Total Body Surgical Blog

As surgeons that wear many different hats during the week (Cosmetic Surgery, Reconstructive Surgery, Bariatric Surgery, and General Surgery), Dr. Swetnam and I are faced with constant challenges; and it is a significant challenge to keep everyone satisfied.  As one of my favorite subjects, today I'll discuss post weight loss cosmetic surgery.

Typically, bariatric surgery patients first and foremost have decided to take the plunge in changing their lives.   I heard it best this week from a patient who told me, "Dr. Miller, I am sick and tired of being sick and tired." It's a lifetime of habits that they must break: the way they eat, the way they exercise, even just the way they think. The positive repercussions of weight loss are legion.  It truly is an entire lifestyle change.  It is amazing for me to see how one positive change by a bariatric patient effects those around them.  I recently saw a patient that was 12 weeks out from a sleeve gastrectomy.

To both of our satisfaction, he had already lost 70 pounds.  On top of that, his wife had also lost 30 pounds just by following the same diet that I'd ask him to impart postoperatively.  The little cherry on top of all this icing post surgery was that their daughter had also decided to begin to make healthy food choices, resulting in weight loss as well.  It's amazing how one positive decision begets another positive decision.  Unfortunately, one of the few anticipated post weight loss "problems" (besides having to purchase a new "skinny" wardrobe), is what to do with all the extra skin that sometimes results from losing excess weight...? The thing is, not everyone ends up with excess skin.  Really, it depends on multiple factors: the patient's age (no, I didn't just call you old); how many children a patient may have had; excess roller coaster weight loss and gain over the year; and the personal skin elasticity of a patient.  The latter really making the majority of the difference.  Quite honestly, it really comes down to how you picked your parents when it comes to skin elasticity.  Genetics is key to just about everything under the sun, and skin elasticity certainly falls into that category.  So why does this matter? Think of it this way: if you have a 10 pound sack of potatoes and take out 9 pounds of those potatoes, you've got a lot of sack left over, right?  Sometimes this sack shrinks down, and other times it does not.  Again, all as a result (or lack thereof) of the degree of skin elasticity someone may or may not have.   I am often asked if exercise will help to tighten up the skin. Unfortunately, I can assure you that all the situps and jogging in the world will not help that excess skin to shrink.  So, what is the answer then?  What do I do now that I've lost this weight and my skin gets rashes between the folds?  And sure, I've lost a significant amount of weight, but my clothes still don't fit right lugging this extra skin around!  This is where the post weight loss recontouring comes into play. 

     Though not every post weight loss patient needs them, there are multiple  body contouring options for those that do post weight loss: tummy tucks, liposuction, arm lifts, breast lifts, thigh lifts, and body lifts. Typically, one or a combination of these procedures have been successfully used after weight loss surgery to refine patients’ bodies, and help them enjoy everyday activities as they envisioned at the beginning of their journey.  The most common procedure that Dr. swetnam and I do is the tummy tuck.  Essentially, that entails not just removing the excess skin present, but also tightening up the actual abdominal muscles.  We basically create an internal corset that results in a waist that many people had not seen for many, many years.  Following the tummy tuck, I would say that breast lifts are our next most common procedure post weight loss.  It's amazing to see how people's attitudes change as they continue along their weight loss journey.  Specifically, people who had become shy wall flowers virtually become alive again. Their inner personality that had been stifled for so long is reawakened.  No longer just satisfied to wear bulky sweaters and oversized tshirts to hide their insecurities, they sometimes pursue breast lifts.  Breasts that were once being tucked into their front pockets are now perky and full on the top of their chest- right where they should be.  Following breast lifts, arm lifts (sometimes termed brachioplasty in doctor-ese) would be the next most common procedure that Dr. swetnam and I perform.  It is essentially just removing extra skin and remaining fat to create a nicely contoured arm again.  Thigh lifts are much like arm lifts, except just a bit further south.  I would say that thighs are the most challenging to operate on, as God didn't create us in anticipation of having incisions in our groins (location required to lift up those thighs again).  I should mention here that the great thing about having two fellowship trained cosmetic surgeons together in a group means that more procedures can be done at the same time.  Why does that make any difference? First and foremeost, the operative time is more than halved.  This is not just better for the patient's health, but also is more cost friendly for the patient in the long run. 

     So when should a post weight loss patient consider having body contouring procedures done?  Typically, I suggest that a patient be within 80% of their weight loss goal.  Typically, this is at sometime between 12 and 18 months.  As I said, body contouring is not something that is essential from a health perspective, but rather as the end result of a long journey.  It's basically seeing the final end point result come to fruition.  It has been said more than once that we are flattered to be a part of this whole process, both as the wearing the weight loss surgeon's hat, as well as that of  the body recontouring surgeon's.  We literally know our patients inside and out!   

Come see us today for your complimentary Cosmetic consultation!!  918-786-7780 or 1-877-weight-0. 

For the past several weeks I have taken the time to reflect.  Some of the time has been spent venting here, mostly, the time has been spent on my back deck looking at the lake and re-evaluating some things.  This week I wanted to touch on a few points that I think are important and how they relate to Cosmetic Surgery and Bariatric Surgery...namely, happiness and fulfillment.

Now first of all, I am not a philosopher.  I did take several classes in the subject in college and I have read philosophy since, but I am not a pro. 

As children, all of us start off pretty happy.  We really have no point of reference to create sadness.  Whether we are rich or poor, have good parents or not, are good looking or not as good looking as we think we should be, we are usually content with our existance.  Then society steps in to tell us all the reasons we should not be happy.  The TV tells us that if we don't have this gizmo or that, this car or that car, blah blah blah, we are inferior to others.  The process worsens in school as peer pressure takes over, and the process goes on and on as we get older. 

We all reach points in our life where we are not happy with some portion of ourself or our situation.  Maybe we are overweight, maybe there is something about our body that is making us unhappy, maybe it's our job, family, belief system, or a combination.  I personally think that it is OK to be unhappy about some things and it is OK to strive to improve them.  For instance, if you were unhappy with your employment situation, you could start investigating new career options, start taking some classes, if that is what is needed, and start a new career path.  If your marriage is not so great, you and your spouse can seek counseling sessions to find out why your compatability has waned and start communicating better.  We have all seen situations like these where people improve their lives dramatically with a little self improvement or education.

What if we are too heavy?  Of course starting off with exercise and diet may help.  Physician directed diets and medication are also accepted methods and are, for some, successful.  However, when they fail, it is also perfectly acceptable to seek a surgical option.  My philosophy is fairly simple when it comes to bariatric surgery and similar to the philosophy when treating drug abusers....if you don't get it under control, it's going to kill you, so do whatever it takes to get it under control.  For any addiction problem, it may mean drug rehabilitation and for the morbidly obese, it means bariatric surgery.  The two problems are very similar as both deal with controlling desires and changing lifestyle.  Rehab is a tool, and so is weight loss surgery.  Let me tell you, once a person loses 150 lbs, they become happy.  They realize that the extra person they have carried around for all those years has made their life miserable, socially, physically, and otherwise.  Life for these people becomes much more fulfilling because they are happier, their self image restored.  They are now able to get out of the house, socialize, play with their children or grand children, work and become better providers.  Most of all, they get rid of the stigmata of obesity that society tags them with.  I find this an exciting and life changing event.  We have one life to live so live it to the fullest.  If your weight is prohibiting this and all else has failed....what's stopping you?  Don't let those that don't have the problem dictate what you do.  Obesity is a dangerous problem that WILL shorten your life so fix the problem if you can.

Cosmetic surgery falls more into the "want to" category, but is no less important.  People that have some sort of Cosmetic problem are no less self conscious than the obese person.  Whether it is breasts that are too large or too small, stretch marks after children or a sagging lower abdomen, or facial changes that occur with age, all can cause a person to be less able to fully participate in society, be happy, and fulfilled.  We have the ability to correct these problems so why not be happy.  Of course most say that "happiness comes from within" which is a statement I believe in.  However, if fixing a Cosmetic problem gives one the self esteem to let that happiness out....I say fix it!  Again, don't allow others to dictate what will make you happy, and remember that most of them would have something done if they could.

Our lives are a gift from God.  It is our job to make the best of that life.  Live every day like it is your last, and do whatever it takes to be fulfilled and happy, even if that means fixing something.  Love deeply, laugh out loud, cry when you need to, make good friends and cherish them, treat others like they are family (but love your family a little more), hug everyone, and most of all, thank God every day for what you do have in life.  Pretty simple, but now you know my philosophy. 

Come see us....we will treat you right, and Cosmetic Consultations are always complimentary.

918-786-7780 or 1-877-weight-0.

Possibly more changes on the horizon for weight loss surgery are in the making.   

These changes will have an effect on the entire landscape of bariatric surgery in the U.S.  First, a little history....

When bariatric surgery first started (weight loss surgery) there were few regulations and a multitude of procedures that were tried.  All procedures were done through a large incision and most of the patients are high risk due to their weight and many other additional medical problems brought on by the weight, i.e., diabetes, high blood pressure, heart disease, sleep apnea, etc.  This combination led to a high complication rate and high mortality.  What has changed in the past several decades to make these procedures much safer is the innovation of laparoscopy.  This allows us to do the procedure with tiny incisions, fewer wound problems, much less pain, and shorter hospital stays.  Other changes that have happened are the standards that were set for bariatric centers. These standards were fairly rigid and the procedures done were made more standard.  What we have learned is the bariatric patient needs a higher level of pre-operative evaluation and post-operative care than the average patient.  Because of this, the American Society for Bariatric Surgery was formed and guidelines were created to improve safety and "centers of excellence" were created.  Centers of excellence were formed based on criteria set for pre and post op care, and a minimum number of cases done in a year. 

After gaining experience and analyzing a ton of data, it was discovered that the center of excellence really does not change outcomes.  What this means is you can have a procedure done at a center of excellence or a non-accredited center and have just as good an outcome.  The net effect of the center of excellence has been to limit access for medicare and medicaid patients with no real benefit.

After joining forces, the American College of Surgeons and the American Society for Bariatric Surgery are trying to change (in my opinion for the better) the center of excellence guidelines.  Here is what the proposed changes will look like:

1. Three divisions will be set up, the first being band centers, where only lap bands will be performed.

The Gastric Band on the stomach.

The second division will be "low acuity" centers of excellence.  These are smaller facilities "like INTEGRIS Grove hospital" that have qualified surgeons but limited ancillary services.  These centers will be able to do staple procedures on "lighter" individuals with few other medical problems. In other words, healthier, lighter patients will be able to have their procedure done on a more local basis and not have to travel to big centers.

Sleeve gastrectomy                                               Gastric bypass

In these lower acuity centers, the work up is the same and all of the patients are tracked by a National Data base.

The third division is the high acuity center.  This is where heavier and more complicated patients will have to go, usually in the larger regional hospitals.

This is the proposal that was sent to the CMS (Medicare).  However, they have different ideas about the whole thing.  CMS, looking at the data, thinks that possibly communities would be better served if the whole center of excellence thing was just eliminated.  They do have a substantial amount of data that shows there is no improvement in outcomes.  Now the Politics come in.  What politics?  Well, current centers of excellence don't want any change and centers that want to gain this distinction can't because the number of cases that must be performed, under the current rules, cannot be reached.  The number of people needing the surgery continues to grow and many cannot get to a current center of excellence for care.  My feeling is that if you have a qualified surgeon and a program in place....what difference does it make.  People that need the surgery should not have to travel hundreds of miles, and according to the data, it makes no difference.  Hopefully, a reasonable compromise will prevail....and soon.  Many programs, ours included, are sitting on go, waiting for some sort of direction.  In the mean time, we are limited to private pay patients and private insurance patients currently.  We are looking for some type of decision in 2014 and are hoping for good things.

   Of course the changes will mostly only effect Medicare and Medicaid patients but some private insurance as well.

So that is what's on the horizon...better access.  We hope to be a low acuity center in the very near future as Dr Miller is fellowship trained, certainly qualified, and ready to go!

Our cash prices are pretty good too (see below) and you don't need to travel to Mexico either!!

So come see us today!!  Cosmetic consultations are always complimentary!! The spring laser liposuction special is going on so act now to reserve your time!  918-786-7780 or 1-866-weight0.  And don't forget our low prices on breast augmentation either!!!

Keep an eye out for the news reports on the sleeve gastrectomy!!!

This is a great article that was written for a magazine in NW Arkansas.  I also wanted to mention our 2013 spring time special on Breast enhancement.  You must act now though as it is on only until April 30.  Click on the button below to see the great pricing!!

Green Country Bariatrics: There IS a Light at the End of the Tunnel!

By Nathan G. Miller, M.D., board-certified general surgeon, fellowship trained bariatric surgeon and cosmetic surgeon

“Please help me. I’ve tried every diet out there, I exercise, I can’t get rid of my weight, and it’s literally killing me.” These are the words I hear all too often from my patients. You see, obesity has become a problem in the United States, and it’s not going away – not even close.

I often see patients at their wits’ ends. They have tried everything to lose weight, and nothing works. Rest assured, there IS light at the end of the tunnel! The surgical solutions of today are unparalleled to those of the past. The complications and problems of old have been minimized, and weight loss is now maximized. And in addition to pounds lost, many patients see up to an 85% resolution rate of their diabetes issues and 50% resolution of high blood pressure problems. Several are able to get off medications altogether.

At Green Country Bariatrics, we work very closely with another fellowship-trained bariatric surgeon in the region, Dr. Josh Roller. We consult frequently about patient care and our areas of expertise. I specialize in sleeve gastrectomy and lap band, whereas Dr. Roller concentrates on gastric bypass.

What is possible?

Lap Band - A fully adjustable collar that is placed around the top of your stomach, the lap band causes you to eat less and feel fuller, faster. It is nonpermanent, and is typically done on an outpatient basis. Patients return to our clinic to tighten or loosen the band as needed, depending on weight loss and hunger. With this technique, we often see a 50 percent maximum excess weight loss, meaning, if the patient was carrying an extra 100 pounds, he or she would typically lose nearly 50. Most patients are able to return to work within a week. 

Gastric Sleeve - The gastric sleeve is an operation where 80 percent of the stomach is removed, including the hormone center for hunger. In addition, this surgery also removes the part of the stomach where food is stored, sometimes referred to as the reservoir. While this is a permanent procedure, the patient’s anatomy is not rearranged as it is in the gastric bypass or mini gastric bypass. With this technique, we often see a 70 to 80 percent excess weight loss, meaning, if the patient was carrying an 100 extra pounds, he or she would typically lose around 80. Normally, this procedure requires one to two nights in the hospital. It is less associated with malnutrition, dumping syndrome, ulcers, and internal hernias than other bariatric procedures, and it is usually performed through six tiny holes in the abdomen. Return to work is often within two weeks, and many insurance companies now cover this procedure (including Medicare).

Gastric Bypass - This is an operation that removes a significant amount of native  stomach.  Typically, it also bypasses anywhere from 90-120 cm of the native small bowel. This causes the body to absorb fewer calories and fats. It is a permanent procedure wherein the patient often loses 80% of his or her excess weight. Many times, this is a prime procedure for brittle diabetics, or those with diabetes requiring insulin for more than five years. It is also an excellent procedure for those with extensive reflux problems and a related need for weight loss.

What happens after the weight loss?  Let’s pretend we have a 10-pound sack of potatoes.  Now, let’s also imagine that we’ve taken 9 pounds out of that sack. There’s quite a bit of sack left over, right? Such is the case with weight loss. Skin has only a certain amount of elasticity. Age, yo-yo dieting and childbearing all work to degrade that elastic property. For many on a weight loss journey, removal of excess skin is often the final destination. Men and women alike often opt for tummy tucks, and also add arm lifts, neck lifts, breast lifts or thigh lifts. Essentially, these procedures are the polishing step in the complete rejuvenation of the patient. 

Tummy Tuck - A tummy tuck is performed through an incision in the lower abdomen a few centimeters above the pubic region. The incision goes from hip bone to hip bone and also around the stalk of the belly button. The skin is raised off of the underlying connective tissue and muscle up to the ribs. Next, the loose muscle and underlying connective tissue is tightened to make the abdomen flat. The skin is then pulled down and the excess is removed. A new opening for the belly button is created. The smooth, firm skin from above the belly button is pulled down, and stretch-marked tissue and scars are removed. The result? Voila: a flat abdomen.

  Typical loose skin after weight loss surgery.

Arm Lift - An arm lift, or brachioplasty, reduces excess skin and fat between the underarm and the elbow, reshapes your arm to result in smoother skin and contours, and results in a more toned and proportioned appearance.

Sagging arm skin after weight loss.

Breast Lift - A breast lift, or mastopexy, raises the nipples and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. Implants can also be placed to fill out the deflated breast.

Loss of breast volume after weight loss.

At Green Country Bariatrics and Total Body Surgical Cosmetic Surgery, our cosmetic consultations are always complimentary. If you’ve been considering these options, call us today for an appointment at 918-786-7780.  For more information, we welcome you to visit our websites and “like” us on Facebook!  Be sure to check the breast special!!!

www.greencountrybariatrics.com

www.totalbodysurgical.net

LIPOSUCTION: FACTS AND MYTHS

GENETICS

Liposuction, like all cosmetic procedures, is a combination of skill and artistry.  It sounds hokey, but just as each person is taught they are a snowflake in grade school, every individual requires a very personalized approach when addressing areas of fat.  Now, typically speaking, many women usually tend to focus their problem areas as being the lower abdomen, flanks (the dreaded muffin top), thighs, and arms.  Meanwhile, guys tend to focus on their chest and belly.  Obviously, crossover does occur regarding areas; and to be perfectly honest, it all depends on how we pick our parents! 

The dreaded "muffin top"

  "love handles"...not so lovely

Fatty thighs...saddle bags, inner thighs, anterior thigh, and fatty knees.

AM I A CANDIDATE?

Many people will begin to notice collections of fat post baby that they just can’t get rid of.  Others will turn to liposuction when they have pesky areas that just won’t disappear,  no matter how much exercise and dieting they do.  Still others want extra help in appearance for a wedding or class reunion coming up.  Whatever the case, liposuction is a spectacular avenue to help someone on the  road to the body that they envision.

JUST A TOOL

It should be emphasized that liposuction is only a tool.  Specifically, it is NOT a weightloss technique.  Without a doubt, one will lose weight from the procedure, but its main focus is actually to shape by removal of fat. In addition, once a person has  liposuction, that area where fat is removed means that it is gone for good.  However, this doesn’t mean you’re free to go and gain weight- quite the contrary!  In fact, weight gain will go to other areas of your body, making it look abnormal.  We encourage our liposuction patients to utilize this opportunity as a complete jumpstart to a new and healthy lifestyle. From a very positive point of view, if fat is removed by liposuction from problematic areas, this also means that calories burned by diet and exercise in the future will then be focused on other areas, rather than those where fat has been removed. 

WHAT IS THE PROCESS?

STEP 1

Essentially, the way liposuction done at Total Body Surgical is a 3 step process.  Though it is not commonly practiced outside of the East and West Coasts, our liposuction is usually performed with what is called the  tumescent technique.  It has also been termed, “lunchtime lipo”, “Smartlipo”, or “laser lipo”.  Patients remain awake throughout the procedure, receiving local anesthesia in the areas of treatment. This allows the patient to communicate with the physician throughout the procedure. It also helps physicians provide great results by allowing them to easily position the patient in the best way possible to treat each area. For those that may be concerned about being awake during the procedure, patients are provided medications to assist in their relaxation and comfort.

In addition, the tumescent technique allows the patient to avoid the general anesthetic that is so hard on your health.  Many times, the recovery from a surgery is not so much related to the procedure, but rather to the administration of the general anesthetic.  Essentially, tumescent technique cuts your recovery time by at least 50%.  Meaning, it is a quicker return to work and your daily activities (typically 3-7 days). 

STEP 2

After getting the patient numb, the second step of the process begins.  Many people have heard the term, “Smartlipo”, or “laser lipo”, which is essentially the utilization of a laser to melt the fat in the  problematic areas being addressed.  Utilization of the laser also decreases swelling, bruising, and also helps to speed recovery.  This is especially true when compared to the old way that liposuction has traditionally been performed. The micro-laser is so tiny that it can contour small areas that were more difficult to treat in the past, such as upper arms and under the chin. This technique smoothes out the work done with the power-assisted micro cannulas and stimulates collagen formation which can help the skin tighten, producing a smooth final appearance to the treated areas.

STEP 3

After the fat is melted, then the fun part begins.  Meaning, all of the melted fat is then gently  removed  by a very small suction tube.  This is where inches are lost, and new waistlines are formed.  The majority of the time during the procedure is spent on this stage.

Fat abdomen

 Am I A Candidate?

Most importantly, you must be in good health. Ideally, not having any active diseases or significant pre-existing medical conditions is best. 

Make sure you  have realistic expectations of the outcome of liposuction. Open communication is absolutely imperative! You have to clearly understand what your desired results are and be able to convey  this information to your surgeon.  Then, discussion of your goals with your surgeon to determine what can feasibly be done to reach all or part of this goal will be essential.

Further, the elasticity of your skin plays a huge role in whether you are a good candidate. You should have good elasticity, so that your skin is able to shrink  back to its former tightness once the fat is removed. As we get older, have babies, and yo-yo diet, our skin loses its elastic property.  Think of it this way:  if you took a brand new pair of underwear out of the package and stretched out the elastic waistband for 2 hours, then let it go, it wouldn’t snap back to the way it was when you took it out of the package brand new, would it?  Our skin is much the same.  In addition regarding your skin, if you had a 10 pound sack of potatoes and you took out 8 pounds, you’d have quite a lot of sack left over, right?  Obviously, we want that sack to shrink up. Analogously, when you take a large amount of fat out of an area, you’ll have the tendency to have extra skin.  This is where using the laser comes into play. Utilizing the laser (remember stage 2 of the procedure) optimizes the chances that this will happen.  However, the overwhelming factor of whether or not this skin will shrink back  is by far and away your genetics.  How we picked our parents plays a huge roll in this life!  The presence of stretch marks is a flashing neon sign that your skin is not what it used to be, and may not shrink up as tight as it would have when you were 18.  However, many patients really just desire to look better in clothes.  Having extra skin after removal of fat will not effect this.  Again, discussion of realistic expectations between you and your surgeon is a must!

To have that discussion at no charge to you, call 918-786-7780 today!!  We can help and Cosmetic appointments are complimentary!!

Hey everyone!!  Hope ya'll are avoiding the flu bug...bad deal!  People are dropping like flies around here.  The epidemic should be over in a couple of weeks and we'll all be feeling better.  In the mean time, drink plenty of liquids and keep the tylenol handy.

What I want to talk about today is the other epidemic we face in Oklahoma, and essentially the entire country....obesity.  As most of you know, we are in the process of becoming a center of excellence for bariatric surgery.  The new guidelines are out for review and if accepted in the current state, we should be there this year.  What that means is, we will be able to accept Medicare, Soonercare, and most other insurances.  This is good news.  Our goal is to provide quality care locally, big city care with a small town twist.  We are also committed to giving great value, the best pricing around.

We are in the process of doing seminars in multiple towns in the area.  The schedule has been set, but not finalized.  The first one was in Grove this past week and it was a great success.  They last about an hour and cover weight loss surgery, post weight loss cosmetic surgery, and a little about veins.  It's a great opportunity for us to meet you and for you to see what we are about.  It also gives you the chance to start the ball rolling to the new you.  With the lap band, or the gastric sleeve, you can expect to lose a substantial amount of weight and in doing so, correct many of the problems associated with that weight.....hypertension, type II diabetes, joint breakdown, sleep apnea, cholesterol issues, and others.  For those with insurance, we can start the process for you at the seminar (in fact, the seminar is usually a requirement).  For those without insurance, we are working up something special to give you the best price available anywhere.  This will be a limited offer so if you need help, or know someone who does, keep and eye out here...you don't want to miss it.  Of course our current lap band offer still stands and is a great one.

The communities we will be coming to soon are, Vinita, Pryor, Tallequah, Joplin, Miami, Grove, Claremore, to name a few.

We look forward to meeting you and helping you get on track.  Of course you can call for an appointment at any time....918-786-7780

“Please help me.  I’ve tried every diet out there.  I exercise.  I just can’t get rid of my weight, and it’s literally killing me.”  These are the words I hear all too often in my clinic here at Green Country Bariatrics in Grove, OK.  You see, obesity has become a problem in our United States, and it’s not going away- not even close.  In fact, recent studies of the population show obesity increasing exponentially throughout the world with the USA leading the way.  More specifically, Oklahoma is ranked 7^th, with Missouri close behind at 11^th.  It is truly a staggering statistic to consider  that 30% of our nation is now considered obese.

Why am I overweight?

What is the reason that I continue to be unable to get rid of my excess weight?  Unfortunately, this is not an easy question to answer in a simple way.  Multiple reasons and theories abound, though most likely, it is a combination of more than one of the following explanations:

1. Psychological

Certainly, overeating can be a reason why you’re overweight.  However,
let’s be honest: eating makes us feel good, right? Many eat not just because they are hungry, but rather a result of feeling lonely, bored, or depressed.

2. Anti-Depressants and Other Medications
Did you know that weight gain is a somewhat common side effect of many antidepressant medications?   By slowing down your metabolism or increasing your appetite, they make you gain weight.  Other common medications that cause weight gain in some form or another are Beta blockers and anti inflammatory steroids (corticosteroids).

3. Sleep Deprivation
Look, we all know that we are living in a busy world.   Fitiing in a normal life around work, kids, and various other responsibilities can be difficult.  Did you know that 63% of Americans feel that their night’s sleep is not meeding their daily energy needs?  Scientific studies prove that people who sleep less than eight hours a day gain more body fat that those who sleep more. Why?
Sleep deprivation causes the hormones that control our hunger to get out of control.  What else do you do during the day when you feel sluggish and tired? Yes, that’s correct. You guessed it: we grab that high calorie soft drink, candy bar, or whatever catches our eye in the vending machine to give us a “pick me up”.

4. Slow down!
Did you know that the part of our brain that helps to govern our hunger (the hypothalamus) shuts down after 25 minutes into a meal?  Slow down.  Chew your food.  You’ll find that you won’t consume quite as much.

5. How we picked our parents
Your genes may be causing you to have trouble fitting into your jeans.  According to research, metabolic rate and where your fat is deposited on your body has been linked to genetic inheritance.  Are one or more of your parents heavy? If so, you’ll have a higher risk of gaining and retaining weight.

What do I do?

Fortunately, we live in a day and age of new techniques and  technology to help those with weight issues resolve them.   Did you know that 98% of people who lose weight through diet and exercise alone eventually regain their weight? I have seen countless people at their wits end and frustrated, suddenly find hope.  There IS a light at the end of the tunnel!   Our main focus at Green Country Bariatrics is on YOU.  That being said, our way of getting there is surgery.  We specialize specifically in adjustable gastric bands (lap bands) and gastric  sleeves.  What if I told you that I could help you lose 70-80% of your excess weight?  What if I told you that I could give you a >50% chance that we could cure your diabetes and get you off of your blood pressure meds?  That’s EXACTLY what we offer at Green Country Bariatrics.

Tell me more!

Lap Band: This is a fully adjustable collar that is placed around the top of your stomach.  In a nutshell, it causes you to eat less, and makes you feel fuller, faster.  It is nonpermanent, and is usually done on an outpatient basis.  Occasionally, a patient will need to stay overnight due to their insurance mandate.  A patient will visit our clinic to tighten or loosen the band when needed. A 50% maximum excess weight loss is often seen. Return to work is usually within a week.

Gastric Sleeve: This is an operation that removes 80% of your stomach.  In doing so, we remove the part of the stomach that houses the hormones that cause you to feel hungry.  In addition, we are removing the part of the stomach where you store your food.   It should be noted that it is much safer and quicker than the traditional gastric bypass.  Many of the complications often seen with the traditional gastric bypass (ulcers, internal hernias, dumping syndrome, etc) are NOT seen with the gastric sleeve.  In addition, the anatomy is not rearranged as it is in the gastric bypass or mini gastric bypass.  However, the weight loss is very similar with both giving approximately a 70-80% excess weight loss.  All the perks, but fewer of the hassles!  It is a permanent procedure, and will require 1-2 nights in the hospital.  Return to work is often within 2 weeks.  Many insurances now cover this procedure.

Green Country Bariatrics

We are here for YOU.  We want to tailor your weightloss surgery to fit your needs and personality.  Certainly, we here at Green Country Bariatrics understand your challenges with weight, and want to provide whatever support we can in order to help you accomplish these goals.  Please note that in treating our patients, we want to see you reach your maximum weightloss potential and keep it off!  In doing so, we help you get started with our nutritionist to teach you how to eat, and make better food choices.  We also encourage participation in a support group for camaraderie, accountability, and just being around others who have been through the process.  A contact with a trainer in your area for post surgical exercise can also be arranged.  Lastly, in beginning the new you, many of our patients desire to have reconstructive surgery to lift and remove excess skin after the wight has been lost.  This is completely optional, but we find that the majority of our patients opt for this to complete the transformation process. All of our surgeons at Green Country Bariatrics are fellowship trained in this particular type of reconstructive surgery.

Acne can be a terrible affliction or a very minor problem.  It can occur from the teenage years, and also as an adult.  Acne can cause problems that will be present for life, leaving cosmetic issues that may be very hard to deal with.  I want to discuss today the process of the problem and how to handle it.

First of all, what is the process behind the problem???  Acne usually starts in adolesence.  It is a familial problem that manifests during hormonal changes.  It can occur in all skin types and with different degrees of severity.    Acne can lead to social problems that may last a lifetime.  Hormonal increases in adolecense lead to changes in the output of oil in our skin, making it thicker.  This leads to the pores becoming closed, and with bacteria in the skin using this "food" source, they multiply.  The result is the inflamed cystic "comedones" that we call acne. In most instances, the blemishes are limited, resolve in a short period of time, are not severe, and, with the exception of slight embarassment, do no long term harm.  In a minority of cases, the problem is severe, unremitting, and can lead to permanent skin changes.  The changes that can occur are scarring, changes in skin pigmentation, and the resulting self confidence issues that remain. 

What can be done about all of this then?  Most manage by keeping the skin clean and using over the counter products that we see on television.  For minor cases, this is enough.  For more severe cases, these products are no match and the blemishes continue.  At this point, hopefully, parents recognize the severity of the problem and will seek other help.  That is where we can help. 

The first step usually recommend is a change in basic skin care.  We like cleansers that contain salicylic acid.  The salicylic acid in the cleanser helps to liquify and remove the oil that is the root of the problem.  We also recommend benzoyl peroxide solutions that will help reduce the bacterial load.  The third thing I like for patients to do is start a retinol topical cream.  Retinol also helps reduce oil, dry the skin, and compact the stratum corneum, the dead layer of skin cells.  If need be, I will also start an oral antibiotic to decrease the bacteria and decrease the inflammatory response that the bacteria cause.  Antibiotics are generally continued at a low dose as the inflammatory response is less while on them.

For most, these routines are effective in managing the acne.  In others, these steps may not be enough.  The next step I usually add is laser therapy.  We use the Cutera system on a setting that will heat up the skin and kill the actively reproducing bacteria.  There is no recovery time and these treatments can be repeated at 4-6 week intervals with no pain. 

After this step, if no response is noticed, we have a decision to make.  In some women we will add some other medications as hormone modulators such as birth control pills or spironolactone.  If these do not give us results, we then must consider more powerful oral medications.  The one that is the most effective is Accutane.  Accutane is a medication that works very well.  It is also capable of causing problems for some patients.  Everyone has heard of a horror story related to Accutane but few hear of the great number of successes.  The biggest problem a patient can encounter is conception while on the medication.   I-pledge is a program that was instituted to educate patients taking the drug about how to avoid pregnancy and the birth defects that can occur.  Secondly, headaches, brain swelling, depression to name a few are the other side effects than may be encountered while on  Accutane.  The biggest complaints I see are that of dry skin and cracked lips and these are very tolerable.  In most instances the results far exceed expectations and over shadow the risks.  The usual patient takes the medication for 6 months.

My personal philosopy is that the risks of Accutane, when given correctly, are very much worth it.  I am often asked to try to treat patients with scarring and pigment changes resulting from severe cystic acne....this is VERY hard work and is usually only marginally successful.  For that reason, I start off with the less problematic treatments and give them a fairly short trial...6-8 weeks.  If there is no measurable result and the acne is severe, I usually will then suggest Accutane if the patient is a reliable person and can understand the risks.

Come see us today at Total Body Surgical Cosmetic Surgery if you need help....918-786-7780.

Winter time is vein time a wise man once said (that's me ya'll)!!

Why is winter time the time to worry about those pesky leg veins??  Well, it's because you are already wearing pants.  In spring and summer we want to wear shorts, or other more revealing clothing, it is then too late to conseal any ongoing treatment.  In winter, the healing process can take place under your clothing and people won't ask too many questions.  Now is the time to treat spider veins and larger varicose veins.

Spider veins are small areas that most of us get as we age.  These are pesky and ugly but usually do not indicate any major underlying problem with the larger venous system, although they can be an indicator.  They look like the skinny legs of a spider, thus the name.  They can also look like a bruised area that doesn't go away.  Spider veins progress with time and can be made worse by certain occupations..standing, etc.  They usually cause little concern except for their ugly appearance, however, they can become large enough to bleed if traumatized and an episode like this can be very frightening. 

What do we do for spider veins??  The best way to handle them is with sclerotherapy.  Now that may sound scary but really it is pretty simple.  We inject the veins with a chemical that causes them to stop working.  Sometimes a small clot forms in them and over time, your body resorbs the clot and vein eliminating the problem.  The process is fairly easy, quick, and causes minimal pain.  We have you wear a tight (compression) stocking for about two weeks after the injections and after that....nothing.  You may have some areas of pigmentation in the area for a few months and this usually resolves without further treatment.  Because this problem is superficial, most insurances consider this treatment Cosmetic and will not cover it under the usual policy.  We charge $350 per treatment and a treatment consists of two vials of the solution we use which is the safe amount at one sitting.  If more treatments are required, we usually wait about 6 weeks before re-treating.  Small areas usually require only one session.  Big, or multiple areas may require several sessions.

For a little larger veins we call reticular veins, we still use the sclerosing solution.  Sometimes it is used in a higher concentration and we use an instrument called a vein light. 

The vein lite allows me to see the larger veins under the skin that fill the small spider veins on the surface.  This instrument produces a very bright, circular light that produces no heat and is very good at showing reticular veins as you can see from the picture above.  I can then inject them with the sclorosing solution, stop the blood flow, and with time, the vein is eliminated by the body.  I usually try to find and eliminate any of these veins at the time I do the routine sclerotherapy.  Again, stockings should be worn for two weeks after the therapy and strenuous exercise is avoided for two weeks as well.  This helps in preventing future spider veins originating from this one source at least.  

Maintenance may be required when treating spider veins.  They usually sneak back into your life after a few years, even if all of them are eradicated along with the reticular veins.  I like to recommend that less is more....in other words, if we treat a large amount the first series of treatments, it is a lot easier to keep up by treating small areas as they arise.  Don't let them get out of hand again. 

More about varicose veins next time.  Don't forget our special pricing and come meet Dr. Miller, he knows veins too!!!

Sorry for the hiatus!  Finally moved in and most of the boxes are unpacked.  We are now official residents of the Grove community!!  Time to get down to business.

I have written here a few times about obesity and the problem just keeps getting bigger and bigger (no pun here).  The consequences of this supersizing phenomenon are going to be serious for society at large and for those individuals that are involved.  Rates of diabetes, high blood pressure, sleep apnea, joint failure, and high cholesterol are all on the rise.  Probably the biggest casualty of obesity is the loss of quality of life and productivity.  There is an untold psychological effect that cannot be measured.  We are seeing our children getting bigger as well, the problem is becoming world wide.

At Total Body Surgical, we offer weight counseling and have medical and dietary solutions for those who need help.  For some, these methods can be very effective.  Unfortunately, most people with a significant weight issue have been down this and many other roads on numerous occasions and have been unsuccessful. 

At Total Body Surgical we also offer the Lap Band for those that can afford to lose weight on a slower basis and are willing to pay attention and work a little to drop the weight.  Surgical options are great for the times when diets and medication fail.

So what's new??  INTEGRIS, the Grove medical community, and Total Body Surgical are committed to serving the Grove community and the surrounding communities in Joplin, Tulsa, Fayetteville, Bentonville, Rogers and any areas between.  We are getting serious about weight loss by increasing our committment.  The most consequential thing we are doing is bringing in a fellowship trained bariatric surgeon.  Dr. Nate Miller will be joining the practice next month and we are very excited to have him on board.  He is a very skilled young surgeon who is board certified in general surgery, has completed a Cosmetic surgery fellowship, and just completed a Bariatric surgery fellowship in Houston.  He will bring his expertise to Grove to help get our official bariatric surgery program going.  Not only will we be able to do Lap Bands, but now we will be able to offer gastric sleeves for those that need to lose the weight quicker.  The gastric sleeve has minimal maintenance too.  Another addition is Danny Ludwig, RN.  He is our new bariatric coordinator.  He is there to help you walk through the process.

With the addition of Dr Miller, we can now offer the full service of medical and surgical weight loss, then help you remodel the body by removing the excess that comes with massive weight loss.

We are stepping up our game by bringing you the most qualified people and offering the best in Bariatric, Cosmetic, and Vein surgery.  We are also constantly trying to give you the best experience available.  Our team, Mekala, Trish, Janet, myself, Danny, and now Dr. Miller are always striving to make your experience the best it can be.  Of course, with the addition of new staff and a new Doctor I am sure there will be some growing pains, but we will do our best to keep them minimal.  We are all very excited to serve your needs with great service AND competitive pricing. 

Come see us today for a weight loss consult or to get your new look on. 918-786-7780  And don't forget our ongoing special pricing, click on them to see...