We’re happy to introduce Sarah Spano (aka LessOfSarah) as a speaker for the 2014 ObesityHelp Conference!
YOUTUBE LINK:
http://www.youtube.com/watch?v=ZQaovn3-Q-E
Workshop Session: With A Little Help From Your Friends: The Importance Of Support To Your Weight Loss Journey
If this is your first conference or your 10th, you won’t want to miss Sarah’s workshop! You’ll feel like you’ve just walked into a friend’s house…a friend that gets it, that understands. Sarah is going to be the vibrant friend that discusses the importance of making real connections and exploring community support on your weight loss journey and how it can contribute to your success.
The workshop will include discussion about…
In-person Support Groups
Online Support (ObesityHelp.com forums, YouTube etc.)
Social Media (Facebeook, Twitter, Instagram etc.)
Personal Support Network, Accountability Groups etc.
Attending Conferences, Meet n’ Greets
How to connect online
How to connect in person/locally
About Sarah
Sarah Spano (AKA LessOfSarah) is a loser – over 240 lbs and shrinking! Sarah is an active part of the weight loss surgery community on YouTube and Facebook, sharing her 18-month weight loss journey through 275+ candid videos.
Her key to WLS success? Support! Making connections in the community is something that Sarah is passionate about, and it’s been her favorite part of the WLS experience. In fact, you may have spotted Sarah at last year’s OH conference as part of the epic #TeamVSG Spice Girls group (she was Posh Spice).
Sarah is a mom to two beautiful boys and one handsome husband, a proud Canadian, an intense football fan, an avid traveler and has a wicked Starbucks addiction. And if it’s Sunday night, she’s probably singing karaoke.
Learn more about our 2014 ObesityHelp Conference Speaker line-up and purchase tickets on the event website.
Monday, April 21, 2014
No regrets after having weight loss surgery.
From obesityHelp.Com
booniedog
I had VSG surgery with Dr. Aceves at Almater Hospital on March 20. The entire experience was top-notch. From the time I inquired about surgery with Nina, Dr. Aceves' patient coordinator, I knew I was in good hands. She always responded to my questions within 24 hours and was very patient with me. I was having some doubts on the drive from San Diego to Mexicali, but meeting Dr. Aceves and talking with him completely took my doubts away. Dr. Aceves has a warm and compassionate manner and he thoroughly explained the surgery process, risks, and patient post-op responsibilities, and answered all of our questions with patience. Dr. Campos is great, too. He has a witty sense of humor and gave detailed instructions regarding post-op eating and nutrition.
Karla and Yolanda are fantastic, as are all of the nurses I met. Ernesto, the driver, was sweet and funny. I had the feeling I was being taken care of by a big, warm, competent family. Drs. Aceves and Campos checked in on me a couple of times each day and were always happy to answer any questions I had. The hospital itself is clean, quiet, and in a safe location. Any time I felt discomfort or pain, my needs were immediately taken care of. I had no problems communicating with any of the nurses and my Spanish is really bad. They provide a list of common phrases in English/Spanish that will come in handy if you speak no Spanish.
Before I even checked in to my hotel in San Diego after surgery, I received an email from Gaby, the after-care coordinator. Gaby is always prompt to answer my questions and I've never felt like I was alone in my recovery, even though I live so far away.
If I could give Dr. Aceves and his wonderful team a 10 star rating, I would. I simply can't recommend him enough.
(My insurance would have covered this procedure but I chose to pay out of pocket to avoid jumping through the ridiculous hoops required. I'd read so many reviews of Dr. Aceves and was confident he was the most qualified and best option for me. I'm so glad I did. My incisions were unbelievably tiny and they healed up very quickly. I was back to work 10 days post-surgery with abundant energy. None of my colleagues know or even suspected I'd had surgery.)
April 26, 2014
Ingrid Tejada
Guys this surgery has change my life... I've not felt this happy in such a long time! Can't wait to see myself 4 more month from now. Stay strong, focus... Drink your water and protein shakes you will see your results!!! All it takes is patience and don't go to your old self trying those sweets and bad eating habits. Pre-plan your meals for the day 2oz-4oz a meal at a time , then put in your fluids an hour later. Lastly working out!! I've been since day 3from surgery !! You all have the key instruction from the doctor and if you do as they say, it works
Gina Bullock
Never ever not once ever regretted my decision to have surgery. It was the best decision I ever could have made for myself. You can do this you want to live you want to be happy and healthy and be there for your family.
Nancy
I felt that that way too but , my weight was a big issue too so go for it you will c that it's all worth it.
Jessica
I haven't read anyone on any message board that has regretted it, even the few with complications (not normal). Everyone always seems to say they just regret not doing it sooner
Sue
Best thing I ever did for me !
January Kolar
No regrets...look at it in a different manner...how many kids do you have? How many grand children do you have? How long have you been married? Do you value watching them grow up? You will be around so much longer to be there for all of them. My children and grand children will have me for many yrs because of the surgery. ..is your life worth $8000 mine was divide your surgery dollar between the members of your family...then by another 20 yrs and ill bet you'll come up with a small miniscule number that your hubby and children and grandchildren will feel it is way worth it!!!
Christa Gill
I never regretted a penny it gave me back my life I am a way better mother because I am not caring another person around with me every minute of every day!
Loni Turner
If I had to max every credit card and take a second mortgage I would do it again
Jen
No regrets here either! I'm only 4 weeks out today, and we had to pay out of pocket for the entire thing! My husband was happy to do it, because he didn't want to lose me, or have to raise our kids alone... That was a possibility eventually! I'm down 47 lbs today and already have more energy than I have in years. It's worth it!
Michelle
I think it is natural for us to feel some amount of guilt. After all, we spend our lives taking care of everyone else EXCEPT us Consider it an investment in your health and your future. I could have used the money for all sorts of other things that would have brought some temporary pleasure....but deciding to using for the sleeve was the best decision I could have made. There are no regrets and I love the way my clothes are hanging on me right now Make the decision and be at peace with it - you will be happy that you did.
Beth
I'm almost 3 years out and don't miss a single, solitary thing from my 'fat' life. Hubby just returned from his VSG as well - that's around $18,000 spent between the two of us that could have gone to so many more things - kids' college, a used car, a really nice vacation abroad - but we were more than willing to instead invest in our health. No regrets here!
Carol
sleeved Nov 27, 2013. no regrets to this point. maybe could have done it 10 years sooner.
Christine
You are worth every penny and you absolutly will NOT regret it. Best desision Ive ever made
Leah
Think of how much it would cost you and your family if you had a heart attack or stroke... Sorry to be blunt... I play with my kids now and go dancing with my friends! I have my life back and LOVE every second of it! My only regret is not doing it ten years ago. Don't feel guilty ... do it FOR your family! They will love you much more alive!
booniedog
I had VSG surgery with Dr. Aceves at Almater Hospital on March 20. The entire experience was top-notch. From the time I inquired about surgery with Nina, Dr. Aceves' patient coordinator, I knew I was in good hands. She always responded to my questions within 24 hours and was very patient with me. I was having some doubts on the drive from San Diego to Mexicali, but meeting Dr. Aceves and talking with him completely took my doubts away. Dr. Aceves has a warm and compassionate manner and he thoroughly explained the surgery process, risks, and patient post-op responsibilities, and answered all of our questions with patience. Dr. Campos is great, too. He has a witty sense of humor and gave detailed instructions regarding post-op eating and nutrition.
Karla and Yolanda are fantastic, as are all of the nurses I met. Ernesto, the driver, was sweet and funny. I had the feeling I was being taken care of by a big, warm, competent family. Drs. Aceves and Campos checked in on me a couple of times each day and were always happy to answer any questions I had. The hospital itself is clean, quiet, and in a safe location. Any time I felt discomfort or pain, my needs were immediately taken care of. I had no problems communicating with any of the nurses and my Spanish is really bad. They provide a list of common phrases in English/Spanish that will come in handy if you speak no Spanish.
Before I even checked in to my hotel in San Diego after surgery, I received an email from Gaby, the after-care coordinator. Gaby is always prompt to answer my questions and I've never felt like I was alone in my recovery, even though I live so far away.
If I could give Dr. Aceves and his wonderful team a 10 star rating, I would. I simply can't recommend him enough.
(My insurance would have covered this procedure but I chose to pay out of pocket to avoid jumping through the ridiculous hoops required. I'd read so many reviews of Dr. Aceves and was confident he was the most qualified and best option for me. I'm so glad I did. My incisions were unbelievably tiny and they healed up very quickly. I was back to work 10 days post-surgery with abundant energy. None of my colleagues know or even suspected I'd had surgery.)
April 26, 2014
Ingrid Tejada
Guys this surgery has change my life... I've not felt this happy in such a long time! Can't wait to see myself 4 more month from now. Stay strong, focus... Drink your water and protein shakes you will see your results!!! All it takes is patience and don't go to your old self trying those sweets and bad eating habits. Pre-plan your meals for the day 2oz-4oz a meal at a time , then put in your fluids an hour later. Lastly working out!! I've been since day 3from surgery !! You all have the key instruction from the doctor and if you do as they say, it works
Gina Bullock
Never ever not once ever regretted my decision to have surgery. It was the best decision I ever could have made for myself. You can do this you want to live you want to be happy and healthy and be there for your family.
Nancy
I felt that that way too but , my weight was a big issue too so go for it you will c that it's all worth it.
Jessica
I haven't read anyone on any message board that has regretted it, even the few with complications (not normal). Everyone always seems to say they just regret not doing it sooner
Sue
Best thing I ever did for me !
January Kolar
No regrets...look at it in a different manner...how many kids do you have? How many grand children do you have? How long have you been married? Do you value watching them grow up? You will be around so much longer to be there for all of them. My children and grand children will have me for many yrs because of the surgery. ..is your life worth $8000 mine was divide your surgery dollar between the members of your family...then by another 20 yrs and ill bet you'll come up with a small miniscule number that your hubby and children and grandchildren will feel it is way worth it!!!
Christa Gill
I never regretted a penny it gave me back my life I am a way better mother because I am not caring another person around with me every minute of every day!
Loni Turner
If I had to max every credit card and take a second mortgage I would do it again
Jen
No regrets here either! I'm only 4 weeks out today, and we had to pay out of pocket for the entire thing! My husband was happy to do it, because he didn't want to lose me, or have to raise our kids alone... That was a possibility eventually! I'm down 47 lbs today and already have more energy than I have in years. It's worth it!
Michelle
I think it is natural for us to feel some amount of guilt. After all, we spend our lives taking care of everyone else EXCEPT us Consider it an investment in your health and your future. I could have used the money for all sorts of other things that would have brought some temporary pleasure....but deciding to using for the sleeve was the best decision I could have made. There are no regrets and I love the way my clothes are hanging on me right now Make the decision and be at peace with it - you will be happy that you did.
Beth
I'm almost 3 years out and don't miss a single, solitary thing from my 'fat' life. Hubby just returned from his VSG as well - that's around $18,000 spent between the two of us that could have gone to so many more things - kids' college, a used car, a really nice vacation abroad - but we were more than willing to instead invest in our health. No regrets here!
Carol
sleeved Nov 27, 2013. no regrets to this point. maybe could have done it 10 years sooner.
Christine
You are worth every penny and you absolutly will NOT regret it. Best desision Ive ever made
Leah
Think of how much it would cost you and your family if you had a heart attack or stroke... Sorry to be blunt... I play with my kids now and go dancing with my friends! I have my life back and LOVE every second of it! My only regret is not doing it ten years ago. Don't feel guilty ... do it FOR your family! They will love you much more alive!
Monday, April 7, 2014
Dr. Alberto Aceves Patient / Five years after surgery.
Kristen Kloth
HI Dr Aceves and Team -
A friend of mine (Scott Lachance) was just down at your facility last week to have sleeve surgery and he said that you were eager to hear from people who are 5 years out about how they are doing.
You did my surgery in January of 2009 and I believe I weighed right around 272 pounds. I am currently at 155 pounds, a weight that I have maintained since hitting a low of 142 (I looked too thin).
I feel great, have no residual health problems... and although I am on a low dose of blood pressure meds due to genetics I am 10,000 times healthier than I was when I walked into the hospital for my surgery. I'm looking forward to Scott having the same success I did.
Thank you for what you did for me,
Kristen Kloth
HI Dr Aceves and Team -
A friend of mine (Scott Lachance) was just down at your facility last week to have sleeve surgery and he said that you were eager to hear from people who are 5 years out about how they are doing.
You did my surgery in January of 2009 and I believe I weighed right around 272 pounds. I am currently at 155 pounds, a weight that I have maintained since hitting a low of 142 (I looked too thin).
I feel great, have no residual health problems... and although I am on a low dose of blood pressure meds due to genetics I am 10,000 times healthier than I was when I walked into the hospital for my surgery. I'm looking forward to Scott having the same success I did.
Thank you for what you did for me,
Kristen Kloth
Wednesday, April 2, 2014
WHY SHOULD I CONSIDER UNDERGOING ANOTHER WEIGHT LOSS SURGICAL PROCEDURE, THIS TIME A REVISION BARIATRIC SURGERY?
• Weight Regain and / or Inadequate Weight Loss
These are the most common reasons to undergo Revision Weight Loss Surgery, since just not every single individual fits into the "average patient" profile, so weight loss doesn't happen with any single bariatric surgery in the same quantities happening with average patients. Since there are different kinds of bariatric surgical procedures, sometimes a surgery that did the job for a certain set of patients will accomplish or not the exact same achievements it does for another individual, and this feat is also due to different reasons...
- Some persons have a hard time or total inadequacy at adapting to the new lifestyle that should be engaged after a particular bariatric procedure
- A specific kind of procedure does not properly address a certain patient's metabolic needs
- The anatomical changes happening to the patient's biology during bariatric surgery are not maintained afterwards
The bariatric surgical procedure can fail due to some or all of the above mentioned reasons. Before deciding to undergo Revision surgery, it's very important to establish whether the bariatric weight loss procedure was inadequate for the patient or rather if the patient failed to the surgery (and therefore to the whole weight-loss process). Sometimes, a patient does not receive enough information previous to undergoing a bariatric surgical procedure in order to select the best procedure according to his/her biology, needs and/or expectations; other times a patient is not properly instructed about the necessary changes in eating and/or exercising behavior after a weight loss surgery in order for the procedure to work the best for them; these delicate procedures require a full heads-on follow-up from patients in order to keep being successful in the long term, following instructions from specialists as not to gain back undesired weight.
It is often that the bariatric surgery's failure is due to metabolically and/or mechanical problems. The latter are caused due to anatomical changes (made during first time weight loss surgery) not being maintained in the short to mid-term after an intervention, some of these examples are:
- Pouch enlargement
- Gastric pouch outlet's diameter increases
- A gastric fistula (also gastro fistula) has recently formed between the bypassed stomach and the gastric pouch
- The intestine's absorbing qualities may have increased beyond expectations
- Restriction decreases due to band slippage
In most of the above cases, the best solution is restoring an environment allowing proper weight loss by reconstruction of the anatomy's shape during the first bariatric procedure. Dilated, stretched or enlarged pouches can be subject to a re-trimming. This kind of fix requires a band placed around a dilated gastric bypass outlet. Previously, it was suggested to re-staple any deteriorated staple lines of gastroplasty procedures; but because of high rates of long term failure for gastroplasty procedures, it has been recommended that these should be converted to a different bariatric surgical procedure.
Sometimes bariatric weight loss surgical procedures simply do not meet what a particular patient's metabolism needs.
Aside from the detailed processes involving any bariatric weight loss surgery kind, it is just part of a complete goal: losing weight, avoid gaining back any more weight as not to become overweight again and thus provide a healthy lifestyle during the rest of the patient's lifetime. All of this means that the success measure of this feat goes beyond eating properly. Any person's metabolism influences weight loss and same-weight maintenance, and any failure of these sorts is considered a Metabolic Failure. Meanwhile corrective surgery attempts to turn the anatomy back to its previous shape, the correction of metabolic failure implies a patient's conversion through a kind of bariatric weight loss procedure more metabolically active; for example converting a Gastric Bypass (also known as RNY) to a Duodenal Switch (or DS), as opposite to just re-trimming the gastric pouch.
• Weight loss and comorbidities (also known as polypathy)
The failure to address and heal/stop any other illnesses or affecting conditions after a weight loss procedure is also a much-recurred reason to consider undergoing a revision or conversion bariatric surgical procedure. The unsatisfactory resolution of other illnesses is normally related to factors that cause metabolic failure, thus resulting in insufficient weight loss. A condition displaying metabolism failure and other comorbidites need a conversion of the failed bariatric surgery towards an improved metabolic activity derived as end result of a surgery.
• Medical Complications
As with many other kinds of surgeries and also different body biology within many different patients, sometimes an individual presents medical complications due to bariatric weight loss surgery which must receive Revision Bariatric Surgery. In some occasions, the medical complications receiving revision surgery will be treated pretty much in the way of previously discussed mechanical and metabolic failure; others may be apt for reversal of the first-time surgery while preserving weight-loss. Some of the medical conditions subject to revision surgery include:
- Anemia (iron, thiamine and other minerals and vitamin deficiency)
- Malnutrition
- Metabolic bone disease
- Severe malabsorption
- Severe dumping syndrome
- Stricture
- Ulcer
Laparascopic Banding / Lap Band Revision Surgery as a Remedy
The possibility of Lap Band failure due to band slippage -leading to a slow chronic condition or in need of immediate attention- requires the patient to go through emergency surgery. When the lap band is not working the way it is meant to, the issue may be solved by removing the Lap Band, repositioning the Lap Band or replacing it altogether. Removing the band will -of course- take the patient back to potential weight gain.
Another complication derived from Lap Band Surgery is Lap Band erosion happening for a number of reasons: from not enough bloodflow into the part of the stomach where the Lap Band is placed to friction in this same area; the band becomes ineffective and weight is gained again. Some of lap band erosion's symptoms is blood vomit, and another symptom is an infection around the port's side. Because of this erosion, saliva keeps leaking through overtures in the stomach and flows into the Lap Band tubing, which causes tissue under the skin of the Lap Band port to become infected. As told, the band removal leaves the patient in a condition as if he hadn't been through weight loss surgery, with -of course- weight regain. So it is recommended that Lap Band erosions receive the treatment in order to convert the process into Vertical Sleeve Gastrectomy (VSG), Duodenal Switch (DS) or Ileal Transposition. Considering a portion of the stomach may be weakened and prone to further leakage; all of these procedures may be completed with some trimming of the affected area.
Lap Band surgery still can fail for a number of different reasons, thus requiring Revision Bariatric Surgery. With Lap Band being a restrictive weight loss surgery, some patients' bodies' metabolism is not proper to help weight loss through a Lap Band procedure. Other cases regard patients not being able to change their eating habits the way it should be in order to embark in a successful process and, as a consequence, the usual weight gain is brought back. Failed attempts at Lap Band surgery can be converted to other kind of weight loss procedure, considering that those surgeries more likely to succeed are the ones which go beyond restrictive weight loss surgery into turning the body into a more metabolically active organism. There's more than enough evidence proving that in the long run, properly managed Lap Band surgery processes are about as efficient as Gastric Bypass (RNY), as in the aftermath both procedures imply keeping a restrictive diet due to reduced size gastric pouches. For patient conversion from a Lap Band failure into Gastric Bypass Surgery, there are risks of leak development as well as marginal results.
Finally, for individuals looking no further than restrictive bariatric weight loss surgery, Vertical Sleeve Gastrectomy (VSG) is their option. Vertical Sleeve Gastrectomy remains limited to the patients' metabolism and the metabolic activity of surgery in itself. But VSG produces better long-term results than Lap Band. Ileal Transposition and Duodenal Switch (DS) both provide the patient of a metabolic process able to cause weight loss besides restriction. Patients subject to Ileal Transposition or Duodenal Switch are subject of weight loss advantages beyond those the Lap Band procedure offers.
Laparascopic Banding / Lap Band Revision Surgery as a Remedy
The possibility of Lap Band failure due to band slippage -leading to a slow chronic condition or in need of immediate attention- requires the patient to go through emergency surgery. When the lap band is not working the way it is meant to, the issue may be solved by removing the Lap Band, repositioning the Lap Band or replacing it altogether. Removing the band will -of course- take the patient back to potential weight gain.
Another complication derived from Lap Band Surgery is Lap Band erosion happening for a number of reasons: from not enough bloodflow into the part of the stomach where the Lap Band is placed to friction in this same area; the band becomes ineffective and weight is gained again. Some of lap band erosion's symptoms is blood vomit, and another symptom is an infection around the port's side. Because of this erosion, saliva keeps leaking through overtures in the stomach and flows into the Lap Band tubing, which causes tissue under the skin of the Lap Band port to become infected. As told, the band removal leaves the patient in a condition as if he hadn't been through weight loss surgery, with -of course- weight regain. So it is recommended that Lap Band erosions receive the treatment in order to convert the process into Vertical Sleeve Gastrectomy (VSG), Duodenal Switch (DS) or Ileal Transposition. Considering a portion of the stomach may be weakened and prone to further leakage; all of these procedures may be completed with some trimming of the affected area.
Lap Band surgery still can fail for a number of different reasons, thus requiring Revision Bariatric Surgery. With Lap Band being a restrictive weight loss surgery, some patients' bodies' metabolism is not proper to help weight loss through a Lap Band procedure. Other cases regard patients not being able to change their eating habits the way it should be in order to embark in a successful process and, as a consequence, the usual weight gain is brought back. Failed attempts at Lap Band surgery can be converted to other kind of weight loss procedure, considering that those surgeries more likely to succeed are the ones which go beyond restrictive weight loss surgery into turning the body into a more metabolically active organism. There's more than enough evidence proving that in the long run, properly managed Lap Band surgery processes are about as efficient as Gastric Bypass (RNY), as in the aftermath both procedures imply keeping a restrictive diet due to reduced size gastric pouches. For patient conversion from a Lap Band failure into Gastric Bypass Surgery, there are risks of leak development as well as marginal results.
Finally, for individuals looking no further than restrictive bariatric weight loss surgery, Vertical Sleeve Gastrectomy (VSG) is their option. Vertical Sleeve Gastrectomy remains limited to the patients' metabolism and the metabolic activity of surgery in itself. But VSG produces better long-term results than Lap Band. Ileal Transposition and Duodenal Switch (DS) both provide the patient of a metabolic process able to cause weight loss besides restriction. Patients subject to Ileal Transposition or Duodenal Switch are subject of weight loss advantages beyond those the Lap Band procedure offers.
Vertical Sleeve Gastrectomy (VSG) Revision Surgery
Even though Vertical Sleeve Gastrectomy (VSG) is one the most effective kind of surgeries regarding weight loss, there are a number of patients not losing enough weight after undergoing this operation, so Revision Weight Loss Surgery is sometimes required in order to obtain the desired weight loss. The following are the two most common beliefs causing VSG surgery failure:
- For a stretched stomach, undergoing re-sleeving via a Revision Surgery may be enough
- In some other cases, a Duodenal Switch or Ileal Transpositon should be performed so patients improve a certain metabolic and/or food malabsorptive aspect of their entire process, thus completing the purpose of a Vertical Sleeve Gastrectomy.
When undergoing the process of a Revision Surgery with the purpose to switch from Vertical Sleeve Gastrectomy to a Duodenal Switch, there is less risk than that of performing the latter as a first-time weight loss surgery, because a completed VSG surgery involves part of the process that the Duodenal Switch surgery requires, thus resulting in a shorter procedure.
Stretching the stomach is not always the best procedure, since it may cause other problems different than regaining weight or inadequate weight loss. The stomach’s tube may stretch in a non-uniform manner, thus having parts of the stomach tube larger than the others and the stomach takes the shape of an hourglass, with the upstream and downstream portions being large and separated by a very narrow part. Food intake in itself does not increase because of this reason, but it sure causes disordered and/or uncomfortable eating. Depending on the symptoms a patient presents and the volume of food consumption, there are two revision options resulting in a more direct food flow through the stomach.
Duodenal Switch (DS) Revision Surgery
With weight loss surgery in general being in whole a recently developed series of surgical procedures, we are all becoming more adept at completely understanding and striking the balance between malnutrition and proper weight loss. As of today, about 2% to 5% of patients that had been through Duodenal Switch are possible candidates for Revision Weight Loss Surgery. The number of individuals having to go through Revision Surgery after DS will certainly decrease, though not eradicated entirely. These are usual reasons for Duodenal Switch revision:
- Excess weight loss
- Inadequate weight loss
- Malabsorption / nutritional deficiencies
Excess weight loss and nutritional deficiencies are conditions that clearly require Revision surgery after Duodenal Switch, and more than often these happen simultaneously. In this cases timing is a factor upon which much of the success of a remedy depends on. With the passing of time, the possible malabsorptive effect after undergoing Duodenal Switch will decrease as the intestine evolves by increasingly improving protein and other nutrients absorption. This means Duodenal Switch revision shouldn't be considered too early for patients suffering from malabsorptive complications; conservative therapy is much rather recommended before undergoing Revision surgery, so the intestine's increase in abilities develop within enough time. If this time lapse seems interrupted by Revision surgery, then the patient risks excessive weight re-gain after the intestine increases its full absorptive capacity.
Malabsorptive complications due to Duodenal Switch usually require elongation (adding intestinal length). To attain the desired results in the common limb, elongation can be achieved by using the biliopancreatic limb. For common elongation surgery, then the alimentary and common limbs must be elonged, thus providing protein, starch and fat absorption of additional surface area. An increase in fat absorption abilities helps the body's ability to absorb soluble vitamins such as vitamin D. In fact, the revision procedure treatment after Duodenal Switch surgery will treat both excessive weight loss as well as the patient's ability to absorb fat soluble vitamins.
Enteroenterostomy, also known as "the kissing X" is the most simple revision surgery procedure able to increase both common and alimentary limbs length by just a single connection to the small intestine. Patients are enabled to keep a certain level of weight loss due to the "neuro-endocrine brake" effect, which is also the cause for weight loss after Ileal Transposition surgery
Ileal Transposition is also a recurring procedure when a calcium and iron malabsorption condition is present after Duodenal Switch; this surgery is the mean of intestinal elongation providing remedy for such cases, in which the conventional Ileal Transposition is replaced by the same procedure done at the duodenum level, without the need to re-connect such organ. This isn't considered an easy procedure, since only a segment of the alimentary limb may be used to perform the transposition in what is known as High Duodenal Ileal Transposition. What is left of the alimentary limb takes part in the "Parallel Ileal Transposition", which is done at the level of the biliopancreatic limb and which joins the food flow resulting from the above mentioned (and performed) High Duodenal Ileal Transposition. Calcium and iron absorption restoration is accomplished through this procedure without a complete reversal of the Duodenal Switch procedure.
Sometimes after the initial weight loss happening by the Duodenal Switch procedure, some patients may experience inadequate weight loss or weight re-gain. Assuming that there have been failed non-surgical weight loss attempts, two theoretical approaches to solve this problem are considered:
- Reducing the stomach size
- Shortening of the common limb's length
In North America, stomach size reduction seems to achieve better results than common limb length's shortening, even though results of these revisions may vary.
These are the most common reasons to undergo Revision Weight Loss Surgery, since just not every single individual fits into the "average patient" profile, so weight loss doesn't happen with any single bariatric surgery in the same quantities happening with average patients. Since there are different kinds of bariatric surgical procedures, sometimes a surgery that did the job for a certain set of patients will accomplish or not the exact same achievements it does for another individual, and this feat is also due to different reasons...
- Some persons have a hard time or total inadequacy at adapting to the new lifestyle that should be engaged after a particular bariatric procedure
- A specific kind of procedure does not properly address a certain patient's metabolic needs
- The anatomical changes happening to the patient's biology during bariatric surgery are not maintained afterwards
The bariatric surgical procedure can fail due to some or all of the above mentioned reasons. Before deciding to undergo Revision surgery, it's very important to establish whether the bariatric weight loss procedure was inadequate for the patient or rather if the patient failed to the surgery (and therefore to the whole weight-loss process). Sometimes, a patient does not receive enough information previous to undergoing a bariatric surgical procedure in order to select the best procedure according to his/her biology, needs and/or expectations; other times a patient is not properly instructed about the necessary changes in eating and/or exercising behavior after a weight loss surgery in order for the procedure to work the best for them; these delicate procedures require a full heads-on follow-up from patients in order to keep being successful in the long term, following instructions from specialists as not to gain back undesired weight.
It is often that the bariatric surgery's failure is due to metabolically and/or mechanical problems. The latter are caused due to anatomical changes (made during first time weight loss surgery) not being maintained in the short to mid-term after an intervention, some of these examples are:
- Pouch enlargement
- Gastric pouch outlet's diameter increases
- A gastric fistula (also gastro fistula) has recently formed between the bypassed stomach and the gastric pouch
- The intestine's absorbing qualities may have increased beyond expectations
- Restriction decreases due to band slippage
In most of the above cases, the best solution is restoring an environment allowing proper weight loss by reconstruction of the anatomy's shape during the first bariatric procedure. Dilated, stretched or enlarged pouches can be subject to a re-trimming. This kind of fix requires a band placed around a dilated gastric bypass outlet. Previously, it was suggested to re-staple any deteriorated staple lines of gastroplasty procedures; but because of high rates of long term failure for gastroplasty procedures, it has been recommended that these should be converted to a different bariatric surgical procedure.
Sometimes bariatric weight loss surgical procedures simply do not meet what a particular patient's metabolism needs.
Aside from the detailed processes involving any bariatric weight loss surgery kind, it is just part of a complete goal: losing weight, avoid gaining back any more weight as not to become overweight again and thus provide a healthy lifestyle during the rest of the patient's lifetime. All of this means that the success measure of this feat goes beyond eating properly. Any person's metabolism influences weight loss and same-weight maintenance, and any failure of these sorts is considered a Metabolic Failure. Meanwhile corrective surgery attempts to turn the anatomy back to its previous shape, the correction of metabolic failure implies a patient's conversion through a kind of bariatric weight loss procedure more metabolically active; for example converting a Gastric Bypass (also known as RNY) to a Duodenal Switch (or DS), as opposite to just re-trimming the gastric pouch.
• Weight loss and comorbidities (also known as polypathy)
The failure to address and heal/stop any other illnesses or affecting conditions after a weight loss procedure is also a much-recurred reason to consider undergoing a revision or conversion bariatric surgical procedure. The unsatisfactory resolution of other illnesses is normally related to factors that cause metabolic failure, thus resulting in insufficient weight loss. A condition displaying metabolism failure and other comorbidites need a conversion of the failed bariatric surgery towards an improved metabolic activity derived as end result of a surgery.
• Medical Complications
As with many other kinds of surgeries and also different body biology within many different patients, sometimes an individual presents medical complications due to bariatric weight loss surgery which must receive Revision Bariatric Surgery. In some occasions, the medical complications receiving revision surgery will be treated pretty much in the way of previously discussed mechanical and metabolic failure; others may be apt for reversal of the first-time surgery while preserving weight-loss. Some of the medical conditions subject to revision surgery include:
- Anemia (iron, thiamine and other minerals and vitamin deficiency)
- Malnutrition
- Metabolic bone disease
- Severe malabsorption
- Severe dumping syndrome
- Stricture
- Ulcer
Laparascopic Banding / Lap Band Revision Surgery as a Remedy
The possibility of Lap Band failure due to band slippage -leading to a slow chronic condition or in need of immediate attention- requires the patient to go through emergency surgery. When the lap band is not working the way it is meant to, the issue may be solved by removing the Lap Band, repositioning the Lap Band or replacing it altogether. Removing the band will -of course- take the patient back to potential weight gain.
Another complication derived from Lap Band Surgery is Lap Band erosion happening for a number of reasons: from not enough bloodflow into the part of the stomach where the Lap Band is placed to friction in this same area; the band becomes ineffective and weight is gained again. Some of lap band erosion's symptoms is blood vomit, and another symptom is an infection around the port's side. Because of this erosion, saliva keeps leaking through overtures in the stomach and flows into the Lap Band tubing, which causes tissue under the skin of the Lap Band port to become infected. As told, the band removal leaves the patient in a condition as if he hadn't been through weight loss surgery, with -of course- weight regain. So it is recommended that Lap Band erosions receive the treatment in order to convert the process into Vertical Sleeve Gastrectomy (VSG), Duodenal Switch (DS) or Ileal Transposition. Considering a portion of the stomach may be weakened and prone to further leakage; all of these procedures may be completed with some trimming of the affected area.
Lap Band surgery still can fail for a number of different reasons, thus requiring Revision Bariatric Surgery. With Lap Band being a restrictive weight loss surgery, some patients' bodies' metabolism is not proper to help weight loss through a Lap Band procedure. Other cases regard patients not being able to change their eating habits the way it should be in order to embark in a successful process and, as a consequence, the usual weight gain is brought back. Failed attempts at Lap Band surgery can be converted to other kind of weight loss procedure, considering that those surgeries more likely to succeed are the ones which go beyond restrictive weight loss surgery into turning the body into a more metabolically active organism. There's more than enough evidence proving that in the long run, properly managed Lap Band surgery processes are about as efficient as Gastric Bypass (RNY), as in the aftermath both procedures imply keeping a restrictive diet due to reduced size gastric pouches. For patient conversion from a Lap Band failure into Gastric Bypass Surgery, there are risks of leak development as well as marginal results.
Finally, for individuals looking no further than restrictive bariatric weight loss surgery, Vertical Sleeve Gastrectomy (VSG) is their option. Vertical Sleeve Gastrectomy remains limited to the patients' metabolism and the metabolic activity of surgery in itself. But VSG produces better long-term results than Lap Band. Ileal Transposition and Duodenal Switch (DS) both provide the patient of a metabolic process able to cause weight loss besides restriction. Patients subject to Ileal Transposition or Duodenal Switch are subject of weight loss advantages beyond those the Lap Band procedure offers.
Laparascopic Banding / Lap Band Revision Surgery as a Remedy
The possibility of Lap Band failure due to band slippage -leading to a slow chronic condition or in need of immediate attention- requires the patient to go through emergency surgery. When the lap band is not working the way it is meant to, the issue may be solved by removing the Lap Band, repositioning the Lap Band or replacing it altogether. Removing the band will -of course- take the patient back to potential weight gain.
Another complication derived from Lap Band Surgery is Lap Band erosion happening for a number of reasons: from not enough bloodflow into the part of the stomach where the Lap Band is placed to friction in this same area; the band becomes ineffective and weight is gained again. Some of lap band erosion's symptoms is blood vomit, and another symptom is an infection around the port's side. Because of this erosion, saliva keeps leaking through overtures in the stomach and flows into the Lap Band tubing, which causes tissue under the skin of the Lap Band port to become infected. As told, the band removal leaves the patient in a condition as if he hadn't been through weight loss surgery, with -of course- weight regain. So it is recommended that Lap Band erosions receive the treatment in order to convert the process into Vertical Sleeve Gastrectomy (VSG), Duodenal Switch (DS) or Ileal Transposition. Considering a portion of the stomach may be weakened and prone to further leakage; all of these procedures may be completed with some trimming of the affected area.
Lap Band surgery still can fail for a number of different reasons, thus requiring Revision Bariatric Surgery. With Lap Band being a restrictive weight loss surgery, some patients' bodies' metabolism is not proper to help weight loss through a Lap Band procedure. Other cases regard patients not being able to change their eating habits the way it should be in order to embark in a successful process and, as a consequence, the usual weight gain is brought back. Failed attempts at Lap Band surgery can be converted to other kind of weight loss procedure, considering that those surgeries more likely to succeed are the ones which go beyond restrictive weight loss surgery into turning the body into a more metabolically active organism. There's more than enough evidence proving that in the long run, properly managed Lap Band surgery processes are about as efficient as Gastric Bypass (RNY), as in the aftermath both procedures imply keeping a restrictive diet due to reduced size gastric pouches. For patient conversion from a Lap Band failure into Gastric Bypass Surgery, there are risks of leak development as well as marginal results.
Finally, for individuals looking no further than restrictive bariatric weight loss surgery, Vertical Sleeve Gastrectomy (VSG) is their option. Vertical Sleeve Gastrectomy remains limited to the patients' metabolism and the metabolic activity of surgery in itself. But VSG produces better long-term results than Lap Band. Ileal Transposition and Duodenal Switch (DS) both provide the patient of a metabolic process able to cause weight loss besides restriction. Patients subject to Ileal Transposition or Duodenal Switch are subject of weight loss advantages beyond those the Lap Band procedure offers.
Vertical Sleeve Gastrectomy (VSG) Revision Surgery
Even though Vertical Sleeve Gastrectomy (VSG) is one the most effective kind of surgeries regarding weight loss, there are a number of patients not losing enough weight after undergoing this operation, so Revision Weight Loss Surgery is sometimes required in order to obtain the desired weight loss. The following are the two most common beliefs causing VSG surgery failure:
- For a stretched stomach, undergoing re-sleeving via a Revision Surgery may be enough
- In some other cases, a Duodenal Switch or Ileal Transpositon should be performed so patients improve a certain metabolic and/or food malabsorptive aspect of their entire process, thus completing the purpose of a Vertical Sleeve Gastrectomy.
When undergoing the process of a Revision Surgery with the purpose to switch from Vertical Sleeve Gastrectomy to a Duodenal Switch, there is less risk than that of performing the latter as a first-time weight loss surgery, because a completed VSG surgery involves part of the process that the Duodenal Switch surgery requires, thus resulting in a shorter procedure.
Stretching the stomach is not always the best procedure, since it may cause other problems different than regaining weight or inadequate weight loss. The stomach’s tube may stretch in a non-uniform manner, thus having parts of the stomach tube larger than the others and the stomach takes the shape of an hourglass, with the upstream and downstream portions being large and separated by a very narrow part. Food intake in itself does not increase because of this reason, but it sure causes disordered and/or uncomfortable eating. Depending on the symptoms a patient presents and the volume of food consumption, there are two revision options resulting in a more direct food flow through the stomach.
Duodenal Switch (DS) Revision Surgery
With weight loss surgery in general being in whole a recently developed series of surgical procedures, we are all becoming more adept at completely understanding and striking the balance between malnutrition and proper weight loss. As of today, about 2% to 5% of patients that had been through Duodenal Switch are possible candidates for Revision Weight Loss Surgery. The number of individuals having to go through Revision Surgery after DS will certainly decrease, though not eradicated entirely. These are usual reasons for Duodenal Switch revision:
- Excess weight loss
- Inadequate weight loss
- Malabsorption / nutritional deficiencies
Excess weight loss and nutritional deficiencies are conditions that clearly require Revision surgery after Duodenal Switch, and more than often these happen simultaneously. In this cases timing is a factor upon which much of the success of a remedy depends on. With the passing of time, the possible malabsorptive effect after undergoing Duodenal Switch will decrease as the intestine evolves by increasingly improving protein and other nutrients absorption. This means Duodenal Switch revision shouldn't be considered too early for patients suffering from malabsorptive complications; conservative therapy is much rather recommended before undergoing Revision surgery, so the intestine's increase in abilities develop within enough time. If this time lapse seems interrupted by Revision surgery, then the patient risks excessive weight re-gain after the intestine increases its full absorptive capacity.
Malabsorptive complications due to Duodenal Switch usually require elongation (adding intestinal length). To attain the desired results in the common limb, elongation can be achieved by using the biliopancreatic limb. For common elongation surgery, then the alimentary and common limbs must be elonged, thus providing protein, starch and fat absorption of additional surface area. An increase in fat absorption abilities helps the body's ability to absorb soluble vitamins such as vitamin D. In fact, the revision procedure treatment after Duodenal Switch surgery will treat both excessive weight loss as well as the patient's ability to absorb fat soluble vitamins.
Enteroenterostomy, also known as "the kissing X" is the most simple revision surgery procedure able to increase both common and alimentary limbs length by just a single connection to the small intestine. Patients are enabled to keep a certain level of weight loss due to the "neuro-endocrine brake" effect, which is also the cause for weight loss after Ileal Transposition surgery
Ileal Transposition is also a recurring procedure when a calcium and iron malabsorption condition is present after Duodenal Switch; this surgery is the mean of intestinal elongation providing remedy for such cases, in which the conventional Ileal Transposition is replaced by the same procedure done at the duodenum level, without the need to re-connect such organ. This isn't considered an easy procedure, since only a segment of the alimentary limb may be used to perform the transposition in what is known as High Duodenal Ileal Transposition. What is left of the alimentary limb takes part in the "Parallel Ileal Transposition", which is done at the level of the biliopancreatic limb and which joins the food flow resulting from the above mentioned (and performed) High Duodenal Ileal Transposition. Calcium and iron absorption restoration is accomplished through this procedure without a complete reversal of the Duodenal Switch procedure.
Sometimes after the initial weight loss happening by the Duodenal Switch procedure, some patients may experience inadequate weight loss or weight re-gain. Assuming that there have been failed non-surgical weight loss attempts, two theoretical approaches to solve this problem are considered:
- Reducing the stomach size
- Shortening of the common limb's length
In North America, stomach size reduction seems to achieve better results than common limb length's shortening, even though results of these revisions may vary.
CAN I ALSO HAVE REVISION WEIGHT LOSS SURGERY IN MEXICO / MEXICALI?
This is a common scenario after initial surgery, and there are a few reasons why. Most patients' condition requires only a single operation to accomplish the desired weight loss. But there are cases in which one bariatric weight loss surgery does not achieve the goals set initially: maybe the already lost weight has been in a lesser quantity than originally desired, maybe some circumstances became a difficulty for a patient's will to modify some eating habits, some may still be having comorbidities and in some cases there could even exist medical complications from a previous weight loss surgical procedure. Dr. Alberto Aceves is one of the top bariatric weight loss surgeons in Mexico and is able to offer different quality treatments to first-time weight loss surgery patients as well as for those who had been previously through these kinds of procedures, offering the best possible alternative as a solution to achieve a desired weight for a lifetime.
Risks and results of Revision Weight Loss Surgery
Undergoing Revision Weight Loss Surgery is a very important decision in which risks and benefits are brought into the light for consideration. Revision surgery implies higher risks than the ones taken in a first time procedure, and these are some reasons why:
-Operation time for Revision weight loss surgery is longer
- There are frequent unnecessary incisions...
- ... which, in turn, produces a larger blood loss
- Infections and leakage happens frequently. Leak rates increase because of changes regarding the blood flow towards the stomach due to a previous weight loss surgery
But also Revision surgery is far more predictable according to medical conditions treatment, not on weight loss itself. Weight loss decreases after Revision surgery. This is caused by metabolic adjustments happening after first time surgery. Patients with slower metabolism (also known as "metabolically obstinate") usually underachieve after first-time surgery.
Because of the particular needs and biology of every single patient requiring Revision Weight Loss Surgery, each of these procedures is planned on a personalized basis to meet unique desired conditions.
http://mexicalibariatric.com
Risks and results of Revision Weight Loss Surgery
Undergoing Revision Weight Loss Surgery is a very important decision in which risks and benefits are brought into the light for consideration. Revision surgery implies higher risks than the ones taken in a first time procedure, and these are some reasons why:
-Operation time for Revision weight loss surgery is longer
- There are frequent unnecessary incisions...
- ... which, in turn, produces a larger blood loss
- Infections and leakage happens frequently. Leak rates increase because of changes regarding the blood flow towards the stomach due to a previous weight loss surgery
But also Revision surgery is far more predictable according to medical conditions treatment, not on weight loss itself. Weight loss decreases after Revision surgery. This is caused by metabolic adjustments happening after first time surgery. Patients with slower metabolism (also known as "metabolically obstinate") usually underachieve after first-time surgery.
Because of the particular needs and biology of every single patient requiring Revision Weight Loss Surgery, each of these procedures is planned on a personalized basis to meet unique desired conditions.
http://mexicalibariatric.com
THOSE WHO ENJOY LONG TERM SUCCESS AFTER WEIGHT LOSS SURGERY BELONG TO SUPPORT GROUPS KEEP YOUR HEAD IN THE GAME- CHOOSE SUPPORT
By Sandi Henderson and Wendy Lee Sims Campbell
You made a decision to have a weight loss surgery and improve your health. Good for you! Now that you are back home, facing your food centered culture every day, how are you going to deal with facing every day confronted with food? Food is no longer a social event for you, it is not a celebration, and it’s not your central theme of family time. Food no longer defines you or every single significant event in your life.
This is quite a change for all of us who have had weight loss surgery. Your excellent bariatric surgeon operated only on your stomach, not your head. YOU need to find your path to keeping your head in the game. Your spouse, children, significant others, friends and family may support your efforts to reclaim your health, or some may not understand why you no longer join them in their food oriented celebrations. Then there are those who monitor every last bite you put in your mouth, raising an eyebrow at you or perhaps even asking, do you REALLY want to eat that? Whichever role these folks play, weight loss surgery friend or foe, they are not in the same place mentally and emotionally that your decision to have weight loss surgery has put you.
The ONE certain way to be able to BELONG to a group of folks who truly “get you”, who can share their struggles and successes, their frustrations and their celebrations and help you learn what it takes for YOU to be successful is to belong to a support group. The most successful people in the weight loss surgery community, those who have not only lost all of the weight that they wanted, but have kept it off for a number of years are those who are active in support groups.
Here are some statistics that support these conclusions as found in a Stanford University School of Medicine study of patients at 5 or more years post-op. (Highly successful patients were those who maintained at least an 80% excess weight loss. ) New Research Confirms Need For Post-Op Education:
• Highly Successful Patients were 3 times more likely to attend support groups regularly • Highly Successful Patients were 5 times less likely to eat mindlessly • Highly Successful Patients were 3 times more likely to exercise regularly • Highly Successful Patients took their vitamins and supplements regularly, weighed themselves regularly, limited their portion sizes, avoided drinking liquids with calories, ate protein first, avoided fast food and carbonated beverages, kept their portion sizes in check.
To summarize, those patients who maintained their excess weight loss for five years or more learned how to integrate what it took to become and stay successful into their daily living. They adjusted their lifestyles permanently.
Your weight loss surgery gives you the opportunity to quickly change your eating, however over time, unless these changes become ingrained habits, old habits and bad choices can creep right back in before you are even aware of them.
The one way to help insure YOUR long term success is to take advantage of all educational opportunities that are offered, beginning with following the post-operative instructions you have been given by your bariatric surgeon and his team of skilled professionals, and following up by attending the support groups and classes offered. Beginning right now, whether you have just had surgery or are just planning surgery you can find one to attend, whether in person, on line or by telephone.
www.wlssuccessmatters.com
WLS Success Matters on Facebook
Sandi Henderson and Wendy Campbell are successful weight loss surgery patients with over 14 years of experience between them. They are licensed bariatric educators and bariatric coaches and all of their material is based on The Success Habits of Weight Loss Surgery Patients as developed by Bariatric Support Centers International.
If you have any questions, please visit our website at http://www.mexicalibariatric.com or contact our office by calling 888-344-3916.
You made a decision to have a weight loss surgery and improve your health. Good for you! Now that you are back home, facing your food centered culture every day, how are you going to deal with facing every day confronted with food? Food is no longer a social event for you, it is not a celebration, and it’s not your central theme of family time. Food no longer defines you or every single significant event in your life.
This is quite a change for all of us who have had weight loss surgery. Your excellent bariatric surgeon operated only on your stomach, not your head. YOU need to find your path to keeping your head in the game. Your spouse, children, significant others, friends and family may support your efforts to reclaim your health, or some may not understand why you no longer join them in their food oriented celebrations. Then there are those who monitor every last bite you put in your mouth, raising an eyebrow at you or perhaps even asking, do you REALLY want to eat that? Whichever role these folks play, weight loss surgery friend or foe, they are not in the same place mentally and emotionally that your decision to have weight loss surgery has put you.
The ONE certain way to be able to BELONG to a group of folks who truly “get you”, who can share their struggles and successes, their frustrations and their celebrations and help you learn what it takes for YOU to be successful is to belong to a support group. The most successful people in the weight loss surgery community, those who have not only lost all of the weight that they wanted, but have kept it off for a number of years are those who are active in support groups.
Here are some statistics that support these conclusions as found in a Stanford University School of Medicine study of patients at 5 or more years post-op. (Highly successful patients were those who maintained at least an 80% excess weight loss. ) New Research Confirms Need For Post-Op Education:
• Highly Successful Patients were 3 times more likely to attend support groups regularly • Highly Successful Patients were 5 times less likely to eat mindlessly • Highly Successful Patients were 3 times more likely to exercise regularly • Highly Successful Patients took their vitamins and supplements regularly, weighed themselves regularly, limited their portion sizes, avoided drinking liquids with calories, ate protein first, avoided fast food and carbonated beverages, kept their portion sizes in check.
To summarize, those patients who maintained their excess weight loss for five years or more learned how to integrate what it took to become and stay successful into their daily living. They adjusted their lifestyles permanently.
Your weight loss surgery gives you the opportunity to quickly change your eating, however over time, unless these changes become ingrained habits, old habits and bad choices can creep right back in before you are even aware of them.
The one way to help insure YOUR long term success is to take advantage of all educational opportunities that are offered, beginning with following the post-operative instructions you have been given by your bariatric surgeon and his team of skilled professionals, and following up by attending the support groups and classes offered. Beginning right now, whether you have just had surgery or are just planning surgery you can find one to attend, whether in person, on line or by telephone.
www.wlssuccessmatters.com
WLS Success Matters on Facebook
Sandi Henderson and Wendy Campbell are successful weight loss surgery patients with over 14 years of experience between them. They are licensed bariatric educators and bariatric coaches and all of their material is based on The Success Habits of Weight Loss Surgery Patients as developed by Bariatric Support Centers International.
If you have any questions, please visit our website at http://www.mexicalibariatric.com or contact our office by calling 888-344-3916.
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