Seminar: Questions & Answers

The first Thursday of every month Dr. Cowan holds a seminar at UT of Memphis. I went to the first Seminar available to me. As a result before my surgery date, I had developed a better list of questions. Then I went back to another seminar. This turned out great because the second time around I knew more about it and had more specific concerns.

I think that the first time everything was happening so fast and I knew so little before hand, a lot of his talk went over my head. This time I have learned enough from some reading and talking with my regular physician that I was able to use this seminar to get some important questions answered.

Dr. Cowan's obesity lecture topics are:

1. Introduction & definitions.
2. Psychological/social/physical problems associated with obesity.
3. Causes of obesity.
4. Medical treatment of obesity.
5. Insurance.
6. Questions & Answer session.

Dr. Cowan began his talk with about 35 - 40 people in attendance. After he finished each topic I was able to ask my questions and get the answers I needed. I think he enjoyed the audience participation that my questions generated. In brief here are some of the things I learned:

? Staple line breakdown?
Other forms of gastric surgery have a slight chance of staple line breakdown or stretching. The old style Basic Gastric Bypass, Vertical Banded Gastroplasty and Stomach Stapling all share in this slight risk. To some it could cause an enlarging of the stomach pouch or even seepage which might require corrective surgery. Dr. Cowan does his quite differently, the stomach is transected or separated from the stomach pouch. This new food pouch is wrapped round and round with a heavy stitch. This prevents undue stress on the staple line and removes the possibility of the stomach pouch stretching to a larger size.

? If the stomach, duodenum, jejunum and the first part of the ileum are left in tack but no longer in the food path does it wither and die?
No, even though the food no longer pass along this route about a quart per day of digestive fluids continue to pass out into the last section of the ileum that does contain food to be digested.

? If in time, something goes wrong is this surgery reversible?
Yes, although Doctor Cowan has done some 3000 of this type operations he has never had to reverse one. But the way he closes the stomach by rolling the fat into the closure he can reverse the operation.

? What about ulcers?
If the stomach continued to produce acid without a doubt there would be a chance for ulcers to form in the unused stomach. To prevent this happening during the operation he cuts the nerves to the stomach that signal the brain to call for acid release.

? How long is the average hospital stay?
About a week or less.

? How long are you off from work?
Depending on how well you snap back, it could be from 2 weeks - up to- 8 weeks. For me, on the 5th day post-op Dr. Cowan told me I would be discharged the following day.

? How much physical activity will you be able to do post-operatively?
This depends upon the individual, but most doctors want you to be walking for exercise during the first 6 months. As soon as you feel up to it after the actual operation, with assistance, get up and start walking around. Even if just to get up out of the bed and stand for a few moments. Better if you get up and walk to the bathroom when you need to rather than using the bed pan. The reason for his is to lessen the chances of the blood pooling in your legs and forming a blood clot.

? What bout my regular prescriptions?
For up to 5 weeks post operative you are not allowed to take pills. If your medicine cannot be obtained in liquid form the pills must be crushed. It is advised to stay away from Enteric-coated pills from now on. Due to the decreased "in transit time" coated pills could exit the bowels the same way they came in!

? Is Diarrhea a side effect?
Since the large intestines are not changed, your bowel movements should not change very much. If you normally have a bowel movement once or twice a day, after the surgery you may have more bowel movements and they may be much softer than you were used to. But the number of BM's per day should decrease as time goes on. There have even been some cases of constipation reported post-operatively. But after a period time you shouldget back to a more normal routine. Also since the food you eat does not get broken down as fully as before it will be like when you increased the roughage in your diet before this surgery. That means softer stools but not diarrhea. This is what I was told before the surgery but--- for me I did have diarrhea, for a long time. At first I was out of control. Then when I discussed it with Dr. Cowan he told me how to get it under control using Metamucil with a prescription medication. It worked and I got much better.

? Daily nutrition?
Each day you will need to take vitamins, Dr. Cowan likes "Flintstones Plus Iron" (three times a day), and supplemental calcium. "Tums" works great for this requirement. Just take three at bedtime. To check up on your nutritional status there are periodic blood tests scheduled. These test give a good overall picture of how your new plumbing is working and if any changes in supplements are needed. After my first series of blood tests post-operatively it was found that I needed extra Magnesium and Vitamin D: the corrective action was simply take a Magnesium pill and a Vitamin A & D pill with my morning Flintstones vitamin pill. No problem.

There was a lot of material covered but these were a few of the items I was concerned with. If you have some specific questions that you are concerned with just email me and I will respond as best I can.