JourneyLite Physicians-Weight Loss, Plastics, and Spine Experts!
Your team for all your weight loss, body contouring, and spine surgery needs! Gastric sleeve, gastric bypass, gastric balloon, appetite suppressants and more!
Among the variables measured during sleep testing, the AHI (apnea-hypopnea index) is one of the most important. The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (episodes of shallow breathing) that occur each hour, on average.
In patients with an AHI below 10, the test is considered negative (or normal) and no further treatment or follow-up is required.
For any questions please call or text our office at 513-540-1207.
Among the variables measured during sleep testing, the AHI (apnea-hypopnea index) is one of the most important. The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (episodes of shallow breathing) that occur each hour, on average.
In moderate or severe sleep apnea, the AHI is 15 or higher. These patients will need to be treated with CPAP or some other type of device prior to surgery.
Our practice works with Cornerstone Medical to provide CPAP devices to patients with moderate-to-severe sleep apnea and help them get it set up. They will contact the patient directly to make this arrangement.
If an order was sent to Cornerstone on your behalf and they do not contact you within the next 48 hours, please contact them at 888-594-0066.
Patients who are diagnosed with moderate-to-severe sleep apnea must use their CPAP devices as prescribed in order to proceed with surgery, otherwise anesthesiology will cancel the procedure!
The Spatz gastric balloon has recently been approved by the FDA in the US, and over 100,000 have been implanted outside the US over the last decade. When the FDA approves a medical device, the manufacturer of the device must do a “Post Approval Study” (commonly abbreviated as “PAS”) on their device and submit data on actual patients in whom the device was implanted.
JourneyLite has participated in post approval studies on all gastric balloon systems that have come to market in the US, and we are proud to have been selected to participate in the Spatz PAS.
There are always specific criteria for patient inclusion and exclusion, and in order to be considered for participation in the Spatz PAS a patient must meet the following guidelines:
Inclusion Criteria (you must meet all of these conditions to be considered for the study):
Exclusion Criteria (if you have any of these things you cannot be in the study):
Patients who participate in this trial will need to have some pre-procedure testing done. Click here for more info.
If you are interested in the Spatz gastric balloon PAS and you meet the above criteria, the next step in the process would be to schedule a consultation with one of our physicians to discuss the procedure and the study in more detail.
The Spatz 3 adjustable gastric balloon was approved by the FDA in the United States in 2021. It is indicated for patients with a body mass index (BMI) of 35-40, or a BMI of 30-35 with an obesity related medical issue. Spatz 3 has been available outside the US for some time, and over 100,000 have been implanted.
What makes the Spatz unique is that it is the only adjustable balloon system. This is important for several reasons:
An additional benefit of the Spatz is that it can be left in the stomach for 8 months, as opposed to a maximum of 6 months for other saline gastric balloons that have been approved in the US.
These advantages have resulted in significantly better weight loss and long-term success for the Spatz balloon in their FDA trial than for any other gastric balloon, whether saline or gas-filled.
As can be seen in the above table comparing all gastric balloons with which we have experience, the Spatz has not only the best weight loss, but also the highest success rate.
Currently, only patients who are able to participate in the Spatz FDA Post-approval Study can have one of these balloons implanted. Click here if you’re interested to find out if you may be eligible!
A frequent question we get from surgical patients is “Will I lose a lot of hair?” This is a common concern, as some patients have heard isolated reports that they will experience hair loss after bariatric surgery. Although it can occur after surgery, maximizing your protein intake and taking the appropriate supplements can minimize this issue.
When hair loss does occur after weight loss surgery, it is typically a result of the body experiencing some degree of malnutrition as well as a stress reaction. Rapid weight loss plus major surgery both put stress on the body, and obviously bariatric procedures limit food intake by design and if the patient isn’t eating right, mild malnutrition can occur.
Protein intake is our primary focus after surgery for many reasons. One such reason is that adequate intake of protein is the best way to avoid significant post-op hair loss. Vitamin supplementation is important as well, to ensure proper nutrition to support all of the body’s functions, including hair health.
Biotin supplementation stimulates the regrowth of hair in some individuals. However, biotin will not prevent the actual loss so patients will still experience hair falling out without overall adequate nutrition.
Keeping all of your follow up appointments is key to maintaining good health and minimizing issues such as hair loss. Our providers and Registered Dietitians will monitor nutritional intake as well as lab values. Our team uses that information to help us to tailor a supplementation regimen appropriate for each patient!
Plenity is a new weight loss treatment that expands after hydration to help patients feel full on smaller amounts of food. For more information on Plenity click here. Plenity has currently not been studied in surgical weight loss patients, however our practice has some experience with this and when closely supervised it can be done safely and effectively.
For patients with a normal stomach it is recommended to take 3 Plenity capsules, 20-30 minutes prior to lunch and dinner. For surgical weight loss patients however, it is very important if you are going to take Plenity to do it only under the supervision of your surgical weight loss team and to follow the dosing regimen outlined below.
For any patient who has had a gastric bypass, gastric band, gastric sleeve, SIPS, or gastric balloon, Plenity must be titrated. This means that you do not start off with the full 3 capsules. Rather, begin by just taking 1 capsule with 16 oz of a non-carbonated clear liquid 20-30 minutes prior to lunch or dinner. See how you feel with just 1 tablet. If you feel full on smaller portions, and have no symptoms of pain, bloating, or vomiting, then this will be your ongoing dosage moving forward.
If you feel minimal effect, as long as you have have no pain, bloating, or vomiting, then for your next meal you can try 2 tablets. Again, if you feel full on smaller portions and have no adverse symptoms, then this will be your ongoing dosage.
As before, if you feel minimal effect and have no adverse symptoms, you can try 3 capsules for your next meal.
Do not take more than 3 capsules at one dosing!
With weight loss surgery it is important to follow the recommendations of your team and get your labs drawn promptly when ordered! If you are receiving this message, we have not yet received your lab results. If you have not gotten them drawn please do so as soon as possible! If you had them drawn, we have not received the results, so it would be helpful if you could contact the lab and ask them to fax them to us at 513-559-1235.
If you have any questions, please email our medical assistants at ma@curryweightloss.com, or call our office at 513-559-1222.
Sincerely,
JourneyLite Physicians
Among the variables measured during sleep testing, the AHI (apnea-hypopnea index) is one of the most important. The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (episodes of shallow breathing) that occur each hour, on average.
In moderate or severe sleep apnea, the AHI is 15 or higher. These patients will need to be treated with CPAP or some other type of device prior to surgery. Patients who have an AHI of 10-15 have mild sleep apnea. Treatment in this range is based on the severity of symptoms. Weight loss is proven as an effective treatment for mild sleep apnea, therefore it is our protocol to not recommend a sleep appliance for patients with an AHI of 10-15 who are preparing to undergo weight loss surgery. If symptoms persist after losing weight, then a referral to a sleep specialist may be recommended.
If you are diagnosed with mild sleep apnea and end up not proceeding with a weight loss procedure, we recommend that you follow up with your primary care provider for further recommendations.
Plenity is a new therapy that works like no other FDA-approved weight loss treatment, and is approved for use in patients with a body mass index of 25-40 kg/m 2. It consists of 2 simple natural ingredients: cellulose fiber and citric acid contained and dehydrated in a gelatin capsule. After swallowing 3 capsules (around 20 minutes prior to lunch and dinner) and drinking 16 ounces of water, Plenity re-hydrates itself, absorbing more than 100 times its own weight in water. After this absorption occurs, Plenity expands in the stomach to take up space (see animation below). The presence of expanded, re-hydrated cellulose in the stomach can reduce hunger and help patients get full earlier. As it is not absorbed into the body at all, Plenity has actually been classified as as weight loss device, rather than a drug. Plenity is the first weight loss treatment to be approved by the FDA for patients who are just mildly overweight, with a BMI of 25-27 kg/m2.
In a clinical study, nearly 6 out of 10 people who took Plenity lost at least 5% of their body weight. Their average weight loss was 10% of their total body weight (about 22 pounds). Patients in our Plenity program must come in for monthly office visits and meet with one of our providers and a registered dietitian, as well as following a mindful eating plan and exercising regularly.
One major issue with many weight loss drugs is that they have a significant rate of adverse systemic side effects such as elevation in blood pressure or heart rate, nausea, overstimulation, etc. A significant advantage of Plenity is that it does not have any major systemic side effects, since it is not absorbed at all into your body at all.
Plenity must be prescribed by a physician, nurse practitioner, or physician’s assistant and can be obtained from their partner pharmacy, GoGoMeds. In order to receive Plenity, your provider must send a prescription to GogoMeds, and the patient must log on to GoGoMeds.com and register as a patient. After registering, you will have to add your prescriber in your account. After payment, GoGoMeds will ship your medication to your home address. The current 2021 pricing including shipping for a 30 day supply of Plenity from GoGoMeds is $98.
It remains to be seen if this medication can be used in patients who have had prior surgical weight loss procedures and at this point we would recommend against it, unless under the close supervision of a bariatric surgeon.
By Dr. James Augusta
Gastroesophageal reflux disease (or GERD for short) is a common condition affecting overweight and obese patients. It is caused by irritation to the lining of the esophagus by gastric acid or bile. Many people have felt heartburn before, but GERD is a little different.
Symptoms can include:
These symptoms may be worsened by certain types of food, alcohol, smoking, or even bending over or lying flat particularly after eating a meal. Many factors are involved with severity of GERD including weight, and the presence of a hiatal hernia. A hiatal hernia is located where the esophagus crosses the diaphragm to enter the abdomen. When this opening becomes enlarged it distorts the normal anatomy and can lead to increased reflux symptoms. It can even cause some of the stomach to pull up into the chest.
In general, If hiatal hernias are moderate or large we will repair them during your weight loss surgery. If they are small sometimes they are best left alone as making the hiatus too tight can cause issues with swallowing meats and other hard foods.
The two most common options at JourneyLite for weight loss surgery include the gastric sleeve and the Roux-en-Y gastric bypass.
In our experience following a gastric sleeve procedure:
In contrast, the gastric bypass is actually an increasingly-common surgical treatment for severe GERD. This is because we divert 80-90% of the acid production away from the esophagus with the creation of a small gastric pouch at the top of the stomach. If you do happen to develop severe GERD symptoms after a sleeve gastrectomy (and we are unable to control it with medications), we can convert this to a gastric bypass. In almost all cases this will resolve GERD symptoms, however this would require another surgical procedure and workup (including insurance approval if applicable).
Another condition known as bile reflux can also cause GERD after a gastric sleeve. This is a condition where bile (produced by the liver) comes backwards into the stomach and potentially up the esophagus causing reflux symptoms. Most patients with pre-existing bile reflux will have worsening symptoms after a sleeve. The gastric bypass is also a surgical cure for bile reflux.
For patients with GERD symptoms an EGD (esophagogastroduodenoscopy-an endoscopic camera down the esophagus and stomach) can help you and your surgeon confirm which procedure is best for you. During your consultation, discuss your symptoms and your surgeon can decide if an EGD is warranted. Additionally, if you have already had an EGD done you can request the records be sent to our office for your surgeon to review.
In summary, when considering which procedure is best for you, having a discussion with your surgeon about GERD symptoms is crucial to making the right choice. An EGD can be a good starting point for the surgeon to give recommendations about procedure selection. If you’ve had an EGD done before, you can request the records to be faxed to our office at 513-559-1235. This may save you time and help get your procedure completed sooner. Sometimes it simply comes down to a tradeoff between a gastric bypass with a lower risk of post-op GERD, or gastric sleeve with a higher risk of GERD but a much lower overall long-term risk.