Gastric Bypass Surgery News

3 Years after gastric bypas surgery, man loses 259 pounds and competes in triathalons

noreply@blogger.com (iLitigate) — Mon, 09 Nov 2009 04:14:00 +0000

St. Petersburg, FL

Three years ago, Chad Soileau was sitting in a roller coaster seat at Six Flags amusement park near Washington, D.C., when he was overcome with panic. He had waited in line for more than an hour for the four-minute ride on the Wild One, but when it came time to buckle up, the seat belt wouldn't fit.

"The attendant walked up and told me I was too big for the ride," recalled Soileau. "She yelled back to her co-workers, 'Bring the tool, we've got a large rider.' "

Five minutes seemed like an eternity as the crew struggled to extend the roller coaster's seat belt.

"Hundreds of people were watching," Soileau said. "It was the most humbling, humiliating experience of my life."

Afterward, Soileau stumbled off the ride and ran to the nearest restroom. "My stomach was in knots," he said. "I vomited for 10 minutes."

On Nov. 14, a very different Soileau will again face an audience — but this one will be cheering his remarkable achievements.

The Louisiana man will be among the 1,500 or so elite athletes who will gather on Clearwater Beach to swim 1.2 miles, bike 56 miles and run 13.1 miles in the Ironman World Championship 70.3. (The name comes from the combined distance of the three events, which is half the distance of the world famous Ironman World Championship held each October in Kona, Hawaii.)

"It has been a long road to get here," said Soileau, 37. "And I still have a long way to go."

Team 464

Despite the trauma of the roller coaster incident, it wasn't until a few months later that Soileau realized the full extent of his obesity.

"I was on the scale at the doctor's office when he asked if I knew how much I weighed," he said. "I figured about 350. He said no, 464."

Soileau couldn't believe he was off by 114 pounds. He made up his mind, then and there, that he would do something about his weight.

On March 22, 2006, he underwent gastric bypass surgery. "I call it my re-birthday," he said.

The surgery came with complications. He developed several blood clots and had to undergo three additional surgeries, including one to have his gallbladder removed and another to repair a twisted bowel and an internal hernia. But Soileau persevered.

Soileau was 34 when he started his weight-loss journey. Overcoming his longtime addiction to food was his first obstacle.

"I used to order double of everything . . . two appetizers, two entrees, two desserts," he said. "When I would go to the drive-through I would pretend there was somebody else in the car because I was ordering so much food."

Weight-loss surgery is no sure bet; plenty of people regain weight after the procedure. But after his surgery, Soileau found it easier to control his urges. (See related story, Page 12.)

"Physically I couldn't eat as much," he said.

The physical changes soon were followed by emotional ones. "After a while I stopped wanting the food,'' he said.

The victories piled up. One day, he discovered he could bend over to tie his shoes. "It was a huge accomplishment for me when I could get in my truck without my stomach hitting the steering wheel," he said.

Soileau set weight goals, which he published on his Web site, www.Team464.com:

"Weigh less than 400 pounds — DONE!''

"Weigh less than 350 pounds — DONE!''

He also kept track of his progress by his pants size: He went from a size 64 to a size 34.

ONE STEP AT A TIME

As he recovered from the surgery and started to drop pounds, he began to exercise.

He started off small, walking back and forth to the stop sign a block from his house. Gradually, his walks got longer and longer. Eventually, he started running, then swimming, then biking.

"I came up with a list of goals for myself," he said. "One of them was to complete a triathlon."

To help him reach his goals, he kept a training log.

"At first it was just a mile, then 2 miles, then 3 miles," he said. "The whole time I dreamed about completing a marathon."

Soileau, who has a girlfriend, works as a Web site designer in New Orleans. He struggles to find time for the one to two hours of daily training a triathlon requires. As for his diet, he focuses on fruits, vegetables, whole grains and lean protein to help power his new physique.

The discipline paid off. In February 2008, Soileau finished the Mardis Gras Marathon in New Orleans with a time of 5 hours and 36 minutes.

IRONMAN

Soileau has completed dozens of road races and triathlons. He was invited by the World Triathlon Corporation to be its guest at this year's event in Clearwater. Officials hope Soileau's story will inspire others to try the sport.

"It is an honor to be here," he said. "What other sport lets you share the course with the pros?"

But despite his success, Soileau doesn't feel as if he has won his battle against obesity. He won't feel victorious, he said, until he completes a full-distance Ironman.

"I will know I won when I step over the finish line and I hear the announcer yell, 'Chad Soileau, you are an IRONMAN!' "

Gastric bypass and diabetes: CNN Health Q&A

noreply@blogger.com (iLitigate) — Mon, 02 Nov 2009 03:46:00 +0000

Q: Does roux-en-Y gastric bypass cure diabetes?

Expert Answer: (by Dr. Melina Jampolis)

Hi, Rick. I'm not a surgeon, so to answer your question more thoroughly, I consulted with a very well-respected bariatric surgeon in San Francisco, John Rabkin, M.D. He explained that the roux-en-Y gastric bypass (RGB) improves type 2 diabetes via at least three different mechanisms:

1. The surgery decreases caloric intake immediately after the procedure because food intake is restricted by the small volume of the created stomach pouch, which holds only 1 ounce. The decrease in food intake, particularly refined carbohydrates, which are not well-tolerated after this procedure, can help stabilize blood sugar levels and immediately improves control of diabetes.

2. The significant amount of weight loss that results from the surgery improves insulin resistance over time.

3. There are changes in hormones and caloric processing because the food ingested bypasses the segment of the small intestine closest to where it attaches to the stomach (the duodenum and proximal jejunum), but not quite as much as you mentioned (not one-third of the small intestine). Because of the anatomical changes resulting from the surgery, it appears that these hormonal changes are greater than would be seen with weight loss via diet and exercise, but no research has yet to compare the two directly and evaluate hormonal changes.

The overall outcome is complete resolution of type 2 diabetes in greater than 70 percent of patients with diabetes before the procedure.

Unfortunately, as many RGB patients regain weight over time, the durability of the cure isn't as high as with a newer procedure called the duodenal switch.

In this procedure, there is a much larger pouch created (4 to 5 ounces), and the complete stomach anatomy is preserved, which helps preserve more normal stomach function. In this procedure, the rearrangement of the intestines leads not only to some restriction of food, but also causes your body to absorb significantly fewer calories, which has a more lasting effect.

Rabkin, a leader in this procedure, reports that he has had a 96 percent cure of type 2 diabetes at one year after surgery, which has persisted for five and 10 years post -op and seems to be similarly durable out past 15 years post-op.

Hope this helps. I strongly recommend spending a considerable amount of time with your surgeon if you are considering either of these procedures, as both have important lifestyle-related issues that should be discussed to determine the best procedure for you for the long term.

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Probiotics may help gastric bypass patients

noreply@blogger.com (iLitigate) — Wed, 28 Oct 2009 05:08:00 +0000

Hueytown, AL

Probiotics are sometimes prescribed by doctors to improve the body’s response to antibiotics by increasing levels of gut bacteria used by the body, but new research suggests they may play a complementary role in another treatment.

Researchers at Stanford University School of Medicine included probiotics as part of a regimen for patients who had recently undergone gastric bypass surgery.

They found that patients who used the "good bacteria" were more likely to lose weight than study subjects in the control group, and were also able to limit vitamin B12 deficiencies associated with the procedure.

Dr. John Morton, the study’s co-author, says that the research was initiated in response to obese patients who complained that it was difficult to eat properly after surgery because of the effects on the digestive tract.

"A lot of people aren’t aware that we all carry around a lot of bacteria in our intestines and that they’re extremely helpful in aiding digestion," he added. "And I thought, ‘Well, if we give these patients probiotics, then maybe we can improve these symptoms."

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Is gastric bypass surgery a diabetes fix?

noreply@blogger.com (iLitigate) — Wed, 28 Oct 2009 05:03:00 +0000

Los Angeles, CA

Within days of various weight-loss surgeries, blood sugar levels become easier to manage -- or are normal.

The discovery came about by accident more than a decade ago: Weight-loss surgery often led to dramatic improvements in the control of Type 2 diabetes, often before patients had even left the hospital.

Today, evidence of the connection is so solid that some doctors say surgery should be considered as a treatment for diabetes, regardless of a person's weight or desire to lose weight.

"We thought diabetes was an incurable, progressive disease," says Dr. Walter J. Pories, a professor of surgery at East Carolina University and a leading researcher on weight-loss surgery. "It . . . is a major cause of amputations, renal failure and blindness. This operation takes about an hour, and two days in the hospital, and these people go off their diabetes medication. It's unbelievable."

As many as 86% of obese people with Type 2 diabetes find their diabetes is gone or much easier to control within days of having weight-loss surgery, according to a meta-analysis of 19 studies published earlier this year in the American Journal of Medicine (78% of patients with a remission of diabetes and 86.6% with remission or improvement). But experts still aren't sure why obesity surgery helps resolve Type 2 diabetes or how long the effect might last. And they disagree on how big a role surgery should take in treating the illness.

"We are going from seeing the results to understanding why it happens," said Dr. Santiago Horgan, director of the Center for the Treatment of Obesity at UC San Diego.

This much is clear: Patients who have weight-loss surgery begin to lose weight rapidly, which by itself improves Type 2 diabetes, allowing diabetics to more easily control their blood glucose levels. But something else appears to be occurring as well.

There is strong evidence that surgery -- especially gastric bypass surgery, which makes the stomach smaller and allows food to bypass part of the small intestine -- causes chemical changes in the intestine, says Dr. Jonathan Q. Purnell, director of the Bionutrition Unit at Oregon Health & Science University. The small intestine has been thought of simply as the place where digestion occurs.

But researchers now suspect it has other functions related to metabolism. Surgery somehow alters the secretion of hormones in the gut that play a role in appetite and help process sugar normally.

Multiple studies in humans and animals indicate that surgery triggers reductions in ghrelin, the hormone that stimulates hunger, and elevates levels of peptide YY and glucagon-like peptide-1, both of which act as appetite suppressants. Another theory is that surgery might alter the expression of genes that regulate glucose and fatty-acid metabolism.

"There are these known components that improve glucose metabolism," Purnell says. "But there are very likely other things happening as well."

Which procedure?

The effect on diabetes can depend on the type of weight-loss surgery that is performed, says Pories, past president of the American Society for Metabolic and Bariatric Surgery. The highest rates of diabetes remission are seen in people who have gastric bypass -- about 83%.

But diabetes also tends to resolve or improve in 50% to 80% of people who have lap-band surgery, in which a band is placed around the top of the stomach to make it smaller, he says. And there is some evidence that the effect occurs a newer type of weight-loss surgery called gastric sleeve, in which a portion of the stomach is removed so that it takes the shape of a tube or sleeve.

Evidence suggests the effect on diabetes can last for an extended period or even indefinitely, particularly if people don't regain a lot of weight.

"There is durability, but we also know that some people do get the disease back again," Purnell says. "Weight rebound is probably one factor. We also know that diabetes is a progressive disease. It may depend on how long you've been diagnosed with diabetes. If it's early on, I think the durability may be better."

It's not clear yet why people have different responses.

"There is some evidence that African Americans don't respond as well as Caucasians, and men don't respond as well as women," Pories says.

Despite the unknowns, the evidence that a majority of people experience long-term improvement in blood glucose control suggests the surgery could eventually play a greater role in the treatment of obese people with Type 2 diabetes. The majority of American adults with Type 2 diabetes are overweight.

Traditional medical guidelines, which insurers follow, state that weight-loss surgery should be restricted to patients with a body mass index of 35 or greater who have related health problems. But some diabetes and nutrition experts think those recommendations don't go far enough. Several studies are underway, or will soon begin, to examine the benefits of surgery in people with Type 2 diabetes and a BMI of less than 35.

"We may have a cure for diabetes," Santiago says. "So we need to ask how medical therapies and surgery can help each other in the treatment of diabetes."

Studies from several other countries show that surgery also results in remission of diabetes for people who are not morbidly obese. There is even discussion, particularly in other countries, of performing weight-loss surgery for people with Type 2 diabetes who are not overweight.

Not without risks

In the United States, weight-loss surgery is still largely viewed as a cosmetic procedure and obesity as a lifestyle issue, not a chronic disease. Moreover, weight-loss surgery carries risks. The death rate is about one per 200 operations and severe complications can occur, including blood clots, infections related to surgery, and the need for corrective surgery due to leaks at the staple lines.

Other complications include vitamin and mineral deficiencies, dehydration, gallstones, kidney stones, hernia and low blood sugar.

However, a risk-benefit analysis published in April in the Journal of the American Medical Assn. by Purnell and a colleague suggests that if the number of gastric bypass operations performed on diabetic patients increased to 1 million per year, as many as 14,310 diabetes-related deaths might be prevented over five years.

Surgery also leads to other health benefits besides weight loss and better control of diabetes. Patients often see improvements in blood pressure, cholesterol, gastroesophageal reflux disease and sleep apnea.

"Doctors say, 'If I can lower glucose by medications, why send patients to surgery?' " Purnell says. "Surgery, however, allows people to have meaningful and sustained weight loss and their diabetes is better. There are risks involved with surgery, obviously, but it makes sense, to me, to do surgery."

The discovery of the gut hormones that play a role in appetite and insulin regulation may also lead to new medications for Type 2 diabetes, Pories says.

"You can't operate on 31 million Americans," he says. "But if we understood this mechanism and what are the molecules secreted by the intestines that cause diabetes, then we can cure it with a pill. I would not be surprised if, in the next five years, we have new medications."

Beverly Hills bariatric surgeon claims he performs most lap band surgeries

noreply@blogger.com (iLitigate) — Wed, 28 Oct 2009 04:56:00 +0000

Beverly Hills, CA

Dr. Michael Feiz, lead surgeon at the Beverly Hills Comprehensive Weight Loss Center, has performed more Lap Band surgeries than any other doctor. For overweight Los Angeles residents, Lap Band surgery is the answer they have been looking for to shed the unhealthy weight and return to a more active life. Performed laparoscopic with almost no scarring, Lap Band surgery has the added benefit of enabling the patient to control their weight loss progress. Unlike gastric bypass surgery, Lap Band surgery does not involve the permanent reduction in size of the stomach. Instead, a small cinched section of plastic is placed around the upper area of the stomach, creating a temporarily shrunken stomach area for food to pass through. The other factor that makes Lap Band surgery so unique from gastric bypass is that the Lap Band is connected to a port that enables adjustment of the amount of solid food that can pass through the stomach. Finally, Lap Band
surgery is so attractive because it can be easily reversed by simply removing the Lap Band if something goes amiss.

A pioneer in successful Lap Band surgery, Dr. Michael Feiz of the Beverly Hills Comprehensive Weight Loss Center has performed the world's most cosmetic Lap Band surgery. With degrees from UCLA, New York Medical College and a residency and fellowship at USC Medical Center and Cedars Sinai, Dr. Feiz is highly trained and skilled in Bariatric and minimally invasive surgery. All prospective Lap Band surgery patients who visit the Beverly Hills Comprehensive Weight Loss Center must first undergo a full 360 degree evaluation of their health - mental and physical - as well as their habits and attitudes toward exercise and food.

Typical Los Angeles Lap Band surgery patients lose multiple pounds per week, but the real success after Lap Band surgery is keeping the weight off. The Beverly Hills Comprehensive Weight Loss Center ensures that their Lap Band surgery patients lose the weight and keep it off. So many people turn to the Beverly Hills Comprehensive Weight Loss Center due to the success rate of this center.

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Single-incision gastric sleeve, gastric bypass surgery alternative

noreply@blogger.com (iLitigate) — Thu, 15 Oct 2009 04:11:00 +0000

Houston, TX

There's a new weight loss surgery option available in Houston that doctors say is less invasive and allows patients a faster recovery. It could offer patients as much weight loss as the "gold standard" weight loss procedure, gastric bypass.

Denise Abrego-Carter is about to undergo a new procedure to help her lose weight. It's called the single-incision gastric sleeve.

She said, "He guarantees me about 70-80 pounds."

The "sleeve" procedure is similar to the more radical gastric bypass. But unlike gastric bypass, the "sleeve" requires only one incision and is a less complicated surgery.

Dr. Sherman Yu, a Memorial Hermann bariatric surgeon, explained, "With this newer procedure people are actually losing just as much weight as a gastric bypass, but the risks are about half the gastric bypass because we're not rerouting any of the intestines."

Surgeons go through the belly button to do the surgery which allows for less pain, faster recovery and better cosmetic results. It was an attractive idea for patients like Rebecca Hammonds. She had the surgery in May.

"I've seen absolutely fantastic results. I'm so thrilled," she said. "I did not like the idea of having an implantable device inside of me so that's why I didn't go with the band."

Hammonds has already lost 70 pounds in about four months and is thrilled. But what really surprised her were the other health benefits she gained from getting the gastric sleeve procedure.

"The increased energy, how much better I feel," Hammonds said. "Before surgery I had a lot of hip pain and I'd come home from work and I could hardly walk, I was hurting so bad. And now I get home and I can deal with my children and play with them."

For the doctors, that's what makes it all worthwhile.

"People are losing, again, 60, 70, 80 percent of their excess body weight," said Dr. Yu. "But more importantly, really what we focus on is that their medical problems get better."

"I haven't been ill. I haven't been really sick," Hammonds said. "I'm losing weight and feeling great."

Dr. Yu and Dr. Terry Scarborough of Memorial Hermann are the only doctors in Houston performing the single incision gastric sleeve procedure. They are currently training other surgeons around the country how to do it.

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Laparoscopic gastric bypass surgery helps man shed obesity

noreply@blogger.com (iLitigate) — Thu, 15 Oct 2009 04:03:00 +0000

St. Louis, MO

Two years ago, Herb Simmons tipped the scales at 497 pounds.

"As the years snuck up on me I noticed it was getting harder to get around," he says. "I couldn't leave home in the morning without soaking my knees in Ben Gay."

He was suffering from sleep apnea, atrial fibrillation and hypertension. Getting from his car to his house was an exhausting, stop-and-go process because he'd rest every few feet to catch his breath. He needed an extra seat belt on airplanes and a chair without arms in restaurants.

Simmons says he didn't eat big meals, but admits to snacking on chips and slurping sugary colas every day. He says he's been on every diet known to man.

"I once lost 100 pounds on OPTIFAST and regained 200," he says. "I was a yo-yo dieter."

In 2007, he attended a bariatric seminar to learn more about Lap-Band surgery, a laparoscopic procedure to place a silicone band around the top of the stomach. The band reduces the amount of food the stomach can hold so patients eat less. Simmons made an appointment with one of the surgeons, Dr. Van L. Wagner, of Heart of America Bariatrics in Lemay. He was surprised when Wagner recommended gastric bypass instead.

Gastric bypass uses staples to make the stomach smaller, then reroutes food past part of the small intestine. Patients feel full sooner, and absorb fewer calories and nutrients.

With a Lap-Band, patients lose only between 50 and 70 pounds in the first year then often taper off on weight loss, Wagner says. With gastric bypass they almost always lose between 200 and 250 pounds in two years.

"Bypass is usually a better option for patients who are sicker, older and have higher weights," Wagner says. "And Herb was extreme on several of those things so banding would not have provided the weight loss he needed."

Wagner performed laparoscopic gastric bypass surgery on Simmons Sept. 19, 2007, at St. Alexius Hospital.

Gastric bypass comes with risks, including developing gallstones and nutritional deficiencies.

Simmons takes calcium and vitamin pills and drinks protein shakes to prevent malnutrition. Two weeks after surgery, he began walking, first up and down the sidewalk in front of his house, then on a quarter-mile track. At first he couldn't walk a lap without stopping to rest several times. Within a few months, he was walking two miles. Now, he walks three to five miles every afternoon and bicycles three to five miles every evening.

He also eats a lot less, especially high-fat, sugary foods.

"It can cause dumping syndrome, which makes you want to lock yourself in a room for hours," Simmons says. WebMD describes the syndrome as a shock-like state that lasts for 30 to 60 minutes after small, easily absorbed food particles are rapidly dumped into the digestive system. Symptoms include a clammy sweat, butterflies in the stomach, a pounding pulse, cramps and diarrhea.

Simmons says his triglyceride and cholesterol levels have plummeted, his sleep apnea has dissipated and his blood pressure medications are one-fourth the dose they were before surgery. His legs no longer swell and his knees feel fine.

He credits ongoing counseling by Wagner and St. Alexius' NewStart program for his success. Both offer emotional support, nutritional guidance and ongoing education.

Last month, Simmons celebrated the second anniversary of his surgery by walking 3.7 miles as part of the Walk From Obesity event in Creve Coeur.

"After my wedding anniversary, my surgery date is the second-most important anniversary for me," Simmons says.

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Gastric bypass surgery increased risk of iron deficiency

noreply@blogger.com (iLitigate) — Mon, 05 Oct 2009 07:56:00 +0000

New York, NY

Weight loss surgery can help you lose weight, but it's also likely to leave you unable to absorb iron, a new study suggests: Iron deficiency is a common problem after stomach bypass surgery to treat severe obesity -- and standard iron supplements may not be enough to prevent it in some patients.

Researchers found that among 67 Chilean women who had undergone the most common form of weight-loss surgery, 39 percent developed low blood counts, also known as anemia, within 18 months of surgery. That anemia was most often due to a deficiency in iron, which the body needs to produce healthy red blood cells that carry oxygen.

In contrast, less than two percent of the women had been anemic before surgery, the researchers report in the American Journal of Clinical Nutrition.

It's well known that nutritional deficiencies are a risk after the type of surgery examined in the trial, known as Roux-en-Y gastric bypass, the most common and most effective form of weight- loss surgery for severe obesity.

The procedure involves stapling off the upper portion of the stomach to create a small pouch that restricts the amount of food a person can eat at one time. The surgeon also makes a bypass from the pouch that skirts around the rest of the stomach and a portion of the small intestine, limiting the body's absorption of nutrients.
The new findings suggest that impaired iron absorption, rather than reduced iron intake, is the major cause of long-term deficiency after gastric bypass, according to the researchers.

Tests done six months after surgery showed that, on average, women were absorbing just one-third of the iron from food that they had before surgery.

What's more, their absorption of iron from supplements showed nearly as great a decline. And many women became deficient in iron despite taking supplements after surgery, according to the researchers, led by Manuel Ruz of the University of Chile in Santiago. More "Gastric bypass surgery increased risk of iron deficiency"

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Gastric bypass surgery and anemia: Monitoring nurtitional deficiencies needed

noreply@blogger.com (iLitigate) — Thu, 24 Sep 2009 03:45:00 +0000

Washington, D.C. (National Anemia Action Council)

In recent years, bariatric surgery has become a much more common procedure to treat morbidly obese patients in the United States, with the number of surgeries increasing more than 10-fold in the last decade.1 This growth has occurred in part due to the large number of obese and morbidly obese individuals in need of weight reduction and the relative success of the surgery at shedding excess weight and reducing obesity-related health conditions.

Yet, surgery often creates permanent alterations of the digestive tract, which can lead to a variety of nutritional consequences. Many bariatric patients develop new or worsen preexisting iron and vitamin deficiencies, with some patients becoming anemic in the months and years following the procedure. These patients may then be relying on you, their primary care providers, to monitor their nutritional health. This article explains why bariatric surgery patients are prone to developing nutritional deficiencies and what you can do help them avoid anemia.

Candidates for Bariatric Surgery

In 2008, about 220,000 bariatric surgeries were performed in the United States to help patients permanently reduce excess body weight.2 Only morbidly obese patients are eligible for the surgery, as determined by their body mass index (BMI) – calculated by weight relative to height (kg/m2). Patients with a BMI >40, or a BMI >35 in combination with comorbidities, are considered for bariatric surgery. Comorbidities may include type 2 diabetes, heart disease, hypertension and sleep apnea, among many others. Approximately 15 million people in the United States (about 5%) are considered morbidly obese and about one-third are considered obese, with a BMI >30.2,3

Prior to surgery, morbidly obese patients may have numerous chronic illnesses and health complications, including nutritional deficiencies and anemia. According to Dr. John W. Baker, President of the American Society for Metabolic & Bariatric Surgery (ASMBS), about 60% of his patients have low or deficient levels of vitamin B12 prior to surgery and about 20%, both male and female, had preoperative iron deficiency. This rate is consistent with current statistical data of nutritional deficiencies among bariatric surgery candidates.4

Although prevalent, the etiology of their preoperative anemia can be elusive, with some morbidly obese patients displaying evidence of both iron deficiency and chronic inflammation. In a considerable percentage of candidates, the cause of anemia may be undiagnosed. Dr. Baker advises that preoperative anemia should be treated prior to surgery either by the surgeon or by the patient’s primary doctor. Following bariatric surgery, the surgeon and the patient’s primary care doctor often communicate about continuing care of the patient to decide the roles and responsibilities of each physician in the postoperative period. This coordination is especially important for a patient with any preexisting anemia, which will need to be monitored closely.

The Surgery Itself

Bariatric surgery has a considerable impact on both a patient’s overall weight and many of the obesity-related conditions that affect quality of life. A meta-analysis of over 22,000 bariatric surgery patients revealed that patients lost on average 60% of their excess weight. In contrast, patients treated with conventional diet and exercise reported losing less than 10% of their excess weight for a sustained time period and exhibited only mild effects on reduction in obesity-related conditions.4

Studies have reported type 2 diabetes being resolved in 73-87% of patients following bariatric surgery, depending on the type of surgery.5,6 Risk of coronary heart disease was cut in half5 and sleep apnea was resolved in more than 85% of patients.7 Additionally, when compared to candidates who did not have surgery, patients improved their life expectancy 89% of the time8 and reduced their risk of premature death by 30-40%.9 Risk of death from diabetes, cancer, and from coronary artery disease was also reduced by 92%, 60%, and 56%, respectively.10

Speaking in regards to the effectiveness of bariatric surgery at treating concomitant conditions of obese patients, Dr. Baker said, “This is one of the most durable procedures we have for resolution of chronic diseases. What other procedure can improve hypertension, heart disease, diabetes, sleep apnea and high cholesterol?”

How bariatric surgery affects a patient is largely determined by the type of procedure and how it alters the mechanics of the digestive tract. Weight loss results from reduction in the capacity of the digestive tract and number of calories consumed (restrictive), alteration of the absorption of food (malabsorptive), or a combination of both approaches. Restrictive methods include vertical banded gastroplasty (VBG) and laparoscopic adjustable gastric banding (LAGB). Malabsorptive procedures with some restriction include biliopancreatic diversion (BPD) and biliopancreatic diversion with duodenal switch (BPD-DS). Restrictive procedures with some malabsorption include roux-en-Y gastric bypass (RYGB) and vertical banded gastric bypass.11

Following surgery, a patient’s body must get necessary nutrients from less food with a smaller, less effective digestive system. Although helpful in reducing their caloric intake and fat absorption, these physical and metabolic changes leave them susceptible to nutritional deficiencies and subsequent anemia. Depending on the form of bariatric surgery, alterations to the digestive tract which may lead to an increase in nutritional deficiencies and anemia include the:

* Lower intake of food and essential nutrients
* Decrease in the absorptive surface area in the digestive tract
* Decrease in available stomach acid to help break down food and nutrients
* Possible intolerance to some nutrient-rich foods, such as red meat

Nutritional Deficiencies Related to Anemia

Iron deficiency is the most common cause of anemia after bariatric surgery and can be found in 20-49% of patients. This is especially true after the RYGB procedure in menstruating women (51%) and in patients with super obesity (49-52%).12 Other deficiencies which can lead to anemia are less common, but do include vitamin B12 and folic acid, which are most common in patients who exhibited signs of the deficiency prior to surgery or who are not receiving adequate supplementation. For instance, vitamin B12 deficiencies can occur in older patients, patients taking H2 blockers or proton pump inhibitors (PPIs), or in roughly 12-33% of patients not receiving supplementation after the RYGB procedure.

Baker quoteAlthough these deficiencies are mostly related to the altered absorption in the digestive tract, all forms of bariatric surgery can contribute to lower serum levels or reduced stores of nutrients. Dr. Baker has observed that, “Even in patients who didn’t have a malabsorptive procedure, I still see them coming in with deficiencies at follow-up; often due to preoperative deficiencies or preexisting conditions.”

The ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient states that, “Taking daily micronutrient supplements and eating foods high in vitamins and minerals are important aspects of any successful weight loss program. For the morbidly obese, taking vitamin and mineral supplements is essential for appropriate micronutrient repletion both before and after bariatric surgery.” The surgeon will recommend the necessary vitamins during presurgical education and consultation. Concerning anemia-related nutrients, these recommendations include a multivitamin with at least 100% of daily value for vitamin B12, 18 mg of iron, and 400 μg of folic acid. Following surgery, an additional vitamin B12 supplement or oral iron supplement may be required if monitoring indicates low or deficient levels of these nutrients.12 Patients may also be taking a recommended 1200 mg of calcium citrate daily, but should not ingest it at the same time as an oral iron supplement because the two will compete for absorption.

Continuing Care Following Surgery

Surgical patients are typically enrolled in postoperative programs to help them adjust to their new lifestyle and reinforce compliance with recommended dietary restrictions and nutritional supplementation. All patients in these programs are instructed to take multivitamin supplements, usually with iron. Many physicians recommend life-long supplementation, with iron-deficient patients being treated initially with oral iron. Patients who cannot or will not take oral iron because of gastrointestinal side effects may need to receive the generally more tolerable ferrous fumarate oral preparation or parenteral iron supplementation.

Postoperative nutritional care puts a great deal of responsibility on the patient who may not realize the drastic nature of the procedure as it relates to nutrient absorption and the need to comply with supplementation and follow-up care. It can be difficult for patients to adhere to these programs with many of them dropping out 3-6 months after surgery. Dr. Annette von Drygalski, a hematologic fellow at the University of California-San Diego who has worked with many anemic patients following bariatric surgery, has witnessed this. She said, “Some patients may not be educated enough about the surgery and some may not even remember what procedure they had. And, because bariatric surgery is a relatively new field, some physicians may not be educated about the nutritional implications.” Patients may remain healthy for a short time and may attribute postoperative symptoms of fatigue to the procedure alone while deficiencies develop. Iron deficiency and other causes of anemia can manifest years later, potentially putting primary care physicians in a tough spot.

“Sometimes patients won’t follow-up with anybody until they finally develop a complication,” noted Dr. Baker. “We encourage our patients to identify their primary care physician so that lab work and recommendations can be shared. This way, physicians can identify patients who are not following up after the surgery.”

Monitoring Nutrition & Deficiencies

Patients are often enrolled in a postsurgical program operated by the surgical team. Programs of this nature normally require patients to attend follow-up visits at the first, third, sixth and 12th months to monitor their overall health and address any symptoms they may be experiencing. At a minimum, screening for nutritional deficiencies occurs at the 6-month and 12-month visits. Adjustments to a patient’s dietary supplementation levels, initially set by the surgeon, may occur at these visits, if necessary. Some patients prefer to have these visits coordinated with their primary doctors instead of with the surgical team. In this case, the primary doctor should continue to update the surgical team of the patient’s care and status, and the surgeon should remain available for consultation.
Information for Bariatric Surgery Patients

* Bariatric surgery is not harmless, it drastically alters your body
* There are lifelong dietary and nutritional considerations
* You may not absorb vitamins or iron as well from the food you eat
* It is important to follow vitamin and iron supplementation
* Do not take iron supplements with tea, cola, coffee, calcium citrate or levothyroxine
* Remember the type of surgery you had performed and be sure to tell your doctor

If you are working with a known bariatric surgery patient for the first time, even if you have not had prior consultation with their surgeon, Dr. Baker recommends inquiring about their dietary intake, types of foods they eat, their menstrual blood loss if they are female, and any symptoms of fatigue which could be related to anemia, in addition to monitoring their levels of iron, vitamin B12 and folate as described below. Notable things to watch for include excess tea, cola or coffee consumption, which may interfere with iron conversion to an absorbable form. If taking an iron supplement, it is necessary to wait at least two hours before drinking any tea, taking calcium supplements, or taking the synthetic thyroid hormone levothyroxine. If possible, communication with their surgeon about recommended supplementation and follow-up care should be pursued prior to subsequent visits.

The first step in screening for anemia is acquiring a complete blood count that includes red blood cell indices. If anemia is present – determined by a hemoglobin <12 g/dL in women and <13 g/dL in men – indices can point toward the appropriate further investigation.13 Patients with a microcytic, hypochromic anemia most likely have an iron deficiency. Vitamin B-12 deficiency produces macrocytic red blood cells. Remember that the cause of anemia may be multi-factorial, so indices are not the final answer. Some screening guidelines of anemia-related nutrients, taken in part from the ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient,12 are listed below.

Iron – Ferritin levels should be checked at six months, one year and annually at a minimum following bariatric surgery. A normal ferritin level for men is 15-200 ng/mL and for women is 12-150 ng/mL.12 Also check serum iron (normal range 60-170 mcg/dL), total iron binding capacity (normal range 240-450 mcg/dL) and transferrin saturation (normal range 20-50%). Note that normal ranges vary by lab, so be sure to check for their established levels.
Related Research Review

A recent research review of the study by Coupaye et al prospectively compared the prevalence of nutritional deficiencies after adjustable gastric banding and gastric bypass procedures. Read more about the study in Research Reviews:
Evaluation of Short-term Nutritional Regimens Following Bariatric Surgery

Vitamin B12 – Serum B12 levels should be checked at six months, one year and annually at a minimum following bariatric surgery. A normal vitamin B12 range is 200-900 pg/mL,14 but serum measurements may miss 25-30% of deficiency cases in lower normal ranges. If symptoms of a vitamin B12 deficiency are present (including fatigue, bright red/smooth tongue or tingling/numbness in hands and feet) and vitamin B12 levels are 200-250 pg/mL, MMA and tHcy measurements may help identify the cause.12

Folate – RBC folate should be checked at six months, one year and annually at a minimum following bariatric surgery. A normal RBC folate range is 280-791 ng/mL, with a deficiency present at <305 nmol/L and the presence of anemia <227 nmol/L.12 Serum folate more closely reflects recent dietary intake than actual folate status measured by RBC folate. Although relatively uncommon before and after bariatric surgery, folate deficiencies should be monitored, especially in women who may become pregnant.

The Lasting Effects

Bariatric surgery and the behavioral changes patients adopt have shown to be very effective reducing excess weight and the effects of obesity-related health conditions. However, the physical and metabolic alterations as a result of the procedure must be monitored by patients and their healthcare providers for the rest of their lives.

A dedication to following supplementation recommendations and monitoring nutrient levels should be incorporated into routine care which the patient can follow, the primary care physician can execute, and which allows the bariatric surgeon to remain informed and available for consultation.

Patient bleeds to death after gastric band surgery

noreply@blogger.com (iLitigate) — Sun, 13 Sep 2009 12:49:00 +0000

A mother told to lose weight to avoid serious health problems died hours after surgery to fit her with a gastric band.

Susan Alderson had three litres of blood in her abdomen and had bled to death, a post mortem found.

Experts had advised the 49-year-old to have the band fitted, a procedure which reduces the size of the stomach.

Susan Alderson received gastric band surgery at the former Derby City General Hospital in January. She later bled to death

But after the operation, which was also to repair a hernia, Mrs Alderson suffered internal bleeding, which claimed her life, an inquest was told.

Mrs Alderson, a diabetic who weighed more than 16 stone, was told by dieticians she would need the surgery to help prevent other potentially life-threatening illnesses.

She was admitted to the former Derby City General Hospital in January.

The hearing, attended by Mrs Alderson's husband and son, was told the operation went ahead without complications and Mrs Alderson appeared to be recovering well.

Derby Coroner's Court heard she started bleeding internally hours later, leading to a cardiac arrest and her death the next morning.

Paul Leeder, who carried out the operation, said: 'I had never experienced any problems with patients having severe complications. I had not had a death either before that operation or since.'

He said Mrs Alderson's body mass index (BMI), which determines whether a patient has a healthy body weight by measuring their height and weight, was 44, classing her as morbidly obese.

A patient who weighs too much in comparison to their height is in danger of developing problems such as strokes, heart problems, arthritis and an increased risk of cancer.

Mr Leeder said: 'Mrs Alderson had been on a low-calorie diet but had only lost four kilogrammes (nine pounds).

'The three options were for her to carry on as she was, without surgery, to have a gastric bypass or to have the gastric band.

'The risk of bleeding, risk of death and failure rate of the procedure were explained. But the long-term benefits of sustained weight loss would have far outweighed the risks involved with the surgery.'

After surgery, Mrs Alderson, of Sinfin, Derby, was moved into a recovery area, where her blood pressure started to drop.

Doctors gave her injections to help boost her blood pressure but, later that evening, it started to drop again. She was moved to a higher dependency ward and appeared to be recovering.

Mrs Alderson was later transferred to a 'step-down' ward, where she suffered a heart attack and later died.

Her post mortem examination found between two-and-a-half to three litres of blood collected in her abdominal wall, close to the repaired hernia.

Dr Andrew Hitchcock, consultant pathologist at Royal Derby Hospital, said it was not clear where the bleeding had originated.

Dr Hitchcock said Mrs Alderson's medical cause of death was internal bleeding, related to the hernia repair and gastric band operation.

Recording a narrative verdict, deputy coroner Louise Pinder gave the cause of death as intra-abdominal haemorrhage and incisional repair and gastric band application.

Miss Pinder said: 'She had no particular interest in losing weight for interests of vanity, this was very much a medically-based decision.'

A spokesman for Derby Hospitals, said: 'Our thoughts are with Mrs Alderson's family.

'Any surgery carries a risk and in Mrs Alderson's case the risks were higher due to her high BMI, severe diabetes, liver problems and a hernia repair.

'These factors meant that when Mrs Alderson developed complications, her blood did not clot in the normal way.

'The coroner said that the clinical team could not have foreseen the tragic outcome in Mrs Alderson's case.'

Gastric Bypass Surgery Wrongful Death Lawsuits

Indiana Court of Appeals rules that employer must pay for obese employees gastric bypass surgery to ensure success of back surgery for work injury

noreply@blogger.com (iLitigate) — Sun, 13 Sep 2009 12:44:00 +0000

Indianapolis, IN

Experts say a court decision today in Indiana could make employers think twice before hiring workers who have health conditions that might prove costly down the road.

An appeals court ruled that a pizza shop has to pay for weight-loss surgery for a 340-pound employee. The surgery will ensure the success of another operation for a back injury that he suffered at work.

The ruling raises concerns among businesses bracing for similar claims.

The pizza shop had agreed to pay for the back surgery, but said it wasn't obligated to pay for the weight loss operation because the man was already obese before he was hurt.

The court found that the surgery was covered because the man's weight and the accident had combined to create a single injury.

There was a similar ruling recently in Oregon, where the state's Supreme Court ruled that the state workers' compensation insurance has to pay for gastric bypass surgery to ensure that a man's knee replacement surgery is effective.

The head of a consulting firm that helps businesses manage workers compensation says the Indiana case "draws a line in the sand" -- because it's based on principles used in several states.

Gastric Bypass Surgery Lawsuits

Risk of alcohol abuse increases after gastric bypas surgery

noreply@blogger.com (iLitigate) — Sun, 13 Sep 2009 12:38:00 +0000

Sacramento, CA

On Friday's Live_Online at 11 a.m., we learned that an unintended consequence of gastric bypass surgery is the risk of alcohol abuse, said Laura Lagge, a certified alcohol and drug counselor with New Dawn Recovery in Citrus Heights.

Lagge told viewers she's seeing more women who turned to gastric bypass for their weight problem now struggling with alcohol abuse.

She said after the surgery, alcohol enters a person's system more quickly and the effects are stronger.

Lagge said, "If you are considering gastric bypass, tell your doctor truthfully about how much alcohol you currently drink." Once the surgery is done, patients must reduce the amount of food and beverages they consume or face serious health consequences, such as alcohol abuse.

Several high profiles DUI cases involving women, most recently the off-duty Sacramento County deputy who crashed into a Natomas Starbucks, prompted Friday's discussion on women and addiction.

Lagge added that alcoholism and addiction is a disease that "strikes all kinds of people, regardless of age, race, economic standing, gender or education."

"Having the disease does not mean you are immoral, weak or defective," and that recovery is a gradual process, like any other chronic disease, she said.

If you're wondering if you have a drug or alcohol problem, Lagge said consider the following questions:

1. Have you ever felt you should cut down or try to control your drinking or drug use?

2. Have you ever felt guilty or bad about your drinking or using drugs?

3. Do you ever take a morning eye-opener to steady your nerves or to get rid of a hangover? Do you use drugs or drink daily or weekly? Do you use prescription medications more often than prescribed?

4. Are alcohol or drugs sometimes more important that other things in your life, such as your family or your job?

5. Do you find yourself lying to your spouse, your kids, or your employer to cover up your drinking or using?

6. Have you ever switched from one type of drug to another to either prove you're not addicted or to help with withdrawal symptoms from another drug?

7. Have you had problems with your job, your relationship, finances, legal or your health due to your drinking or drug use?

8. Have friends or family members expressed concern for you about your drinking or drug use?

9. Have you gone to work or driven while intoxicated or in a drug-induced haze?

10. Have you been drunk or high more than four times in the past year? Do you sometimes stay drunk or high for days at a time?

11. Do you need more alcohol or drugs in order to do something (start the day, have sex, clean the house, socialize, for example) or to change how you feel?

12. Do you need more of the drug or alcohol in order to get the same effect?

13. Are you uncomfortable when you have to be somewhere where no alcohol or drugs will be available?

Lagge said if people answer yes to two or more of the above questions, "they are at the very least abusers and would benefit greatly from stopping."

Gaastric bypass malpractice law firm

California woman seriously ill after gastric bypass surgery finds hope

noreply@blogger.com (iLitigate) — Wed, 26 Aug 2009 03:11:00 +0000

Modesto, CA

Tests have shown that Sandi Krueger's golf-ball-sized pouch no longer breaks down the food she eats, but dumps it directly into her small intestine. Before the feeding tube, her attempts to eat caused nausea and she often had dumping syndrome, a reaction when certain foods pass too quickly into the intestine, resulting in sweating, rapid heart beat and weakness.

Her journey began in 2002 with a gastric bypass at Doctors Hospital of Manteca, which later closed its bariatric program. She had constant dumping and severe weight loss, had a falling out with her surgeon and went to the University of California at San Francisco for corrective surgery in 2004.

Her condition improved for several months and then her condition gradually deteriorated. She stopped working as a nursing assistant last year and then UCSF rejected her request for a reversal surgery.

Repairs are complex

She's made the 165-mile trip to Delano because Keshishian accepted her Medi-Cal coverage and he specializes in revising or reversing gastric bypasses. A reversal has some of the same risks as gastric bypass; in addition, the surgeon must deal with scar tissue that grows between the left side of the liver and upper part of the stomach.

"You have to peel the stomach away from the liver," Husted said. "It's tricky and can take a long time."

Many patients who aren't absorbing enough nutrients can improve with counseling and treatment, experts say.

Until her surgery is scheduled, Krueger will stay with the tube- feeding routine — 44 ounces of water mixed with a formula of protein, vitamins and other stuff costing the family $549 a month. With her husband drawing unemployment, it strains the family budget, but at least she feels healthy.

"It is nice to be a mom again," she said. "It feels like I have missed six years of my life."

Gastric Bypass Malpractice Lawsuit Attorneys

Gastric bypass surgery death rates drop, study reveals

noreply@blogger.com (iLitigate) — Sun, 23 Aug 2009 04:25:00 +0000

Seattle, WA

Obese, but worried that surgery for it might kill you? The risk of that has dropped dramatically, and now is no greater than for having a gall bladder out, a hip replaced or most other major operations, new research shows.

The study looked at safety results for gastric bands and stomach stapling at 10 U.S. hospitals specializing in these procedures from 2005 through 2007. For every 1,000 patients, three died during or within a month of their surgery, and 43 had a major complication.

That is much better than the 20 or so deaths per 1,000 patients that studies found just a few years earlier. And it's surely lower than the longer term risk of dying of heart disease, diabetes and other consequences of lugging around more pounds than an obese person's organs can handle, experts say.

Many studies have compared those odds, and "all show a higher risk of dying if you do not have surgical treatment than if you do," said Dr. Eric DeMaria, weight loss surgery chief at Duke University Medical Center.

He had no role in the new study, which was led by Dr. David Flum at the University of Washington in Seattle. Results appear in Thursday's New England Journal of Medicine.

About one-third of American adults are obese, with a body mass index of 30 or more. The index is based on height and weight. Someone who is 5-feet-4 is obese at 175 pounds; a 6-foot person is obese at 222 pounds.

Federal guidelines say obesity surgery shouldn't be considered unless someone has tried conventional ways to shed pounds and has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.

Last year, at least 220,000 obesity surgeries were done in the United States, says the American Society for Metabolic & Bariatric Surgery. The most popular method is a gastric bypass in which a small pouch is stapled off from the rest of the stomach and connected to the small intestine. People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. This can be done with traditional surgery or laparoscopically, through small keyhole incisions.

Another solution is a gastric band. A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.

The new study looked at the safety of these methods in 3,412 gastric bypass patients and 1,198 given stomach bands.

Death, serious complications or the need for another procedure occurred in 1 percent of people receiving bands, nearly 5 percent having laparoscopic gastric bypass, and nearly 8 percent of those given a traditional surgical bypass. Maybe

DeMaria cautioned against comparing the numbers, because healthier people may have been steered toward laparoscopic procedures that may not have been an option for others with more health risks.

Complication rates were greater in people with a history of clot problems, sleep apnea and certain other medical issues, the study found.

The federal government paid for the study. Many of the researchers have ties to companies that make obesity treatments, and several have testified in surgery lawsuits.

The results put the spotlight on cost issues, Dr. Malcolm K. Robinson, a surgeon at Harvard Medical School, wrote in an editorial accompanying the study.

"In the past, now outdated bariatric procedures carried unacceptably high risks. The weight loss associated with the procedures was questionable, and the long-term health benefits were unproven," he wrote.

Now, the evidence shows that "surgery is safe, effective, and affordable," because it can lower doctor visits, medication use and other medical expenses, Robinson wrote. However, "the expense of operating on the millions of potentially eligible obese adults could overwhelm an already financially stressed health care system."
On the Net:

* New England Journal: http://www.nejm.org
* National Institutes of Health surgery explanation: http://win.niddk.nih.gov/publications/gastric.htm

Gastric Bypass Malpractice Wrongful Death Trial Lawyers

Gastric bypass surgery patients with seep apnea at higher risk, study says

noreply@blogger.com (iLitigate) — Sat, 22 Aug 2009 12:20:00 +0000

Overland Park, KS

While short-term complications and death rates are low following bariatric surgery, according to the Longitudinal Assessment of Bariatric Surgery (LABS-1), patients with a preoperative history of sleep apnea remain at a greater risk of complications.

According to the study, funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, less than 1% (0.3%) of patients died within 30 days of surgery. The findings support the short-term safety of bariatric surgery as a treatment for patients with extreme obesity.

"Evaluating the 30-day safety outcomes of bariatric surgery in large populations is an essential step forward," said coauthor Myrlene Staten, MD, senior advisor for diabetes translation research at NIDDK in an announcement. "And LABS-1 data are from all patients who had their procedure performed by a surgeon participating in the study, not from just a select few patients."

The LABS-1 consortium followed 4,776 patients having bariatric surgery for the first time, and evaluated complications and death rates within the first 30 days after surgery. Patients were at least 18 years old and had an average body mass index (BMI) of 44. The majority of LABS-1 patients were white and female, which, according to the NIDDK, is the most common population to undergo bariatric surgery. The study took place over 2 years at 10 medical sites, with one additional center coordinating data collection and analyses.

Within 30 days of surgery, 4.1% of patients had at least one major adverse outcome, defined as death, development of blood clots in the deep veins of the legs or in the pulmonary artery of the lungs, repeat surgeries, or failure to be discharged from the hospital within 30 days of surgery.

Thirty-day mortality was low but varied depending on the type of bariatric surgery performed. This ranged from no deaths in the laparoscopic adjustable gastric band group, to six (0.2%) in the laparoscopic Roux-en-Y gastric bypass group, to nine (2.1%) in those undergoing open Roux-en-Y gastric bypass. After adjusting for patient and center characteristics, there were no significant differences in complication risk that could be attributed to the type of procedure. Patient factors such as a preoperative history of deep vein blood clots and sleep apnea increased the risk of postoperative complications. Patients with a very high BMI were also at an increased risk: A patient with a BMI of 75 had a 61% higher risk of complications than those with a BMI of 53.

LABS-1 is part of the Longitudinal Assessment of Bariatric Surgery consortium, an NIDDK-funded study launched in 2003 to examine the short- and long-term benefits and risks of bariatric surgery for adults with extreme obesity.

Results appear in the July 30 issue of the New England Journal of Medicine

Gastric Bypass Malpractice Lawsuits

Obese student seeks charitable donations for gastric bypass surgery

noreply@blogger.com (iLitigate) — Thu, 20 Aug 2009 01:12:00 +0000

Seattle, WA

A Seattle college student doesn't want to be the "biggest" man on campus and has started a Web site asking for donations to help him get gastric bypass surgery.

Comedianne Mo'Nique becomes weight loss leader

noreply@blogger.com (iLitigate) — Fri, 14 Aug 2009 02:24:00 +0000

Philadelphia, PA

Lately, the blogosphere has been blowing up over two big sisters: comedian Mo'Nique and President Obama's pleasingly plump new surgeon general, Dr. Regina Benjamin.

There's so much controversy that I'll need two columns to address it all. First, let's talk about Mo'Nique.

Actress-comedian Mo'Nique Imes Jackson, author of "Skinny Women Are Evil" and "Skinny Cooks Can't Be Trusted," has lost 40 pounds. Rumors have been flying that she had gastric bypass surgery, which she flat- out denies. But that hasn't appeased the size-acceptance camp, whose members are angrily abuzz about the weight loss she disclosed in a recent interview with Jet magazine.

In the interview, Mo'Nique says she knew it was time to lose weight when her husband, Sidney Hicks, watched her step off the scale at 262 pounds and said, "Baby, that's too much, and I want you for a lifetime."

Now the 5-foot-6-inch star is making the necessary sacrifices and has vowed to get her weight down to 200 pounds.

"This was truly making the commitment to watch what I eat and commit to working out," she said. "I stopped eating red meat. I want to say to big people, 'Let's be healthy big people. Everybody can't be a size 0, but let's be healthy.' "

Her efforts are worthy of applause. So why the criticism?

It is true that for years, this fat and fabulous one has been a champion for size acceptance. She has made a generous living dissing so-called "skinny bitches" while encouraging fat women to stay, well, fat.

Mo was always the first to say how proud she was to be representing for the big girls. So is this some sinister plan she's made to unleash an internal skinny bitch who's been dying to get out?

I don't think so.

Quite frankly, it has always stupefied me why the plus-size community feels betrayed when a plus-size celebrity - or a friend, for that matter - decides to slim down. Why are efforts at living a healthier lifestyle viewed as a personal affront?

Mo'Nique shouldn't be shunned for losing weight. Even if she reaches her goal of 200 pounds, she'll have a BMI of 32.3, which still makes her medically obese.

Would size acceptance groups prefer that Mo'Nique eat herself into disease, disability or death?

I suspect that fat advocates' swagger and confidence is really false bravado. Embracing your size does not make your health problems disappear. None of us has the luxury of throwing in the towel on a healthy lifestyle of daily exercise and good nutrition.

From where I sit on the front lines, it's clear we cannot continue this masquerade. And this is especially true for black folks. Black women, who have the highest overweight and obesity levels of any U.S. population, cannot afford false bravado. We need solutions. We need to keep it real with ourselves and take control of our health.

Why can't we be honest with ourselves and admit that being overweight or obese is not healthy? Why don't we understand that this hits the black community especially hard?

It's not healthy to carry an extra 20 pounds, let alone 100 pounds. Our bodies are just not designed for this type of trauma.

I have seen enough premature death, disease and disability in the black community to confirm the truth. I don't even have to cite the statistics on this, but I will.

If you are still on the fence about where black women are on the obesity front, then check this out:

_ African Americans, particularly African-American women, need to protect themselves against the ravages of obesity, which strikes us harder than any other group.

According to the Centers for Disease Control and Prevention Web site, 31.2 percent of African Americans were obese in 2001, up from 19.3 percent from the previous decade. That's a whopping increase in just 10 years. And experts say that today, half of all African-American women are obese.

_ African Americans suffer disproportionately from heart disease, hypertension, and diabetes, among other lifestyle-related diseases.

Surely, Mo'Nique is aware of all this. Now she's on the precipice of change.

Mo'Nique has the extraordinary potential to save some lives. Her decision to tackle her weight may influence more women to take charge of their health.

Can you imagine it? Maybe, just maybe, Mo'Nique is going to help lead the battle against obesity. Could she be the one to kick-start Obama's new health initiative? And will she get some help, perhaps, from a recent Obama appointee?

Gastric Bypass Malpractice Lawsuits

More than 50% Increase in gastric bypass surgeries over past 12 months in UK

noreply@blogger.com (iLitigate) — Fri, 14 Aug 2009 01:30:00 +0000

York City, UK

Operations to combat weight gain have increased by more than a half in the past 12 months.

The news follows the tragic death of York mum Kerry Greaves, who underwent gastric bypass surgery to try to slim down so her daughter, Melissa, would not be teased at school. Sadly, complications led to Kerry’s death at the age of only 30.

Figures released by the NHS show that in the 12 months leading up to April this year, 4,324 people nationally underwent operations to have gastric bypasses or gastric bands fitted to help them lose weight. That is a 52 per cent increase over the 2007-2008 figures, when 2,838 opted for surgery.

Operations of this type can cost about £10,000 and most of those who opt to go “under the knife” are women – about three-quarters of the total who opt for surgery.

The treatment is predominantly available for patients whose body mass index (BMI) exceeds 50 – the average BMI is between 18 and 25.

People with a BMI of more than 40 are considered to be morbidly obese while a measurement of more than 30 is classed as obese.

According to the NHS figures, only 38 per cent of people are a healthy weight. The rise in the number of people wanting gastric bypass surgery has been borne out by York GP Dr David Fair, who said he had seen a marked increase in the number of people wanting the procedure.

But surgery should always be seen as the last option when dieting and exercise has failed.

Although low risk, Dr Fair said that potential problems could arise with any type of operations.

That is what happened to Kerry. After having the operation her stomach failed to heal properly, and she underwent a further 14 operations before dying of organ failure.

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Study identifies several risk factors linked to poor bariatric surgery utcomes

noreply@blogger.com (iLitigate) — Thu, 06 Aug 2009 05:31:00 +0000

Cambridge, MA

Several risk factors may help identify factors linked to poor outcomes for bariatric surgery, according to the results of a prospective, multicenter, observational study reported in the July 30 issue of the New England Journal of Medicine.

"To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization," write David R. Flum, MD, from the University of Washington in Seattle, and colleagues from the Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. "Concern about the safety of bariatric surgery has grown with its increasing popularity and has been heightened by periodic high-profile reports in the lay press of deaths after bariatric surgery and of the closure or threatened suspension of bariatric programs because of safety issues. Malpractice insurers have expressed concern about the increased risk they incur when they provide liability-insurance coverage to bariatric surgeons."

From 2005 through 2007, the investigators evaluated 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical US sites. For 4776 patients undergoing first-time bariatric surgery, the composite endpoint of 30-day major adverse outcomes included death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; and failure to be discharged from the hospital.

Mean age of the study sample was 44.5 years, 21.1% were men, 10.9% were nonwhite, and more than half had at least 2 comorbid conditions. Median body-mass index (BMI), defined as weight in kilograms divided by the square of the height in meters, was 46.5 kg/m2.

The bariatric procedure performed was Roux-en-Y gastric bypass in 3412 patients (performed laparoscopically in 87.2% of these patients) and laparoscopic adjustable gastric banding in 1198 patients. The analysis excluded 166 patients who underwent other procedures. Among patients treated with Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding, 30-day mortality rate was 0.3%, and 1 or more major adverse outcomes occurred in 4.3% of patients.

Factors independently associated with an increased risk for the composite endpoint were a history of deep-vein thrombosis or pulmonary embolus, a diagnosis of obstructive sleep apnea, and impaired functional status. Although extreme BMI values were significantly associated with increased risk for the composite endpoint, age, sex, race, ethnicity, and other comorbid conditions were not.

"The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics," the study authors write. "In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese."

Limitations of this study include possible lack of generalizability to the general community; limited size of certain patient subgroups, resulting in a type II error that did not identify a difference in safety among groups; comorbid conditions determined by patients' self-report; and inability to determine the case volume at the centers.

In an accompanying editorial, Malcolm K. Robinson, MD, from Harvard Medical School in Boston, Massachusetts, is hopeful that learning more about how bariatric surgery works may help develop even less invasive procedures.

"It is a sobering fact that some obese young adults may lose up to 20 years of life expectancy if they do not reduce their weight," Dr. Robinson writes. "One must treat obesity aggressively, though thoughtfully, and with an eye toward developing effective prevention and better therapies that ideally would eliminate the need for surgery altogether. But until we get to that point, the weight of the evidence indicates that bariatric surgery is safe, effective, and affordable."

The National Institute of Diabetes and Digestive and Kidney Diseases and the General Clinical Research Center supported the LABS study. Some of the study authors have disclosed various financial relationships with Covidien, legal firms representing cases involving bariatric surgery, Allergan, Pfizer, sanofi-aventis, Stryker, GlaxoSmithKline, Lilly Research, Legacy Health System, W.L. Gore and Associates, Ethicon Endo-Surgery, Johnson & Johnson, Tyco, and/or EnteroMedics.

Dr. Robinson has received consulting fees from Storz and has served as an expert witness in legal cases regarding standards of care in bariatric surgery.

N Engl J Med. 2009;361:445-454, 520-521.

New study claims gastric bypass and gastric banding weight-loss surgery safe

noreply@blogger.com (iLitigate) — Thu, 30 Jul 2009 12:38:00 +0000

St. Louis, MO

Obese patients who undergo weight-loss surgery have a low risk of dying or developing complications that require a second surgery or longer hospital stay, a study found.

About 4.1 percent of 4,610 people in the study who had either gastric bypass surgery or gastric banding developed at least one major complication in the 30 days after surgery, according to research published today in the New England Journal of Medicine. Those who underwent gastric banding had fewer complications.

Weight-loss surgery has soared in popularity in the U.S. The number of such operations rose more than tenfold to about 171,000 in 2005 from about 16,200 in 1994, according to an editorial in the journal. The data shows that, at least in the short term, these procedures are relatively safe and future research may help identify which surgery is best for a particular patient, said study author Bruce Wolfe, a professor of surgery at Oregon Health and Science University in Portland, in a telephone interview. Based on the findings, he said, "the surgery is basically safe."

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Gastric bypass surgery malpractice: Fatal malpractice at NY hpspital unreported

noreply@blogger.com (iLitigate) — Mon, 27 Jul 2009 00:41:00 +0000

Coney Island, NY

On July 17, 2006, Robert Asta had gastric bypass surgery at Coney Island Hospital. Six days later, the 54-year-old cook was dead.

Internal hospital records reveal a "foreign object" was left inside his body postsurgery, but for the year 2006, Coney Island Hospital reported zero cases in which a foreign object was mistakenly left in a patient after surgery.

Robert's son, Michael, was devastated. It was a surgery Michael didn't want him to have, but Asta desperately wanted to lose weight. The 6-foot, 375-pounder had tried all kinds of diets with little success.

"My life has never been the same. We were supposed to go into business together," Michael Asta said. "My family is heartbroken."

Asta never told his family what he was planning.

"None of us would have let him go," Michael Asta said.

The son said his father told him about the surgery a day after the operation — and said he was in a great deal of pain.

Robert called the hospital, but was told that pain after such an operation is a normal part of the recovery process.

Then on July 20, Asta received a call from the hospital asking him to come in for some further testing after lab tests came back with abnormal results.

The hospital found a piece of surgical tubing in material removed from Asta's body — an indication something had been left inside Asta postsurgery.

A CT scan was taken and the results were inconclusive. On July 23, Michael Asta received a call from his father's long-time girlfriend.

"She told me to come over because, she said, 'He feels very cold and I think he's dead,'" Asta said. When Asta arrived, his father was dead.

In response to the News' questions, the city Health & Hospitals Corp. insisted it didn't need to report this incident as "foreign object left in body" – a specific reporting category. Instead it was reported merely as "unexpected death."

HHC said surgical tubing was not left inside Asta, but an internal Coney Island Hospital document dated Aug. 22, 2006, that the family obtained in its lawsuit states, "Foreign Object left in body during surgical operation."

The autopsy report lists the cause of the death as a postoperative infection in the abdominal cavity that involved "retention of surgical tubing" in a surgical specimen.

Manner of death is listed as "therapeutic complication." Though the hospital didn't admit wrongdoing, the family's malpractice claim was settled for $675,000.

Asta left behind three adult children and two grandchildren.

Unreported gastric bypass malpractice at New York hospital results in patient death

noreply@blogger.com (iLitigate) — Mon, 27 Jul 2009 00:28:00 +0000

Coney Island, NY

On July 17, 2006, Robert Asta had gastric bypass surgery at Coney Island Hospital. Six days later, the 54-year-old cook was dead.

Internal hospital records reveal a "foreign object" was left inside his body postsurgery, but for the year 2006, Coney Island Hospital reported zero cases in which a foreign object was mistakenly left in a patient after surgery.

Robert's son, Michael, was devastated. It was a surgery Michael didn't want him to have, but Asta desperately wanted to lose weight. The 6-foot, 375-pounder had tried all kinds of diets with little success.

"My life has never been the same. We were supposed to go into business together," Michael Asta said. "My family is heartbroken."

Asta never told his family what he was planning.

"None of us would have let him go," Michael Asta said.

The son said his father told him about the surgery a day after the operation — and said he was in a great deal of pain.

Robert called the hospital, but was told that pain after such an operation is a normal part of the recovery process.

Then on July 20, Asta received a call from the hospital asking him to come in for some further testing after lab tests came back with abnormal results.

The hospital found a piece of surgical tubing in material removed from Asta's body — an indication something had been left inside Asta postsurgery.

A CT scan was taken and the results were inconclusive. On July 23, Michael Asta received a call from his father's long-time girlfriend.

"She told me to come over because, she said, 'He feels very cold and I think he's dead,'" Asta said. When Asta arrived, his father was dead.

In response to the News' questions, the city Health & Hospitals Corp. insisted it didn't need to report this incident as "foreign object left in body" – a specific reporting category. Instead it was reported merely as "unexpected death."

HHC said surgical tubing was not left inside Asta, but an internal Coney Island Hospital document dated Aug. 22, 2006, that the family obtained in its lawsuit states, "Foreign Object left in body during surgical operation."

The autopsy report lists the cause of the death as a postoperative infection in the abdominal cavity that involved "retention of surgical tubing" in a surgical specimen.

Manner of death is listed as "therapeutic complication." Though the hospital didn't admit wrongdoing, the family's malpractice claim was settled for $675,000.

Asta left behind three adult children and two grandchildren.

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Gastric bypass surgery using robots reduce pain and speed recovery

noreply@blogger.com (iLitigate) — Sat, 25 Jul 2009 20:15:00 +0000

Phoenix, AZ

Gastric bypass surgery has gone robotic at one Arizona hospital.

Using robots, doctors at Banner Gateway Medical Center can perform the surgery from inside the person's body, KPHO-TV reported.

"The robot allows you to perform the surgery (not only) in high definition, but also in three dimensions," said chief of surgery Dr. Rob Schuster.

Schuster said the procedure is less invasive and painful and it cuts the risk of infection.

Doctors use state-of-the-art technology with a three-dimensional image of the surgical area. The display controls the surgical instruments, working with the doctors' hands, wrists and eyes in real time.

"It really allows us to perform a more precise and perfect operation," Schuster said.

Schuster said the new procedure will result in shorter hospital stays and shorter recovery times, so patients are able to return more quickly to their normal routines.

Banner Gateway Medical Center is one of only a handful of hospitals in the country that use this technology.

KPHO's report did not address any additional costs or risks from the assisted surgery.

Gastric Bypass Surgery Malpractice Lawsuits

ASMBS: Laparoscopic adjustable gastric banding less effective than gastric bypass and sleeve gastrectomy

noreply@blogger.com (iLitigate) — Wed, 08 Jul 2009 02:51:00 +0000

Dallas, TX

Patients who underwent laparoscopic adjustable gastric banding achieved less weight loss and less improvement in comorbid conditions than those who had gastric bypass or sleeve gastrectomy.

Slightly more than half of gastric banding patients lost more than 50% of excess weight after five years compared with more than 90% of patients who underwent laparoscopic Roux-en-Y gastric bypass, Diego Awruch, MD, reported at the American Society of Metabolic and Bariatric Surgery.

Surgical failure, defined as less than 50% excess weight loss, was almost six times more common with gastric banding.

"Laparoscopic adjustable gastric banding was associated with fewer complications, but the percent weight loss at one and five years was inferior to laparoscopic Roux-en-Y gastric bypass," said Dr. Awruch, of Pontificia Universidad Catolica in Santiago, Chile.

"Surgical failure occurred in more than 40% of patients who underwent gastric banding, and 16% of the patients required surgical revision of the initial procedure," he said.

Similar disparities in weight loss occurred in the comparison of gastric banding and sleeve gastrectomy.

Across the entire range of body mass index (BMI), laparoscopic sleeve gastrectomy led to greater weight loss, said David Schumacher, MD, of Wright State University in Kettering, Ohio.

Dr. Awruch reported outcomes for 91 patients treated with laparoscopic Roux-en-Y surgery and 62 who underwent gastric banding from 2001 to 2003.

Five-year follow-up was available for 73.6% of the gastric bypass patients and 91.5% of the gastric banding patients.

Comparison of baseline characteristics showed that bypass patients weighed significantly more (106.4 versus 97.6 kg, P<0.001) and had a significantly higher BMI (39 versus 35, P<0.001).

Gastric bypass was associated with a higher rate of early complications (14.2% versus 1.6%, P=0.009). In addition, nine bypass patients required reoperation or endoscopic dilatation compared with one patient in the banding group.

Late complications occurred in 37.3% of bypass patients compared with 27.4% of gastric banding patients, but the difference did not reach statistical significance. A higher proportion of gastric banding patients required reintervention (23 of 62 versus 20 of 91).

Percent weight loss at five years averaged 92.9% with gastric bypass compared with 59.1% with gastric banding (P<0.001).

Dyslipidemia, insulin resistance, hypertension, and type 2 diabetes improved or resolved in 80% to 100% of bypass patients compared with 20% to 40% of the gastric banding group.

At five years, 94% of bypass patients and 54.4% of gastric banding patients had maintained >50% excess weight loss.

Dr. Schumacher reported outcome data for 104 patients who underwent laparoscopic sleeve gastrectomy and 227 who had gastric banding from January 2006 through August 2008. Follow-up data were 99% as of January 2009.

Among patients followed for at least 18 months (about half of the total), weight loss averaged 133.82 lb in the sleeve group versus 58.93 lb in the banding group.

For the same time interval, excess weight loss averaged 55.54% with sleeve gastrectomy versus 38.65% with banding.

Stratification of patients by baseline BMI showed that sleeve patients had a greater excess weight loss in patients with BMI more than 50 (50% versus 33%), 40 to 49 (68% versus 40%), and less than 40 (90% versus 43%).

Readmission rates were 6% of sleeve gastrectomy patients and 1.3% with gastric banding. One patient (0.96%) in the sleeve group required reoperation compared with 19 (8.4%) gastric banding patients.

"Laparoscopic sleeve gastrectomy appears to allow greater weight loss in all BMI classifications over time with fewer reoperations," said Dr. Schumacher. "The most efficient weight loss occurred in the lowest BMI classification.

"Laparoscopic sleeve gastrectomy can be used effectively as a primary operation in any weight classification, achieving a greater than 50% excess weight loss in all BMI subsets."

Weight-loss surgery may decrease the risk of cancer in women

noreply@blogger.com (iLitigate) — Sat, 04 Jul 2009 02:29:00 +0000

from CancerConsultants.com

Researchers from Sweden have reported that weight-loss surgery (bariatric surgery) was associated with a reduced incidence of cancer in obese women but not in obese men. The details of this study appeared in an early online publication in Lancet Oncology on June 24, 2009.[1]

Previous studies have suggested that obesity increases the risk of developing cancers of colon, rectum, liver, gallbladder, pancreas, breast, uterus, cervical, ovary, and kidney as well as lymphoid tumors such as non-Hodgkin’s lymphoma and multiple myeloma. It has been estimated that obesity increases the cancer death rate in men and women by more than 50%. It has been suggested that obesity causes 14% of all cancer deaths in men and 20% of all cancer deaths in women in the United States.

Weight loss surgery is usually the last resort for morbidly obese individuals when diets fail. Weight loss surgery refers to various procedures that restrict nutrient intake such as bands or bypasses. (See Wikipedia [http://en.wikipedia.org/wiki/Bariatric_surgery] for descriptions of the various surgical procedures currently being used.)

The current study evaluated the risk of cancer in 2,010 obese patients with a body mass index greater than 34 kg/m2 in men and greater than 38 kg/m2 in women who underwent weight loss surgery. Outcomes were compared with 2,037 controls who were comparably obese but did not opt for weight loss surgery. The median follow-up of this study was over 10 years.

* Weight loss surgery was associated with a 20 kg weight loss over the 10 years of observation compared with a 1.3 kg gain in controls.
* There were 117 cancers in the surgery group and 169 in the control group.
* There were 79 cancers in women in the surgery group and 130 in the control group.
* There were 39 cancers in men in the surgery group and 39 in the control group.
* Similar results were obtained when cancers developing in the first three years from surgery were excluded.

These authors concluded: “Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men.”

Comments: This is the first study to document a decreased risk of cancer following significant weight loss. It is very interesting that this decreased risk was limited to women. This may suggest that cancers in women are more hormonally dependent than in men. It has been speculated that hormones produced by fat may be the cause of increased breast, uterine, and ovarian cancer risk in obese individuals.

References:

[1] Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncology [early online publication]. June 24, 2009.

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