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Food intolerances two years after gastric bypass (PS - No, really?)

Apparently this concern with gastric bypass patients hasn't been "well-studied."

Hey researchers - PLEASE SEEK OUT PATIENTS WHOM COMPLAIN OF EXACTLY THESE ISSUES FROM DAY ONE.  

Because, uh, *putting on my Dr. Google Hat* they're totally normal and expected, or so we thought?  Or am I living under a rock where it's that we're not supposed to live with digestive distress most of the time?I suppose this is my bias because I live as a distressed patient, with a distressed patient, and know mostly only distressed patients?  And WHAT IS GOING ON WITH THE FOODS LISTED IN THIS STUDY!?

I am using a lot of question marks lately.  I need to stop that.

Discuss.

Study blurb via Reuters -

(Reuters Health) - A common weight loss surgery is associated with long-term gastrointestinal problems and food intolerance, a recent study suggests.

Researchers examined data on 249 extremely obese patients who had what’s known as laparoscopic Roux-en-Y gastric bypass, which reduces the stomach to a small pouch about the size of an egg.

Two years after surgery, these patients had lost about 31 percent of their total body weight on average. But compared to the control group of 295 obese people who didn’t have operations, the gastric bypass patients were far more likely to experience indigestion and an inability to tolerate multiple foods.

“It was already known from previous studies that the Roux-en-Y gastric bypass might aggravate gastrointestinal symptoms after surgery,” said lead study author Dr. Thomas Boerlage of MC Slotervaart in Amsterdam.

 

 


Study - Weight-Loss Surgery Linked To Increased Suicide Risk

Another OBVIOUS. 

Reuters -

“These findings suggest that more effort may be needed to improve access to mental health care services in these patients should they need them, and perhaps some screening in the second year and onwards,” Bhatti said. 

During the first three years after surgery, 111 patients received emergency care for self-inflicted injuries, or roughly 1 percent of people in the study. While small, the risk of these emergencies was 54 percent higher after surgery than it was before.

Study - JAMA

Importance  Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery.

Objective  To compare the risk of self-harm behaviors before and after bariatric surgery.

Design, Setting, and Participants  In this population-based, self-matched, longitudinal cohort analysis, we studied 8815 adults from Ontario, Canada, who underwent bariatric surgery between April 1, 2006, and March 31, 2011. Follow-up for each patient was 3 years prior to surgery and 3 years after surgery.

Main Outcomes and Measures  Self-harm emergencies 3 years before and after surgery.

Results  The cohort included 8815 patients of whom 7176 (81.4%) were women, 7063 (80.1%) were 35 years or older, and 8681 (98.5%) were treated with gastric bypass. A total of 111 patients had 158 self-harm emergencies during follow-up. Overall, self-harm emergencies significantly increased after surgery (3.63 per 1000 patient-years) compared with before surgery (2.33 per 1000 patient-years), equaling a rate ratio (RR) of 1.54 (95% CI, 1.03-2.30; P = .007). Self-harm emergencies after surgery were higher than before surgery among patients older than 35 years (RR, 1.76; 95% CI, 1.05-2.94; P = .03), those with a low-income status (RR, 2.09; 95% CI, 1.20-3.65; P = .01), and those living in rural areas (RR, 6.49; 95% CI, 1.42-29.63; P= .02). The most common self-harm mechanism was an intentional overdose (115 [72.8%]). A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the 5 years before the surgery.

Conclusions and Relevance  In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.

Link - http://archsurg.jamanetwork.com/article.aspx?articleid=2448916


FAAAAAHTS or Gastrointestinal colonization with methanogens increases difficulty of losing weight after bariatric surgery

Gastrointestinal colonization with methanogens increases difficulty of losing weight after bariatric surgery.

PAC MAN
This is totally my gut.
 
I feel like we knew this - have you lived with a gastric bypass or duodenal switch patient for a period of time?  I'm just saying, those of us with altered bariatric intestines  LIVE with "MARSH ASS."   Welcome to the world of pre-biotics, probiotics, fart-smell-better products and I kid you not, LINED UNDERWEAR.  

 
Hey, I never said I was a professional.  Read the studies.
 
What is a methanogen?  Wisegeek says --
"Methanogens are a type of microorganism that produces methane as a byproduct of metabolismin conditions of very low oxygen. They are often present in bogs, swamps, and other wetlands, where the methane they produce is known as "marsh gas." Methanogens also exist in the guts of some animals, including cows and humans, where they contribute to the methane content of flatulence. Though they were once classified as Archaebacteria, methanogens are now classified as Archaea, distinct from Bacteria.

Some types of methanogen, including those of the Methanopyrus genus, are extremophiles, organisms that thrive in conditions most living things could not survive in, such as hot springs, hydrothermal vents, hot desert soil, and deep subterranean environments. Others, such as those of the Methanocaldococcus genus, are mesophiles, meaning they thrive best in moderate temperatures.  Methanobrevibacter smithii is the prominent methanogen in the human gut, where it helps digest polysaccharides, or complex sugars."

Gut bacteria may decrease weight loss from bariatric surgery March 6, 2015
 

The benefits of weight loss surgery, along with a treatment plan that includes exercise and dietary changes, are well documented. In addition to a significant decrease in body mass, many patients find their risk factors for heart disease are drastically lowered and blood sugar regulation is improved for those with Type 2 diabetes.

Some patients, however, do not experience the optimal weight loss from bariatric surgery. The presence of a specific methane gas-producing organism in the gastrointestinal tract may account for a decrease in optimal weight loss, according to new research by Ruchi Mathur, MD, director of the Diabetes Outpatient Treatment and Education Center at Cedars-Sinai.

"We looked at 156 obese adults who either had Roux-en-Y bypass surgery or received a gastric sleeve. Four months after surgery we gave them a breath test, which provides a way of measuring gases produced by microbes in the gut," said Mathur. "We found that those whose breath test revealed higher concentrations of both methane and hydrogen were the ones who had the lowest percentage of weight loss and lowest reduction in BMI (body mass index) when compared to others in the study."

The methane-producing microorganism methanobrevibacter smithii is the biggest maker of methane in the gut, says Mathur, and may be the culprit thwarting significant weight loss in bariatric patient. Mathur and her colleagues are conducting further studies to explore the role this organism plays in human metabolism.

While that research continues, bariatric patients may still have options to improve weight loss after surgery.

"Identifying individuals with this pattern of intestinal gas production may allow for interventions through diet. In the future there may be therapeutic drugs that can improve a patient's post-surgical course and help them achieve optimal weight loss," said Mathur.

The study, "Intestinal Methane Production is Associated with Decreased Weight Loss Following Bariatric Surgery" was done in collaboration with the Mayo Clinic. The paper is being presented by Mathur Thursday, March 5, at the 97th annual meeting of the Endocrine Society in San Diego.

 


A dirty not-so-secret of the gastric bypass world has been studied! AND WE WERE RIGHT.

carbonation bubbles
Via Mira Shemeikka - Flickr

What does a gastric bypass patient do when they feel food stuck - trapped - balled up - in their gastric pouch or stomach, or even further down in the intestine?

Sometimes we walk it out, sometimes change positions rapidly hoping the food shifts, oftentimes we lay on a certain side and get all fetal-curled and try to work the food down... we do countless things to relieve the pressure of a stucked.

BE_Stage13_f01

However, many times it is just easier to break up a stuck, and many of us know this because we have been doing it for years intuitively because STUCKS!! HURT!!

Before you ask -- "What Does A Stuck Feel Like?"  You'll know it when it happens.  You will also know it if it has happened to you.

You may have another word to describe it -- too.  I often describe it as oncoming death.  I may or may not have sent myself to the ER once with a stuck because it felt like a heart attack, panic attack because the squeezing in my chest made me anxious -- bad combination.   Too much of the wrong, sticky, fibrous food, trapped in the gut PLUS anxiety over the malcontent = OMG I AM DYING.   I am dying right now.  Am I really?  OMG. 

I know better now.  I avoid it.  

DISCLAIMER -- THIS POST IS NOT INTENDED NOR CONSTRUED AS MEDICAL ADVICE.  I AM A 10.6 year post GASTRIC BYPASS PATIENT WITH ZERO PROFESSIONAL CREDS.  DO NOT LISTEN TO ME.  This is JUST my personal experience, mmmkay? YES I AM YELLING CAUSE Y'ALL DO NOT LISTEN.

Some of us whom grew up as baby bariatric patients not following our rules -- learned something early on.

Carbonated liquids fix stucks, because it forces the food through.  This relieves the pain, and clears the gut.  You might notice something about those of us willing to tell the truth about our (bad) habits.  We tend to drink a LOT of Diet Coke, Diet Pepsi, and have for years since our weight-loss surgeries, some of us more than we did before WLS.  

"Diet Coke and Coke Zero worked just as well as the sugared versions because they contain the same basic ingredients."

BECAUSE IT FEELS GOOD.

Bubbles fix the stucks.  

Stucks are technically called bezoars or phytobezoars which means FOOD BALL - a gastric concretion formed of vegetable fibers, with the seeds and skins of fruits, and sometimes starch granules and fat globules.  It's basically a GREASE TRAP of things that we might not have been able to digest due to our WLS arrangement - and the diet soda goes down and acts as Liquid Plumbr.

Screen Shot 2014-10-15 at 9.00.49 AM

 

Hey, it's not my study, but it is my pre-treatment -- and has been for at least ten years - 

Not exactly THIS way - but - y'know -

 

Apt12141-fig-0002

http://onlinelibrary.wiley.com/doi/10.1111/apt.12141/full

Medscape - 

Drinking Coca-Cola appears to be an effective treatment for gastric phytobezoar in 50% of cases, and combining the soda with additional endoscopic methods may lead to resolution of as many as 91.3% of phytobezoars, according to a newly published review.

Spiros D. Ladas, MD, from the Gastroenterology Division, First Department of Medicine–Propaedeutic, Medical School, Athens University, Laikon Hospital, Greece, and colleagues presented the results of their systematic literature review in an article published online December 17, 2012, and in the January 2013 issue ofAlimentary Pharmacology and Therapeutics.

The authors searched the literature for the combined keywords "phytobezoars treatment" and "Coca-Cola lysis" and reviewed 24 articles published during a 10-year period between 2002 and 2012. The articles included 46 patients. The authors note that the majority of the articles included in the review did not have patient follow-up, and therefore the review cannot speak to patient relapse.

Although most of the articles were case reports, one was a retrospective study of 17 patients. In their review, Dr. Ladas and colleagues found that only 4 patients (8.7%) who received Coca-Cola treatment went on to develop small bowel obstruction that required surgical treatment. Despite the need for surgery, 3 of the 4 patients still had partial dissolution of their phytobezoars from the Coca-Cola treatment.

The researchers also report that the soda was able to completely dissolve gastric phytobezoars in half of the patients. Although they were unable to state the mechanism of action with certainty, they posit that the soda's pH of 2.6 played an important role in fiber digestion.

Diospyrobezoars (persimmon bezoars) are one of the more difficult types of bezoars to dissolve. They are formed after persimmon ingestion and are characterized by a hard consistency. The authors found that diospyrobezoars were less likely to be completely dissolved by the soda than were phytobezoars (60.6% vs 23%; P = .022).

Physicians seek conservative treatment options, such as dissolution therapies and endoscopic fragmentation techniques, for bezoars, to avoid surgery. The reviewers suggest that Coca-Cola ingestion should be the treatment of choice for gastric phytobezoars because it allows for reduced patient stay in the hospital and may not require endoscopies or equipment. "Moreover," they conclude, "availability, low cost, rapid way of action, simplicity in administration and safety renders Coca-Cola a cost-effective therapy for gastric phytobezoars."

Low-cost effective therapy for stucks.  Um, yeah?  Considering the alternative, I'll avoid the pain --

Slide22


The Biggest Loser Meltdown Moment

Did you watch this last night?

"I don't want you to go through what your dad has gone through." -Dr.

So -- you KNOW I am thinking it -- I probably yelled AT THE TV.

angry lego head

I would like to know what happened to Rob's dad after all this crying and freaking out with the shaming of the wheel-chair.  I hate when information about weight loss surgery is thrown out there to the general public like "this" without any context.

Biggest Loser, please explain.  I understand that the producers like to create 'breakthrough' moments with the contestants to get them motivated and moving forward and to tear off all excuses, but why create a stigma around weight loss surgery? 


#itfits

It, fits?  OH COME ON.  

The NEW AND IMPROVED LAPBAND!  

You can do better!

New

Apollo Endosurgery, Inc., the leader in minimally invasive endoscopic surgical products for bariatric and gastrointestinal procedures, today announced the launch of the “It Fits” campaign, aimed at rejuvenating the LAP-BAND® System and educating a broad range of patients about the benefits of the minimally-invasive weight loss procedure.

“It Fits” supports the company’s decision to place greater emphasis on the unique advantage of the LAP-BAND® System – the only FDA approved device for weight reduction for people with at least one weight-related health problem, and having a BMI of 30 or greater.

Read more: http://www.digitaljournal.com/pr/1989812#ixzz34taKYjn9

The new ad spot - from Apollo - tugs right there at your heart, don't it?  I might be tearing up over all of the completely stereotypical situations right here in this here commercial!  OMG I CAN FIT IN THE AEROPLANE SEATBELT WITHOUT AN EXTENDER COULD YOU PLEASE PUT ME IN A COMMERCIAL ALTHOUGH I WAS NEVER SUPER MORBIDLY OBESE I AM JUST AN ACTOR!

Until this and my tears dry up!

Screen Shot 2014-06-17 at 7.33.40 AM

Because of course we will ignore the patient histories of thousands -- to have a procedure to lose how much weight?  

Just as a frame of reference, that makes me qualify in a few BMI points.  Confession:  when I reached my high weight about the same time the new BMI-qualifications for the Allergan-owned lap-band came around, I decided THAT WAS IT.  I could not possibly do it again, my butt was not revising band-over-bypass for that much weight, not after watching this weight loss community for 12 years.  Nope.

Jawdrop


Carnie Wilson Speaks At WLSFA 2013 Las Vegas Luncheon

Carnie Wilson Speaks At WLSFA 2013 Las Vegas Luncheon


Null and Void. #WLSFA2013 Post #1 Good Tried To Do Good

PHILANTHROPY is based on voluntary action for the common good. It is a tradition of giving and sharing that is primary to the quality of life. To assure that philanthropy merits the respect and trust of the general public, and that donors and prospective donors can have full confidence in the not-for-profit organizations and causes they are asked to support, we declare that all donors have these rights:

BBGC Donates to the WLSFA
Donating $1000 to the WLSFA


  1. To be informed of the organization's mission, of the way the organization intends to use donated resources, and of its capacity to use donations effectively for their intended purposes.
  2. To be informed of the identity of those serving on the organization's governing board, and to expect the board to exercise prudent judgment in its stewardship responsibilities.
  3. To have access to the organization's most recent financial statements.
  4. To be assured their gifts will be used for the purposes for which they were given.
  5. To receive appropriate acknowledgement and recognition.
  6. To be assured that information about their donations is handled with respect and with confidentiality to the extent provided by law.
  7. To expect that all relationships with individuals representing organizations of interest to the donor will be professional in nature.
  8. To be informed whether those seeking donations are volunteers, employees of the organization or hired solicitors.
  9. To have the opportunity for their names to be deleted from mailing lists that an organization may intend to share.
  10. To feel free to ask questions when making a donation and to receive prompt, truthful and forthright answers.

I'm going to add one more:

Don't do this to your donors - particularly when they're YOUR PEOPLE.

944348_10200358558301203_515314105_n

That is a scanned image of the check I donated to the Weight Loss Surgery Foundation of America or WLSFA organization.  

I was not home twenty-four hours before I received a letter from the CEO of the foundation and this image with the letters V O I D enscribed across it.  I have not slept much yet - so - forgive my even sharing this with you -

Screen Shot 2013-05-22 at 3.26.23 PM

I especially like how I wronged the sponsors.  Because many of them are also mine.  (*See sidebar.  I love my sponsors.  Click their links.  Buy stuff.)

That feels really good, Antonia.  That makes my heart swell with pride and stuff.

50931-Colbert-slow-clap-gif-tOP4
It's a day later and I've received no response as to what I did, aside from hand the WLSFA $1000 in a non-confrontational manner.   I actually had to beg them to take it - we were skipped over in the first round of donation announcements - they took it publicly and gave it back like this.  

The event itself?  Was a non-issue.  I only have two or three issues that I'd concern myself with -- and they wouldn't involve this check.  At all.  One issue was big enough for me to want to blog - but - I've refrained so far.

My bariatric support group's fundraising is obviously not wanted in this exclusionary non-profit.  I do not know if it's legal to shun a cash donation from legal fundraising.  Lawyers?

As a group we are more than disgusted.  I have spent hours promoting this event, and spent thousands of dollars, and frankly I sit here ashamed that I asked my peers to donate to the cause.  

Consider for a second how much I spent just for myself -

  • BBGC Donation - $1000
  • WLSFA Ticket - $150
  • Carnie Wilson Luncheon - $99
  • Flight - $600
  • Hotel - $100+ night
  • Travel (Shuttle, cabs, etc.)
  • Food
  • Discretionary stuff
  • Ticket for a friend 

I am more sickened that I suggested friends JOIN ME at the event -- and asked them to spend their hard-earned money on the event as well just to be shunned so specifically.  Friends brought husbands -- this isn't cheap.  

I am not a happy MM.  I apologize to YOU.  We learned a hard lesson here.

Tumblr_mczxx1wt3Q1rvaj6zo1_500
 

We have have offers to take our GOOD elsewhere, of course.   I got offers of help in the middle of the night.  And we will, if you donated or made a purchase - your money is going to another reputable non-profit.  Thank you.  


Medication malabsorption?

I do not think I am absorbing my anti-epilepsy medication very well.   I know - surprise, surprise.

Shocked-will-smith

Keppra-12691_3

I take two medications -

Topamax

  • Topamax 200 mgs
  • Levetiracetam 2000 mgs
  • Both in divided doses

My blood test results - suck -

58148_10200208561311372_58561554_n

My medication dosages are higher than the "therapeutic levels" suggested above - and my blood lab results don't seem to fit.  

While my grand mal seizures are controlled (thank you Keppra?) I am having multiple complex partial seizures in clusters each week.  My family says they are increased, I can't tell the difference because they happen regardless of my awareness level.

(Side note:  I am also still pushing along toward brain surgery for the removal of the area of the brain that is the trigger area for the seizures, however the neuro team has suggested that it's a very large section - larger than anticipated in earlier scans - and less likely to be a cure... I still have testing to visualize and narrow it down... another post.)

  • My point in posting my medication blood levels was that maybe someone out there has knowledge of this -- epilepsy AND gastric bypass AND medication levels or alternative dosing?  

While I am aware that is NORMAL to have absorption issues post gastric bypass - I guess this is some proof - that medication just DOESN'T always work entirely.

UIC College Of Pharmacy -

The Roux-en-Y gastric bypass is most commonly performed in the United States and produces a more profound and sustained weight loss than the other two methods.2,5 This procedure uses a combined restrictive and malabsorptive approach to induce weight loss. During this procedure, a 30- to 60-mL portion of the stomach is sectioned off in an effort to limit food intake. The small intestine is then cut from the base of the stomach, and the lower intestine is connected to the pouch at the top of the stomach. The narrow opening to the small intestine slows the emptying of the stomach and produces a sensation of early satiety.By circumventing the lower portion of the stomach (90% to 95%) and much of the small intestine (the entire duodenum and part of the proximal jejunum), the surface area for absorption is greatly decreased and malabsorption can occur.2

Drug absorption and bariatric surgery

The mechanism of altered drug absorption depends partly on the type of procedure done-restrictive or malabsorptive. In general, drug absorption is affected by drug disintegration and solubility and the surface area available for absorption, all of which can be affected by restrictive procedures. 5,7 Disintegration of the dosage form is the first step needed for drug absorption. The smaller volume of the stomach with restrictive procedures may prevent adequate tablet or capsule disintegration due to reduced gastric mixing.Solubility of a drug is dependent on pH. Drugs that are more soluble at a lower pH are absorbed in the stomach, while those that are soluble in more basic environments are absorbed in the small intestine. Changes in the stomach volume after bariatric surgery result in a decrease in gastric acid production and a higher pH compared with the stomach as a whole. The change in pH may cause a decrease in the absorption of medications that rely on an acidic pH for solubility or absorption. A reduction in the surface area of the stomach may further decrease drug bioavailability. These changes may be especially important for drugs that are slowly absorbed, such as sustained-release formulations. Use of liquid formulations or chewing or crushing solid dosage forms (if appropriate) may help overcome some of these factors.

Malabsorptive procedures bypass much of the small intestine.7 This technique not only decreases intestinal length but also limits mucosal exposure of drugs and alters intestinal transit time. Mixing of highly lipid soluble drugs with bile acids may be reduced, with a loss of enterohepatic recirculation and decreased absorption.

In addition to drug absorption, drug distribution can also be affected following bariatric surgery.Obesity-related factors that can influence drug distribution include increased blood volume, cardiac output, lean body mass, organ size, and adipose mass. After bariatric surgery, these factors are expected to change and, therefore, may necessitate drug dosing adjustments.


Report: Some money in Lap-Band settlement to pay for billboards on weight-loss surgery risks

AP -  Report: Some money in Lap-Band settlement to pay for billboards on weight-loss surgery risks

LOS ANGELES — A company that promoted Lap-Band weight-loss surgery has agreed to pay $1.3 million to settle a false-advertising lawsuit, with some of the money going to billboards warning the public about the risks of weight-loss surgery, a newspaper reported Thursday.

From 2009 to 2011, five patients died after Lap-Band surgeries at clinics affiliated with the 1-800-GET-THIN ad campaign, according to the Los Angeles Times (http://lat.ms/11knLBS ).

The proposed settlement still needs the approval of Los Angeles County Superior Court Judge Kenneth Freeman, who asked attorneys at a hearing Thursday to provide more information and resubmit their settlement motion before he gives the deal his OK.

Relatives of two of the dead patients, Ana Renteria and Laura Faitro, filed the lawsuit as a class action in 2011.

The lawsuit sought damages from several companies and two brothers, Michael and Julian Omidi, who court documents said owned and managed Top Surgeons, a weight-loss business.

John Hueston, an attorney for the Omidis, said the settlement was not an admission of wrongdoing.

“Under the agreement, our clients ... are dismissed without any admission of liability, and made no contribution whatsoever to the settlements,” Hueston said in a statement cited by the Times.

A lawyer for the surgery centers, Konrad Trope, said the action against the facilities was dismissed without admission of liability or financial penalty.

The proposed settlement will be paid only by Top Surgeons, one of the companies behind the GET-THIN operation, the newspaper said. The company did not immediately return a message from The Associated Press.

The lawsuits and other public documents showed that 1-800-GET-THIN was a marketing company that steered patients to a network of outpatient clinics, where thousands of weight-loss surgeries were performed.

The company used dozens of billboards — along with ads on television, radio and the Internet — to promote Lap-Band weight-loss surgery.

Some of the suits alleged that the clinics put profits above patient safety, employing physicians who were unqualified and allowing surgeries to be performed in unsanitary conditions, the Times said.

The proposed deal calls for $100,000 to be spent on billboard advertising throughout Southern California “intended to explain the risks of weight-loss surgery.” The agreement does not specify the language to be used in the ads but says it must be approved by the court.


Weight-Loss Surgery's Weird Alcoholism Risk (It's not weird.)

Weight-Loss Surgery's Weird Alcoholism Risk | The Fix.

Copied entire article from Weight-Loss Surgery's Weird Alcoholism Risk | The Fix. - because - BECAUSE -

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Gastric bypass surgery is something of a medical marvel. In Roux-en-Y surgery, a small pouch is made from part of your stomach, building a new, smaller one. The pouch is then connected to the middle portion of the small intestine (the jejunum), bypassing the upper part (the duodenum). Because your new stomach is about 90% smaller than your old one, you feel full with much smaller amounts of food and take in many fewer calories. Another popular smaller-stomach operation is adjustable gastric band surgery, in which an inflatable silicone device is placed around the top of the stomach.

In all, the American Society for Metabolic and Bariatric Surgery estimates that approximately 200,000 people have bariatric surgery every year. The Roux-en-Y operation generally costs between $15,000 and $30,000; the band is cheaper by about $10,000. Many private insurance policies offer no coverage for what they consider an elective procedure.

There have been previous reports of bariatric surgery patients having serious trouble with alcohol use after their surgeries. A 2012 Archives of Surgery study by the New York Obesity Nutrition Research Center looked at 100 people who had Roux-en-Y and 55 who had the adjustable band. The post-op patients were significantly more likely than the general population to use addictive substances, especially two years after the procedures. The Roux-en-Y cohort seemed particularly susceptible to alcohol use.

If food has always been your drug, and surgery abruptly denies you your fix, you turn to other drugs.

A much larger 2012 study in the Journal of the American Medical Association came to a similar conclusion. University of Pittsburgh researchers followed almost 2,000 people who had Roux-en-Y, adjustable band or another weight-loss surgery. Before their operations, 7.6% of the group abused alcohol; after the knife, 9.6% did so. And, the patients who had the Roux-en-Y surgery were twice as likely to abuse alcohol as those who had the gastric band.

Health experts have long known that obesity and depression often go hand-in-hand. Depression can lead to becoming obese, and the opposite is also true. Many obese people are depressed before they have surgery and are therefore at high risk of depression afterward. For one thing, recovery is a slow process, and health complications of the surgery are very common; 40% of patients suffer from infection and post-operative bleeding. Perhaps more important, bariatric surgery is no magic bullet, and some patients become disillusioned as they realize that in order to "solve" their serious weight problems, they have to maintain good eating and exercise habits—lifestyle changes that likely proved elusive in the past. 

Addiction experts see the problem as one of switching addictions. People become obese because they use eating as a drug. Excessive eating is a form of self-medication for painful feelings associated with depression, anxiety and deeper personality disorders. Like most drugs, food, especially carbs and sugars, trigger the brain's reward pathways, causing a feeling of pleasure. But sustained excessive eating causes the brain to lose its capacity to produce these feel-good chemicals. That's whenaddiction starts.

Weight-loss surgery fixes the outside of a person, but not the inside. While it can reduce the harm of obesity, it leaves the needs driving your addiction untouched. So if food has always been your drug, and stomach-minimizing surgery abruptly denies you your fix, you turn to other drugs. Alcohol, being legal, is the most available, but patients can take their pick among the panoply of addictive substances.

Hogwash, says John Morton, MD, a bariatric surgeon at the Stanford School of Medicine and member of the executive council of the American Society for Metabolic and Bariatric Surgery. Like many other surgeons who specialize in this procedure, he favors a physical rather than a psychological or switching-addiction explanation for the high risk of alcohol abuse. "[There is a] heightened sensitivity to alcohol [and it is] purely physiologic," Morton says. Along with the liver, the stomach produces alcohol dehydrogenase, an enzyme that breaks down alcohol into other, less toxic molecules. Because gastric bypass patients have much less stomach, and therefore less of that enzyme, more alcohol enters their bloodstream.

"As a result," Morton says, "you get drunker faster and stay drunker longer." The same phenomenon occurs with people who have their stomachs removed because of cancer. If alcohol abuse in bariatric patients were due to psychological issues, you wouldn't expect cancer patients to have greater alcohol sensitivity, Morton argues.

Mitch Roslin, MD, a specialist in bariatric medicine at New York's Lenox Hill Hospital, agrees. He calls the switching-addictions theory "BS.” Drinking alcohol in your post-Roux-en-Y life is "the epitome of drinking on an empty stomach"—after all, your stomach is almost nonexistent. "Essentially," Roslin says, "drinking alcohol after Roux-en-Y is like having an alcohol IV."

"Essentially, drinking alcohol after Roux-en-Y is like having an alcohol IV," Roslin says.

But why does alcohol sensitivity show up more in the second year after the surgery? Roslin suggests that the second year is when you realize that your surgery will not, by itself, keep you healthy, that you do indeed have to "fix the inside." At that point, you might feel depressed, use alcohol to escape and comply less with your post-op instructions. 

Morton’s and Roslin’s explanations may account for why people who have had gastric bypasses can get a buzz by drinking a small amount of alcohol, but they don't quite explain why some people who never abused booze before end up becoming post-op alcoholics. Nor do they account for another, even more serious, health risk for people who have had gastric bypasses: suicide.

Two recent studies—in Pennsylvania and Utah—reinforce the link between obesity and emotional distress by focusing on suicide rates. A study of 17,000 weight-loss surgeries performed in Pennsylvania from 1995 to 2004 showed a surprisingly high incidence of suicide. Of the 440 deaths that occurred, 16 resulted from suicide or drug overdose; by comparison, the rate for the general population is only three. And this August, a study published in The New England Journal of Medicineshowed that a group of almost 10,000 bariatric patients had a 58% higher than average risk of dying in an accident or suicide. When the bariatric patients' suicide rate was compared to that of obese people who had not had surgery, it was close to double, 11.1 per 10,000 compared to 6.4 per 10,000.

When the high risk of suicide is coupled with the high risk of alcohol abuse, a psychological, if not a switching-addiction, explanation is almost inescapable. Patients may be aware of these risks, but the need for the surgery overrides such concerns. While prospective patients often undergo psychological evaluations before the procedure, doctors often do not follow up with the patients and patients often do not participate in post-surgery counseling. The addiction to food is typically viewed as more or less having been "treated" by the gastric bypass. The danger of developing a new addiction remains low on the list of health priorities.

There is no denying the benefits of bariatric surgery. Without it, many people struggling with obesity would be doomed to lives burdened with diabetes, heart disease, mobility problems and high risk of stroke and early death. At the same time, it's clear that the surgery's benefits would be increased by improved screening of patients for mental health problems—and addiction—before surgery as well as deeper, longer counseling afterward. This may mean fewer people will be eligible for the surgery—a prospect that neither doctors nor patients would embrace. At the very least, reframing how patients understand the surgery is in order: It is not a magic bullet but one in a serious of interventions that are, like it or not, lifelong.


No long-term cost savings with weight loss surgery

Weight loss surgery does not lower health costs over the long run for people who are obese, according to a new study.   Shocking?  Meh.  No.

Pre-op patients don't want to know this sticky business, so maybe you should close your eyes or click away.  NOW.  I don't want to pop your bubbles.  I am not in the biz of selling weight loss surgery up in heah.

I don't think it would come as a surprise to many long-term post bariatric patients.  I know you understand.  We live it.

But that is just me, consider my stance as a nine year gastric bypass post op, married to a nine year gastric bypass post op, with a mother in law and sister in law who are both gastric bypass post ops.  Collectively we have about 30 years of missed "obesity" costs, but we have increased our health-care costs in other areas.  (*Looks at my current tally at the hospital.*)

Tumblr_lwj43hxcbD1ql141xo1_400The four of US (yes, this is totally biased because it is my immediate circle and what I know...this is understood, I am not arguing, I do not care to sell WLS nor unsell it!) are currently all maintaining a normal or slightly overweight body weight 6-9 years post bariatric surgery, however between us, we have created some seriously HUGE bills and other health conditions since having weight loss surgery.  (I have not shared much of it because I'm already TMI and HIPPA cries.)

Imagine now if any of us have a full and complete regain - which is a totally and absolutely typical pattern.  What then of our health?  What if we have the comorbids of obesity come back?  (Some of which don't always go away.... have you met my legs?)  Just saying.  I know we have made it this far, but it has NOT been cheap.

208673_9202
Reuters -

Some researchers had suggested that the initial costs of surgery may pay off down the road, when people who've dropped the extra weight need fewer medications and less care in general.

The new report joins other recent studies challenging that theory (see Reuters Health story of Jul 16, 2012 here: reut.rs/NrQKPU).

"No way does this study say you shouldn't do bariatric surgery," said Jonathan Weiner from the Johns Hopkins Bloomberg School of Public Health in Baltimore, who led the new research.

But, he added, "We need to view this as the serious, expensive surgery that it is, that for some people can almost save their lives, but for others is a more complex decision."

According to the American Society for Metabolic and Bariatric Surgery, about 200,000 people have weight loss surgery every year.

Surgery is typically recommended for people with a body mass index (BMI) - a measure of weight in relation to height - of at least 40, or at least 35 if they also have co-occurring health problems such as diabetes or severe sleep apnea.

A five-foot, eight-inch person weighing 263 pounds has a BMI of 40, for example.

For their study, Weiner and his colleagues tracked health insurance claims for almost 30,000 people who underwent weight loss surgery between 2002 and 2008. They compared those with claims from an equal number of obese people who had a similar set of health problems but didn't get surgery.

As expected, the surgery group had a higher up-front cost of care, with the average procedure running about $29,500.

In each of the six years after that, health care costs were either the same among people who had or hadn't had surgery or slightly higher in the bariatric surgery group, according to findings published Wednesday in JAMA Surgery.

Average annual claims ranged between $8,700 and $9,900 per patient.

Weiner's team did see a drop in medication costs for surgery patients in the years following their procedures. But those people also received more inpatient care during that span - cancelling out any financial benefits tied to weight loss surgery.

One limitation of the study was that only a small proportion of the patients - less than seven percent - were tracked for a full six years. Others had their procedures more recently.

The study was partially funded by surgical product manufacturers and pharmaceutical companies, including Johnson & Johnson and Pfizer. Claims data came from BlueCross BlueShield.

It's clear that surgery can help people lose weight and sometimes even cures diabetes, Weiner told Reuters Health. But it might not be worthwhile, or cost-effective, for everyone who is obese.

That means policymakers and companies will have to decide who should get insurance coverage for the procedure and who shouldn't.

"It's showing that bariatric surgery is not reducing overall health care costs, in at least a three- to six-year time frame," said Matthew Maciejewski, who has studied that topic at the Center for Health Services Research in Primary Care at the Durham VA Medical Center in North Carolina, but wasn't involved in the new study.

"What is unknown is whether there's some subgroup of patients who seem to have cost reductions," he told Reuters Health.

In the meantime, whether or not to have weight loss surgery is still a personal decision for people who are very obese, Weiner said.

"Every patient needs to talk it through with their doctor," he said. "It obviously shouldn't be taken lightly, but shouldn't be avoided either."

SOURCE: bit.ly/K8qAyI JAMA Surgery, online February 20, 2013.

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Importance  Bariatric surgery is a well-documented treatment for obesity, but there are uncertainties about the degree to which such surgery is associated with health care cost reductions that are sustained over time.

Objective  To provide a comprehensive, multiyear analysis of health care costs by type of procedure within a large cohort of privately insured persons who underwent bariatric surgery compared with a matched nonsurgical cohort.

Design  Longitudinal analysis of 2002-2008 claims data comparing a bariatric surgery cohort with a matched nonsurgical cohort.

Setting  Seven BlueCross BlueShield health insurance plans with a total enrollment of more than 18 million persons.

Participants  A total of 29 820 plan members who underwent bariatric surgery between January 1, 2002, and December 31, 2008, and a 1:1 matched comparison group of persons not undergoing surgery but with diagnoses closely associated with obesity.

Main Outcome Measures  Standardized costs (overall and by type of care) and adjusted ratios of the surgical group's costs relative to those of the comparison group.

Results  Total costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. However, the bariatric group's prescription and office visit costs were lower and their inpatient costs were higher. Those undergoing laparoscopic surgery had lower costs in the first few years after surgery, but these differences did not persist.

Conclusions and Relevance  Bariatric surgery does not reduce overall health care costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term health care costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.

 


All the weight I didn’t lose

All the weight I didn’t lose - from Salon.com 

"I am the “after” side of surgery, having lost more than 250 pounds. No one gets this, at least not without an explanation, because I still weigh over 200 pounds, and the weight loss fable is supposed to end when you’re thin, not when you’re merely “an average fat American.”

Yes, some of us do "get it."  

This is a powerful article a friend of mine who happens to be a special kind of "after"  (which is not the kind of " air quotes" that indicate failure, but that she has SHIT TO DEAL WITH and y'all need to stop judging a person at first glance, you know?) posted in my BBGC support group.   Thank you, Sarah.  I GET IT.  Some of us DO.  Rawr.  

Please read it.  Please open your mind to all "afters," and stop the WLS shaming.  

Continue reading "All the weight I didn’t lose" »


Trigger warning - Aspire Assist Aspiration Therapy - Sucking vomit out of a tube for weight loss.

"Losing weight shouldn’t take the fun out of life – dinners out with friends, a glass of wine with dinner, or a home-cooked meal with your family. With the AspireAssist, there are no burdensome restrictions on what and when you can eat and drink. Continue to eat the foods you love – and as you start to lose weight, gradually learn how to make healthy choices to match your leaner, healthier body!"

With the Aspire Assist Aspiration Therapy System, you can STILL EAT the foods you crave!  Want that half-gallon of ice cream?  Feel free to dig in!

Nom those noms!

Just twenty minutes after your meal -- you can discreetly withdraw a portion (OF VOMIT) of your partially digested meal THROUGH YOUR ABDOMEN and dispose of it without the hassle of you know:  lower digestion,  fecal production and weight gain!

Digestive_enzymes

I thought this was an article from The Onion.

It's not.  It's for real.

Jezebel -

Dean Kamen, the inventor of the Segway, a machine that exists to stop people from walking, has teamed up with Aspire Bariatrics (that name — shudder) to apply for a patent on a pump that will suck food and beverage straight out of your stomach and rids it from your intestines/life.

Please hold me again.  I'm a Bariatric Patient that is FUCKING TERRIFIED by the thought of giving people the opportunity for controlled bulimia.  I am still wary that this can't be for real -

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The Aspire Assist Aspiration Therapy System works by reducing the calories absorbed by the body. After eating, food travels to the stomach immediately, where it is temporarily stored and the digestion process begins. Over the first hour after a meal, the stomach begins breaking down the food, and then passes the food on to the intestines, where calories are absorbed. The AspireAssist allows patients to remove about 30% of the food from the stomach before the calories are absorbed into the body, causing weight loss.
To begin Aspiration Therapy, a specially designed tube, known as the A-Tube™, is placed in the stomach. The A-Tube is a thin silicone rubber tube that connects the inside of the stomach directly to a discreet, poker-chip sized Skin-Port on the outside of the abdomen. The Skin-Port has a valve that can be opened or closed to control the flow of stomach contents. The patient empties a portion of stomach contents after each meal through this tube by connecting a small, handheld device to the Skin-Port. The emptying process is called “aspiration”.
The aspiration process is performed about 20 minutes after the entire meal is consumed and takes 5 to 10 minutes to complete. Because aspiration only removes a third of the food, the body still receives the calories it needs to function. For optimal weight loss, patients should aspirate after each major meal (about 3 times per day)  GAHHHH!!!!!!!!!!! initially. Over time, as patients learn to eat more healthfully, they can reduce the frequency of aspirations.

25% Drink 16% Calories Via Alcohol Daily.

About 25% of you drink alcohol every day -- given the normal non-weight loss surgical population according to a new CDC study.  And about 16% of your daily calories come from alcohol.  

PS.  Give this study to bariatric patients -- I would say from my very non-professional standpoint that results would be higher vs. calorie intake given our higher rates of addictions to All The Things.  

That is some scary daily nutrition math.

No-Light-Beers

Cheers.

CDC -

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The U.S. population consumes an average of 100 calories a day from alcoholic beverages. Men, 150 calories; women, 53.

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“If you are drinking an extra 150 calories more than you need a day, those extra calories could end up on your waist or your hips,” said Joan Salge Blake, a clinical associate professor in the nutrition program at Boston University and a spokeswoman for the Academy of Nutrition and Dietetics. “Those excess daily calories could cause you to put on a pound monthly and would add up to over 10 pounds in a year,” Blake said.

Specifically for a gastric bypass patient -- it can lead to all sorts of damage.  Play in the Google.  


Living on borrowed time - Health Benefits of Gastric Bypass Surgery Persist for Six Years

Health Benefits of Gastric Bypass Surgery Persist for Six Years -  I guess I am living on borrowed time, seeing as I am working on year nine, as is Mr. MM, and Mr. MM's mom, and Mr. MM's sister.  We're all screwed.  - MM.

Gastric Bypass

The health benefits of Roux-en-Y gastric bypass (RYGB) surgery in severely obese patients persist for six years, according to a prospective, controlled study (JAMA 2012;308:1122-1131). These benefits include weight loss and improvements in major cardiovascular and metabolic risk factors.

Continue reading "Living on borrowed time - Health Benefits of Gastric Bypass Surgery Persist for Six Years" »