Interesting Article - Cross Post
received my new OH magazine today and there was an interesting article about Revision surgery by Dr Halmi. It appears he does all of the procedures including DS and revisions.
He says that most commonly the reason for WLS surgery failure is patient eating behavior, when mechanical reasons for failure have been ruled out,
He goes on to say that no matter how drastic the surgery it will not work without patient cooperation and that if the first surgery failed because the patient could not make the needed changes the 2d surgery would not do it either.
He does talk about how malabsorbtive procedures can benefit some folks that had a restrictive only procedure the first time but that these patients should be carefully selected and that their success will require extremely strong behavior modification.
He kind of wraps things up by saying being proactive is the best path to success and that this involves changing your eating behavior, following your MD's instructions about eating, nutrition and excerise and being honest with the surgeon about your habits so as a team the decision can be made about the best procedure for each person. He also talks about being aware of the success and failure stats of each surgery and the info about why those procedures may have failed.
He says that most commonly the reason for WLS surgery failure is patient eating behavior, when mechanical reasons for failure have been ruled out,
He goes on to say that no matter how drastic the surgery it will not work without patient cooperation and that if the first surgery failed because the patient could not make the needed changes the 2d surgery would not do it either.
He does talk about how malabsorbtive procedures can benefit some folks that had a restrictive only procedure the first time but that these patients should be carefully selected and that their success will require extremely strong behavior modification.
He kind of wraps things up by saying being proactive is the best path to success and that this involves changing your eating behavior, following your MD's instructions about eating, nutrition and excerise and being honest with the surgeon about your habits so as a team the decision can be made about the best procedure for each person. He also talks about being aware of the success and failure stats of each surgery and the info about why those procedures may have failed.
Whatever you do is it truthful, necessary and kind?
Again, it all falls on the patient. When I had surgery, if you went to nutrition classes, if they even had them, it was fine and if you didn't it was fine. I lived 75 miles from where I had surgery and their were no nutrionist dealing with bypass patients at that time. For many people the only insturction they received was a book stuck in their had, and a thank you very much.
Granted, part of the problem may be behavioral, if that is the case, they why not schedule the classes before surgery so a person can have an excellent understanding of what is expected of them andthis will let them know IF they really want to go through the procedure. In 2000, the process was totaly different. You were told to eat 6 to 8 small meals a day, you were informed to take 2 multivitamins per day and not to drink through a straw. If that is teaching, I think a 5 year old can do that. I believe the some doctors really feel their procedure is excellent, but what will they say when the stoma grows (expands). From what I have read this is the main reason for most of the weight that is regained. Another thing of interest
How will they explain some of the things that patients really go through. Yes, some just don't want to change their eating habits and some believe it is a magic bullet, but before everyone is put in the same bucket, and before they get paid the 20 or $30,000 the surgery cost, and the patient feels like and is often looked at as a failure, why not be cost effective and proactive? Why didn't they have you take the nutrition classes before they scheduled the surgery. Often I think that even though they are surgeons, many don't have a concept of what an overweight individual goes through. I think it should be a requirement before any doctor becomes board certified in Baratric Surgery, they must wear a fat suit every night and day for 3 months.
I think that would help them not only understand the medical side, but the physical and mental side as well. It would really help them understand All of the WHAT IF's a person deals with along with the looks of disgust that are often given to overweight individuals. What if I start loosing weight, will they say I can't have surgery, what if I start loosing weight, will I be able to do this on my own? What if I start loosing weight, will they say I was/am being lazy because I still want surgery? What if, what if, what if.
Granted, part of the problem may be behavioral, if that is the case, they why not schedule the classes before surgery so a person can have an excellent understanding of what is expected of them andthis will let them know IF they really want to go through the procedure. In 2000, the process was totaly different. You were told to eat 6 to 8 small meals a day, you were informed to take 2 multivitamins per day and not to drink through a straw. If that is teaching, I think a 5 year old can do that. I believe the some doctors really feel their procedure is excellent, but what will they say when the stoma grows (expands). From what I have read this is the main reason for most of the weight that is regained. Another thing of interest
How will they explain some of the things that patients really go through. Yes, some just don't want to change their eating habits and some believe it is a magic bullet, but before everyone is put in the same bucket, and before they get paid the 20 or $30,000 the surgery cost, and the patient feels like and is often looked at as a failure, why not be cost effective and proactive? Why didn't they have you take the nutrition classes before they scheduled the surgery. Often I think that even though they are surgeons, many don't have a concept of what an overweight individual goes through. I think it should be a requirement before any doctor becomes board certified in Baratric Surgery, they must wear a fat suit every night and day for 3 months.
I think that would help them not only understand the medical side, but the physical and mental side as well. It would really help them understand All of the WHAT IF's a person deals with along with the looks of disgust that are often given to overweight individuals. What if I start loosing weight, will they say I can't have surgery, what if I start loosing weight, will I be able to do this on my own? What if I start loosing weight, will they say I was/am being lazy because I still want surgery? What if, what if, what if.
Margiev
While I was researching my surgery both in 2008 and when I was considering lapband in 2005 all of the AZ programs I looked at REQUIRED pre-op nutrition and exercise info classes. From the support groups I attended with bariatric programs at the local hospitals this is also required. Most of the programs locally have on-goiong facilitated support groups that include both pre-op and post-op patients who have had or were going to have WLS procedures.
I agree that surgeons can be insensitive and clueless about many things not directly related to their surgical skills. I agree that sometimes nutritionists are not up to date with the needs of the various procedures.
That having been said, at least, in my experience in the lcoal area the type for pre-op classes you are referring to ARE mandatory. I have no idea what is done in other parts of the country.
I had my procedure in MX and when I spoke to the surgeon prior to me even sending in a deposit he went over, in detail, what I would need to do post op, and pre op re my eating, vitamins etc. I was also sent home with a fairly easy to follow progressive food plan taking me from liquids, to full liquids to mushies etc.
I understand that WLS procedures and programs have evolved over the years and there certainly is a lot more info out there now then there was in 05 when I was looking at lapband.
I understand that with the RNY procedure there is an issue of the stoma expanding but bear in mind not all WLS procedures have a stoma.
I agree that surgeons can be insensitive and clueless about many things not directly related to their surgical skills. I agree that sometimes nutritionists are not up to date with the needs of the various procedures.
That having been said, at least, in my experience in the lcoal area the type for pre-op classes you are referring to ARE mandatory. I have no idea what is done in other parts of the country.
I had my procedure in MX and when I spoke to the surgeon prior to me even sending in a deposit he went over, in detail, what I would need to do post op, and pre op re my eating, vitamins etc. I was also sent home with a fairly easy to follow progressive food plan taking me from liquids, to full liquids to mushies etc.
I understand that WLS procedures and programs have evolved over the years and there certainly is a lot more info out there now then there was in 05 when I was looking at lapband.
I understand that with the RNY procedure there is an issue of the stoma expanding but bear in mind not all WLS procedures have a stoma.
Whatever you do is it truthful, necessary and kind?
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