| Dr. Michael Johnell is a surgeon. Here the doctor has answered some of the common questions Bizymoms visitors have about Bariatric Surgery.
Q. What is sleep apnea and how is it affected by bariatric surgery?
A. The Greek word "apnea" literally means "without breath." There are three types of apnea: obstructive, central, and mixed; of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.
Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.
Sleep apnea can be weight-related. Additional fat around the neck may make the airway narrower, making obstructions more likely to occur. For some overweight people, especially those with mild cases, losing weight can be an effective treatment. Or weight loss may reduce the severity of the sleep apnea. However, it may be hard to lose weight when you have untreated sleep apnea: you may be too tired to exercise and you may eat to stay awake. Also, it may take some time before the weight loss is achieved, so in light of the potential consequences of untreated OSA, using another treatment option while working towards the weight loss goal may be an option. Losing weight may also improve your health in other ways, but it is always advisable to talk to your doctor before beginning a weight-loss program.
Q. What are the routine tests before bariatric surgery?
A. Routine testing would include: Labs, EKG, sleep study, possible cardiac clearance, other testing determined by individual health history.
Q. What is Gastric Bypass surgery?
A. Gastric bypass is both restrictive and malabsorptive surgery. In other words, it both reduces the size of your stomach and limits the amount of nutrients your intestines can absorb.
It is called "Roux-en-Y" because the two new connections form a Y.
The restrictive part of Roux-en-Y surgery involves making the stomach smaller. The surgeon will cut the stomach, leaving a pouch about the size of a small egg. This will make you feel full very quickly.
The malabsorptive part of the surgery involves rearranging the small intestine so that it absorbs fewer calories and nutrients.
Q. What is Adjustable Gastric Band Surgery
A. The gastric banding surgery is a restrictive operation that reduces the size of your stomach without cutting it or bypassing any intestine. Several small incisions are made and the adjustable gastric band is inserted around the upper part of the stomach patitioning the stomach into two parts. The smaller part, the pouch, will hold your food and make you feel full quicker. The rest of the stomach will still secrete digestive juices that aid in digestion. The band is designed to be completely adjustable and is customized for each patient. The band is also intended to stay in place for life to help maintain weight loss.
Q. Who is a good candidate for these types of surgeries?
A. To be considered for surgery, you must be seriously overweight, or "morbidly obese." You also must be unsuccessful at losing weight by conventional diet and exercise methods. If you meet certain conditions, you may be a candidate for weight loss surgery. However, weight-loss surgery is not for everyone.
Q. What Conditions Define Me as Morbidly Obese?
A. Several medically accepted criteria define morbid obesity. You are likely morbidly obese if you:
- Are more than 100 lbs. over your ideal body weight
- Have a Body Mass Index (BMI) of over 40
- Have a BMI of over 35 and have one or more serious health conditions related to morbid obesity
- Are unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
Q. What is the cost involved in the different types of procedures?
A. Cost involved include the before surgery testing, the surgery itself and then after care is required for a lifetime which includes follow up office visits and long term vitamin and mineral supplementation.
Q. What is the Bariatric Surgery recovery process?
A. The recovery process depends on the surgery that is performed and the technique that is used (Open vs. Laparoscopic). Generally with laparoscopic procedures, the patient can expect to be back to work within a week to 10 days; there is a diet progression that needs to be followed and can last anywhere from 4-6 weeks consisting of full liquids, pureed, soft foods and then back to regular solid foods. Walking is encouraged right after surgery and is started while in the hospital. Pain is generally controlled with oral pain medications. Incisions are very easy to care for especially if the surgery is completed laparoscopically.
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