Bariatric Surgery Found to Help COPD

According to estimates, 6% of American adults have chronic obstructive pulmonary disease (COPD), and 35% of those COPD patients are considered obese. In addition to being common among COPD patients, studies have also suggested that obesity leads to a higher risk of acute exacerbations, indicating that obesity may be a risk factor. Now a U.S. study suggests that obese people with COPD who get weight loss surgery may go to the hospital less often with acute breathing problems after their operations. The study found that among obese adults with COPD, those who had bariatric surgery to lose weight, needed to go to the emergency room or have inpatient care half as often as before surgery.

The researchers examined data on 481 obese adults aged 40 to 65 who had COPD and underwent bariatric surgery in California, Florida and Nebraska. They followed patients from 2005 through 2011 to see how hospital and emergency room visits for COPD in the two years before weight loss surgery compared to the two years afterwards.

At the start of the study, when patients were 13 to 24 months away from getting their operations, 28 percent of them had an emergency department (ED) or hospital visit for acute COPD symptoms, researchers report in Chest. During the second year of the study, the 12 months right before surgery, these rates didn’t change much, but compared with that first year of the study, the chances of an ED or hospital visit dropped by 65 percentin the first year after bariatric surgery. Just 12 percent of patients had a COPD visit during that time. During the last year of the study, 13 to 24 months after surgery, the odds of an ED or hospital visit were 61 percent lower than in the first year of the study. These findings suggest that benefits of bariatric surgery may extend beyond remission of chronic health problems associated with obesity to include COPD and other respiratory conditions.

If you are considering bariatric surgery in the Las Vegas area, schedule a consultation at VIP SURG. Our expert team can help you find the right treatment for your unique situation.

COPD Chronic obstructive pulmonary disease health medical concept

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LINX: Treating GERD with Innovation

A hiatal hernia occurs when part of the stomach pushes through the diaphragm. The diaphragm normally has a small opening for the esophagus. This opening can become the place where part of the stomach pushes through. Small hiatal hernias often cause no symptoms, while larger ones can cause pain and heartburn, leading to gastroesophageal reflux disease, or GERD. In 2012, the Food and Drug Administration approved a new treatment device called the LINX Reflux Management System to offer a new approach to treating GERD, a disease that is increasing at a rate of 30 percent every decade.

Think of the stomach as a mixing bowl that allows food and digestive juices to combine to begin the digestive process. The stomach has a protective lining that prevents acid in the digestive juices from eating away at the stomach muscle and causing inflammation. Unfortunately, the esophagus does not have a similar protective lining. Instead it relies on the lower esophageal sphincter (LES) to act as a valve to prevent acid from refluxing from the stomach into the esophagus. In the situation of a hiatal hernia, part of the stomach pushes up through the opening allowing acid to pass into the esophagus causing symptoms may include the following:

  • heartburn
  • nausea, vomiting, or retching (dry heaves)
  • burping
  • water brash, the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing acid

Symptoms usually are worse after meals. These symptoms may be made worse when lying flat and may resolve with sitting up or walking.

In some patients, reflux into the lower esophagus sets off nervous reflexes that can cause a cough or even spasm of the small airways within the lungs (asthma). A few patientsanatomy-archers may reflux acid droplets into the back of their throat. This acid can be inhaled or aspirated into the lung causing coughing spasms, asthma, or repeated infections of the lung including pneumonia and bronchitis. This may occur in individuals of all ages, from infants to the elderly.

Fortunately, the innovative LINX procedure is helping with this significant health problem. This device is a series of magnets in the form of ring that is implanted around the bottom of the esophagus during a short, 40-minute laparoscopic procedure.

The ring of magnets is designed to stay closed and prevent the reflux valve from opening thereby preventing acid from the stomach move up into the esophagus. The magnets will open up the ring when people are eating to let food in much like a person’s native reflux valve.

 

Here are some things you need to know about the LINX procedure.

  • It is focused on the underlying cause of reflux disease not the side effect. Reflux disease is a result of a damaged lower esophageal sphincter (LES).
  • It is safer than the long-term use of proton pump inhibitors (PPIs). Studies have proven that reflux disease can progress even when PPI therapy has effectively eliminated GERD symptoms. LINX is effective at reducing symptoms and improving quality of life.
  • A recent study published in the New England Journal of Medicine tracked 100 patients for three years after their LINX surgery. That study found an overall decrease in stomach contents reaching the esophagus, fewer reflux symptoms, and a substantial reduction in PPI usage.
  • The side effects disappear over time in most cases. Initially, most patients experience some discomfort, but it typically dissipates over several weeks. In addition, the most commonly reported side effect is mild difficulty swallowing, which usually subsides over time.
  • The cost can be much less than a lifetime of PPI use: a 2010 study by Consumer Reports found once-a-day PPI use can range from $2,000 to $4,500 per year for brand name prescription PPIs.
  • This is minimally invasive and is performed as an out-patient procedure.
  • LINX is reversible and can be replaced.
  • Since the LINX band is placed around the LES, the device can be removed or replaced, if necessary.
  • This procedure is recommended for those with continued GERD symptoms under maximum therapy prescribed by a specialist.
  • LINX is not for everyone with advanced GERD. Today LINX is not approved for those with Barrett’s Esophagus or anyone suffering from esophageal cancer. It is important for everyone suffering from advanced stages of reflux disease to explore all available options before their disease progresses to the point where options are limited.

It is important to take your heartburn symptoms seriously because they are signals from your body that something is wrong. Since reflux disease is a progressive chronic condition, treating it early could prevent you from having to consider surgery later on.

As the first LINX trained surgeons in Las Vegas, Dr. Shawn Tsuda and Dr. Heidi Ryan at VIP SURG are ready to help you fight back against gastroesophageal reflux disease. Schedule a consultation to learn more.

 

 

The Link Between Seasonal Allergies and Reflux

While many may think of seasonal allergies happening in the spring along with blooming flowers, fall can also be a difficult time for those who are allergic. Ragweed, dust, mold, mildew, and the removal of fall crops are just some of the possible fall triggers for allergy sufferers. What many people don’t know is that allergies can be a big issue for people dealing with acid reflux disease. Separate from food allergies, seasonal allergies can also play a role in exacerbating the symptoms of acid reflux.

The link between seasonal allergies and acid reflux disease is that as allergic response becomes more active, one has more nasal drip, and more nasal drip leads to more acid, and that acid can then reflux up into the nasal passages and make the whole cycle even worse. In addition, one of the ways that seasonal allergies can aggravate acid reflux disease is the pressure from coughing or sneezing. This pressure can temporarily weaken the lower esophageal sphincter (LES) and allow stomach contents to splash into the esophagus. In order to get the added acid reflux pain under control, suffers also need to get the drainage, sneezing and coughing under control.

The first line of defense in the seasonal allergy arsenal is generally the use of antihistamines. Medications provide a way to lessen the reaction the body has to the histamines produced by allergies. These medications can help many people deal with their allergies without any further treatments.

Senior man with reflux

If you do need antihistamines in the pollen season, remember that they can dehydrate and cause constipation. The latter is also a huge reflux trigger. Be sure to drink plenty of water and gradually increase your fiber intake to counteract any unpleasant side effects. You don’t want to trade one reflux trigger for another.

There are a few things that you can do this time of year to help lessen your increased acid reflux symptoms due to allergies:

  • Even though the weather this time of year can be gorgeous, keep the windows closed in at least one room of your house. Spending time in this room throughout the day will give your entire bodily system a break from the environmental stress being placed on it.
  • Shower and change clothes after working or being outside. Most aller
    gens cannot be seen. Especially on a windy day, just assume that if you have been outside, you are wearing allergens when you come inside.
  • Be proactive with your reflux medication and your allergy medication this time of year. Reflux comes in waves. One of the best ways to manage reflux is to understand ahead of time when your reflux may be troublesome and manage accordingly. An antihistamine can be helpful. It works by blocking a certain natural substance (histamine) that your body makes during an allergic reaction. This medication can also slow down your runny nose and nasal drip whichin turn can help your reflux symptoms.
  • Do not experiment with new foods. Keep your eating very simple and reflux friendly until at least the first frost in your area.
  • Avoid raw fruits and vegetables. Allergens can be found in our environment and also in raw fruits and some vegetables. These same foods can often be better tolerated cooked. When foods are heated, the proteins are distorted and the immune system no longer recognizes the food as a problem.

If you live in the Las Vegas area and are suffering from acid reflux. Schedule a consultation at VIP Surg. We can help find the right treatment for you.

 

Eating in Moderation: What Does that Really Mean?

“Everything in moderation,” says a co-worker, dipping the tines of her fork into her low-fat salad dressing.

“Everything in moderation,” says a friend helping himself to a third scoop of ice cream.

What is moderation? If this concept of moderation confuses you, you’re not alone. Everyone appears to define it differently. Eating in moderation is a subjective term, meaning something slightly different depending on your perspective. Individual perception of reasonable limits opens the door to a wide variety of complex answers for a seemingly simple question.

On one end of the spectrum, there are those who don’t put much thought into eating a healthy and well-balanced diet. Convenience and taste are the main factors influencing their dietary decisions.

On the opposite end, one may find those who label food as either wholesome and pure or downright evil, with seldom anything in between. Typical “bad” foods such as sugar, carbs, dairy, and processed or refined foods are avoided at all costs.

Both extremes can have detrimental effects on health. Eating calorie-dense foods high in sugar, fat, and salt on a regular basis, combined with a sedentary lifestyle increases the risk of chronic diseases like heart disease, obesity, and diabetes.

However, cutting out entire food groups without replacing missing nutrients can also pose problems. While “clean eating” might come in an attractive package, severe restrictions can lead to cycles of binge eating, feelings of guilt and shame, and further restriction.

Toward which end of the spectrum do you tend to lean? Where is the fine middle ground?

Eating in moderation means you do not consume more calories than your body needs to function properly. A person who does not eat a moderate number of calories gains weight, risking obesity and its associated illnesses.

The quality of the food is also an important factor when talking about eating in moderation. Consuming food your body does not need or want, such as excess sugar and fat has a detrimental effect on your body.

Eating in moderation means consuming nutritionally dense food so your body gets all the vitamins and minerals it needs without harmful or needless substances. According to the MyPlate scheme from the USDA, a healthy dinner plate contains lean protein, whole-grain foods, fruits and vegetables.

Plan your plate to ensure you are eating the proper foods in moderation. Draw an imaginary line down the middle of your plate. Fill the left half your plate with fruits and vegetables. Draw another imaginary line to cut the right half of your plate into two quarters. Fill one section with lean meat and put whole-grain products in the other section.

Moderation is about a healthy relationship with food – balancing the pleasure of eating with our basic need for sustenance. It is realizing that eating one piece of cake a week probably won’t kill you, but that doing so everyday just might.

If you live in the Las Vegas area and are fighting obesity and metabolic disease, schedule a consultation at VIP SURG. We can help you find the right treatment for your unique situation.

The True Size of the American Obesity Epidemic

To understand the true magnitude of the American obesity epidemic, we first need to understand what it really means to be overweight. Doctors and nutritionists classify people as either underweight, healthy weight, overweight, or obese. These different classifications are determined by body mass index (BMI), or a measure of body fat based on your height and weight.

To get a basic idea, this chart from the CDC approximates what that means for someone who is 5’9” tall.

Height Weight Range BMI Considered
Source: CDC      
5′ 9″ 124 lbs or less Below 18.5 Underweight
  125 lbs to 168 lbs 18.5 to 24.9 Healthy weight
  169 lbs to 202 lbs 25.0 to 29.9 Overweight
  203 lbs or more 30 or higher Obese

As for what is driving America’s chronic weight problem, there are no definite answers. Scientific studies often reach conflicting conclusions. Many theories are out there, but the preponderance of evidence points to the two causes most people already suspect: too much food and too little exercise.

Bigger portions, confusing “diet” for “nutrition,” and lack of exercise are a deadly combination. Today, each American puts away an average of 195lbs of meat every year, compared to just 138lbs in the 1950’s. Consumption of added fats also shot up by around two thirds over the same period, and grain consumption rose 45% since 1970.

Research published by the World Health Organization found that a rise in fast food sales correlated to a rise in body mass index, and Americans are notorious for their fast-food consumption. It is not just how much we eat, but what we eat.

The role of diet in the obesity epidemic is obviously major, but it’s also complex. Consumers are sent mixed messages when it comes to what to eat and how much. Larger portions, processed packaged food, and drive-thru meals are branded as almost classically American — fast, cheap, filling, and delicious, but yet we spend billions of dollars annually on weight loss schemes.

Lack of exercise is also a major culprit in the obesity epidemic. A far greater majority of us are sitting throughout our workday. According to one study, only 20% of today’s jobs require at least moderate physical activity, as opposed to 50% of jobs in 1960. Other research suggests Americans burn 120 to 140 fewer calories a day than they did 50 years ago. Add this to the higher number of calories we are packing in, and we get a perfect recipe for weight gain.

A number of other factors are thought to play a role in the obesity epidemic, such as the in- utero effects of smoking and excessive weight gain in pregnant mothers. Poor sleep, stress, and lower rates of breastfeeding are also thought to contribute to a child’s long-term obesity risk. Of course, these factors are not explicit or solitary causes of obesity, but they are reliable indicators of the kinds of systemic problems contributing to this crisis.

In the end, though, we can’t lose sight of the big picture. Over the past years, diet fads have come and gone, with people rushing to blame red meat, dairy, wheat, fat, sugar, etc. for making them fat, but in reality, the problem is much simpler. Genetics and age do strongly influence metabolism, but as the CDC points out, weight gain and loss is primarily a formula of total calories consumed versus total calories used.

If you are looking for answers to debilitating obesity and the health issues that often accompany the extra weight, contact VIP Surg at (702) 487-6006. We can help you find the right treatment for your unique situation.

A pair of female feet on a bathroom scale

Normal Heartburn or GERD?

Acid reflux is a serious disorder that can and must be treated to prevent symptoms and stave off potentially life-threatening consequences. Known medically and commercially as GERD, the acronym for gastroesophageal reflux disease, repeated bathing of the soft tissues of the esophagus with corrosive stomach acid can seriously damage them and even cause esophageal cancer, which is often fatal.

Acid reflux is more than just a nuisance. It involves the backward flow of stomach acid into the tissues above it. It results when the lower esophageal sphincter, a ring of muscle between the esophagus and the stomach, fails to close tightly enough to prevent the contents of the stomach from moving up instead of down. Sometimes the upper sphincter, between the esophagus and the throat, malfunctions as well.

Contrary to what many believe, heartburn is but one of the many symptoms of GERD, and failure to recognize the others when heartburn is not among them can result in harmful untreated reflux. In addition to indigestion, GERD can cause:

  • persistent dry cough
  • sore throat
  • frequent throat clearing
  • hoarseness
  • burping or hiccups
  • bloating
  • difficulty swallowing
  • a sensation of a lump in the throat

If, when faced with such an otherwise unexplainable symptom, your doctor fails to thinkhand holding stethoscope with GERD word. medical concept of GERD as a possible reason, you might suggest it yourself. An examination of the esophagus may be the only way to find out if someone without obvious heartburn has acid reflux but doesn’t know it.

One characteristic often associated with acid reflux — being overweight, especially with abdominal obesity — largely explains why the condition has become so common in Western countries. Someone with a body mass index in the overweight range is almost twice as likely to have GERD as a person of normal weight. Losing weight is one of the best ways to find relief without having to rely on medication. Other ways to relieve GERD symptoms include:

  • quitting smoking
  • limiting alcohol
  • avoiding carbonated drinks
  • eating five or six small meals a day rather than one or two big ones
  • avoiding eating within three hours of bedtime
  • Raising the head of the bed by six inches or more

If you suffer from GERD and are looking for treatment, schedule an appointment with Dr. Shawn Tsuda. Among other procedures, Dr. Tsuda specializes in a revolutionary treatment for GERD called LINX. Find out if it’s right for you.

 

Most Common Surgical Treatments for Clinically Severe Obesity

The obesity epidemic continues to grow in our country, and with obesity comes a whole host of additional health risks, like type 2 diabetes, heart disease, high blood pressure, osteoarthritis and stroke. Those looking to reduce these obesity-related health risks are turning to bariatric or medical weight-loss surgeries like gastric bypass.

With weight-loss surgery, your surgeon makes changes to your stomach or small intestine, or both. The procedure resolves diabetes 80 percent of the time, and patients lose an average of 70 percent of extra weight. However, gastric bypass isn’t the only choice. Learn about your options:

Laparoscopic Adjustable Gastric Band – The surgeon puts a small band around the top of your stomach. The band has a small balloon inside it that controls how tight or loose the band is. The band limits how much food can go into your stomach. This surgery is done using a laparoscope. Advantages include:

  • Minimally invasive with small incisions
  • Short hospital stay
  • Adjustable without additional surgery
  • Can support pregnancy
  • Removable at any time

Laparoscopic Gastric Sleeve – This surgery removes most of the stomach and leaves only a narrow section of the upper part of the stomach, called a gastric sleeve. The surgery may also curb the hunger hormone ghrelin, so you eat less. Advantages include:

  • No cutting, bypassing, or stapling of the intestine
  • Little concern about vitamin and calcium absorption
  • No adjustments or artificial devices put into place
  • Most foods are possible

Laparoscopic Roux-en-Y Gastric Bypass Surgery – The surgeon leaves only a very small part of the stomach (called the pouch). That pouch can’t hold a lot of food, so you eat less. The food you eat bypasses the rest of the stomach, going straight from the pouch to your small intestine. This surgery can often be done through several small incisions using a camera to see inside (laparoscope). Doctors can also perform a mini-gastric bypass, which is a similar procedure also done through a laparoscope. Advantages include:

  • Tiny incisions, resulting is less scarring and easier healing
  • Excellent cosmetic result
  • Little pain
  • Few wound complications
  • Fast recovery
  • Short hospital stay
  • Resuming physical activity soon
  • Little risk of hernia formation

Duodenal Switch- This is complicated surgery that removes most of the stomach and uses a gastric sleeve to bypass most of your small intestine. It limits how much you can eat. It also means your body doesn’t get as much of a chance to absorb nutrients from your food, which could mean you don’t get enough of the vitamins and minerals you need. Advantages include:

  • Results in greater weight loss than other methods, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up
  • Allows patients to eventually eat near normal meals
  • Reduces the absorption of fat by 70 percent or more
  • Causes favorable changes in gut hormones to reduce appetite and improve satiety
  • Is the most effective against diabetes compared to other methods

If you’re considering bariatric surgery, schedule an appointment with Dr. Shawn Tsuda. He can help you decide which, if any, of these treatments is right for your unique situation.Fat man running