Is it Healthy to Lose Weight This Fast?

Is it Healthy to Lose Weight This Fast? FAQ with Dr. Rodrick McKinlay
By: Dr. Rodrick D. McKinlay

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

“You can achieve your weight loss goal. Achieving your goal requires diligence, adherence to eating guidelines, frequent exercise, and a positive mental attitude.”

Question: Is it healthy to lose weight this fast after weight loss surgery?
Dr. Rodrick McKinlay’s Answer:
Most weight loss surgery patients are excited to see excess pounds shed quickly in the first few months after surgery. It is usual to lose 50 pounds in the first three months after surgery, or substantially more for severely obese patients. But many patients wonder, am I losing weight too fast?

In general, you are much healthier at a significantly lower weight, regardless of how fast you lost the weight. You can be healthy and lose weight fast, up to 10 pounds a week right after surgery. This weight loss will slow down as time progresses. But you must follow principles of hydration and good nutrition to ensure the healthiest weight loss possible.

Ideal hydration means drinking at least 64 ounces of water a day, but you may need more on hot summer days, during exercise, or if you have a fever. If you are drinking less than 32 ounces of water a day, you may need to have IV fluid support in the first month or two after surgery.

Good nutrition means following the guidelines you received at surgery: eat 70% protein and 30% vegetables. By eating the protein portion first, you are sure to provide your body with the fuel it needs to keep all its essential functions running smoothly.

Another common question from patients has to do with weight loss plateaus—periods of time (up to one or two weeks) where you may not lose a pound. This is simply your body taking time to “catch up,” slowing its metabolism a bit, before you begin to lose weight again. Just remember to stick to the dietary guidelines, and weight loss will continue in a healthy way.

About the Author:

Dr. Rodrick D. McKinlay, MD, FACS, joined Rocky Mountain Associated Physicians (RMAP) in 2004 as a board certified general surgeon with expertise in minimally invasive or laparoscopic surgery. In addition to the surgical treatment of obesity, his practice involves a wide range of minimally invasive gastrointestinal surgery, including hernia repair, gallbladder removal, anti-reflux surgery, and the surgical treatment of spleen and adrenal disorders.

Find more answers to Frequently Asked Questions here.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

The Real Deal on Obesity, Part 2

Apr 25 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

The Traditional Diet:

You have probably experienced the stress and frustration associated with unsuccessful diets and weight loss programs. The traditional diet is a short sighted food selection program that has an end date. It is not a comprehensive lifelong protocol aimed at long term effects.

You are not a failure, the traditional diet is.

Most methods of weight control are usually ineffective in providing long-term weight loss in the Morbidly Obese patient. The end result of diet attempts is the regaining of the lost weight, and the person experiencing an increase in their pre-diet weight.

A traditional diet in which a person achieves a 10% weight loss is deemed successful. In a morbidly obese person a 10% weight loss will not return them to healthy weight or provide the quality of life that is desired.

Why Surgery?

Diet & exercise only works for 1 in 20 people who are morbidly obese
Surgery is safe & effective when the benefits outweigh the continued risks of weight and weight gain.
Improves co-morbidities
Provides for a longer and greater quality of life
Benefits of surgery outweigh the risks for the morbidly obese
Individuals experience emotional and social benefits with improved health

What about Diabetes?
The International Diabetes Federation (IDF) released a position statement in March 2011 calling for bariatric surgery as an appropriate treatment for people with type 2 diabetes who are obese.

“In addition to behavioral and medical approaches, various types of surgery on the gastrointestinal tract, originally developed to treat morbid obesity (“bariatric surgery”), constitute powerful options to ameliorate diabetes in severely obese patients, often normalizing blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.”

The IDF puts the lifetime cost of diabetes in the United States at $172,000 for a person diagnosed at age 50 years and $305,000 at age 30 years. More than 60% of this amount is incurred in the first 10 years after diagnosis. Futhermore…

The American Diabetes Associated has stated:
“Bariatric surgery should be considered for adults with BMI >35 kg/m² and type 2 diabetes, especially if the diabetes or associated co-morbidities are difficult to control with lifestyle and pharmacologic therapy.”
Standards of Medical Care in Diabetes: 2010

Diabetes Care January 2010 vol. 33 no. Supplement 1 S11-S61

History of Bariatric Surgery
The most popular procedure in the United States is the gastric bypass surgery. This procedure grew out of results of operations for cancer or severe ulcers in which large portions of the stomach or small intestine were removed. Because patients undergoing these procedures tended to lose weight after surgery, some physicians began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was the intestinal bypass. This operation, first used 50+ years ago, produced weight loss by causing malabsorption.

The side effect of this surgery was that it caused a loss of essential nutrients and its effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used. Over the years several different procedures have been developed that are either restrictive or malabsorptive in nature.

Restrictive Procedures
A restrictive procedure is one that limits the amount of food intake but does not impact the way the food is absorbed or digested. Restrictive procedures focus on the stomach alone and not the intestines. The laparoscopic adjustable gastric bands (LAP-BAND® or Realize® Band) and the sleeve gastrectomy are examples of restrictive procedures.

The gastric band cinches the upper portion of the stomach, slowing the passage of food through the lower esophagus and upper stomach. The slower passage in turn creates a sense of satiety or fullness with less food than would otherwise be consumed.

The sleeve gastrectomy is also a purely restrictive procedure creating a smaller stomach or “sleeve”. The residual stomach is removed therefore making this procedure non-reversible. The curvature as well as the size of the “sleeve” slow the passage of food and limit the amount consumed at any one time. Patients who choose purely restrictive operations typically lose weight more gradually and at a slower rate than gastric bypass, duodenal switch or other procedures that involve the intestine. Restrictive procedures rely on patients’ compliance with dietary recommendations, exercise and general lifestyle changes.

Restrictive/Malabsorptive Procedures
Restrictive/Malabsorptive operations produce quicker weight loss than restrictive operations, and can be more effective in reversing certain health problems associated with severe obesity such as diabetes. These types of procedures combine restriction of food by reducing the size of the stomach as well as bypassing parts of the intestinal tract which causes some nutrients to not be absorbed. Because some nutrients are being “malabsorbed” these procedures also carry greater risk for nutritional deficiencies.

Malabsorptive/restrictive operations include Roux en Y Gastric Bypass, Biliopancreatic Diversion, and Duodenal Switch. The gastric bypass procedure bypasses about only 1/3 of the intestine whereas the Duodenal Switch procedure typically bypasses roughly 2/3 or more of the intestine making this a truly malabsorptive procedure.

To learn more about Weight Loss Surgery and see if it is right for you, sign up to attend our FREE informational seminar that is taught by one of our Bariatric Surgeons. He will go over all of the Risks and Benefits of each procedure and answer any questions or concerns you might have. To sign up, click HERE or go to www.RMAP.com or call (801) 268-3800.

For The Real Deal on Obesity, Part 1, go HERE.

For more information on Adjustable Gastric Band, go here.
For more information on Sleeve Gastrectomy, go here.
For more information on Roux-en-Y Gastric Bypass, go here.
For more information on Biliopancreatic Diversion with Duodenal Switch (DS), go here.

Find more answers to Frequently Answered Questions here.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Understanding Weight Loss Surgery and Being Aware

Apr 17 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Surgery to produce weight loss is a serious undertaking. Every patient considering weight loss surgery should clearly understand and be aware of what the operation involves both physically and psychologically.

It All Begins with Awareness
The purpose of this instructional material is to educate and make you aware of the risks one consents to when they undergo weight loss surgery. In addition you must be aware of the commitment your surgeon requires you to make in order to live the directed healthy lifestyle essential for long term success.

As you go through these materials it is important to realize that the most serious risks of weight loss surgery are similar to those of ANY type of major surgery. When you consent to weight loss surgery you are indicating that you have been instructed in the common complications associated with the surgery and accept these risks.

Information is given about the lifestyle changes that one must undergo post-operatively. These changes you will experience after surgery include dietary and fitness requirements. You will also experience changes in the emotional and social aspects of your life.

Informed Consent
The primary purpose of informed consent is to make sure you understand and are aware of the risk factors associated with the surgery as well as the necessary guidelines you must follow for long-term success.

Your surgeon desires to be your health partner. However, you play the critical role in achieving permanent weight loss. Ultimately the choice is yours to live the required lifestyle of health.

If you are not willing, or think at this time that you may be unable to make these adjustments, then you will only be wasting your time and money while exposing yourself to the unnecessary risks of this surgery.

Risk of Complication
When you consent to undergo weight loss surgery you must be aware that your anatomy will be altered and that the risk of complication is possible. Your surgeon will explain the alteration process. Complications may occur during or after your surgery.

The severity of complications can vary from mild to extreme. Life threatening complications can occur that require intensive medical intervention and may result in death.

All patients, especially cash paying patients, must be aware that complications can cause significant medical costs due to extended hospital stays or additional surgery. You must also understand that insurance companies that exclude coverage for weight loss surgery may deny future coverage of any complications caused as a result of weight loss surgery. Contact your insurance company to verify future coverage as a result of weight loss surgery complications.

Important Risk Factors
People who suffer from morbid obesity often have other medical conditions which are related to obesity. Other medical conditions, termed co-morbidities, can increase the risk of complications occurring with your surgery. They may also be the cause of a longer recovery period. Your surgeon will consult with you regarding the risks of any co-morbid condition(s) you may have.

Another risk factor is age. There is generally a higher risk for older individuals.

Any medical procedure that involves reactions to stress, trauma, and drugs can cause unpredictable negative complications. Your surgeon will assess your current medical status. You and your surgeon will determine if the surgery is appropriate for you.

Please note that it cannot be accurately predicted who will have complications and who will not. Only you can decide if you are willing to accept the risks that are involved with surgery.

Possible Operating Room Complications
Be sure to consult with your surgeon regarding the items listed below:

Allergic Reactions: All kinds of allergic reactions are possible. They range from minor reactions such as a rash to sudden overwhelming reactions.

Anesthesia Complications: Anesthesia is used to put you to sleep during the surgery. Anesthesia can be associated with a variety of different complications as with any surgery.

Bleeding: Surgery involves opening your body, which can create bleeding complications. Bleeding can range from minor to massive. Blood transfusion may be necessary.

Heart Attack: The trauma of surgery on the body can result in a heart attack. Patients who enter surgery with pre-existing cardiac related co-morbidities are at higher risk for complications.

Spleen Removal: The spleen may experience unavoidable damage during surgery and may have to be removed to prevent future problems and the need for additional major surgery.

Gallbladder Removal: If your gallbladder is abnormal in any way, you are giving consent to have it removed to prevent future problems and the need for additional major surgery.

Death: This is major and serious operation. Although death is rare, these complications may lead to death in the operating room or post-operatively.

Possible Post-Operative Complications
Anastamotic Suture / Staple Line Leaks (not band patients): An occasional patient may have a complication relating to the staple line or the outlet of the gastric pouch. For example, there might be leakage, perforation, or bleeding. Other possible complications include; the formation of an ulcer or stricture, or failure of the staple line to heal properly. These kinds of complications may make additional surgery necessary. Even though all precautions are taken to prevent them, occasionally they do occur.

Pneumonia: Pneumonia is an infection in the lung. All patients who are recovering from any type of surgery where general anesthesia is administered are at risk for this post-surgical complication. Walking and breathing, as instructed, after surgery is a preventative measure that is taken for this complication.

Pulmonary Embolism: The obstruction of the pulmonary artery or a branch of it leading to the lungs by a blood clot. The blood clot usually originates from the leg or pelvic veins. It can also be caused by foreign material. Blood clots create a sudden closure of the vessels.

Preventative measures are taken pre, intra, and post operatively. This treatment includes anticoagulants such as heparin and warfarin (Coumadin). Compression (boots) devices may also be used in the hospital. About 10-15% of patients with pulmonary embolism die. Getting up frequently and walking around after surgery is essential to decrease the risk of experiencing a Pulmonary Embolism. Early reporting of leg or chest pain to your surgeon is essential.

Infections: The surgery creates an open wound (or wounds), which can bleed, fail to heal, or become infected. Washing incisions with soap and water lessen risk of infection.

Bleeding: When a blood vessel that has been cut and tied off during surgery reopens, it can create a hemorrhage. Transfusions and/or re-operation may be required.

Vomiting: Some patients may experience pain or vomit after intake of food. In most instances, this is caused by eating too much and too fast. If eating is slow and calm, you will learn to listen to the signals from your stomach pouch. Call the nursing staff if you feel nauseated, have pain, or vomit.

Regular vomiting is a warning sign of obstruction. Initially, vomiting may be caused by swelling at the operative site. Later, there is a possibility that vomiting might be caused by a formation of a stricture, scarring of the outlet of the gastric pouch to the small intestine, ulceration, or by an obstruction of the pouch outlet by a lump of poorly chewed food, tablet, or other foreign body.

In most cases vomiting related complications can easily be corrected without additional surgery. However, re-operation or simple dilation of the outlet may be required.

Adhesions / Bowel Obstruction: All operations involving the abdominal wall will leave behind scar tissue that sometimes places the patient at risk for the development of a bowel blockage or obstruction. The bowel can twist, obstruct and even perforate leading to serious complications. Adhesions sometimes soften up on their own. Occasionally there are instances that some adhesions will require additional surgery to correct the situation and restore bowel function.

Constipation: Many patients feel constipated after surgery. It is normal to have fewer bowel movements after weight loss surgery. Constipation can also be the result of inadequate fluid intake.

Incisional Hernia: Cuts and incisions in the abdominal wall can lead to hernias after surgery. Hernias are a protrusion of fat or bowel through an incision that has pulled apart. Hernias can lead to pain, bowel blockage or obstruction. Treatment of hernias usually requires additional surgery.

Gallbladder Disease: Gallstones may develop requiring a postoperative cholecystectomy. (Removal of the Gallbladder)

Kidney Stones: Some patients experience kidney stones after surgery. Kidney stones are frequently found in individuals who are not drinking enough water. Make sure you are drinking a minimum of 64-ounces of water each day to prevent the formation of kidney stones. If you already have a history of kidney stones, be sure to inform your surgeon.

Caffeine Withdrawal Headache: Caffeine withdrawal has been shown to occur in many patients who drink coffee, tea or sodas. This can happen after surgery and can be a very painful experience. Caffeine is a diuretic and can interfere with your hydration level post-operatively. To avoid this problem stop all caffeine a minimum of 1 month before your surgery.

Dumping Syndrome (not band, sleeve or DS patients): The consumption of sugar and some fats trigger the dumping syndrome for gastric bypass patients. It is an unpleasant physiological reaction to concentrated calories and carbohydrates hitting the intestine. It is characterized by the rapid movement of body fluids into the intestine in response to a high caloric and carbohydrate load. (For more information on Dumping Syndrome, go here).

Vitamin and Mineral Deficiencies: Because of the limitation of vitamins and minerals in food intake, supplemental vitamins must be taken FOREVER. Vitamin and mineral supplementation is necessary to minimize the risk of anemia, weakness, muscular in-coordination, and clinical depression.

Yearly Blood Tests: You must have yearly blood tests to measure the blood levels of these vitamins and minerals. Common deficiencies that can occur after weight loss surgery include iron, calcium, B12 and Folate deficiencies.

The tests you need to have each year are as follows:

Complete Blood Count
Lipid Profile
Comprehensive Metabolic Panel
B-12 Level
Thiamine Level
Folate Level
Hemoglobin A1-C
Vitamin-D Level

Duodenal Switch patients should also have the following test done with their annual labs.

Vitamin A level
Protime

Forgetting to take your vitamins can have serious consequences. Deficiencies can become so severe that they can lead to brain or nerve damage. Simply taking a daily multivitamin, a sublingual B-12 (not for band patients), a calcium supplement and having your annual blood work completed is a way to prevent this type of complication from occurring.

Hair Loss: It’s not uncommon for patients to experience hair loss for a period of time after the operation. Hair loss is reported most commonly by patients 3-4 months after surgery. Hair re-growth is seen around 7-9 months post-operatively. Hair loss is usually not a permanent condition. Rarely do patients lose more than 1/3 of their hair.

Depression: Feeling down after major surgery is a common side effect. As weight loss progresses some patients may experience increased anxiety about their body image and interactions with others. Ongoing difficulties may lead to a visit to your primary care physician or treating physician. If any medications are prescribed, be sure your doctor does not prescribe the type that can cause weight gain. Patients have also found it helpful to seek outside help from a psychologist or counselor. Ask RMAP for referrals.

Pregnancy: A weight loss of about 10% in an obese woman is effective in improving menstrual regularity, ovulation, hormonal profiles, and pregnancy rates. If you are sexually active you must use some type of birth control to prevent pregnancy during the first 18 months following weight loss surgery. Pregnancy during rapid weight loss can harm a developing fetus.

Adjustable Gastric Band
You may have risks that come from how your body responds to any foreign object implanted in it. Published results from past surgeries, however, do show that adjustable gastric band surgery may have fewer risks than other surgical treatments for obesity. Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation.

Recent rates of complications are as follows:

Band Slippage 5%
Band Erosion less than 1%
Tubing or Port Problems 1-2%
Nausea and/or Vomiting 5-20%

Surgeons with more laparoscopic experience and more experience with weight loss surgery procedures report fewer complications.

Minimizing Your Risks Prior to Surgery
There is no way to eliminate the possible complications and risks of weight loss surgery. With a little planning and effort on your part you may be able decrease the likelihood that complications will occur. You may have a few weeks before you undergo surgery. Utilize this time to prepare your body physically as well as your mind. It is essential that your family, friends, and extended support system be prepared as well.

If you smoke, DON’T!
The surgeons at Rocky Mountain Associated Physicians recommend you refrain from smoking for at least two weeks prior to the surgery. To decrease your odds of pulmonary complications after surgery stop smoking as soon as possible and do not start again. Smokers have been found to have difficulty after surgery with returning to normal pulmonary (breathing) function. Wound healing is also shown to be slower and individuals who smoke experience a higher postoperative incidence of infection. And development of ulcers is also seen in patients who smoke.

Smokers who quit smoking for the surgery and then resume again report more frequent episodes of vomiting, narrowing of the anastomosis, increased scar tissue, and higher risk for ulcers. Smoking is just bad for you all the way around. Stop doing it now! Start living a healthier lifestyle today.

Avoid second hand smoke. If you live with someone who smokes ask them to refrain from smoking in your presence. Responsible individuals will take their smoking outdoors when requested. Some will even quit.

Lose Weight
It has been recognized that most traditional diets fail at long term weight loss in the morbidly obese patient. However, losing even 10 pounds prior to your weight loss surgery can decrease the odds of your experiencing problems post-operatively.

The loss of a few pounds can shrink your liver and will give your surgeon more room to maneuver during the operation. This can make significant difference in the laparoscopic approach to weight loss surgery. It may also minimize post-operative hernias, and infections in the open approach.

Discuss pre-surgery diet with your surgeon during your consultation with him.

Avoid the Last Supper Mentality
Many patients who are waiting to undergo weight loss surgery recognize that their diet is about to change. They indulge themselves by consuming mass quantities of all of their favorite foods. The result is a possible increase of your pre-operative weight increasing the risk of complications and points to a possible lack of commitment to your new lifestyle of health.

Your transition to a lifestyle of health started the day that you chose weight loss surgery as a treatment, not the day you are admitted for surgery.

Begin Taking a Daily Multivitamin
Many patients presenting for weight loss surgery have pre-existing nutritional deficiencies. Taking a daily multi-vitamin is a life-long requirement. Starting now will not only improve your pre-operative health but will begin the formation of a habit that must stay with you for the rest of your life.

When choosing a multi-vitamin look for one that easily dissolves in water, and contains adequate quantities of B vitamins and calcium. Name brand varieties usually cost more but are of a higher quality. Since you will be spending less on your grocery bill don’t skimp on the price of your vitamins and supplements.

Exercise
Consult with your surgeon about exercising prior to surgery. The benefits of exercise can reduce your complication rate significantly by improving strength, circulation and lung capacity. Getting into an exercise routine prior to surgery can reduce the risk of pulmonary complications, recover faster, and actually lose the weight sooner.

For helpful hints on how to curb hunger between meals click here.

Find more answers to Frequently Answered Questions here.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

The Real Deal on Obesity, Part 1

Mar 21 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Some of the causes of obesity may be attributed to some of the following factors:

Abundance of food
Environmental
Emotional eating
Genetics
Inactive lifestyles
Lack of awareness
Portion distortion / Super-sized portions

Although the cause of obesity is not clearly understood, it is known that obesity is a result of an energy imbalance over a long period of time. Energy balance is like a scale, when calories consumed are greater than calories used weight gain results.

Basic differences in people’s genetic predisposition may partly explain why some remain lean in the current cultural environment of fast food and huge portion sizes, while others are hundreds of pounds overweight. However, food choices and lifestyle behaviors cannot be discounted. Emotional eating is the largest factor with poor food selection and preparation coming in 2^nd and genetic factors coming in 3^rd.

In January of 2003 John Hopkins University released a study on the years of life lost due to obesity. They found the following information:

People with a BMI over 45 can expect their lives to be significantly shorter.
Women could expect to lose 5-8 years of life.
Men could expect to lose 12-20 years of life.

To see that the years of life lost could be as much as 20 years lost clearly demonstrates that:

Obesity is not a benign condition but a killer!

A report from the Surgeon General’s offices detailed that approximately 300,000 deaths per year can be associated with obesity. That becomes a startling statistic when you compare it to the 400,000 deaths per year that are associated with cigarette smoking. Obesity is now the second leading cause of preventable death in the United States.

Obesity is a chronic progressive life impairing disease of excess fat storage with multiple negative health effects termed co-morbidities. The excess weight can so severely impact your body that you may develop major health problems leading to premature death.

Medical professionals view morbid obesity as a disease with serious medical, physical, social and psychological effects, not as a lack of will power or self-control. There are at least 23 genes discovered that affect obesity.

Morbid Obesity

Defined as an individual being greater than 200% of ideal weight, or 100 lbs. overweight, or a body mass index (BMI) greater than 40.
Chronic disease process characterized by:
- Severe accumulation of fatty tissue in the body and organs
- Minimal response to dietary management

Body Mass Index
BMI is the standard that medical professionals use to measure the relationship (or ratio) of weight-to-height. The BMI is more highly correlated with body fat than any other indicator of height and weight. The BMI has replaced the Ideal Body Weight tables, which vary from country to country.

If you have a BMI of 40 or greater, BMI of 35 or greater with co-morbidities, or 75 to 100 pounds or more overweight, you are one of over 4 million Americans who have the disease of Morbid Obesity.

Determining Your Body Mass Index (BMI)
Formula: weight in pounds X 703 ÷ height (inches) ÷ height (inches)

Underweight                          <19
Healthy Weight                      20-24
Overweight                             25-29
Obese                                      30-34
Severely Obese                       35-39
Morbidly Obese                     >40

Co-Morbidities Related to Obesity

Medical Co-Morbidities Related to Obesity
· Respiratory dysfunction · Cardiac Dysfunction · Arthritis · High Cholesterol · Bladder Control · Menstrual Irregularities · Gallbladder Disease · Diabetes Type II · High Blood Pressure
Physical Co-Morbidities
· Personal hygiene · Mobility · Sexual limitations · Difficulty tying shoes · Limited clothing choices, selection, availability and prices · Furniture weight bearing incapacity · Theater seats, planes, buses, restaurant booths, toilet & shower cubicles · Limited access to chairs, passage ways, stairs and difficulty walking
Psychological Co-Morbidities
· Approximately 89% of morbidly obese individuals suffer from Clinical Depression · Poor self-esteem, depression, guilt and self-hate · Social withdrawal · Neurotic & Anxiety disorders · Major psychiatric illnesses are the same as the rest of the population
Economic Co-Morbidities
Employment discrimination · Getting hired · Promotions · Special projects or accounts	Education discrimination · Select schools and Universities	· Cost of special devices necessary to perform daily acts of living · Cost of weight loss programs · Denial of insurance coverage
· Greater than 140 billion dollars is spent each year battling obesity · Over 30 billion dollars in personal costs · Over 68.8 billion dollars on medical care · Unknown costs to business
Social Co-Morbidities (Discrimination)
· Weight harassment, prejudice and “fatism” · Studies show society has low respect for morbidly obese (Same as for alcoholics and drug addicts) · Many have limited number of friends · Dating and marriage is less common

For The Real Deal on Obesity, Part 2, go here.

Find more answers to Frequently Answered Questions here.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

When Should I Be Worried?

Nov 10 By rmap nurse

When Should I Be Worried? FAQ with Dr. Steven Simper
By: Dr. Steven C. Simper, MD, FACS

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Question: My abdomen hurts. When should I worry?
Dr. Simper’s Answer: All of us get stomach aches from time to time. The question is when does stomach pain represent something serious? This can be an even more pressing question after having abdominal surgery. Scar tissue or altered anatomy from the surgery can predispose a person to bowel obstruction even years after surgery.

Perhaps you are like many bariatric surgery patients who have read about such problems on the internet, or in the news. Perhaps you have heard about these types of problems at your support group or read about the signs and symptoms to look for in RMAP’s literature. While I don’t think bariatric patients are any more likely to develop bowl obstructions than, for example, a patient who has had a hysterectomy, they still are at risk and often very aware of that risk. What follows are some basic warning signs to look for and general principles that surgeons use to try diagnosing abdominal pain.

Let’s look first at common causes of abdominal pain. The most common is gastroenteritis, or the “stomach flu.” Flu, however, is a misnomer because gastroenteritis is not the flu. It is most often caused by a virus. However, the cause can also be bacterial, such as salmonella or shigella. It usually lasts twenty-four to forty-eight hours and is associated with severe, intermittent abdominal cramping, nausea, vomiting, and diarrhea. Frequently you will feel relatively well for a period of time, followed by a period where you wonder whether you are going to live or die. Most of us have been there: confused whether we should stick our head in the toilet to vomit or sit on it—often we try to do both! Surprisingly, even though a person with gastroenteritis is very sick, most of us recognize it instinctively for what it is and don’t seek medical care unless it persist or unless dehydration sets in. Of course, in these cases it is wisest to seek help at the nearest emergency room.

Irritable bowel syndrome (IBS), also called “functional bowel,” is difficult for doctors and patient alike. This problem is often intermittent and lifelong; therefore, a patient having an episode likely knows what it is, since most episodes are similar. Symptoms are frequent and severe abdominal cramping, bloating, and diarrhea or constipation sometimes alternating and sometimes lasting for hours. IBS is often brought on by emotional stress but not necessarily. It is difficult to diagnose and treat and can mimic other problems such as lactose intolerance, or sprue (gluten intolerance). In Gastric Bypass patients, IBS can mimic the “dumping syndrome.” Most patients with irritable bowel can recognize “their symptoms” and take measures to either prevent or to relieve their discomfort, such as taking their previously prescribed medication, avoiding certain foods, eating a high fiber diet and so forth. However, if you have not had these symptoms before and are now having intermittent pain that is quite severe either daily, weekly, or even monthly, it is important that you contact your bariatric surgeon. These symptoms can be a sign of a partial bowl obstruction.

More serious causes of abdominal pain are things like appendicitis, gallbladder attacks, and as we have already mentioned, bowel obstructions. These are much more serious, but can still be difficult to differentiate from the less serious and more common problems mentioned earlier.

There are several rules, however, that may be able to help you. First, pain that is continuous and lasts six hours or longer is more likely to be serious. Second, you should never ignore severe pain, pain that is “worse than anything” you have experienced before. Finally, we want you to be concerned about any new type of pain, pain unlike any other pain you have experienced before. None of these scenarios absolutely indicates a life-threatening problem, but they increase the chance that something serious is going on in your abdomen. You should seek expert care and evaluation.

I believe that a patient’s own sense of well-being is a very good indicator. We all have aches and pains that we instinctively know are probably not serious. We know, or sense, that we don’t need to seek care for these kinds of aches and pains. But when a serious problem does arise, we often find ourselves saying “this is different, this may be more serious.” In these situations, it is best to follow your own sense or feeling that something is amiss.

Just a last word about small bowel obstructions. Sometimes these can be hard to diagnose, particularly if they are intermittent or partial. If you have a new onset of intermittent abdominal pain and your doctors are not sure what is causing it, please contact your bariatric surgeon. We may be able to help. Remember, it is always a good idea to keep your bariatric surgeon involved with your care. We bring a different perspective and years of experience in dealing with bariatric surgery problems to the table to help solve your problems.

Remember: eat right, exercise, take your vitamins and minerals, and most of all—enjoy life!

About the Author:
Dr. Steven Simper, MD, FACS, performed his first bariatric procedure in 1984 at Wilford Hall Medical Center in Texas. Currently, he performs laparoscopic gastric bypass, sleeve gastrectomy, duodenal switch, and revisional surgery. In addition to general surgery procedures.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Is This Normal?

Sep 26 By rmap nurse

Is This Normal? FAQ with Dr. Rodrick McKinlay
By: Dr. Rodrick D. McKinlay, MD, FACS

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Weight loss surgery induces many physical, emotional, and social changes. Many patients are surprised (sometimes pleasantly, sometimes not) by certain changes they experience after weight loss surgery. One question that runs through everybody’s mind sooner or later is, “Is this normal?” Some changes are very normal; others are not—but are harmless; and others are not normal and need to be investigated.

“Food just seems to taste different. Is this normal?”
It is normal to have taste changes and even some food aversions after weight loss surgery. You may feel like you want saltier foods, for example, after gastric bypass. No study has been done to show whether taste changes are permanent, but it appears that food aversions are most apparent in the first year or two after surgery. It is also possible for taste changes to occur multiple times after surgery, so don’t write off a certain food, just because you didn’t tolerate it well one time. In several months, you may enjoy what you once could not tolerate.

“I had my surgery six weeks ago and still feel so fatigued. Is this normal?”
Fatigue is normal to a certain degree after weight loss surgery. Not only have you had a major abdominal operation with general anesthesia, but your caloric intake has dropped dramatically. For this reason, people tend to feel fatigued for up to two months after surgery. Most people can return to work within one to three weeks after surgery, but after returning to work, many people feel exhausted at the end of the day. On the other hand, some people gain their energy back (and more!) in as quickly as one month after surgery. If you think you are more tired than you should be, talk to your doctor. It may be that drinking more water and taking in more protein are what you need.

“My hair keeps falling out. Is this normal?”
It is normal to experience some hair loss following weight loss surgery. Typically this occurs three to nine months after the operation, or after you have lost at least 50-75 pounds. Hair loss occurs as a natural stress reaction to weight loss. The hair loss should not be permanent. After weight loss tapers off, your hair will stop falling out and should return to normal growth. Remember to drink at least 64 ounces of water a day and eat plenty of protein, as this may help lessen hair loss. Some patients have reported that a biotin supplement or various thickening hair products help slow hair loss, but this is anecdotal and not scientific advice.

“It hurts when I eat. Is this normal?”
Pain after eating is not normal, but mild pain with swallowing may be a side effect of healing tissue in the first few weeks after surgery. If the pain is severe, regardless of the time since surgery, you should call your doctor’s nurse to discuss the problem. If the pain is still going on several weeks after your surgery, it could be a symptom of an underlying problem, such as a narrowing of the pouch outlet (“stricture”), or an ulcer. With any kind of abdominal or chest pain after surgery, especially pain that lasts longer than several hours, don’t hesitate to contact your doctor or even go the nearest Emergency Room if you’re worried.

“I had my surgery three years ago and have done great, but now I am starting to regain weight—is this normal?”
After losing a large amount of weight in the first year or two after surgery, it is common for patients to gain a small amount of weight back, about 5-10% of what they initially lost. But then the weight should plateau and stay relatively constant long-term, provided post-surgery guidelines are met, such as: avoiding liquid calories, no grazing, regular exercise, consumption of adequate protein, and avoidance of high-carb and sugary foods.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Vitamins After Weight Loss Surgery

Aug 8 By rmap nurse

Vitamins After Weight Loss Surgery
By: Sarah Christensen, PA

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

All bariatric surgery patients require life-long vitamins after having weight loss surgery. The changes in anatomy following surgery can change the amount of vitamins the body receives. Daily supplemental vitamins are used to avoid the risk of deficiencies.

What vitamins should I take?
Each type of surgery has a specific group of recommended vitamins because of the changes in anatomy. Below are listed the daily vitamins recommended according to the surgery performed.

Lap Band – multivitamin
Sleeve Gastrectomy – multivitamin, sublingual vitamin B12 and Calcium citrate
Gastric Bypass – multivitamin, sublingual vitamin B12 and Calcium citrate
Duodenal Switch – ADEK vitamins, multivitamins , sublingual vitamin B12 and Calcium citrate

Why do I need vitamins?
It is important to continue on these supplemental vitamins indefinitely to avoid vitamin deficiencies which can lead to various health concerns including:

Vitamin B12 – Important for neurological health. Deficiencies can lead to fatigue, tingling of the hands and extremities, anemia and neurological disorders. Vitamin B12 is given under the tongue because the new stomach anatomy does not produce the necessary protein needed to absorb dietary vitamin B12.
Vitamin B1 (thiamine) – Important for neurological health. Deficiency can lead to neurological disorders including muscle weakness that can be permanent.
Calcium – Important for muscles and bones. Deficiency in calcium can lead to osteoporosis.
Vitamin A – Deficiency in vitamin A can affect vision and weaken the immune system.
Vitamin D – This vitamin is important for the immune system and bones. Deficiency can lead to osteoporosis, fatigue and weaken the immune system.
Vitamin E – Promotes wound healing.
Vitamin K – Important in appropriate blood clotting. Deficiencies can lead to increased risk of osteoporosis, heart disease and bleeding.

How do I avoid vitamin deficiencies?
Take supplements consistently as prescribed by your bariatric surgeon. Be sure to get blood work done annually even after you are done following up routinely with your bariatric surgeon. Be sure you are seen each year by your primary care physician for health screening and annual labs to monitor vitamin levels.

Bariatric vitamins are very important and needed to avoid the risks of vitamin deficiencies. Stay in close contact with your surgeon if there are questions or concerns regarding your supplemental vitamins.

About the Author:

Sarah Christensen joined the team as a physician assistant in August 2015. She attended Brigham Young University in Provo, Utah with both academic and musical scholarships and earned a Bachelor of Science degree in Biology in 2009. She then completed her Master of Science in Physician Assistant Studies at Idaho State University in Pocatello, Idaho in 2011. Prior to joining Rocky Mountain Associated Physicians, Sarah spent 3.5 years working in liver transplant, managing end-organ failure and post-transplant care. She is certified by the National Commission for Certification of Physician Assistants.

For more information on Medical Follow Ups after weight loss surgery, click here.
For more information on the Various Complications that can occur after weight loss surgery, click here.
For more information on Annual Labs that need to be taken, click here.
For additional information on Vitamins and Minerals you should be taking after weight loss surgery, click here.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Medical Follow-Ups after Weight Loss Surgery

Jul 19 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

The surgeons and staff of Rocky Mountain Associated Physicians (RMAP) seek to be a partner in your health. During the first year following surgery a series of follow-up visits are scheduled. After the first year you are required to have an annual physical and blood work either with your surgeon or with your primary care physician.Gastric Bypass, Sleeve Gastrectomy and Duodenal Switch (DS) patients:
You should schedule an appointment to see your surgeon for follow up visits at:

2 weeks
8 weeks
4 months
8 months
1 year or additionally as requested by your surgeon
Annually thereafter

Adjustabel Gastric Band:
You should schedule an appointment to see your surgeon for follow up visits monthly for the first 6 months following surgery, then bimonthly until 1 year. Quarterly during 2^nd year and as needed thereafter.

Why Follow-Up?
Follow-up visits are occasions for monitoring health and weight status. They also provide an opportunity for you and your surgeon to evaluate progress towards goals. They allow you to focus on the positive changes that occur and for the utilization of a problem solving approach toward the obstacles that you may be experiencing.

If you do not keep your follow-up appointments you are excluding your surgeon from being a partner in your health. These visits are important to your surgeon’s ability to diagnose and treat you for long-term health. You are placing yourself at great risk if you fail to keep your follow-up appointments.

Your surgeon will assist you in establishing patient-selected incremental goals as well as long-term goals. By keeping your follow-up appointments you allow your surgeon to make an assessment of your health and instruct you on modifications that need to be made when necessary.

Annual Blood Work
You will need to have certain blood tests done every year. Your family physician or our office can order them one to two weeks before your annual visit. The tests will be reviewed by your surgeon and placed in your chart.

Complete blood count
Lipid profile
Comprehensive metabolic panel
B-12 level
Thiamin
Folate
Hemoglobin A1c
Vitamin D; 25 hydroxy level
DS Patients will need to do 2 additional tests to include:
Vitamin A level
Protime

Mail or fax a copy of these tests to our office. Fax number (801) 268-3997.

Special Medical Considerations for Gastric Bypass, Gastric Sleeve and DS:
Your anatomy changes after these surgeries. Because of these changes you physicians may need to perform some medical tests with modifications. In addition, there are some over the counter medications you will not be able to take. Make sure that your Primary Care Physician is aware of these special medical considerations.

Upper GI Testing
If this test is ever ordered for you, please inform the ordering physician that you will not be able to drink the contrast solution in the amount that is being requested due to the limited size of your stomach. Inform the radiologist performing the test that you have had weight loss surgery and that he should call your surgeon if he has questions regarding the amount of contrast solution to use.

Glucose Tolerance Testing
Weight loss surgery patients are unable to participate in traditional glucose tolerance testing because the volume required for the test exceeds the volume your gastric pouch/sleeve can tolerate and may give inaccurate testing results. Also, for gastric bypass patients, the sugary drink could cause the “dumping syndrome.”

Keep in Touch
Your surgeon, nurses and staff is your unified team with your best interests in mind. Stay in contact. Attend support groups regularly. Where available, attend scheduled classroom instruction. Check the website at www.RMAP.com for interactive events and downloadable materials.

We want you to reach improved health and experience an enriched quality of life. We seek to be a partner in your health. However, the necessary adjustments to your present behaviors will be yours to make. The pride and feeling of accomplishment as you lose weight and maintain your weight loss will be yours as well.

Find more answers to Frequently Asked Questions here.
Find more Complications after WLS information here.
Find more information on Dumping Syndrome here.
For more information on Support Groups, click here.

If you are interested in learning more about weight loss surgery, and the risks and benefits of each procedure, you can either attend one of our free informational seminars or watch a video online. Click here to sign up to attend our informational seminar, or click here to watch the video online.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Various Complications after Weight Loss Surgery

Jul 5 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Just like with any kind of surgery, there are some risks and benefits. Having surgery can be a huge impact on your body; the changes and healing process. Every body type is different, so our bodies heal differently, and can also take different times, too. Here are some of the most common side effects and complications that can occur after weight loss surgery.

Dumping Syndrome (Gastric Bypass Patients Only)
Dumping Syndrome is a condition some patients may experience after gastric bypass surgery, when foods high in sugar content have been consumed. Abdominal symptoms include pain, stomach rumbling and diarrhea. Other symptoms can include weakness, sweating, flushing, rapid heart rate and palpitations. If you have symptoms of Dumping Syndrome that last longer than a few hours, please call the office and speak to your doctor’s nurse.

Gas
Gas is often produced by consuming complex carbohydrates. Certain foods are gas-producing: broccoli, cauliflower and onions to name a few. Extra air taken in with chewing gum and straw usage can also contribute to gas. If you are feeling symptoms of gas, try increasing your exercise and eliminating gassy foods.

**For medication that can help with gas-relief, please call our office and ask to speak with your surgeons nurse. She will be able to look up your medical history and see which medicine will be best for you.

Constipation
It is normal to have occasional constipation and decreased bowel movements; (ever two to three days). If your stools are hard, try:

Adding high fiber foods to your food plan (legumes)
Increase your raw vegetable intake
Add fruit occasionally (1-2 servings/week)
Make sure you are getting the required 64 oz. of water a day
Increase your exercise
Add a fiber supplement

If the tips above do not help, please call the office and speak to your doctor’s nurse.

Diarrhea
Diarrhea can be caused by consuming sugars, including fruits and fruit juices. The first thing to do is to eliminate these from your diet. Keep your fluid level elevated to compensate for the extra fluid lost through your bowels. If there is no improvement, contact the office and ask to speak with your doctor’s nurse.

Bowel Blockage
The percentage of postoperative patients that we see with a bowel obstruction is less than 5%. A bowel obstruction can be defined as interference with the normal passage of intestinal contents through the small and/or large bowel caused by partial or complete obstruction. This obstruction is usually caused by adhesions (scar tissue).

Symptoms can include: bloating or distention in the abdominal area, bowel cramping, abdominal pain, vomiting, constipation and/or diarrhea. If you have severe abdominal cramping and/or pain that continues for up to six hours, especially accompanied by any of these other symptoms, it is crucial that you call our office and talk to your doctor’s nurse. If you are calling after hours, the answering service will page the doctor immediately. When you’re in doubt, you can always go straight to the emergency room. Please have them contact your surgeon here at Rocky Mountain Associated Physicians (RMAP). They are experience on how best to handle your care in this area (even if it has been a number of years since your surgery). It is much better to call if you are having any of these above symptoms, than to let time go by. Time is critical in curing a bowel obstruction. The more time that a bowel obstruction goes untreated by medical personnel, the higher the chances of it causing a major problem for you, including death. When in doubt…call!

Hernia
A hernia is a rupture or a weakness in the muscle wall allowing protrusion of tissues normally contained within the abdominal cavity. This usually happens along or beside the incision line. This is the main reason that abdominal exercise is limited in the immediate postoperative phase. Most often, hernia causes an ache or pain in some area of the abdomen that tends to worsen with heavy lifting. A notable protrusion in the abdomen or groin area can be an obvious hernia symptom. If you have symptoms of a hernia, please call the office and speak to your doctor’s nurse.

Excess Skin (need for cosmetic surgery)
Some patients have an excess of skin in the abdomen, thigh, chest, breast and/or upper arm areas after losing a large amount of weight. Sometimes exercise does not help these areas tone up as much as you would like to see them toned. If you desire, you may call our office and ask for recommendations for plastic surgeons. Many patients elect to have one or more of the following procedures done after their weight loss:

Abdominoplasty/Panniculectomy (tummy tuck).
Breast augmentation, reduction and/or lift.
Removal of excess skin from arms and thighs.
Scar revision.

It is important to see your surgeon or family physician for an annual exam and blood work. Included in this exam will be:

Comprehensive metabolic panel
Complete blood count
Vitamin B-12, Folate, Thiamine and Vitamin D; 25 hydroxy level
Lipid profile, Hemoglobin A1c
Weight and blood pressure check
DS patients: Vitamin A levels and Protime

Make sure RMAP receives a copy of your test results by faxing them to (801) 268-3997.

**If you are experiencing any kind of vomiting or symptoms listed above, please call our office at (801) 268-3800. That is also the after-hours number you will call to speak with the doctor that is on call.

For more information on Dumping Syndrome, click here.
For more information on vomiting after weight loss surgery, click here.
If you are interesting in learning more about weight loss surgery, and the risks and benefits of each procedure, you can either attend one of our free informational seminars or watch a video online. Click here to sign up to attend our informational seminar, or click here to watch the video online.

Let us know how you are doing after weight loss surgery.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Dumping Syndrome for Gastric Bypass Patients

May 3 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians at www.RMAP.com (801) 268-3800

Dumping syndrome is a condition some patients may experience after gastric bypass surgery, when foods high in sugar content have been consumed. These symptoms occur within one hour of eating. Abdominal symptoms include pain, stomach rumbling and diarrhea. Other symptoms can include weakness, sweating, flushing, rapid heart rate and palpitations. These symptoms will usually occur within one hour of ingestion of an inappropriate meal.

To help avoid dumping syndrome, it is important that you do not eat foods containing sugar (candies, cookies, cakes, pastries, ice cream, fruit and fruit juices). It is also very important to avoid drinking with your meals, and do not begin drinking until 30 minutes after a meal. This will allow for a gradual emptying of the stomach contents.

With the diarrhea, be sure to keep your fluid level elevated to compensate for the extra fluid lost through your bowels. If there is no improvement, or if you haven’t stopped having any of the symptoms above within a couple of hours, contact our office and ask to speak with your doctor’s nurse.

If you have any other questions about Dumping Syndrome, its symptoms, concerns or how to help avoid it, please feel free to contact us at (801) 268-3800.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Is it Healthy to Lose Weight This Fast?

The Real Deal on Obesity, Part 2

You are not a failure, the traditional diet is.

Understanding Weight Loss Surgery and Being Aware

The Real Deal on Obesity, Part 1

Obesity is not a benign condition but a killer!

Morbid Obesity

Co-Morbidities Related to Obesity

When Should I Be Worried?

Is This Normal?

Vitamins After Weight Loss Surgery

Medical Follow-Ups after Weight Loss Surgery

Various Complications after Weight Loss Surgery

Dumping Syndrome for Gastric Bypass Patients

Contact Information

Procedures Offered

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