Know the Changes to Your Body Created by Weight Control Surgery
Edward E. Mason, M.D., Ph.D.
University of Iowa Hospitals and Clinics
Creation Date: September 2001
Peer Review Status: Internally Peer Reviewed
Whether you are considering an operation or have had an operation to help you control your weight, you should educate yourself regarding that operation. These operations change your anatomy and the way you eat, digest and absorb food. Operations differ. Most operations limit food intake. Many interfere with digestion. Some stimulate the release of a hormone that decreases appetite and increases insulin effectiveness. If you know more about your new anatomy and how your operation works, you can make better use of that operation to improve your health. That should be your goal. Education can prepare you to take care of your operation so that it will serve you long and well.
Operations have both a goal and side effects. You need to know both. You may need to eat more of certain foods and avoid other foods. Eating habits should change. You may need to supplement your diet with vitamins, iron and calcium. You need to watch for certain complications and be able to tell any physician you might see at some time which one of the operations you have. You have special anatomy that many physicians know nothing about. If you are injured or develop vomiting or abdominal cramps, distention and inability to have a bowel movement or if blood shows up in your vomitus or stool can you draw a diagram of your anatomy and tell the physician some of the things to look for? Probably not now, but you could if you educate yourself about your operation. It could help the physician to determine what to look for. This is education that could save your life. You are a special person. You also can be a specialist with regard to your new anatomy and what it may mean tomorrow or years from now.
Operations can limit the capacity for a meal. That may be the only effect. Such operations provide a small, usually vertical, pouch that fills up quickly as you eat or drink. If you overeat, the food or liquid comes back or you will have discomfort or pain that tells you not to eat more. If you persist in eating more, you could disrupt the small pouch. Early after the operation, such disruption could require an emergency operation to repair the pouch and/or drain the area so that the area could heal. If the disruption occurred later it might only result in a failure for the operation to restrict your eating. Operations vary in the length of intestine that is bypassed. You should know the measurements of bowel that is bypassed and that is still in use so that you can eat accordingly and so that you can tell any physician you see later in life.
You need to know the size of your pouch and whether you have a bypass of most of your stomach, duodenum and a length of your small bowel. Bypass operations usually decrease iron and calcium absorption. That is because the duodenum is the chief site for absorption of these minerals and the food, fluid and medications no longer pass through that important part of the anatomy. The result may be anemia, which is usually due to a decrease in total body iron. It can be due to a decrease in folic acid or vitamin B12. Special tests may be needed to determine the type of anemia and the treatment. You could develop anemia years after the operation so you need to know if your operation has that potential by knowing the anatomy and the changes in function.
We have known for many years that the duodenum is the site of absorption of calcium and that any operation that bypasses the duodenum may result in bone disease. You read in the magazines about osteoporosis and the need to drink at least a quart of milk a day to keep the bones strong. Many women develop osteoporosis, especially after they have their ovaries removed or after the menopause. An operation that bypasses the duodenum increases the risk of bone disease. Osteomalacia is another bone disease that may occur when the duodenum is bypassed because vitamin D absorption requires pancreatic enzymes that are normally mixed with the food in the duodenum. These enzymes assist in the digestion and absorption of fat. Vitamin D is a fat-soluble vitamin.
These are just two examples of increased risks that result from bypass operations. There are others that are less common but that can be serious. These other risks also require a knowledge of the new anatomy to understand how complications occur and what needs to be done to diagnose and to treat them if they occur and before it is too late. When you choose an operation to control your weight you are choosing not only a method of weight control, but also certain risks that go with that operation. I purchased a Ford Explorer when they first became available because I wanted to sit up straight. I thought it would be better for my back and that I would pay closer attention to the road. I knew that I had an increased risk of tipping over and that I should slow down more when approaching a curve. In the same way, you need to know how the operation you choose will meet your goals, and what you need to know in order to remain healthy while you are enjoying a reduction in weight. You need to consider how you can work with the operation so that it will serve you safely for many years.
You should be able to draw a diagram of your anatomy and how it is different from normal. You should be able to label the esophagus, duodenum, small bowel and any changes in the small bowel. You should be able to explain how a closed segment obstruction might occur and why it is an emergency. You should be able to explain where a bleeding stomal ulcer can occur and where a bleeding duodenal ulcer might occur. Very few patients have educated themselves to be able to do these things but it could be life saving.
I have heard it said, “a little knowledge is a dangerous thing”. I have heard it said “If I had only known.” My responses are “too little knowledge is dangerous” and “educate yourself now and don’t ever quit educating yourself.” Education is our purpose on earth. “If you want it done well do it yourself.” Seeing the doctor should be a cooperative endeavor. You can be the greatest specialist in the world regarding your new anatomy and the effects it has or might have upon your health. Be a well-trained personal specialist. The doctor is still the one to advise you, but you are the one to make final choices about your care. Therefore you need to be able to understand what you are advised and how it fits with what you know about your anatomy and function. Study, draw diagrams, and ask questions. Take notes and do your homework. Nobody said education was easy, but it is very worthwhile.
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