Weight-loss efforts combat chronic pain

This cycle is one everyone recognizes – when we hurt for a period of time, we are less active and tend to put on weight. In turn, the extra weight makes us hurt more.

Excess body weight puts greater physical strain on the joints and muscles. The “daily grind” of just moving around can especially affect the lower extremities, including the hips, knees, ankles and feet. In fact, among the patients we evaluate before surgery at the N.E.W. Program, severe pain is most often reported in the knees, lower back, feet and hips, in that order. Many have already had knee and hip replacement surgery.

Chronic pain problems and obesity go hand-in-hand. Excess weight slows you down. You get less exercise, less activity in general.

In a study of patients at a local pain clinic,. more than 63 percent of chronic pain patients had moderate to severe obesity. Did the weight cause the pain, or vice versa? Cause and effect doesn’t matter much, although 41 percent of these patients said they were overweight before the onset of their pain. The rest claimed that their weight gain occurred after their pain started.

Medications used to treat pain may work at first, but they ultimately lose their effectiveness and require greater dosages. Some pain medications also lead to weight gain. Gradually increasing physical activity, not medication, is the primary way professionals treat chronic pain. This is often a very difficult goal when pain is severe, especially in a patient with excess body weight.

In many cases, patients find not only significant reductions in extremity pain following weight-loss surgery, but increased activity as well. Some, who were candidates for knee or hip surgery, no longer need it after weight loss.

In a recent study done at the N.E.W. Program, a group of our patients wore pedometers which measure the number of steps taken each day. Patients wore them and recorded their daily steps for one month before and five months after bariatric surgery.

The pedometer reading is an excellent indicator of activity level. Most of our patients increased their activity by more than 100 percent within 6 months after surgery, compared with pre-surgical readings These new results were presented at a San Diego meeting of the American Society for Bariatric Surgery.

When there is excessive body weight, the most effective way to prevent or reduce chronic pain is to lose weight. This is particularly true for those with morbid obesity. In this case, bariatric surgery is a powerful tool to combat chronic pain.

Share/Bookmark

Program choice crucial in weight-loss journey

Surgery for obesity is recommended by the American College of Physicians (ACP) if you have a BMI greater then 40 or a BMI greater then 35 and an obesity related co-morbidity such as elevated cholesterol or high blood pressure.

Published medical literature does show a mortality benefit from cardiovascular disease after significant weight loss. Co-morbidities such as diabetes mellitus, elevated cholesterol, hypertension and sleep apnea generally improve after gastric bypass. Other complications from obesity such as stress urinary incontinence (urinary leakage with coughing or sneezing), non-cardiac shortness of breath, asthmatic symptoms and joint pain and stiffness also improve dramatically.

Dr. Tracy Siegfried

When choosing a bariatric surgical program where and by whom your surgery is performed can make a significant difference in your outcome. The association between superior experience and lower mortality is well documented. In one study, the mortality was 5 percent among patients of surgeons who had performed fewer then 20 procedures per year and near zero for those treated by clinicians who have done greater the 250 surgical procedures annually.

Another to factor to consider is whether a surgeon performs the operation laparoscopically for the majority of procedures. When you interview prospective surgeons ask their percentage of transition from laparoscopic to open incisions. The ACP guidelines observe that critical differences are not limited to the surgical skill but extend to more comprehensive aspects of the providing program.

Better outcomes depend also on the capacity of the systems of care, from the pre-operative evaluation to the post-operative follow-up. Many surgical groups do not have comprehensive pre-operative evaluations or extensive close follow up care, which is critical to long term success after your procedure and weight loss.

And lastly, your surgery should be performed at a COE, “Center of Excellence” as designated by the American Society for Bariatric Surgery. These centers are evaluated extensively by the society and must meet rigorous criteria in order to maintain a COE classification.

This article was written by Tracy Ann Siegfried , M .D., Bariatric Internist for The NEW Program in Newport Beach, Calif. The NEW Program at South Coast Medical Center offers state-of-the-art weight loss treatment for people who are at least 100 pounds above their ideal body weight. The N.E.W. Program is the most comprehensive weight loss surgery program in the region.

Share/Bookmark

The Safer Answer for Weight Control (Dispelling Myths on Weight Loss Surgery)

By now, everyone is aware that excess weight will threaten your health.  It’s in the newspaper and on television, the internet and radio.  Hardly a week goes by where a new report on the hazards of excess weight doesn’t hit the national media.

The media has focused on adverse health consequences associated with excess weight, but the truth is that the primary problem caused by severe obesity is the inability of many overweight people to live life to the fullest.  The more overweight a person is, the more difficult it becomes to enjoy normal activities; to walk up stairs comfortably, to easily get in and out of a car and to sit in a booth at a restaurant are some of the constant restrictions felt by obese people every minute of their lives.

What can be done?  How can this excess weight be controlled and how can a severely overweight person experience that healthy feeling, that “normal life” again?  Of course, the answer is permanent weight loss.  But, how is this achieved?  Fortunately, the truth is finally being published in the major medical journals and reported in the national media.  The truth is that for people suffering from severe obesity, the only highly successful method to achieve substantial permanent weight loss is through weight loss surgery.  This has been demonstrated over and over again in scientific studies (as opposed to the misleading reports promoted by diet companies).  So, knowing the truth about weight control for people 80 lbs or more overweight, what are the key questions?  The questions are obvious; “Is weight loss surgery safe?” and “Where should I go for surgery?”

The Gold standard for weight loss surgery is Laparoscopic, or minimally invasive, weight loss surgery.  At The N.E.W. Program Laparoscopic Gastric Bypass has been performed safely in patients weighing over 700 pounds.  Almost every patient who has surgery for weight loss is able to have surgery successfully using these minimally invasive techniques.  The need to perform these surgeries by the traditional, large-incision method generally indicates that the surgeon is poorly trained in laparoscopic surgery and probably should not be performing weight loss surgery at all.

With Laparoscopic Gastric Bypass, Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Band surgery, the complication rate should be very low.  The vast majority of patients should never need to be in the intensive care unit (ICU) after surgery and should be able to go home after only one night in the hospital.  Recovery should take about one week.  Finally, the mortality rate from this surgery should be well below 1 out of 200, or less than 0.5%.  In over 2000 procedures, there has never been a single death due to a leak or other complication after weight loss surgery at The N.E.W. Program.

After thinking through these facts, it is clear that severely obese people who wish to gain permanent control of their weight should consider surgery.  Of course, before deciding on which surgeon to see, be sure to ask about their statistics, and write them down.  If the surgeon ends up performing open, large-incision surgery more than 2% of the time, be wary.  And of course, don’t be afraid to ask about that surgeon’s mortality rate, complication rate and the chance of ending up in the ICU.  Always remember, it’s your life.  If done right, surgery for weight loss can be done safely and effectively, with a fast recovery.  The long-term goal is to improve your health and help you to regain that healthy feeling, that “normal life” again.

Joint Pain, Weight Loss and Orthopedic Surgery

Orthopedic surgeons, rheumatologists and physicians specializing in rehabilitation medicine know that the knee joint has to support the force of three to six times one’s weight.  The impact of extra weight is also multiplied on other joints, including those of the back, hips and ankles.  The results of this increased wear and tear are impressive; for example, men who are just 40 pounds over their ideal body weight have a five-fold increase in osteoarthritis (1).  This close link between obesity and osteoarthritis is well documented (2).  Of course, the incidence of severe osteoarthritis in people that are one hundred or more pounds overweight is exponentially higher, and the age of onset is much earlier.  As always in medicine, unless patients and their doctors attack the root cause of their disease, in this case arthritis, medications and other therapy will only temporarily alleviate the pain and allow for permanent injury to the bone and cartilage.

For patients who do not yet require surgery to replace damaged joints, substantial weight loss has been shown to alleviate the debilitating symptoms of osteoarthritis.  Schauer, et al, documented that seventy percent of patients that were taking medications for joint pain had no pain and were off all arthritis medications after weight loss surgery (3). Another published study documented that 58 percent of patients undergoing weight loss surgery complained of chronic low back pain, but this number decreased to only 20 percent after surgery (4).

Unfortunately, not everyone will have resolution of his or her knee pain after weight loss since joint cartilage lost after years of obesity will never regenerate.  This damage may result in the need for surgery to repair or replace the damaged joint.  Of course, recovery from joint replacement is more difficult in obese patients and many orthopedic surgeons will not perform joint replacement surgery in severely obese patients because of the significantly higher risk of complications.  A patient who is unable to undergo joint replacement due to excess weight is a prime example of a person who needs surgical weight loss.

To evaluate the impact of surgical weight loss on patients requiring joint replacement therapy, the Mayo Clinic followed 20 patients who had hip and knee replacements after weight loss from gastric bypass.   This recent study found a significant improvement in physical rehabilitation after joint replacement in patients who had previous weight loss due to gastric bypass.   In fact, not only did the recovery from joint replacement improve, the re-operation rate due to complications after surgery was dramatically lower (5).

Everyone is aware that osteoarthritis will often improve with good weight control.  For those people who are severely obese and are suffering from chronic joint pain, surgery for permanent weight control may be the best option to help your physician or surgeon improve your treatment results.

1- Annals of Rheumatic Disease; Felson, 1996,  2- Amer. Jour. of Public Health; Sahyoun, 1999, 3- Schauer 20004, 4- Melissas, 2004, 5- Parvizi, 2000

Article courtesy of Ramsey Dallal, MD

Share


Gastric Sleeve Procedure

Dramatic Weight Loss with No Adjustments and No Bypass!

The Vertical Sleeve Gastrectomy (VSG) is an exciting new weight loss procedure that results in dramatic and lasting weight loss without risk of malabsorption.  The VSG is a very simple procedure that is now being performed worldwide as an excellent alternative to the gastric band and bypass operations.  The Gastric Sleeve Procedure causes weight loss through much the same mechanism as the gastric band, by restricting the amount of food that a person can eat before becoming “full.”  Approximately 80% of a patient’s stomach is removed but because there is no bypass involved there is no defined risk of malnutrition.  The VSG is performed using minimally invasive surgery and patients typically leave the hospital in less than 24 hours.

The gastric sleeve procedure generates weight loss due to reduced stomach volume and earlier satiety (feeling full with smaller amounts of food).  The stomach is made smaller by removing approximately 80% of the volume, so the procedure is not reversible. The remaining stomach is filled with approximately 3-4 ounces of food, there is no dumping and the sleeve operation requires no adjustments.

An important fact to remember is that the sensation of certain food cravings seems to be far less after this procedure than after the gastric band procedure, and studies have shown that the average weight loss with the VSG is much more consistent and significantly greater than with the gastric band. Many patients have described a complete lack of hunger for several months after this operation which may be due to a dramatic reduction in the hunger-inducing hormone grehlin, which is produced by the stomach.

All patients who qualify for weight loss surgery are candidates for the Vertical Sleeve Gastrectomy.  This surgery has also been shown to be safe and effective for individuals with lower BMI, between 30 and 35, meaning people who’s excess weight is having a negative impact on their health and quality of life but who are only moderately obese.

Individuals who qualify for this procedure include:

  1. Any person that otherwise qualifies for weight loss surgery.
  2. People with a BMI between 30 and 35 who have struggled with weight control and have weight related health concerns.
  3. Those who are concerned about the potential nutritional effects of gastric bypass.
  4. Those who do not want gastric band surgery because they dislike the idea of an artificial device attached to their stomach and do not want to have to undergo band adjustments.

Although weight loss is still the greatest after gastric bypass, the VSG provides weight loss that is superior to the gastric band operation making it an excellent option for patients interested in permanent weight control.

Share


Five Principles of Healthy Eating

1. Eat Chewable Food—Not “Mush”
Chewing food provides more satisfaction when eating.  Also, adequate chewing is important to avoid discomfort after surgery.  Eating soft mushy foods that don’t require chewing will decrease your satisfaction after a meal, result in less satiety and limit your post-surgical success. (Mac and Cheese is high-calorie mush)

2.  Eat 2-3 meals per day and 2-3 snacks per day. (eat 5-6 times/day)
Eating regularly during the day will maintain a higher metabolism.  Skipping meals will also result in fluctuations of your blood sugar and energy level and may cause cravings and headaches.  Always eat breakfast.

3.  At least three of the meals should be high protein meals.
Remember, “protein first.”  Protein causes more satiety than carbohydrates.  When eating smaller portions, following a pattern of starting with protein-based foods (meat, fish, eggs, etc…) will also ensure better nutrition.

4.  Drink at least 2 quarts of calorie-free beverage per day, and drink 1 glass (8oz) of water, 30 minutes prior to regular meals.  Do not drink during meals.
Dehydration will often be mistaken as hunger, resulting in a need to eat more.  Drinking a thirst-quenching liquid prior to meals will also eliminate the feeling of a need to drink during the meal.  Drinking during a meal will “wash” food through the pouch and leave you hungry.

5.  Eat good tasting, flavorful food; chew well and eat slowly.
This is very important.  There is no rule that patients cannot eat spicy, hot or tangy foods after surgery.  You will be eating slowly and chewing for a longer time, and therefore you need to make sure that you have good tasting food that you enjoy.  This is an important part of feeling satisfied after a meal.  Eat well.

Check out The N.E.W. Program for more information on Healthy Eating!


Share


The Safer Answer for Weight Control (Dispelling Myths on Weight Loss Surgery)

By now, everyone is aware that excess weight will threaten your health.  It’s in the newspaper and on television, the internet and radio.  Hardly a week goes by where a new report on the hazards of excess weight doesn’t hit the national media.

The media has focused on adverse health consequences associated with excess weight, but the truth is that the primary problem caused by severe obesity is the inability of many overweight people to live life to the fullest.  The more overweight a person is, the more difficult it becomes to enjoy normal activities; to walk up stairs comfortably, to easily get in and out of a car and to sit in a booth at a restaurant are some of the constant restrictions felt by obese people every minute of their lives.

What can be done?  How can this excess weight be controlled and how can a severely overweight person experience that healthy feeling, that “normal life” again?  Of course, the answer is permanent weight loss.  But, how is this achieved?  Fortunately, the truth is finally being published in the major medical journals and reported in the national media.  The truth is that for people suffering from severe obesity, the only highly successful method to achieve substantial permanent weight loss is through weight loss surgery.  This has been demonstrated over and over again in scientific studies (as opposed to the misleading reports promoted by diet companies).  So, knowing the truth about weight control for people 80 lbs or more overweight, what are the key questions?  The questions are obvious; “Is weight loss surgery safe?” and “Where should I go for surgery?”

The Gold standard for weight loss surgery is Laparoscopic, or minimally invasive, weight loss surgery.  At The N.E.W. Program Laparoscopic Gastric Bypass has been performed safely in patients weighing over 700 pounds.  Almost every patient who has surgery for weight loss is able to have surgery successfully using these minimally invasive techniques.  The need to perform these surgeries by the traditional, large-incision method generally indicates that the surgeon is poorly trained in laparoscopic surgery and probably should not be performing weight loss surgery at all.

With Laparoscopic Gastric Bypass, Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Band surgery, the complication rate should be very low.  The vast majority of patients should never need to be in the intensive care unit (ICU) after surgery and should be able to go home after only one night in the hospital.  Recovery should take about one week.  Finally, the mortality rate from this surgery should be well below 1 out of 200, or less than 0.5%.  In over 2000 procedures, there has never been a single death due to a leak or other complication after weight loss surgery at The N.E.W. Program.

After thinking through these facts, it is clear that severely obese people who wish to gain permanent control of their weight should consider surgery.  Of course, before deciding on which surgeon to see, be sure to ask about their statistics, and write them down.  If the surgeon ends up performing open, large-incision surgery more than 2% of the time, be wary.  And of course, don’t be afraid to ask about that surgeon’s mortality rate, complication rate and the chance of ending up in the ICU.  Always remember, it’s your life.  If done right, surgery for weight loss can be done safely and effectively, with a fast recovery.  The long-term goal is to improve your health and help you to regain that healthy feeling, that “normal life” again.

Share


The Final Touch

Skin reduction surgery helps weight-loss patients achieve their ultimate goals.

Each year, well over 100,000 people undergo bariatric surgery in the United States in the battle against an obesity epidemic that affects nearly nine million Americans.  In their first year after weight-loss surgery, those who comply with their physician’s diet and exercise advice typically lose a significant amount of weight.

While this weight reduction is a great victory for their physical and psychological health, many of these people are dismayed by the large amount of excess skin that remains on their arms, abdomen, waist, thighs, breasts and other areas.

Fortunately, plastic surgery offers an excellent solution to alleviate this problem.  However, for a variety of reasons, post-bariatric surgery patients present special challenges for additional surgery and should, therefore, seek out a plastic surgeon who understands their special needs and has experience in this rapidly developing sub-specialty.

Safety First

Safety is the most critical consideration for all surgery patients, but even more so for those who have had bariatric surgery.  Because of the nature of stomach-reduction procedures, these patients often have altered hemodynamics (blood flow throught the body) and may have ionic imbalances, which can lead to such conditions as iron deficiency anemia and deficiency of vitamin B12 and/or folate.  Therefore, thorough blood work to detect these and other possible complications is an absolute necessity prior to skin reduction surgery.

In addition, these considerations also place a limit on the length of time this patient should be in surgery.  Because of this and the often great amount of skin to be removed, patients are normally counseled to expect a series of surgeries to accomplish all of the skin reduction they desire.

Special Considerations

A plastic surgeon who is skilled in skin reduction for post-bariatric patients will know how to modify common plastic surgery techniques to accommodate the especially large amount of skin to be managed.  For instance, the tummy tuck incision is started lower and modified to eliminate skin folds.  Other incision changes are used to make adjacent body features look attractive and natural.

Surgeons familiar with the special needs of post-bariatric patients are careful to minimize the risk of pressure sores by padding key areas of the body during surgery.  These patients are also at risk for hypothermia, so they are provided a warm room and intravenous fluids to keep their internal body temperature at an appropriate level.

Both during and after surgery, there is special attention given to minimizing the risk of blood clot formation.  Surgeons give patients IV medication and place special compression garments on them while operating.  As soon as possible after surgery, patients are encouraged to walk in order to deter the development of clots that can move through the body and damage vital organs or even threaten a heart attach or stroke.

Also following surgery, skin reduction patients are closely monitored to avoid variety of complications from diabetes, sleep apnea, a body mass index (BMI) greater that 35 and other conditions they may have developed while they were obese.

Overall, post-bariatric patients are to be commended for their diligence and perseverance in losing their excess weight.  Skin reduction surgery goes the extra step beyond that achievement to finally give them the desired result of all their efforts.

Article by Arian Mowlavi, MD


Share


Spicy Chipotle Shrimp Salad

This is a delicious recipe containing plenty of satisfying, high-quality protein. Shrimp is extremely low in saturated fat, and is known for being unlikely to raise blood cholesterol levels. Lime, cilantro, cumin, and chipotle are a great way to add fresh Mexican flavors to your favorite recipes, without the high fat and calories typically found at many Mexican restaurants. Cilantro has traditionally been used as a digestive aid for nausea and gas.

Total:
30 minutes
Yield: 4 servings
Ingredients

  • 1 ½ pounds peeled and deveined large shrimp
  • 1/8 teaspoon salt
  • 1/8 teaspoon freshly ground black pepper
  • Cooking spray
  • ¼ cup finely chopped celery
  • 2 tablespoons finely chopped red onion
  • 2 tablespoons chopped fresh cilantro
  • 3 tablespoons canola mayonnaise
  • 1 tablespoon chopped chipotle chile, canned in adobo sauce
  • 2 teaspoons fresh lime juice
  • ½ teaspoon ground cumin
  • 8 Boston lettuce leaves

Preparation

1. Heat a grill pan over medium-high heat. Sprinkle shrimp with salt and black pepper. Coat pan with cooking spray. Add half of shrimp to pan; cook 2 minutes on each side or until done. Remove shrimp from pan; repeat procedure with remaining shrimp. Cool shrimp for 5 minutes.

2. Place shrimp in a medium bowl; stir in celery and next 6 ingredients (through cumin). Arrange 2 lettuce leaves on each of 4 plates; top each serving with 3/4 cup shrimp mixture.

Nutritional Information
Calories: 235
Fat: 10.9g (sat 0.9g,mono 3g,poly 6.2g)
Protein: 29.2g
Carbohydrate: 3.2g
Fiber: 0.8g
Cholesterol: 219mg
Iron: 3.8mg
Sodium: 400mg
Calcium: 87mg

Recipe courtesy of  www.myrecipes.com

Share


“Because You Can”

Thursday, September 23

“Because You Can”

A few of our successful patients will be talking about their weight loss experience and how their careers and lifestyles have greatly affected their everyday life. Come Join Us!

Please Contact Julian Reyes – 949.428.4118 to Sign Up

*Seating Limited*



Share