Chatting With Dr. Ortiz: Episode #3

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

  • How come you don’t require people to get bloodwork at home? If they do get bloodwork done, what should they get done? (5:29)
  • You wear nice clothes in your pictures, do you actually do surgeries? Do you change your clothes? (6:40)
  • Why should I wait 30 minutes after eating before I drink anything? (7:35)
  • Does having thyroid disease affect your weight loss after surgery? (9:06)
  • How do I resume my medication when I’m on a clear liquid diet? (10:48)

Transcript

Why don’t you require patients to get blood work done at home? What do you want patients to get done before they come here?

Obviously, it’ll be best if they send us their health questionnaire and all their labs. It’s not required, but if patients could send their routine blood work results from their PCP, it’d be easier for us. When patients arrive here, we do a complete routine of blood work, and if we see that someone has issues, we fix them before the surgery.

Why do patients need to wait thirty minutes before drinking anything and thirty minutes after eating? That was always very challenging for me.

Remember, after the sleeve or bypass, the size of the stomach reduces a lot, so there’s no space for liquids and solid foods. If you eat something solid and drink at the same time, the mix in the tiny new stomach will be very uncomfortable. The patient could develop reflux, or, if they’ve had a bypass, they could develop dumping syndrome. You can eat first or drink first, but not both at the same time. With time, people learn how to start eating and drinking at the same time, but in the beginning, it’s just not recommended.

Some patients need to resume their medication the day after surgery. If they’re supposed to be on liquids only, how does that affect taking a pill?

A large percentage of patients in our field have diabetes, and they notice that even during the pre-op diet, their glucose levels go down. After the surgery, some patients don’t need to take any more diabetes medication—only if it’s needed. It’s a bit different with type 1 diabetes, because they’ll always need to take insulin, but the level of insulin they need always decreases. If they have high blood pressure, they need to start their blood pressure medicine again the day after surgery. High blood pressure takes a bit more time to get under control than diabetes; in a few weeks or months, they may notice they don’t need it anymore, but that’s the PCP’s call. Don’t take cholesterol medication anymore, because your cholesterol levels will be lowered, and if you take it you may get a headache. If you take some other type of medication—for a mood disorder, anxiety, depression, sleep aids, whatever—yes, you can take your pills. If they’re big, solid pills, you need to crush them, but if they’re tiny or crushed, there’s no problem at all.

Does having thyroid disease affect your weight loss after the surgery?

If it’s not under control, yes. If a patient has hypothyroidism—low function of the thyroid—associated with obesity, they have to be tested by their PCP before they come here so we know they’re under control, that their levels of Synthroid levothyroxine are good. Sometimes they’ll need to increase or decrease their doses in order to be under control. If a patient comes in with thyroid issues that are not under control or are unsure because they didn’t complete their blood work, their weight loss is going to be slower due to the lower function of the thyroid. Patients should complete another blood test one to three months after the surgery, as sometimes their PCP needs to modify their treatment.

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