Our Affiliate System

We are building one organization with affiliates in two regions. Our parent company, now known as Prisma Health, supports both affiliates with overall direction and leadership as we continue to align. We will soon share one brand across the entire organization to better reflect this. The rebranded Palmetto Health-USC Medical Group will continue to operate as a joint venture between the Midlands affiliate and the USC School of Medicine.

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We are becoming Prisma Health in early 2019

FAQs

When considering any medical option, proper education will only aid you in making the correct decision. We have provided several “Frequently Asked Questions” below. We also offer a free surgical information seminar every other week in our office. If you would more information, please contact us.

Why is Obesity becoming such a big problem?

Obesity rates have been rising steadily in the U.S. for decades. In the last ten years, there has been a rapid increase in obesity among both adults and children? even very young children.

There are many risk factors for obesity including heredity, sedentary lifestyle, lack of regular exercise, and an abundance of inexpensive, high-calorie, low-quality food. Making poor food choices leads to a cycle that’s difficult to break. Most “quick and easy” foods are loaded with carbohydrates and fats and relatively little protein. This imbalance leads to hormonal dysregulation of blood surgar and satiety mechanisms? In english, that means that the low-quality foods don’t satisfy your body’s needs for nutrients, and so your body sends the message to “eat some more” in an attempt to get the nutrients it needs. And so you feel hungry and munch some more. As you can see, this cycle coupled with no exercise is a recipe for obesity.

It can be difficult or impossible to break this cycle. Carbohydrate addiction holds a powerful grip on people. Once someone has become obese, it becomes more difficult to exercise? and so they don’t. Because of their larger body size, they require more calories and they eat more. Once someone has become severely obese with arthritis, sleep apnea, diabetes, etc, it is statistically nearly impossible for that person to successfully lose significant weight by any other means than bariatric surgery. While this may be a sad commentary on our society, it is nonetheless a situation that millions of Americans deal with every day.

Gastric bypass surgery forces you to eat the properamounts of the properfoods, at properintervals, at the properspeed. The operation also breaks the hormonal dysregulation that leads to hunger. The cycle is broken? and the results are not only amazing? they are life-saving.


What is Body Mass Index (BMI)?

Body mass index (BMI) is a way of measuring obesity that as relative to your height. 200 pounds is not as obese for a 6 foot 4 inch male that a 5 foot 2 inch female. Its not a perfect measurement, but it is the standard that is used for determining who will qualify for bariatric surgery.

To be a candidate for surgery, you must have a BMI of 35 or higher. If your BMI is 40 or higher, you may qualify for surgery, even if you don’t have medical problems as a result of obesity yet.

To figure out your BMI, you can click on the link below. If you are 5 foot 9 inches, put “5” in the “height in feet” box and “9” in the “height in inches” box.


Why is obesity the second leading cause of preventable death?

Only cigarette smoking kills more people than obesity? and that will probably change in 2005. Obesity is classified as a disease? and for good reason. Obesity leads to dozensof serious, life-threatening medical conditions and contributed to the death of over 400,000 Americans last year. Below is a short list of associated medical problems?

· High blood pressure

· Diabetes (obesity is the number one cause of diabetes!)

· High cholesterol and blood lipids

· Coronary artery disease (heart attack)

· Cardiomyopathy

· Pulmonary hypertension

· Asthma

· Hypoventilation syndromes

· Obstructive sleep apnea

· Gallstones

· Fatty liver

· Non-alcoholic steatohepatitis (NASH)

· Gastroesophageal reflux disease (GERD)

· Arthritis

· Low back pain

· Infertility

· Irregular menstrual cycles/bleeding

· Obstetric complications

· Deep venous thrombosis (DVT? blood clots)

· Pulmonary embolism

· Depression

· Immobility

· Breast cancer

· Colon cancer

· Esophageal cancer

· Endometrial cancer

· Prostate cancer

· Venous stasis disease & varicose veins

· Intertrigo (severe skin infection)

· Accidents (yes, we said “accidents.” Severely obese people are more likely to have severe accidents AND more likely to die as a result)

There are more? but you get the idea. There has never been a disease studied that didn’t have a worse prognosis in severely obese people. Complication rates after routine surgeries such as gallbladder surgery or hysterectomy are higher in obese people, too.


What medical problems are associated with obesity?

Obesity leads to dozensof serious, life-threatening medical conditions. Below is a short list?

· High blood pressure

· Diabetes (obesity is the number one cause of diabetes!)

· High cholesterol and blood lipids

· Coronary artery disease (heart attack)

· Cardiomyopathy

· Pulmonary hypertension

· Asthma

· Hypoventilation syndromes

· Obstructive sleep apnea

· Gallstones

· Fatty liver

· Non-alcoholic steatohepatitis (NASH)

· Gastroesophageal reflux disease (GERD)

· Arthritis

· Low back pain

· Infertility

· Irregular menstrual cycles/bleeding

· Obstetric complications

· Deep venous thrombosis (DVT? blood clots)

· Pulmonary embolism

· Depression

· Immobility

· Breast cancer

· Colon cancer

· Esophageal cancer

· Endometrial cancer

· Prostate cancer

· Venous stasis disease & varicose veins

· Intertrigo (severe skin infection)

· Accidents (yes, we said “accidents.” Severely obese people are more likely to have severe accidents AND more likely to die as a result)

There are more? but you get the idea. There has never been a disease studied that didn’t have a worse prognosis in severely obese people. Complication rates after routine surgeries such as gallbladder surgery or hysterectomy are higher in obese people, too.


Why don’t diets, exercise and medications work?

Proper diet and exercise does work, especially when started at a young age and continued faithfully throughout your life. Unfortunately, for people who are already struggling with obesity, the cards are stacked against them. Its not a fair fight. An obese person’s body forcefully fights against attempts at weight loss. Also, an obese person’s ability to exercise? really exercise…is limited by their obesity. As a result, people become discouraged because of the difficulty and slow results and rebound to their old habits and pack on the pounds? and then some.

Despite the billions of dollars spent on diets and exercise equipment every year in the U.S., the country is getting fatter? at an alarming rate. There is no magic diet that will work for everybody. Nearly all fad “diets” end the same way? you gain the weight back AND usually more. This leads to feeling of depression, hopelessness, and failure. People feel as if they have no will power and turn to their old friend for comfort? food. There is hope! What we have learned about diets has helped our understanding of bariatric surgery and how it works. One thing is clear: to have successful, long-term weight loss you must eat a proper diet low in processed carbohydrates (sugars and flour) and saturated fats, and with the proper amount of protein. Gastric bypass is the best tool ever invented to help people eat the proper amounts of the proper foods, at the proper intervals, and at the proper speed for optimal nutrition.

With regard to medications? There is no medication on the market or in clinical trials that has EVER proven to be a safe, effective, long-term solution. Perhaps someday there will be. Most medications on the market for obesity fall into one of two categories: stimulants and those that inhibit absorption of fats. Stimulants such as phenteramine can suppress appetite? for a while, but usually the effect goes away and there can be unacceptable risks and side-effects. Some stimulants such as caffeine actually increase appetite in most people. Drugs that inhibit absorption of fats are newer. So far, the results have been dismal, but there may be a role in the future for them as an adjuct to bariatric surgery.


Why is surgery the only long-term solution for most people?

Of all the diets, medicines, and treatments ever devised for obesity, only Roux-en-y gastric bypass has been shown in scientific clinical trials to produce safe, effective, and long-term results? both with respect to weight loss and reduction of medical co-morbidities.

Gastric bypass has been shown to produce results lasting 20+ years and greatly reduces the rate of death in those who had it compared to those who did not. In one recently published study, the overall death rate in obese individuals who had gastric bypass surgery was 90% less than similar individuals who did not after five years. (Ann Surg. 2004 Sep;240(3):416-23)

The initial results with the Lap Band are promising, but since it has not been around as long, we really don’t know the long-term results.

What is a Roux-en-Y Gastric Bypass?

This operation converts the stomach into a very small pouch that holds less than one ounce of food and rearranges the intestinal tract to cause malabsorption of fats. This limits the amount of food that can be eaten (leaving the patient feeling full and satisfied on very little food) and further acts to reduce the absorbed calories.

(click here to see a diagram of a gastric bypass)

The Roux-en-Y gastric bypass has been around for over 30 years and has stood the test of time. There are published studies demonstrating the safety and efficacy of this operation after 20 years of follow-up. It is, by far, the most common bariatric operation performed in the U.S. and is endorsed by the American College of Surgeons (ACS), American Society for Bariatric Surgery (ASBS), Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the National Institutes of Health (NIH), and many others. There are over 100,000 Roux-en-Y gastric bypasses performed annually in the U.S. and it is becoming one of the most common elective operations.

The Roux-en-y gastric bypass has become so common because it works. Greater than 90% of patients maintain significant, long-term weight loss with minor or no complications. Study after study has shown this operation to reduce or eliminate co-morbid medical problems and significantly reduce an obese person’s chance of death.In one recently published study, the overall death rate in obese individuals who had gastric bypass surgery was 90% less than similar individuals who did not after five years. (Ann Surg. 2004 Sep;240(3):416-23)


How does a Roux-en-Y Gastric Bypass work? 

A gastric bypass is a powerful tool to help you lose weight and become healthy. It works 3 ways. First, it reduces the amount of food you can eat significantly at one time (usually no more than 4-5 oz). Second, it diverts or “bypasses” the food past the stomach and first section of intestine resulting in delayed digestion of the food. Then, the bile and pancreatic juices are added (this the Roux-en-Y part) to allow for digestion and absorption of nutrients. Third, the operation will produce “dumping syndrome” if unhealthy foods are eaten. Dumping Syndrome is a very unpleasant feeling which may result in abdominal pain, cramps, nausea, vomiting, or diarrhea. Needless to say, patients steer clear of these unhealthy foods.

The result is that patients are forced to eat properamounts of properfoods, at properintervals, and at the properspeed. When this is combined with exercise, psychological support, and nutritional support, the results can be amazing. It is not unusual for severely obese patients to lose 150-200 pounds or more in the first year.


How much weight do you lose after gastric bypass?

Most patients lose between 80 and 90% of their excess body weight in 12-18 months. If you only have a hundred pounds to lose, then about 80-90 pounds. If you are 300 pounds overweight (as many of our patients are), you could lose over 250 pounds! Some patients lose 100% of their excess body weight, but very rarely more than that. Its unusual for people to lose “too much” weight. Alternatively, some people don’t follow the rules of the program, don’t exercise, don’t take supplements, or don’t come to support group. As you might expect, their results are not as good.

If you follow our program as we have it laid out, there is no reason you can’t lose all your excess weight and keep it off. There are no guarantees, however. You get as much out of this program as you put in.


Will my weight-related medical problems go away after gastric bypass? 

Short answer: yes

Longer answer: The majority of patients who have gastric bypass have many of the medical problems associated with morbid obesity. They are usually on many medications for high blood pressure, diabetes, etc. Most patients come off of the majority of their medications within a year. Many people come off of all their medicines. However, some problems, such as high blood pressure, have other contributing factors other than obesity (yes, there are skinny people with high blood pressure and high cholesterol). Some people cannot completely come of their medications for this reason, but they are nearly always on less medication.

For example, 90% of non-insulin diabetics are cured by this operation. About two-thirds of insulin-dependent diabetics are cured? but all are improved. Sleep apnea is essentially cured by this operation as well. Everything on the list of associated medical problems is either eliminated or significantly improved after gastric bypass. That’s why we do it! Remember: the whole point of this surgery is to make you healthy.. not just to make you skinny!


What if i don’t have any medical problems yet?

If you have a BMI greater that 35, you will. It is extremely uncommon for severely obese people not to have medical problems associated with their obesity. Sometimes, people don’t even know they have these problems. For example, one common medical problem of obesity is non-alcoholic steatohepatitis (NASH), which is a severe and dangerous liver condition. Unfortunately, it doesn’t have any symptoms until the damage is done. Many go for years without even knowing that their liver is being destroyed by fatty infiltration. Many people with NASH go on to need liver transplants. The ONLY effective treatment for NASH is carbohydrate restriction and significant, SUSTAINED weight loss? like you get with a gastric bypass.

Perhaps the best thing about a gastric bypass is its ability to prevent these medical problems in obese young people. That’s why if your BMI is 40 or greater, you medically qualify for the surgery, even if you don’t have any medical problems yet.

Will I feel hungry after surgery?

Short answer: no

Longer answer: Most patients never feel hunger as you know it now. In fact, many patients forget to eat and have to use a timer to remind them its time to eat. It is extremely rare for someone to feel “hungry all the time” after gastric bypass surgery. “Hunger” is a complicated feeling and is more than just your stomach asking for food. There are complex neurological, hormonal, and psychological factors that contribute to someone feeling “hungry.” The gastric bypass operation itself down-regulates the neurological and hormonal portions substantially. There has been a hormone recently discovered called grehlin. This hormone is a powerful stimulant of hunger and is produced by the stomach. In obese patients that are stuck in “the cycle” of carbohydrate addiction and high-fat diets, this hormone level is very high. Thus, they feel hungry all the time? eat more? get more obese. After gastric bypass surgery, grehlin levels fall very low and people simply lose the drive to eat beyond what is needed to sustain their bodies. Also, because the stomach pouch is only about the size of an egg, people feel “full” and “satisfied” after a small amount of food. A small percentage of people feel a true psychological drive to over-eat. This is part of the reason that we require a comprehensive psychological screening prior to surgery. We try to identify those patients ahead of time and address the issues they over-eat BEFORE surgery, so their chances of success aren’t doomed AFTER surgery.Do some people lose too much weight after surgery?


Do some people lose to much weight after surgery?

It is very rare that someone unintentionally loses more than 100% of their excess body weight. Most patients lose and maintain between 80 and 90% excess body weight. Some highly motivated patients do better than this and shoot for 100% excess body weight loss.

What if I don’t have any medical problems yet?

If you have a BMI greater that 35, you will. It is extremely uncommon for severely obese people not to have medical problems associated with their obesity. Sometimes, people don’t even know they have these problems. For example, one common medical problem of obesity is non-alcoholic steatohepatitis (NASH), which is a severe and dangerous liver condition. Unfortunately, it doesn’t have any symptoms until the damage is done. Many go for years without even knowing that their liver is being destroyed by fatty infiltration. Many people with NASH go on to need liver transplants. The ONLY effective treatment for NASH is carbohydrate restriction and significant, SUSTAINED weight loss? like you get with a gastric bypass. Perhaps the best thing about a gastric bypass is its ability to prevent these medical problems in obese young people. That’s why if your BMI is 40 or greater, you medically qualify for the surgery, even if you don’t have any medical problems yet.


Am I a surgery candidate?  

To qualify for surgery, you need to have a BMI of 35 or higher and at least two obesity-related medical problems . If your BMI is 40 or greater, you may qualify for the surgery even if you don’t have any obesity-related medical problems yet.

Will bariatric surgery resolve my co-morbid conditions? 

Bariatric surgery delivers significant co-morbid resolution and quality of life benefits.

Bariatric surgery patients have significantly reduced rates of developing endocrinologial disorders, cancer, cardiovascular disease, infectious diseases, musculoskeletal disorders, psychiatric and pulmonary disorders. 3

Bariatric surgery patients benefit from improved social and employment opportunities, perception of well-being, social function, self-image, self-confidence, ability to interact with others and the enhanced capability of participating in recreational and physical activities which lead to a higher quality of life. 1

CO-MORBIDITY

RESOLUTION

IMPROVEMENT RATE

Type 2 Diabetes

83% to 98% 4,5

—–

Hypertension

69% 4

—–

Dyslipidemia/Hypercholesterolemia

64% 6

33% 6

Obstructive Sleep Apnea

74% to 98% 2,5,6

—–

Osteoarthritis/Dengenerative Joint Disease

41% 6

47% 6

GERD

98% 5

—–

Asthma

13% 6

69% 6

Urinary Stress Incontinence

44% 6

39% 6

Depression

8% 6

47% 6

Migraine

57% 6

29% 6

References:

  1. Buchwald H, Avidor Y, Braunwald E., et al. Bariatric Surgery: A Systematic Review and Meta-analysis. JAMA 2004 Oct;292(14):1724-1737.
  2. Long SD, O’Brien K, MacDonald KG, et al. Weight Loss in Severely Obese Subjects Prevents the Progression of Impaired Glucose Tolerance to Type 2 Diabetes: A longitudinal interventional study. Diabetes Care 1994;17(5):375-5.
  3. ChristouNV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Ann Surg 2004;240(3):416-24.
  4. Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and Hypertension in Severe Obesity and Effects of Gastric Bypass-Induced Weight Loss. Ann Surg 2003;237(6):751-8.
  5. Wittgrove AC, Clark CW, Laparoscopic Gastric Bypass, Rou-en-Y—–500 Patients: Technique and results, with 3-60 month follow up, Obes Surg 2000;10:233-9.
  6. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes After Laparscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Ann Surg 2000;232(4):515-29.