Tips for Finding the Right Surgeon for You

Almost any surgery can cause serious complications, so you always want to be in good surgical hands. With so many doctors, how do you know which is the right surgeon for you?

One indicator to note is how often surgeons perform a procedure. That can be vital for operations that are relatively new, such as gastric bypass surgery for treating obesity. While many surgeons have started performing the operation, not all are qualified. A September 2009 study found that the risk of serious complications from the most common form of gastric bypass surgery fell by 10 percent for every additional 10 cases per year the surgeon had performed.

However, quantity isn’t the only or even most important measure of quality. A May 2009 study of 81,289 adults who had heart bypass surgery, for example, found that success depended more on how well surgeons and hospitals adhered to various markers of surgical excellence—such as using the appropriate technique during the operation and prescribing the right medications before and afterward—than the number of procedures performed.

Don’t be afraid to question your doctor. Ask your prospective surgeon these questions before going under the knife:

  • Is surgery really 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. You don’t have to find the busiest, most experienced surgeon in North America, but it’s important to avoid the doctor who does very few of the procedures, especially in a place that does very few.
  • What are your success, failure, and complication rates? Not all will be able or willing to tell you, but the good ones should be.
  • What’s the hospital’s infection rate? Seventeen states now make that information public, and many hospitals report their rates voluntarily.

doctor-650534_960_720Just remember to worry less about bedside manner and more about the final outcome. If you have to choose between a nice surgeon and a highly skilled surgeon, the skilled surgeon is the better bet.

If you live in the Las Vegas area and are looking for a surgeon who is both compassionate and highly skilled, Dr. Tsuda at VIP Surg is everything you’re searching for. Whether you have general surgery needs or are interested in bariatric surgery, he and his team of experts have the experience and skill for you to have an excellent outcome.

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Bariatric Surgery: Impacting High Blood Pressure Through More Than Weight Loss

According to the Centers for Disease Control, about one in three U.S. adults has high blood pressure (hypertension). Risks include family history, advancing age, poor diet, consuming excessive amounts of alcohol, and being overweight or obese.

Lifestyle changes are a big part of controlling high blood pressure. The main tenets include:

  • Following a healthy diet, which may include reducing salt. The DASH (Dietary Approaches to Stop Hypertension) diet is often recommended. In addition to lowering salt intake, DASH is replete with fruits, vegetables, and low-fat or nonfat dairy. The diet emphasizes whole grains and is rich in potassium, magnesium, calcium and fiber.
  • Exercising regularly.
  • Maintaining a healthy weight.
  • Keeping stress levels at bay. (Stress can cause us to engage in unhealthy blood pressure-raising behaviors.)
  • Drinking only moderate amounts of alcohol.
  • Taking your medications as prescribed.

There are many types of prescription medications that can help control blood pressure and reduce the risk of heart attack or stroke. These medications may need to be taken for life to maintain their effect.

New research is showing, however, that bariatric surgery can allow obese people taking a lot of antihypertensive medications to cut way back on them. Study subjects’ blood pressure was maintained in the normal range with only one agent or even without drugs.

Within a year, those in a recent trial who had bariatric surgery were more than six times as likely to have cut back on their number of blood pressure (BP) medications by hypertension-867855__340about a third. Half of the surgical patients didn’t need any antihypertensive meds to maintain their BP at healthy levels. On the other hand, all of the “standard-care” patients in the study needed antihypertensive medications to keep BP that low, and half of them needed at least three different ones.

Interestingly, most patients in the gastric-bypass group achieved the primary end point in the first month of the postop period. That seems to indicate that something more is happening beyond just weight loss.

That something is likely to be related, at least in part, to the metabolic changes in the surgery group compared with the control group, which included significant improvements in fasting plasma glucose, HbA1c, LDL cholesterol, triglycerides, and high-sensitivity C-reactive protein in addition to the lowering of blood pressure.

If you live in the Las Vegas area and are wondering if bariatric surgery might be right for you, schedule an appointment at VIP Surg. Dr. Tsuda and his team can help find the right treatment for your unique situation.

 

Gallbladder Disease and Gallstones

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.

Your gallbladder is most likely to give you trouble if something blocks the flow of bile through the bile ducts. That is usually a gallstone. Gallstones form when substances in bile harden. Rarely, you can also get cancer in your gallbladder. Many gallbladder problems get better with removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways of reaching your small intestine.

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.

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 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.

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.Tsuda 11-18
  • 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 at VIP Surg.

Overcoming Genetics with Bariatric Surgery

Many of us have struggled with our weight. Whether it’s those 30 pounds of baby weight that have stubbornly hung around long after the baby was born or the 50 pounds gained after a back injury, weight gain is for many a constant struggle and a sensitive subject.

However, inactivity and poor diet are not the only causes of obesity. Research estimates that genetics determines at least 40 to 50 percent of our weight. Unfortunately, the specific genes are not well understood.

How can one overcome genetics? If everyone in your family is heavy, isn’t it a foregone conclusion that you will be heavy also? Not necessarily. Fortunately, we can level the genetics playing field with weight-loss surgery.

The most popular weight loss procedure in the United States is the laparoscopic sleeve gastrectomy. The surgery is minimally invasive, takes about an hour and requires an overnight stay in the hospital for most patients. The stomach, which regularly can hold about the volume of a football, is stapled and divided so that it is the shape and size of a banana.

Weight loss is achieved because the patient can no longer eat a large volume of food, and calories are proportionately decreased. The pylorus, the muscular valve at the outlet of the stomach, is left intact in this surgery. This also helps patients who have this procedure stay full.

Besides the effects of the procedure on restricting food volume, there is increasing evidence that the mechanisms in the brain that cause hunger are permanently modified by the sleeve gastrectomy. People state that they no longer feel hungry and no longer crave some of the high-calorie foods they used to.

Weight-loss surgery is a powerful tool in the hands of the patient, but it is not an “easyfix.” Sleeve gastrectomy requires commitment to healthy food choices and exercise on the part of the patient. The exciting news is that those struggling with obesity are not doomed to a life of aches and pains, poor health, and a miserable quality of life. There is help, and there is hope.

If you are in the Las Vegas area and are considering bariatric surgery, schedule an appointment with VIP Surg. Dr. Tsuda, Dr. Ryan, and their expert team can help find the right treatment for you.

Overweight Woman is Overjoyed

 

Robotic Surgery Explained

Screen Shot 2017-10-10 at 12.35.38 PMRobotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions. When performing surgery with the da Vinci Si—the world’s most advanced surgical robot—these miniaturized instruments are mounted on three separate robotic arms, allowing the surgeon maximum range of motion and precision. The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure.

The surgeon controls these instruments and the camera from a console located in the operating room. Placing his fingers into the master controls, he is able to operate all four arms of the da Vinci simultaneously while looking through a stereoscopic high-definition monitor that literally places him inside the patient, giving him a better, more detailed 3-D view of the operating site than the human eye can provide. Every movement he makes with the master controls is replicated precisely by the robot. When necessary, the surgeon can even change the scale of the robot’s movements: If he selects a three-to-one scale, the tip of the robot’s arm will move just one inch for every three inches the surgeon’s hand moves. And because of the console’s design, the surgeon’s eyes and hands are always perfectly aligned with his view of the surgical site, minimizing surgeon fatigue.

The ultimate effect is to give the surgeon unprecedented control in a minimally invasive environment. Utilizing this advanced technology, surgeons are able to perform a growing number of complex surgical procedures. Since these procedures can now be performed through very small incisions, patients experience a number of benefits compared to open surgery, including:

  • Less trauma on the body
  • Minimal scarring
  • Faster recovery times

If you’re facing general or bariatric surgery in the Las Vegas area, contact VIP SURG to learn about how we can help. Drs. Tsuda and Ryan specialize in minimally invasive procedures and are experts in robotic surgery. Call for a consultation at 702-487-6000.

Weight Loss after Gallbladder Surgery

If you have a tendency to develop painful gallstones, the remedy is usually removal of the gallbladder. This procedure is called a cholecystectomy. The gallbladder is the part of your digestive system that stores bile, which is produced in the liver. Bile helps with the digestion of fatty foods. Removing the gallbladder doesn’t stop the liver from making the bile necessary to digest fats. Instead of being stored in the gallbladder, the bile will continuously drip into your digestive system. Your digestive system will continue to function without a gallbladder. The surgery may affect your weight in the short term, but certain lifestyle changes may help you lose or maintain weight in the long term.3D illustration of male Gallbladder.

Fast facts on weight loss after gallbladder removal:

  • A person can live without their gallbladder.
  • When gallstones become a problem, surgery is usually required to remove the gallbladder.
  • It is not uncommon for people to lose a little weight after having a cholecystectomy.
  • There are several strategies, including exercise and diet that can be used to make this short-term weight loss a more permanent change.

There seems to be some connection between diet and gallstones. For example, obesity and rapid weight loss are risk factors for developing gallstones. There’s also an increased risk for gallstones if you have a diet high in refined carbohydrates and calories, but low in fiber.

After having your gallbladder removed, it’s quite possible that you’ll experience some weight loss. This may be because of:

  • Eliminating fatty foods: After surgery, you may have some trouble digesting fatty foods until your body adjusts. For that reason, your surgeon may instruct you to avoid high-fat and fried foods until your body is better able to handle them.
  • Eating a bland diet: During recovery, you may also find that spicy foods and foods that cause gas can lead to gastrointestinal upset. This can make you shy away from some of your favorite dishes.
  • Selecting smaller portions: For a few weeks after surgery, you may not be able to eat large amounts of food at one sitting. You’ll probably be advised to eat more frequent, but smaller meals.

During this time, you might be taking in fewer calories than you were before the surgery. If so, you’re likely to lose weight, at least temporarily. If you want to continue the trend, remember that short-term and quick weight-loss plans are not healthy and may make matters worse in the long run. Instead, strive to make weight loss part of an overall healthier way of living. That means making good dietary choices and engaging in regular exercise. It doesn’t mean starving or completely depriving yourself of the foods you love.

Living an active lifestyle is essential for weight loss after gallbladder removal. However, it is important to speak with your doctor about when it is appropriate to return to or begin an exercise routine after surgery. Someone with a significant amount of weight to lose should speak with their doctor for advice and support.

Despite having your gallbladder removed, it’s still possible to lose weight. If you have a lot of weight to lose, schedule a consultation with VIP SURG to learn how you can do it safely.
 

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