Issue #210 June 15, 2011
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In This Issue

About My Facebook WLS Private Group

ASMBS Annual Meeting
Gastric Sleeve
Back On Track with Barbara
Research Article: Absorption of Pain Medication
Painful Story: Lisa S.

About My Facebook WLS Private Group

I am so excited about my new Facebook group, called WLS Private Group.  It is categorized as a CLOSED group by Facebook.  This does not mean it is closed to new members. It is definitely open for new members and I hope you will join. A CLOSED group in Facebook means that only members of the group can read posts and comments. That provides members with the privacy that what they are discussing cannot be seen by anyone outside of the group membership.

The discussions in my WLS Private Group have really been great. Within the past day, the discussions have been about exercise, what's on your grocery list, eating out in a small town, and Greek yogart.

Here are some comments from members:
“I love this site! I sure wish this was around when I was a new post-op! I think I would be close to 300+ pounds off instead of working my way to 250 off. I am learning so much as well.” Carrie

“I thank you for having this group. I read everything every day.” Lora

“Isn’t this group wonderful? I have learned more here than in months of going to a normal support group.” Shelly

Please join us. We would love to have you. Just click on the box above.

 

ASMBS Annual Meeting

This is an abbreviated edition of my newsletter. I am in Orlando right now attending the Annual Meeting of the American Society for Metabolic and Bariatric Surgery. This annual meeting is probably being attended by your surgeon, and his or her staff including the bariatric coordinator, nurses, dietician, perhaps the psychologist. The annual meeting allows colleagues to meet and share research and techniques as well as to improve techniques. There are some social activities at night, and the opportunity to renew friendships. I look forward to this every year.

As Chairman of the Board of the Obesity Action Coalition, I am spending my time at our booth; talk with people about the OAC, letting them know all that we do,  and trying to get them to join.

It is an important time and I love it!

The Gastric Sleeve

I have had more and more questions from people who are having the gastric sleeve. This is becoming a more common and popular form of weight loss surgery.

In the gastric sleeve, about 85% of the stomach is removed. What is left is a thin eight inch long sleeve that is sealed by staples along its outer edge.  I have always thought that the sleeve, or the portion of the stomach that remains, looks like a small, slim banana.

The intestines are not rerouted, they are left intact. When the patient eats, they feel fuller sooner because the remaining stomach is so small. Also the portion of the stomach that is removed contains the tissue that releases the hormone ghrelin. Ghrelin is known as the hunger hormone. This hormone works on the brain to signal hunger. With a dramatic decrease in ghrelin, patients are not motivated to eat.

After food is eaten, it passes through the pyloric valve, just as it normally would.  The pyloric valve is between the stomach and intestines, and determines when to stop digestion in the stomach and let it pass into the small intestines.  Because this is not a malabsorption procedure, there is little problem with nutritional deficiencies.

As with other weight loss surgery procedures, patients see improvements in diabetes, high blood pressure, high cholesterol and sleep apnea within one to two years.

With the gastric sleeve, patients lose approximately 60% to 70% of their excess weight, so it is not quite as successful as the gastric bypass, but nearly so.

It is wonderful that there are more and more options for weight loss surgery, so that patients are able to choose the type of surgery, and later the lifestyle that suits them. With choices, patients can ultimately be more successful.

Back on Track with Barbara

Internet Mentoring Program

The Back on Track with Barbara Internet Mentoring Program really concentrates on lifestyle changes. Join our group and receive lessons via the internet and the support of others who are struggling just like you are.

Get Ready for Summertime Fun

Are you suffering from emotional eating and can’t stop?
Are you grazing on carbohydrates and can’t control it?
Are you lacking inspiration to lose the weight you have regained?
Do you feel that you don’t know what to do now that you have had surgery?
Are you dying to be in better shape?

My Back on Track Internet Mentoring Program will give you the
support you need to get your weight under control.

View a FREE Lesson and Listen to a FREE Telephone Seminar by
clicking here and scrolling down to the bottom of the page.

Research Article:
  Absorption of Pain Medication

Hi Barbara,
I am a gastric bypass patient, eight years post-op. I have a question about pain medication.  I will soon be having major back surgery. I know we don't absorb food as well as we used to, so I assume that goes for medications as well.  I am wondering what to do about post-op pain management.  How much should I take in order to keep the major pain at a decent level? 

So many doctors are still not very familiar with gastric bypass surgery, so it's hard to make them understand that we may need more medication or a different plan than patients with a normal stomach.  Any tips or suggestions?

Thank you,
Becky

Hi Becky,
I don’t know of any studies that specifically pertain to pain medications, but I do know of the following two studies that deal with the absorption of anti-depressants and anti-psychotic medications. Both studies show that gastric bypass post-op patients do not absorb medications as well as they did prior to surgery. It is important that your doctor understands this, and agrees to work with you on finding a level of pain relief that is designed for you.

Here are the two studies:

A study was conducted by Dr. Giselle Hamad in which she tested the blood of a woman who was taking an SSRI (serotonin reuptake inhibitor) anti-depressant called sertraline. The woman was tested before and after the surgery. In the study, her blood was tested before taking her morning dose of her anti-depressant and then every 30 minutes for the next eight hours. Here are the results:

Before surgery, the blood level of her anti-depressant was:
17.5 ng/ml before taking the medication
41.6 ng/ml at the peak level after taking the medication

After surgery, the blood level of her anti-depressant was:
11.1 ng/ml before taking the medication
14.4 ng/ml at the peak level after taking the medication

Naturally, after surgery when her anti-depressant was not being absorbed, the patient complained of moodiness and irritability. Many surgeons have attributed post-op depression to problems of patients adjusting to surgery, or finding that their circumstances have not improved significantly with their loss of weight.  However, the problem may be that patients are not absorbing their medications.

Further study needs to be done, but this may explain not only the depression of patients, but it may contribute to weight regain, as post-op patients are unable to cope without the absorption of their anti-depressant and turn to food to calm and comfort them.

From: 
Frangou, Christine. SSRI Absorption Plummets after Gastric Bypass: Case Study. General Surgery News, Vol. 35:09, Sept. 2008.

Here is another article that I have reported on previously:

Seaman, Jeff S. et al. Dissolution of Common Psychiatric Medications in a Roux-en-Y Gastric Bypass Model. Psychosomatics. 46: 250-253, Je 2005.
http://psy.psychiatryonline.org/cgi/content/full/46/3/250

In the article, the authors compare the absorption of many psychiatric medications in pre-op patients and post-op patients. While each medication shows less absorption in post-ops than pre-ops, what is especially interesting is that each medication shows a different level of absorption. Some medications are absorbed better than others. Therefore there can be no general rule as to how much of any one medication is absorbed.  

Further, we are all different. Our surgeries may be the same type, but our anatomies are all slightly different. Your pouch and the exact amount of intestines bypassed vary depending upon your surgeon, your own anatomy, and even when your surgery was performed because surgeons have been making pouches smaller and smaller over the years. Because the variances are so great, doctors or pharmacists cannot say that for every bypass patient taking every medication, there will be a certain amount less medication absorbed. The percentages can be all over the map.

Dosage should be adjusted for the best result with the least amount of dosage. It is all very individual.

Best wishes on you upcoming back surgery.

  Painful Story: Lisa S.

I want to offer a special thanks to Lisa S. for sharing her story of pain with us. After reading her story, my assessment (although I am not a medical professional of any kind) is that she has a leak from her pouch into her old stomach. This is very painful, and I have heard this from others who have had the same pain. Here is her story:

Hi Barbara,
I had gastric bypass surgery over 5 years ago and transformed from a size 24/28 to a size 6/8 today.  I went from a shocking 280 pounds down to less than 130, and am currently at 155. 

Although I was very pleased with the results from my bypass surgery, I have been back and forth to doctors for over 2 years now dealing with the same issues. 

Let me start from the beginning.  After I took off my excess weight, I decided to have a tummy tuck and a breast lift and augmentation, which took place about 3 years ago.  The results were amazing!!  But, about a year later, I started to develop serious stomach pains that usually took place right after eating. 

Now I know that I am not perfect, and sometimes I eat things that cause dumping, but this pain was different, and would happen after eating anything, healthy or not. 

For almost 2 years I was seen in Urgent Care regularly with the same stomach issues (pain, cramping, bloating) so unbearable to handle that it landed me there, because the pain was "urgent.”  I saw and spoke to my bypass surgeon and my primary care doctor about the pain, but they just masked it with pain killers. 

Then, this past January I again returned to Urgent Care, and the doctor ordered a CT scan.  It was then that he discovered that I had a strangulated hernia that was causing part of my small intestine to die off, and I was rushed to emergency surgery that same evening.  I felt so relieved to finally find the root of all my discomfort. 

But, after weeks of recovery things still weren't right.  I was still feeling pain in my stomach, the same pain that brought me to the hospital in the first place.  Many tests were ordered; gall bladder scans, blood tests, endoscopy, urine tests, etc., but the doctor found nothing wrong with me. 

I suppose that is good news, but my quality of life is completely ruined.  I have two beautiful teenage children and a husband that are tired of me being ill all the time. I am not able to participate in anything because of the pain that I am in.  I don't know where to turn anymore.

Sincerely,

Lisa S.

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The OAC is the ONLY non profit organization whose sole focus is helping those affected by obesity.  The OAC is a great place to turn if you are looking for a way to get involved and give back to the cause of obesity.

There are a variety of ways you can make a difference, but the first step is to become an OAC Member.  The great thing about OAC Membership is that you can be as involved as you would like.  Simply being a member contributes to the cause of obesity.

 

 

 

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