The Morbid Me

Telogen Effluvium kicking in! (WLS Hair Loss)

I am more than 4 1/2 months Post-op, and I am experiencing one of the most annoying "side effects" of Gastric Bypass... Hair Loss ! I wrote about this a few months ago, but now I am experiencing it on my own head!

I have done an extensive research on this issue, and I ready to share all the tips and tricks I can give you. The pictures you see are my shots from my actual head. I wanted to post them so you can see how it is affecting me.

Now, Hair Loss during WLS is common and you have to expect it, like it or not. You will have this issue. The good news is that it is temporary until your body adapts to the pseudo starvation mode your body is on. So, don't worry so much.

What is Telogen Effluvium (Hair Loss related to WLS, for the rest of us) ?

At any given time, about 85% to 90% of the hairs on the average person's head are actively growing (the anagen phase) and the others are resting (the telogen phase). Typically, a hair is in the anagen phase for two to four years, then enters the telogen phase, rests for about two to four months, and then falls out and is replaced by a new, growing hair. The average person naturally loses about 100 hairs a day.

In a person with telogen effluvium, some body change or shock pushes more hairs into the telogen phase. Typically in this condition, about 30% of the hairs stop growing and go into the resting phase before falling out. So if you have telogen effluvium, you may lose an average of 300 hairs a day instead of 100.

Telogen effluvium can be triggered by a number of different events, including:

• Surgery
• Major physical trauma
• Major psychological stress
• High fever or severe infection
• Extreme weight loss
• Extreme change in diet
• Abrupt hormonal changes, including those associated with childbirth and menopause
• Iron deficiency
• Hypothyroidism or hyperthyroidism
• A new medication

Because hairs that enter the telogen phase rest in place for two to four months before falling out, you may not notice any hair loss until two to four months after the event that caused the problem. Telogen effluvium rarely lasts longer than six months, although some cases last longer.

Although losing a great number of hairs within a short time can be frightening, the condition is usually temporary. Each hair that is pushed prematurely into the telogen phase is replaced by a new, growing hair, so there is no danger of complete baldness. Because hair on the scalp grows slowly, your hair may feel or look thinner than usual for a time, but fullness will return as the new hairs grow in.

Symptoms

If you have telogen effluvium, you'll notice more hair than usual accumulating on your pillowcase, on the shower or bathroom floor and in your hairbrush. Your scalp hair may feel or look less dense than usual. Often, though, the hair loss is subtle, and other people may not notice anything different about your hair.

Expected Duration

Typically, hair loss begins two to four months after the event that triggered the problem, and lasts approximately six months. New hairs begin growing immediately after the hair falls out, but significant growth may not be noticed for several months.

Prevention

Nothing can be done to prevent most of the types of physical shock that can start telogen effluvium. Some cases may be caused by a poor diet, and these might be prevented by eating a balanced diet that provides enough protein, iron and other nutrients.

Treatment

No treatment for active telogen effluvium has been proven effective.

Some causes of the disorder can be corrected. For example, if you have a poor diet, consult a dietitian to help you balance it. Many times, however, the cause is a specific event in the past, and you can expect that the hair will grow back. In cases where hair growth has not returned to a satisfactory level, your doctor may prescribe minoxidil (Rogaine), a lotion applied to the scalp that stimulates hair growth in some people.

Prognosis

The outlook for telogen effluvium is very good. Most cases run their course within six to nine months, and the hair usually grows back. In some cases, the disorder may last longer. In other cases, not all hairs grow back.

Heading back to the original weight.

I get a lot of emails with personal stories of friends and "fans" willing to share their experience with WLS. I picked up a special one, from Ron Koopman in  Lake Oswego, OR.

His experience with Gastric Bypass Surgery is one of those you hope will never happen to you, but as he explains, it is possible and it could easily happen to all of us WLS patients .

"Back in March 17, 1999 I weighed in at 360 pounds. Had gastric bypass (surgery) at Sacred Heart (Medical Center) in Eugene. During the next year, dropped to 210 pounds and never felt better. Gave up things like Big Macs, carbonated drinks, all bread. Learned how to make what I did eat count -- a lot of protein and small portions. Knees felt better, back felt better. Got off high blood-pressure meds, did a lot of walking and, as I said, never felt better. Looked better. Self-esteem was better. Never regretted the surgery.

During almost five years, put 60 pounds on and could see I was heading back to the original weight. I was able to eat more, took the attitude that I never had to worry again and did not keep track of what was happening to my body. Forgot all those things I used to tell people in support groups: "This is only a tool." Hello! Wake-up call! The knees began to hurt; the clothes no longer fit; the back was aching.

Now, the amazing part: Rather than go back to 360 pounds, with encouraging words from my wife, I simply stopped eating so much, started moving again and, within six months, the 60 pounds came off, the small surgery pouch shrunk back to original size and, bingo, I weigh in at 200 pounds. I am now 50 years old. I get on the scale every morning. I eat right; I exercise and weigh less than when I graduated from high school. I want to spread the word to gastric bypass folks that we still have a great advantage. We can take it back off and keep it off. I am living proof. And it is a simple formula: Eat less. Keep track of your weight. Move around. Care about how you look and feel."

-- Ron Koopman, Lake Oswego

New Study finds Gastric Bypass to help your Heart

Well, this might sound logic, but at least there is a trusty health institution that confirms what we already know.

A new study shows stomach stapling surgery may reduce one’s risk of heart disease.

Mayo Clinic researchers were surprised by the findings.

The estimated 10-year risk for death or cardiovascular events, such as a heart attack, in the surgical group decreased from 37 percent to 18 percent as a result of the study but remained the same for the control group which didn’t get surgery.

Those who underwent bariatric surgery had a more significant improvement in body weight, cholesterol levels, blood pressure and fasting sugar levels, despite a reduction in medications for diabetes, high blood pressure and high cholesterol.

The researchers estimated that for every 100 patients, the surgery likely would prevent 16 cardiovascular events and four overall deaths, as compared with the control group.

This is also the first study estimating the risk reduction for death or heart complications.

Gastric Bypass risk of Nerve Injury

Mayo Clinic researchers have found a significant number of patients who undergo “stomach stapling” or gastric bypass surgery for weight reduction develop peripheral neuropathy, damage to any of the body’s nerves outside of the brain and spinal cord. The development of nerve damage is associated with malnutrition, and so the researchers contend may be largely preventable with proper nutritional care.

“Surgeons who do weight-reduction surgery and the general public and should be aware that nerve damage is a frequent consequence of the surgery,” says P. James (Jim) Dyck, M.D., Mayo Clinic neurologist and lead investigator in this study, which will be presented at the American Medical Association Science Reporters Conference on Oct. 14 and published in the Oct. 26 issue of the journal Neurology. “I’m not saying that people shouldn’t have this surgery, but I am saying that there are real potential complications and that good follow-up care is necessary.”

The Mayo Clinic investigators found that 16 percent of weight-reduction surgery patients they studied developed a peripheral neuropathy: nerve problems ranging from minor tingling or numbness in the feet to severe pain and weakness confining patients to wheelchairs.

“It’s surprising how many of these patients developed peripheral neuropathy,” says Dr. Dyck. “Sixteen percent is a large number. But patients who were part of nutritional programs before and after their weight loss surgery generally didn’t develop these neuropathies, so we believe the nerve damage is largely preventable.”

Dr. Dyck and colleagues identified risk factors in weight-reduction surgery patients who later developed nerve problems:

1. They lost weight at a much faster pace
2. They received less nutritional supplementation
3. They experienced prolonged nausea and vomiting
4. They failed to attend nutritional clinics

“The evidence is very strong that nerve complications are associated with malnutrition,” says Dr. Dyck.

Some forms of malnutrition are well recognized to cause peripheral neuropathy, such as thiamine deficiency in the disease beriberi. Rather than the surgery being a direct cause of neuropathy, the associated rapid weight loss and prolonged nausea and vomiting can lead to malnutrition and neuropathy.

An important key to preventing peripheral neuropathy is to seek a robust program with pre-surgical and post-surgical care by a multidisciplinary team of specialists who can oversee the patient’s nutritional status. “Don’t just choose a surgeon, choose a program,” says Dr. Dyck. “Patients in our study who were not part of programs were more likely to end up with nerve problems. This is a life-changing operation. It’s like having transplant surgery -- you need long-term follow-up.”

Michael Sarr, M.D., a Mayo Clinic weight-reduction surgeon who participated in this study, adds, “It’s a risky operation, but it’s a calculated risk in that morbid obesity is life threatening. Obesity can cause sleep apnea, diabetes untreatable by insulin, excess fatty substances in the blood, and coronary artery disease. Weight-reduction surgery shouldn’t be taken lightly, but it has tremendous benefit to select patients.”

Dr. Dyck and colleagues embarked on this study due to a pattern they observed in the peripheral neuropathy clinic. “We’d seen patients with nerve problems in our clinic who’d had weight-reduction surgery,” he says. “We saw the association, and we wanted to test it in a scientific way.”

The investigators searched the charts of 435 patients who had undergone either Roux-en-Y gastric bypass or vertical banded gastroplasty, also known as “stomach stapling,” at Mayo Clinic or other medical institutions to determine who later developed peripheral neuropathy. Three nerve disorders were identified in the study patients: 1) sensory predominant neuropathy, marked by pain and/or sensory loss, usually in the feet, 2) mononeuropathy, involving individual nerves, as in carpal tunnel syndrome, and 3) radiculoplexus neuropathy, marked by weakness, sensory loss and/or pain in a patchy, multifocal way. Radiculoplexus neuropathy can have the most serious consequences of the three, including confining a patient to a wheelchair.

To ensure that peripheral neuropathy was not linked to just any abdominal operation, the team also identified a control group of 123 obese patients who had undergone open gallbladder removal, another abdominal surgery. Only 3 percent of the control group developed a peripheral neuropathy.

“This is highly statistically significant,” says Dr. Dyck. “We believe that the peripheral neuropathy relates specifically to the weight-reduction surgery and not just any type of abdominal surgery.”

Dr. Dyck and colleagues have not yet studied whether these nerve problems are reversible. “We don’t know what the long-term outcomes will be for these patients,” he says. “Nerves can regrow, and there are people who have improved.”

According to Dr. Dyck, this is the largest and most systematic identifying patterns of neuropathy in weight-reduction surgery patients. It also is the first to use a control group to look for an association between weight-loss surgery and nerve problems, and the first to identify risk factors for developing peripheral neuropathy.

Alcohol and Gastric Bypass

A recent study reported in the British Journal of Clinical Pharmacology found that the gastric bypass procedure significantly affects alcohol absorption and its inebriating influence. According to the study protocol, a group of gastric bypass patients, three years post-surgery, and their non-surgical controls consumed an alcoholic drink containing 20% v/v alcohol (95% ethanol), and blood alcohol levels were examined over a period of time. The data showed that blood alcohol levels of the gastric bypass patients were far higher and required much less time to peak than those of the non-surgical controls.

The more rapid absorption of alcohol and heightened blood alcohol levels would cause the bariatric patient to have a more pronounced feeling of inebriation during and shortly after drinking.

Why would alcohol absorption be higher for someone who has had gastric bypass? With the gastric bypass procedure, 95% of the stomach and the upper gut (duodenum and a portion of the jejunum) are bypassed. Alcohol passes directly from the stomach pouch, usually without restriction, into the second portion of the gut, known as the jejunum. This portion of the gut has a large surface area and readily and rapidly absorbs the alcohol.

In addition to anatomical changes in the tract that influence alcohol absorption, the gastric bypass patient may also be more sensitive to the intoxicating effects of alcohol because of the reduced calorie intake that occurs after surgery. A number of studies have found that alcohol absorption is far higher if fasting or when consumed on an empty stomach than if provided with a meal or drank soon thereafter.

Drinking alcohol in the early postoperative period may have other adverse effects on health. Frequent vomiting, low calorie intake, not taking multivitamins and malabsorption may cause a number of vitamin and mineral deficits, including thiamin.

Addiction transfer is yet another precaution to be considered with regard to alcohol. The prevalence of food addiction and associated eating abnormalities, i.e. binge eating, carbohydrate cravings, are high among individuals with morbid obesity. With bariatric surgery, the addictive tendencies for food and aberrant eating behavior are considerably improved. However, individuals with addictions often transfer their addiction to yet another substance, such as alcohol. According to the findings of one study, addiction transfer may occur in up to 25% of bariatric patients.

Drinking alcohol after surgery may also reduce maximal weight loss success. Alcohol has no nutrient benefits and contains high numbers of calories that may cause weight gain or prevent weight loss. One 12-ounce can of beer, for instance, contains 150 calories; 3.5 ounces of wine contains 70 calories; 1.5 ounces of gin, rum, vodka or whiskey contains between 97 and 124 calories; and 1.5 ounces of liquor contains 160 calories.

The bariatric patient should absolutely NOT drink alcohol during the rapid weight loss period and definitely not if consuming no or low carbohydrates, not taking vitamin and mineral supplements, vomiting frequently, or not able to keep their food down. However, with time, there is no reason an individual should not be able to enjoy an occasional drink, provided they are aware that it only takes a small amount of alcohol to produce an inebriating effect. With such knowledge, appropriate precautions should be taken, such as waiting a sufficient length of time after drinking to drive or perform other skilled tasks.

Gastric Bypass Among Celebrities

Would you like to know the celebrities who had Gastric Bypass surgery? Well, I compiled a small list I hope you help me out to make it grow:

• Randy Jackson
• Diego Maradona
• Jackie Guerra
• John Popper
• Anne Rice
• Al Roker
• Roseanne Barr
• Anna Nicole Smith (Rumored)
• Carnie Wilson
• Star Jones Reynolds
• Kirstie Alley (Rumored)
• William Moody (Paul Bearer)
• Rep. J. D. Hayworth (R-AZ)
• Rep. Jerrold Nadler (D-NY)
• Charlie Weiss

The Dumping Syndrome

Dumping is often mentioned as a complication of gastric bypass, but it really is a side effect of theFigure 10 procedure caused by the way the intestine is hooked up.

Dumping syndrome occurs when the contents of the stomach empty too quickly into the small intestine. The partially digested food draws excess fluid into the small intestine causing nausea, cramping, diarrhea, sweating, faintness, and palpatations.

Dumping usuallly occurs after the consumption of too much simple or refined sugar (e.g. simple carbohydrates like sugar and some starches) in people who have had surgery to modify or remove all or part of the stomach.

Usually the symptoms will subside in about an hour. Most patients find the symptoms are alleviated after they lie down for a while. Dumping syndrome is not dangerous, but as you can tell by the symptoms, it's quite unpleasant.

Weight Loss Surgery Insurance Secrets

Those of us who have had WLS know what a difference it has made in our quality of life, to the point of even saving our lives. But thousands of people who fight a daily struggle with morbid obesity can't get weight loss surgery because they can't afford it, or their insurance won't cover it.

Last week I met Craig Thompson, who himself has successful maintained a healthy weight for nearly nine years after having a RNY Gastric Bypass, has written a new e-Book that addresses the financial side of WLS, called "Weight Loss Surgery Insurance Secrets." The e-Book takes you step-by-step through the process of requesting insurance approval for weight loss surgery. He includes information about the specific requirements of commercial insurance carriers and of Medicare, and exactly how to phrase and format your request to ensure you are pre-approved for surgery.

The e-Book also features a section devoted to the appeals process, and how to change your insurance carrier's mind if you have already been denied coverage for weight loss surgery. If you don't have insurance or your carrier won't pay the full cost of WLS, you can learn about options for paying out of pocket or arranging surgery abroad.

"Weight Loss Surgery Insurance Secrets" is the only book out there I could find that teaches you the ropes, in plain language, of how to work with your insurance carrier and get approved for WLS. Because it's an e-Book, you can download it to your computer in just a few minutes. It's a quick read and an essential guide for anyone considering this life-changing procedure. I highly recommend it!

LIVE Gastric Bypass Procedure

Former USC Trojan Football Star Anthony Davis to Undergo Gastric Bypass Surgery LIVE ON THE INTERNET on March 11th, 2006

Lite and Hope, the website that offers support, information and referrals to the morbidly obese who are researching bariatric surgery as a treatment option, will host a live cybercast of a gastric bypass procedure on Anthony Davis, former running back of the University of Southern California Trojans football team (1972-1974). The surgery, to be performed by Dr. Alan Wittgrove, the pioneer in the laparoscopic approach to gastric bypass surgery who has been performing these procedures since 1993, will be available live on the internet on Saturday morning, March 11 from Scripps Memorial Hospital La Jolla.

The cybercast, which will begin at 7:30AM Pacific time (10:30AM Eastern), will be hosted and narrated by singer Carnie Wilson, whose own bypass procedure in 1999 was the first to be shown live on the internet and became an inspiration to many who were considering the surgery.

The Ticker Factory for Weight Loss

I found this nice little nice website that allows you to create a Weight Loss ticker, so you can show the world how your progress is doing. This weight loss ruler can track your weight loss towards your goal. Display your progress in pounds or kilograms. It's free and fun !