30 August 2008

Herb for Losing Weight : Beneficial or Harmful?

Thermogenic Herbs
Thermogenic herbs (most classified as stimulants) contain substances like caffeine that speed up body functions like heart rate, digestion, and respiration. Their effects may get you up off the couch and keep you moving. Some thremogenic herbs like green tea, nettle, and dandelion are safe as, or safer, than prescription and over the counter weight loss drugs. Other herbs act as diuretics (water reducers) by causing water weight loss. Buchu and uva-ursi rid your body of excess fluid, but weight returns quickly when the herb is halted. Even though some can be very beneficial, others can be potentially dangerous and even toxic.

Danger Herbs!!
It should be noted that the FDA (Food and Drug Commission) has linked the following to cause serious side effects and even death.
  • Ephedra - Also known as ma huang, in high doses can raise blood pressure, increase heart rate, and over stimulate the central nervous system. The FDA reports more than 800 reports of side effects linked with the use of ephedra, including heart palpitations, seizures, stroke, chest pain, and heart attack. This herb has caused at least two deaths.
  • Herbal Laxatives - Usually sold as a diet tea, cascara, senna, buckthorn, aloe and rhubarb root. These herbs can cause cramping, diarrhea, and if overused, could cause your bowels to no longer function without laxative stimulation.
  • Herbal fen-phen - Ephedra is the main ingredient in the version of the dangerous diet drug known as fen fen. Herbal fen-phen has not been shown to even work in clinical trials, buy we know its misuse is associated with sever side effects, from heartbeat irregularities to death from heart attack and stroke.
Which one is Safe?
  • Green Tea - This tea is a natural stimulant that behaves much like coffee but with the added benefit of vitamin C and flavoniods (compounds that are antioxidants). You can regulate the strength of the stimulant by steeping the tea quickly or for a long time. It can be purchased in a tea bag, or loose. It also is available in capsules, but is said to be better assimilated as a liquid.
  • Cayenne - If you aren't plagued by spicy food, try sprinkling a dash of cayenne on your food. It contains an ingredient called capsaicin that stimulates saliva, stimulates digestion and accelerates your metabolism at a safer level.
  • Seaweed - A good source of trace minerals such as chromium and iodine, seaweed is a natural thyroid stimulant. It is usually contained in kelp capsules or tablets., Check with a doctor before taking kelp or seaweed, if you suspect your weight problem is due to a thyroid problem, or if currently take any thyroid medication
Remember! Health is very important and herbal remedies should be viewed with the same precaution as taking any medication. If you want to make herbs a part of your health regime, you should research and thoroughly investigate all our earth has to offer!

How Often Should I Eat?

Most people can eat 3 regular meals and 1 snack every day. The 3 meals should be about the same size and should be low in fat. Try to eat 1 to 2 cups of fruits and vegetables, 2 to 3 ounces of whole grains and 1 to 2 ounces of meat (or a meat alternative) at most meals.

Some people benefit more if they eat 5 to 6 smaller meals throughout the day, about 2 to 3 hours apart. For example, their first meal of the day might be a cup of low-fat or nonfat yogurt and a banana. Three hours later they might eat a simple deli sandwich with whole-grain bread and fat-free mayonnaise.

Do not skip meals. While this may help you lose weight in the beginning, it fails in the long run. Skipping meals may make you feel too hungry later in the day, causing you to overeat at your next meal.

After about a month of eating a normal breakfast, lunch and a light dinner, your body will adjust.

What is a 2-Stage Operation?

Certain patients may have a body shape that makes their surgery more technically difficult. For example, patients with a BMI over 60 -- particularly those who carry their weight in their belly area -- may be at increased risk for bariatric surgery. If you fall into this category, you may benefit from a 2-Stage bariatric surgery.

In the staged approach, a multi-step operation like the gastric bypass or the duodenal switch is broken down into 2 simpler and safer operations. In the first stage, a sleeve gastrectomy is performed. This allows losing 80 to 100 pounds or more, which will make the second part of the operation substantially safer.

The second stage operation is usually performed 8 to 12 months after the first. The "sleeve" stomach is converted into a formal gastric bypass or duodenal switch. This will permit additional weight loss and will provide a much more permanent result than sleeve gastrectomy alone.

Both stages of the surgery can be performed laparoscopically, giving the advantage of shorter recovery, shorter incisions, fewer incision-related problems and less pain.

27 August 2008

Gastric Electrical Stimulation – Does it Suitable for Weight Loss?

Gastric electrical stimulation is performed using an implantable device designed to treat chronic drug-refractory nausea and vomiting secondary to gastroparesis of diabetic or idiopathic etiology. Gastric electrical stimulation is also proposed as a treatment of obesity.

Currently, there is only one gastric electrical stimulator that has received approval from the U.S. Food and Drug Administration (FDA) The EnterraTM Therapy System (formerly named Gastric Electrical Stimulation (GES) System) manufactured by Medtronic is approved for treatment of chronic refractory gastroparesis. No gastric stimulation device is FDA approved for treatment of obesity. The GES system consists of four components :
  1. The implanted pulse generator
  2. Two unipolar intramuscular stomach leads
  3. The stimulator programmer
  4. The memory cartridge
With the exception of the intramuscular leads, all other components have been used in other implantable neurological stimulators, such as spinal cord or sacral nerve stimulators. The intramuscular stomach leads are implanted on the greater curvature of the stomach either laparoscopically or during a laparotomy and are connected to the pulse generator that is implanted in a subcutaneous pocket. The programmer sets the stimulation parameters, which are typically set at an on time of 0.1-sec alternating with an off time of 5.0 sec.

Gastroparesis is a chronic disorder of gastric motility characterized by delayed emptying of a solid meal. Symptoms include bloating, distension, nausea, and vomiting. When severe and chronic, gastroparesis can be associated with dehydration, poor nutritional status, and poor glycemic control in diabetics. While most commonly associated with diabetes, gastroparesis is also found in chronic pseudo-obstruction, connective tissue disorders, Parkinson disease, and psychological pathology. Treatment of gastroparesis includes prokinetic agents such as metoclopramide, and antiemetic agents such as metoclopramide, granisetron, or odansetron. Severe cases may require enteral or total parenteral nutrition.

Gastric electrical stimulation has also been investigated as a treatment of obesity as a technique to increase a feeling of satiety with subsequent reduced food intake and weight loss. The exact mechanisms resulting in changes in eating behavior are uncertain but may be related to neuro-hormonal modulation and/or stomach muscle stimulation. There are no gastric electrical stimulation devices approved by the FDA for the treatment of obesity. However, the Transcend® implantable gastric stimulation device, manufactured by Transneuronix Corporation, is currently available in Europe for treatment of obesity. Transneuronix is currently funding clinical trials in the United States and hopes to obtain FDA approval in a couple of years for use of the Transcend® device to promote weight loss in the management of obesity.

Policy/Criteria
  1. Gastric electrical stimulation may be considered medically necessary in the treatment of chronic intractable nausea and vomiting secondary to gastroparesis of diabetic or idiopathic etiology when all three of the following criteria are met :
    • Significantly delayed gastric emptying as documented by standard scintigraphic imaging of solid food
    • Patient is refractory or intolerant of two out of three classes of prokinetic medications and two out of three antiemetic medications. (see appendix for classes)
    • Patient's nutritional status is sufficiently low that total parenteral nutrition is medically necessary as defined in Regence Allied Health Policy, No. 6: Parenteral Nutrition; Home and Intradialytic
  2. Gastric electrical stimulation is investigational for all other indications including but not limited to the treatment of obesity.

Gastric Stimulation for the Treatment of Obesity

Gastric electrical stimulation is also proposed as a method of weight reduction in morbidly obese individuals. Gastric stimulation may make patients feel full with less food. Small clinical trials have reported positive outcomes in weight loss and maintenance of weight loss along with minimal complications. However, due to lack of long term outcomes from well-designed randomized clinical trials, conclusions cannot be made concerning the safety and efficacy of chronic gastric stimulation in morbidly obese individuals. No gastric electrical stimulation devices have received FDA approval for treatment of obesity.

Vertical Sleeve Gastrectomy Risks and Complications

As with all forms of weight loss surgery, the vertical gastrectomy does carry risk and these will clearly vary from one patient to the next and must be discussed with physician. Because the procedure requires stapling of the stomach patients do run the risk of leakage and of other complications directly related to stapling. Complications might include:
  • Gastric leakage and fistula 1.0%
  • small bowel obstruction 1.5%
  • Deep vein thrombosis 0.5%
  • Non-fatal pulmonary embolus 0.5%
  • Post-operative bleeding 0.5%
  • Splenectomy 0.5%
  • Acute respiratory distress 0.25%
  • Pneumonia 0.2%
  • Death 0.25%
The risk of encountering any of these complications is however extremely small and varies from about 0.5 and 1%. Having said this, the risk of death from this form of surgery at about 0 .25% is extremely small.

The Candidates for Vertical Sleeve Gastrectomy

Surgery for high BMI patients.
  1. For patients with a particularly high body mass index (typically 50+) many forms of weight loss surgery are either difficult to perform or present increased risk.
  2. Vertical sleeve gastrectomy (or increasingly a laparoscopic sleeve gastrectomy) is sometimes performed as the first of a two-part weight loss solution to provide an initial drop in weight which then makes other bariatric follow up possible at a reduced level of risk.
Surgery for low BMI patients.
  1. For obese patients with a relatively low body mass index the vertical sleeve gastrectomy can also prove a good choice, especially where existing conditions (such as anemia or Crohn's disease) prevent them from having other forms of bariatric surgery.
  2. In addition, patients may choose this form of surgery if they are concerned about the long-term affects of bypass surgery or object to having a 'foreign' body implanted into their body, as is the case with lap band surgery.

Advantages and Disadvantages of the Sleeve Gastrectomy

Advantages of the sleeve gastrectomy:
  • Although the stomach is reduced in size and the amount of food which can be eaten is restricted, the stomach otherwise functions normally.
  • The major part of the stomach which produces hormones responsible for stimulating hunger is removed from the digestive system.
  • The problem of dumping is avoided as the pylorus is retained.
  • Minimizes the possibility of the patient developing ulcers.
  • Avoids the problems associated with bypass forms of weight loss surgery including anemia, intestinal obstruction or blockage, osteoporosis and protein and vitamin deficiency.
  • Provides a solution for patients with conditions which place them at an unacceptably high risk from other forms of bariatric surgery.
  • Provides a laparoscopic solution to patients with a particularly high body mass index (BMI).
Disadvantages of the sleeve gastrectomy:
  • ·As this form of surgery does not provide any element of gastric bypass some patients may experience a disappointing weight loss or weight regain.
  • High BMI patients will often require follow-up weight loss surgery to achieve their goal. Although this may be seen as a disadvantage by some patients, in many cases, this two procedure option not only produces the results that the patient wants but may also provide a lower overall risk for the patient. This is something which need to de discussed with your physician.
  • Patients can slow weight loss if they do not stick to a strict diet following this form of surgery.
  • Complications may occur as the result of stomach stapling.
  • The procedure is not reversible as part of the stomach is permanently removed. It should be remembered though that the sleeve gastrectomy can be extended at a later date if required by performing additional bypass surgery.

Vertical Sleeve Gastrectomy Benefits and Outcomes

This procedure is considered a starting point for people who are so obese that they are not candidates for gastric bypass surgeries like Roux-en-Y or biliopancreatic diversion. For patients who are too heavy for gastric bypass and unable to lose enough weight to become a candidate, this surgery provides an opportunity to lose enough weight to have a more radical surgery done once their body size will allow it.
  • Does not involve any bypass of the intestinal tract
  • Patients don not therefore suffer the complications of intestinal bypass such as intestinal obstruction, anemia, osteoporosis, vitamin deficiency and protein deficiency
  • It also makes it a suitable form of surgery for patients who are already suffering from anemia, Crohn's disease and a variety of other conditions that would place them at high risk for surgery involving intestinal bypass.
  • It is a technically simpler operation than the gastric bypass or the duodenal switch
  • It may be a safer operation for some patients with a BMI more than 60.
  • It may be used as the first stage of a 2-stage operation.
  • Most patients can expect to lose 30 to 50% of their excess body weight over a 6 - 12 month period with the sleeve gastrectomy alone. The timing of the second procedure will vary according to the degree of weight loss, typically 6 - 18 months.

26 August 2008

The Vertical Sleeve Gastrectomy Procedures

The surgery is typically performed in a hospital or a surgery center, using general anesthesia. Surgeries are performed laparoscopically, which allows the surgeon to work using long instruments placed in the body via incisions a few centimeters long. In some cases, the surgery will performed “open,” with the larger traditional incision, or a surgery that begins laparoscopically may be converted to the open procedure when the surgeon determines it is necessary.

The surgery begins with multiple half-inch long incisions in the area of the stomach. The instruments are inserted through these incisions, and the surgeon begins by removing up to 85% of the stomach. The sides of the stomach are then joined by staples, leaving the stomach smaller and tubular in shape, but retaining the sphincter muscles at the top and the bottom of the stomach.

Once the surgeon determines that the staples are holding the stomach closed and no areas are leaking, the instruments are withdrawn and the incisions are closed, typically absorbable sutures and sterile tape.

What is Sleeve Gastrectomy Surgery?

Other names: vertical sleeve gastrectomy, sleeve gastrectomy, greater curvature gastrectomy, parietal gastrectomy, gastric reduction and vertical gastroplasty.

The vertical gastrectomy, or sleeve gastrectomy, is a type of restrictive weight loss surgery. Vertical gastrectomy surgery causes weight loss by restricting the amount of food that is able to be consumed before feeling full. This procedure is usually performed on superobese or high risk patients with the intention of performing another surgery at a later time.

It can be used as a primary weight loss operation or as a first-stage operation in a 2-stage approach in patients who are extremely obese and may carry significant risks to undergo a one step definitive surgical approach.

The vertical sleeve gastrectomy is a restrictive form of weight loss surgery in which approximately 70-80% of the stomach is removed laparoscopically leaving a cylindrical or sleeve shaped stomach vertically from top to bottom with a capacity ranging from about 60 to 150 cc, depending upon the surgeon performing the procedure.

The stomach still functions as normal, but is much smaller so that people who have this operation must make radical changes in his food intake and lifestyle in order for the procedure to have a successful long-term outcome. Because the stomach has the ability to stretch to accommodate food, the stomach can expand greatly from the one-ounce capacity the surgery allows for. Meals should be small (less than half a cup) and drinking fluids with meals can fill the pouch, preventing the intake of solid food at that time.

The operation is usually done by keyhole surgery and requires a 1-2 night stay in hospital. Most people lose 30-50 percent of their excess weight in the first 12 months. This operation is sometimes carried out as the first step in a two-part procedure for extremely obese people with a BMI of 60 or more, where other procedures are more risky to them. After 12 to 18 months of receiving a sleeve gastrectomy, these people may then go on to have a gastric bypass or duodenal switch.

The Biliopancreatic Diversion - Duodenal Switch (BPD-DS)

The BPD-DS
The biliopancreatic diversion with duodenal switch goes by many names. The National Institutes of Health refers to the procedure as an "extensive gastric bypass with duodenal switch." While less commonly performed than the gastric bypass, this operation has received a great deal of attention recently, particularly on the internet, because it provides excellent weight loss while allowing you to eat larger portions than a gastric bypass.

The BPD/DS combines restrictive and malabsorptive elements to achieve and maintain the best reported long-term percentage of excess weight loss among modern weight-loss surgery procedures.

In the BPD/DS, roughly one half of the stomach is permanently removed. The stomach goes from the shape of a small pineapple to the size and shape of a banana. The pylorus, which is the valve at the outlet of the stomach, remains intact. The stomach is then connected to the last 250 centimeters (8 feet) of small intestine. The remainder of the small intestine is connected 100 centimeters from the end of the small bowel, forming the common channel, where food mixes with the digestive enzymes.

Unlike the unmodified BPD and RNY, which both employ a gastric “pouch” and bypass the pyloric valve, the DS procedure keeps the pyloric valve intact. This eliminates the possibility of dumping syndrome, marginal ulcers, stoma closures and blockages, all of which can occur after other gastric bypass procedures. The DS procedure keeps a portion of the duodenum in the food stream. The preservation of the pylorus/duodenum pathway means that food is digested normally (to an optimally absorbable consistency) in the stomach before being excreted by the pylorus into the small intestine. As a result, the DS procedure enables more-normal absorption of many nutrients (including protein, calcium, iron and vitamin B12) than is seen after other gastric bypass procedures.

The BPD-DS Major Advantages
  • The pylorus remains intact: this usually keeps dumping syndrome from occurring after surgery (although you may have different dietary restrictions)
  • Since the stomach pouch is larger than with other bariatric operations, you can eat larger portions than with the gastric bypass or LAP-BAND®.

Living with the BPD-DS
It is necessary to take a number of nutritional supplements after the operation than after gastric bypass. These include:
  • Multivitamins (usually twice per day)
  • Iron supplements (usually twice per day)
  • Calcium (usually twice per day)
  • ADEKs (fat-soluble vitamins) usually 3 times per day

Side Effect of BPD-DS
Additionally, there are some very significant side effects that accompany this procedure, including:
  • Frequent soft bowel movements (up to 4-6 per day)
  • Frequent passing of foul-smelling gas
  • Change in body odor
  • Gas pains and bloating
  • Hair loss
  • ntolerance of certain foods (varies from person to person)

The Risks of the Implantable Gastric Stimulator

  • Nausea and/or vomiting
  • Approximately 20% of the individuals who are implanted with the hunger reducing pacemaker require further surgery to correct complications that develop with the gastric stimulator.
  • About 30% of the individuals who are implanted with the hunger reducing pacemaker develop nutritional-related deficiencies as the vitamins, minerals and calories in foods that are normally absorbed by the body suddenly have limited absorption powers.

25 August 2008

What is Implantable Gastric Stimulator

Implantable Gastric Stimulator Is a method that provide an alternative to more invasive and induces satiety, while avoiding the morbidity and the mortality of the common restrictive, malabsorptive or combination restrictive/malabsorptive operations. Surgical procedures for treating morbid obesity The procedure does not alter the normal anatomy.

The procedure involves implanting two electrodes into the wall of the stomach via keyhole surgery. These are then attached to a small battery powered stimulator that’s inserted beneath the skin to the side of the stomach. The stimulator sends out programmed electrical pulses to the electrodes, which in turn stimulate the stomach to send messages to the brain to induce feelings of fullness.

The lead is implanted in a laparoscopic procedure with 2 - 4 trocars used during the implantation: one for the camera, two for operating ports and one (optional) for liver retraction. The IGS is placed in a subcutaneous pocket in the abdomen. The regular surgery time is less than one hour.

The implanted pulse generator delivers electrical pulses to the stimulation lead. The lead conducts the pulses to the smooth muscle of the stomach. The external programmer can noninvasively communicate with the implanted pulse generator and allows the electrical parameters to be adjusted. The programmer consists of a computer connected to a small programming wand. It is used to check and, if necessary, change electrical values of the IGS before and after implantation. Communication is accomplished noninvasively via radio frequency signals.

Initial trials reveal that 80 percent of people lost weight after having the device implanted, with 60 percent losing more than 10 percent of their body weight over 29 months.

How Does the Hunger Reducer Pacemaker Work?
Via electrical stimulation, appetite is suppressed by the implantable gastric stimulator. In turn, the patient experiences a feeling of fullness thus curtailing food intake, thus achieving weight loss.

What is the Surgical Procedure for the Implantable Gastric Stimulator?
The hunger reducer pacemaker can be implanted in about an hour and may be performed on an outpatient basis for most individuals.

What does the Procedure for Implantable Gastric Stimulator cost?
About $15,000. The gastric stimulator pacemaker is expected to be reviewed by the FDA in about 2 years and should be available shortly thereafter if approved.

When is a Gastric Balloon Not Suitable For Me?

In some cases a gastric balloon is not a suitable option due to a current or past medical or surgical condition, or because of long-term treatment with certain classes of drugs. The following list is not comprehensive, but lists the most important potential contra-indications.
  1. A large hiatus hernia
  2. Previous anti-obesity surgery such as gastric banding or bypass
  3. Previous upper gastrointestinal surgery of any kind
  4. Strictures (narrowing) of the oesophagus (gullet)
  5. Inflammatory disease of the upper gastrointestinal tract
  6. Currently under treatment for cancer
  7. Conditions or drugs that predispose you to bleeding
  8. Long-term treatment with certain drugs, such as aspirin and non-steroidal
  9. Anti-inflammatory drugs (NSAIDs)
  10. Long term steroid therapy
  11. Severe heart, kidney, liver or lung disease.
  12. Certain psychiatric disorders
  13. History of alcoholism or drug addiction
  14. Women who are pregnant or breast-feeding

The Risks of Gastric Balloon Implants

The procedure itself is simple, and serious complications are uncommon. In the scientific literature reported complications include:

If the Gastric Balloon ruptured it will usually pass through the bowel and be expelled quite naturally. However, in rare cases it may cause intestinal obstruction (blockage of the bowel). If this occurs, surgical or endoscopic removal would be required

Bleeding or perforation of the oesophagus or stomach could occur during the balloon insertion or removal, requiring surgical correction

Gastric discomfort like nausea and vomiting are common for the first few days following balloon placement. A feeling of heaviness in the abdomen, abdominal or back pain, gastro–oesophageal reflux or indigestion have also been reported.

In one of the largest published studies of the gastric balloon 1 involving 2,515 patients, the authors reported the following:

Implanting the BIB was uneventful in 99.9% of cases Overall complication rate was 2.8%, consisting of:
  1. Gastric perforation in 5 (0.19%) cases
  2. Rupture of the balloon in 9 (0.36%)
  3. Inflammation of the oesophagus occurred in 32 (1.27%)
  4. Gastric obstructions in 19 (0.76%)
  5. Gastric ulcer in 5 (0.2%)
  6. There were only 2 (0.08%) deaths
These results confirm that the balloon is a very safe intervention for the overwhelming majority of patients.

Who is the Candidate for Gastric Balloon Implant?

A gastric balloon is ideal for patients who have tried many alternative ways to lose weight, but would prefer to avoid surgery.

Many people have tried a wide variety of diets and weight-loss programmes without success, but are not willing to consider a surgical intervention. If you are one of these people, you are probably feeling trapped. If yourself in this position, the gastric balloon may be a safe and effective option for you.

There are three groups of patients who may benefit from the BIB.

1.) BMI 28-30 Kg/m2
If your BMI is only 28-30kg/m2 you are not suitable for surgical treatment with a gastric band or bypass. However Gastric Balloon implant may be an excellent alternative. In practical terms it lies midway between a conventional weight-loss programme and a true surgical intervention. It is clearly something more than a diet, but at the same time it falls well short of being a surgical procedure. It facilitates rapid weight loss safely and effectively, without the risk of general anaesthesia.

2.) BMI greater than 30kg/m2
If you have a BMI above 30 kg/m2 and you have decided against the usual surgical options for which you may be eligible (gastric band, bypass etc), the Gastric Balloon may be an acceptable and effective alternative. So if you definitely don’t want surgery but have reached the point where standard approaches to weight loss just don’t work, a gastric balloon might be the next step.

3.) BMI greater than 50kg/m2 and/or co-morbidities
If you have a major weight problem with a BMI above 50 kg/m2 and/or medical problems such as diabetes, heart and lung problems etc, you may not be suitable for standard weight-loss surgical procedures which involve general anaesthesia. In this case a Gastric Balloon may be a safe and effective first option. Losing weight with the gastric balloon will improve your physical functioning and reduce your anaesthetic risks, so that if you do then decide to go ahead and have a gastric band or a gastric bypass, the operative risks will be much less.

Gastric Balloon Aftercare

Even though a gastric balloon is not a surgical procedure, you do need to be very careful in the first couple of weeks following balloon insertion.
  1. For the first day or two you may experience nausea but this will pass.
  2. Some unfortunate people may feel queasy for slightly longer than this.
  3. Do persevere - as a Healthier Weight patient you are encouraged to call us at any time for advice and always have the 24 hour emergency helpline number for reassurance out of hours.
  4. You will be give clear instructions on what to eat and drink in the first two weeks.
  5. You will be encouraged to attend the Healthier Weight 8 week weight loss programme to learn new lifestyle tips to maintain your weight loss once the balloon is taken out.

Benefits of Gastric Balloon

The health benefits of the gastric balloon are :
  1. Those associated with any method of weight loss, including an improvement in diabetes, hypertension (raised blood pressure) and sleep apnoea.
  2. A major improvements in mobility and self-esteem.
  3. At the time of removal of the Gastric Balloon, average weight loss for the 100 patients in the study was 14 kg (40% excess weight). One year later, mean weight loss was 9 kg (27% of excess weight). A further study of 140 patients with a follow-up of up to 30 months, found that 40% of patients maintained a weight loss of 25% excess weight or above.
Taken together, these results are encouraging and serve to make the very important point that long-term success with the gastric balloon depends upon a genuine commitment to making - and sustaining - significant lifestyle changes.

How is the Balloon Implanted?

Placing the Silicon Ballon in the stomach is a simple procedure which will take approximately 20-30 minutes and which will be carried out under light sedation by a Consultant Gastroenterologist.
  1. The doctor passes a special endoscope (camera) through the mouth, down the oesophagus (gullet) and into the stomach.
  2. A preliminary examination of the stomach is carried out and, assuming there are no abnormalities, the Silicon Balloon will then be passed into the stomach.
  3. The balloon is made of a soft and pliable silicone elastomer material and is inserted while in its smallest, deflated form.
  4. The swallowing process is made easier with the help of some local anaesthetics to help numb the throat area. Muscle relaxing medications are also used.
  5. Once the gastric balloon is inside the stomach, it is immediately filled with sterile saline through a small filling tube (catheter) attached to the balloon.
  6. Once filled, the doctor removes the catheter by gently pulling on the external end.
  7. The balloon has a self-sealing valve, and at this point the balloon is floating freely in the stomach.
  8. At the same time, a special dye is introduced into the balloon which will cause your urine to change colour (usually green) in the very unlikely event that the balloon ruptured or developed a leak.
Because there is no general anaesthesia involved, you will normally be able to leave hospital after a few hours of observation.

What is Gastric Balloon Implant?

This is a short-term treatment that involves placing a deflated silicone balloon into the stomach through the mouth and gullet under sedation. Once in the stomach, the balloon is filled with sterile saline (salt water) and so partially fills the stomach to create a feeling of fullness. Because the balloon fills a significant portion of the stomach, it means that you have to stick to much smaller portion sizes, which means fewer calories.

Adjusting to the gastric balloon
For the first few days you will feel uncomfortable as your stomach adjusts to the presence of the BIB™. During this time you may experience nausea, vomiting, bloating and some cramping until your body adjusts. Thereafter your symptoms should decrease, allowing you to settle into your concentrated weight loss period of around 6 months.

How long does the balloon stay in?
The gastric balloon can stay in place for a maximum of 6 months, though most of the weight loss occurs in the first 4 months. At the end of the 6-month period, the balloon will be removed in a 20-minute procedure similar to that of the placement.

A gastric balloon is ideal for patients who have tried many alternative ways to lose weight, but would prefer to avoid surgery. It’s also a good option for people for whom surgical procedures to treat obesity may be inappropriate.

How much weight will I lose?
Patients who have the gastric balloon implanted can expect to lose around 25-45% of excess weight, which in most cases equates to around 30-50lbs (15-20kg)2,3 Heavier patients may lose substantially more than this.

Duodenal Switch Surgery for Weight Loss

This is a variation of the bilopancreatic diversion. A large portion of the stomach is removed by a sleeve gastrectomy.

Procedure
At the base of the stomach, a small section of the small intestine (the duodenum) is left behind, but the remainder is cut. The lower half of the small intestine is then joined to this small piece of remaining duodenum. As with the bilopancreatic diversion, bile and pancreatic juices are redirected to the lower part of the small intestine.

Duodenal switch preserves the outlet muscle that controls emptying of the stomach. It also offers the ability to eat larger portions than after gastric bypass or adjustable gastric banding and has reliable and long-lasting weight loss. Since this operation induces a state of decreased absorption, you may experience more bowel movements, and need to be closely monitored for vitamin, mineral and protein levels.

The operation can be performed by keyhole or regular surgery but it’s extremely complex and can take up to seven hours to complete, and requires 5-6 days in hospital.

Expected Weight Loss
Most patients can expect to lose 60 to 80 percent of their excess body weight over a 2-year period.

Risk
the most risky operations with 1 in 100 people dying from surgery.
It also has unpleasant side effects including wind and diarrhoea caused by the malabsorption of fat, although eating a low-fat diet can help to limit this.

Nutrient deficiencies, including protein, iron, zinc, and the fat-soluble vitamins A, D, E and K, are also more likely and can lead to severe malnutrition. Supplements therefore need to be taken for the rest of life, together with a diet that contains twice as much protein as normal.

Call Your Surgeon Immediately! an Emergency After Weight Loss Surgery

Call your surgeon is an essential part of weight loss surgery, as the complications can be sudden and severe. In the weeks after surgery, you should call your weight loss surgeon immediately if you:
  • Develop a fever over 101 degrees
  • Have uncontrollable pain
  • Cannot keep fluids down
  • Feel short of breath or have difficulty breathing
  • Have dark or tarry (bloody) stools
  • Begin to bruise far more easily than before
  • Your incisions begin to leak pus or bleed heavily
If you are unable to notify your surgeon, it is important to seek emergency care. As the intake nurse and doctor treating you will not be as familiar with your condition as your surgeon, it is essential that you explain that you are a bariatric patient, what symptoms you are experiencing, what procedure you had and when you had it. You should also offer your surgeon's name and request that he or she be notified or your condition immediately.

Bariatric Surgery : Cost, Payment and Insurance

While the choice to undergo weight loss surgery is an important medical decision, for many, it is a significant financial decision as well. Because weight loss surgery can cost patients thousands of dollars, many insurance companies and financial lenders offer assistance to help make payment more manageable.

The Cost of Weight Loss Surgery
The cost of weight loss surgery varies from surgeon to surgeon. It can range from $15,000 to over $40,000, if the surgery is successful and there are no complications.. The process is typically initiated when you have your initial consultation with your surgeon.
The cost of surgery includes the following fees:
  • Hospital fees
  • Surgeon fees
  • Anesthesia fees
  • Lab and X-ray fees
  • Miscellaneous fees
If you are paying for weight loss surgery yourself, be aware that the surgeon’s fees are only a portion of the total cost. There are additional fees for blood tests, X-rays, anesthesia, nursing care, medications and many other types of care.

Convincing insurance companies that bariatric surgery is medically necessary is likely to be the biggest hurdle patients face. It is important that patients understand the insurance approval process and play an active role in pursuing coverage for the cost of bariatric surgery.

Bariatric Surgery and Insurance
In many states, there are laws in place that require insurance companies to provide benefits for weight loss surgery when a patient meets the National Institutes of Health (NIH) criteria. However, obesity surgery patients should still prepare themselves for what is commonly a long and complicated approval process. The best chance for obtaining insurance coverage for the cost of LAP-BAND and gastric bypass surgery comes from working diligently in cooperation with your bariatric surgeon and other experts.

The Insurance Approval Process
There several helpful things that you can do to smooth along the insurance approval process. Following the steps below may be able to increase your chances of being approved for obesity surgery coverage.

It is important that you read and understand your insurance company's "certificate of coverage." You can get it from your insurance company directly or from your employer's benefits contract.
  • Get an obesity surgery referral from your doctor. You must have your doctor's full support.
  • Save all of your receipts and always keep accurate, detailed records.
  • Carefully document each visit you make to doctors and other healthcare professionals for obesity-related issues. In addition to doctor's appointments, this includes visits to diet centers, fitness clubs, and weight loss programs.
The Insurance Authorization Process
The lengthy authorization process will begin when your bariatric surgeon sends your primary care physician a letter asking him or her to verify the "medical necessity" of your surgery for obesity. Your doctor can establish this by proving that any of the following apply to you:
  • You are morbidly obese with a BMI (body mass index) of 40 or higher
  • You have suffered from morbid obesity for at least the past five years
  • You have attempted, under your physician's care, other methods of weight loss for at least two years
  • You have co-morbidities – such as hypertension, diabetes, sleep apnea, degenerative arthritis, and heart disease – that constitute medical necessity for obesity surgery
  • You do not have major psychiatric or emotional problems
Any of the following that apply to you should also be mentioned :
  • You have significant liver, kidney, or gastrointestinal disease
  • You have a history of alcohol or substance abuse
  • A thyroid test has been ordered and results will be sent to your surgeon
The Appeals Process
Even if your pre-authorization for obesity surgery coverage is denied by your insurance company, there is still a chance that you can receive full or partial coverage for the cost of your bariatric surgery through the appeals process. During the appeals process, you may contest each reason your insurance company has given for denying coverage. It is critical that you submit your appeal quickly in order to have the best chances for a successful outcome. In some instances it may be helpful to employ the services of an insurance advocate or lawyer to help you effectively navigate the appeals process. Your insurance company may limit the number of times that you can appeal for weight loss surgery coverage, so make sure that you understand the guidelines set in your "certificate of coverage."

Financing Can Help Cover Weight Loss Surgery Costs
If you have gone through the approval, authorization, and appeals process and are still unable to get insurance to cover the cost of bariatric surgery, you still have options. Many financial lenders offer financing to help make payment for weight loss surgery easier on patients. Financing is also an option for those with benefits that only cover part of the cost of their gastric bypass or LAP-BAND® surgery. Many surgeons understand that weight loss surgery is a high cost procedure that yields beneficial life-changing results, so they are often willing to assist patients by providing information on available financing programs and payment plans.

23 August 2008

Weight Loss Surgery Risks

It is essential that you consider the risks that accompany the procedure. Some potential risks are minor and are resolved soon after the weight is lost, while others can be more serious and/or long-term.

In addition to the general risks of surgery that apply to patients undergoing any surgical procedure, there are additional concerns that those considering weight loss surgery need to be particularly aware of.

Anemia
Common with all types of malabsorptive surgeries, which decrease the body's ability to absorb nutrients, anemia is a deficiency of hemoglobin caused by iron deficiency. This can typically be managed with supplements.

Osteoporosis and Bone Degeneration
Calcium deficiency is another risk of malabsorptive procedures. Too little calcium can cause weak and brittle bones and stooped or "humped" back posture. When caught early, supplements can manage the deficiency and help head off serious problems. Medication may be required if the condition progresses.

Malnutrition
Vitamin and mineral deficiencies from weight loss surgery can cause malnutrition. Low levels of vitamins and minerals can happen very quickly in patients who have had malabsorptive surgeries that limit the digestion of food. Supplements are typically an adequate defense.

Excess Skin
When significant amounts of weight are lost, skin may begin to hang off of the body. This is because skin loses its elasticity when stretched and cannot spring back after significant weight loss.

Dumping Syndrome
When patients who have had a gastric bypass procedure, specifically Roux-en-Y, eat too much or consume a meal high in sugar, the stomach contents rapidly “dump” into the small intestine. This causes cold sweats, diarrhea and feelings of faintness. The symptoms are distressing, though not life-threatening, and they typically improve within a few hours. Eliminating or decreasing sugar intake and eating smaller meals can prevent dumping syndrome.

Erosion
When a surgery introduces a foreign object into the body, one runs the risk that that object may wear away healthy tissue, causing damage. This can occur, for example, when someone eats an excessively large meal after weight loss surgery, or when a gastric band is fitted too tightly.

Spleen Injury
In rare cases, the spleen must be removed during weight loss surgery to control bleeding, a procedure called a splenectomy. In some cases, the spleen can also be injured during surgery due to its close proximity to the structures being operated on, though it does not need to be removed.

Suture Line Disruption (SLD) When there is an interruption in an area that is stapled or sutured in the digestive tract, known as an SLD, food can pass into areas that are no longer intended for food. For example, if part of the stomach is stapled to prevent food from entering a section of the stomach, but the staples do not actually prevent food from entering, food becomes trapped; the area it's resting in no longer moves food into the rest of the digestive tract. Severe abdominal pain, infection, abscess and local and body-wide infections can result. SLD is a life-threatening condition.

Hernia
A hernia occurs when an organ begins to protrude through a weakened area of muscle. Any type of abdominal surgery can weaken the muscle walls enclosing the abdomen, but as many as one out of every five weight loss surgery patients requires a second surgery to fix a complication such as a hernia, especially at incision sites.

Long-term Nausea and Inability to Tolerate Food
In some instances, weight loss surgery can work too well, leaving patients unable to tolerate eating without experiencing symptoms ranging from severe nausea to vomiting. The food intolerance may be so severe that the patient must be hospitalized.

Migration
With band surgeries, the band can shift out of position, decreasing or eliminating the effectiveness of the band.

Narrowing of Stomach Outlet (Stenosis)
After bariatric surgery, scarring of the area where food leaves the stomach can occur, causing it to narrow and restrict the flow of food. In serious cases, where the narrowing causes severe vomiting and inhibits digestion, an outpatient procedure is necessary to enlarge the area.

Leaking
After weight loss surgery, it is possible for the suture or staple lines created during the surgery to leak. The most common type of leak can cause stomach contents (including digestive acid) to seep into the abdominal cavity. Leaks require additional surgery to repair and, depending on the severity of the leak, may be considered an emergency.

Ulcers
An ulcer occurs when the area of the stomach that has been cut during surgery erodes when exposed to stomach acid. Many surgeons prescribe medication to prevent stomach acid from harming the tissue.

Gallstones
As many as one in three patients develops gallstones after having weight loss surgery. Rapid weight loss and low calorie intake are risk factors for gallstones, and both of those conditions are met in the weeks immediately after surgery when patients are eating tiny meals as they adjust to their new stomach size. Gallstones can be minimized with medication prescribed by your surgeon.

Constipation
The abrupt and major change in eating habits can leave many patients constipated after surgery. In addition to the discomfort, the “bearing down” that is done when trying to have a bowel movement can cause extreme stress on incisions that are healing. Your surgeon should have recommendations for treatment; over-the-counter treatment is not recommended.

Bariatric Surgery Preparations

The decision for bariatric surgery will changes your lifestyle dramatically for years to come. When you choose to undergo gastric bypass, gastric band, or other types of bariatric surgery, you will need to alter your exercise and diet regimen, both before and after your bariatric surgery operation.

Preoperative Preparations for Bariatric Surgery
Before undergoing any type of bariatric surgery, it is important that patients follow doctor's instructions closely and educate themselves on the risks and potential benefits of the procedure.
  • Understand the surgical process and what to expect afterwards
  • Talk to people who have had surgery for obesity
  • Start a journal about your experience
  • Get your family to write you a letter of support
All patients must undergo preoperative counseling before undergoing obesity surgery. This counseling will help you better understand that bariatric surgery is only one part of a multidisciplinary approach to weight loss. Rather, gastric bypass surgery patients will be required to make lifelong changes to their diet and exercise habits to ensure a lasting result after bariatric surgery.

Behavioral Therapy
A thorough psychological evaluation is a crucial part of every obesity surgery patient's surgical preparations. Once you have spoken with a doctor about the possibility of bariatric surgery, you will meet with a behaviorist trained in counseling bariatric patients.

In addition to asking about your reasons for desiring gastric bypass surgery, the behaviorist will also determine whether you are prepared to alter your diet and exercise plan before and after bariatric surgery. The patients with the highest rate of long-term success are those with a strong support system of family and friends who are willing to assist patients physically and emotionally.

Certain physical and psychological conditions can reduce the chance of bariatric surgery success. These conditions include :
  • Substance or alcohol abuse
  • Undiagnosed, untreated depression
  • Schizophrenia or other personality disorders
Evaluation by a behaviorist can uncover these conditions, allowing your doctors to treat them and giving you the best chance of success after bariatric surgery.

Physical Preparation for Obesity Surgery

Nutrition and Diet Therapy

Obesity surgery candidates should meet with a registered dietician on a regular basis to determine diet needs both before and after bariatric surgery. Caloric and nutrient needs should be determined based on medical history, actual weight, food preferences, and meal frequency. Individualized meal plans can then be customized to each patient's eating habits, lifestyle, budget, and nutritional needs.

Fitness and Exercise Therapy
An individualized exercise and physical activity plan is one of the most important steps of obesity surgery preparation. This exercise plan should begin well before and should be resumed as soon as possible after bariatric surgery. Even a small increase in exercise can improve a patient's flexibility, range of motion, and balance, as well as decrease the chance of injury and soreness.

All new fitness and diet plans should begin well before bariatric surgery and be closely supervised by a doctor. The doctor will provide the patient with a set of guidelines, which are likely to include the following provisions:
  • Drink at least 5 glass of water each day
  • Don’t smoke for at least eight weeks before obesity surgery
  • Cease consumption of caffeinated beverages
  • Take a multivitamin each day, unless you have anallergic
  • Keep a detailed written food diary
  • Eat at least three meals per day and avoid snacking in between - don't worry about the calories for now, focus on the behavior
  • Begin a walking program if possible
  • Write down your feelings every day to remind yourself of your commitment to begin a new and healthier lifestyle
  • Attend support groups for patients considering gastric bypass surgery or other obesity surgery
  • Follow surgeon's instructions regarding any medications you may be taking to control other health conditions
The Big Day for Surgery
On average, surgery for obesity takes about two hours and is performed under general anesthesia. When possible, most bariatric surgeons use laparoscopy, a procedure in which a tiny video camera is inserted inside the patient's abdomen. Through the laparoscope, the surgeon can view the procedure on a separate video monitor. The camera allows doctors to perform minimally invasive bariatric surgery that uses only a small abdominal incision. Compared to more invasive techniques, laparoscopy has fewer complications, and patients can return to work and other activities more quickly. There is also a lower risk of infection, and some recent studies have shown that patients experience less pain after laparoscopic bariatric surgery.

Bariatric Surgery Recovery
The average time in the hospital is two days for laparoscopic bariatric surgery, and about three to five days for open bariatric surgery. Recovery time is about two to six weeks, depending on the type of operation, your condition, the type of work that you do, and other factors.

Postoperative Considerations for Obesity Surgery
Healing time and long-term success after gastric bypass surgery depend largely on diet and exercise habits. After bariatric surgery, following your surgeon's fitness and nutrition guidelines will decrease the risk of complications and increase the chance that you will be satisfied with the outcome.

Diet
Your’e gonna have a drastic diet changes! The stomach will be reduced to a much smaller size and, as a result, the amount of food you can eat is very limited. In order to ensure good nutrition and health, you must also pay very close attention to the types of food you eat. Foods that were well tolerated prior to surgery for obesity may cause discomfort afterwards. Discussing your diet with a nutritionist both before and after bariatric surgery can prepare you to make educated and healthy food choices.

Exercise
Exercise plays a crucial role after bariatric surgery. Patients take in far fewer calories directly following surgery, sometimes causing the body to react as if it were starving. In its search for more energy, the body can begin to burn muscle instead of fat. To prevent this, it is imperative to begin exercising regularly as soon as possible. This alters the metabolism so that the body begins to burn fat instead of muscle.

Ongoing Support
Joining a support group is one of the best things a patient can do after bariatric surgery. Bariatric surgery requires many lifestyle and behavioral changes, and patients usually need the support of family, friends, and healthcare professionals to help get through any rough spots.

Types of Weight Loss Operations

There are several operations for weight loss to choose from and obese people who are suitable for surgery should discuss the risks and benefits of each with a health professional.

Some weight loss operations reduce the size of the stomach so that only small amounts of food can be eaten; others bypass part of the small intestine so that the body absorbs fewer calories from food; and others combine the two.

Malabsorptive Weight Loss Surgery
Commonly referred to as or metabolic surgeries, these procedures partially bypass the small intestine, limiting the body’s ability to absorb nutrients. The unprocessed food passes through the body as feces while the decrease in calories causes weight loss.

1. Biliopancreatic Diversion Surgery.
This operation removes most of the stomach and attaches a small pouch left to the final part of the small intestine.
2. Gastric Bypass
A line of staples separates the top part of the stomach to create a pouch which means food bypasses most of the stomach and small intestine.
3. Duodenal Switch
A similar operation to the biliopancreatic diversion, this operation involves removing part of the stomach.

Restrictive Weight Loss Surgery
These procedures work by making you feel full with far less food. Since you feel full more quickly, your total intake of calories is lower, resulting in weight loss.
1. Banded Gastroplasty Surgery
A band fitted around the top of the stomach which severely restricts the amount of food you can eat.
2. Vertical Sleeve Gastrectomy Surgery
An operation for weight loss which reduces the size of the stomach.

Mixed Weight Loss Surgery
These procedures combine elements of malabsorptive and restrictive procedures to make you feel full more quickly and reduce the number of calories your body is able to utilize from the food you eat.
1. Roux-en-Y (Gastric Bypass) Surgery

2. Biliopancreatic Diversion with Duodenal Switch (BPDDS) Also known as vertical sleeve gastrectomy with duodenal switch (VSGDS).

Others
1. Intragastric Balloon
A deflated silicone balloon is placed into the stomach and filled with liquid to create a feeling of fullness.
2. Implantable Gastric Stimulator
This operation involves implanting electrodes into the stomach which stimulates the stomach to send messages to the brain to induce feelings of fullness.

Why Consider Surgery? Morbid Obesity!

Morbid obesity is defined as being 50–100 percent above one’s ideal body weight, or 100 pounds above ideal body weight. Persons who are at least 80 pounds over weight and have life-threatening obesity related problems such as diabetes, hypertension, sleep apnea, etc. A person with a BMI value of 40 or greater also considered morbidly obese.

Obesity problems can afflict men and women, adults, teenagers, and children. There are gender- and age-related differences in the types and incidence of obesity problems, but every person who is suffering from morbid obesity has the same problem — determining the best way to safely attain normal weight.

Morbid obesity surgery is a serious choice for an obese person, one not to make lightly or in an emotional moment. However, chronic obesity problems have made life an unhealthy and unpleasant journey for many people, and morbid obesity surgery has greatly improved the health and lives of thousands of patients. The various types of obesity surgery each have a distinct set of possible complications that should be taken into account. Consulting with an experienced and qualified obesity surgeon to determine whether you are the candidate for obesity surgery is a recommended preliminary step.

Psychological and Social Effects of Morbid Obesity
While morbid obesity certainly takes a physical toll on the body, it also takes a psychological toll. Some of obesity's worst effects are emotional pain and suffering. Society does not look kindly upon those who are very overweight, and many people do not understand obesity's complex causes and effects. Additionally, there is the common misconception that all obese people are simply lazy, which is absolutely not true. Nevertheless, this misconception leads to prejudices and discrimination in the job market, at schools, and in social situations. These prejudices often cause obese people to feel rejection, shame, and depression.

Causes of Morbid Obesity
The causes of obesity cannot be defined easily. An individual's transition from normal weight to overweight to obesity to morbid obesity usually involves an intake of food calories that is greater than the rate at which the individual is burning off those calories. However, there are many different reasons for this imbalance of calories in/calories out, and several factors are involved. The causes of obesity may include an individual's genetic makeup, metabolism, culture, environment, socioeconomic status, and behavior.

Genetic Factors
It is possible for an individual's genetic makeup to directly cause obesity; disorders such as Prader-Willi syndrome and Bardet-Biedl syndrome are examples. However, most cases of morbid obesity are not based solely on such a genetic cause. The term "genetic factors" might be more easily understood as heredity. It has been observed that obesity often runs in families, with obesity being more common in some families than others. This would suggest genetic causes of obesity. However, a given family would also probably share a similar lifestyle and similar diet, which would contribute to the incidence (or absence) of obesity.

Environmental Factors
A person's environment (home, workplace, school, community, etc.) can have a significant impact on risk of developing morbid obesity
  • The types of food that are available to the individual
  • The quantity of food available
  • The level of physical activity available or attainable
  • The diet and exercise habits of the individual
  • Diet and exercise habits of people in the individual's immediate environment
People may make health-related lifestyle decisions based on their environment. For example, someone may choose not to walk to many places because of the car-oriented layout of the surrounding community. Another individual might find the unhealthy lunch buffet at his/her office very difficult to resist. And of course, children do not have much control over their environment; their food choices are usually dictated by their parents.

Psychological Factors
A person's risk of developing morbid obesity is often heavily influenced by psychological factors. Boredom, depression, anxiety, stress, trauma and feelings of low self-esteem are examples of psychological factors that could result in an individual's overeating and under-exercising. Although the psychological aspect of morbid obesity can be difficult to overcome, it is not impossible. Merely identifying the psychological problems can help an individual greatly in his or her understanding of the basis of overeating.

Other Causes
Illnesses can also lead to morbid obesity. Some of these include hypothyroidism, Cushing's syndrome, depression, and other neurological problems. The use of steroids and certain antidepressants can also lead to weight gain.

Obesity impairs a person's mobility, making physical activity more difficult, compounding the problem and further increasing the risk of developing or worsening some of these conditions. Here is an abbreviated list of conditions which are affected by obesity:
  • Coronary heart disease
  • Stroke
  • High blood pressure
  • Fatty liver disease
  • Osteoarthritis
  • Gout, a disease affecting the joints
  • Diabetes
  • Gallbladder disease
  • Respiratory problems, including sleep apnea
  • Cancer
  • Reproductive and gynecological problems in women

Bariatric Weight Loss Surgery : Operation Obesity

In recent months, there have been numerous documentaries and magazine articles reporting on the stories of people who’ve resorted to surgical procedures to help them lose weight. Although many people will be familiar with the terms gastric bypass surgery and weight loss surgery, the terms bariatric weight loss surgery and bariatric surgery may be less familiar.

The term bariatrics was coined in the mid 1960s from the Greek root baro (meaning weight) and the suffix -iatrics (a branch of medicine) and bariatrics deals principally with the causes, prevention and treatment of obesity.

The number of people who are having surgery is rising rapidly. Figures from the British Obesity Surgery Patient Association reveal that UK surgeons performed more than 4,300 surgical operations for weight loss in 2005 – almost double the number of 2004.

From this it follows that the surgical treatment of obesity (or perhaps more correctly morbid obesity) is now often referred to as bariatric surgery which is performed by a bariatric surgeon.
Operations for obesity are not a miracle cure to help people shift a few unwanted pounds and should not be considered to be similar to cosmetic surgery. They are a last resort for people who have severe health problems due to their excessive weight. All surgery comes with risks and these risks are even greater for people who are obese, so any procedure should be given plenty of thought and not be undertaken lightly.

Before undergoing surgery you should be properly prepared and understand both the risks and the benefits, both in the short and long term.

The type of operation you have will help to determine how much weight you will lose. But ultimately, a big part of the success of any of the treatments will depend upon your willingness to change your eating and lifestyle habits. Don’t ever think if having a weight loss operation means you don’t have to diet or exercise again.

Surgery means they will be on a life-long restricted eating plan that allows only small amounts of food. Large meals, loads of snacks and lots of fatty and sugary foods will continue to be off the menu.

Over the Counter (OTC) Medication for Cold and Flu

There are so many over the counter medications available to treat cold and flu symptoms. Sometimes people confuse and hard to choose, which one is right for me. Here, you will find just a sample of over the counter cold and flu medications. To decide which one is right for you, figure out what your symptoms are and which medication will provide the most relief.

1. OTC medication for Runny Noses, Sneezing and Itching
There are a few different medications available over the counter for runny noses, sneezing and itching. These are known as antihistamines. Antihistamine help dry up runny nose and stop you from sneezing and itching so much.

2. OTC Medications for Pain Relief and Fever Reduction
Several different types of medications are available over the counter for bringing down fevers and relieving minor aches and pains. The brand names are Tylenol, Motrin and Aleve and also come in generic form. Be sure to find out which one is right for you and your family before taking pain relievers and fever reducers.

3. OTC Medications for Congestion
Having a stuffed up head can not only be uncomfortable, but it can also lead to headaches and sinus infections. There are a couple of different options available if you are looking for an over the counter medication to get rid of your congestion. They are known as decongestants.
In the US, pseudoephedrine (PSE) is now available only behind the pharmacy counter but still without a prescription. Several drug companies, including the makers of Sudafed, have replaced PSE with a medication called phenylephrine. It is available in the cold and flu aisle.

4. OTC Medications for Cough
A cough is one of those annoying symptoms that is hard to treat. You may want to evaluate your cough before taking cough medication. If you decide that an over the counter cough medication would be right for you, a choice still must be made between one that breaks up your chest congestion (expectorant) and one that stops your cough (suppressant). It is important to be sure you are taking the right over the counter cough medication.

5. OTC Medications for Multiple Symptoms
If you have more than one symptom you need to treat, which most people do when they get a cold or the flu, you may want to consider a medication that treats multiple symptoms. There are many options available, just make sure you are taking one that treats only the symptoms you have. Taking medication for symptoms you do not have is not only unneccessary, but it can also be dangerous.

6. Natural and Herbal Medications For Cold and Flu
Many people prefer natural or herbal treatments when it comes to their health. These can be good options, but it is important to talk with your doctor about what herbs you are taking. They can interact with other medications you may be on or be dangerous for people with certain diseases. Because herbal supplements are not regulated by the Food and Drug Administration, they do not always list potential side effects or interactions with other drugs.

21 August 2008

Who is The Candidate for Biliopancreatic Diversion Bypass Surgery?

1. People who classified as obese
Stable obesity for more than five years, BMI of 35 kg/m2 or above, with added weight-related comorbidities such as heart disease, sleep apnea, severe mobility problems or a condition preventing employment.

2. Obesity is causing problems for you
The problems you perceive may be physical (back pain, reflux, fatigue, lack of mobility, hypertension etc), psychological (depression) or social (low self-esteem, social isolation etc) or a combination of all or several of them. You may also be concerned about the effect your obesity could have on your future health and life expectancy.

3. Losing weight by conventional treatment failed
Diet failure or weight loss drug therapy for more than one year. Patients have tried numerous diets and weight-loss programmes over many years, but have still failed to achieve and maintain any significant weight reduction. It is important that you have tried all these options, because it tells us that you are genuinely committed to achieving your weight loss objectives. Unless you have that level of commitment and purpose, you will not be successful with the gastric band.

4. Emotional suitability for obesity surgery
Bariatric clinics routinely operate a vetting procedure for all candidates for BPD obesity surgery, to screen out patients who lack the necessary commitment to participate fully in the necessary post-op lifestyle of healthier eating and increased exercise.

5. Aged between 18 and 65 years

6. People who fit for anesthesia and well prepared to undergo intensive follow –up and monitoring after weight loss surgery

7. Absence of glandular diseases such as hypothyroidism


8. No history of alcohol abuse alcohol or drugs

9. Do not have untreated depression or another major emotional disorder

The Risks of Biliopancreatic Diversion Surgery

Death. As is the case with any major surgical procedure there is a risk of death associated with Biliopancreatic Diversion surgery and estimates fewer than 3 in 200 (1.5%) people die after surgery for weight loss The risk varies according to patient’s age, as well as with other medical conditions from which you are suffering and your general state of health.

Narrowing of the opening between the stomach and small intestine.
The connection between the stomach and the intestines narrows (stomal stenosis) 5% to 15% of the time, leading to nausea and vomitiong after eating.

Dumping syndrome. A biliopancreatic diversion may cause dumping syndrome. This occurs when food moves too quickly through the stomach and intestines. It causes nausea, weakness, sweating, faintness, and possibly diarrhea soon after eating. These symptoms are made worse by eating highly refined, high-calorie foods (like sweets). In some cases you may become so weak that you have to lie down until the symptoms pass. Dumping syndrome does not occur in a biliopancreatic diversion with duodenal switch.

Malnutrition.
The principal health danger of biliopancreatic diversion stomach bypass is malnutrition, which is a lifelong and constant health risk. The malabsorptive effect of the BPD operation is so severe that nutritional supplementation is mandatory for life. Vitamin B12 injection therapy, calcium and iron supplements or a daily multivitamin are also essential. Failure to maintain this regime of mineral and vitamin supplementation leads to a range of serious nutritional complications including anemia (30 out of 100 people ) and osteoporosis.

Hospitalized. About 4 people out of 100 need hospitalization because of lack of protein. Protein deficiency is somewhat less of a risk in the biliopancreatic diversion with duodenal switch.

Stomach Ulcer. Ulcer develop 5% to 15% of the time.

Chronic Diarrhea.

Frequent, bad-smelling stools.

Benefit of Biliopancreatic Diversion (BPD)

  1. High Degree of weight loss in most patient.
  2. Weight loss. Follow up data indicate 75-80% of excess weight compared to 50-70 percent weight loss for Roun –en-Y gastric bypass patients is lost at 2 years.
  3. the larger-than-usual stomach allows BPD patients to eat significantly more food than RYGBP patients
  4. Greater stomach capacity (200-250 mls) therefore can eat a small main meal instead of an entre portion.
  5. Improvements in the “co-morbidities” of obesity-mood, mobility, exercise capacity and sleeping patterns
  6. talk about obesity surgery as being not just life transforming but also life saving, nowhere is this more true than for BPD/Bandinaro patient.

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