Arturo Rodriguez, MD

August 30, 2010

Lap Band Office Fills

Lap Band Office Fills

Your Lap Band fills are the most important part of the follow-up care that you need to succeed in your Weight Loss Journey. There is very little written about Lap Band Office Fills. Many people assume that the “office fill” is the best way to have the Lap Band adjusted.  Take some time to read through this information about office fills, and contact your Doctor if you have any questions.

Facts About Lap Band Office Fills

  • It is a fast profitable growing medical business as the Lap Band population increases in number
  • It is very rare that the Bariatric Surgeon is involved with the lap band fills
  • The Office Fills are cheap for most of the patients
  • No need for Doctor’s infrastructure (fluoroscopy)
  • It is easily done at the Doctor’s office
  • The Nurse is often in charge of doing the fills for patients
  • There is a learning curve to adjust the band properly
  • The fill might go into the fat instead of the port, and the need to return for another fill is frequently seen
  • You can get a leak from the hose due to needle puncture or penetration (due to multiple intents to reach the port’s target area) 
  • The Doctor will not know your lap band status with an office fill
  • The Doctor can’t detect early avoidable complications

 Office fills are an option for lap band adjustments. However, we do recommend having lap band fills done under fluoroscopy guide. If this is not possible, have your lap band checked under fluoroscopy at least once a year to determine the status of your lap band system and to check for any complications.

 

Arturo Rodríguez, MD

Bariatric Surgeon

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2008-07-19 22:32:22. Republished by Blog Post Promoter

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January 10, 2010

INTERNAL HERNIAS RELATED TO A GASTRIC BYPASS

INTERNAL HERNIAS RELATED TO A GASTRIC BYPASS

 

The internal hernias after a Laparoscopic Gastric Bypass may occur in 10 % of patients.  Early detection is important because they threaten the patient by causing intestinal obstruction, intestinal strangulation with perforation and peritonitis.

It is very important to know that the Internal hernias often pass unnoticed delaying the diagnosis and the treatment. 

The doctors either do not suspect the problem as a cause of the symptoms or the patients misunderstand the severity of their symptoms due to their initially vague clinical symptoms.

It is very common that the patients tend self medicate themselves delaying the prompt attention, not consulting with a doctor until symptoms are more serious with a higher risk of catastrophic complications.

Internal hernias in patients with Gastric Bypass occur most frequently 18 months after surgery, however there are reports from the first postoperative day up to 25 years after the operation.

It is important to know if your doctor completed a laparoscopic Gastric Bypassretro colic” or gastric Bypass “ante colic”.

There are 3 sites in the first case (retro colic) where hernia occurs: At the Petersen’s space, at level the jejunum-jejunostomy and at the mesocolon underneath the transverse colon; and there are two sites in the ante colic laparoscopic Gastric Bypass with a potential internal hernia presentation.

When a surgeon uses sutures during the bypass surgery the potential of a hernia space decrease the risk of the presentation of internal hernia.

In some private hospitals operatory time is very expensive and some doctors prefer to ignore this very important surgical step, on the other hand, to close these spaces also requires the development of advanced laparoscopic skills to do it correctly and in expeditious manner with intracorporeal stitches to close such potential hernia spaces and that has to be done by hand (not staplers), as a result, that explains some of the incidence of hernia with intestinal obstruction.

Common symptoms of internal hernia after a Laparoscopic Gastric Bypass are mild peri umbilical pain progressing to an intermittently cramping pain but increases in frequency and if not treated it will progress to the classic intestinal obstruction.

Occasionally the intestinal obstruction is mild and resolves quickly but may become a true surgical emergency where the life of the patient is at risk and surgical laparoscopic treatment has to be done without delay.

If you experience any of the described symptoms you must act quickly to resolve the hernia and need to be explore the area by laparoscopic means.  Closure of the hernia ring is very feasible in most cases, even more, when a bypass patient arrives with obstruction and it is diagnosed quickly needs to undergoing laparoscopic exploration to avoid complications.  If not treated immediately the chances increase due to the high possibility of a second catastrophic event.

Don’t expect that the hernia will be resolved with general measures because sooner or later the patient’s life is in jeopardy.

Dr. Arturo Rodriguez

Gastric Surgery and Obesity

http://www.thebariatric.com

http://www.bandstersforum.com

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December 5, 2009

Life After Gastric Bypass Surgery

Life After Gastric Bypass Surgery

There are a number of important things to consider for patients after they have had Gastric Bypass Surgery. Take some time to read through the information and get informed if you are considering this procedure.

Diet

After having a gastric bypass, the modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss.  Without these necessary changes, such as decreasing or limiting your intake of high-fat, high-sugar foods, you may stop losing weight or even begin to gain weight again.  Limiting high intakes of sugary foods is especially important to decrease the chance of Dumping Syndrome, where these foods move too quickly through the digestive tract into the intestine and can cause cramping, pain and discomfort, among other related symptoms.

Post-surgery dietary guidelines will vary by surgeon. You may hear of other patients who are given different guidelines following their gastric bypass surgery. It is important to remember that every surgeon does not perform the exact same weight loss surgery procedure and that the dietary guidelines will be different for each surgeon and each type of bariatric procedure.

What is most important is that you adhere strictly to your surgeon’s recommended guidelines. The following are some of the dietary guidelines I recommend after a gastric bypass:

  • During 4 weeks you will go on a liquid diet and advance in steps to a puree/baby food type diet for one or two additional weeks and transition to an almost normal (solid food) diet after that.
  • When you start eating solid food it is essential that you chew thoroughly.
  • You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
  • Don’t drink fluids while eating. They will make you feel full before you have consumed enough food or they will flush down more food than you should be taking in.
  • Omit desserts and other items with sugar listed as one of the first three ingredients.
  • Omit carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods and foods with high fiber content.
  • Avoid alcohol.
  • Limit snacking between meals.

Going Back to Work

Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of gastric bypass you had (open or laparoscopic). Many patients return to full pre-surgery levels of activity within six weeks of an open Gastric Bypass procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a week.

Birth Control & Pregnancy

It is strongly advised that women of childbearing age use effective forms of birth control during the first 16 to 24 months after a gastric bypass surgery since the fertility increases during weight loss. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.

Long-Term Follow-Up

Although the short-term effects of weight loss surgery are well understood, there are still some questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years are well known if you don’t take the recommended supplements. You will take supplements of Vitamins and Minerals (such as calcium and iron) for life and have a full blood work test done at least once every year.

Support Groups

The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various issues.  Most learn, from example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Most surgeons have support groups in place to assist you with short-term and long-term questions and needs. I highly recommend enrolling into a support group.

Be cautious when turning to message boards as they are full of doctor’s coordinators or brokers more concerned with increasing business in their direction than providing support. You have to be aware of their presence and not allow them to manipulate you; they are only interested in gossiping or scaring you when you are only looking for the right answers.

Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients.

Arturo Rodríguez, MD

Bariatric Surgeon

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2008-10-26 07:45:58. Republished by Blog Post Promoter

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November 14, 2009

My Life with the Lapband

Tricia

My Life with the Lapband

My Journey…

Boy how time flies! 

As I approach my 5th year Bandiversary, I started thinking how the Lapband has changed my life or how I had to change my life to live with the Lapband.

First off, I thank God every day for showing me there was an option and giving me the opportunity to have the Lapband procedure.

Like most in my situation, I tried every diet that always ended in failure. I almost got to the point where I wouldn’t want to diet because I KNEW I would gain the weight back and probably gain more. It was a horrible vicious cycle that I lived in for years.

Living with the Lapband was a continual learning process for a while. I tested foods to see what I could eat and what gave me difficulties. I tested out drinking with meals and not drinking with meals. Unfortunately, I had to learn the hard way on a lot of these issues, but the key is I learned and now the changes that I have made in living with the Lapband are part of my normal way of living. I don’t even think about it anymore.

One of the most frustrating things about the Lapband is obtaining proper restriction level. On one hand, I wish doctor’s would be a little more aggressive with the fill amounts, on the other hand, I think that working your way up to the proper restriction level is the way to go to avoid getting filled too tight which can be very uncomfortable and dangerous. I think that more discussion needs to be made about preparing one’s self for life after the lapband which includes the cost of adjustments/fills and the expectation of how many fills it may require to achieve proper restriction.

For self payers, many people use all their financial means to pay for the actual Lapband surgery and then don’t have the funds to get adjustments afterwards. This creates frustration because you just paid a lot of money and went through surgery and now want to lose the weight. Sounds reasonable……. But many feel like they wasted money when they don’t lose weight after the surgery or they feel like they can eat like they could before the surgery which is true until the band is adjusted properly.

So if someone is scheduled for lapband surgery and they ask me about the band, I make a point of preparing them for after surgery. I also try to tell them that their patience level will be tested to the max until they get their bands filled properly. I’ve heard this said by many and it’s so true “It took us a long time to become this overweight, we’re not going to lose it all overnight” It may take some time to lose weight with the Lapband, but with a little patience and following some very basic rules, you will lose weight and you will be successful.

Things that have changed for me after I was banded…

I don’t drink with meals. I found that this flushes food from my small upper pouch into my lower pouch which enables me to eat more food. This kind of defeats the band doesn’t it? I don’t want to eat more food, because this little thing called weight gain occurs if I do.  Not drinking with meals was probably the hardest thing for me to get used to, but now I don’t even think about it.

I still take small bites and have slowed down while eating. I found that taking smaller bites and slowing down while eating actually fills me up quicker. I also don’t look like I’m inhaling my food anymore, which was a very unattractive habit that I got into pre-band.

I listen to my band. It tells me when to stop eating. Oh, I’ve tried to argue with my band in the past and tell it that I could eat more even when it warned me that I have had enough, but for some reason the band was always right. I paid a small price for trying to fight the band. I would feel horrible until the food passed through the band. Sometimes I would PB (not pleasant) and learned very quickly that it’s just not worth fighting the band. It knows best, so now I listen to it.

I try to stick to protein foods first. I’m not always good at this, but it’s something that I feel is very important for Lapbanders. I have also found that when I eat protein foods first like chicken, fish, etc… then I don’t require as much food to feel full and I stay fuller longer. Not to mention the benefits to my health for eating protein.

Since I can’t eat as much as I used to, my food choices have changed. Before the band, I would eat horribly. It’s because I could eat a lot of anything I wanted. So if I wanted to snack on chips before dinner, no problem. I would still be hungry enough at dinner to eat it, and then have enough room for dessert after wards.

I now chose quality over quantity. I do this because I know I can’t eat a lot, so what I DO eat becomes very important. I have found that if I eat chips now, I will fill up on them, and I won’t feel hungry to eat what I should be eating. Then I end up feeling awful because “foods” like chips drain my energy if I try to use them as my source of nutrition. Don’t get me wrong, I still eat things like chips, but I make a point of not eating them when I’m hungry because I know that I will fill up on them and won’t eat what I need to be eating. So I will have junk food occasionally, but usually with my meal and have very little.

I don’t eat dinner late in the evening. I have a cut off time for dinner. I make sure that I don’t go to bed for about 3 hours after I eat. I also don’t drink a lot of fluids at night and I religiously take 2 Pepsid AC chewables before I go to bed. I believe that these things have decreased my chances of having acid reflux at night.

So yes, the Lapband has totally changed my life. With 155 pounds gone I’m feeling terrific! I feel that the minor things that I have changed in my life (with eating) due to the band are so minor and so worth it to help insure that I keep this weight off. Don’t get me wrong, I don’t struggle to keep the weight off, which is fantastic, but I believe that the minor changes that I have made have contributed to this.

The Lapband won’t do it all. You’ll need to help it some, but once your band is adjusted properly, the band will work for/with you instead of you working for the band.

Life is wonderful!Tricia before Lapband
Tricia after Lapband

Starting BMI 43

Current BMI 20

Tricia
Banded July 16th, 2004
Lost 155 pounds

Dr. Arturo Rodriguez

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2009-03-11 18:21:38. Republished by Blog Post Promoter

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July 20, 2009

Why My Weight Loss Procedure Can Fail?

Why My Weight Loss Procedure Can Fail?

The first and most important step to minimize the chances of failure from a Bariatric procedure and to increase your success rate is to be well informed about each one of the surgeries before you choose any of them.

What should you know about Weight Loss Surgery?

  • How does each procedure work? How will they assist in weight loss?
  • What should you expect from the Lap Band, Gastric Sleeve, or Gastric Bypass procedures, in terms of weight loss and/or Type 2 Diabetes
  • The difference in short and long-term benefits for each procedure
  • The operative risks and complication rates for each procedure
  • How much follow-up and support will you need for each procedure
  • How much of the Total Patient Care (TPC) program services will you need
  • What kind of adjustments will you need following surgery?
  • What kind of commitment is expected from you, for each procedure
  • What should you expect from the Doctor or Bariatric Group that you choose
  • The surgical options you have for each of the procedures in case of a failure
  • Finally, the cost of each procedure

What should you know about the Doctor or Bariatric Group?

You have to be well informed about the Doctors and medical team performing the Lap Band, the Gastric Sleeve or the Gastric Bypass.  Choose your surgeon and medical team wisely in order to ensure the best results for your weight loss success.

  • Ask about their education and training credentials if you are planning to go to a Latin Country. Look for Medical Degrees in Private Colleges like Monterrey Tech, University of Monterrey, or LaSalle School of Medicine, or other reputable medical universities.
  • Ask about where they received their Surgical Training. There can be a big difference in the treatment you will receive between doctors trained in well-known Private Hospitals, rather than in the Social Governmental Health Care System.
  • Ask about their Diplomas. Did they have to write a Medical Tests to join the Medical Society or Surgeon group, or did they just pay a subscription fee to become a member?
  • Check the number of Revision Surgeries they have been involved with. This may give you an indication of the quality of their work.
  • Check their Surgical Staff for credentials and experience. Consider the Anesthesiologist and any other assistant surgeons. It is important that they have experience in Bariatric surgery.
  • Double-check the Ethics and Professionalism of their Promoters or Coordinators.
  • Finally, check the Follow Up and Support they would provide you after your surgery.

Diet Rules to Follow (Regardless of the Weight Loss Procedure you Choose)

For any weight loss method to be successful and effective, you have to make some healthy lifestyle choices regarding the foods that you eat.  Bariatric surgery is an effective way to increase the rate of weight loss, but the best results can only happen when you make healthy choices.  After Bariatric surgery, you will feel full with a smaller amount of food – make sure to choose foods with the most nutritional value to help you on the journey to a new, healthier you!

  • Follow the Diet Steps recommended by your Doctor or the Nutritionist after surgery.
  • Chewing very well will help to maintain the pouch size, preventing stomach stretching and decreasing the risk of blockages and reflux in the esophagus or stomach.
  • Eat 6 small meals a day.
  • Eat slowly; take your time at the table.
  • Preferably, hydrate or drink beverages between meals.
  • Avoid Gastric Irritants like Alcohol, Coffee, Hot or Spicy, Vinegar, Soy Sauce or other Acid Beverages.
  • Limit high calorie foods like chocolate, cream and full-fat dairy products.

Failure Features Characteristically observed with Bariatric Procedures

These “failures” can be a result of a number of different circumstances or actions, or may develop slowly over time.  Therefore, it is important to have regular follow-ups to monitor your weight loss and the status of your lap band, sleeve or gastric pouch.  Remember: If you have any concerns, don’t be afraid to ask your doctor.

  • Big Gastric Pouches
  • Mega- esophagus
  • Wide Gastric Sleeve
  • Excessive tightness of the Gastric Band
  • Wide outlet of the Bypass Gastro-Yeyuno
  • Very Short common limb of the Gastric Bypass

 

Arturo Rodríguez, MD

http://www.thebariatric.com

Originally posted 2008-07-10 23:25:31. Republished by Blog Post Promoter

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What If my Bariatric Procedure Fails?

What If my Bariatric Procedure Fails?

Patients can have minor or large complications after a Lap Band, Gastric sleeve or Gastric Bypass procedure.  Many patients may need another surgery to correct the complications, which can cost them more money. However,  medical complications are not always a result of a bariatric procedure failure.  A Weight Loss Procedure is classified as a failure if the procedure is no longer working.

When a Bariatric Procedure Fails for a patient, there are several different consequences to be considered.  They include the emotional, economical, and physical impacts of the failure.  

What are the emotional consequences of Procedure Failure?

Depending on the type of procedure (Lap Band, Gastric Sleeve or Gastric Bypass), the patient may regain all the weight back again. This can be emotionally devastating because it gives the patient the feeling that he or she has thrown away money for nothing.  They feel anger towards the doctor and themselves, and during this whole process, their health and life could be at risk due to the complications. It is important for patients to know they are not alone. It is also important that they take positive action to address the situation, since this increases the probability of succeeding in the future. 

 What happens after a Procedure Failure?

We can say a Bariatric Procedure is no longer working when the patient has regained all the weight originally lost. This means that the patient needs a new procedure called Revision Surgery. The need for a revision surgery after a procedure has failed may jeopardize the health or life of the patient, as the complication rate increases from 2% to 25%. In addition, it will cost additional money for the revision surgery.

The chances for success for a second, different, Bariatric Surgery are lower then the first time, and the morbidity increases up to 25% depending on the revision procedure to be done. This is in part because the doctor has to be able to finish a new Weight Loss Procedure over the scar tissue and be able to repair what went wrong in the first place. The decision as to which will be the chosen bariatric surgery for the second time will depend on the type of surgery first performed.

How can a patient succeed after Revision surgery?

The patient must be careful to avoid any mistakes made before that may have influenced the development of complications.  It is very important that you ask your doctor and yourself questions like:

  • Why didn’t the first procedure work for me?
  • Which procedure works for me best after failing the first time?
  • Am I going to be able to follow the rules for success with the procedure I am choosing?
  • How much help will I get from the doctor and his staff after revision surgery?
  • Am I looking only for the best price I can get, or for the procedure that can work best for me?

You have to analyze both the pros and cons for any procedure that you are considering, especially when considering a second procedure or revision surgery. You have more chances to succeed if you keep in mind what went wrong the first time, in order to develop a plan for success in the future.

 

Arturo Rodríguez, MD

http://www.thebariatric.com/

http://www.bandstersforum.com/

Originally posted 2008-07-27 21:53:21. Republished by Blog Post Promoter

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