6 Mai 2017
I know I keep saying it, but time has been flying by! I wrote about the actual surgery day and the first few days of recovery already. Last time I talked about tummy. Which is right for you? The desire for a youthful flat and smooth stomach is common, but so is confusion about the best way to achieve it. In our practice, we receive.
Tummy Tuck Recovery Update 1. Days Post Op. I know I keep saying it, but time has been flying by! I wrote about the actual surgery day and the first few days of recovery already. Last time I talked about tummy tuck recovery I was waiting to have my drains out!
I was SO SO SO nervous that it was going to hurt. Honestly, the most painful/annoying thing about the first week of recovery for me was the drains. So I took one last pain pill before going and lets just say I was feeling really relaxed once we got to the appointment. He snipped the stitches told me to take a deep breath and him and the nurse pulled both out at the same time. It felt weird, but it didn’t hurt. Sidenote: Nothing good ever happens after a doctor/medical professional/anyone tells you to take a deep breath.
That wasn’t painful at all either. He told me that I could wear spanx if I wanted to but had to keep some kind of garment on full time until my next appointment. He also said I could walk as much as I want, just no “power walking” or anything more intense.
He warned me that I would get tired quickly and that I just needed to listen to my body. When I got home I TOOK A SHOWER! Seriously the best shower ever.
I also got my first peek at my tummy without the binder and drains. Unreal. I don’t even recognize that as MY stomach.
It was a very emotional moment for me to be able to see just a glimpse of the stomach I have dreamt about. I know it is still swollen at just 8 days out but there is even a tad bit of ab definition! SERIOUSLY, IS THAT ME?! When I first started on my health journey I had this as the after in my head. I would work out and eat right and in .
The truth about weight loss isn’t always pretty. I worked out twice as hard as people I watched get amazing results in half the time. I was meticulous about what I would eat.
But I worked hard and left it all out there. There are a few things that come into play here. So is the amount of time you have spent being obese. I remember having that big hanging pouch of fat back in middle school. Of course it got bigger as I got bigger.
But that skin was done, it wasn’t going back no matter how many wraps/creams/pills/heavy weights/”Just toning” or whatever amazing miracle remedy you have for me. I’ve said it a million times and I’ll say it again. This is a functional, elective, plastic surgery that I decided to do to make my life better. I worked hard and lost 7. I didn’t do this to be skinny.
I will always be a thick, curvy girl. I posted on instagram. I felt tired and worn out last Monday but it was because of a combination of the surgery and (TMI ALERT) that time of the month. Seriously, I couldn’t tell what was worse.
It was just bad timing for that, for sure. But once that went away and the drains were out I started to feel better and better. I even tried to put some “real” clothes on and felt good in them! I haven’t been brave enough to try on my jeans because I am still so swollen plus the part of my stomach from my belly button to my incision is still really numb and it feels really weird. Since I’m talking about swelling I noticed that, yes, my stomach is swollen but so are my upper legs. I know they did lipo around the flanks and there is probably swelling/healing going on from that. I just didn’t expect my legs to feel this swollen.
I also tried on some spanx, the high waisted shorts kind. How do people wear this every day? It was like alligator wrestling trying to get it on. The pair I had didn’t have a pee hole or anything so I’m convinced people who wear spanx like that have to be chronically dehydrated because going to the bathroom was a major life event. I wore them for maybe an hour and a half while washing my binder and went to the bathroom twice. All this spanx talk reminds me of the buzzfeed video of men trying on spanx for the first time.
You’re welcome. Day 8, the day I got my drains out, was my last day taking the pain pills (which means I can drive again, yay!) Now I only take tylenol maybe once a day if needed. I’ve been able to stand up straight since around day 5 or 6 so that helped me not be as sore because most of the pain was in my back from hunching over.
Overall, recovery has been uneventful for me. I’m not telling you that this surgery was a cakewalk, because it wasn’t. But I believe that Cross. Fit made me strong and fit which helped my recovery go so well. I’m used to a certain level of pain/soreness so this isn’t out of the ordinary.
My body knows how to recover well. I’m already missing my workouts, so instead of workout out I just dress like I’m going to work out. A little jedi mind trick. I love my results and would do it over in a heartbeat. Dr Mills is truly an artist. My scar is low and thin (you can see part of it in the before and after above). I know I’ve made it through the toughest part and recovery should be all downhill from now.
It will only get better! Thanks so much for all your kind words. You guys are the best. Be sure to follow me on Instagram or Facebook for more regular updates. If you have any specific questions leave them in the comments and I’ll try to answer them all or do another Q& A post if I get a lot of the same. Any recovery tips? Have you ever worn spanx?!
Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient. Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Abstract. The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2. CPG). Each recommendation was re- evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type- 2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 7. 4 recommendations (of which 5.
There are 4. 03 citations, of which 3. EL 1, 1. 31 (3. 2.
EL 2, 1. 70 (4. 2. EL 3, and 6. 9 (1.
EL 4. There is a relatively high proportion (4. EL 1 and 2) studies, compared with only 1. AACE- TOS- ASMBS CPG. These updated guidelines reflect recent additions to the evidence base.
Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues. Outline. Introduction. Methods. Executive Summary. Q1. Which patients should be offered bariatric surgery?
Q2. Which bariatric surgical procedure should be offered? Q3. How should potential candidates for bariatric surgery be managed preoperatively? Q4. What are the elements of medical clearance for bariatric surgery?
Q5. How can early postoperative care be optimized? Q6. How can optimal follow- up of bariatric surgery be achieved? Q7. What are the criteria for hospital admission after bariatric surgery? Evidence Base. References. Introduction. Obesity continues to be a major public health problem in the United States, with more than one third of adults considered obese in 2. Obesity has been associated with an increased hazard ratio for all- cause mortality.
Indeed, obesity is not only a chronic medical condition but should be regarded as a bona fide disease state. Nonsurgical management can effectively induce 5%. Bariatric surgery procedures are indicated for patients with clinically severe obesity. Currently, these procedures are the most successful and durable treatment for obesity.
Furthermore, although overall obesity rates and bariatric surgery procedures have plateaued in the United States, rates of severe obesity are still increasing and now there are approximately 1. United States with a BMI. Only 1% of the clinically eligible population receives surgical treatment for obesity.
Given the potentially increased need for bariatric surgery as a treatment for obesity, it is apparent that clinical practice guidelines (CPG) on the subject keep pace and are kept current. Since the 2. 00. 8 TOS/ASMBS/AACE CPG for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. A Pub. Med computerized literature search (performed on December 1.
Updated CPG are therefore needed to guide clinicians in the care of the bariatric surgery patient. What are the salient advances in bariatric surgery since 2. The sleeve gastrectomy (SG; laparoscopic SG . A national risk- adjusted database positions SG between the laparoscopic adjustable gastric band (LAGB) and laparoscopic Roux- en- Y gastric bypass (RYGB) in terms of weight loss, co- morbidity resolution, and complications.
The number of SG procedures has increased with greater third- party payor coverage. Other unique procedures are gaining attention, such as gastric plication, electrical neuromodulation, and endoscopic sleeves, but these procedures lack sufficient outcome evidence and therefore remain investigational and outside the scope of this CPG update. There is also emerging data on bariatric surgery in specific patient populations, including those with mild to moderate obesity, type 2 diabetes (T2. D) with class I obesity (BMI 3. Clinical studies have demonstrated short- term efficacy of LAGB in mild to moderate obesity (.
Although controversial, this position was incorporated by the International Diabetes Federation, which proposed eligibility for bariatric procedures in a subset of patients with T2. D and a BMI of 3.
In 1 study, metabolic surgery was shown to induce T2. D remission in up to 7. In a more recent study, patients who underwent RYGB sustained diabetes remission rates of 6. The overall long- term effect of bariatric surgery on T2. D remission rates is currently not well studied. Additionally, for patients who have T2. D recurrence several years after surgery, the legacy effects of a remission period on their long- term cardiovascular risk is not known.
The mechanism of T2. D remission has not been completely elucidated but appears to include an incretin effect (SG and RYGB procedures) in addition to caloric restriction and weight loss. These findings potentially expand the eligible population for bariatric and metabolic surgery. Another area of recent interest is the use of bariatric surgery at the extremes of age. Historically, the 1.
National Institutes of Health (NIH) consensus criteria stipulated that treatment of obesity with bariatric surgery is limited to adults. Until 2. 00. 3,<. However, in academic centers alone, the number of bariatric procedures in adolescents nearly doubled from 2. Morbidity and mortality in this 2. Prospective data collected from a single academic center demonstrated that patients age. However, recent American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data of 4.
Although many bariatric programs have established arbitrary cutoff levels for age at 6. These included advanced age (. However, a more recent multicenter study of 4. OS- MRS. The Longitudinal Assessment of Bariatric Surgery (LABS) data did find that a history of thrombophilia (deep venous thrombosis .
Age and gender, however, were not predictors of death in the LABS analysis. Moreover, 3. 0- day mortality for RYGB and LAGB occurred in only . Data reported from the Swedish Obese Subjects (SOS) study, a large prospective observational study of> 2. HR) of . 7. 1, 1.
More recent data from this cohort followed for up to 2. HR of . 4. 7 in cardiovascular death (including stroke and myocardial infarction) among surgical subjects compared with obese controls(2.
In another cohort, all- cause mortality was reduced by 4. RYGB, compared with the control group, and cause- specific mortality in the surgery group decreased by 5. T2. D, and by 6. 0% for cancer. Promising pharmacological (including biological) treatments are on the horizon, but at present, bariatric surgery remains superior to nonsurgical treatments in terms of short- term benefits in surrogate markers of metabolic disease. Durability of benefit in terms of pertinent clinical outcomes will be the endpoints of current prospective trials. An enriched evidence base, expanding eligible patient populations, and safer, innovative surgical treatments for obesity will likely result in a greater number of obese patients undergoing surgery. This CPG update aims to keep pace with the evidenced based literature, and along with the accompanying checklist.
These CPG expired in 2. National Guideline Clearinghouse (2. Selection of the co- chairs, primary writers, and reviewers, as well as the logistics for creating this evidence based CPG were conducted in strict adherence with the AACE Protocol for Standardized Production of Clinical Practice Guidelines. This updated CPG methodology has the advantage of greater transparency, diligence, and detail for mapping the strength of evidence and expert opinion into a final graded recommendation. Nevertheless, as with all white papers, there is an element of subjectivity that must be recognized by the reader when interpreting the information. Table 1. 2. 01. 0 American Association of Clinical Endocrinologists Protocol for Production of Clinical Practice Guidelines. American Association of Clinical Endocrinologists Protocol for Production of Clinical Practice Guidelines.
American Association of Clinical Endocrinologists Protocol for Production of Clinical Practice Guidelines. When subjective factors have little or no impact (. When subjective factors have a strong impact, then recommendation grades may be adjusted up (.
If a two- thirds consensus cannot be reached, then the recommendation grade is D. NA=not applicable (regardless of the presence or absence of strong subjective factors, the absence of a two- thirds consensus mandates a recommendation grade D).
Table 4. 2. 01. 0 American Association of Clinical Endocrinologists Protocol for Production of Clinical Practice Guidelines. In many cases, recommendations have been condensed for clarity and brevity. In other cases, recommendations have been expanded for more clarity for complex decision making. The relevant evidence base, supporting tables, and figures for the updated recommendations follow the Executive Summary. The reader is encouraged to refer to the 2. AACE- TOS- ASMBS CPG. There are 5. 6 revised recommendations and 2 new recommendations (R3.
R5. 9) in this 2. Consensus among primary writers was obtained for each of the recommendations. Q1. Which patients should be offered bariatric surgery? R1(1)- r. Patients with BMI of 3.
There is insufficient evidence for recommending a bariatric surgical procedure specifically for glycemic control alone, lipid lowering alone, or cardiovascular disease risk reduction alone, independent of BMI criteria (Grade D). Q2. Which bariatric surgical procedure should be offered? R4(5/6/7)- r. The best choice for any bariatric procedure (type of procedure and type of approach) depends on the individualized goals of therapy (e.
How should potential candidates for bariatric surgery be managed preoperatively?
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