Leading Medicine Spring Summer 2019, Houston Methodist Baytown Hospital edition by Houston Methodist

LEADING MEDICINE SPRI N G/SUM M ER 2019

A Closer Look at Your Colon 4 Frequently Asked Questions About Weight Loss Surgery

Orthopedic and Sports Injuries

PROTECT YOURSELF FROM HEAD TO TOE

YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN EAST HOUSTON/BAYTOWN

IN THIS ISSUE - SPRING/SUMMER 2019

A Closer Look at Your Colon Very few people look forward to discussing issues relating to the colon or rectum with their doctor, but it’s a necessary conversation.

H ow Pelvic Floor Therapy Offers Pain Relief Specialized therapy may offer relief for pelvic pain, a condition that is more common in women than men.

O pen Valves, Open Heart For people about to undergo a heart valve replacement, the idea of having surgery can be scary. Rest assured; the procedure is very common.

rotect Yourself from Head to Toe P Everyday types of injuries happen all the time and can lead to long-term problems if not treated properly.

3 Truths About Cancer Treatment Although many people may think they know a lot about cancer, some still have common misconceptions about the disease.

M ake Your Varicose Veins Vanish One in 5 adults has varicose veins — bulging reddish-purple veins that occur most often in the legs. Learn when to seek help.

4 Frequently Asked Questions About Weight Loss Surgery If you suffer from obesity, diet and exercise may never be enough to achieve the weight loss needed to reach a healthy body weight.

NEWS & EVENTS FOCUS ON STROKE PREVENTION

In recognition of May’s designation as National Stroke Awareness Month, Houston Methodist Baytown Hospital — a Gold Plus Primary Stroke Center — hosts a free stroke seminar to help Baytown area residents understand their risk of stroke. The seminar is scheduled for 6 to 7 p.m., May 30, at the Community Resource Credit Union Community Room. A stroke occurs when blood flow to the brain is cut off by a blood clot (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke). As the blood supply is stopped, brain cells begin to die and brain damage occurs. If you or someone you know shows symptoms of a stroke, early intervention can make all the difference, so get immediate medical care by calling 911. For more information and to register for the seminar, visit houstonmethodist.org/events or call 281.428.2273.

CELEBRATING CANCER SURVIVORS

The National Cancer Institute (NCI) estimates there are 15.5 million cancer survivors in the U.S. and projects that number will increase by 31 percent to 20.3 million by 2026. The organization attributes the increase in the number of survivors to the improved preventive, diagnostic and treatment procedures developed in recent years. In observance of Cancer Survivors Day, the Houston Methodist Cancer Center at Baytown, the only Commission on Canceraccredited facility in Baytown, hosts its annual free Cancer Survivors Day Celebration scheduled from 11:30 a.m. to 1 p.m., June 20, in the conference center classroom. The event celebrates the achievements of survivors, their families and caregivers. It also draws attention to the ongoing challenges of cancer survivorship and encourages the development of more resources, research and survivor-friendly legislation. To register for the celebration, visit houstonmethodist.org/events or call 281.428.2273.

VIRTUAL URGENT CARE The next time you get sick, you can skip the waiting room. See our providers via video visit — 24/7, from wherever you are. Virtual Urgent Care is available through the MyMethodist app. Download it today or visit houstonmethodist.org/virtual-care to learn more.

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Colorectal Cancer Screenings

A CLOSER LOOK AT YOUR COLON

ery few people look forward to discussing issues relating to the colon or rectum with their doctor, but it’s a necessary conversation. Of cancers that affect both men and women, colorectal cancer is the second leading cause of cancer-related deaths in the U.S. and the third most common cancer, according to the Centers Dr. Ziad Kronfol for Disease Control and Prevention. Dr. Ziad Kronfol, a colorectal surgeon at Houston Methodist Baytown Hospital, said colorectal cancer is one of the few cancers that has a screening method that not only detects the cancer in its early stages, but also helps prevent the cancer in the first place.

Schedule a Screening Today

To schedule an appointment with a specialist at Houston Methodist Baytown Hospital for colorectal cancer screening or treatment, visit houstonmethodist.org/baytown or call 281.428.2273.

SCREENING RECOMMENDATIONS

“Colorectal cancer almost always develops from polyps in the colon or rectum. With a screening test, such as colonoscopy, polyps can be found and removed before they become cancerous,” Kronfol said. “The earlier a polyp is found during screening, the greater the chance it can be surgically removed laparoscopically with small incisions.” Unfortunately, fewer than half of adults age 50 and older get the recommended screenings, according to the Health Resources & Services Administration. The American Cancer Society and the U.S. Preventive Services Task Force recommend colorectal cancer screening for men and women at average risk beginning at age 45 and continuing until age 75. Continuing beyond this age should be considered on an individual basis, and only after assessing the patient’s overall health and other factors. “People at an increased risk for developing colorectal cancer should discuss screening earlier and may require more frequent tests. Talk to your doctor about a screening schedule that’s right for you,” Kronfol said.

RISK FACTORS

The exact causes of colorectal cancer are not known. However, certain factors increase your risk of developing the disease. According to the National Cancer Institute, they include: A ge: Most people who develop colorectal cancer are over age 50. P olyps: (abnormal growths that stick out from the inner wall of the colon or rectum). While most polyps are noncancerous, the majority of colorectal cancers develop from polyps. P ersonal history of colorectal cancer: Women who have had ovarian, uterine or breast cancer also have a higher risk. F amily history of colorectal cancer U lcerative colitis or Crohn’s disease D iet: Eating a lot of red and processed meats and not many whole grains, fruits and vegetables may increase risk. S edentary lifestyle S moking

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How Pelvic Floor Therapy OFFERS PAIN RELIEF

N Dr. Paul Redman

o one is immune to pelvic pain. While it may be more common in women than men, pelvic pain can occur at virtually any time in a person’s life. People who suffer from pelvic pain may also experience urinary incontinence (leakage), increased urinary frequency, difficulty emptying the bladder and pelvic pain during sexual activity. Their symptoms may keep them from enjoying daily activities due to pain or worry about finding a bathroom at a moment’s notice. But there is hope.

A COMMON PROBLEM FOR WOMEN

Dr. Paul Redman, an obstetrician-gynecologist at Houston Methodist Baytown Hospital, says pelvic pain and urinary incontinence in women is more common than many realize. “Urinary incontinence can affect women of Dr. Olubayo all ages, especially women ages 65 and older,” Tojuola Redman said. In addition to surgical options, women with pelvic pain or urinary incontinence may find relief through pelvic floor muscle training (PFMT). This therapy targets the muscles that control continence and sexual function and support internal organs. PFMT is frequently the first line of treatment for women suffering with these conditions. During the initial appointment, your doctor will discuss your medical and personal history, as well as any symptoms, to determine how pelvic pain is affecting your life. They may also perform a vaginal or rectal exam to determine if PFMT can help your condition.

MEN MAY ALSO BENEFIT

Dr. Olubayo Tojuola, urologist at Houston Methodist Baytown Hospital, says he also prescribes PFMT for men suffering with pelvic pain or urinary incontinence. “The training may be especially beneficial for men before a prostatectomy, surgery to remove all or part of the prostate gland, because it relieves the severity of symptoms in the three months after surgery,” Tojuola explained. PFMT therapy sessions can last for several weeks or months, depending on each patient’s condition, their symptoms and treatment goals.

PELVIC THERAPY: MORE THAN KEGELS Women often use Kegel exercises to strengthen pelvic floor muscles to deal with urinary incontinence. Michelle Jernsletten, a pelvic physical therapist at Houston Methodist Baytown Hospital, says a variety of therapies are available to improve function in the pelvic region, including: P osture and body alignment adjustments R elaxation techniques to relieve pain M anual therapy to reduce bladder and/or bowel urgency, pain and constipation B owel and bladder retraining to minimize or eliminate incontinence “Pelvic physical therapists are highly trained and certified in addressing the cause of patients’ pelvic problems and easing symptoms,” Jernsletten said. Call Houston Methodist Baytown Hospital's Department of Physical Therapy at 281.420.6840 to make an appointment.

Say Goodbye to Pelvic Pain

If you're experiencing pelvic pain, leakage or other urination issues, visit houstonmethodist.org/ baytown or call 281.428.2273 to schedule an appointment with a urology or OB-GYN specialist at Houston Methodist Baytown Hospital.

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Valve Replacement Options

Open Valves, Open Heart

or people about to undergo a heart valve replacement, the idea of having surgery on one of their most vital organs can be scary. Rest assured; the procedure Dr. Walter is very common. Here, O’Hara we explain why a valve replacement procedure may be necessary and review the options.

WHAT THE VALVES DO

The heart has four valves responsible for keeping blood moving in a circular pattern through the organ. The aortic and mitral valves are located on the left side, the pulmonary and tricuspid valves on the right. “Each valve has flaps, or leaflets, that work like gates and prevent the backflow of blood,” said Dr. Walter O’Hara, cardiothoracic surgeon at Houston Methodist Baytown Hospital.

HEART VALVE PROBLEMS

Problems can occur when a valve becomes weak, narrow or leaky, preventing blood from circulating properly. This can happen at birth or because of aging or certain conditions, such as rheumatic fever or a bacterial infection. The aortic and mitral valves are most often affected. In a narrowed valve (stenosis), the leaflets don’t open completely, restricting blood flow. The heart must work harder to pump blood and there’s not enough oxygen-rich blood flowing through the body. Stenosis symptoms include shortness of breath, chest pain and syncope (fainting). In a leaky valve (regurgitation), the flaps let blood flow back through the valve because they’re not closing tightly or completely. “Aortic regurgitation occurs when the aortic valve allows blood to flow back into the heart. This limits the amount of blood moving through the heart, causing it to work harder. Mitral regurgitation occurs

when the mitral valve allows blood to flow back into the lungs, instead of moving through the heart,” O’Hara explained. The symptoms of mitral and aortic regurgitation are shortness of breath and heart failure symptoms, such as fluid retention, fatigue and irregular heartbeat.

SURGICAL REPLACEMENT OPTIONS

“If the valve is only slightly damaged, the surgeon may be able to repair it by inserting a ring to keep the valve in shape.

However, when the valve is beyond repair, it must be replaced,” O’Hara said. The two most common types of valves are bioprosthetic and mechanical. “Mechanical valves last a very long time, but have to be supported by anti-coagulant medication,” O’Hara said. “The bioprosthetic valve does not last as long, but patients do not have to take anti-coagulant medicine. Your doctor will discuss treatment options with you based on your condition, medical history and other factors.”

Expert Cardiovascular Care

Visit houstonmethodist.org/heart-vascular or call 832.556.6625 to make an appointment to discuss heart valve replacement surgery options with a cardiothoracic surgeon.

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Orthopedic and Sports Injuries

Protect Yourself from HEAD TO TOE D ealing with orthopedic and sports injuries often comes with the territory for football players, marathon runners, gymnasts and other competitive athletes. But you don’t have to be on the field or court to end up with a painful or chronic injury. Everyday types of injuries — from carrying groceries or unloading the dishwasher — happen all the time and can also lead Dr. Karthik to long-term problems if not treated properly. Jonna Back problems, joint disorders and osteoarthritis are among the top reasons for seeing a doctor. “Musculoskeletal issues result in millions of orthopedic visits every year,” said Dr. Karthik Jonna, an orthopedic surgeon specializing in knee and hip surgery at Houston Methodist Baytown Hospital.

KNOW YOUR LIMITS

Jonna says it’s important to listen to your body when it’s telling you to slow down. “Sometimes we try to push through the pain, but you can end up doing more damage if you’re not careful. When you have joint and muscle pain, you can’t always walk off the pain or solve it by taking anti-inflammatory medicines,” he noted. “With age, our ability to heal is not as fast as it used to be and we don’t have as much elasticity in those tendons — like a rubber band that loses its elasticity over time. The best thing you can do is modify your activities or try a new activity that puts less stress on your body, such as biking or swimming,” Jonna added.

WHEN TO GET CHECKED

Injuries are bound to happen whether you’re competing in sports or just taking a walk around the block. Minor injuries can often be treated at home with rest, ice, compression and elevation. But there are times when it’s important to see a doctor so you can avoid further damage and ensure that you can heal properly. It’s wise to get medical help if you experience the following symptoms after an injury: Instability (unable to bear Significant swelling or weight on your knee or ankle) tenderness Limited range of motion Weakness or lack of Numbness or tingling strength while moving a Persistent joint pain limb or muscle In addition, any impact to the head should be taken seriously, whether it’s from a sports collision or a minor fall at home. “When it comes to head injuries, always seek medical help for signs of concussion, such as any loss of consciousness, confusion or dizziness following a bump on the head,” Jonna said.

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JOINT REPLACEMENT SURGERY

For those suffering with daily, debilitating pain caused by arthritis, joint replacement surgery, primarily of the knees or hips, may bring relief and improve quality of life. Advances in technology have made these procedures very common, and the recovery time has been reduced as well. Artificial joint durability — joints can be made of plastic, metal and/or ceramic — is also vastly improved, so most patients who receive one will never need another. Affecting 1 in 5 Americans, arthritis is typically the culprit in causing joints to become so stiff, tender and painful that joint replacement surgery is considered. The resulting pain can be so pervasive that nonsurgical measures meant to manage it, such as pain medications and creams, exercise, physical therapy, steroid or other injections, and bracing the joint, provide only brief relief. “By the time people get to the point where they are considering joint replacement, they’re enduring pain on a daily basis and it’s dominating a significant part of their life,” Jonna explained. “It’s the kind of pain that leads them to become less active. The decision to proceed with joint replacement surgery will lead to the elimination of the pain and suffering.”

Comprehensive Orthopedic Care

For more information on our full range of services and to schedule an appointment with an orthopedic surgeon at Houston Methodist Baytown Hospital, visit houstonmethodist.org/orthopedics or call 281.427.7400.

HEAD AND NECK

INJURY PREVENTION TIPS

Concussion Whiplash

Dr. Karthik Jonna, an orthopedic surgeon at Houston Methodist Baytown Hospital, shared the following injury prevention tips.

Injury prevention: Stay fit and maintain good posture for a strong neck and upper back. Wear headgear for contact sports or safety equipment for your activity.

BACK Herniated disk Repetitive strain Injury prevention: Protect your back from injuries by strengthening your core muscles (the muscles that wrap around your entire torso) by doing exercises, such as planks and/or abdominal bracing exercises.

SHOULDER Rotator cuff injury Shoulder instability Injury prevention: Lift properly by picking up objects in front of you and as close to your body as possible.

ARM AND ELBOW

HIP AND LEG

Bursitis Golfer’s elbow Tennis elbow

Hamstring strain Hip flexor strain Shin splints

Injury prevention: Mix up your routine by doing a variety of arm movements to avoid repetitive injuries. Learning the proper mechanics for throwing and swinging is key to avoiding upper extremity injuries.

Injury prevention: Take care of your muscles and joints by warming up and stretching before exercise.

KNEE ACL injuries Jumper’s knee (patellar tendonitis) Osteoarthritis of the knee Injury prevention: Lose weight or maintain a healthy weight to take pressure off the knee and reduce wear and tear over time. Staying active helps protect the knee because you’re building muscles in the hips, quads and thighs to support the knee.

WRIST AND HAND FOOT AND ANKLE Ankle sprains Tendonitis Turf toe Injury prevention: Wear good shoes with solid support to absorb impact and prevent ankle injuries. Balance activities can help with stability — it can be as simple as standing on one leg.

Carpal tunnel syndrome Jammed fingers Skier’s thumb Wrist sprains Injury prevention: Take breaks from activity to rest the hands and wrists. If you spend a lot of time at a desk, set a timer throughout the day for every half hour to remind you to stretch and move.

KEEP MOVING Jonna shared some additional tips to help you keep moving and stay injury-free: Warm up before you exercise — walking, squatting, cycling, jumping jacks, arm circles, shoulder rolls or lunges. Get your heart rate up with activities such as a brisk walk in a park with friends.

A im for 30 minutes of exercise every day — you can break this up into smaller 10-minute bursts of exercise throughout the day. B uild strength with weights a few times a week. A dd balance activities at least once a week — stretching, yoga, tai chi. F ocus on good posture — avoid the “head forward, rounded neck” posture when looking at your phone.

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3 TRUTHS ABOUT CANCER TREATMENT

lthough many people may think they know a lot about cancer, some still have common misconceptions about the disease, according to a recent American Cancer Society survey. Dr. Cesar De Las Casas, a medical hematologist-oncologist at the Houston Methodist Cancer Center at Baytown, says Dr. Cesar De it’s important to understand all of your Las Casas options when making decisions about cancer treatment. The following three truths help set the record straight so you can move forward with confidence.

CAN BE TREATED — BETTER 1 CANCER THAN EVER.

Many think cancer is unstoppable once it develops. But improvements in early detection and more precise treatments can often stop cancer in its tracks. In 2002, for example, more than 10 million Americans were alive who had been diagnosed with cancer at least five years earlier. Of those, almost 716,000 were diagnosed with cancer more than 27 years ago.

IS AN EFFECTIVE TOOL IN 2 SURGERY TREATING CANCER.

Years ago, cancer was often more advanced by the time doctors found it during exploratory surgery. This fueled the notion that exposing tumors to air during an operation caused cancer to spread. “On the contrary,” De Las Casas said, “surgery to remove malignant tissue is a critical part of many cancer treatment plans. It’s often performed before chemotherapy and radiation therapy.”

CAN HELP REDUCE 3 MEDICATIONS CANCER PAIN.

About 90 percent of people with cancer pain can get relief, according to the Federal Agency for Healthcare Research and Quality. Unfortunately, many people don’t seek help for their pain. Some patients forget to take medication or wait too long between doses. Others won’t tell their doctors that they’re having pain. Be honest with your health care team. They will work with you to find a way to ease your pain.

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INFUSION THERAPY ADVANCING CANCER CARE An extensive renovation of the Houston Methodist Cancer Center at Baytown was completed in February 2019. A centerpiece of the project was the addition of 12 private and semiprivate infusion therapy suites. Infusion therapy for cancer patients involves the IV administration of medications, including chemotherapy and immunotherapy. Dr. Cesar De Las Casas, a medical hematologistoncologist at the Cancer Center, explains that in addition to treating cancer patients, the infusion center provides care for those with a variety of illnesses. Patients can receive IV medications for conditions, such as multiple sclerosis, rheumatoid arthritis, psoriasis and Crohn’s disease. “The new center provides a comfortable setting so patients can stay close to home to receive these vital therapies,” De Las Casas said.

Cancer Care Close to Home

For more information about the full range of cancer treatments and services available at the Houston Methodist Cancer Center at Baytown, visit houstonmethodist.org/cancer-baytown or call 281.420.8809.

Make Your Varicose Veins Vanish

ne in 5 adults has varicose veins — bulging reddish-purple veins that occur most often in the legs. They can be unsightly and Dr. Jacobo may cause discomfort Nurko or pain. Varicose veins can sometimes lead to serious health problems like skin ulcers, which need immediate medical attention. “Normally, valves in your veins keep blood flowing forward to return it to your heart. But if the valves aren’t working properly, blood can leak back into the veins and pool there. When backed-up blood makes the veins bigger, they can become varicose,” said Dr. Jacobo Nurko, vascular surgeon with Houston Methodist Baytown Hospital. They’re more common among older people, people who are overweight or obese, those who sit or stand for long periods, and women.

SELF-HELP OPTIONS

To help keep varicose veins from getting worse, try these tips: Get regular exercise that uses the legs. Eat a low-salt, high-fiber diet. Maintain a healthy weight. Elevate your legs when resting. Avoid wearing tight clothing on your waist, groin or legs. Keep from crossing your legs for long periods when sitting. Wear compression stockings to help blood move more efficiently.

WHEN TO SEEK HELP

It’s time to see a health care provider about varicose veins if: Varicose veins cause pain or aching. A vein is red, swollen, very tender or warm to the touch. You have sores or a rash on the leg or near the ankle. The skin on your calf and ankle becomes thick and changes color. A varicose vein begins to bleed. Your symptoms interfere with your daily activities. The appearance of the varicose veins distresses you.

AVAILABLE THERAPIES

Often a specialized ultrasound is performed to assess the cause of varicose veins, which helps guide treatment. Here’s a rundown of treatment options: Sclerotherapy and Microsclerotherapy: These procedures are performed in your

doctor’s office and require no anesthesia. “Your doctor injects a special solution into the problem vein. This causes the vein to seal shut, shrink and fade over a few weeks. Veins may need to be treated more than once,” Nurko explained. Laser and radiofrequency treatments: With traditional laser therapy, your doctor directs a strong burst of light onto the vein, causing it to break down and disappear. “Laser therapy may involve several treatments and is performed in your doctor’s office, after which you can return to normal activity. Endovenous laser therapy (EVLT) and radiofrequency ablation (RFA) are newer treatments that work similarly,” Nurko said. Surgical removal: Due to the success of noninvasive procedures, surgical removal of varicose veins is used only in complex cases. “If you have large varicose veins, your doctor may remove them surgically,” Nurko said.

Find the Right Treatment

To learn what treatment is right for you, visit houstonmethodist.org/heart-vascular or call 832.556.6625 to schedule an evaluation with a vascular surgeon at Houston Methodist Baytown Hospital.

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4 FREQUENTLY ASKED QUESTIONS

About Weight Loss Surgery

iet and exercise are commonly recommended methods of reaching and maintaining a healthy body weight. However, if you suffer from obesity, diet and exercise may never be enough to achieve the weight loss needed to reach a healthy body weight. If, despite efforts to shed pounds, your health is compromised by your weight, you may be considering weight loss surgery. Dr. Kendell “Weight loss surgery is a major decision, and Sowards you’re bound to have questions,” said Dr. Kendell Sowards, a bariatric surgeon at the Houston Methodist Weight Management Center at Baytown. Here are four common questions as you consider whether weight loss surgery is right for you.

Can anyone get weight loss surgery? At Houston Methodist Baytown Hospital, we perform weight loss surgery on patients age 18 and up. You may have to provide a “letter of medical necessity” to qualify for insurance coverage of weight loss surgery, which is usually determined by your body mass index, or BMI, and previous unsuccessful efforts to lose weight without surgery. “A person is considered obese if their BMI is greater than 30,” Sowards said. “To qualify for bariatric surgery you usually must have a BMI greater than or equal to 40, or greater than or equal to 35 with a serious health problem linked to obesity, such as diabetes, high blood pressure, sleep apnea and compromised cardiac function.”

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BENEFITS OF WEIGHT LOSS SURGERY

Studies show that those who have weight loss surgery experience several health benefits: Reduced risk of heart disease ecreased risk of colon, breast, endometrial, D kidney and pancreatic cancers Decreased risk of diabetes Increased ability to become pregnant Less sleep apnea Less heartburn (with gastric bypass procedure)

WHICH SURGERY IS RIGHT FOR YOU? GASTRIC BYPASS Roux-en-Y gastric bypass is a common type of bariatric surgery. Part of the stomach is stapled off, leaving a small pouch that will only hold a few ounces of food. The digestive tract is redirected — bypassing the upper small intestine — reducing total calories absorbed, decreasing hunger and providing the most efficient weight loss. You’re a good candidate if you … H ave a BMI greater than 40 S uffer from life-threatening obesity-related disease A re otherwise healthy enough to withstand the surgery H ave severe reflux (heartburn)

How much weight will I lose? Total weight lost depends on many factors, including the type of surgery you have, how closely you follow postoperative nutrition and activity guidelines and other factors. Typical “maintenance” weight loss, meaning the percentage of excess body weight that is lost and kept off, is from about 40 to 50 percent. Talk to a doctor to determine realistic expectations for weight loss surgery.

SLEEVE GASTRECTOMY

You’re a good candidate if you … H ave a BMI of 40 or more H ave a BMI of 35 and an associated medical condition

What will my long-term diet be like after surgery? While surgery is a tool toward weight loss, it’s not a magic solution. Work and commitment following surgery are equally important. Our nutritionists can help you create a plan that’s right for you. In general, your guidelines will be somewhere between 800 and 1,500 calories with 60 to 80 grams of protein a day. You’ll want to avoid eating too many carbohydrates, such as breads, pastas, crackers and refined cereals, along with sugars. And if you have gastric bypass surgery, stay away from foods high in sugar and fat. More importantly, you’ll focus on eating healthy, vitaminand protein-rich foods.

What positive effects will weight loss surgery have on my health? Research suggests successful weight loss surgery can help you live longer and resolve comorbid conditions, such as diabetes, high blood pressure, sleep apnea and high cholesterol. “While results will vary, some of the health benefits you can expect include improved mobility and mental health,” said Sowards. “Weight loss surgery can also have a positive impact on chronic conditions, as well as reduced risk of cancer and heart disease.”

With this popular option for weight loss surgery (also known as gastric sleeve), the surgeon removes about 75 percent of the stomach to create a long vertical tube, decreasing the size of the stomach. This allows patients to feel full more quickly, which curbs hunger.

REVISION SURGERY Revisions may be performed because of a complication from a previous bariatric surgery, including bypass, sleeve, adjustable-band or vertical-banded gastroplasty. To achieve more effective weight loss, revisional surgeries may include: A n adjustable band that has eroded or slipped. Or the patient no longer can tolerate solid foods. The surgeon would remove the band and convert to a sleeve or bypass. A patient develops a complication, such as ulceration or strictures. The surgeon may have to revise the anatomy. A patient with a sleeve develops severe gastroesophageal reflux disease (GERD) that medications cannot resolve. The surgeon would convert the sleeve to a bypass. A patient develops maladaptive eating and weight regain. The surgeon would revise or convert to another procedure.

ACHIEVING LONG-TERM RESULTS

Weight loss surgery is a major decision that can change your life for the better — but it requires a lifelong commitment to a healthy lifestyle. Surgery is the tool to help you lose weight, but the actions you take afterward when it comes to diet and exercise are key to long-term success.