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By C ori U rban Special To The Republican

At Holyoke Medical Center, medical staff empower patients who are having weight-loss surgery with education and guidance and become partners in their care.

Clomaris Velazquez, of Holyoke, had successful bariatric surgery with Dr. Yannis Raftopoulos in 2017 and a complex recurrent incisional hernia repair by Dr. Martin Walko last year at Holyoke Medical Center; she lost 123 pounds over the course of five years and recently said she feels great. “I feel more energetic, and I am looking forward to going back to work,” as a medical assistant, she hopes.

The doctors and staff “were there for anything I needed,” she said, awarding them five out of five stars, meaning she received top-notch care.

Patients like Velazquez are taught about healthier food choices, eating fewer processed food with empty calories and the importance of some activity to help burn calories. “We help them and monitor their progress as well as recommend modifications for what works and what isn’t working,” said Walko, a Valley Health Systems Inc. bariatric and general surgeon.

He helps persons who are obese to lose weight and enjoy a higher quality of life.

Obesity is defined as having a body mass index greater than 30; in the United States, two thirds of adults are overweight or obese.

One of the obesity related comorbidities is hernia. “Simply stated, a hernia is a hole that allows an organ to protrude into an area where it’s not supposed to be,” Walko explained.

The most common hernia are holes in the fascia, which is the gristle that holds muscles and bodies together. In the case of abdominal wall hernias, once there’s hole in the fascia, the hole won’t close on its own. Over time, with increased intra-abdominal pressure, many hernias will get larger and more symptomatic. “They can even cause life-threatening problems if the tissue gets stuck out or twists and loses its blood supply, which is known as a strangulated hernia,” he said.

How obesity creates a hernia is complex and “we don’t understand all the reasons,” the doctor continued. Some issues that are agreed upon include increased intra-abdominal pressure that stretches and applies pressure on any weakness. Also, “obese patients tend to be more sedentary, so their fascia, in theory, will be weaker than an athlete’s.” tion also be addressed or the hernia will return,” Walko emphasized. “This is where addressing obesity becomes important. Technically, both open and minimally-invasive (laparoscopic) repairs are options and tailed to patient needs.” He also is trained in robotic repairs, which is another aspect of minimally-invasive surgery.

There are risks to hernia repair.

“As with any operation, there are always risk of bleeding, infection and anesthesia risks, which are uncommon,” Walko said. “In the case of hernia repair, the hernia mesh/ patch can become infected or pinch, causing pain or even more serious issues. But the hernia repair-specific first. “However, sometimes repair before weight loss is fraught with greater risks, including recurrence.”

Obese patients have a greater chance for complications during hernia surgery depending on whether it’s emergent or elective surgery and the specific problem. “In general, emergency surgery is usually accompanied by a patient who has poorly-controlled or uncontrolled health issues, like diabetes, smoking, lung problems, so yes, the risk of complications are greater,” Walko said. “However, when an obese patient follows a care plan to minimize other health issues, like smoking/nicotine use, weight loss, better control of diabetes, better control of breathing

“Bariatric surgery begins with patient education for healthier lifestyle choices, better nutrition, weight loss and, as these changes occur, the related health problems like type 2 diabetes, lipid problems and unhealthy lifestyle choices like substance abuse or nicotine abuse are improved by the patient and healthier choices.”

Many obese patients also have type 2 diabetes, which impairs healing, as well as other health issues, such as sleep apnea, restrictive lung disease and other health issues which makes a “one -size-fits-all” repair complicated.

Valley Health Systems/Holyoke Hospital treats umbilical, incisional, inguinal and other abdominal wall hernias as well as hiatal and para-esophageal hernias that cause and contribute to GERD/heartburn.

“Hernias, in general, require returning the organ to its proper body space and closing of the hole; it’s paramount that any medical problems that contributed to its forma- risk is that the hernia can return, especially in the setting of weight-gain or not following activity restrictions around the time of surgery.”

Ideally, the best data show bariatric surgery first and weight-loss increase options for the patient in abdominal wall hernia repairs, but hiatal hernias are repaired during bariatric surgery. “But, patients don’t always present in a manner that allows it, so a symptomatic hernia will need to be repaired before bariatric surgery, at times,” he added. If the hernia is causing debilitating symptoms, is incarcerated (stuck out) or is causing bowel blockage, then it’s usually repaired problems, the risks are minimized, which is why following a health care plan is always important.”

Symptoms of hernia depend on the type of hernia. Sometimes, there are no symptoms, which is common with umbilical hernias; hiatal hernias cause heartburn and sour tastes in one’s mouth; incisional, abdominal and groin hernias tend to cause local pain/pressure and affect some activities.

Hernias usually are diagnosed during a physical exam, but sometimes a CT scan is required due to patient’s build and the need to look for other, smaller hernias.

Obesity carries with it increased intra-abdominal pressure, type 2 diabetes, pulmonary problems like sleep apnea, vascular problems and can also be accompanied by other health issues like cigarette smoking which increase the risk of complications and additional hernias, explained Walko, who attended Robert Wood Johnson Medical School Camden Campus which is now known as Rutgers Medical School and whose general surgery residency program was five years at Abington Memorial Hospital outside of Philadelphia. “Bariatric surgery begins with patient education for healthier lifestyle choices, better nutrition, weight loss and, as these changes occur, the related health problems like type 2 diabetes, lipid problems and unhealthy lifestyle choices like substance abuse or nicotine abuse are improved by the patient and healthier choices.”

In the Holyoke Medical Center program, he has performed at least 100 hernia operations, not including emergencies and several hundred bariatric surgery operations including emergencies.

He suggested persons who think they are a candidate for bariatric surgery contact the team at Holyoke Medical Center.

“Everyone should bear in mind that your surgeon will meet with the patient, review your health history and formulate the best plan as well as other options,” he said. “When I was a resident, one of my surgical instructors told me … the word ‘doctor’ means ‘teacher,’ and that we should be teaching our patients how to make healthy choices to prevent illness whenever possible. Some illnesses not preventable, but education is still paramount in helping a patient make the best choice in their care.”

For more information, call Holyoke Medical Center at 413-534-2500.

The number of calories that go into a person should be exceeded by the energy expended by exercise and the normal biological functions of the body.

This often involves controlling caloric intake, which can be simple when people cut back on portion sizes. Some people believe they can lose weight by limiting what they eat and even skipping certain meals altogether. But skipping a meal like breakfast could actually have an adverse effect on weightloss efforts. People who lose weight and keep it off are generally those who eat a large, healthy breakfast.

In a study about meal frequency and changes in body mass index published in The Journal of Nutrition, researchers found that those who made breakfast the largest meal of the day were more likely to have a lower body mass index (BMI) than those who ate a large lunch or dinner. A portion-controlled breakfast full of lean protein and whole grains can help people to feel fuller longer. Breakfast can curb hunger pangs before lunch, reducing the likelihood that people will reach for unhealthy vending machine fare to tide them over until their midday meals.