What’s discussed in this episode with Dr. Elias Ortiz
- What size bougie do you use? Do you use different sizes based on weight loss goals? (0:46)
- Can you tell us about board certifications in Mexico and what they mean? (1:48)
- How is the bougie inserted into the stomach? (3:15)
- How long should you wait after having a baby before getting the surgery? (4:17)
- Can hormonal issues cause weight loss differences after surgery? (5:16)
- How do you know if you’ll have a hernia repair or not during surgery? (6:15)
- Can you have carbonated drinks ever again after having surgery? (7:43)
- Does weight loss surgery affect your mood? (9:02)
- How do you know if the gall bladder needs to be removed? (10:52)
- Is vomiting after eating normal? (12:55)
- What long term effects are there from having weight loss surgery? (15:21)
- Can you have a vasectomy shortly after having weight loss surgery? (18:05)
Dr. Elias Ortiz is a gastric surgeon from Baja California, Mexico. Today we spoke with him about gastric surgery procedures and common issues associated with the surgery.
Sheila Terrell: We get a lot of people asking us about board certification. Can you tell us about board certifications in Mexico and what that means?
Dr. Elias Ortiz: Here there are certifications for the surgeons, and there are also certifications for the hospitals. You have to follow certain guidelines; otherwise, you’re going to have problems with the government. This hospital—it’s new, only one year old—is doing well with the government. They don’t have any problems. They still have to get several more certifications, but remember, it’s only been open a year. It’s on track. For surgeons, if you’re going to do surgeries, you have to be certified by the Mexican Agency of the Surgeons. It’s very similar in the United States or Canada, or anywhere else.
For your surgeries, what size bougie do you use?
We use the 32-French bougie. I’ve never changed since the beginning. I still always use the 32-French bougie in the bypass and the sleeve.
And you don’t adjust it? If they don’t want to lose as much, or they need to lose more—it’s the same for everybody?
It doesn’t matter. The reality is, we always do it the same. It doesn’t matter if it’s a woman, a man, younger people, not-so-young people, high BMI, low BMI…It’s always the same.
How is the bougie inserted into the stomach?
Once you’re under anesthesia, the anesthesiologist introduces the bougie through your mouth. It doesn’t hurt; you’re under anesthesia, so you’re not going to notice. It’s very long; it goes all the way through your esophagus to your stomach. Once the bougie is inside the stomach, we place it in such a way that we’re able to do the gastric sleeve surgery or the bypass.
How long should you wait to have surgery after giving birth and nursing—or not nursing—the baby?
Well, I’m not a gynecologist or obstetrician, but we all know it’s always better if the mom feeds the baby. If the lactation period is going to last six, eight, ten months, the surgery should wait until that period ends. Remember, when you have the surgery, the patient—in this case, the woman—is going to have some issues eating and drinking and feeding themselves. Imagine them feeding themselves and another person. So yes, until the lactation period is over.
Can hormonal imbalances cause slower weight loss?
Yes. For example, if somebody has thyroid issues, they should first get tested and treated. You should make sure your thyroid levels are under control. Otherwise, your weight loss is going to be slower than other people’s. Some women in the postmenopausal stage need hormone replacement. If you need hormone replacement and that’s not detected, the weight loss can be affected, slowed. As long as you’re under treatment, you’re going to be fine.
How do you know if you’ll need a hernia repair?
Hernias are very common in our field. For example, yesterday we did seven surgeries, and three patients had a hiatal hernia. They didn’t know. If you want to know if you have a hiatal hernia, get an endoscopy first, but the reality is, many people don’t have one beforehand. We detect it here during the surgery.
Who’s most likely to have a hiatal hernia? People with very bad acid reflux. If you know someone that has bad acid reflux, they have a history of waking up at night choking because they have acid in their throat, it’s pretty likely that person has a hiatal hernia. If someone has a hiatal hernia, we can see it during the surgery, and we have to fix it; otherwise, the acid reflux is going to get much, much worse after the sleeve. Even with the bypass we can have issues. It’s common with obesity.
Can you have carbonation again after the weight loss? What happens?
People think, “I’m not supposed to have carbonated drinks because I’m going to stretch my sleeve.” No, that’s not the reason. After the gastric sleeve surgery, there’s not much space inside the stomach. The volume of the stomach is reduced by twenty percent. When you drink something with carbonation—for example, Coke or beer—you’re not going to like the sensation of the liquid and gas at the same time. That can give you acid reflux, actually. GERD. That is the main reason you have to avoid carbonated drinks after the gastric sleeve or bypass surgery, not because it’s going to stretch the stomach.
How can one’s mood and emotions change post-op? How long does that last?
Well, that depends. In our field, most of our patients already take something for anxiety. Probably six or seven out of ten already take medication for anxiety or depression, for both, for sleeping, for bipolar disorder. With these mental issues, and the surgery, I always tell my patients to restart their meds immediately.
Not only because of the hormones stored in the fat, right? A lot of people turn to food as their drug, so when they can’t have that anymore, that affects them, too.
Yes, that’s another reason.
One commenter, Jameela, asks, “How does one know if the gallbladder needs to be removed?”
If you have a history of pain under your right ribs, that may be a gallbladder issue. If you already know you have stones because you have an [unintelligible 00:11:11] back home, we should also take it out. If you have a family history of stones in the gallbladder, that would be another good reason to take it out. But if you never have pain under your right ribs, no family history, and you know you don’t have any stones in the gallbladder, my suggestion would be to leave it there. It’s not good to take healthy organs out. The gallbladder procedure is fast: I can take it out in fifteen minutes, no problem, but I don’t suggest that. It can have complications.
Carol says she’s still throwing up after she eats, four months later. What would you recommend?
Well, I don’t know if she’s continuing the Omeprazole. The day of the surgery, I always send patients an email telling them to start the Omeprazole—Prilosec, Nexium—the same day. Same thing daily, nonstop for the next four to five months, but the reality is that a lot of people don’t do that because they feel good. I tell them, even if you feel good, you still have to take them daily. Otherwise, if you develop gastritis or acid reflux, it’s going to be hard to get treated. My recommendation would be to take the Omeprazole—Prilosec, Nexium—Monday to Sunday, nonstop, for the next four to five months.
I’ve seen people on Facebook say, “I didn’t know I was supposed to continue.” It’s mentioned a lot, but I guess they missed it.
Yes, it’s mentioned. We have post-op meetings Mondays, Thursdays, and Saturdays, where we see all the patients that had surgery. My assistants, Pat, Dr. Reyes or Dr. Ron, always mention the Omeprazole. The email I send everybody says you have to take the forty milligrams of Omeprazole daily, nonstop, for the following four to five months.
She says she still takes it. She should email Cindy what she’s eating, right?
Yes, and if it gets really, really bad even with the Omeprazole and isn’t fixed by a change in the diet, she might need an endoscopy to figure out what’s happening inside her.
Gotcha. Now, what are the long-term effects of the sleeve, or weight loss surgery in general?
You might have mineral and vitamin deficiencies; it’s very common for people to have low iron. Some could need an iron transfusion, but that all depends on the diet. Remember, the gastric sleeve surgery takes out the part of the stomach that produces hormones that makes us desire food. After the gastric sleeve surgery, many people don’t desire to eat more, but it’s not good to fast for several hours during the day. You still have to have three or four small meals. Some people don’t eat and then develop anemia or low iron levels. I’ve seen patients who developed hemoglobin levels of eight or even seven. Problems with the hair, teeth, skin—they’re because of a bad diet, of nutritional deficiencies. As long as you have three or four small meals daily and take your nutritional supplements, you’re going to be fine.
And what you eat in those meals matters, too. Don’t have junk.
Yes, no junk, no snacks. Try to avoid snacks. Some people snack too much, and they don’t realize they eat a lot of calories just by snacking. Make sure you have a really good, balanced diet.
Grace: Today we had a patient that came in for pre-ops. His surgery is tomorrow. Monday, he’s going to have a procedure for a vasectomy reversal. Is it recommended for a patient to go have another procedure the next week?
That’s okay, in this case. A vasectomy is done in five minutes and it’s with local anesthesia, so no problem with that. But you can’t have several procedures that require general anesthesia in a short period of time. Only if it’s needed, obviously.