Chatting With Dr. Ortiz: Episode #1

What’s discussed in this episode with Dr. Elias Ortiz

  • Can a hiatal hernia be repaired more than once?
  • Does the gastric sleeve always cause gastric reflux and if so why?
  • Is the recovery harder with the gastric bypass or the gastric sleeve?
  • What’s the standard for blood products in Mexico vs. the USA?
  • Why is the pre-op diet so important?
  • Is it possible to follow the bariatric diet strictly but not lose weight?

Transcript

Does the sleeve always cause acid reflux, and if so, why?

Yes. The smaller you make the stomach, the higher the pressure inside it. It’s more difficult for food and liquids to pass from the esophagus to the intestines. With the sleeve, it’s easier for them to go back up through acid reflux. It’s also important that the patient starts their medication right away and keeps it up for the next four to five months; otherwise, the acid reflux can get really, really bad. The technique for the sleeve is much better than in years past, so reflux issues will continue to decrease in the future.

You already answered this one: whether or not the bypass helps with heartburn.

If somebody has heartburn, we check their history to see why that might be. We might need to perform an endoscopy beforehand or run other tests. Many people have a hiatal hernia—thirty, even forty percent of obese patients. And if you have a hiatal hernia, there’s a big chance you’re going to have acid reflux. So what we do is fix the hiatal hernia during the gastric sleeve surgery, or we might opt to do the Roux-en-Y bypass.

Which surgery has a tougher recovery?

You might think the recovery is harder for the bypass because it’s the bigger surgery, right? Well actually, no. If two people have the sleeve and the bypass one day, the next day you’ll see the patient who had the bypass is better off than the one who got the sleeve. Why? Well, the restriction of the sleeve causes more nausea and a little more pain. When you drink up, you feel like you have bowel issues. People who get the bypass are able to breathe better compared to those who get the sleeve. Recovery is faster and smoother for the bypass.

Why is the pre-op diet so important?

All obese people have a fatty liver, fat around their organs, like the intestines. All of them. The reason we ask patients to follow the pre-op diet is because it’s been proven that when somebody loses about ten percent of their original weight, the volume of the liver reduces up to twenty percent, and all the fat around the organ sort of melts around it. When we go inside the patient, if they’ve followed the pre-op diet, they look normal, and the surgery is going to be easier, faster, and safer. If the patient didn’t follow the pre-op diet, we’re going to have problems. We’re going to see a fatty liver; we’re going to see a lot of it between the organs, and the surgery is going to be much more challenging. It’s going to take more time. Also, patients who do well with the pre-op diet are patients who will continue to do well post-op. When someone comes in and tells me, “I didn’t lose very many pounds. I don’t know why, I did everything,” I can be pretty sure that person won’t do well post-op. Make sure you’re on track beforehand, and chances are you’ll be on track after the surgery.

We do see that a lot—people saying they followed the diet strictly but didn’t lose any weight. Can you tell me how that might be possible?

Yes, they’ll tell me they did the diet and exercised but didn’t lose weight. I’d like to point out that you build muscle once you start losing weight and going to the gym—but you have to watch your diet. There are many people who snack too much and don’t notice. For example, just look at how many calories one almond has. It has a lot—thirty, I believe—but people don’t count those things. They snack, they drink a Coke, but they don’t realize all those things have calories. They might try to do a diet and exercise, but there are some things their mind just doesn’t record. It’s very important to keep that in check. I’m pretty sure that if you follow the pre-op diet and do some form of activity, you have to lose weight, but just do your best.

When that happens—when people say, “I didn’t lose any weight on the pre-op diet and I did everything right”—can you tell when you go in? Does their liver look all right?

Well, no. With the liver, you can tell. You can see their liver is jell, very greasy. But there’s only been two times we were unable to do the procedure because all their organs were huge, but we were still able to do so in the other nine thousand patients.

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Dr. Almino Ramos Joins Elias Ortiz & Company

Dr. Almino Ramos is a world famous bariatric surgeon and former president of the IFSO who we are excited to welcome to our team!

CREDENTIALS

Dr. Elías Ortiz, Bariatrics

Professional License Number: 8684409

Federal Taxpayers Registry: OIGJ810323D28

CURP: OIGJ810323HBCRMS08

Qualifications

Undergraduate Degree in Medicine (1999–2004), Faculty of Medicine of the Autonomous University of Baja California
– Overall average: 8.85 / 10

Undergraduate Internship (2004–2005), Regional General Hospital No. 1, IMSS, Tijuana, Baja California, Mexico.
– Overall average: 9.49 / 10

Social Service (2005–2006), Mobile Unit No. 19, SSA, Tijuana, Baja California Mexico.

Graduate Professional XXXI National Aspiring medical residencies
– Place finish in specialty group (Surgery): 32 of 3602.

General Surgery Specialty (2008-2012), Medical Unit of High Specialty, West National Medical Center, Mexican Social Security Institute
– Total Rating: 96.40 / 100.

Certifications

Certificate of Accreditation of Foreign Language Skills: English. April 22, 2006, at the Autonomous University of Baja California, Mexico

Resident Coordinator of General Surgery, generation 2008–2009, Regional General Hospital No. 45, Mexican Social Security Institute, Guadalajara, Jalisco, Mexico.

Chief Resident in General Surgery, 2011–2012 in Medical Unit of High Specialty, West National Medical Center, Mexican Social Security Institute, Guadalajara, Jalisco, Mexico.

Professional Experience

2nd Regional and International Congress on Obesity conducted by the Association for the Study of Obesity and its complications AC.
– May 2004, Tijuana, Baja California, Mexico.

Natural Orifice Transluminal Endoscopic Surgery
– General session speaker
– Regional General Hospital No. 45, May 15, 2008, Guadalajara, Jalisco, Mexico

Natural Orifice Transluminal Endoscopic Surgery
– General session speaker
– Zapopan General Hospital, November 5, 2008, Guadalajara, Jalisco, Mexico

ERCP (endoscopic retrograde cholangiopancreatography)
– General session speaker
– Regional General Hospital No. 45, February 12, 2009, Guadalajara, Jalisco, Mexico.

1stCourse News and Controversies in Surgical GERD
– April 2009, Regional General Hospital No. 45, Guadalajara, Jalisco, Mexico

Laparoscopic Surgery Program in the Regional General Hospital No. 1
– Social Security Institute, April–May 2010, Tijuana, Baja California, Mexico

Laparoscopic Surgery Program in the Regional General Hospital No. 1
– Social Security Institute, June–August 2011, Tijuana, Baja California, Mexico

Gastric Plication Surgery Mini Fellowship
– Hospital Angeles Tijuana, November 2011

Adjustable Gastric Band Surgery Mini Fellowship
– Hospital Angeles Tijuana, December 2011

Bariatric Surgery Program at Hospital Angeles Tijuana
– November–December 2011, Tijuana, Baja California, Mexico

Theoretical and Practical Course XIV of Endoscopic Surgery, AMCE, AC
– Medical Unit of High Specialty, West National Medical Center Gdl, Jal. January–February 2012

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