Atrium Health Navicent Weight Management
Welcome
Atrium Health Navicent Weight Management is excited to provide weight loss management to patients throughout Georgia. Our multidisciplinary team offers both surgical and non-surgical weight loss solutions to get you on the road to better health. If you are considering weight loss surgery, BMI offers several options to our patients. We look forward to helping you get on the road to a healthier lifestyle. We invite you to call us and sign up for a seminar or schedule a consultation today!
If you are considering Bariatric Surgery, please view our mandatory video below for prospective patients.
Welcome to Atrium Health Navicent Weight Management, Navicent Health Seminar for Bariatric Surgery. We are excited that you are here to view the seminar and learn more about Bariatric surgery. Bariatric surgery is an effective weight loss tool which can improve lives and health dramatically. We are excited to be a part of your weight loss journey. Atrium Health Navicent Weight Management, Navicent Health surgeons specialize in weight loss surgery, which is the surgical treatment of obesity. Our office is located at 5437 Bowman Rd, Suite 126. Phone numbers are listed for your convenience as well as our website, should you have questions or need additional information. Danny Vaughn, MD is the medical director for our practice and a Bariatric surgeon. He was raised near Rhyme Georgia. He is board certified by the American Board of Surgery. He earned an undergraduate degree from University of Georgia and attended Mercer University School of Medicine, earning his medical degree. He decided to peruse general surgery and was a resident at Medical Center, Navicent Health for 5 years. After residency, he moved to Kansas City Missouri where he was part of St Luke's Hospital Advanced, Minimally Invasive and Bariatric Surgery Fellowship. He then returned to Macon and began practicing general surgery and subsequently started the Bariatric program at the Medical Center, Navicent Health.
Robert J Perel, II, MD is a general surgeon who also specializes n Bariatric surgery and is a partner at Atrium Health Navicent Weight Management, Navicent Health. He was raised in Augusta, GA. He earned a BS in microbiology from the honors program at the University of Georgia in Athens before earning his medical degree from the Medical College of Georgia in 1997. He then completed his internship and residency in general surgery in the Oxford Clinic in Louisiana in 2002 and has been practicing in Macon since 2005 with an emphasis on minimally invasive surgery. His specialty includes laparoscopic and robotic surgery and he applies these modalities to all aspects of surgery to include Bariatrics. He has been involved with the Atrium Health Navicent Weight Management of Georgia since its inception. He is an assistant professor of surgery at the Mercer University School of Medicine, Department of Surgery, is board certified by the American Board of Surgery and is a fellow of the American College of Surgeons.
Causes of obesity are multi-factorial. And include, family causes, family trait, behavioral causes, over eating or choosing wrong foods, and environmental, monetary situation, large portions at restaurants. All of these together, or even alone, can lead to obesity.
Eating out is very common these days due to our busy lifestyle. Eating out contributes to weight gain due to the choleric content related to portion size. As you can see in this slide, portion sizes have grown considerably over the years. A hamburger was typically 2.8 ounces with 202 calories in 1954 and the average hamburger in 2004 was 4.3 ounces with 310 calories. Now, restaurants offer double and triple decker hamburgers to boot! Again, French fries have increased in portion size as well. Candy bars and cokes, foods with high sugar content have also increased in size considerably as well. A 16-ounce coke is almost 200 calories!
Obesity can contribute to a number health problems. Health problems that are either partly or completely caused by obesity are called comorbidities. Listed here are common Comorbidities related to being overweight. These Comorbidities can contribute to decreased function, pain and illness. This is compounded if you are overweight. When considering approval for surgery, insurance companies often review charts to look for comorbidities related to the patient's weight. This slide is a comparison of obesity trends in the US from 1990 to 2010. As you can see, in 1990 about 10 to 15% of the population was obese. This rose on 2000 to 15 to 24%. Astonishingly, we are now up to 30% obesity in some states. Again, environment, fast food, poor food choices have contributed to this increase.
Body mass index is the measurement used to determine if a patient is of normal weight, under weight or over weight. It is basically a ratio between weight and height and helps us determine if you are a candidate for bariatric surgery. Often people try to loose weight on their own prior to making the decision to have the surgery. Sometimes patients purse treatments with their physician and request to use diet pills to assist in weight loss. This slide is a comparison of weight loss from dieting alone, use of diet pills and Bariatric surgery. As you can see, studies show that dieting and diet pills alone show a 10% weight loss with most patients unable to keep it off at 5 years, however, with Bariatric surgery, approximately 68% of excess weight was lost and 80 to 90% of patients were able to keep it off at 5 years. Great results with surgery!
Obesity affects all aspects of life. Lets consider the personal cost of obesity. Drug costs, out-of-pocket health care expenses such as x-rays, scans or stress tests, inability to go to work due to obesity related illness, commercial weight loss program and subscription fees can all contribute to high out-of-pocket expenses related to obesity. Lastly, grocery costs and eating out are another factor to look at when considering the personal cost of obesity. Eating out is costly and most Americas eat out 2 to 3 times per week.
Prescription medications, as shown on the last slide, can contribute to out-of-pocket expenses if one is obese. When a patient looses weight from Bariatric surgery, amazing things can happen, such as, reduction in medications. Some patients no longer take any medications after loosing weight from Bariatric surgery. Definitely some thing to think about when considering bariatric surgery. It'll save money and time, going to pharmacy, not to mention less physician visits as well.
Morbid obesity is a vicious cycle. Over eating leads to weight gain which leads to depression which leads to over eating and so forth. This is a cycle that is often very difficult to break on our own. This is where Bariatric surgery can make a difference in your life. Lets talk about obesity and mortality rates. A study done in the new England Journal of Medicine shows that obese patients die 10 to 15 years earlier than their counter parts. There is a 22% reduction in total life expectancy, which leads to over 300,000 premature deaths per year in the US. Fortunately, when bariatric surgery is done, the risk of mortality over 5 years is 89% lower.
Is Bariatric surgery safe? Comparing mortality rates of procedures which are done such as Cholecystectomy, Gall Bladder removal, Hip Replacement, Colectomy and Hysterectomy, is as safe or safer than those commonly done procedures.
Now that you have an understanding of obesity and the risks of obesity, we would like to tell you a little bit about our staff. We are proud that we have a comprehensive program which allows us to be a one-stop-shop, so to speak. Atrium Health Navicent Weight Management, Navicent Health consists of two Bariatric surgeons, Danny M Vaughn, MD and Robery J Perell, II, MD, who perform all surgeries at the Medical Center, Navicent Health. Michelle Rowell, the nurse practitioner, assists the surgeons by rounding off patients in the hospital, following patients, both pre-op and post-op as well as educating patients. Atrium Health Navicent Weight Management also has it's own dietician, Emily Johnson, as well as Exercise Physiologist, Dave Grimsley, who assist patients with diet and exercise both before and after surgery. Alexandria Clark is our patient advocate and coordinates pre-op work up and getting surgeries approved through insurance. Crendon Brazil is our medical assistant who helps care for our patients pre and post operatively. Lastly, our front desk is maned by Lucretia, whos responsibilities include checking in patients as well as scheduling patients. She assists with all new patients and is the sweet voice you hear at the end of the telephone when you call.
Our surgeons perform 3 procedures which include Laparoscopic Adjustable Gastric Banding, Laparoscopic Sleeve gastronomy and Laparoscopic Roux-en-Y Gastric Bypass. Who qualifies for the previously mentioned surgeries? This slide depicts body mass index from normal weight patient to morbidly obese patient. BMIs of 35 or above are classified as morbidly obese and qualify for surgery. BMI of 35 to 39.9 usually require one to two comorbidities, such as DM or HDN, to qualify for surgery. If a patient has a BMI of above 40, most insurances which cover the surgery will consider this patient an acceptable candidate for the surgery. Atrium Health Navicent Weight Management, Navicent Health, follows NIH criteria for surgical candidates which is also followed by the ASMBS, American Society for Metabolic and Bariatric Surgery, the governing body over bariatric surgery. At Atrium Health Navicent Weight Management, you must be at least 18 years old to be considered for surgery, have been morbidly obese for over 5 years and have had short term success with other weight loss attempts. You can not have another disease which could have caused your obesity. Most importantly, the patient must be prepared to attend regular follow-up sessions and make lifestyle changes. Otherwise, surgery might not be successful. Lifestyle changes must be made by the patient, even with surgical intervention.
Atrium Health Navicent Weight Management, Navicent Health does have policies related to body mass index and surgical intervention. Generally, if a patient has a body mass index or BMI of 60 or higher, then patient is required to loose weight, to get below 60 BMI, before surgical intervention is done. In order to have a Gastric Bypass or Sleeve Gastrectomy done, BMI must be less than 60. In order to have gastric Band placed, BMI must be less than 50. Medical problems including reflux and diabetes as well as medical history are also taken into consideration when deciding on surgical intervention for a patient. This is discussed with the patient and a decision is made together between the surgeon and patient.
On this slide you can see different views of the band. As you can see, there is a port in the picture on the left. This port allows access to the band to fill the band with saline to cause greater restriction if needed or to un-fill the band, removing the saline if there is too much restriction contributing to symptoms such as reflux, nausea or vomiting. Generally, our ports are placed in the upper abdomen, but some surgeons do place them in the chest. The patient will loose approximately 50% of excess body weight with this surgery at 2 years. There are 2 bands available at this time, the Realize band and the Lap-Band. Think of the types of band like Coke and Pepsi. They are basically put in similarly but made by different companies. We generally use the Realize band out of preference but either band can be used.
So what are the risks and potential complications associated with band placement. First of all, there are the basic risks associated with any surgery, such as bleeding and infection. With the band, there is the risk of slippage where the band could slip out of place, which is about a 3 to 5 % risk. There is risk of erosion, less than 1%, where the band can actually erode into the stomach which can lead to infection and band removal. In addition, a patient could has problems with the port as it is a foreign object placed in the body with risk of infection or slippage of the port. This surgery can be defeated by drinking high calorie liquids or by eating high calorie, high fat foods that can slide through easily. The Sleeve Gastrectomy is a purely restrictive operation in that it limits the amount of food intake. About 80% of the stomach is removed, leaving a small banana shaped stomach as you can see in the picture. The patient will loose approximately 60 to 70% of excess of body weight at 2 years with this procedure. Again, another view of the Sleeve Gastrectomy.
Possible risks and complications of the Sleeve Gastrectomy may include risks associated with surgery in general, such as blood loss and respiratory issues such as pneumonia. We will have you use a device called an incentive spirometer to help prevent respiratory complications such as pneumonia. A leak is a complication which occurs when there is a disruption in the staple line for some reason and acid from the stomach leaks into the abdominal cavity. This can lead to peritonitis, infection and even death. This a serious complication that we are always on the lookout for after a surgery, especially in the first 30 days. The key is, to catch a leak early rather than later. If caught late, the outcome may not be as good. Symptoms we look for include, elevated HR, fever and persistent abdominal pain. Or pain that seems inconsistent with what is usually seen post-operatively. If suspected, an upper GI and/or CT scan will be ordered to further evaluate. A leak will most likely lead to a prolonged hospitalization of several weeks. And the patient will be treated with antibiotics and returned to surgery to repair the leak. A leak is serious, and we take this very seriously. The risk of a leak occurring is 1 in 100 patients or 1% leak. Another complication which can occur is narrowing of the sleeve which can make it difficult for food to pass through, causing nausea and vomiting. Again, this would most likely need to be repaired through surgical means. Incisional hernias can occur after surgery as well. Generally, these types of hernias are associated with being overweight. So, hopefully this will not occur with our patients as they are losing weight. However, it is a risk. An incisional hernia is generally not repaired until 18 to 24 months after surgery if it is not a problem. The goal is for the patient to lose all of excess body weight prior to hernia repair being done as the hernia may reoccur if the patient has not lost all of the necessary weight. Pulmonary Embolism is the most feared and lethal complication of these surgeries. A Pulmonary Embolism is a blood clot which travels to the lungs. These can be deadly and are very serious. To help prevent a Pulmonary Embolism, several measures are taken while in the hospital which include early Embolation of patients, having the patient receive injections of blood thinner before surgery and in the post-operative phase as well as using devices that contribute to adequate circulation of the lower extremities.
The Roux-en-Y Gastric Bypass is a surgery where a small pouch is created which empties directly into the small intestine. The first bypass was done about 49 years ago and it's the gold standard of Bariatric surgeries. It is the most well researched bariatric procedure to date. On this slide on the left, you see normal gastro intestinal anatomy. With the bypass there are basically three steps. The first step is the formation of a small egg-sized pouch from the stomach, which holds approximately 2 ounces. This is seen on the right image. The next step involves cutting the small intestine in half and bringing the lower portion up to meet the pouch. Lastly the first part of the small intestine is connected to the small intestine which was brought up to meet the pouch. After surgery, food travels into the new pouch and down to the newly rerouted intestine to then be digested. The remaining stomach stays in place. And acids from the stomach continue to be produced and travel down through the duodenum and aide in digestion. As you can see, you now have a new route for your food to pass through as the old stomach and duodenum are bypassed. The bypass is a restrictive procedure in that you can only eat a limited amount of food, approximately 2 ounces. It is also called a mal-absorptive procedure, as food is no longer seen in the first part of the small intestine where most of the absorption of food, vitamins and minerals take place. If no absorption takes place, then mal-absorption occurs. Restriction plus malabsorption equals weight loss. Because of the mal-absorption, it is important to take bariatric vitamins for the rest of your life. A bypass can have both early and late complications. Again, as with the sleeve, there can be respiratory problems such a pneumonia after the surgery. We strongly encourage our patients to use an incentive spirometer after surgery, ten times an hour. Respiratory therapy usually brings this to the floor with in two hours of arrival and the patient is educated on how to use.
An Anastomotic Leak is a leak at one of the anastomotic sites, sites where the pouch was connected to the small intestine, or where the small intestine was connected to small intestine. An Anastomotic Leak is serious, and we are vigilant in looking for signs of symptoms of a leak. A leak can lead to treatment with antibiotics, additional surgery to repair the leak and prolonged hospitalization. Again, the risk of leak is 1 in 100 patients or 1 %. Infection can occur after any surgery. You will be treated with antibiotics before and after surgery to help prevent infection. Blood loss is another risk associated with any surgery. This may lead to blood transfusion if anemic as well as additional imaging to rule out the problem.
Blood clots are the most feared and complication of any Bariatric surgery. Blood clots can develop in the legs and can contribute the development of Pulmonary Embolism. Patients are, again, treated with blood thinners as well as sequential compression devices to aide in prevention of blood clots. Early embolation of patients is also essential in prevention of formation of blood clots.
Late potential complications include incisional hernias as stated earlier with the sleeve. There are hernias that occur at incision sites after the surgery and are generally not repaired until 18 to 24 months after surgery, when the patient has lost all of their excess body weight.
Another complication which can occur with a bypass is bowel obstruction. Bowel obstruction is usually related to the formation of scar tissue after surgery. This can occur within a few months after surgery but may not occur until many years later. Bowel obstructions require rehospitalization, imaging and potential for additional surgery to remove the obstructed area.
Ulcers are a potentially serious complication of bypass surgery. Ulcers can occur at the anastomotic site of the food pouch and small intestine. Usually the patient will present with epigastric or left upper abdominal pain and or pain after eating. Ulcers are usually found through endoscopy and are treated with proton pump inhibiters and other medications. Bypass patients are sent home with proton pump inhibitors after surgery to help prevent the formation of an ulcer at the anastomotic site. Smoking contributes to marginal ulcers post-operatively. Which is why patients must quite smoking 8 weeks prior to surgery and remain non-smokers for life. Persistent use of NSAIDs will also contribute to ulcers. NSAIDs are aspirin products such as Motrin, morphine, Ibupropion, Goodys and BC just to name a few. We do not allow the use of NSAIDs after surgery. And if there are any questions, feel free to discuss your concerns with our clinical staff.
Anastomotic strictures, narrowing of the connection between the stomach and bowel, usually occur secondary to the formation of scar tissue. These can be treated with surgical intervention and sometimes dilation.
Nutritional deficiencies are a risk with bypass surgery, secondary to the malabsorpic component of the surgery. It is important for the patient to take bariatric specific vitamins after surgery daily in order to prevent iron deficiencies, calcium deficiencies as well as other vitamin deficiencies.
This slide shows the differences between the surgeries. Hospital stay. As you can see, a band is generally an outpatient procedure. Our practice is generally to keep sleeve and bypass 2 nights. There are places that keep sleeve only one night but that is generally not our practice.
Bowel/ stomach cut. No bowel or stomach cut is done with a band, however, with a sleeve and bypass, surgical alterations are made to the stomach.
Foreign body used. Only with a band. If problems, this may have to be removed.
Risk of death. As you can see, the risk of death is low. Especially when you consider the risk of staying obese.
Speed of weight loss. The band has a slower weight loss than the other two procedures, about 1 to 2 pounds per week. The sleeve has a speed of weight loss which is between a band and a bypass. Maybe 2 pounds per week. The bypass is the fastest with the patient loosing 100 pounds, 6 to 12 months after the surgery.
Long term weight loss. With a band most patients loose about 50% of their excess weight at 2 years. With a sleeve there is weight loss of 60 - 70% of excess weight at around a year or so. With a bypass the patient will lose 70 - 80% of excess weight loss at 12 - 18 months.
Continuing to look at the differences in the bariatric procedures. Malabsorption restriction. Band and sleeve provide restriction only. With bypass there is both malabsorption and restriction. At our practice, all patients take bariatric specific vitamins after surgery.
Revisable. The band is considered reversible in that it may need to be removed if there is a problem. Sleeve is not reversal. Bypass can be reversed although this is very rare and difficult. Reversal of bypass requires and open operation. And would only be done if patient has severe complications requiring reversal.
Adjustable. The band is adjustable. This does not apply to the other surgeries.
How long have these surgeries been performed? Bypass over 40 years. Band greater than 20 years. And sleeve 10 years.
Long term prognosis. With the band and the sleeve having less research than the bypass, their prognosis is not completely known. However, the bypass can result in sustained weight loss at 10 years out from surgery.
Do all three surgeries work for everyone? The answer is no. Each patient has different needs and medical issues which result in different surgical needs for every patient.
Urban legends. This slide is to help clarify some inaccuracies about surgery that you may see online. Or hear from friends, family, surgery patients. None of these urban legends listed are true. Here are the facts.
Flintstone or prenatal vitamins are not adequate for bypass patients to take after surgery. The Medical Society for Bariatric and Metabolic Surgery developed guidelines for vitamin and mineral supplementation after bariatric surgery. Our practice follows those guidelines.
You will eventually be able to eat more than a couple of tablespoons. Your body will adjust somewhat to the surgery and you may not be able to eat large amounts of food but your capacity will increase somewhat over time. We believe that weight loss surgery is a tool that is used in addition to lifestyle changes. Therefore, if you have a band, we will not remove fluid so a patient can go on vacation and eat all they want. We want this to be a permeant lifestyle change and we do not want the patient to have any setbacks.
Swift weight loss does not result in any more saggy skin than slow weight loss. The surgery chosen has nothing to do with the patients skin elasticity and resulting amount of loose skin, if any.
So, as you can see, the secret to success is not due to surgery alone. It is a tirade of surgery, a tool to jumpstart weight loss. Proper diet and exercise. All three of these components must be in place in order for a successful result after the surgery. Maximum success can not be achieved if proper diet and exercise are not put into place.
Significant weight loss can be the beginning of the end to many health issues which include migraines, high cholesterol, fatty liver, diabetes, depression, sleep apnea, hyper tension, reflux and joint pain. Improved quality of life are one of the most important changes which can occur with this surgery, We all want a good quality of life.
Important things to know. Nothing will work until you make a permanent lifestyle change. Special vitamins for the bariatric patient are required for the rest of your life. Normally NSAIDs, nonsteroidal anti-infilamentary drugs, aspirin, IBupropion, Motrin, etc., are not allowed after bariatric procedures. On occasion, there are some exceptions and those can be discussed between surgeon and patient. You can not smoke with these surgeries. Patients are required to quite smoking at least 8 weeks prior to surgery. Patients can not smoke after the surgery as there is a high probability of developing an ulcer, especially with the gastric bypass. Smoking also delays healing and is considered a contributing factor to ulcers.
How do I begin?
After viewing this seminar video, call our office at 478-633-5200 to schedule a one on one consultation with our surgeon and staff. Allow out patient advocate with obtaining insurance verification and surgical clearance. Meet with our comprehensive staff.
Atrium Health Navicent Weight Management, Navicent Health