Traveling with your Sleeve

You are feeling like the world is your oyster, you’ve had the operation, dropped the weight and are ready to move, can you travel?

When can I travel after a sleeve gastrectomy?

During the first four weeks after any laparoscopic surgery you have an increased risk of clots in your legs and lungs, so it is generally advisable to delay travel on long flights until after four weeks. When you do travel, consider taking aspirin or even injectables, however this isn’t routinely needed. Speak to your doctor if you have any concerns or a history of blood clots.

What should I eat when I travel?

If your surgery was more than six weeks ago, you should be on a normal, but reduced diet. You need to be mindful of fluids and protein in particular.
When travelling, it is a good idea to take snack foods with you. Be aware however of customs regulations around fresh fruit! Nuts, protein balls or water crackers are great snack substitutes. If you are travelling with children, make sure you have enough for everyone.
If you can pre-order with the airline you are travelling with, choose your food before you fly. Watch out for the vegetarian options–these are sometimes loaded with mashed starchy vegetables.

What about fluids when travelling?

When travelling people tend to forget about drinking fluids. Although not always convenient, it is best to take bottled water with you. A small drink bottle is good, though often hard to get through international security screening so buy one after the screening process. Constipation is never fun, and worse after a sleeve gastrectomy so take some fibre supplements with you (either capsules or sachet).

What should I bring when travelling?

Make sure you remember your multivitamins when you travel! If you may not have access to clean drinking water, think about taking the chewable vitamins instead. Speak to your dietitian about which is best for you, and optimise your vitamin levels before you travel. If you are due for blood tests while you are away ask the clinic to do these early. At Western Surgical Health, we do routine postoperative blood tests at 3/6/9/12 months post surgery so these can be done to fit around your schedule.

What do I need to watch out for when travelling?

Other than fluids and constipation, make sure you are not lapsing in to the habit of eating what everyone else is eating. Remember to eat your portion sizes (but feel free to leave your portion bowl at home). It is easier to forget to feel the hunger/satiety cue when you’re outside of your normal daily routine, especially when travelling. If you are travelling with family or friends, get them to help you stick to your diet. Remember if you often get steak or bread giving you a “stuck” feeling, avoid these as much as possible when you are away as you may not have easy access to medical facilities.

What if I start vomiting?

If you are in the first few months after sleeve surgery, it is a good idea to take something with you for nausea. Ask your doctor for a script and get it filled before you travel. There is nothing worse than having to search for medications whilst overseas or getting questions from customs because your medication packet is unlabelled! Make sure the dose is on the packet and take these as early as possible if you feel nausea.

Enjoy your time away, keep active and stay mindful of your sleeve. Bon Voyage!

Dr Ruth Blackham, Surgeon

Click on the links below to view the most popular weight loss surgeries that we offer at Western Surgical Health.

Healthy Relationships

An abundance of research has shown that the human life span has increased substantially in the past century, the product of better medical management and a slowing of biological aging. Deaths from cardiovascular disease and stroke have declined. However, this positive increase in life span is offset by a potential increase in other diseases, such as obesity and diabetes. We do not just seek longevity as a goal but we want to maximise our years of healthy living (our “health span” or ”healthy longevity”).

There are several fundamental lifestyle habits that we can adopt which are scientifically proven to slow cell aging.  Being physically active, getting good quality sleep and eating a diet high in fruit and vegetables (which also lowers inflammation). Fifteen population-based studies have shown that eating a Mediterranean diet can lower anxiety, depression and stress. A recent study by Deakin University’s Food and Mood Centre found that a Mediterranean diet could relieve symptoms of depression.

We also know that relationships influence healthy longevity and predict our stress response. Positive relationships can counter the natural anxiety that we are wired to have.

Evidence suggests that being engaged in and accepting the present moment is associated with greater wellbeing. However, engaging with the present moment experience and ignoring unwanted thoughts is difficult, given the nature of our minds and the competing demands for our attention. This may be especially true when experiencing psychological stress. Results of a recent study provide evidence that positive social connection enhances presence in the moment and helps to counter psychological stress.

This is significant for bariatric patients who are trying to maintain healthy lifestyle habits. The immediate family members living with them, the extended family and friends with whom they socialise, and colleagues at work can all impact on the patient’s experience. Positive relationships can provide a valuable buffer in stressful times and serve to enhance their resilience.

Numerous studies have found that socially connected people live longer. It has also been identified as the most important predictor of overall happiness. The social support that we feel when we age is associated with our wellbeing. We should consider the depth and quality of our relationships because, if we make this a priority, then it will have a significant impact on our happiness and “healthy longevity”.

by Melanie Greenfeld, BPsych MPsych MAPS

Click on the links below to view the most popular weight loss surgeries that we offer at Western Surgical Health.

Umbilical Hernia

Why does my belly button get sore?

Many people have a hernia in their umbilicus. These are often called an umbilical hernia or a belly button hernia which may have been present for their whole life but may have only grown large enough to notice as they get older. Many women first notice their protruding belly button when they are pregnant, and it can be quite uncomfortable.

So what is an umbilical hernia?

A hernia is a gap in the muscle layer of the abdomen which can allow the omentum or some bowel to poke through it, making a swelling under the skin. Sometimes, the skin can stretch up quite dramatically, but the hernia will not break through. Most of the time, the discomfort is because of the stretch on the muscles. If it has become uncomfortable, take a few minutes to lie down in a comfortable place and relax. Gently massage the soft lump to encourage it to slip back behind the muscles, into the abdominal cavity.

What to do if it hurts:

If it remains painful, seek medical advice: if the pain is severe, you may need to go to an Emergency Department, but usually it can wait for a more convenient review by your General Practitioner. Umbilical hernias generally remain comfortable if they are not growing larger, and if they are not blocking your bowel.

The hernia can be tiny, or several centimetres across.

Under the skin, if we looked at its profile, we could see the contents of the abdomen poking through the muscles something like this.

Although the lump under the skin can be quite large, the gap in the muscle, shown here in pink, is usually quite small. No wonder it is uncomfortable.

Umbilical hernia repair:

If a hernia is impacting your comfort, or you are worried that some bowel might get caught in it, you may want to consider an umbilical hernia repair. There are no drugs, or clever exercises which will make this gap heal by itself. A surgeon [link to sue] can stitch the gap closed, and this is usually reinforced with a piece of synthetic mesh to give it some support while it heals and provide a scaffold for your scar to grow into. The safest mesh we use remains in the body permanently, which makes it much less likely that the hernia will ever come back. Download this factsheet for more information.

Will repairing my hernia disrupt my life?

Hernia repair is performed under a general anaesthetic in a hospital, but overnight stay is not always required. There will be a little bruising and swelling for three to five days afterwards, and most people are able to return to work within two weeks. Of course, this depends on the size of the hernia and the type of work you do.

If you have concerns about a hernia, whether it be an umbilical hernia in babies through to adults, at Western Surgical Health we have leading surgeons in Perth, both male and female that can review your situation. Contact us now for more information.

Professor Jeffrey Hamdorf awarded Membership in the General Division of the Order of Australia

Western Surgical Health would like to congratulate Professor Jeffrey Hamdorf on being awarded Membership in the General Division of the Order of  Australia in the 2019 Australia Day Honours’ list

This honour acknowledges and rewards Professor Hamdorf’s significant  contribution to Medical Education and all aspects of Bariatric Surgery. Professor Hamdorf has established a legacy of contribution to the education of medical students, junior doctors and those entering new fields of surgical endeavor. Many current surgeons have trained under Prof Hamdorf as a registrar, intern or medical student and fondly remember their time with him.  New cohorts have learned under him as a tertiary hospital Consultant in Upper GI & General Surgery, as well as facilitator and mentor at The University of Western Australia. He is also the Director of CTEC, the flagship surgical education facility of Western Australia.

Prof Hamdorf, along with his professional partners, has pioneered a holistic treatment path for obese patients, facing life threatening complications and co-morbidities, brought on by excessive weight. In recognizing that surgery was only a small part of the obesity puzzle. He has assembled a multi-disciplinary team of specialized health professionals including specialist Dietitians, Psychologists, Physiotherapists and Physicians to treat all aspects of the patient’s weight loss journey.

He is a great champion of women in the medical field and in life. In amongst his many professional obligations, he still finds the time to be very involved in family life with his wife and five children, three of whom are still at school, his grandchildren and extended family.  He is a ballroom dance enthusiast and sometimes golfs!

His contribution to medical education is extensive and far reaching: See HERE

Click on the links below to view the most popular weight loss surgeries that we offer at Western Surgical Health.

Changing Attitudes to Obesity

Much needed dialogue about obesity

Obese people have a metabolic profile that predisposes them to store more fat, due to their body’s inbuilt ‘set point.’ Many of them do not overeat and many of them have robust exercise routines. The current data shows that diets do not work for them in the long term as their body fights to put the weight back on. This usually causes rebound weight gain and we now know from the research that, in the general population, dieting is a significant precursor to long term weight gain. But vulnerable people, faced with our culture that promotes the “thin ideal,” continue to be seduced by false promises from the multi-million-dollar diet industry.

I strongly advocate for lifestyles that are healthy and active, as studies have proven that this can reduce the incidence of many illnesses. However, obesity occurs within a different biochemical context and this relates to many hormone—such as insulin and leptin.

For many, obesity is not a lifestyle choice and we need to reduce the blame, shame and stigma towards our obese family members, friends and fellow members of society. If you have a genetic profile that predisposes you to weight gain, then the odds are stacked against you in our current ‘obesogenic’ environment.

Dr Robert Lustig, demonstrates in the documentary entitled “The skinny on obesity,” that obesity goes way beyond personal responsibility. There are clearly societal and environmental forces at work. Dr lustig points out that fast food outlets are prolific, over 24000 different ‘foods’ enter the market each year, and 80% of food in our stores are laced with sugar. He maintains that consumer choice is limited when processed, highly palatable food is accessible on every street corner. Personal responsibility is not ultimately going to solve the problem and we are not going to effectively change behaviour when our food environment is so unfavourable.

Gemma Togninicalls on us to stop “lowering the bar” and to demand “equality of effort.” Her message is to make people accountable for their choices, concluding that “if I don’t exercise… my rear end expands.” We do need to raise the bar, Gemma, but this lies in regard to public policy. To date Australia does not have a national co-ordinated plan to tackle obesity and the transnational food industry has unequivocally impeded progress on prevention policies and regulations. Companies are not concerned about the health of consumers and will continue to flood the market with processed food and sweetened beverages if it will continue to earn them huge profits. Our policy makers need to effectively address this and we need a cohesive public health community to move the agenda forward to provide an environment that is less obesogenic and more health promoting.

Let us also try to be more understanding of how obesity occurs and what could really help, not hinder the situation. Let us stop the harsh judgements, often based on misinformation, that are dished out so readily.

It is important to educate our children to make healthy choices and to be more active, by modelling this behaviour and creating healthy home environments with limited processed food. We can also teach our children that it is wrong to tease and bully others who may be carrying extra weight as this can cause a lifetime of psychological issues and can also lead to a reliance on food for emotional coping.

We can also increase accountability by demanding a better food environment for our families. We do have a major public health issue but let us deal with it in a helpful way, dispense with false assumptions and advocate for societal measures that will, in fact, improve our health and wellbeing.

Women’s Health, Pregnancy and Bariatric Surgery: Your Questions Answered

Is weight management a women’s issue?

It shouldn’t be – but it is. Australian data shows a slight preponderance of men who are overweight or obese; however, those that seek weight loss management options, particularly bariatric or metabolic surgery are predominantly female (80%). According to the Bariatric Surgical Registry, the mean age for seeking surgery is 43.9 years with average BMI of 42.9 at the time of procedure.

Weight is a women’s health issue. Clinically severe obesity is associated with increased comorbidities associated with metabolic syndrome, but some are worse in females such as type 2 diabetes, coronary artery disease and osteoarthritis. For females the importance also comes from infertility (particularly the association with Polycystic ovarian syndrome), pregnancy and delivery, breastfeeding and some cancers (endometrial, ovarian, cervical and breast).

Is there a relationship between obesity and a patient’s fertility?

Yes – fertility is reduced in obese patients who can be oligo-ovulatory or anovulatory.  A Danish review of 10,99 pregnancies found women with BMI over 25 have a 23% lower change of pregnancy per cycle (1).  Similarly, patients with BMI over 30 are twice as likely not to conceive over 12 months and 30+ are seven times less likely to conceive.

The pregnancy itself can be affected by obesity – there is a higher risk of gestational diabetes, pre-eclampsia and of an interventional birth.  There is a higher operative intervention rate of caesareans and higher wound infection rates.  Being obese and pregnant also adds an extra layer of issues – twice as much reflux-like symptoms, three times the symphysis-pubis pain and carpal tunnel risk and a ten-fold risk of atelectasis (2).  Having a BMI of 30-40 correlates with a 3-fold risk of gestational diabetes (3).

How does bariatric surgery affect pregnancy outcomes?

Current guidelines advise against pregnancy within the first 12-24 months after bariatric surgery. There are several large studies of birth outcomes in clinically severe obesity. Of 1382 gastric banding patients there was no statistically significant difference in neonatal outcomes found (of stillbirths, preterm delivery or macrosomia).  Of those who did conceive within a year of bariatric surgery no significant difference was found of hypertensive disorders or GDM but there was a higher caesarean rate, likely due to caregiver bias (4).

Is obesity and cancer related?

Cancers associated with higher endogenous oestrogen levels have been well considered in the literature and most likely to affect females suffering from clinically severe obesity. These include endometrial, ovarian, cervical and breast cancer.

We do know that higher BMI patients have greater risk and worse survival rates. In general terms they have later screening opportunities, higher rates of weight-related comorbidities, their treatment response may be compromised and they are at greater risk of surgical complications such as wound infection and seroma formation.  Radiotherapy has a lower penetrance and there may be chemotherapy dosage issues.

How should doctors approach the topic of weight management?

In short – with consideration and empathy. A personalised approach is best and the patient’s General Practitioner who knows them best is perfectly placed for this.

• Approach the discussion in health-related terms – if there are comorbidities associated with weight, this is the ideal starting point. Do not blame the patient or stigmatise the issue – obesity is a chronic disease and the patient should be supported in management.
• The number on the scales is *not* the issue – this does not accurately reflect their skeletal muscle mass, body fat percentage or basal metabolic rate nor is it standardised for age or sex. It is used purely as a starting point for the discussion, but the aim of any weight management plan must be health and decreasing severity of comorbidities.
• A multi-disciplinary approach – a well-constructed program should encompass a allied health professionals including dietetics and psychologist alongside specialist medical practitioners, allowing adjuncts such as pharmacotherapy or referral for surgery if appropriate.

References

1.         Jensen TK, Scheike T, Keiding N, Schaumburg I, Grandjean P. Fecundability in relation to body mass and menstrual cycle patterns. Epidemiology. 1999;10(4):422-8.

2.         van der Steeg JW, Steures P, Eijkemans MJ, Habbema JD, Hompes PG, Burggraaff JM, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod. 2008;23(2):324-8.

3.         Torloni MR, Betran AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev. 2009;10(2):194-203.

4.         Sheiner E, Edri A, Balaban E, Levi I, Aricha-Tamir B. Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery. Am J Obstet Gynecol. 2011;204(1):50 e1-6.

Click on the links below to view the most popular weight loss surgeries that we offer at Western Surgical Health.

The Importance of Psychological Resilience for Bariatric Patients

Psychological resilience has been found to be a crucial factor in facilitating long-term, optimal outcomes for bariatric surgery patients. Resilience is the process of adapting well in the face of adversity or major sources of stress.

It is now widely accepted that bariatric surgery is the most effective obesity treatment, typically resulting in substantial weight loss, significant health improvements and better quality of life. However, studies have shown that decreased compliance to recommended lifestyle habits can occur. This may be partially due to a lack of psychological skills that are required over the long-term, when the effects of surgery (on appetite, hunger and desire for food) decrease.

We also know that stress biases the brain towards old habits over intentional actions.  Life events happen and our brains can return to past associations and familiar habits, such as turning to food for comfort.  Sources of stress can include family and relationship problems or workplace and financial stressors.

Additionally, our brains respond more strongly to negative events. We experience them more personally and we feel them more deeply. Some people’s brains are biased towards pain, loss and the emotional toll of their mistakes. This can cause depressive symptoms, which are often accompanied by impulsiveness and poor coping skills. They can also include feeling fatigued and unmotivated, which can derail our newly-acquired positive habits.

Research has shown that mindfulness and acceptance-based skills can help people to tolerate uncomfortable psychological experiences and maintain healthy behaviour-change over the long term. Cultivating self-awareness keeps us in tune with our psychological needs and helps us to regulate our emotions.  Practicing self-care habits, enlisting the support of family and friends, exercise and meditation have also been found to be helpful in coping with adversity.

I often tell my patients that bariatric surgery will help them to change their relationship with food, but that it is also a wonderful opportunity to improve their relationship with themselves. Nurturing a more positive inner dialoguehas been shown to foster better psychological health. However, patients are often at a loss about how to do this, particularly when they have been hearing a harsh, critical inner-voice for so many years.

Western Surgical Health will soon be promoting a workshop that I will be running to help our patients handle psychological challenges and equip patients with the necessary tools to stay on track with healthy lifestyle habits. Further details will be announced soon …

Melanie Greenfeld
Psychologist Western Surgical Health

Bariatric Surgery: Which patients should have it?

Our very own Charlene Grosse, advanced accredited practising dietitian, recently published an article in “Good Practice” outlining the criteria for electing bariatric surgery. Obesity is an importance health issue facing the 21st century with the World Health Organisation estimating that being overweight contributes to 44% of diabetes, 23% of heart disease and up to 41% of some cancers. Risk of these health problems can be dramatically reduced through modifying lifestyle risk factors. For those however who are very overweight, (eg BMI of > 40) the National Health and Medical Research Council recognises that bariatric (or weight loss surgery) is the most effective treatment.

The most common bariatric procedures in Australia are sleeve gastrectomy, adjustable gastric banding and Roux-en-Y gastric bypass. Choosing which surgery is right for you is a decision you make in consultation with your bariatric surgeon explains Charlene, and takes into factors such as age, access to followup, risk profiles, prior interventions and commitment to lifestyle change.

For individuals considering bariatric surgery, their GP will often be the first point of call. The GP will discuss with you whether you meet the necessary criteria before referring you to a specialist surgeon. It is important for individuals considering bariatric surgery to understand that surgery is not a one stop fix, rather part of lifestyle changes that need to be made in order to keep healthy and keep the weight off.

At Western Surgical Health, we understand that obesity and its management are complex and that weight management doesn’t stop with surgical intervention. As such our patients are supported not only through the weight loss surgery, but through recovery and an ongoing support by our multidisciplinary team of physicians, GPs, dietitians, nurses, exercise physiologists and psychologists. Our program is revolutionary, scientifically proven and effective in providing safe weight loss.

To read Charlene’s article in full visit HERE. To contact Western Surgical Health about your weight concerns visit HERE.

Click on the links below to view the most popular weight loss surgeries that we offer at Western Surgical Health.