6 frequently asked questions about bariatric surgery

Medical Intel Podcast: Dr. Timothy Shope Discusses Bariatric Surgery Methods

Bariatric surgery has been available in the U.S. for more than 50 years, and surgeons are doing more every year. In fact, our team performed 336 of these procedures in 2016, compared with 257 in 2013.

Still, bariatric surgery is still not well understood, and many people have questions about it.

I’ve heard many. Two of the most frequent ones I get are, “Is bariatric surgery safe?” and “Will I be left with a lot of flabby skin?”

Bariatric surgery, such as gastric bypass or sleeve gastrectomy, can be a lifesaver for people struggling with obesity and its side effects. So let’s get to the truth of some of the most common questions.

Is bariatric surgery dangerous?

Patients often tell me that friends and family worry they will die during bariatric surgery and try to discourage them from getting a procedure. I suspect this fear is a holdover from when the surgery was new.

As with any surgical procedure, the risks from bariatric surgery were much greater when it was first developed. But with the advent of minimally invasive techniques, such as laparoscopic and robotic surgery, which come with fewer complications, the procedures’ safety has dramatically improved.

In fact, the latest data show that bariatric surgery is safer than having your gallbladder removed. The mortality rate for bariatric surgery is 0.25 percent compared with 0.7 percent for gallbladder removal.

And don’t forget that obesity also is dangerous, increasing the risk of life-threatening conditions, such as diabetes and hypertension, and even decreasing lifespan.

"The latest data shows that bariatric surgery is safer than having your gallbladder removed."

Will I be left with a lot of excess skin after bariatric surgery?

This is a complex issue and it’s specific to every individual. The bigger you are and the more weight you lose, the more excess skin you’ll have. But most patients find they have less excess skin than they expected.

The best advice I can give to avoid excess skin is to maintain and increase muscle mass, giving the skin lean tissue to contract over. I’m not saying you need to become a body builder or look like a star athlete. But developing a fitness routine that promotes healthy muscle tone will help reduce excess skin.

If you do have sagging skin that bothers you, you can explore body contouring, which is an umbrella term for procedures, such as tummy tucks and lifts to the upper arms, midsection, back, thighs, buttocks and hips.

Will I just regain  the weight after weight loss surgery? 

Everyone seems to knows someone who had bariatric surgery and gained all the weight back. But in reality, that’s pretty rare. A 2016 study found that only 3 percent of study participants who had gastric bypass regained most or all of the weight they lost after 10 years.

Weight loss after bariatric surgery occurs on a curve. Weight drops rapidly right after surgery and continues for 18 months to two years. A little weight gain is expected after that, but then it should plateau. This is normal, and we’re talking about a few pounds, not a massive amount of weight (usually about 5 percent).

When a patient does regain a considerable amount of weight, we first try to determine whether there was a problem with the surgery. For example, in gastric bypass, the surgeon reduces the size of the stomach and reconnects the small intestine to the new stomach, bypassing the original stomach and several feet of the small intestine. One rare complication of this surgery is gastrogastric fistula, in which food goes into the old stomach instead of the new stomach pouch, causing weight gain.

Most weight gain can be traced back to dietary habits. People don’t come back for after-care appointments or follow diet recommendations, or they simply fall back into old habits. And while someone might go through all the pre-surgery education, their psychological relationship with food may not change post-surgery.

Regaining all the weight can happen, but it’s rare. We’ll work with you and a dietitian to help you get back on track before you regain too much of the weight you worked so hard to lose.

Is having weight loss surgery the easy way out?

I’m amazed that in this day and age some people still think of surgery as the easy way out. There is nothing easy about bariatric surgery. People who have these procedures prepare for six months on average and then must change their lifestyle and diet after surgery. It’s a lot of work.

Attend our free information sessions to see if bariatric surgery is right for you.

The National Institutes of Health recognizes bariatric surgery as the only effective way to treat severe obesity and maintain long-term weight loss.

Losing weight through diet and exercise can be extremely difficult. Many people experience the yo-yo effect, in which they lose and gain weight multiple times. This can wreak havoc with a person’s metabolism, making losing weight even more difficult. In fact, less than 5 percent of people who lose weight by diet and exercise are able to maintain long-term weight loss.

And weight loss medications come with their own problems. Along with potential side effects, they only work as long as you take them. There’s no long-term weight loss effect.

Will I develop a vitamin deficiency after weight loss surgery?  

Vitamin deficiencies are a real concern after bariatric surgery. Your body will not be able to absorb them, as well as it used to. However, taking a daily multivitamin and following your dietary recommendations should ward off potential problems.

Severe vitamin deficiencies don’t develop overnight, and we have processes in place to catch them early. We check your vitamin levels six months after surgery, at a year, then yearly after that. If your levels are low, we’ll work on it before it becomes a problem.

Will I still be able to eat dessert or drink alcohol after bariatric surgery?  

Yes. Because your body will process and absorb foods differently after surgery, we recommend that you not eat foods high in sugar and fat immediately after surgery or drink alcohol for two years. But after a while, you can have a piece of cake at a wedding or a glass of wine for your anniversary. You’ll need to eat and drink these items in moderation, but you can have them for special occasions. This is also a good guideline for people who just want to live a healthier lifestyle.

If you have heard something fishy about bariatric surgery, don’t hesitate to ask your doctor. We’ve heard it all, and we won’t think your question is silly. If you’re considering bariatric surgery, it’s your right—and our job—to make sure you understand the ins and outs before you commit to preparing for and maintaining a healthier weight.

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2 reasons we’re seeing more high-risk pregnancies in D.C.

We care for about 3,500 pregnant women every year. While that number has remained fairly steady over the past decade, the number of those women with high-risk pregnancies increases every year.  

Because “high-risk pregnancy” is a catch-all term that includes factors such as age and chronic health problems, it can be difficult to determine exactly how many of these women there are. But my colleagues and I can tell you that we’re treating more women who fall into this category than ever before.  

The most severe pregnancy complications – such as eclampsia, heart failure and hemorrhage – are referred to as severe maternal morbidity. The Centers for Disease Control and Prevention reports that the severe maternal morbidity rate has more than doubled from 2000 to 2010, and now affects 650,000 women in the United States every year.  

Many factors contribute to this increase, but the two we see most often in the District of Columbia are obesity and advanced maternal age. 

1. How obesity can complicate pregnancy  

Nearly one in four U.S. women was considered obese when they became pregnant in 2014. While the rate of pre-pregnancy obesity in D.C. was lower than the national average at about one in five women, we still feel the effects of this epidemic.

 Obesity is defined as having a body mass index greater than 29.9, and it can increase the risk of problems during pregnancy, including:

  • Birth defects
  • Gestational diabetes
  • Preeclampsia
  • Preterm birth or stillbirth  

Excess body fat also can make it difficult to analyze an ultrasound and monitor fetal heart rate.  

Obesity also increase a person’s risk for health problems such as diabetes, high blood pressure and heart conditions. Our patients are not nearly as healthy going into pregnancy as they once were. I commonly find myself caring for patients with a condition that requires me to collaborate with a specialist such as a cardiologist.  

The number one thing you can do to decrease the risk of obesity-related pregnancy complications is to lose weight before you become pregnant. Talk with your doctor about lifestyle changes you can make to reach a healthier weight.  

Also, talk to your Ob/Gyn or a maternal-fetal medicine specialist before you become pregnant about what to expect if you have a heart condition or another chronic health problem such as obesity. 

2. More D.C. women delaying pregnancy until 35 or older

Not even 15 years ago, I would have exclaimed, “Whoa! You have a 45-year-old patient who’s pregnant?” These days, we don’t blink an eye at a pregnant woman in her 40s.  

The District of Columbia is somewhat unique in that we have more professional women who delay having children until they are older.  

  • The birth rate for D.C. women age 35 to 39 was 72.7 births per 1,000 women in 2015, compared with 51.8 nationwide.
  • The birth rate for D.C. women age 40-44 was 21.8 births per 1,000 women in 2015, compared with 11 nationwide.
  • The birth rate for D.C. women age 45-49 was 2.5 births per 1,000 women in 2015, compared with 0.8 nationwide.  

It’s wonderful to have the option to wait to have children until you’re in your late 30s and early 40s. However, it does increase certain risks for mom and baby, including:

  • Birth defects
  • Gestational diabetes
  • High blood pressure  
  • Miscarriage
  • Premature birth  

We may recommend additional testing and screening if you are 35 and older to detect certain birth defects. The best thing you can do if you’re 35 or older and want to get pregnant is to talk with your Ob/Gyn about your specific risk factors and how to go into pregnancy as healthy as possible. 

Reduce and manage pregnancy risks

Obesity and advanced maternal age are just two factors for the increase in high-risk pregnancies. Thanks to advances in science, we’re also caring for more women who are having multiples (twins or more), have had organ transplants or are cancer survivors. We also see a number of pregnant women who have HIV.  

With proper preparation, we’re better able to manage the increased risks of these health factors. Request an appointment with an Ob/Gyn or maternal-fetal medicine specialist to discuss your unique challenges. The doctor can help you prepare for pregnancy and manage your and your baby’s health during pregnancy, labor and delivery.  

Don’t be afraid to ask your doctor questions. These can include:

  • How can I get healthier before I become pregnant?
  • What type of prenatal testing will be done?
  • Should I stop or adjust my medications?
  • Will I need extra ultrasounds to monitor my baby’s health?
  • Will I need additional prenatal appointments?  

We may care for high-risk pregnancies more often, but each pregnancy is different and comes with its own challenges. We want the same thing for every woman: to go home with a healthy baby.  

Walk away from colorectal cancer: Exercise can lower risk

In January 2017, researchers reported that exercise is associated with a lower risk of death from metastatic colorectal cancer. Metastatic colorectal cancer is cancer of the colon or rectum that has spread to other areas of the body. This study found people who were physically active for four or more hours per week reduced their risk by 20 percent. People who exercised for at least five hours per week lowered their risk by 25 percent.  

These results reinforce other data researchers have collected on how exercise affects the risk of colorectal cancer. Though we don’t fully understand why, exercise plays a role in the development of colorectal cancer—for people who may be at risk for the disease, people who already have it and people who have been treated for it.

Who’s at risk for colorectal cancer?

Several lifestyle factors can increase the risk for colorectal cancer, including:

  • Diets high in red meat, such as beef and pork
  • Diets high in processed meats, such as hot dogs and bologna
  • Heavy alcohol use
  • Obesity, particularly excess belly fat
  • Smoking

Other factors can also increase the risk of developing colorectal cancer. These include:  

  • A history of inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
  • Family history of colorectal cancer or colon polyps (growths in the colon)
  • Being African-American
  • Having type 2 diabetes

Colorectal cancer tends to affect people in older age groups. That’s why we recommend people over 50 get a colonoscopy on a regular basis to lower their risk for colorectal cancer. Your doctor may recommend starting earlier if you have one or more of the above risk factors. For instance, we recommend African-Americans start getting regular colonoscopies at age 45. Though there are other tests available to screen for colorectal cancer, colonoscopy is still the best option for finding and treating the disease as early as possible. 

Getting active to stay healthy

As we age, we tend to be less active and at higher risk for conditions like heart disease and diabetes, which can further limit our activity levels. But even a little exercise every week can lower your risk of colorectal cancer. Studies cited by the National Cancer Institute have found adults who increase their physical activity can reduce their risk of developing colorectal cancer by 30 to 40 percent compared to people who don’t exercise. That’s on top of the benefit researchers have found exercise has in people whose cancer has spread.  

Modest amounts of moderate exercise can help. I tell patients that if they’re breaking a sweat for about 20 minutes at a time two to three times a week, that seems to be enough. Walking is a great way to do this. Some other examples of moderate exercise, according to the Centers for Disease Control and Prevention (CDC), include:

  • Aerobics
  • Biking
  • Climbing stairs or using a stair climber
  • Dancing
  • Playing basketball
  • Swimming
  • Yoga 

Research shows that people don’t have to do intense exercises to get these survival benefits. When it comes to lowering your risk of colorectal cancer, just getting up and doing something is important. If you can do more, that’s great! If you can’t, do what you can. Just make sure you’re doing something. And talk to your doctor about starting any new exercise plan, especially if you have conditions like heart disease, lung disease, diabetes or other serious conditions.

Exercise even helps after a patient has had surgery to treat colorectal cancer. The American Cancer Society notes that people who exercise regularly after being treated for colorectal cancer have a lower chance of the disease coming back, as well as a lower chance of dying from the disease. In addition, exercise has been linked to an improved quality of life and less fatigue after colorectal surgery. If you’re starting or resuming an exercise routine after colorectal surgery, be sure to talk to your doctor beforehand about the types of exercise you can do safely. 

Controlling your colon cancer risk

I realize that getting active is easier for some people than others. By the time people are in their 60s and 70s, if they haven’t exercised regularly before, making that sort of lifestyle change can be tough. But I encourage my patients to do what they can to lower their risk for colorectal cancer. I let them know that even little changes in their activities or walking just a little bit can benefit them in the long term.  

Older adults who have never exercised before may not know where to start. It can be intimidating to walk into the local gym and get started on a fitness plan. The National Institute on Aging has examples of sample exercises for older adults based on four key fitness areas: endurance, strength, balance and flexibility. Your doctor can also provide guidance on the types and amount of exercise you should do.  

And exercise isn’t the only thing I advise people do to lower their risk. Other ways you may be able to reduce the risk of colorectal cancer include:

Take the first step

We need more research in this area of medicine to find out exactly why exercise lowers the risk of death from colorectal cancer and the risk of developing it in the first place. For now, though, the data show a clear link between the disease and activity levels.

 You don’t have to live at the gym or train for marathons to reduce your risk for colorectal cancer. Take a brisk walk around the block once a day, or watch your favorite TV show while you walk on the treadmill. Every step is one you’re taking to live a healthier, more active life—and one free from colorectal cancer. 

Varicose Veins: Signs, Symptoms and Treatments

Understanding Varicose Veins.

About 55 percent of American women suffer from some sort of venous disorder, with varicose veins topping the list. Varicose veins occur when damaged or weakened valves fail to do their job: keep blood flowing back to the heart. Healthy valves accomplish this task, even against gravity, by opening and closing tightly. But when valves aren’t working correctly, some blood leaks backward and pools in the legs, straining the walls of the veins. Results range from the merely unsightly to the uncomfortable, including feelings of pain, cramping, leg heaviness and fatigue.

In some cases, changes in the skin, and even leg ulcers, may develop. Family history, multiple pregnancies, occupations requiring long periods of standing, obesity and age can all contribute to the condition. While rarely a threat to your health, varicose veins will not go away by themselves and if left untreated, generally worsen over time. Fortunately, a variety of approaches  and therapies are available to get you back on your feet quickly. Chief among them, two outpatient procedures, called sclerotherapy and radiofrequency ablation (RFA) can relieve the pain safely and effectively and restore a healthier appearance, more quickly and easily than ever before.

 

Physician Profile

 As a vascular surgeon at MedStar Heart & Vascular Institute, Misaki Kiguchi, MD, MSc, MBA, specializes in the treatment of both arterial and venous diseases. Her training spans the spectrum of both diseases, including clinical expertise in aortic aneurysm repair, carotid artery disease management, peripheral arterial and venous disease management, which includes varicose veins. Dr. Kiguchi enjoys the long-term relationships she builds with her patients, but it is the technical aspects of vascular procedures that drew her to this specialty.

“Vascular disease is chronic, and patients rely on an ongoing relationship with me, their cardiologist, and primary care provider to keep their disease at bay,” says Dr. Kiguchi.

Caring for patients with life-threatening vascular conditions, and performing cosmetic surgical procedures are both equally satisfying for Dr. Kiguchi. 

"If I am able to improve a patient's quality of life because I'm able to help their cosmetic veins, then I am happy to provide the services, " she adds.

Read more about how the new, less invasive treatments helped one of Dr. Kiguchi's patients in this Center Scope article

Dr. Kiguchi has office hours in Washington, DC and Chevy Chase, MD.

Have any questions?

We are here to help! Contact us for more information about varicose veins or to schedule an appointment. Call us at 202-877-3627.

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