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Schmincke

Gastric Sleeve Patients
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Posts posted by Schmincke

  1. Posted

    I think milk is the least expensive Protein liquid. My NUT suggests making double protein milk by adding 1/4 cup powdered skim milk to a cup of skim milk. But if you are lactose intolerant, this would not be helpful.

    I have not discovered any truly unflavored protein powder but I am enjoying a wide variety of protein smoothie flavors using vanilla whey protein, no-sugar almond milk, and flavoring like powdered coffee, cinnamon, vanilla, 1/4 cup fruit, a piece of banana, vanilla or peppermint or run extract, sugar-free Syrup, etc.

    Some people (not me) like Unjury chicken broth which is protein enriched.

    Good luck!

  4. Posted

    Consider this abstract - malpractice lawsuits are more common with inexperienced surgeons:

    Surg Obes Relat Dis. 2014 Jan-Feb;10(1):121-4. doi: 10.1016/j.soard.2013.04.015. Epub 2013 Jun 11.
    Bariatric-related medical malpractice experience: survey results among ASMBS members.
    Abstract
    BACKGROUND:

    The medicolegal aspects of bariatric surgery are very difficult to analyze scientifically because there is no central, searchable database of closed case claims and little incentive for malpractice insurers to divulge data. Examining medicolegal data may provide insight into the financial and psychological burden on physicians. Detailed data also may be used to improve patient safety and determine common causes of negligence.

    METHODS:

    All U.S.-based members of the American Society of Metabolic and Bariatric Surgeons were asked to complete a survey regarding their bariatric-related medical malpractice experience.

    RESULTS:

    Of the 1672 eligible members that received the survey, 330 responded (19.7%). Mean years in practice was 15.3±9. Mean annual cost of malpractice insurance was $59,200±$52,000 (N = 197). The respondent surgeons experienced 1.5±3.2 lawsuits on average over the course of their practice. Of the 330 respondents, 144 (48%) did not report a bariatric-related lawsuit filed against them. Of the 464 lawsuits reported by 156 surgeons, 126 were settled out of court (27%), 249 were dropped (54%), and 54 (18%) went to trial. Seventy-two percent of cases that went to trial were found to be in favor of the defense. The mean lifetime amount paid for suits was $250,000±$660,000. The probability of a bariatric surgeonexperiencing a lawsuit was independently associated with the years in practice (P = .03) and number of total cases thesurgeon has performed (P = .01). The annual cost of malpractice insurance was independently predicted by the amount paid in previous claims (P = .01).

    CONCLUSIONS:

    The probability of a medical malpractice lawsuit correlates positively to the number of proceduresperformed and the number of years the surgeon has been in practice.

    ChristmasJanet and BellaHugz reacted to this

  7. Posted · Edited by Schmincke

    It may not be reassuring but here are two very recent abstracts on the topic, suggesting that worsening of reflux is very common unless there is hiatal hernia repair performed too. The first abstract simply reflects the experience at one newly-opened center so its results may have more complications than would be seen with very experienced surgeons, especially at a Bariatric Center of Excellence:

    BMC Surg. 2014 Feb 11;14(1):8. doi: 10.1186/1471-2482-14-8.

    Changes in obesity-related diseases and biochemical variables after laparoscopic sleeve gastrectomy: a two-year follow-up study.

    Abstract
    BACKGROUND:

    To evaluate changes in obesity-related diseases and micronutrients after laparoscopic sleeve gastrectomy (LSG).

    METHODS:

    We started the procedure in May 2007, and by December 2011, 117 patients could be evaluated for a two year follow-up. Comparisons of preoperative status with 12 and 24 months postoperative status were made for body mass index (BMI), obesity-related diseases and micronutrients.

    RESULTS:

    Major complications included bleeding requiring transfusion at 5.1%, leak at 1.7% and abscess without a visible leak at 0.9%. Mean BMI was reduced from 46.6 (standard deviation (SD) 6.0) kg/m2 to 30.6 (SD 5.6) kg/m2 at two years, and resolution occurred for 80.7% of patients with type 2 diabetes, 63.9% with hypertension, 75.8% with hyperlipidemia, 93.0% with sleep apnea, 31.4% with musculoskeletal pain, 85.4% with snoring and 73.3% with urinary incontinence. Amenorrhea resolved in all premenopausal females. The proportion of patients with symptomaticgastroesophageal reflux disease increased from 12.8% to 27.4%. The prevalence of patients with low ferritin-levels increased, while 25-hydroxyvitamin D (25(OH)D) deficiency decreased postoperatively.

    CONCLUSIONS:

    LSG is an effective procedure for morbid obesity and obesity-related diseases, but the technique should be further explored particularly to avoid gastroesophageal reflux. Free PMC Article

    Expert Rev Gastroenterol Hepatol. 2014 Mar 3. [Epub ahead of print]

    The effects of sleeve gastectomy on gastro-esophageal reflux and gastro-esophageal motility.

    Abstract

    Sleeve gastrectomy is an increasingly performed bariatric procedure associated with low morbidity and good short to medium term effects on weight loss and comorbid conditions. Studies assessing the prevalence of post-operative gastro-esophageal reflux disease (GERD), show sleevegastrectomy may provoke de novo GERD symptoms or worsening of pre-existing GERD. Pathophysiological mechanisms of GERD after sleevegastrectomy include a hypotensive lower esophageal sphincter, increased gastro-esophageal pressure gradient and intra-thoracic migration of the remnant stomach. A reduction in the compliance of the gastric remnant may provoke an increase in transient lower esophageal sphincter relaxations. Time-resolved MRI suggests relative gastric stasis in the proximal remnant and increased emptying from the antrum. A lack of standardisation of technique, along with heterogeneity of studies assessing GERD may explain the wide variability in reported results. Simultaneous and careful repair of an associated hiatus hernia may result in a reduction in the prevalence of post-operative GERD.

  16. Posted

    RJ, I thought I could never do those moves when I started. Within a couple weeks I could and they just got easier every time. I weighed about 220 at the time. I never, ever thought that exercising could be fun, but after a while it was - and I missed it if I could not! So hang in there, you can do it.

    RJ'S/beginning reacted to this

  18. Posted

    Motrin (ibuprofen) and all other NSAIDs as well as aspirin are discouraged if not prohibited by most bariatric surgeons after surgery (usually for life) except in very select circumstances. Tylenol (acetaminophen) is the OTC painkiller of choice after bariatric surgery. It is not as good an anti- inflammatory, but it does not mess with the stomach lining either.

  21. Posted

    I am down 19 pounds since surgery, 24 since pre-Surg diet. The past few days, I find that my appetite and stomach capacity have started to creep up. Foods that I could not eat post-op are starting to be okay. Yesterday I had a small nibble of my friend's b-day cake. I tracked it, sure, and was within my goals for the day but ... Feeling a bit more normal, whether that is a good thing or not. Very glad of Fitnesspal right now as it holds me accountable!

  22. Posted

    I am past pureed, on soft foods like fish and veggies and fruit. I rarely get past 600 calories a day. Don't worry too much about it.

    What you really need to watch is

    (1) did you get all your fluids today (60 oz+)?

    (2) did you get all your Protein today (60 gm +)?

    (3) did you stay away from junk today? (Eat Protein first, then veggies/fruit, then if there is any space left, carbos)

    If the answer to all three is Yes, then you should be on track, and losing weight. Maybe not weighing less every single day - and sometimes stalling for a while - but on the slow-and-steady path to a healthy weight.

  23. Posted

    Just ordering Protein Shakes now. My NUT gave me a huge list of them, but obviously not by taste. The highest in Protein are:

    Natures best Isopure zero carb

    Vitamin shop 100% soy protein

    Matrix

    Bariatric Advantage

    Unjury

    Any comments on which tastes best?

    :)

    I do not like the Unjury products. They have a great return policy, fortunately, because I bought a big shipment and am returning almost everything.

    I like Premier Protein shakes from costco or Sam's Club.

    I like Muscle milk powder.< /p>

    I like Target's house brand vanilla Protein Powder too.

  25. Posted

    The only sweeteners that I consider natural are the ones that are in their natural form in fruits and veggies. And they are probably the safest ones. They have also never caused me to do any compulsive eating. I did not get fat eating grapes.

    The artificial sweeteners that I am most afraid of are sugar and corn Syrup. Both are manufactured and both are demonstrated to be dangerous to someone like me. They got me into this position - them and other simple carbohydrates plus my own compulsions. So I try not to go near them. I don't trust myself around them.

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