories in the diet.
    • Sometimes the timing of your meals will need to be adjusted rather than the amount of calories.
    • Adding variety into your diet can help add different nutrients into your diet and ramp up weight loss.
    • If you aren’t tracking food already, get back into it to see if any extra calories are sneaking into your diet somewhere.  Ideally, use our Healthtrac app so that our team has access to your data!
  • Ramp up your workout routine.
    • Increasing the amount or intensity of your workouts could help you break out of a weight loss plateau because it can:
      • Help you burn more calories.
      • Make you feel better mentally and physically.
      • Bring more structure into your day.
  • Weight loss isn’t only related to what you eat. Consider if there are other factors in your life affecting your ability to lose weight.
    • Lack of sleep, excessive stress, and mental health issues can cause the body to produce more cortisol, which can tell the body to store more fat.
    • Seek medical advice if these things are affecting your life.

We hope these tips help you to explore the cause of a weight loss plateau and find ways to remedy it. Remember: You are NOT a failure for falling into a stall with weight loss, you are doing the best you can!

“When you feel like quitting, think about why you started” ~ Anonymous

Filed Under: Education, Post op Tagged With: plateau

Diabetes, weight loss surgery, and SGLT2 inhibitors

by DrCurry Leave a Comment

SGLT2 Inhibitors

Diabetes management is a rapidly-changing field.  It seems like every few days there is a new medication being advertised.  If you are a diabetic, it’s important to understand how to manage your medications before and after surgery.

SGLT2 (sodium-glucose transport protein 2) inhibitors are a new class of medications used to treat type 2 diabetes.  They are also known as “gliflozins.”  If you are on a medication and the generic name of it ends in “flozin” you are likely on an SGLT2 inhibitor.  They work by preventing the reabsorption of glucose from the blood that gets filtered by your kidneys, causing excess glucose to flow out in the urine.

It is recommended that these medications be stopped 5 days prior to surgery, and not to be resumed until a reasonable amount of calories are consumed on a daily basis.  This would typically be around 4 weeks post-operatively (unless instructed otherwise).

Current medications in this class include:

  • Invokana (canagliflozin)
  • Invokamet (canagliflozin and metformin)
  • Farxiga (dapagliflozin)
  • Xigduo XR (dapagliflozin and metformin)
  • Jardiance (empagliflozin)
  • Glyxambi (empagliflozin and linagliptin)
  • Steglatro (ertugliflozin)

If you are on one of these medications, please make sure you formulate a plan with your provider at your pre-op visit!

Filed Under: Diabetes, Education Tagged With: diabetes, faxiga, glyxambi, invokana, jardiance, sglt2 inhibitor, synjardy, xigduo

Negative Sleep Apnea Test

by DrCurry Leave a Comment

sleep apnea

Among the variables measured during sleep testing, the AHI (apnea-hypopnea index) is one of the most important.  The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (episodes of shallow breathing) that occur each hour, on average.

In patients with an AHI below 10, the test is considered negative (or normal) and no further treatment or follow-up is required.

For any questions please call or text our office at 513-540-1207.

Filed Under: Pre op Tagged With: ahi, cpap, sleep apnea

Moderate-to-Severe Sleep Apnea

by DrCurry Leave a Comment

sleep apnea

Among the variables measured during sleep testing, the AHI (apnea-hypopnea index) is one of the most important.  The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (episodes of shallow breathing) that occur each hour, on average.

In moderate or severe sleep apnea, the AHI is 15 or higher.  These patients will need to be treated with CPAP or some other type of device prior to surgery.

Our practice works with Cornerstone Medical to provide CPAP devices to patients with moderate-to-severe sleep apnea and help them get it set up.  They will contact the patient directly to make this arrangement.

If an order was sent to Cornerstone on your behalf and they do not contact you within the next 48 hours, please contact them at 888-594-0066.

Patients who are diagnosed with moderate-to-severe sleep apnea must use their CPAP devices as prescribed in order to proceed with surgery, otherwise anesthesiology will cancel the procedure!

Filed Under: Pre op Tagged With: ahi, cornerstone medical, cpap, sleep apnea

Spatz Balloon FDA Post-approval Study Eligibility

by DrCurry Leave a Comment

spatz 3 adjustable gastric balloon

The Spatz gastric balloon has recently been approved by the FDA in the US, and over 100,000 have been implanted outside the US over the last decade.  When the FDA approves a medical device, the manufacturer of the device must do a “Post Approval Study” (commonly abbreviated as “PAS”) on their device and submit data on actual patients in whom the device was implanted.

JourneyLite has participated in post approval studies on all gastric balloon systems that have come to market in the US, and we are proud to have been selected to participate in the Spatz PAS.

There are always specific criteria for patient inclusion and exclusion, and in order to be considered for participation in the Spatz PAS a patient must meet the following guidelines:

Inclusion Criteria (you must meet all of these conditions to be considered for the study):

  1. Age 22-65
  2. BMI 35-40, or BMI 30-34.9 with one or more major obesity-related conditions (diabetes, hypertension, sleep apnea, etc)
  3. Willing to comply with substantial lifelong dietary restrictions required by the procedure
  4. History of obesity (BMI 30+) for at least 2 years
  5. History of failure with non-surgical weight loss methods
  6. Willingness to follow protocol requirements, including signed informed consent, routine follow-up schedule, completing laboratory tests, and completing diet counseling
  7. Residing within a reasonable distance from the investigator’s office and able to travel to the investigator to complete all routine follow-up visits
  8. Ability to give informed consent
  9. Women of childbearing potential (i.e. not post-menopausal or surgically sterilized) must agree to use adequate birth control methods.  Acceptable methods are limited to hormonal contraceptives (oral, flexible vaginal ring, skin patch, injection), diaphragms, IUDs, condoms with or without spermicide, and voluntary abstinence.

Exclusion Criteria (if you have any of these things you cannot be in the study):

  1. Prior surgery involving the esophagus, stomach, and duodenum or hiatal hernia surgery
  2. Prior open or laparoscopic bariatric surgery
  3. Any inflammatory disease of the gastrointestinal tract including esophagitis, Barrett’s esophagus, gastric ulceration, duodenal ulceration, cancer, or specific inflammation such as Crohn’s disease
  4. A gastric mass
  5. A hiatal hernia >2cm or severe or intractable gastro-esophageal reflux symptoms
  6. Acid reflux symptoms to any degree that require more than one medication for symptom control
  7. A structural abnormality in the esophagus or pharynx such as a stricture or diverticulum that could impede passage of the balloon alongside the endoscope
  8. Achalasia or any other severe esophageal motility disorder that may pose a safety risk during the removal of the device
  9. Severe coagulopathy
  10. Insulin-dependent diabetes (either Type 1 or Type 2) or a significant likelihood of requiring insulin treatment in the following 12 months
  11. Subjects with any serious health condition unrelated to their weight that would increase the risk of endoscopy
  12. Chronic abdominal pain
  13. Motility disorders of the GI tract such as gross esophageal motility disorders, gastroparesis or intractable constipation
  14. Hepatic insufficiency or cirrhosis
  15. Serious or uncontrolled psychiatric illness or disorder that could compromise patient understanding of or compliance with follow up visits and removal of the device after 8 months
  16. Alcoholism or drug addiction
  17. Patients unwilling to participate in an established medically-supervised diet and behavior modification program, with routine medical follow-up
  18. Patients receiving daily prescribed treatment with aspirin, anti-inflammatory agents, anticoagulants or other gastric irritants
  19. Patients who are unable or unwilling to take prescribed proton pump inhibitor medication for the duration of the device implant
  20. Patients who are known to have, or suspected to have, an allergic reaction to materials contained in the system
  21. Patients who have BOTH:
    a. A previous history of a serotonin syndrome
    AND
    b. currently taking any drug known to affect the levels of serotonin in the body [e.g., selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs)]
  22. Patients who are pregnant or breast-feeding
  23. Subjects with Severe cardiopulmonary disease or other serious organic disease which might include known history of coronary artery disease, Myocardial infarction within the past 6 months, poorly controlled hypertension, required use of NSAIDs
  24. Subjects who have tested positive for H. Pylori, and who have not yet been treated

Patients who participate in this trial will need to have some pre-procedure testing done.  Click here for more info.

If you are interested in the Spatz gastric balloon PAS and you meet the above criteria, the next step in the process would be to schedule a consultation with one of our physicians to discuss the procedure and the study in more detail.

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Filed Under: Uncategorized Tagged With: gastric balloon, spatz

Spatz Adjustable Gastric Balloon

by DrCurry Leave a Comment

spatz 3 adjustable gastric balloon

The Spatz 3 adjustable gastric balloon was approved by the FDA in the United States in 2021.  It is indicated for patients with a body mass index (BMI) of 35-40, or a BMI of 30-35 with an obesity related medical issue.  Spatz 3 has been available outside the US for some time, and over 100,000 have been implanted.

 

What makes the Spatz unique is that it is the only adjustable balloon system.  This is important for several reasons:

  • One of the most common complications for traditional saline-filled balloons is balloon interolerance.  This means that a small percentage of patients will not tolerate their balloon and will have ongoing issues with vomiting and discomfort.  In the past, if these issues persisted beyond a week or so then the balloon was typically removed early.  With the Spatz however, some saline can be removed from the balloon which will usually cause these issues to resolve without balloon removal.  This does require a repeat endoscopy, however.
  • Another issue with saline balloons in the past is that some patients will only lose weight for the first few months.  These patients will either have a weight loss plateau or even weight gain.  If this occurs with a Spatz, some additional saline can be added to the balloon which will usually lead to additional weight loss.  This also requires a repeat endoscopy.

An additional benefit of the Spatz is that it can be left in the stomach for 8 months, as opposed to a maximum of 6 months for other saline gastric balloons that have been approved in the US.

These advantages have resulted in significantly better weight loss and long-term success for the Spatz balloon in their FDA trial than for any other gastric balloon, whether saline or gas-filled.

Spatz balloon results

As can be seen in the above table comparing all gastric balloons with which we have experience, the Spatz has not only the best weight loss, but also the highest success rate.

Currently, only patients who are able to participate in the Spatz FDA Post-approval Study can have one of these balloons implanted.  Click here if you’re interested to find out if you may be eligible!

How the Spatz Adjustable Gastric Balloon Teaches You to Eat Less!

Filed Under: Anouncements, Education Tagged With: gastric balloon, spatz

Weight Loss Surgery And Hair Loss

by DrCurry Leave a Comment

hair loss

A frequent question we get from surgical patients is “Will I lose a lot of hair?” This is a common concern, as some patients have heard isolated reports that they will experience hair loss after bariatric surgery. Although it can occur after surgery, maximizing your protein intake and taking the appropriate supplements can minimize this issue.

When hair loss does occur after weight loss surgery, it is typically a result of the body experiencing some degree of malnutrition as well as a stress reaction. Rapid weight loss plus major surgery both put stress on the body, and obviously bariatric procedures limit food intake by design and if the patient isn’t eating right, mild malnutrition can occur.

Protein intake is our primary focus after surgery for many reasons.  One such reason is that adequate intake of protein is the best way to avoid significant post-op hair loss. Vitamin supplementation is important as well, to ensure proper nutrition to support all of the body’s functions, including hair health.

Biotin supplementation stimulates the regrowth of hair in some individuals. However, biotin will not prevent the actual loss so patients will still experience hair falling out without overall adequate nutrition.

Keeping all of your follow up appointments is key to maintaining good health and minimizing issues such as hair loss. Our providers and Registered Dietitians will monitor nutritional intake as well as lab values. Our team uses that information to help us to tailor a supplementation regimen appropriate for each patient!  

Nutrients to Help Minimize/Prevent Hair Loss and Promote Hair Regrowth

Maintaining an adequate daily amount of protein (>80-100 grams), hydrolyzed collagen (2.5-15 gms), and fluid (>80 oz) may promote optimal hair regrowth and minimize hair loss. In addition, there are many vitamins and minerals, when consumed in a routine diet or taken in a daily supplement, which may also promote hair regrowth and may help reduce hair loss. These include: 

 

Vitamin E (15 mg) – can block the erosion of your scalp tissues

Zinc (8-11 mg) – helps promote hair tissue growth and repair

Magnesium (320-420 mg) – helps to release hair follicles clogged by calcium

Vitamin C (65-90 mg) – helps build collagen

Vitamin A (700-900 mcg) –  moisturizes the scalp

Vitamin B5 (5 mg) – helps by strengthening and nourishing hair follicle to promote healthy hair growth

Vitamin B12 (2.8 mcg) – promotes healthy hair growth by assisting in the production of oxygen-rich red blood cells which feed hair follicles

Biotin (30 mcg) – stimulates keratin production in hair and can increase the rate of follicle growth

Iron (18 mg) – prevents iron deficiency, which can cause anemia (a major cause of hair loss)

Vitamin D (600 IU) – stimulates hair follicles to grow

 

Maintaining a diet rich in eggs, seafood, leafy green vegetables, fruits, grains, nuts and seeds, as well as taking a comprehensive multivitamin will promote the opportunity to provide the necessary vitamins and minerals as outlined.

Filed Under: Education Tagged With: hair loss

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