Here we will have links to articles and medical organizations that can provide additional information on our specialties.
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| Friday, January 16, 2009 |
| Did you know that your pills may be causing you heartburn or reflux? |
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There have been several recent research studies that validate and confirm our suspicions that some of the medications and vitamin supplements may be causing your heartburn or reflux. This is a very significant finding, because heartburn or painful swallowing are symptoms associated with having your band being too tight or in the “Red Zone.” This usually means that an “unfill” or removing fluid from the band may be a required intervention.
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A recent patient care presentation conducted by John Hopkins Medical Center, published in the Journal of Gastroenterology and Hepatology found that esophageal injury can be caused by medications or pills. The researchers found that the size, shape and how easily the pill dissolves and the amount of time the medication stays in contact with the esophagus are the most common characteristics associated with “pill esophagitis.” The symptoms of pill esophagitis include painful swallowing, persistent pain or discomfort behind the sternum or breast bone. The patient that presented in the case study was admitted to the hospital for chest pain. After she had a negative cardiac workup, the diagnosis was made that the patient had a pill lodged in her esophagus. The patient’s symptoms improved after she started to crush her medications and ensuring that she remained in an upright position and drank 6-8oz of fluid with the medication.
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Another study conducted by Dr. Joel E. Richter, also found that pills may cause esophagitis. Dr Richter found that the most common site of pill-induced injury is the lower 2/3 of the esophagus and the GE junction, which is where the esophagus and the stomach meet. Keep in mind that the patients who were studied were not surgical weight-loss patients. Gastric banding as well as gastric bypass are restrictive procedures where the food ingested is slowed down, as well as decreased. Therefore, we believe that the incidence of pill esophagitis is higher in our patient population. Dr Richter found that the medications that were the most common offenders were aspirin, naproxen or NSAIDS, potassium chloride, quinidine, ascorbic acid (vitamin C) and ferrous sulfate (Iron). Dr Richter also noted that most patients’ symptoms improved within one week of stopping the pills suspected as causing the esophagitis, as well as starting treatment with an acid inhibitor (PPI).
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Based on the current research and information available, Dr’s Christine Ren-Fielding, Dr George Fielding and Dr. Marina Kurian have made the following recommendations:
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Vitamins and supplements must be either liquid, chewable or dissolve easily. Vitamin supplements and iron are a necessity to ensure that the patient has adequate nutritional levels. Most supplements are large and may increase the likelihood of the pill getting stuck and causing esophagitis. The same applies to prescribed medications; ask your prescribing practitioner if your medication is available in liquid, chewable or crushable form. Medications that come in extended release are usually not meant to be crushed.
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Take your early medications a little later and your late medications earlier. Taking your medications too early or too late may also contribute to the pill esophagitis. Ask your prescribing clinician if it is okay to take your medications later in the day for your morning doses and your night medication a little early.
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The rational for changing your medication administration time is that the band usually feels tighter in the morning and relaxes and loosens as the day progresses. If you take a pill too early, you increase the chance of the pill getting stuck. Taking the night or evening dose just before lying down or going to bed also increases the chance of the pill sitting in your esophagus or pouch, causing the esophagitis. Therefore, you must take your medication or pill at least one–to-two hours before reclining, with enough liquid to clear the pill through your pouch or band.
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After having read these articles in preparation to write this article, I realized that there are many patients who have had their band loosened because of “pill esophagitis” and not necessarily because the band was too tight. The best treatment for this condition is prevention.
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Gaspar Rosario, MSN, NP-C, APN-C
NYU Program for Surgical Wt-Loss,
News Letter
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| 5:39 pm est |
| What to do after a lap band adjustment |
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| What to do after a lap band adjustment |
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| POST ADJUSTMENT INSTRUCTIONS |
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| After having a lap band adjustment you must maintain a liquid diet for 48 hours and then advance your diet to a pureed diet for 48 hours. If you fail to follow these instructions, you are taking the risk of vomiting. Once you vomit the stomach at the band site experiences irritation and swelling. This will lead to the band feeling even tighter, resulting in more swelling, pain and vomiting. This cycle of vomiting can ultimately result in difficulty tolerating your saliva and possibly lead to dehydration and even slippage of the band. |
What you should do if you vomit or regurgitate is to maintain a thin liquid diet x 24 hours.
Examples of thin liquids: |
Broth, that means screening out all vegetable and food particles.
Protein supplement shakes, if it is too thick, add water or skim milk to make it thinner.
Propel or powerade, these drinks contain some electrolytes, and should work well too. |
| Pureed diet |
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| Lowfat cottage cheese, yogurt, tuna fill, baby food |
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| As long as you can drink fluids, you will be okay and overcome the discomfort that you will experience when you have eaten something too fast or did not chew it well enough. We must remember that we have a lap band and we must learn to live with it. We cannot go around and expect to feel no consequence for eating too fast or not chewing well. You will feel some discomfort and even pain and pressure at the band site. To work through this situation, you must try to relax by putting the utensil down and breathe slowly and deeply. You can also try swallowing, which will stimulate your esophagus to try to propel the food through. The worst thing you can do is try to drink when you feel something stuck. Yes, if your band is not really tight, you might be getting away with this. However, the opposite effect will happen if your band is somewhat restricting and you get something stuck. You will vomit or regurgitate if your band is tight and you try to drink to wash the food through. Save your self the trouble, don’t do it. Your stomach is like an hour glass, with the new pouch funneling through the band and into the lower stomach. This band site gets blocked with food, and then you drink something to wash it down you essentially over flood the pouch’s capacity. This causes the fluid level to backup into the esophagus, leading to nausea and eventually vomiting a thick white or brownish mucous. |
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| posted by GasparRosarioNP |
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| 5:34 pm est
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| 2009.01.01
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| Lap Band Commandments |
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GASPAR’S
LAP BAND COMMANDMENTS
THY SHALL:
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- NOT HAVE ICE CREAM OR CHOCOLATE
- CHEW WELL AND EAT SLOW
- REMAIN ON A LIQUID DIET FOR 2 DAYS, FOLLOWED BY PUREED DIET FOR 2 DAYS AFTER EACH ADJUSTMENT
- MAINTAIN A LIQUID DIET FOR 1 TO 2 DAYS, IF YOU VOMIT FOR ANY REASON
- MAKE AN APPOINTMENT IF YOU CAN EASILY EAT :
- DOUGHY BREAD,
- STEAK
- WHITE MEAT CHICKEN
- MORE THAN A CUP OF FOOD
- ANOTHER APPOINTMENT IF YOU ARE STILL HUNGRY
- NOT PANIC, BEING HUNGRY IS NOT AN EMERGENCY. MAKE GOOD FOOD CHOICES UNTILL YOUR NEXT APPOINTMENT
- MAKE AN APPOINTMENT EVERY 4 WEEKS FOR THE FIRST YEAR AND GET YOUR ANNUAL ESOPHAGRAM AND LAB WORK
- SEE YOUR DOCTOR ON YOUT NEXT APPOINTMENT IF YOU FOLLOWED THE ABOVE COMMANDMENTS AND YOU ARE NOT LOOSING 1-2 LBS / WEEK.
- ENJOY SUCCESSFUL WEIGHTLOSS, RESOLVING
COMORBIDITIES, AND A HEALTHIER LIFE, IF YOU
FOLLOW THESE INSTRUCTIONS
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| BY:GASPAR ROSARIO, ANP |
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| posted by GasparRosarioNP |
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| Informational Links |
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| Diabetes |
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| NYU Medical Center |
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| LAP-BAND.Com |
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