Gallstones and Gallbladder Disease

Some people think of their gallbladder as being “expendable”. Not that anybody wants any of their organs to be removed, but since many people live a seemingly normal life after getting their gallbladder removed, many people don’t think their gallbladder plays an important role in their overall health. After all, how important can your gallbladder be if you can do just fine after it’s surgically removed? The gallbladder actually plays a very important role in your body. It is an essential part of the digestive system.

In the United States, about a million new cases of gallstone disease are diagnosed each year, and some 800,000 operations are performed to treat gallstones, making it the most common gastrointestinal disorder requiring hospitalization. Gallstones or gallbladder disease can quickly turn a great meal into a period of misery.

Gallstone disease is the most common disorder affecting the body’s biliary system, the network of organs and ducts that create, transport, store, and release bile. Bile is a thick fluid, made in the liver and stored in the gallbladder, which acts in the small intestine to digest fat. Bile contains cholesterol, water, proteins, bilirubin (a breakdown product from blood cells), bile salts (the chemicals necessary to digest fat), and small amounts of copper or other materials. If the chemical balance of bile contains too much of any of these components, particularly of cholesterol, crystals form and can harden into stones.

Bile is stored in the Gallbladder and is concentrated up to five times by the removal of water. Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. Bile contains water, cholesterol, bilirubin and other substances. Ideally these minerals remain in liquid form until they are passed out of the body. However, excessive amounts of these minerals in bile can cause them to crystallize.

These small crystals that form out of the saturated bile may begin to clump together. Any existing crystals makes it easier for other crystals to form. If they stay in the gallbladder too long, the crystals gradually grow larger until they become a gallstone so large that it cannot pass through the biliary ducts.

In terms of size, gallstones can be as small as a grain of sand or as large as a golf ball. A person can form one large stone in his or her gallbladder, or hundreds! About 10 percent of the population has gallstones, but the vast majority experiences no symptoms and need no treatment. However, in 1 percent to 2 percent of these people, gallstones can cause problems by lodging in bile ducts, stopping the flow of bile or digestive enzymes, and leading to severe abdominal pain, vomiting, inflammation, and even life-threatening infection.

Gallstone attack has some classic symptoms:

The most agonizing pain is experienced in the upper right part of the abdomen under the ribs. Usually it appears suddenly, sometimes an hour or two after eating a fatty meal. The pain may get worse quickly, and then last for several hours. Many times the pain may radiate to the back between the shoulder blades or under the right shoulder. Inhaling deeply, or moving, often makes the pain worse. The primary therapy for gallstones that are causing pain, inflammation, or infection is removal of the gallbladder.

A number of factors put people at higher risk of gallstones:

  • Gender: Women between the ages of 20 and 60 are 3 times more likely to develop gallstones than are men in the same age group. By age 60, 20 percent of American women have gallstones.
  • Age: The incidence of gallstone disease increases with age.
  • Genetics: Family history and ethnicity are critical risk factors in development of gallstones, though no gene responsible for gallstone formation has yet been discovered. African-Americans seem to have lower rates of gallstone disease than American Indians, whites, or Hispanics.
  • Obesity: Obesity is a significant risk factor, particularly for women. Obesity also slows down the emptying of the gallbladder.
  • Location of body fat: Belly fat, that spare tire around the middle, dramatically increases the chance of developing stones.
  • Diabetes: People with diabetes often have high levels of triglycerides in their blood, and these fatty acids tend to increase the risk of gallstones.

Even if you’re not at risk for gallstones, it is wise to maintain a healthy body weight, by among other things, sticking to a diet that is low in fat and cholesterol and high in fiber.

If you are in the Las Vegas area and suffering with gallstones or gallbladder disease, schedule a consultation with Dr. Shawn Tsuda.

Gallbladder Disease - Doctor with chalkboard on white background

What you Need to Know about Protein

You probably know you need to eat protein, but what is it and where exactly do you find it? The answer is – everywhere – if you’re talking about the body. Proteins make up about 42% of the dry weight of our bodies. The protein collagen—which holds our skin, tendons, muscles, and bones together—makes up about a quarter of the body’s total protein. Protein builds, maintains, and replaces the tissues in your body. Your muscles, your organs, and your immune system are made up mostly of protein. All of our cells and even blood are packed with protein molecules.

Proteins, along with fats and carbohydrates, are the macronutrients that form the basis of our diets. Once consumed, some people associate protein only with helping to build muscle, but keep in mind that’s not all it does for us. In our bodies, protein performs a range of duties, from building new cells to regulating metabolism to helping cells communicate. Proteins help shuttle oxygen throughout the body in the form of hemoglobin, as well as build muscle.

When you eat foods that contain protein, the digestive juices in your stomach and intestine go to work. They break down the protein in food into basic units, called amino acids. The amino acids then can be reused to make the proteins your body needs to maintain muscles, bones, blood, and body organs.

Amino acids are the building blocks of proteins. Our DNA directs the body to join various combinations of amino acids into a variety of sequences and three-dimensional shapes for an arsenal of over 2 million different proteins, each serving a unique function. Our bodies can make some of these amino acids, but there are nine that are considered “essential amino acids” because we must consume these through our diet.

Many foods contain protein, but the best sources are:

  • Beef
  • Poultry
  • Fish
  • Eggs
  • dairy products
  • Nuts
  • Seeds
  • legumes like black beans and lentils

While our bodies can store fats and carbohydrates to draw on when needed, we do not have a storage pool of amino acids. We need a fresh source each day in order to build the body proteins we need. If the body is missing a particular amino acid to form the protein it needs, it will pull that amino acid by breaking down existing muscle protein. If we consistently lack certain amino acids we will lose muscle weight, energy and, eventually, fundamental functions.

The amount of protein you need depends on your weight and health. The Recommended Daily Allowance (RDA) for protein for the healthy individual is 0.8 grams of protein per kilogram of body weight or 3 to 4 grams per 10 pounds, and two to three servings of protein-rich food will meet the daily needs of most adults. Athlete’s protein intake recommendations may be higher.

The good news is that you don’t have to eat all the essential amino acids in every meal. As long as you have a variety of protein sources throughout the day, your body will grab what it needs from each meal.

You can look at a food label to find out how many protein grams are in a serving, but if you’re eating a balanced diet, you don’t need to keep track of it. It’s pretty easy to get enough protein.

*Dr. Shawn Tsuda is a General Surgeon specializing in robotic bariatric surgery. Schedule a consultation to learn more.
gabel mit verschieden Proteinen

Weight-loss Surgery Myths – Setting the Record Straight

If you are considering bariatric surgery, you’ve probably heard many of the popular myths. These run the gamut from horror stories to fairy tales. In reality, these procedures are neither as awful nor as fantastic as they’re made out to be. Here are some facts to help set the record straight about weight-loss surgery (WLS).

Myth: All bariatric surgery involves stomach stapling.

  • There are many different types of gastrointestinal procedures for weight loss, some of which reduce the functioning size of the stomach and others that bypass parts of the digestive tract, reducing absorption of calories and nutrients. Different types of surgeries offer different results, and some are more suitable for particular people than others.

Myth: People who get weight-loss surgery don’t have willpower.

  • Many bariatric surgery patients have struggled for years, pushing themselves to extremes to lose weight and keep it off. They understand that surgery is a final option when everything else has failed. The surgery, recovery and lifestyle changes that accompany WLS require both courage and determination on the part of the patient.

Myth:  Bariatric surgery is only for the morbidly obese.

  • Obesity is only one of the criteria that qualify patients for surgery. Overweight patients may also be candidates if they have one or more health problems that might be reduced or alleviated by weight loss such as diabetes, sleep apnea, hypertension, arthritis, and high cholesterol.

Myth: Bariatric surgery is extremely dangerous.

  • Any type of surgery has associated risks, such as complications or even death. However, a number of recent advances have helped to minimize risks. Surgeries are usually done laparoscopically with mini-incisions that result in faster healing, less pain, and less scarring.

Myth: You will finally be skinny after bariatric surgery.

  • Losing just 50% of excess weight and keeping it off is considered a success story. That’s still going to be overweight in the eyes of most people. Plus, your skin isn’t necessarily going to tone up and be free of drooping after weight loss. However, the health benefits in reducing weight-related problems like sleep apnea often occur even in patients who don’t lose all the weight they would like.

Myth: Weight loss from bariatric surgery is permanent.

  • Unfortunately, even this one is not true. In fact, some regain is likely. Part of this is simply the body adjusting and learning to store fat even on a very restricted diet. At other times, a patient’s failure to adhere to the post-surgery lifestyle recommendations plays a role.

Myth: You should only have WLS if you are done having kids.

  • It isn’t safe to get pregnant in the first year or two after bariatric surgery. You simply won’t be getting enough nutrients to support a growing fetus. After you are done losing weight (if you are taking all your supplements and monitoring your health carefully), getting pregnant should be okay. This is something to discuss with your bariatric surgeon.

Myth: After bariatric surgery, you won’t be able to eat anything that tastes good.

  • Patients who undergo gastric bypass may need to avoid very sweet foods because it can cause side effects like dizziness and nausea. Patients who have a duodenal switch typically need to keep fatty foods to a minimum. However, many patients can and do eat their favorite foods after they recover from surgery. They just eat very small portions.

Myth: You can never be far from a bathroom after WLS.

  • In the aftermath of surgery, you may find yourself having some “emergency” bathroom visits. However, symptoms like diarrhea and vomiting should subside over time as you get a better handle on how your altered digestive system responds to food.

Myth: Bariatric surgery is reversible.

  • Gastric banding is usually reversible. That’s because the stomach and intestines are not cut or stapled with this surgery. Gastric bypass may be reversible, but this is a very involved surgery. It’s more difficult to put everything back where it was, and there is a risk that the revision won’t restore normal function. Sleeve gastrectomy and duodenal switch entail actual removal of part of the stomach without reattaching it lower on the intestine. This type of surgery is not reversible.

Surgery for weight reduction is not a miracle procedure. Weight loss surgery is designed to assist the morbidly obese in developing a healthier lifestyle. A surgical weight loss operation is a useful tool for weight loss, but it is a surgical procedure that requires a substantial lifelong commitment. The surgery alone will not help someone lose weight and keep it off. The patient must change eating and exercise habits. Without changes to the daily pattern of eating and activity, the patient is likely to regain the weight over time.

 

Tips for Choosing the Right Surgeon for You

Whether you need a complicated, invasive surgery or a simple out-patient operation, choosing the right surgeon can seem overwhelming. Even what should be relatively straightforward procedures such as gallbladder removal or hernia repair can sometimes result in serious complications, so you always want to be in good surgical hands. Here are some tips on finding the surgeon and hospital that are best for your situation.

Once you have narrowed down your list of potential surgeons, schedule a consultation. If you have a fairly urgent need for surgery, you may have to cross surgeons off of your list purely because of the wait for a visit. Otherwise, plan to meet with at least two surgeons and discuss your potential surgery.

Things to ask:

  • Is surgery necessary? The best way to avoid surgical errors is to avoid surgery entirely, so ask about the effectiveness and safety of alternatives. Compare those with the risks of surgery and the chance that it will help you.
  • Is your board certification up-to-date? Look for a surgeon who has undergone the necessary training, even after being in clinical practice, to maintain board certification in his or her specialty.
  • What’s your experience? Ask how many operations the surgeon has performed in the past year and how that compares with his or her peers.
  • What are your success, failure, and complication rates? Not all will be able or willing to tell you, but the good ones should.
  • What’s the hospital’s infection rate?
  • Does the hospital follow best practices? The federal Centers for Medicare and Medicaid Services tracks how frequently hospitals give antibiotics on schedule, control blood sugar in heart-surgery patients, prepare skin properly before incisions and take other steps proven to help prevent surgical complications.Make the right choice.

You may be expected to schedule a surgery at the end of the consultation. If you are not confident that you have found your ideal surgeon, do not schedule the surgery. Either way, it’s fine to ask for a day to consider everything the doctor has said before making the surgery official.

If the surgeon you consulted with is not your ideal surgeon, schedule a consultation with a different surgeon. Even if you think the first surgeon is your best choice, a second opinion from another surgeon can be valuable. Most types of insurance will allow for two or three consultations. If you believe you have found your ideal surgeon you can schedule your surgery, confident in your decision.

If you’re looking for an experienced general surgeon in the Las Vegas area, Dr. Shawn Tsuda specializes in minimally invasive surgical techniques including the laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, sleeve gastrectomy, foregut surgery, ventral and inguinal hernia repairs, endoscopy, and basic laparoscopy. Schedule a consultation to learn what he can do for you.

 

 

Robotic Gallbladder Surgery

A horrendous pain hits you in the upper right side or middle of the abdomen. You might think it’s a gas pain because your abdomen might feel especially full, or maybe it’s bad indigestion because you are also very nauseous and vomiting. These are all symptoms of a problem with the gallbladder. If the pain and/or nausea isn’t enough to send you to your doctor or the emergency room, symptoms such as fever, clay-colored stool, or yellowing of skin and whites of eyes (jaundice) should be assessed by a medical professional as soon as possible.

Gallbladder disease is very common, affecting about 10-15% of adults in Europe and the U.S. Treatment for gallbladder disease may include lifestyle changes and medication. However, if your symptoms worsen, your doctor may recommend surgery to remove your gallbladder.

Fortunately, your gallbladder is an organ that you can live without. The surgery to remove Gallbladderthe gallbladder is called a cholecystectomy. This surgery can be performed using open surgery through one large incision or through minimally invasive surgery (laparoscopy). Minimally invasive surgery can be done either through a few small incisions in your abdomen or one incision in your belly button. In laparoscopic procedures, surgeons use long-handled instruments to reach your gallbladder. One of the instruments is a tiny camera that takes images inside your body and sends them to a video monitor to guide surgeons as they operate.

Cholecystectomy through the belly button can be done using traditional single incision laparoscopy or da Vinci® Single-Site® Surgery. The da Vinci System features a magnified 3D high-definition vision system and flexible Single-Site instruments. These features enable your doctor to operate with enhanced vision and precision.

It is important to discuss all treatment and surgical options with your doctor, as well as the risks and benefits of each. If your doctor believes you are a candidate for da Vinci Single-Site Surgery, your doctor removes your gallbladder using state-of-the-art precision instruments. With da Vinci, surgery is performed through one incision in the belly button, which dramatically limits visible scarring.

As a result of da Vinci technology, da Vinci Single-Site Cholecystectomy offers the following potential benefits compared to traditional laparoscopy:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Virtually scarless surgery
  • High patient satisfaction
  • Minimal pain

Though it is often called a “robot,” da Vinci cannot act on its own. Surgery is performed entirely by your doctor. This state-of-the-art technology must be operated by an experienced and specially trained surgeon like Dr. Tsuda.

If you need gallbladder surgery, contact Dr. Shawn Tsuda to see if you are a candidate for this type of procedure. Da Vinci surgery allows one to get back to normal life much more quickly than with traditional open and even laparoscopic surgeries.

Hernias and Surgery

Anyone who sews or does even simple crafts or carpentry knows that for a project to be well made, the seams have to be just right so that they don’t pull apart.

Our bodies are like that too. If our numerous “seams” aren’t made just right, they can pull AdobeStock_117491372 (3).jpgapart and let body parts slide into places they don’t belong. The abdomen is surrounded by muscles to keep the stomach, small intestine, and colon where they belong, but if one of these organs starts to slip though a weakness or a hole in the muscles, it’s called a hernia.

Other parts of the body can have organ herniation too. By definition, a hernia is a bulge or protrusion of an organ through a muscle or other structure that normally serves to keep it contained. However, when people talk about hernias, they are usually talking about the abdomen. While there are many types of abdominal hernias (hiatal, umbilical, or incisional), mentioning a hernia usually means they are talking about one in about the groin.

Risk factors for developing a hernia include:

  • family history
  • premature birth
  • chronic cough
  • constipation
  • lifting heavy weights
  • being overweight
  • smoking
  • Pregnancy

Surgery is often the only way to truly repair a hernia. Hernia repair can be done using traditional open surgery or minimally invasive surgery.

Open Surgery: With open surgery, a large incision is made in your abdomen that allows your surgeon’s hands to reach and touch your organs.

Minimally Invasive Surgery: Minimally invasive surgery is also known as laparoscopy. It is done through a few small incisions using long, thin surgical instruments and a tiny camera. The camera takes images inside your body and sends them to a video screen in the operating room to guide doctors during surgery.

da Vinci Surgery is another minimally invasive surgical option for adult patients facing abdominal hernia surgery. The da Vinci System features a magnified 3D HD vision system and special wristed instruments that bend and rotate far greater than the human hand. da Vinci technology enables your surgeon to operate with enhanced vision, precision, and control.

Early clinical data suggests: da Vinci Ventral Hernia Surgery offers the following potential benefits:

  • Low rate of pain
  • Low rate of the hernia returning
  • Low rate of surgeon switching to open surgery
  • Short hospital stay

Your doctor controls the da Vinci System, which translates his or her hand movements into smaller, precise movements of tiny instruments inside your body. Dr. Shawn Tsuda is one of a growing number of surgeons worldwide offering da Vinci ® Surgery. Schedule an appointment to discuss the best treatment for you.

Bariatric Surgery as a Last Resort for Teens and Children

SurgeryasaLastResortforTeensandChildrenThe epidemic of childhood obesity has brought an increase in obesity-related diseases including type 2 diabetes and nonalcoholic fatty liver disease (NAFLD). Of course, weight reduction through lifestyle change and diet is the best treatment for these conditions, but the long-term results are often disappointing. According to the Journal of Pediatric Gastroenterology and Nutrition, bariatric surgery — as a last resort when conservative interventions have failed — can improve liver disease and other obesity-related health problems in severely obese children and adolescents.

Although studies are limited, recent evidence suggests that in carefully selected patients an early intervention by bariatric surgery can strongly reduce the risk of adulthood obesity and obesity-related diseases, including NAFLD. Because of limited research data and the known risks of the procedure, the appropriate use of bariatric surgery in pediatric patients remains unclear.

Some believe that bariatric surgery should be limited to two groups of pediatric patients: those with body mass of 35 or higher (severe obesity), with severe NAFLD or other obesity-related medical conditions; and those with body mass index 40 or higher (morbid obesity), and mild medical conditions.

Several additional factors must be taken into account when considering bariatric surgery, including the patient’s physical and psychological maturity, desire to undergo the procedure, previous attempts at weight loss, and ability to comply with follow-up medical care. Also, which type of bariatric surgery should be performed? In adult patients, gastric bypass procedures (especially Roux-en-Y) are the most commonly used. However, concerns over the complex nutritional deficiencies occurring after these surgical procedures have limited their use in children and adolescents.

Temporary devices like the intragastric balloon are appealing for use in younger patients, as the effects are fully reversible. However, the data is limited on the use of these procedures in adolescents. The same is true for alternative procedures such as laparoscopic adjustable gastric banding and sleeve gastrectomy. All of these approaches should be considered investigational in pediatric patients.

Read more online at: http://www.sciencedaily.com/releases/2015/01/150119100822.htm