St. Joseph Mercy Oakland to Hold Free Educational Seminar

Pontiac, MI—St. Joseph Mercy Oakland (SJMO), in partnership with the Michigan Bariatric Institute (MBI), will host a free educational seminar focusing on bariatric surgery options at 6 p.m. Monday, Feb. 15, 2010, in the SJMO Franco Communications Center Auditorium, 44405 Woodward Ave., Pontiac.

 Entitled, “A Minimal Surgical Approach to Treating Obesity,” the seminar will feature an overview of the bariatric surgery program and the types of procedures it offers, as well as a question and answer session.

 Speakers include Tallal Zeni, MD; Jacob Roberts, DO; and Paula Magid, MBI program director and former bariatric patient. 

Surgeons at MBI are experienced in advanced laparoscopic surgical techniques, including laparoscopic gastric bypass, sleeve gastrectomy and adjustable gastric banding.  Laparoscopic bariatric surgery results in minimal pain, less scarring, shorter hospital stay and recovery time.  Weight loss of about 70 percent of excess body weight can be anticipated within the first year and maintained.

Dr. Roberts recently joined the St. Joseph Mercy Oakland medical staff as a general and minimally invasive bariatric surgeon.  He will perform surgeries at SJMO and at St. Mary Mercy Livonia, both Saint Joseph Mercy Health System member hospitals. 

Dr. Roberts received his medical degree at the Michigan State University College of Human Medicine and was chief resident at St. John Macomb-Oakland Hospital, Oakland Center in Madison Heights, Mich.  He completed his fellowship training at the Chicago Institute of Minimally Invasive Surgery at Saint Francis Hospital in Evanston, Ill.  Dr. Roberts also is board certified in General Surgery.

Dr. Zeni, director of Minimally Invasive and Bariatric Surgery at St. Mary Mercy Hospital in Livonia and MBI medical director, received his medical degree from the Indiana University School of Medicine, where he completed his residency in General Surgery.  He completed his fellowship in Minimally Invasive and Bariatric Surgery at Evanston Northwestern Healthcare, Evanston, Ill.  He is board certified in General Surgery.

Since the program’s inception in 2005 at St. Mary Mercy Hospital, MBI has performed more than 500 bariatric surgeries to date. 

The MBI program provides a comprehensive approach to the bariatric surgery experience, including

• Medical director
• Program director
• Team of specially trained registered nurses, registered dieticians, behavioral specialists and exercise physiologists to assist the patient through the process
• Free educational seminars
• Comprehensive pre-surgical classes
• Post-surgical follow-up visits
• Monthly support group

 To register for the educational seminar or for more information, call 877-Why-Weight.

St. Joseph Mercy Oakland to Hold Free Seminar on Bariatric Surgery

Pontiac, MI—St. Joseph Mercy Oakland (SJMO), in partnership with the Michigan Bariatric Institute (MBI), will host a free educational seminar focusing on bariatric surgery options at

6 p.m. Monday, Sept. 14, 2009, at the SJMO Franco Communications Center Auditorium, 44405 Woodward Ave., Pontiac.

 Entitled, “A Minimal Surgical Approach to Treating Obesity,” the seminar will feature an overview of the bariatric surgery program and the types of procedures it offers, as well as a question and answer session.

 Speakers include Tallal Zeni, MD; Jacob Roberts, DO and Paula Magid, MBI program director and former bariatric patient. 

 Surgeons at MBI are experienced in advanced laparoscopic surgical techniques, including laparoscopic gastric bypass, sleeve gastrectomy and adjustable gastric banding.  Laparoscopic bariatric surgery results in minimal pain, less scarring, shorter hospital stay and recovery time.  Weight loss of about 70 percent of excess body weight can be anticipated within the first year and maintained.

 Dr. Roberts recently joined the SJMO medical staff as a general and minimally invasive bariatric surgeon.  He will perform surgeries at SJMO and at St. Mary Mercy Livonia, both Saint Joseph Mercy Health System member hospitals. 

 Dr. Roberts received his medical degree at the Michigan State University College of Human Medicine and was chief resident at St. John Macomb-Oakland Hospital, Oakland Center in Madison Heights, Mich.  He completed his fellowship training at the Chicago Institute of Minimally Invasive Surgery at Saint Francis Hospital in Evanston, Ill.  Dr. Roberts also is board certified in General Surgery.

 Dr. Zeni, director of Minimally Invasive and Bariatric Surgery at St. Mary Mercy Hospital in Livonia and MBI medical director, received his medical degree from the Indiana University School of Medicine, where he completed his residency in General Surgery.  He completed his fellowship in Minimally Invasive and Bariatric Surgery at Evanston Northwestern Healthcare, Evanston, Ill.  He is board certified in General Surgery.

 Since the program’s inception in 2005 at St. Mary Mercy Hospital, MBI has performed more than 500 bariatric surgeries to date. 

 The MBI program provides a comprehensive approach to the bariatric surgery experience, including

• Medical director
• Program director
• Team of specially trained registered nurses, registered dieticians, behavioral specialists and exercise physiologists to assist the patient through the process
• Free educational seminars
• Comprehensive pre-surgical classes
• Post-surgical follow-up visits
• Monthly support group

 To register for the educational seminar or for more information, call 877.Why.Weight.

St. Joseph Mercy Oakland to Hold Free Educational Seminar on Bariatric Surgery

 

Pontiac, Mich.—St. Joseph Mercy Oakland (SJMO), in partnership with the Michigan Bariatric Institute (MBI), will host a free educational seminar focusing on bariatric surgery options at 6 p.m. Monday, Aug. 24, 2009, at the SJMO Franco Communications Center Auditorium, 44405 Woodward Ave., Pontiac.

 Entitled, “A Minimal Surgical Approach to Treating Obesity,” the seminar will feature an overview of the bariatric surgery program and the types of procedures it offers, as well as a question and answer session.

 Speakers include Tallal Zeni, MD; Jacob Roberts, DO and Paula Magid, MBI program director and former bariatric patient. 

 Surgeons at MBI are experienced in advanced laparoscopic surgical techniques, including laparoscopic gastric bypass, sleeve gastrectomy and adjustable gastric banding.  Laparoscopic bariatric surgery results in minimal pain, less scarring, shorter hospital stay and recovery time.  Weight loss of about 70 percent of excess body weight can be anticipated within the first year and maintained.

 Dr. Roberts recently joined the SJMO medical staff as a general and minimally invasive bariatric surgeon.  He will perform surgeries at SJMO and at St. Mary Mercy Livonia, both Saint Joseph Mercy Health System member hospitals. 

 Dr. Roberts received his medical degree at the Michigan State University College of Human Medicine and was chief resident at St. John Macomb-Oakland Hospital, Oakland Center in Madison Heights, Mich.  He completed his fellowship training at the Chicago Institute of Minimally Invasive Surgery at Saint Francis Hospital in Evanston, Ill.  Dr. Roberts also is board certified in General Surgery.

 Dr. Zeni, director of Minimally Invasive and Bariatric Surgery at St. Mary Mercy Hospital in Livonia and MBI medical director, received his medical degree from the Indiana University School of Medicine, where he completed his residency in General Surgery.  He completed his fellowship in Minimally Invasive and Bariatric Surgery at Evanston Northwestern Healthcare, Evanston, Ill.  He is board certified in General Surgery.

 Since the program’s inception in 2005 at St. Mary Mercy Hospital, MBI has performed more than 500 bariatric surgeries to date. 

 The MBI program provides a comprehensive approach to the bariatric surgery experience, including

• Medical director
• Program director
• Team of specially trained registered nurses, registered dieticians, behavioral specialists and exercise physiologists to assist the patient through the process
• Free educational seminars
• Comprehensive pre-surgical classes
• Post-surgical follow-up visits
• Monthly support group

 To register for the educational seminar or for more information, call 877.Why.Weight.

Choosing to Lose…

As Mary White, 48 of Clarkston, begins her cardio warm-up with her personal trainer Peggy Staycoff, the inspiration of what her body is now capable of doing mitigates her profound dislike of the next 12 minutes she will spend running on the treadmill.

In March of 2007, Mary underwent gastric bypass surgery, a form of bariatric or weight loss surgery that alters the anatomy of your digestive system by limiting the amount of food you can eat and digest.

“Even though I’ve been overweight my whole life, I’ve always considered myself a healthy person. I’ve always believed in the power of exercise and a healthy diet,” says White.

At 5 foot two inches tall, White’s heaviest weight was 234 pounds.

“For years, I had tried every diet, exercise routine, and diet pill that came onto the market. Nothing worked for me. I finally realized that I could not achieve my optimal weight goal alone,” says Mary.

The decision to have gastric bypass surgery is a weighty one loaded with many concerns, questions and even dangers. For Mary, her decision took many years of investigative work where she educated herself on what the surgery involves, its risk factor and its long-term prognosis for sustained weight loss.

During gastric bypass surgery or Roux En Y, the kind of surgery Mary had, the stomach is reduced to the size of a walnut and food is allowed to bypass part of the small intestine. Not only is the stomach’s capacity diminished thereby resulting in feeling full more quickly but fewer calories are absorbed as food is bypassed from the small intestine. Generally, individuals with a Body Mass Index (BMI) of 40 or higher or individuals who have a life-threatening disability due to obesity can be considered as candidates for the procedure.

In the spring of 2006, Mary thought she had her decision made and surgery was scheduled for April. But her family, fearful for her safety and survival, sat Mary down and discussed with her their concerns over the operation. During her family’s intervention, she decided against having the procedure and cancelled her surgery date.

That year, she gave herself the freedom to eat whatever she wanted. Much to her surprise, she only gained six pounds.

“But I was constantly tired. At the beginning of 2007, I decided to give the procedure more thought once again, said Mary.”

This time, she teamed up with Dr. Mark Pleatman, a general surgeon specializing in bariatric surgery at St. Joseph Mercy Hospital in Pontiac. Dr. Pleatman provided Mary with not just the scientific and medical answers she was still searching but also the comfort in addressing her and her family’s concerns. After a few consultations with him, she and her family members changed their minds and set a date for Mary’s surgery.

Mary knew that having the surgery was just part of the change that could eventually result in her reaching her weight goal. Once the surgery was complete, the onus was on her to make the additional changes in her lifestyle.

If bariatric surgery is accompanied by sustained behavioral changes such as a healthy and balanced diet, and exercise, it can provide a long-term solution to weight loss, says Dr. Pleatman.

During the next few months, with the procedure always present in her mind, she tried to lose some extra weight in an effort to put less stress on her liver during the time of surgery. And, she spent many sleepless nights terrified over the uncertain outcome of her decision to have this life-changing procedure.

The operation, which took about 4 hours, was a success. For the next six weeks, Mary would have to follow a strict diet: two weeks of liquids, two weeks of pureed foods and two weeks of soft foods. After six weeks, regular food was gradually added back into her diet as her stomach began to heal.

She also worked with a nutrition counselor who advised her on what to eat, how much to eat and how to appropriately balance her foods so that she was meeting her nutritional requirements.

“I realized that for years, I was eating wrong. I wouldn’t eat the whole day and then I would consume way too much because I was so famished. I was eating so fast that my brain could not receive the signal that I was full,” says Mary.

With her current weight at 124 pounds, Mary has lost almost over hundred pounds since her surgery last spring. She also exercises with a personal trainer three days a week.

In addition to her physical appearance, her eating patterns have also changed significantly. Mary eats six small meals every day and she can only eat about one cup of food at a time due to the reduced size of her stomach. If she tries to eat more, her body will reject it and pain and vomiting will consequently and unfortunately follow. She also takes a cocktail of vitamins, which are specifically designed, for bariatric patients and will have to take them for the rest of her life. But for her, these lifestyle changes are worth every ounce of weight that has vanished from her body.

“I can finally walk the talk I’ve been trying to walk. Having this procedure was the best and most difficult decision I have made so far in my life. It has made a life-long dream of mine come true,” Mary says.

Reshaping You to Fit Your New Body

A growing epidemic in the United States is morbid obesity.

Be it genetic predisposition, poor eating habits, a sedentary lifestyle or post partum weight gain, the US and the world is realizing the medical costs associated with this epidemic. Already, the statistics are staggering. Forty percent of the population is obese and increasing every year.

For the longest time morbid obesity was treated non-surgically. Weight reduction was usually tied to exercise and calorie controlled diets. Medically, physicians were able to help by correcting imbalances in hormone status such as thyroid, estrogen, and cortisol. Anti-obesity

drugs such as phentarmine have also played a role, but their long term side effects are still questionable and cost is a factor. But as obesity skyrocketed, so has diabetes.

About 15 years ago, a surgical option was developed for the very morbidly obese and was reserved for those in life and death situations. Although complications were relatively high, it was the beginning stages to developing the protocols for surgical weight loss procedures that we are accustomed to today.

Weight loss surgeries today consist of either lap bands or gastric bypass. These procedures have proven very successful in extreme weight loss for the morbidly obese and has been maintained over a longer period of time than

most non-surgical entities. In fact, according to the Agency for Healthcare Research and Quality, bariatric surgeries have increased nine-fold between 1998 and 2004 from 13,386 to 121,055. Complication rates have also decreased due to laparascopic techniques.

While significant weight loss may look successful on the outside, it leaves another side that is largely not talked about – excess and sagging skin.

When consulting for bariatric surgery, the potential for body reconstruction should always be addressed. A lot of physicians and patients assume that once the weight loss is done, the patient will go back to their perceived new looks without any corrective surgery. As a plastic surgeon who performs post-bariatric cosmetic surgeries, almost 95% of patients require some reconstructive work approximately one to two years after their surgery.

A lot of patients don’t realize that with morbid obesity the skin, fascia and underlying tissue support system is strained and damaged to the point that it loses its recoil abilities. Very few people will have their skin go back to normal.

Think about pregnancy and how the abdominal skin does not return 100 percent to its pre-pregnancy state. Now, use this same analogy and put it to skin on the entire body for a much longer period of time. You can realize the extent of the damage to the skin and underlying tissue.

Our skin, breasts, and underlying tissues are soft, pliable and somewhat durable. But our bodies were never made strong enough to handle excessive weight over a long period of time.

So where do we start?

In the face, one usually sees the tell tale signs of aging: redundant skin in the face, neck and eyes; fatty deposits in the neck and eyes; early jowling; thinner skin; exaggerated facial lines (nasal labial folds). These are usually taken care of with brow lifts, eyelifts, face and neck lifts and fillers such as fat, Restylane or Radiesse.

Also common after weight loss is hair loss. This can be taken care of medically or sometimes surgically with micro or macro hair graft transplantation.

The chest and breast area usually does not fair well after extreme weight loss. The breast support system is made of skin, connective tissue and ligaments. Unfortunately, these specific tissues don’t hold up well to excess weight over long periods of time. As the weight loss is complete, the breasts tend to lose a lot of their volume, shape and support. They decrease in size and become ptotic (droopy).

Treatment options may include a breast lift, augmentation or oftentimes both. Thanks to newer techniques in minimally invasive surgery (PEBAM, SPAIR) scarring is left to a minimum while the saline or silicone implants can increase the breast’s volume.

The arms also suffer from redundant skin. The skin in the inner aspect of the arm is the thinnest compared to the outer arm. Some of the redundant skin involves the axilla and upper back area. The excessive skin is usually excised and the upper arm reconstructed to give a more natural look. This is known as a brachioplasty.

Liposuction is also used as an adjuvent in certain areas. The scar heals up somewhat well and is located on the inside of the arm extending into the axilla. If the upper back has redundant skin, an upper body lift is considered to get a more cosmetic appearance.

The areas most people complain about is the abdomen and thighs. In the abdominal area, the skin may be loose and overhanging their beltline, there could be some fatty deposits that are not desirable, and the muscles may be weak and need to be tightened. Also, hernias resulting from the gastric bypass may be present. The best way to take care of the abdominal area is either liposuction, abdominoplasty, or both.

In the thighs, the skin becomes redundant and sags both in the inner and outer areas. The buttocks can also lose their volume and sag. An inner and outer thigh lift is usually done in conjunction with a buttock lift. This can involve liposuction to contour the thighs. The abdominoplasty, inner and outer thigh lift, and buttock lifts are collectively known as a lower body lift. The scars are acceptable and usually hidden in creases or the underwear line.

Liposuction alone is not enough to give the body the contouring that is most pleasing. It is an adjunct only. Surgical scars usually take a year to heal and in about 10 percent of patients, revisions may be necessary. Like all surgeries, the risk of complications is greater in the post bariatric population. A thorough medical clearance is advisable, and peri-operative antibiotics and DVT prophylaxis is given.

The big question is how much of this surgery should be performed at a single setting? There is no right answer. However, scientific studies show that the longer in surgery you are, the more at risk you are to suffer afterwards (pneumnia, DVT, Pulmonary emboli, atelactasis, etc.).

The general rule of thumb is usually six hours. My philosophy is to stage the surgeries over a three month period, doing no more then 6-8 hours at a time. Remember, it’s not how fast you get to the finish line. It is getting there in the safest fashion.

In the end, realistic expectations and safe and effective reconstruction by a board certified plastic surgeon can help you get over the stigma and the resultant excess skin left. Leaving behind, a new you!

Ayoub Sayeg, M.D. is a Board Certified Diplomate, American Board of Plastic Surgery, Cosmetic and Breast Fellowship Trained. He received his medical degree from the University of Toronto and served his general surgery residency at Washington Hospital Center, Washington, D. C. Dr. Sayeg served his plastic surgery residency at Wayne State University in Detroit from 1998 to 2000.

Fight Obesity and Win!

With Dr. Mark Pleatman, MD

There is a certain portion of the population that is unable to lose weight despite diet and exercise. For these people, their obesity can lead to many health complications. Statistics have linked obesity to increased risks of diabetes, heart disease and vascular disease. Obese people generally have shorter life expectancy than their thinner peers.

In the past, when diet and exercise would fail these people, they did not have many other options. However, the advent of surgical procedures has given hope to patients who otherwise would have to live the rest of their lives morbidly overweight.

Gastric bypass surgery has been made popular by celebrities such as Al Roker and Carnie Wilson. But “chic” is not the reason to undergo this procedure.

“Bariatric surgery is not cosmetic surgery,” says Dr. Mark Pleatman, a board certified surgeon. “It is for treating obesity. It’s for those people who are more than 100 pounds overweight and have failed with diet and exercise.”

There are four types of procedures generally available for those wishing to undergo surgery to lose weight. These four options are: Lap-Band; Vertical Sleeve Gastrectomy (VG); Roux-en-Y Gastric Bypass; and vertical gastrectomy with duodenal switch. All procedures can be done with minimally invasive, or laparoscopic techniques.

The different procedures affect the modality of weight loss for an individual. The Gastric Bypass and Vertical Gastrectomy with Duodonal Switch affect the stomach and intestines and restrict food intake as well as cause malabsorption. The Lap-Band and Vertical Sleeve Gastrectomy restrict the intake of food into the stomach. With either of these procedures there is no bypassing of the intestines, which leads to fewer complications.

So how do you decide which procedure is right for you? First, a patient’s Body Mass Index may determine which procedure is available to them based on safety and results, says Dr. Pleatman. “The Lap-Band is popular in Europe and Australia,” says Dr. Pleatman. “The main attraction is that it is simple, it is an outpatient procedure, and patients experience a rapid recovery with return to normal activities in about one week.”

However, Dr. Pleatman points out that the Lap-Band does require the greatest degree of compliance and motivation on behalf of the patient. It also requires multiple visits to the physician’s office to have the band adjusted. “This can be a disadvantage due to the inconvenience and it can be expensive if you do not have insurance coverage,” says Dr. Pleatman. “Weight loss with the Lap-Band is not as good as with gastric bypass and a significant amount of patients do not lose the amount they want. There is about a 20-25% failure rate.”

The gastric bypass is best suited for patients with BMI over 35, but less than 60kg/m2. It is generally covered by most insurance companies, but does have higher complication rates. The gastric bypass can also cause anemia and osteoporosis because the body does not absorb these nutrients as well. This can be prevented by taking vitamin and mineral supplements.

Patients who undergo gastric bypass can expect to lose up to 70% of their excess weight and due to the history of gastric bypass, most insurance companies cover this procedure. It is more invasive, and patients can expect to return to normal activities between 2-3 weeks.

The latest advancement in bariatric surgery is the Vertical Sleeve Gastrectomy, which is also done laparoscopically with minimal invasiveness. “There are a number of surgeries being done using the laparoscopic approach and that makes it safer and much easier to recover from,” says Dr. Pleatman. “The vertical sleeve gastrectomy can be a bridge procedure for patients with high risk obesity. The advantage to this procedure is that it can be done on very obese patients to help them lose 100-200 pounds and a second procedure (the duodenal switch) can be done at a later date to get even more weight loss.”

Another advantage to this procedure is that it is less invasive and reduces the size of the stomach without rerouting the intestines. The patients have less of a risk of nutritional deficiencies and other long-term complications, according to Dr. Pleatman. “It has turned out that this procedure has been so successful on its own that it is now being used as a primary weight loss and patients are not having to go back for a second stage,” says Dr. Pleatman.

This procedure generally takes about an hour to complete and requires one night in the hospital. Normal activity can be resumed approximately 1-2 weeks after surgery. “Due to the safety and success of vertical sleeve gastrectomy, it has some potential advantage for adolescents because it does not interference with vitamins, nutrients and bone growth,” says Dr. Pleatman. “This also has an appeal for older patients who are too high risk for gastric bypass.”

Dr. Pleatman says the advancement of the VG procedure is leading more surgeons to utilize this procedure first-line when possible. “We are going to see a surge in (VG), especially in high risk patients,” says Dr. Pleatman. “The gastric bypass is a good operation and has been around a long time, and it will certainly still be chosen because we know it’s a good operation and it works.”

Many people are still concerned about the safety of such surgeries, but Dr. Pleatman points out that recent statistics show the current mortality risk with gastric bypass is 0.5% due to the lower complication rates. Post-op, patients can expect quicker recovery times. “The beauty of the laparoscopic approach is the incisions are tiny. Patients are up walking around the next day, showering, etcetera. They are eating and we are encouraging them to eat a small quantity at a time. They are on a progressive diet afterwards from liquids to solids over about 30 days,” says Dr. Pleatman.

“Many patients think it is safer to risk the surgery than it is to be morbidly obese,” says Dr. Pleatman. “Those patients statistically have a 10% chance of dying in the next five years without the surgery because of co-morbid diseases such as high cholesterol, diabetes or high blood pressure.”

In order to prepare for this type of surgery, Dr. Pleatman advises that patients educate themselves, start an exercise program, quit smoking and research physicians who perform this procedure. “Patients are generally asked to lose 5-10% of their weight before the surgery,” says Dr. Pleatman. “I won’t operate on someone who has gained more weight before the surgery because it increases the risk of surgery.”

The benefits for many patients far outweigh the risks. Patients have seen benefits in the reduction of their cholesterol levels, blood pressure and diabetes. The ultimate goal is to help these patients resume a normal, healthy lifestyle.

Dr. Mark Pleatman is certified by the American Board of Surgery, and a Fellow of the American College of Surgeons. He graduated from Haverford College, and received his doctorate degree from the University of Cincinnati College Of Medicine. He completed his Residency in General Surgery at Saint Louis University Hospital. He also completed a fellowship in Surgical Endoscopy at Mount Sinai Medical Center in Cleveland, Ohio. As a Major in the United States Army Reserve, he served in the Army during the Persian Gulf War. Dr. Pleatman’s practice is located in Bloomfield Hills. He is affiliated with many hospitals in the North Woodward area and the DMC hospitals.