University Health System Blog

Las Vegas weight-loss surgeon Dr. Shawn Tsuda answers the question: “What if I regain the weight after undergoing weight-loss surgery?”

More than two-thirds of Americans are either overweight or obese.

For patients who are morbidly obese, or have a body mass index greater than 40kg/m2, it can be difficult to achieve substantial weight loss through diet and exercise alone. In fact, studies show that 95 percent of people who are morbidly obese are unsuccessful in maintaining long-term weight loss.

In 1992 the National Institute of Health established that weight-loss or bariatric surgery is the only treatment proven to provide durable weight loss in the morbidly obese.

Today the laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric band and the sleeve gastrectomy are options for patients who suffer from extreme obesity. However, none of the operations are easy fixes.

Diet and exercise are essential components of maintaining weight loss after these procedures. The best way to incorporate the three modalities of surgery, diet and exercise is to continue a close relationship with your weight loss surgical program. Watching portions, achieving effective exercise and monitoring nutritional status are functions of a comprehensive surgical weight loss program. Absence of close follow-up is responsible for the majority of failed results after weight-loss surgery.

The University of Nevada School of Medicine program on weight-loss surgery in Las Vegas is a comprehensive program that helps patients achieve optimum results.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery. More information on the University of Nevada School of Medicine Weight Loss Surgery Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Mary Beth Hogan answers the question, “Is it possible to have asthma without wheezing?”

Asthma is a disease of inflammation or swelling in the breathing tubes which is frequently associated with bronchospasm or wheezing. Other frequent symptoms associated with asthma include cough, shortness of breath and chest tightness. Triggers for the cough, wheeze and shortness of breath can include allergy exposure.

Possible allergens setting asthma off and starting the process of swelling in the breathing tubes include pollen, animals, dust mites and molds. Other triggers include exercise, cold air and very frequently, the common cold, for instance, an upper respiratory infection.

Cough and chest tightness after exposure to these triggers can even be present when pulmonary function tests are normal.

The coughing may be severe enough to affect the quality of life with inability to sleep from cough, exercise may be limited due to cough and daily activities may be interrupted by coughing bouts. All these symptoms may occur without wheeze. When cough is the predominant symptom without wheeze, some asthma experts might use the term “cough equivalent asthma.”

Some of these asthmatics may have cough for prolonged periods after their trigger as inflammation in the breathing tubes may take awhile to dissipate without appropriate treatment. Fortunately, asthma medications used for asthmatics that have wheezing also work for asthmatics with cough only.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at the University of Nevada School of Medicine and University Health System. Dr. Hogan is based in Reno, Nevada.

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Dr. Gregory Brown answers a question from Margie in Jerome, Arizona: “Is one antidepressant safer than another in developing suicidal thoughts when taking the drug? And is St. John’s Wort helpful for depression?”

People who have depression with suicidal thoughts may have an increased risk during the first few weeks of taking an antidepressant for acting on those thoughts. That’s because the medication may be improving energy level, but has not had an adequate time to help the depressed mood, which can take three to five weeks.

Not one antidepressant or class of antidepressants has any difference in terms of risk-value regarding suicidal thoughts or actions. Some medications that have been on the market for longer than newer drugs, however may be more damaging physically in a case of an overdose.

The importance of close follow-up with a physician during these weeks cannot be underestimated.

St. John’s Wort is considered a pharmaceutical grade antidepressant in parts of Europe, but in the U.S. it is a health food supplement. Different batches of the supplement may vary in strength or purity, thus it can be difficult to maintain a constant blood level over time. Some studies have demonstrated its effectiveness while others have not. It would likely carry the same risk regarding suicide as other antidepressants provided it is effective.

Unfortunately, no known antidepressants work any more quickly than the three to five period as mentioned above and none are without side effects.

Gregory P. Brown, M.D. is chair of psychiatry at the University of Nevada School of Medicine in Las Vegas. Dr. Brown is board certified in general psychiatry and forensic psychiatry by the American Board of Psychiatry and Neurology.

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Dr. Kayvan Khiabani answers the question: What is migraine headache surgery and am I a good candidate?

Migraine headache surgical procedures can eliminate or significantly reduce the frequency and intensity of migraine pain. These surgical procedures focus on removing the triggering sites where nerves are being compressed, causing migraine headaches. The forehead, temples and back of the neck are among the most common trigger points that are decompressed during surgery.

If you’ve been a diagnosed of by your physician as having migraine headaches and have tried other treatments with no or limited success, then you may be a candidate for migraine headache surgery. If you’ve had a good response with Botox injections for relief of migraines, then you probably are an excellent candidate for this migraine headache surgery procedure.

Some of common side effects like a decreased ability to frown and a youthful look, akin to what is experienced after cosmetic Botox injections, are tradeoffs that are considered an advantage by most people. Other common side effects may include temporary hollowing of the temple and numbness in the forehead and scalp.

Kayvan Khiabani, M.D., has an expertise unique in migraine headache surgery. He is an associate professor of surgery at the University of Nevada School of Medicine where he heads the section of microneurovascular surgery.

Dr. Shawn Tsuda answers the question: “I have acid reflux. How do I know if I’m a good candidate for surgery?”

Gastroesophageal reflux disease, also known as GERD, is a common problem and can affect people’s lives from occasional mild discomfort to severe, disruptive pain. The potential complications include erosive esophagitis, increased risk for esophageal cancer, strictures impairing swallowing and the cost of medications used over years.

The majority of patients can control their symptoms with lifestyle changes, such as avoiding foods that cause reflux, not eating too close to going to bed, sleeping with one’s head up, as well as, medications, primarily H2 blockers and proton pump inhibitors.

However, some patients may have already developed complications from GERD or are refractory to even the most aggressive medication regimens. In other cases, a hernia of the stomach through the diaphragm, called a hiatal hernia, may be a contributing factor. For these patients, surgery may be the best option.

After appropriate studies that involve examining the acidic levels of the stomach and the function of the esophagus, a laparoscopic procedure called a Nissen fundoplication can be performed.  This involves wrapping the top of the stomach around the esophagus, preventing acid reflux.

This procedure can be successful up to 90 percent of cases.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery and consults patients at the school’s Patient Care Center in Las Vegas.

Have a health question? University Health System doctors answer select questions from readers like you.

Last week KLAS-TV Channel 8 News aired a series of informative features on University of Nevada School of Medicine surgeons who staff the trauma center at University Medical Center in Las Vegas.

On Monday the news program reported on a local man who survived a spinal injury thanks to the work of trauma surgeons. Jay Coates, D.O., assistant professor of surgery at the School of Medicine, details step-by-step the critical process of stabilizing a patient rushed into a trauma center.

Tuesday’s report focuses on a local woman who fell during a hike, suffering a shattered skull and a collapsed lung. Michael Casey, M.D., professor of surgery at the medical school, recounts the minutes between life and death while saving a trauma patient.

On Wednesday Deborah Kuhls, M.D., associate professor of surgery at the School of Medicine, describes the story of a teenage girl who was struck by a car as she was playing outside.

John Fildes, M.D., professor and vice chair of surgery at the School of Medicine, was cited in Thursday’s feature on a man who survived a motorcycle crash.

The fifth and final report on Friday is the story of a Las Vegas man involved in a near-fatal car crash that  offers Dr. Kuhl’s insight from a trauma surgeon’s perspective.

University of Nevada School of Medicine trauma and critical care surgeons are some of the leading experts in their field and help lead the trauma center at UMC, the fifth busiest in the country.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, contact him by email or call 702-671-2230.

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Robin Morello, bariatric surgery nurse coordinator at the University of Nevada School of Medicine’s weight loss surgery center in Las Vegas, was featured in the Las Vegas Review-Journal yesterday. It chronicles Morello’s first-hand experience with battling obesity and how weight loss surgery changed her life, helping her shed more than 100 pounds. Today, Morello has dedicated her nursing career to helping patients overcome obesity. The weight loss surgery center at the medical school is a collaboration between the University of Nevada School of Medicine and University Medical Center. The center is led by bariatric surgeon, Shawn Tsuda, M.D.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, contact him by email or call 702-671-2230.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. William Zamboni, chair of surgery and chief of plastic surgery at the University of Nevada School of Medicine, appears on the FOX-5 Las Vegas afternoon show “More” with a segment on patients having plastic surgery while awake (video). The segment aired today.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, contact him by email or call 702-671-2230.

Have a health question? University Health System doctors answer select questions from readers like you.

The pediatric allergy and immunology research clinic at the University of Nevada School of Medicine is conducting a clinical research study on hereditary angioedema, or HAE. If you are 18 years of age or older, have a documented diagnosis of hereditary angioedema type I or II, and experienced or are experiencing an hereditary angioedema attack, you may qualify to participate in a study of an investigational drug.

According to the National Institutes of Health, hereditary angioedema is a rare but serious problem with the immune system that is passed down through families. It causes swelling, particularly of the face and airways, and abdominal cramping.

If you qualify, participants will receive all study-related care, including but not limited to all study-related exams, lab work and study medication.

For information, contact Kathy Peele, A.P.N., study coordinator at 775-784-6522 or email.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: Is pregnancy safe after weight loss surgery such as gastric bypass or lap band?

Many women who suffer from severe obesity also suffer from hormonal problems that make it difficult for them to conceive children. Even for women who are not trying to conceive, menstrual irregularities related to obesity can be a significant burden.

After a patient undergoes surgery such as gastric bypass, sleeve gastrectomy or laparoscopic adjustable gastric band to lose weight, a period of hormonal and menstrual irregularity can continue. However, it is also commonplace for women to regain their ability to conceive after weight loss. Rapid weight loss, however, can come with relative nutritional deficiencies. Therefore, it is imperative that patients take vitamin and mineral supplements guided by their physician.

Most patients after weight loss surgery reach their goal between 18 and 24 months. At the University Weight Loss Surgery Program, it’s our practice to encourage nutritional supplementation and appropriate birth control until at least 18 months after bariatric surgery. Only after the patient is deemed nutritionally robust by their doctor should they consider bearing a child.

However, if these criteria are met, the ability to conceive can be a positive life-changing event in patients who were otherwise limited by their severe obesity to have children.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery. More information on the University of Nevada School of Medicine Weight Loss Surgery Center.

Have a health question? University Health System doctors answer select questions from readers like you.