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Uncategorized

Incisional Pain After Gastric Bypass Surgery

29/03/2022 by DrCurry Leave a Comment

pain

Pain after surgery is expected, particularly with the gastric bypass. This is a bigger, more involved surgery than the sleeve! Setting realistic expectations after surgery is important–you should expect to have some pain after surgery. 

 

We always inject local anesthetic in each incision, however the effect of this is only temporary. This can make it seem like your pain is getting worse, but it’s actually just the numbing medicine wearing off.  

 

Most of the discomfort in the gastric bypass there is one incision on the far left side of your abdomen.  This will commonly cause complaints such as: sharp or intense pain, dull cramping pain, burning, tugging, and pulling sensations. These are sometimes worsened by movements, or certain positions and the pain is not always felt directly underneath this incision.   These types of symptoms are normal and expected after bypass surgery. 

 

This incision is necessary in order to safely complete the surgery. Because of the size and depth of this incision, a suture is placed through the deep muscle layers to help prevent a hernia. This suture is almost always the cause of the symptoms described above. This pain will commonly last for 3-6 weeks and perhaps longer in some situations. 

 

We always do our best to minimize the discomfort associated with this incision, but we cannot completely eliminate this pain all together. Patients will be prescribed a narcotic pain medication, a muscle relaxer, and a pill which helps with neuropathic (nerve) pain. In addition to the medications, we recommend using ice packs over the incisions, 20 minutes on and 20 minutes off several times per day. This will help with the inflammation. After 2-3 days you may get better relief with a heating pad as the pain becomes more muscular in nature. 

 

This same far left incision can also be prone to infection, as at the end of the procedure we pull a little piece of small intestine out through it.  This can sometimes contain bacteria which can lead to infection, despite the fact that we place it in a sterile pouch before pulling it out.  Some of the first signs of infection are: fever, swelling at the incision site, redness around the incision, or drainage at the incision )particularly yellow thick foul smelling drainage).  Occasionally a clear or pale-red drainage will be present–this does not necessarily mean there is an infection. If you have concerns with your incisions, please contact us to have your incisions evaluated by our staff! 

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Filed Under: Education, Post op, Uncategorized

Spatz Balloon FDA Post-approval Study Eligibility

01/12/2021 by DrCurry Leave a Comment

spatz 3 adjustable gastric balloon

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):

  1. Age 22-65
  2. BMI 35-40, or BMI 30-34.9 with one or more major obesity-related conditions (diabetes, hypertension, sleep apnea, etc)
  3. Willing to comply with substantial lifelong dietary restrictions required by the procedure
  4. History of obesity (BMI 30+) for at least 2 years
  5. History of failure with non-surgical weight loss methods
  6. Willingness to follow protocol requirements, including signed informed consent, routine follow-up schedule, completing laboratory tests, and completing diet counseling
  7. Residing within a reasonable distance from the investigator’s office and able to travel to the investigator to complete all routine follow-up visits
  8. Ability to give informed consent
  9. Women of childbearing potential (i.e. not post-menopausal or surgically sterilized) must agree to use adequate birth control methods.  Acceptable methods are limited to hormonal contraceptives (oral, flexible vaginal ring, skin patch, injection), diaphragms, IUDs, condoms with or without spermicide, and voluntary abstinence.

Exclusion Criteria (if you have any of these things you cannot be in the study):

  1. Prior surgery involving the esophagus, stomach, and duodenum or hiatal hernia surgery
  2. Prior open or laparoscopic bariatric surgery
  3. Any inflammatory disease of the gastrointestinal tract including esophagitis, Barrett’s esophagus, gastric ulceration, duodenal ulceration, cancer, or specific inflammation such as Crohn’s disease
  4. A gastric mass
  5. A hiatal hernia >2cm or severe or intractable gastro-esophageal reflux symptoms
  6. Acid reflux symptoms to any degree that require more than one medication for symptom control
  7. A structural abnormality in the esophagus or pharynx such as a stricture or diverticulum that could impede passage of the balloon alongside the endoscope
  8. Achalasia or any other severe esophageal motility disorder that may pose a safety risk during the removal of the device
  9. Severe coagulopathy
  10. Insulin-dependent diabetes (either Type 1 or Type 2) or a significant likelihood of requiring insulin treatment in the following 12 months
  11. Subjects with any serious health condition unrelated to their weight that would increase the risk of endoscopy
  12. Chronic abdominal pain
  13. Motility disorders of the GI tract such as gross esophageal motility disorders, gastroparesis or intractable constipation
  14. Hepatic insufficiency or cirrhosis
  15. Serious or uncontrolled psychiatric illness or disorder that could compromise patient understanding of or compliance with follow up visits and removal of the device after 8 months
  16. Alcoholism or drug addiction
  17. Patients unwilling to participate in an established medically-supervised diet and behavior modification program, with routine medical follow-up
  18. Patients receiving daily prescribed treatment with aspirin, anti-inflammatory agents, anticoagulants or other gastric irritants
  19. Patients who are unable or unwilling to take prescribed proton pump inhibitor medication for the duration of the device implant
  20. Patients who are known to have, or suspected to have, an allergic reaction to materials contained in the system
  21. Patients who have BOTH:
    a. A previous history of a serotonin syndrome
    AND
    b. currently taking any drug known to affect the levels of serotonin in the body [e.g., selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs)]
  22. Patients who are pregnant or breast-feeding
  23. Subjects with Severe cardiopulmonary disease or other serious organic disease which might include known history of coronary artery disease, Myocardial infarction within the past 6 months, poorly controlled hypertension, required use of NSAIDs
  24. Subjects who have tested positive for H. Pylori, and who have not yet been treated

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.

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Filed Under: Uncategorized Tagged With: gastric balloon, spatz

Dr. James Augusta Joins JourneyLite!

17/03/2021 by DrCurry Leave a Comment

Dr. James Augusta
To schedule a consultation with Dr. Augusta, click here!

JourneyLite Physicians is pleased to announce that Dr. James Augusta is joining our team of experienced weight loss surgeons!

Dr. Augusta grew up in Utah and moved to the midwest to attend the Kentucky College of Osteopathic Medicine.  He then pursued a general surgery residency at Grandview Hospital in Dayton and was Chief Surgical Resident there.  During his residency, Dr. Augusta did a 6 week mini-fellowship with Dr. Curry and decided at that point he wanted to primarily focus on weight loss surgery.  “The quality of care, efficiency, and high degree of patient satisfaction at JourneyLite left a long-term impression on me that definitely influenced my career path” reports Dr. Augusta.

After completing his term as Chief Surgical Resident, Dr. Augusta joined Kettering Bariatrics, where he served as an attending surgeon for 3 years.

Dr. Augusta focuses his practice on gastric sleeve, gastric bypass, revisional weight loss surgery, and general surgery.  He is a member of The American Society of Metabolic and Bariatric Surgery, the American College of Surgeons, the American College of Osteopathic Surgeons, and the American Osteopathic Association.

Dr. Augusta is in-network with almost all payors and also accepts Medicare, Medicaid, and CareSource.

Filed Under: Uncategorized

Healthy Lifestyle Eating Plan

10/03/2021 by DrCurry Leave a Comment

The goal of this dietary program is to provide a structured program that will help maximize weight loss. This plan focuses on lean proteins and whole fruits and vegetables. Nutritional needs are different for men and women. 

Here are the daily guidelines:

  • 64 ounces of calorie-free fluid daily (minimum)
  • 5 servings of protein: (1 serving: 3-4 oz solid meats, 2 oz nuts/seeds, 8 oz low fat dairy, 1 oz low fat cheese)
  • 2 servings of fruits (1 serving: 1 small whole fruit, or ½ c canned) 
  • 5 servings of vegetables (1 serving:  ½ cup cooked, or 1 cup raw)

This sample menu provides an outline of how your meals will flow daily:

Guidelines Sample Menu
Breakfast 1 protein

1 fruit

1 – egg

1 – grapefruit

Mid-Morning Snack 1 vegetable

1 protein

2 – celery stalks

peanut butter

Lunch 1 protein 

2 vegetables

chicken breast, with green beans and a small salad, with 1 tsp of regular dressing
Afternoon Snack 1 protein

1 fruit

nuts

strawberries

Dinner 1 protein

2 vegetables

fish with cauliflower and a small salad, with 1 tsp of regular dressing.

 

**When using fats such as mayo, salad dressing, and butter you must account for those calories on your food journal.**

The following tables outline food choices that we want to increase in our diet.  Also included is a list of foods to use sparingly!

Protein Choices Ground meats (85% or less fat), pork loin, lean lunch meats, chicken/turkey breast, crab, shrimp, white fish, tuna, salmon, peanut butter, nuts (almonds, pistachios, peanuts, walnuts), cottage cheese, eggs, egg whites, cheese (mozzarella , colby, provolone, swiss cheese, feta cheese, goat cheese), soy protein (tofu soft or firm)

Eat in Moderation: breaded, fried/deep fried protein, bacon, beef (fatty cuts), ground beef (>15% fat), chicken (fried and/or with skin), chicken (buffalo wings), duck, fish sticks, hot dogs (all types), liver, liverwurst, pepperoni, salami, sausage, seafood (canned in oil), 

Fruit Choices FRUITS Count as 15 grams of carbohydrates and 60 calories (Portion sizes listed on next page)

Star fruit, cranberries, watermelon, strawberries, grapefruit, cantaloupe, papaya, peach, pear, plum, honeydew melon, blackberries, raspberries, apples, pineapple, oranges, blueberries.

Eat in Moderation:  Dates, Bananas, Passion Fruit, Pomegranate, Grapes, Figs, Sweet Cherries, Mango.

Vegetable Choices NON STARCHY VEGETABLES count as 5 grams of carbohydrate, 2 grams of protein, 0 grams of fat, and 25 calories

One vegetable exchange: ½ cup cooked or 1 cup raw

Sour pickles, watercress, dill pickles, cucumber, mustard greens, radishes, celery, zucchini, summer squash, lettuce, tomatoes, sauerkraut, swiss chard, bell peppers (all colors). Asparagus, mushrooms, spinach, eggplant, cauliflower, cabbage, arugula, green onions, jalapeños, collard greens, okra, spaghetti squash, green beans, turnip greens, broccoli, onions, carrots, snow peas (snap bean), brussel sprouts, kale, Chinese cabbage, bean sprouts.

Eat in Moderation:  Acorn squash, artichokes (Jerusalem), beans (other than green beans), butternut squash, corn, legumes, parsnips, peas, potatoes, sweet potatoes, and yams.

 

These choices can be taken in any amount since they do not contain sugar. Aim for 48-64 ounces daily.

  • Water, sugar free beverages such as Crystal Light, Wyler’s Light, sugar-free Kool Aid, sugar- free Tang, Diet Snapple, MIO,  Minute Maid Lite (all flavors), Fruit 2 0 or Propel Zero, Powerade Zero, coffee or tea with sugar substitute, broth/bouillon, strained broth soups.
  • Sugar free popsicle, sugar free gelatin, sugar free gum , sugar free mints

 

FRUITS Count as 15 grams of carbohydrates and 60 calories

 

Apple, small – 1 (4 oz)

Applesauce, unsweetened – ½ cup

Apples, dried – 4 rings

Apricots, dried – 8 halves

Apricots, fresh – 4 whole

Apricots, canned – ½ cup

Banana, small = 1 (4 oz)

Blueberries – ¾ cup

Cantaloupe – 1 cup

Cherries, fresh – 12

Grapefruit ¾ cup Grapes, small 17

Honeydew Melon – 1 cup

Kiwi – 1 

Mandarin oranges – ¾ cup

Mango – ½ cup

Nectarine – 1 (5 oz)

Orange, small – 1

Peach, medium – 1 (4 oz)

Peaches, canned – ½ cup

Pear, large fresh – ½

Pears, canned – ½ cup

Pineapple, fresh – ¾ cup

Pineapple, canned – ½ cup

Plum, small – 2

Raisins – 2 Tbsp

Raspberries – 1 cup

Strawberries – 1 ¼ cup

Whole Tangerine, small –  2

Watermelon – 1 ¼ cup cubes

  • Total calories for the meal plan ranges from 1000-1200 calories depending on food choices.
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Healthy Lifestyle Eating Plan

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Filed Under: Uncategorized

Why Weight Loss Surgery Can Be A Problem After Nissen Fundoplication

03/03/2021 by DrCurry 1 Comment

A hiatal hernia occurs when part of the stomach slides or herniates up above the diaphragm, so that it is in the chest instead of the abdomen where it belongs.  Sometimes these can be very minor and cause no symptoms at all.  Other times they can be significant in both size and symptoms, causing severe reflux (GERD) or heartburn symptoms.  The size of the hiatal hernia does not necessarily correlate with the severity of symptoms.

In most all cases, the GERD symptoms can be controlled with powerful acid-reducing agents called proton pump inhibitors, or PPI’s. These commonly used medications include Prilosec, Nexium, Protonix, and Prevacid among others.

In cases where GERD is still severe even after treatment with high doses of these medications, an operation called a Nissen fundoplication is sometimes performed.  The procedure is named after a German surgeon, Dr. Rudolf Nissen, who first performed the operation in 1936.  In times past it was done with a large abdominal or chest incision, but for the last 20 years or so has mostly been done with a laparoscopic (minimally invasive) technique.

A Nissen fundoplication involves stitching closed the hernia in the diaphragmatic hiatus, and then wrapping the stomach around the junction between the esophagus and stomach, as depicted below.  This augments the natural sphincter muscle in that area, which in many cases is not working properly. There are also variants of the Nissen fundoplication such as the Toupet fundoplication, which is a partial wrap.

A Nissen fundoplication involves "wrapping" the stomach

As one could imagine, weight loss surgery would be difficult after this operation, as surgeons need to work on the very area that has been already surgically altered.  When a gastric sleeve or bypass is attempted, the entire fundoplication must be taken down and normal anatomy restored.  This is difficult and carries significant risk of tearing or making a hole in the stomach, among other complications.  If this happens and is unrecognized, it can have serious consequences even including death.

Although we at JourneyLite Physicians have performed this complex operation in the past, we are no longer offering weight loss surgery to patients who have had prior fundoplications due to the significantly increased risk.  While it is technically possible in select patients, it is best performed in an academic, tertiary care setting such as The Cleveland Clinic or Ohio State University.

Filed Under: Uncategorized

PCP Bariatric Surgery Insurance Clearance

25/02/2021 by DrCurry Leave a Comment

Primary Care PhysicianSome policies require a clearance from your PCP (primary care provider) for bariatric surgery before they will approve your procedure.  This means you will need a “History and Physical” from your PCP that also indicates you are medically cleared and are a good candidate to undergo weight loss surgery.

We cannot schedule surgery until a prior authorization approval is received, and we cannot obtain a prior authorization approval until ALL precertification criteria are completed and obtained. This means that if your carrier requires this, you will need to contact your PCP to schedule this appointment BEFORE we can even submit your authorization request for surgery and get us a copy of the documentation of the visit.  This can be faxed to (513) 559-1235.

If we notify you that your policy requires this clearance, below is a list of carrier-specific requirements.  If your carrier is not listed, you should just need a History and Physical with clearance.

Please Note: This is NOT the same as medical pre-operative clearance that may be requested within 30 days of surgery.  We will let you know if and when it is time to schedule the second clearance visit with your PCP, if required.  

Aetna:

  • A History and Physical with clearance is required from your PCP.  This must include a normal EKG and A1c within 3 months of submission. 

Anthem: 

A History and Physical with clearance is required from your PCP. This must specifically state that you are cleared for surgery. 

Medical Mutual:

  • A History and Physical with clearance is required  from from your PCP. This must include:
    • a normal EKG within 3 months of submission
    • a normal hemoglobin A1C within 3 months of submission

In addition, if a comorbid condition is present, specialty clearance is required. For example, if you have a diagnosis of sleep apnea, you will have to get pulmonology (sleep doctor) clearance. 

Filed Under: Uncategorized

Constipation After Weight Loss Surgery/Medical Weight Loss

24/06/2020 by DrCurry Leave a Comment

constipation emojiConstipation is a frequent issue for our patients, either after a surgical weight loss procedure or even just while on one of our appetite suppression programs.

For starter we recommend using Benefiber.  Most pharmacies also sell their own generic brand.  Benefiber is a mostly tasteless, odorless powder that you can mix in with any liquid.   The recommended dose is 1-2 teaspoons, up to 3 times daily.

Our recommendation is to start at the maximum dose of 2 teaspoons three times daily and back off from there to achieve the desired result.

It’s beneficial to stay on a fiber supplement long term, as high fiber diets are associated with less hunger, better weight loss, and lower rates of colon cancer and heart disease.

If Benefiber does not work after a couple of days, Miralax would be the next best option. It works by bringing water from cells into the bowels.  The recommended dose is 17 grams (marked on the cap) dissolved in 4-8 ounces of any clear liquid, once a day.

If you have to step it up to Miralax, stay on it until the desired result is achieved and then switch back to the maximum dose of Benefiber.

It’s important to note that you must follow either of these products with plenty of fluids, or neither will work well.  If you still don’t have success after following these guidelines then please contact the office.

Filed Under: Uncategorized Tagged With: constipation

Ft. Mitchell Drug Shoppe

23/06/2020 by DrCurry Leave a Comment

Many patients who are seeing us in our Northern Kentucky office prefer to use the Fort Mitchell Drug Shoppe for their prescriptions.  We recommend the Fort Mitchell Drug Shoppe, located just a few miles away.  This is a family-owned business that has been around for decades and provides a great level of service to our patients.

Filed Under: Uncategorized

Dayton Thru 6/30/2020: Tuesdays & Thursdays Virtual, Fridays Live!

10/06/2020 by DrCurry 4 Comments

Attention JourneyLite Dayton patients: Through the end of June (2020) all patients scheduled with our nurse practitioner Dana will be virtual appointments through our HealthTrac app. These include any appointments scheduled on Tuesdays or Thursdays. All Friday appointments with the physicians will be live, in-person appointments at the Dryden Road location. Please bring a mask if you have one! Thank you.

Filed Under: Uncategorized

Qsymia Mail Order Program

12/05/2020 by DrCurry 2 Comments

Qsymia is a new weight loss medication that is composed of phentermine and topiramate.  Being new, it is not yet available in a generic form. Therefore it is more expensive, and the pricing can vary greatly from pharmacy to pharmacy.  Fortunately the manufacturer of Qsymia has partnered with Medvantx mail order pharmacy to provide a more affordable alternative.

If one of our providers sent a script to Medvantx, you must go to QsymiaEngage.com and register online so that Medvantx will be able to connect your info to the prescription we sent.  You will then receive two prescriptions in the mail: a 14 day trial of the 3.75mg dose, and 30 days of the 7.5mg dose.

Start with the trial and simply take 1 tablet every morning when you first wake up.  After the trial, if you haven’t had any adverse side effects, transition over to the 7.5mg dose.

Your next appointment with our office should be around 6 weeks from when you started Qsymia, since you received two prescriptions, but after that they will need to be every 4 weeks.

After you have completed 3 months of  7.5mg you may be elligible to increase your dose under certain conditions.

Filed Under: Uncategorized

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