Surgical Weight Loss

Our surgical program is unique to our community and our multidisciplinary team of professionals includes physicians, nurses, dietitians, exercise physiologists and mental health professionals. There are members of our team that have gone through this process themselves and understand what a lifestyle change this really is. Each member of our bariatric surgery team is dedicated to helping you improve the way you live.  Research has proven that surgical weight loss can help reduce many risk factors such as diabetes, hypertension and sleep apnea.

We are with you every step of the way and offer support to ensure that you have a solid foundation following your surgery to live a healthy and full life.

Can I use over-the-counter vitamins after bariatric surgery?

After bariatric surgery, your body is especially vulnerable to vitamin deficiencies because surgery either:

• Reduces your body’s ability to absorb vitamins (malabsorptive procedures)
• Doesn’t allow your body to hold as much food from which to draw vitamins (restrictive procedures)

Smart shopping applies to bariatric vitamins just as it does with other buying decisions in your life. Rather than choosing a general supplement, we recommend taking vitamins that have been specifically formulated for bariatric surgery patients.

What happens if you don’t take your bariatric vitamins as prescribed?

Not routinely having your blood tested or ignoring your doctor’s supplementation guidelines can lead to significant problems up to and including death.

• Calcium deficiency – leads to osteoporosis
• Iron deficiency – can cause anemia (when your body does not have enough red blood cells to carry oxygen throughout the body), increased feelings of fatigue and hair loss
• Folate (folic acid) deficiency – can also lead to anemia
• Protein deficiency – protein is one of the most important components of your body as it makes up most of your major organs. Not getting enough can lead to a myriad of problems, including muscle deterioration, organ failure, gallstones and even death
• Thiamin (Vitamin B1) deficiency – affects the heart, digestive system and nervous system. If not caught and treated quickly, learning and memory could be permanently affected. Ultimately, coma and death could be the result
• Vitamin A deficiency – can lead to night blindness and increases the risk of disease and death from severe infections. During pregnancy after weight loss surgery, it increases the risk of night blindness and child mortality
• Vitamin B12 deficiency – can cause fatigue and tingling in the hands and can eventually lead to anemia and neurological disorders
• Vitamin D deficiency – can lead to liver and kidney disorders and bone softening diseases
• Vitamin E deficiency – causes neurological problems, and anemia and can cause wounds to heal more slowly
• Vitamin K deficiency – increases the risk of osteoporosis and heart disease and can cause you to bruise more easily
• Zinc deficiency – will give you brittle nails and can lead to hair loss

The only way to catch some of the above deficiencies is through regular blood tests. Symptoms that start to show are often confused with other bariatric surgery side effects, and even a physical exam from your doctor may not be enough for a diagnosis. In short, take bariatric vitamins very seriously.

Which is the better surgery for long-term weight loss?

All procedures can provide long-term success with weight loss. However, based on an individual’s underlying health status, it may be determined that one procedure is recommended over the others. This discussion occurs with Dr. Sebastien or Dr. Nelson. In all cases, the real key to lasting success is the effort you put into it. Bariatric surgery is a TOOL to success, it is not a cure.

What is Dumping Syndrome and is it serious?

Dumping Syndrome can happen following gastric bypass surgery and is when food gets “dumped” directly from your stomach pouch into your small intestines without being digested. The symptoms range from mild to severe. It is not a pleasant experience, but it is not life-threatening. It is triggered by foods that are high in concentrated sugars, dairy and/or high-fat foods. Common symptoms include sweating, nausea, dizziness, tiredness, cramps and diarrhea. These symptoms typically last about 30-90 minutes, depending on what and how much the person has eaten. The symptoms can mimic the flu. You can control this by making changes in what and how you eat. By controlling dumping syndrome, you will also be avoiding the foods that also cause weight gain.

Will the stomach pouch stretch so that the lost weight is gained?

As the new pouch/stomach heals, it will be able to hold more food but will not stretch significantly. It is more important to concern yourself with stretching the stomach by persistently overeating, grazing all day or by not chewing food well enough. This does not occur easily but occurs only by persistently overeating over a long period of time.

How long will it take me to recover from surgery?

Most people go back to desk-type jobs about a week after surgery. It generally takes about six weeks before the fatigue of surgery improves. It is important to move, eat and drink properly from the very beginning so you can maintain your energy until the six-week mark arrives. You are not allowed to return to the gym or to lift anything more than 10 pounds for one month following surgery.

What kind of nutrition program will I have after surgery?

We offer a comprehensive nutrition education program for all patients prior to surgery that provides instruction on what foods to eat as well as guidance in re-learning eating behaviors. After surgery, you will meet with the Registered Dietician each time you come in to see the surgeon. This will help to fine-tune those areas you may be having challenges with.

Do I need to follow up after having surgery?

After surgery, it is important to keep up with your follow-up visits. You will meet with the surgeon during your one-month; the six-month and one-year follow-up, then annually thereafter, FOR LIFE.

Additionally, you will meet with the nurse practitioner at your one-month, three-month, six-month, nine-month, one-year and 18-month visits, then annually FOR LIFE, at which time your labs will be reviewed and medication adjustments will be done. The labs will show areas of health improvements as well as areas of deficiencies that will need to be corrected.

My family thinks I am not eating enough, are they right?

Family members may voice concern about the small amounts of food and fewer calories that patients eat after bariatric surgery. The dietary program you will follow along with vitamin and mineral supplements is designed to meet your body’s nutritional needs. Protein is the most essential food you will need to eat after surgery.

Can I smoke after surgery?

Absolutely not! Smoking stimulates gastric secretions that can irritate the lining of the stomach. This irritation can cause chronic gastritis and ulcers in the stomach and small intestine. It can also lead to dangerous strictures of the stomach. The same applies to secondhand smoke.

I have heard that some people experience hair thinning or hair loss after gastric bypass surgery. Will this happen to me?

Any major surgery along with rapid weight loss produces stress on the body. Mild hair loss is often a reaction to this stress and usually occurs three to four months after surgery. However, the undereating of protein can also result in significant hair loss. Some individuals opt to take biotin to help with the growth of stronger hair, but the supplement does not prevent hair loss. Hair loss is temporary, it will grow back.

Why is exercise so important for me after surgery?

It’s important for everyone to exercise to the level of their ability. Even chair exercises count! Exercise maximizes weight loss and protects your muscles from breakdown. If you do not exercise properly, you may have significant muscle wasting and weakness. You will meet with an exercise physiologist that will help design an exercise program that is appropriate to you and your ability. Here are some reasons why physical activity is important to you:

• Exercise increases your metabolic rate, which can help you lose weight fasters
• Exercise is fat burning
• Exercise helps to alleviate constipation
• Exercise improves your mood and feeling of well-being
• Exercise causes a person to feel less hungry

Do I have to track or log everything I eat and drink?

To meet nutritional goals and promote weight loss, patients need to use a food tracker app or log, to monitor all intakes of food and beverages. This is a key component to success with weight loss surgery. This applies to both the weight loss phase and maintenance phase.

How do I know if I am eligible for weight loss surgery?

Rather than using weight, we use body mass index (BMI) as a criteria for surgery — excess fat in relation to height. Individuals are candidates for surgery if:

• Your BMI is greater than 40 or between 35 and 40 with major obesity-related medical problems, such as diabetes, high blood pressure and sleep apnea.

Do you have financing available?

Yes, Bariatrics at Halifax Health works exclusively with Prosper Healthcare Lending® for all your financing needs. You can apply before ever coming to an information session by visiting Prosper Healthcare Lending®.

From the time I start, how long will it take to get to surgery?

It depends upon your insurance requirements. Most insurance providers have a specific nutritional requirement you must complete prior to surgery. We will verify that requirement for you and design a plan with you. Most patients are in surgery as soon as they complete their requirements.

Will my insurance cover weight loss surgery?

Each insurance policy is different. As a courtesy, our insurance coordinator will verify your policy coverage and what requirements are needed to submit for final authorization.

Monthly Bariatric Support Group

Bariatric surgery is a tool to help you improve your overall health and to maintain this new lifestyle requires continuous support. We know first-hand that some of the hardest times come after you have surgery, and we have created a support group that meets monthly to help you during this journey. This group is geared towards bariatric surgery patients that are getting ready for surgery and that are up to one year out from surgery.

Daytona Beach | First Tuesday at 6:00 pm
Halifax Health
France Tower – Meeting Room G
303 N. Clyde Morris Blvd.
Daytona Beach, FL
Phone: 386.238.3205
Email: tsalyerds@fhcp.com

Beyond Bariatrics Support Group

Sometimes, the hardest part of the journey isn’t the decision to start, but years down the road when we take the wrong path and old habits derail us or we even regain weight. We’re afraid or ashamed to stop and ask for directions to get back on the right path. This is the moment when we need support the most. Beyond Bariatrics was created for those that are at least one year or more post weight loss surgery.  This is when the path becomes bumpy and it’s tempting to stop. Wherever YOU are in this journey, come join us.

Daytona Beach | Fourth Tuesday at 6:00 pm
Halifax Health France Tower – Meeting Room E-F
303 N. Clyde Morris Blvd. Daytona Beach, FL
Phone: 386.238.3205
Email: tsalyerds@fhcp.com

Several factors determine if you are a candidate for bariatric surgery or non-surgical weight loss guidance. During your first consultation, they will discuss options that are appropriate for you.

The surgical weight loss solutions are:

Combined Restrictive and Malabsorptive Procedure

In recent years, a better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum to bring it up and construct a connection with the newly formed stomach pouch. The other end is connected to the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

Advantages

• Rapid initial weight loss
• Resolution of co-morbidities (obesity-related health issues)
• Decreased hunger
• Laparoscopic approach
• Longer experience in the USA

Disadvantages

• Stomach cutting, stapling and intestinal re-routing required
• Portion of the digestive tract is bypassed, resulting in lifetime nutritional monitoring
• Non-adjustable

“Dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much refined sugar or foods that are high in fat are consumed.  The results can be extremely unpleasant and can include heart palpitations, nausea, weakness, sweating and fatigue.

Alternative to a Roux-en-Y Gastric Bypass

The Vertical Sleeve Gastrectomy is a laparoscopic procedure that generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically. About 85 percent or more of the stomach is removed. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from two to four ounces. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the function of the stomach while drastically reducing the volume. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potential long-term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions.

The Vertical Gastrectomy is a reasonable alternative to a Roux-en-Y Gastric Bypass for a number of reasons:

• Because there is no intestinal bypass, the risk of malabsorptive complications such as vitamin deficiency and protein deficiency is minimal
• The pylorus is preserved so dumping syndrome does not occur or is minimal
• There is no intestinal obstruction since there is no intestinal bypass
• It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur
• The limited two-year and six-year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data (see Lee, Jossart, Cirangle Surgical Endoscopy 2007)

You and your surgeon will determine the right procedure to fit your needs.

Vertical Sleeve Gastrectomy Advantages

• Reduces stomach capacity but tends to allow the stomach to function normally so most food items can be consumed, in small amounts
• Eliminates the portion of the stomach that produces the hormones that stimulate hunger (Ghrelin)
• Dumping Syndrome is avoided or minimized because the pylorus is preserved
• Minimizes the chance of an ulcer occurring
• By avoiding the intestinal bypass, almost eliminates the chance of intestinal obstruction (blockage), marginal ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.
• Very effective as a first-stage procedure for high BMI patients (BMI > 55)
• Appealing option for people who are concerned about the complications of intestinal bypass procedures or who have existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures
• Appealing option for people who are concerned about the foreign body aspect of Banding procedures

 Vertical Sleeve Gastrectomy Disadvantages

• Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass
• Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Remember, two stages may ultimately be safer and more effective than one operation for high BMI patients. Be sure to discuss your options with your surgeon
• Soft calories such as ice cream, milkshakes, etc. can be absorbed and may slow weight loss
• This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur
• Because the stomach is removed, it is not reversible. However, if maximum weight loss is not achieved it can be converted to a Gastric Bypass

Bariatrics at Halifax Health has the top-rated bariatric surgeons in Volusia county. The program at East Coast Bariatrics is unlike any other in our area as our focus is to provide support for you before, during and after bariatric surgery. We are one of the only programs in Volusia county to offer four surgical weight loss procedures that are all noninvasive.

The Duodenal Switch is a procedure where part of the stomach is removed and re-routed to the digestive tract. For this procedure, almost 70% of the stomach is removed, as well as the duodenum.  A long portion of your small intestine is rerouted into two pathways.  The shorter pathway takes food from the stomach to a common channel. The longer pathway carries bile from the liver to the common channel.  The objective is to reduce the amount of time the body has to capture calories and to selectively limit the absorption of fat.  The result is that your body will only be able to absorb around 20% of the fat you would normally intake. As with all surgeries, there is a chance for complications, however, the risk is very low and can be detected and treated with routine post-operative care.

The majority of obesity related health issues and co-morbidities can be greatly reduced, if not eliminated.

• Sleep Apnea up to 99% improved or resolved
• Hypertension up to 95% improved
• Diabetes up to 95% improved or resolved
• Arthritis up to 85% improved
• Hyperlipidemia up to 95% improved
• Gastroesophageal Reflux up to 99% resolved
• Asthma improved
• Depression improved, medications will be stopped or adjusted

With You Every Step of the Way

The Bariatrics team at Halifax Health are more than experts on bariatric procedures, they will help you create a solid foundation for your new lifestyle. They will give you the tools and resources you need to be successful after surgery and provide support when you need it most. Our team is more like family, and most of our team members have experienced bariatric surgery themselves and can tell you firsthand the struggles they faced and overcame. This is a journey that continues far beyond the day of your procedure, and our team is here to ensure you have long-term success.

Jason J. Arellano, MD, FACS, FASMBS

Dr. Arellano is a minimally invasive and bariatric surgeon at UF Health Surgical Specialists and Halifax Health | UF Health Medical Center of Deltona.

He obtained his medical degree from SUNY Downstate Medical Center in Brooklyn, NY. He later completed his surgery residency at Nassau University Medical Center in East Meadow, NY and a minimally invasive and bariatric surgery fellowship at Albany Medical Center, also in NY.

Since then, he has served as a surgeon at hospitals throughout Long Island, NY performing minimally invasive, bariatric and robotic surgery. Dr. Arellano joined UF Health Surgical Specialists at Halifax Health | Medical Center of Deltona in February 2020 with the aspiration to provide specialized surgical care to all patients in Volusia County.

Dr. Arellano has received several awards and academic achievements, including the Service Excellence Award, Resident Teacher of the Year, and first place in the Brooklyn/Long Island Chapter of the American College of Surgeons’ poster presentation. His current research studies include robotic sleeve gastrectomy using 60 mm automatic tissue compression stapler technology.

Joel L. Sebastien, MD, FACS

The director of Bariatric Surgery at East Coast Bariatrics, Dr. Sebastien is fellowship-trained and specializes in the surgical treatment of obesity. He received his medical degree from the State University of New York at Buffalo, School of Medicine and completed his advanced training internship and residency at Westchester Medical Center in Valhalla, New York.

As the Director of Bariatric Surgery, Dr. Sebastien is committed to providing a multidisciplinary program that achieves great long-term outcomes for his bariatric surgical patients.

Lars Nelson, MD

Dr. Nelson is a board-certified General Surgeon who is also fellowship-trained in bariatric surgery. After graduating Cum Laude from the University of Florida with a B.S. in Chemical Engineering, Nelson attended medical school at St. George’s University School of Medicine where he graduated with honors. He completed his residency and fellowship at Orlando Health where he focused on Bariatric and Minimally Invasive Surgery.

In addition to his extensive research and presentations on surgical weight loss, he is also a member of the American Society of Metabolic and Bariatric Surgery and the Society of American Gastroenterology and Endoscopic Surgeons. Dr. Nelson is passionate about helping his patients achieve a healthier lifestyle that results in long-term success.

Free Information Session

Do not let another summer pass you by! Take the first step towards a healthier lifestyle and call 386.481.6724 to RSVP for our Free Information Session, or complete the form below. The Free Information Session is led by one of our bariatric surgeons and experts from the bariatric surgery program. They will review the types of bariatric surgery, the benefits, what to expect pre-op and post-op and the options for financing.

This is your opportunity to ask any questions you have about bariatric surgery. Get ready to join the more than 2,000 others who have taken this same step. You are not alone, and we are all ready to walk along this journey with you.

RSVP For A FREE Info Session Closest To You!

Taking the Next Step to Transform Your Lifestyle

The first step in any process begins with a choice, a decision to either look back or to continue moving forward. We are honored to be by your side as you take this step toward your new lifestyle. Bariatrics at Halifax Health is a unique program for Bariatric Surgery. The tools we have to help you through this journey are unlike any other in our area.

From the moment you decide to attend an information session through the years that follow your surgery, we are an extension of your family. This is more than just losing the weight once and for all, this is about taking back your life and walking alongside thousands of others that have experienced the same successes and trials that you will overcome.

Why Bariatrics at Halifax Health?

Bariatrics at Halifax Health has supported over 2,000 people just like you who were all in search of something that would truly work. You see, you are not alone. When you join with Bariatrics at Halifax Health, you are not only joining a bariatric surgery program, you are joining a family. This means that we are there for you the minute you pick up the phone to years after your surgery. For most, the weight loss journey is a roller coaster of ups and downs, from losing weight to only gaining it back plus some. We understand your frustration, and we are here to educate, encourage and rejoice with you in this new journey to a healthier lifestyle. Being a part of our program means you have access to the following experts in surgical weight loss:

• Bariatric Surgeons
• Nurse Practitioner
• Bariatric Social Worker
• Registered Dietitian
• Exercise Physiologist
• Program Coordinator
• Clinical Coordinator
• Insurance Specialist