Sleeve gastrectomy limits food intake by reducing the size of the stomach. A stapling device is used to divide the stomach vertically, leaving behind a thin vertical sleeve of stomach. Hormonal changes result in a decrease in hunger while the sleeve increases the feeling of being full since smaller portions of food can fit in the reduced stomach. The excised portion of the stomach is permanently removed.

Advantages:

• Restricts the amount of food the stomach can hold
• Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of greater than 50 percent for three to five years post surgery, and weight loss comparable to that of the bypass with maintenance of greater than 50 percent
• Requires no foreign objects (gastric banding), and no bypass or re-routing of the food stream (gastric bypass)
• Involves a relatively short hospital stay of approximately one to two days
• Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

Disadvantages/Risks:

• This is a non-reversible procedure
• Has the potential for longterm vitamin deficiencies
• Surgery risks include complications due to stomach stapling including bleeding, infection, blood clots, gastroesophageal reflex and other risks associated with bariatric surgery. Please speak with your surgeon about these and other risks in more detail

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Stapling is used to create a small, upper stomach pouch that restricts the amount of food that can be consumed. A portion of the small bowel is bypassed thus delaying food from mixing with the digestive juices to avoid complete calorie absorption. Weight loss is induced by hormonal changes that decrease hunger and increase the feeling of being full.

Advantages:

• Average 77 percent reduction of excess body weight one year after surgery
• Studies show that after 10 to 14 years, patients have maintained 60 percent reduction of excess body weight
• Studies show that 96 percent of associated health problems studied were improved or resolved, including back pain, sleep apnea, high blood pressure, Type 2 diabetes and depression
• In most cases patients report an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat
• Produces significant long-term weight loss (60 to 80 percent excess weight loss)
• Restricts the amount of food that can be consumed
• May lead to conditions that increase energy expenditure
• Produces favorable changes in gut hormones that reduce appetite and enhance satiety
• Typical maintenance of more than 50 percent excess weight loss

Disadvantages/Risks:

• Poor absorption of iron and calcium
• Chronic anemia due to vitamin B12 deficiency
• Dumping syndrome can occur when too much sugar or large amounts of food are consumed
• Bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray of endoscopy
• Operative risks of bypass include bleeding, infection, blood clots and clots that go to the lung. Please speak with your surgeon to learn more details

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The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.

The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.

The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients). Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.

Advantages

1. Results in greater weight loss than RYGB, LSG, or AGB, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up
2. Allows patients to eventually eat near “normal” meals
3. Reduces the absorption of fat by 70 percent or more
4. Causes favorable changes in gut hormones to reduce appetite and improve satiety
5. Is the most effective against diabetes compared to RYGB, LSG, and AGB

Disadvantages

1. Has higher complication rates and risk for mortality than the AGB, LSG, and RYGB
2. Requires a longer hospital stay than the AGB or LSG
3. Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D
4. Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies

_{Source: asmbs.org}

Medications to treat stroke

The most common form of stroke is called ischemic. During this type of stroke, a blood clot forms in an artery, stopping blood flow to the brain. There are more and more medications available on the market to treat people who need “blood thinners” to prevent future strokes.

Therefore, if you are prone to having blood that is not fluid enough, or you have already suffered a stroke and need to make sure your blood is thin to prevent future strokes, you can count on the stroke specialists at St. Charles to get you the medication you need. Two of these medications are:

• Heparin — a blood thinner that is given through an IV and is most commonly used to treat patients who are already in the hospital. It is often used to treat patients who are at risk for stroke or need a blood thinner to reduce the risk of blood clots in their legs.
• Warfarin — now the most commonly used, prescribed oral blood thinner, warfarin (Coumadin) is proven to reduce the risk of stroke in certain patients. As one example, patients who are being treated for atrial fibrillation (an irregular heartbeat) should be prescribed warfarin. Although the use of warfarin needs to be closely monitored including frequent blood tests, it often gives patients great success in thinning their blood.

Discover how medication can treat strokes at St. Charles

Want to learn more about blood thinners and the treatment of stroke at St. Charles Health System Stroke Center in Central Oregon? Please call us today at 541-706-3736.

The stroke experts at St. Charles Bend are here to help you feel better again. Find them right near your home in Central Oregon.

Using antiplatelet medication in stroke treatment

The most common type of stroke is an ischemic stroke, caused by a blood clot moving to a blood vessel in the brain. To prevent this type of stroke or a transient ischemic attack known as a “mini-stroke” from happening, it’s critical to prevent blood clots from forming in the first place — and that’s why stroke experts at St. Charles Bend may use antiplatelet medications in stroke treatment and prevention.

How antiplatelets work

Platelets are parts of blood cells that help blood to clot and prevent bleeding. When you have a cut or scratch, platelets release thromboxane, a chemical that signals other platelets to come to help. In stroke patients, however, this call for “help” can be life-threatening since it can cause blood clots to form. Antiplatelet agents help stroke patients by inhibiting the production of thromboxane and decreasing the blood’s ability to clot. Antiplatelet medications include:

• Aspirin
• Clopidogrel (Plavix®)
• Dipyridamole (Curantyl®, Persantine® and others)
• Ticlopidine (Ticlid®)

Is antiplatelet medication right for you?

Despite their many benefits, antiplatelet medication is not right for everyone. People with a medical history that includes kidney or liver disease, gastrointestinal disease or peptic ulcers, high blood pressure, bleeding disorders or asthma may not be able to take these medications or may require special doses. These medications also require careful monitoring as they can have side effects that include blood in the urine and the stool and excessive bleeding that must be reported to your doctor immediately.

The best way to know if you’re a candidate for antiplatelet medication is to consult your health care provider. Never start any medication — including aspirin — on your own.

Expert stroke care at St. Charles Bend

A certified stroke treatment center, St. Charles Bend has a specialized stroke care unit. You can rely on our skilled team to diagnose and treat stroke quickly and to provide post-stroke treatments and preventive therapies, including medication.

If you’re concerned about your risk for a stroke or have questions about the medications you are taking, call the stroke team at St. Charles Bend at 541-706-3736. When it comes to treating stroke, every minute matters — and our experts are here to help.

In Central Oregon, St. Charles stroke experts diagnose and treat patients quickly for the best possible outcomes.

Carotid endarterectomy stroke treatment in Central Oregon

The right and left common carotid arteries are the large blood vessels in the neck that supply oxygen-rich blood to the front of the brain. A stroke occurs when a blockage in the artery caused by plaque or a clot causes the blood flow to be cut off. During a stroke, brain cells that have been deprived of blood begin to die, impacting speech, memory, personality and mobility. A stroke is a life-threatening emergency that requires immediate medical care. However, there are many proactive steps you can take to prevent having a stroke. One of them is a surgical procedure called a carotid endarterectomy. 

What is a carotid endarterectomy? 

Also known as carotid artery surgery, this is a procedure where plaque build up is removed from the patient’s neck. It is performed in a hospital, usually under general anesthesia. The surgeon takes out the plaque through a small cut on the neck over the carotid artery. Afterward, the artery and neck incisions will be closed with stitches. Following the surgery, patients may remain in the hospital for a few days while their recovery is monitored. During that time, the neck area may be sore or numb and swallowing could be more difficult than usual. There may be a drain put in the incision area that will be removed after the surgery. 

It’s important to know that the procedure can help lower the risk for strokes, but it is not a permanent fix. After their current blockage is removed, patients will need to make dietary and lifestyle changes and possibly take medications to help keep future blockages from forming.

What causes a blocked artery?

Carotid artery disease, a condition that causes plaque to build up in the arteries, is one of the main causes of blockages. Your risk for carotid artery disease increases as you get older, especially if you have high blood pressure, high cholesterol or diabetes, smoke or are physically inactive.

Unfortunately, carotid artery disease rarely causes symptoms until one of the carotid arteries is almost completely blocked. If you have a family history of the condition or possess other risk factors for stroke, your doctor can test your arteries for potential blockages. If you show signs of reduced blood flow or tests reveal blockages, your doctor may suggest carotid endarterectomy surgery. It could also be recommended for people who have previously had a mild stroke, or transient ischemic attack (TIA), to prevent future occurrences. 

Expert stroke care at St. Charles Bend

St. Charles Bend, a certified stroke treatment center, has a specialized stroke care unit. We offer a wide range of treatment options and provide care specifically tailored to the individual needs of each patient.

If you are interested in learning more about carotid endarterectomies and if you could be a candidate for one, call St. Charles Bend today at 541-706-3736. We can explain more about the benefits and risks of the procedure and how it is performed at our hospital.

St. Charles Bend offers our patients a variety of advanced stroke treatments in Central Oregon.

What is interventional neuroradiology

Interventional neuroradiology is an advanced form of cardiovascular treatment in which surgeons use imaging technology to see into the patient’s body and guide their actions. Using advanced medical imaging (radiology) technology such as digital X-rays, ultrasound, computed tomography (CT) scans and magnetic resonance imaging (MRI), not only can interventional neuroradiology diagnose stroke, but it is also a step forward in stroke treatment. With it, doctors can deliver clot-busting medication directly to the clot location or perform surgery within the brain.

The treatment techniques used are some of the least invasive available, most often inserting instruments into and moving through veins to access the problem areas. These techniques are called endovascular treatments, and are sometimes referred to as “endovascular neurosurgery.”

The inserting sites for interventional neuroradiology treatments are usually a small opening where a tiny tube is introduced into the patient’s body, rather than with a long surgical cut or incision of traditional surgery.

Being least invasive, interventional neuroradiology treatments offer less risk, less pain, less scarring, shorter hospital stays and shorter recovery time than for patients treated with traditional surgical methods.

Interventional neuroradiology can treat many medical conditions that could not be treated effectively just a few years ago. New technology and devices introduced even more recently have allowed interventional neuroradiologists to increase the number of life-threatening cerebrovascular diseases that can be treated effectively.

The most common conditions treated include:

• Stroke
• Brain aneurysms and other abnormal cerebral blood vessels
• Certain causes of seizures
• Cardiovascular disease
• Benign and malignant tumors

For more information, contact us at 541-706-3736 today.

St. Charles Bend has established a reputation in Central Oregon as a trusted center in offering a wide range of services to prevent, diagnose and treat strokes.

What is revascularization?

Recovering from a major stroke can be a difficult, life-changing process. In some extreme cases, it may require surgery. St. Charles  Stroke Center wants you to know we specialize in many types of stroke recovery, including revascularization or “brain bypass.” Especially in instances of an ischemic stroke, where arteries to the brain become blocked, a brain bypass may be the only answer to restoring some or all of your ability to function.

As you can imagine, revascularization is a surgery that is designed to restore blood flow within the brain. During this procedure, a branch of the external carotid artery is connected to a branch of the internal carotid artery in your brain. Think of this procedure as the equivalent of a heart or “coronary” bypass surgery: the blood flow around a blocked or damaged blood vessel is rerouted via a length of healthy vessel to restore normal blood flow. It is a stroke treatment that is very serious, but one in which the expert stroke surgeons at St. Charles Health System are specialists.

St. Charles Stroke Center can help

Want to learn more about the St. Charles Stroke Center in Bend? Please call us today at 541-706-3736.

The stroke experts at St. Charles Health System are here to help you feel better again. Find them right near your home in Central Oregon.

Understanding stroke medications

Stroke medications can be used in two ways: to treat a stroke that is happening right now, or to reduce the risk of one happening in the future. However, there are a number of possible stroke treatments, and medication is not always the right one. It’s important to choose the correct treatment based on the type of stroke.

There are two main categories of strokes: ischemic stroke and hemorrhagic stroke. Ischemic stroke is caused by a blocked artery. Hemorrhagic stroke is due to bleeding in the brain. Stroke treatments involving medication are only suitable for ischemic strokes. This is because stroke medications make the blood flow more freely. In the case of a blocked artery, that’s a good thing. In the case of hemorrhagic bleeding, it would make the condition worse. This is why medication cannot be administered to a patient immediately when a stroke is suspected, but must wait until a diagnosis confirms the cause of the problem.

Preventing stroke with medication

Medications to prevent stroke may include thrombolytics, anticoagulants and antiplatelets. Collectively, these are often called “blood thinners.” Although they work in slightly different ways, they all focus on disrupting the way that blood naturally clots. This helps prevent obstructions in the blood vessels and keeps the blood moving easily. These medications may be used to prevent multiple problems in addition to stroke, including heart attacks and thrombosis. Patients taking these medications may need to make certain lifestyle adjustments to avoid potentially serious side effects, including dietary changes and being more cautious to avoid falls and other injuries that could cause bleeding.

Expert stroke care at St. Charles Bend

St. Charles Bend is a certified stroke treatment center with a specialized stroke care unit. That means not only do we excel at providing the acute care that is so critical during the first hours after stroke symptoms appear, but we also provide post-stroke treatments and preventive therapies, including medication. Our multidisciplinary team works together to find the right treatment for each patient.

If you would like to ask a doctor whether medications to prevent a stroke are right for you, or if you have questions about a medication that you are currently taking, call St. Charles Bend today at 541-706-3736. We’re ready to help.

St. Charles Bend offers our patients a variety of advanced stroke treatments in Central Oregon.

Hemorrhagic stroke surgery capabilities in Central Oregon

Sometimes, the severity and scope of a stroke makes it necessary for physicians to surgically intervene in order to preserve as much brain function as possible. In stroke cases at St. Charles Bend, our doctors will first assess if there are nonsurgical options that can allow them to effectively restore blood supply to the brain or prevent bleeding, or whether a patient would be better served through a surgical procedure.

While most instances of ischemic stroke (blood vessel blockage) are treated with medications or, in select cases, medical procedures such as carotid endarterectomy or carotid artery angioplasty and stenting, surgical treatment of hemorrhagic strokes (bleeding in the brain) centers on controlling bleeding and reducing pressure on the brain. St. Charles Stroke Center doctors may repair these blood vessel abnormalities following a stroke, aneurysm or arteriovenous malformation (AVM) using these procedures:

• Aneurysm clipping: After making an incision in the brain, the surgeon places a tiny clamp at the base of the aneurysm to block it from blood vessels in the brain, prevent blood from flowing to it and keep the aneurysm from leaking blood further.
• Coil embolization: After inserting a catheter into an artery in the groin, the surgeon threads it to the aneurysm site, then pushes a tiny coil through the tube into the aneurysm, which causes a blood clot to form and prevents it from bursting again.
• Surgical arteriovenous malformation (AVM) removal: An AVM is an abnormal connection between blood vessels in the brain that could rupture. If an AVM is causing a stroke, AVM repair or removal may be necessary. Removal depends upon whether the AVM is accessible; large AVMs or those located deeper in the brain may not allow this to be an option.

St. Charles offers Central Oregon certified primary Stroke Center care

No matter the stroke type — ischemic or hemorrhagic — it’s essential that anyone experiencing stroke symptoms seek medical care at a hospital that excels in providing acute care during those critical first hours. St. Charles Bend, a certified Primary Stroke Center, has served Central Oregon for many years by offering treatment options designed to treat and prevent strokes.

In Central Oregon, St. Charles Bend offers surgical stroke excellence that can restore proper blood flow to the brain and lessen the scope of vision, speech and movement problems that can be brought on by a brain attack.

Thrombolytic stroke therapy in Central Oregon

On average, one American dies from stroke every four minutes, and every year more than 800,000 people in the U.S. have a stroke. Fortunately, in Central Oregon, St. Charles Bend is recognized for their expert work in diagnosing and treating stroke patients with medical advances that include thrombolytic therapy, the use ofmedications that quickly dissolve blood clots.

The most common type of stroke is an ischemic stroke that is caused by a blood clot moving to a blood vessel in the brain, blocking blood flow to the area and keeping the brain from getting the oxygen and nutrients it needs to function. By administering thrombolytic medications known as “clot busters,” St. Charles stroke experts restore blood flow to the affected area and save brain tissue, helping to limit their patient’s brain damage and disability.

Using thrombolytics

Ideally, a stroke patient should receive thrombolytic medication within three hours of the first stroke symptoms. The decision to use these drugs in stroke treatment is based on:

• A physical exam that shows a significant stroke
• Medical history
• A brain CT scan to make sure there has not been any bleeding

It’s important to note that thrombolytic medicines are not given to a patient who is having a hemorrhagic stroke created by bleeding in the brain since these drugs can worsen this type of stroke by causing increased bleeding. Generally, thrombolytic medications are also not given if you are pregnant or have conditions that include:

• Uncontrolled, severe high blood pressure
• Bleeding problems, including bleeding ulcers
• Taking blood-thinning medications such as Coumadin
• Recent surgery
• Recent head injury

Recognizing stroke symptoms

If you are a candidate for thrombolytic therapy, the sooner the treatment begins, the better your chances for a good outcome. That’s why it is so important to recognize stroke symptoms so you can get emergency medical care as quickly as possible. Remember, time lost is brain lost, so know the signs of stroke and act FAST:

• Face: Has their face fallen on one side? Can they smile?
• Arms: Can they raise both arms and keep them there?
• Speech: Is their speech slurred? Can they repeat a simple sentence?
• Time: Call 9-1-1 immediately if you see these symptoms

In Central Oregon, St. Charles stroke experts are ready day and night to diagnose and treat stroke patients quickly for the best possible outcomes.