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Consultations, laboratory tests and prescriptions during COVID-19 lockdown

Posted by on 3 Apr 2020 in Announcements, Bariatric Surgery | 0 comments

Kia ora koutou,

As we enter the second week of the lockdown our thoughts go out to all New Zealanders during this difficult time.  Although public hospital emergency services continue, all private hospital operating and consulting in the south is on hold, awaiting COVID-19 developments.  Here at ABLE we have been working hard to reconfigure our services and will be continuing to support all our patients during this time.

Consultations

We are offering telehealth consultations using the Zoom videoconferencing platform.  This allows a secure connection from your computer, mobile device or phone.  We are sending out detailed instructions to everyone before your appointment, but please make sure we have your up to date email address and mobile phone number prior to your consultation and please also download and test Zoom prior to your appointment and contact us if you are having any problems with the connection in advance of your appointment.

We are conducting telehealth consultations for all follow-up consultations and selected new patient consultations where a standard physical examination is not required.  For new patients interested in bariatric surgery, we are setting up an on line information webinar, again using the Zoom platform, that will provide everyone with some education about the surgery and the process and speed up future face to face consultations.  There will be no charge for this webinar, please contact us if you wish to register for it.

Laboratory Testing

Southern Community Laboratories has asked all doctors to reduce requests for lab tests where the results will not immediately impact on a person’s treatment or outcome.  We are reviewing all lab test requests individually and reducing what we ask for.  In general for people who have had a sleeve gastrectomy who have had lab tests within the previous 6 months, and no significant abnormalities on those tests, we will not repeat lab tests prior to your consultation.  For those who do need to do lab tests, please have these done before your consultation, Southern Community Laboratories has a list of open testing centres during this time.

Prescriptions and Vitamin Supplementation

The Ministry of Health has permitted us to fax all prescriptions during this time so please contact us to let us know your pharmacy details.  Please continue to take your recommended multivitamins, and calcium if necessary.  Given we will not be doing as many lab tests we will have a lower threshold to recommend other vitamin supplementation such as iron.  We will also be recommending all bariatric surgery patients take monthly vitamin D due to the reduced sunlight exposure from getting out less and winter approaching.  Please contact us if you need a prescription for this or a refill on any of your other prescriptions during this time.

Stay home, stay safe and kia kaha,

Mark Smith

 

Keeping Weight Off During Lockdown

Posted by on 2 Apr 2020 in Uncategorized, Weight Loss | 0 comments

Well we are almost a week in to the Level 4 lockdown here in New Zealand, and aside from all the other challenges this brings, it also makes it hard for us to keep losing or maintain our hard won weight loss. Even though this situation is new and unprecedented we can apply some of the evidence out there on avoiding weight regain following bariatric surgery.  This gives us three areas to focus on.

Eating only for hunger

There is good evidence that eating fast food, binge eating, continuous eating, eating when full and consuming liquid calories all increase the risks of weight gain after bariatric surgery.  While avoiding fast food should be pretty easy during this time, being confined to our houses, stressed and bored makes snacking very tempting.  Suggestion for avoiding this include having a routine, including normal meal times as recommended by your dietitian.  Make sure you continue to eat your protein first as protein helps maintain muscles and keeps us feeling full for longer.  If you are further out from surgery listen to you body – is this really hunger?  If not, walk around the house, read a book, make and drink a cup of tea, keeping your mind engaged on other things is one of the keys to avoid snacking and grazing.  Also make sure you are keeping your water intake up.  Water helps us to feel a little less hungry and also avoids dehydration.

This gets on to the subject of liquid calories.  Our bodies that are usually very good at balancing our hunger to match our physical activity do not account for calories consumed as liquids.  This means that liquid calories sneak in for free.  Use this time to break the habit of liquid calories, you can’t go to your favourite coffee stand anyway so why not develop a taste for homemade tea or coffee without milk or sugar?  Soft drinks and fizz are also big sources of liquid calories, so something else not to panic buy at the moment.  Unfortunately alcohol also counts as liquid calories with a glass of beer or wine containing about 125 calories, about as much as a slice of pizza, so remember not to overdo it during the lockdown.

Physical activity

Again this is likely to be very different during the lockdown, but here we have two things in our favour.  First, we are allowed to leave the house for local exercise through walking, jogging or cycling in our bubbles. Second is that the evidence tells us that after weight loss surgery, avoiding sedentary behaviour (being still) is more important than any specific exercise.

In addition to weight management, physical activity reduces the risk of heart disease, diabetes and some cancers.  It also improves our mood and lowers stress levels.  The World Health Organisation recommends at least 150 minutes of moderate aerobic physical activity throughout the week (things that get your heart rate up) as well as muscle strengthening activities on at least 2 days per week.

So make it part of your regular daily routine to go outside for a walk, jog or bike ride every day, either by yourself or in your bubble.  There are plenty of on line routines too for activity at home including yoga and app based workouts.  Be creative and look around for something you enjoy.  Check our a few links here and here.  Lastly, just make sure you get up and walk regularly, up and down stairs if you have them but even just around the house to keep the blood moving.

Accountability

The third important behaviour associated with less weight gain following bariatric surgery is regular weigh-ins.  While many people hate standing on the scales, and are please to break this habit after bariatric surgery, people who weight themselves once a week or more have less weight regain than those who weigh in less frequently.  We recommend ongoing weekly weigh-ins to keep an eye on where things are tracking and allow people to make changes when necessary before these become too difficult.  Avoid weighing in too often though as day to day fluctuations are far more about fluid status and hydration than body composition.

It is probably best to assume that the level 4 lockdown is going to last beyond April so make it a goal to improve our your health during this uninterrupted stay at home time.  Remember also that we will be continuing our follow-up clinics as telehealth consultations during level 4, and please contact us if you have any other questions or concerns.

Say home, stay safe and kia kaha,
Mark Smith

 

COVID-19 – Updated March 23

Posted by on 16 Mar 2020 in Announcements | Comments Off on COVID-19 – Updated March 23

In light of the announcement from our Prime Minister, Jacinda Ardern today, we will be stopping all elective operating and face to face clinic appointments until the COVID-19 threat level is lowered.  These are unprecedented times and there is a lot still that is unknown.  We are truly sorry for all those who have had surgeries disrupted and will shortly be contacting you individually to explain our plans moving forward.  We anticipate continuing with telehealth consultations using secure videoconferencing for follow-up and some new patient consultations and will shortly contact you to let you know what this involves.  In the meantime, please contact us for any urgent concerns and we will get back to you as soon as possible.

Thank you for your co-operation and understanding.  Again the safety of our patients and staff are our top priority.  Stay safe, keep active and remember that this time will pass and normal life will return.

Kia kaha,

Mark Smith

 

Using Kiwisaver to fund Weight Loss Surgery

Posted by on 3 Mar 2020 in Announcements, Bariatric Surgery, Gastric Bypass, Sleeve Gastrectomy | Comments Off on Using Kiwisaver to fund Weight Loss Surgery

A question I have been asked more commonly in recent times is “Can I access my Kiwisaver to pay for weight loss surgery?”

On the face of it this is a very good question.  Many people have enough money in their Kiwisaver accounts to pay for weight loss surgery and feel the health benefits from significant weight loss will improve their quality of life in retirement.  Also, in the past it has been possible for people with Australian Superannuation to use this to fund weight loss surgery.  Unfortunately, in New Zealand things are not this simple.  Kiwisaver has been established to allow New Zealanders to fund their retirement over and above whatever NZ Superannuation is able to pay in the future.  Aside from the First Home Grant, is is very difficult to withdraw money from your Kiwisaver account, until you reach your age of entitlement.

There is however, one possible exception that some people may be eligible for in certain circumstances.  According to the KiwiSaver Act 2006, an application for early withdrawal may be on the grounds of serious illness.

‘Serious illness’ is defined as: an injury, illness or disability that results in your being totally and permanently unable to engage in work for which you are suited by reason of experience, education or training or a combination of those things; or an injury, illness or disability that poses a serious and imminent risk of death.

While I think the second clause almost precludes bariatric surgery as if someone has a serious and imminent risk of death due to their weight, then almost certainly any elective surgery would not be safe.  The first clause however may be applicable to some people, particularly if weight related health complaints prevent you from working in your chosen occupation.  A doctor will need to certify that a person does meet this clause, and even then the fund manager of a person’s Kiwisaver scheme will still need to make a decision based on the advice they receive, but it may be an option for some people.

Here at ABLE we are not financial advisors.  We strongly encourage anyone considering applying to access their Kiwisaver on the grounds of serious illness to consider the effect it will have on their retirement savings and discuss this with a registered financial advisor.  We also recommend you discuss this with your GP, as they are probably the best placed to advise you as to whether your health problems result in you being totally and permanently unable to work in your chosen occupation.  If you have any other questions, please Contact Us.

 

Enhanced Recovery After Bariatric Surgery

Posted by on 27 Nov 2019 in Announcements, Bariatric Surgery, Evidence Based Medicine | Comments Off on Enhanced Recovery After Bariatric Surgery

I have recently return from the Annual Scientific Meeting of the American Society of Metabolic and Bariatric Surgeons. This is one of the world’s largest scientific meetings of bariatric surgeons and is always a good opportunity to see what is new, what is coming up, and to meet up with colleagues from when I was working in the US. Although there were few surprise developments, it is interesting to see where things are going and where we in Aoteoroa/NZ sit compared to some of the busiest practices in the world.

In this regard, one not particularly headline grabbing, but very important development in the last few years is the so called ERAS or enhanced recovery after surgery pathways. These pathways developed over a decade ago with people undergoing surgery to remove portions of their large bowel. The include a large number of small interventions before surgery (such as limiting the period people have to fast), during surgery (such as laparoscopic surgery and anaesthetic techniques to reduce pain without using strong narcotics), and after surgery (such as letting people eat and walk much sooner). The cumulative effect for these interventions is that people recover from surgery quicker, with fewer complications.

The growth of ERAS across different surgical specialties paralleled the growth of laparoscopic bariatric surgery so many of the now accepted interventions, just became part of the standard care packages for bariatric surgery. This is all well and good, but about a year ago, bariatric surgeons in the US asked if we can do better. They looked at all the studies and evidence since ERAS pathways first developed and came up with a set of new interventions to further smooth people’s recovery after bariatric surgery. These include newer anaesthetic techniques and drugs, nerve blocks of the abdomen at the time of surgery, and moving physiotherapy from after surgery to before surgery where people are more able to take it in.

Second generation ERAS pathways for bariatric surgery have now been in use for long enough for the first results to come through and things look good. Most people are now only staying one night in hospital after surgery and complication rates and readmission rates are dropping. The best news however it that here at Aspiring Bariatrics we have already been adopting these techniques in our patient care pathways over the last few years, with the same results as high volume bariatric surgery centres in the US are reporting. While we are continuing the search to further improve things, I am constantly amazed that my patients mostly go home the day after major digestive surgery looking little different from someone who has had their gallbladder removed or a hernia repaired.

There was a lot of other interesting material covered at the conference including the toxic effects of sugar, how bariatric surgery can prevent cancer, weight loss medications, the one anastomosis (or loop) gastric bypass, and gastric balloons. I will plan to cover these topics with separate blog posts in the coming weeks.

ABLE Moving to Dunedin

Posted by on 27 Nov 2017 in Announcements, Dunedin | Comments Off on ABLE Moving to Dunedin

With the holidays approaching, there are some changes in store for ABLE Ltd and myself.  In January 2018, I will be relocating to Dunedin with my family to take up a position at Dunedin hospital.  Although the reasons for any move like this are numerous, one of the primary goals for me was to protect the future of bariatric surgery in the south.  This will entail working with my upper gastrointestinal surgeon colleagues in Dunedin to support the delivery of surgery for benign and malignant upper gastrointestinal disease throughout the south; with the intention in the future of recruiting another well trained bariatric and upper GI surgeon who can grow the present program with me.

In a practical sense this means that from January 2018:

  • I will still offer clinic appointments for new and follow-up patients in Invercargill, Queenstown and Dunedin.
  • I will see patients with a broad range of general surgical and upper gastrointestinal conditions in Queenstown and Dunedin, but limit my Invercargill practice to bariatric surgery and specialist upper gastrointestinal surgery.
  • I will do all my private operating at Mercy Hospital in Dunedin.
  • I will no longer operate in the private sector in Invercargill
  • I will continue to operate on public bariatric patients in Invercargill every month
  • I will continue to conduct public bariatric surgery clinics in Dunedin and Invercargill
  • I will continue to work with Renovate Nutrition Ltd in Invercargill, and Nutrition and Life Ltd in Dunedin

I am very grateful for all the support I have received over the last 6 years in Invercargill and rest assured that although I will be based in Dunedin I will continue with my goal of excellence in Bariatric and Upper GI surgery throughout Southern New Zealand.  If you have any questions, please contact me.

Wilbur: The King in the Ring

Posted by on 28 May 2017 in Announcements, Bariatric Surgery, Dunedin, Sleeve Gastrectomy, Weight Loss | Comments Off on Wilbur: The King in the Ring

Notable Pictures have just released a brilliant New Zealand made documentary of one man’s struggle with obesity and journey back to health. It stars Wilbur McDougall, a former pro wrestler, who agrees to let his best friend J. Ollie Lucks make a documentary about his laparoscopic sleeve gastrectomy surgery and subsequent transformation. It is a very human story, and is told with respect and compassion. I would highly recommend it for anyone contemplating weight loss surgery, or who knows others who have had it.

Wilbur: The King in the Ring is currently touring New Zealand.

For more information, check out the Facebook page.

ORBERA® Intra-gastric Balloon

Posted by on 4 May 2017 in Announcements, Dunedin, Endoscopy, Weight Loss | Comments Off on ORBERA® Intra-gastric Balloon

 

Here at Aspiring Bariatrics we are pleased to announce that we are now offering the ORBERA® Intra-Gastric balloon.  The ORBERA® balloon is a temporary endoscopic treatment that helps people to feel full, and therefore lose more weight while undertaking a diet and exercise program than with diet and exercise alone.  The ORBERA® balloon is placed under conscious sedation during an outpatient endoscopic procedure, and is removed six months later by a similar procedure.  It is accompanied by a supervised diet and exercise program lasting 12 months in total.ORBERA® Balloon in Stomach

On average people lose 10-15 kilograms of weight while the balloon is in place, approximately three times the amount of weight lost through diet and exercise alone.  The ORBERA® balloon is indicated for people with a body mass index of 27 – 40 kg/m².

For further information please click here.

Southern Cross Affiliated Provider for Consultations

Posted by on 30 Oct 2016 in Announcements, Fundoplication, Gallbladder, Hernia, Laparoscopy | Comments Off on Southern Cross Affiliated Provider for Consultations

Southern Cross AP Horizontal Logo for Web

We are pleased to announce that we have added Consultations to the list of Affiliated Provider services we contract with Southern Cross Health Insurance.  This means that for people with Southern Cross Health Insurance, we are able to directly invoice your insurer and all you will need to pay for on the day is your co-pay (if applicable). In addition, we are also Southern Cross Affiliated Providers for laparoscopic gallbladder surgery, hernia surgery, anti-reflux surgery, skin surgery, gastroscopy and colonoscopy.

For people with other health insurers, we are able to provide assistance, cost estimates, and documentation in a timely manner to facilitate your insurance claim.

 

Caution with activity trackers

Posted by on 15 May 2016 in Weight Loss | Comments Off on Caution with activity trackers

I want to share a good link that explains the potential pitfalls with activity trackers.  These devices, like the Fitbit and others, are a common way for people to track their exercise and other physical activity.  Regular physical activity is important for good health, including cardiovascular health and maintaining healthy bones and joints.  Activity is also important for weight loss and long term weight maintenance following bariatric surgery.  We recommend at least 30 minutes of moderate intensity physical activity on most days of the week.

Fitness trackers are a great way to measure physical activity and to ensure you are meeting your physical activity goals.  They can cause problems for people trying to lose weight however, when the calories burned as measured by the activity tracker are added to the daily calorie budget.  This link explains the issue in more detail.

At Aspiring Bariatrics we encourage regular physical activity and support anything that helps people to incorporate this in to their lives.  Just beware of the calories burned measurement provided by physical activity trackers and use it as a measure of day to day activity, not a reason to eat more.