What is Lovenox? Why do I need it and how do I do the injections?

Blood clots after surgery are a risk for any patient, and being overweight can increase the risk significantly. Lovenox is a short-acting, injectable blood thinner that is frequently used after surgery to prevent deep vein thrombosis (DVT).  Some surgeons use it in 100% of patients, and others use it selectively based on the patients risk.  In any case, if your doctor prescribed Lovenox for you either before or after surgery, it is IMPORTANT that you use the medication as directed by your physician!

DVT’s can be serious after surgery as sometimes they can travel to the lungs, which is called a pulmonary embolism (PE).  In addition to blood thinners such as Lovenox, frequent walking after surgery will also reduce the risk of DVT.

Lovenox is dispensed in pre-filled syringes matching the dosage your doctor wants you to have.  Injecting is pretty simple and causes minimal discomfort.  Please view the information below from the Lovenox® web site to learn more about how to do your injections properly. Note that significant black-and-blue bruising can occur around injection sites, this is normal. If you have any signs of significant bleeding please call your doctor immediately!


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The Importance of Screening For Sleep Apnea

Sleep apnea affects nearly 25 million adults in America by many estimates.  Undiagnosed sleep apnea can be risky to your health, and can increase the risk of pulmonary issues after surgery.  For this reason, we screen all our surgical patients for sleep apnea and test those who are at moderate or high risk.  We will ask you to complete a STOP BANG sleep apnea survey and possibly an Epworth Sleepiness Scale.  If indicated, we will set you up for a sleep test in your own home using a WatchPAT device.

WatchPAT is an FDA-approved portable diagnostic device that uses the most innovative technology to ensure the accurate screening, detection, and follow-up of sleep apnea. Its ease of use is unparalleled in the marketplace and it is greatly complemented by the fact that WatchPAT testing is done in the comfort of your own bedroom; an environment that best reflects the pattern of your sleep habits!

Please return your device to us within 24 hours of completing your testing so that we can transmit your results to our board-certified sleep physicians for interpretation.

Please watch the two videos below to better understand the disease of sleep apnea, and how to properly use your WatchPAT device to obtain an accurate sleep test in your very own bed!

Why sleep apnea testing is important to your health!

How to use your WatchPAT device

Note:  Acryllic nails or dark nail polish may interfere with the accuracy of WathPAT testing.

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Dr. Tracy Pitt & ESG, A Powerful New Duo In The Fight Against Obesity


Dr. Tracy Pitt is a weight loss surgeon JourneyLite Surgery Center, in Cincinnati, Ohio.  He trained at the Cleveland Clinic and has dedicated his career to helping patients lose weight and improve their health.  In the not-so-distant past this meant big operations, big incisions, long hospital stays, and potentially high risk.  Now, however, there are many new developments in the field of weight loss procedures that could be real game-changers in the field.

“Many of my patients are interested in losing weight but they don’t want to have surgery” Pitt says.  “Diets have failed over and over in the past and they need a more powerful option to succeed.”  For decades, gastric bypass was the gold standard, and still is in many circles.  But there are two camps who are looking for non-surgical options:  those who don’t have enough weight to lose to justify full-on surgery, and those who qualify for surgery but their fears of being cut on outweigh the benefits of bariatric surgery.

Dr. Pitt says “The risk of weight loss surgery has really come way down in the last decade.  It’s now no more risky than gallbladder surgery.  But the more options we have in our arsenal, the more effective we can be at treating the disease of obesity.”   He feels that obesity treatments might be more successful if patients were treated at a lower BMI, intervening earlier rather than waiting for the scale to climb high enough to require gastric bypass.

Dr. Pitt has always been interested in minimally invasive techniques, so much that his entire fellowship was dedicated to minimally invasive surgery.  So it was only natural for him to take an interest in weight loss procedures that could be done without surgery altogether.  “First we had the gastric balloon” says Pitt, “but many patients are looking to a more permanent tool,” referring to the fact that gastric balloons must be removed after they’ve been in for 6 months.   When a new procedure called the Endoscopic Sleeve Gastroplasty, or ESG, came on the horizon, Dr. Pitt scheduled himself for a training course almost immediately.

The ESG procedure uses an endoscopic “sewing machine” called the Overstitch (Apollo Endosurgery) with which Dr. Pitt has extensive experience already.  Sutures are placed inside the patients stomach to reduce the gastric volume, while they are under anesthesia.  One study has shown that after patients have the ESG, they require 59% fewer calories to achieve maximum fullness.  Along with a healthy diet and regular exercise, early results have been promising.  Patients can typically have this procedure done on an outpatient basis and be back to work in about a week.

ESG

Endoscopic Sleeve Gastroplasty-ESG

Dr. Pitt performed the first ESG in the state of Ohio in August of 2017 at JourneyLite, and he already has dozens more patients who are scheduled for consultations.  “The field of weight loss surgery is always evolving towards less invasive procedures” says Dr. Pitt, “and this new option can offer patients a much more durable tool to control their weight than any of the non-surgical methods we have seen in the past.”  His first patient, a 35-year-old female with a BMI around 31, wanted to lose weight for two reasons:  to improve her health and prevent future disease such as diabetes, and to look and feel her best for her wedding 6 months down the road.  “This is the perfect kind of patient for an ESG” says Pitt, “one with a lower BMI who is motivated to make lasting changes in both diet and lifestyle.”

Dr. Pitt is optomistic about the future of ESG, but acknowledges that long-term studies need to be done before doctors can truly know how this will fit into the treatment of obesity.  “Until we have those results” Pitt says, “we have to select the best patients who are most likely to be successful with an ESG and are aware of the fact that this is a new procedure that is not yet time-tested.”

For more information on Dr. Tracy Pitt, the ESG, and JourneyLite, visit JourneyLite.com

Sebastian Stomache'

To schedule a live or virtual ESG consult with Dr. Tracy Pitt click here!

(Note: Patients who have already had bariatric surgery are not candidates for the procedure.  Also, ESG is not covered by insurance, but may be eligible for HSA/FLEX healthcare accounts.)

 

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Support Group 7/26/17: High Protein Recipes

We had many requests for the high protein recipes and cookbook from our recent support group by dietitian Parul Kothari.  As any successful surgical weight loss patient can attest, a high-protein/low-carb diet is one of the keys to maximizing and maintaining weight loss after surgery.

Whether we are talking about a weight loss surgery such as gastric sleeve, gastric bypass, or gastric band OR a non-surgical weight loss procedure like gastric balloon or ESG, patients need to make a commitment to lifestyle changes to maintain success.  Unfortunately, we do not have any magic procedures or medications that will do all the work for us!

High-protein/low-carb diets and an active lifestyle are critically important pieces of a complex puzzle that can lead to life-changing, life-long weight loss if you are willing to put the work in!

Download Parul’s recipes and cookbook here:

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Support Group Cookbook 7/26/17 2.31 MB 313 downloads

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Type 2 Diabetes & Medicare?

Glucometer for Diabetics

High blood sugar!

Type 2 diabetes is a growing epidemic worldwide and the CDC says 29 million Americans have diabetes, and 1 in 3 are pre-diabetic.   Type 2 diabetes is so often associated with obesity tha a new term has been coined by the medical community known as diabesity.

It’s estimated that 1 in 4 patients over the age of 65 now have diabetes , and it’s on the rise.  This is most likely one of the reasons that The Centers for Medicare and Medicaid Services started covering weight loss surgery for Medicare recipients nearly a decade ago, as it has been shown to have a very high rate of diabetes resolution or remission.

Gastric bypass, gastric sleeve, and even the Lap Band have all been shown to put diabetes into remission in a very high percentage of patients.  In fact, type 2 diabetes is becoming one of the major reasons patients are seeking weight loss surgery.  As these procedures are now minimally invasive and carry much lower risk than in the past, it is possible for a patient to have an outpatient operation and have a very good chance of eliminating type 2 diabetes.

Most insurance companies that cover weight loss surgery, including Medicare, have certain criteria that a patient must meet in order to be eligible for weight loss surgery.  Typically, patients must have a BMI of 35-40 with a weight related medical issue like diabetes, or just have a BMI over 40 even if no weight related issues are present.  Weight loss surgery shouldn’t be a patient’s first attempt at losing weight either, so a past history of failed diets is usually a pre-requisite also.

If you have Type 2 diabetes and have a BMI over 35, there is an excellent chance that a surgical weight loss procedure can transform your health by putting your diabetes into remission  Call us or make an appointment to find out if you might be a candidate!

 

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Endoscopic Sleeve Gastroplasty (ESG) – A New Incisionless Weight Loss Procedure

ESG is a new procedure that allows physicians to reduce the volume of the stomach without removing any of it, and without making any incisions.  The procedure is most commonly associated with the Overstitch device from Apollo EndoSurgery.  This device is used in combination with an endoscope, while the patient is sedated, to go down through the mouth and place sutures inside the stomach.  Unlike similar devices that have been used in the past, the Overstitch allows for much more secure “full-thickness” sutures to be placed.  This results in more durable sutures that are less likely to pull through in time.

ESG

Endoscopic Sleeve Gastroplasty-ESG

The image above shows how these endoscopic sutures are placed to “tuck” the stomach in on itself, which results in a more narrow diameter and a shorter overall length of stomach.  The result is smaller portion sizes.  As with any weight loss procedure though, long term succes relies on healthy eating habits, regular exercise, and long term follow up.

The procedure is done under sedation in an endoscopy suite on an outpatient basis.  Patients are typically back to work in a few days and diet is advanced slowly from liquids to pureeed, then finally soft solid foods.

Short-term results of the ESG have shown that the weight loss for this procedure lies somewhere between that of gastric band and gastric sleeve.  At this point it is thought to be best utilized on lower BMI patients, in the 30-40 range.

As with any new weight loss procedure, we still await long-term data before we can say definitively that the lost pounds will stay off forever, but preliminary data is encouraging and it is always good to have new non-surgical treatments for the disease of obesity.

See more in this video on the ESG Procedure:

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