University Health System Blog

Dr. Jay Coates answers the question: “What can I expect before and after surgery?”

Few events in life create as much anxiety as having to undergo surgery. To help allay some of your anxieties with ‘going under the knife’ I’d like to offer some general guidelines for undergoing surgery with general anesthesia.

Consent

First of all, before surgery, you must have informed consent. Sounds obvious but some patients may feel too intimidated to ask their surgeon basic questions. What procedure is being preformed? Why is it necessary? Who will be doing it? What are the risks and complications associated with this surgical procedure? Surgery should not be taken lightly. Every surgical procedure has potential risks and complications. Among the most common are bleeding, infection and problems with general anesthesia. Your surgeon and you should review these risks and you should fully understand these risks before undergoing the procedure.

Pre-op clearance

The pre-op clearance answers the surgeon’s basic question of whether the patient is healthy enough to tolerate the surgery. If you’re young and in good general health the surgeon may clear you through with a physical exam. If you’re older or have health problems, your surgeon may want medical clearance from your internist or cardiologist. Your doctor will submit a medical report to your surgeon that indicates what risks, if any, you may encounter while undergoing the physical stress of surgery. If the risks are high your surgeon will discuss these with you and decide whether surgery should still be preformed or if an alternative treatment is a better option.

The night before

No food or drink after midnight the night before the day of the surgery. Patients often wonder why they can’t eat anything past midnight. The answer’s simple actually.

If you’re receiving general anesthesia, you’ll be intubated, meaning you’ll have a breathing tube placed during surgery. The medications that you’ll be given and the intubation procedure itself, could cause you to reflux what you ate the night before. If this happens you can experience aspiration while you’re under, meaning food or liquid from your stomach can come up and then go down the wrong pipe (trachea) and into your airways, possibly causing aspiration pneumonia. The risk of getting aspiration pneumonia is greatly reduced by having your stomach empty. You may have to take pre-operative antibiotics the night before or morning of surgery and perhaps even for a day or so after. These help reduce the chance of infection. There may also be some medications that you’re currently on which you must stop taking from the night before to two weeks before surgery. For instance, you shouldn’t take aspirin 10 days before surgery as it interferes with platelet function, as platelets help your blood clot.

Checking-in

The day of surgery you’ll need to check into the pre-op area of your hospital or surgical center. The nurses will have you change into a gown, place an ID bracelet on you, review any general questions you may have and check your informed consent document and medical clearance. You should be interviewed by your anesthesiologist, who will place you under general anesthesia and intubating you. You’ll repeat a lot of the same information to many different people but this repetition helps to eliminate mistakes. Your surgeon will usually see you before you go to the operating room. If you’re having a procedure like a breast biopsy or hernia repair, you may be asked several times by different people what side of your body the surgery is being done. Again this repetition helps cut down on medical error.

Regardless of the surgical procedure, you should feel confidence in your surgeon and have all your questions answered before surgery. The most common source of conflict between a patient and a doctor is lack of communication. If you don’t feel confident in your surgeon or your questions aren’t being answered, you should look for a second medical opinion and find a surgeon who will take the time to help you understand.

Jay Coates, D.O. is an assistant professor of surgery at the University of Nevada School of Medicine and vice chair of trauma surgery at University Medical Center in Las Vegas.

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Dr. Mary Beth Hogan answers the question: “Is it possible to develop a food allergy as an adult?”

It is possible to develop allergies as an adult. In fact, shellfish allergy is one of the most common foods for adults to develop allergy too. Approximately half of a percent of adults nationwide report allergy specifically to shellfish.

Anaphylaxis, a life threatening reaction, can also occur to foods in adults. They can even occur if there was no previous reaction to the food. They can also happen after a prolonged period of avoidance of the food. Symptoms of anaphylaxis are itching, facial swelling, tongue or throat swelling, hives, vomiting, diarrhea or stomach cramping, difficulty breathing, dizziness and fainting.

If your doctor feels that you are at risk for such a reaction, an epipen will be prescribed. At the first sign of these symptoms, use the epipen as directed and seek emergency help immediately. An epipen will not necessarily stop the reaction, but it will slow the reaction down so that you can reach emergency care. In addition, your doctor will teach you how to read labels and avoid hidden or trace amounts of shellfish in your diet.

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. Dr. Hogan is based out of Reno, Nevada.

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Dr. Shawn Tsuda answers the question: “Laparoscopic gastric bypass versus the laparoscopic adjustable gastric band: Is one or the other better for long term weight loss results?”

The number of weight loss procedures performed over the past ten years has increased by more than a ten-fold in the U.S., exceeding 200,000 operations in 2006. The laparoscopic Roux-en-Y gastric bypass, which provides both restriction and malabsorption of food intake, is still considered the gold standard operation for long-term weight loss.

However, the laparoscopic adjustable gastric band, which uses one of two FDA approved devices for primary restriction of food into the gastrointestinal tract, is the second most commonly performed procedure and is quickly gaining in popularity. There is an abundance of data that supports both the gastric bypass and laparoscopic adjustable gastric band as safe (but not risk-free) procedures with sustainable weight loss and a positive impact on obesity-related diseases such as diabetes mellitus, hypertension and obstructive sleep apnea. (Learn more about weight loss surgery procedures from the U.S. National Library of Medicine).

The amount of weight loss that can be expected on average for the gastric bypass ranges between 60 and 80 percent of excess weight loss, or loss of weight beyond a calculated ideal body weight. The laparoscopic adjustable gastric band has a wider spectrum of success, ranging between 30 and 70 percent of excess weight loss.

Both operations are endorsed by most professional medical societies as acceptable treatments for the severely obese. The choice of operation depends on the patient’s preference, along with his or her surgeon’s counseling on any specific contraindications to either of the operations. An informed decision is essential to undergoing any weight loss procedure.

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

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Dr. Thomas Hunt answers the question: “What is heart rehabilitation?”

According to the American Heart Association high blood pressure affects 70 million Americans—and more than one in three don’t even know they have it. If undiagnosed or untreated, hypertension can lead to the hardening of arteries, which can lead to heart attack, stroke, kidney failure and death. An internist or family physician can help you monitor your blood pressure and help you take the necessary steps to keep your blood pressure at a healthy level to prevent possible heart disease.

But for patients with heart disease, there may still be steps you can take to a healthier heart. Cardiac rehabilitation is a medically supervised program to help patients with heart conditions recover following a heart attack or heart surgery. It’s generally divided into phases that include monitored exercise, nutrition counseling, emotional support and education on lifestyle changes.

A heart rehabilitation program generally begins while the patient is hospitalized and continues after the patient goes home. It’s a customized program that can significantly increase one’s chances of survival following a heart attack. Today through improved programs and close monitoring, cardiac rehabilitation is an option for people of all ages and patients with many types of heart conditions including coronary artery disease, peripheral arterial disease and angina, or who have undergone procedures like a cardiomyopathy, coronary bypass surgery or heart transplant.

Although more patients are able to participate and benefit from cardiac rehab, it’s not appropriate for everyone. A patient needs to undergo a doctor’s thorough evaluation to find out if a patient is a good candidate for heart rehab.

Components of heart rehabilitation

Medical evaluation
Both initial and ongoing medical evaluations allow your doctor to assess physical abilities, medical limitations and other conditions you may have. Your doctor will explore your risk factors for cardiovascular disease, stroke or high blood pressure and use these findings to personalize cardiac rehab for you.

Physical activity
Exercise is a critical component of rehabilitation therapy. No longer is bed rest necessarily recommended if you have a serious heart condition. Exercise improves one’s cardiovascular fitness and can include walking, cycling, rowing or jogging. Strength training is also usually part of the program. If you’ve never exercised, your doctor will design a program that moves at a safe, comfortable pace.

Lifestyle changes
Changes in your lifestyle is an important component of the rehabilitation process. Guidance on diet and nutrition will help you shed extra weight and teach you to make healthier food decisions that reduce the intake of fats, salt and cholesterol. You will receive support on beating unhealthy habits such as smoking or consumption of excess alcohol. You will also learn how to manage the pain or fatigue that may accompany your heart condition. Current AHA guidelines advise on getting cholesterol levels to a healthy level as part of cardiac rehabilitation—reducing your low density lipoprotein, or bad cholesterol, less than 100 milligrams and ideally under 70 milligrams is an important goal.

To learn more about controlling your high blood pressure and heart health, speak to an internist at our Patient Care Center in Las Vegas or Internal Medicine and Multispecialty Clinic in Reno or a family doctor at our Family Medicine Clinic in Las Vegas or Family Medicine Center in Reno.

Thomas Hunt, M.D. is an associate professor in the Department of Family and Community Medicine at the University of Nevada School of Medicine in Las Vegas.

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Dr. James Lau answers the question: “What’s the difference between being overweight and obesity?”

Obesity means having too much body fat. It is different from being overweight, which means weighing too much. Both terms mean that your weight is greater than what’s considered healthy.

Obesity most often occurs over time when you eat more calories than you burn or use. The balance between calories-in and calories-out differs for everyone. Genetics, overeating, eating high fat foods and being physically inactive are factors that can make you obese.

It’s important to note that obesity is not just a cosmetic concern. Obesity and carrying excess body fat places you at greater risk of developing high blood pressure, diabetes, stroke, arthritis, certain cancers, and other serious health problems. Losing even five to ten percent of your weight if you’re obese can help delay or prevent some of these diseases.

If your body hasn’t responded to diet and exercise, you may be a good candidate for weight loss surgery, or bariatric surgery, such as the gastric bypass or the lap band using laparoscopic techniques. It’s important to get the facts about your choices if you believe you’re a good candidate for weight loss surgery.

The University of Nevada School of Medicine and University Medical Center sponsors free seminars in Las Vegas on bariatric surgery that Dr. Shawn Tsuda and I personally conduct. These free seminars are usually held once or twice a month at the School of Medicine. For a complete schedule, and for more information, please contact Robin Morello at 702-671-5150.

James Lau, M.D. is an assistant professor and chief of the bariatric surgery division at the University of Nevada School of Medicine Department of Surgery. Dr. Lau is board certified in general surgery and completed fellowship training in bariatric and minimally invasive surgery at Stanford University. He specializes in weight loss surgery.

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Dr. Kami Larsen answers the question: “In general do young children need a multivitamin supplement?”

This really depends on the age of the child and on their dietary habits. For infants of breast feeding mothers, it is extremely important to start a multivitamin with vitamin D at two months of age. This is particularly important if the baby is exclusively breast fed as breast milk is lacking in vitamin D and a deficiency of this can lead to vitamin D deficiency rickets. For formula fed infants, this risk is much lower and those children do not typically need a supplement at as early an age.

For older toddlers and children, a vitamin supplement is helpful if they don’t have a well-balanced diet. Most toddlers tend to have limited exposure to dark green vegetables and meat, so for these kids a supplement is helpful.

The last factor to consider is whether or not kids are getting any fluoride in their diet. The tap water in southern Nevada has fluoride in it, but for those families who choose to use bottled water, either purchasing water that has already been fluorinated or using a vitamin supplement with fluoride is a good idea.

It is always important to remember, however, that vitamins are medication, and they should only be given under a parent’s supervision. With the recent introduction of popular gummy candy-like vitamins, the risk of intoxication from vitamin A and others has risen. Make sure they are stored in a locked cabinet, out of the reach of younger children.

Kami Larsen, M.D. is a pediatrician at University Health System in Las Vegas, Nevada. Dr. Larsen is assistant professor of pediatrics at the University of Nevada School of Medicine and medical director of Kids Healthcare Clinic.

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