And the days just go on forever...

I am not a very patient person. Ask anyone who knows me. Actually, the only place I have patience is in a restaurant or bar. Why?!? I work in them and have for 20+ years in some form or another. This is the biggest Achilles heal I will have to deal with in the next few decades. There is a veritable buffet available to me and I now have to control my addiction.

I have talked about control before; but, I feel it is almost Zen-like when it comes to how I am approaching this life altering decision. I know I have support.

So, back to patience. I can't wait to have my pre-op with my Doctor. Why can't it be now?!? I have so many questions and want to know everything that is going to happen. I wonder if I can get a DVD of the surgery. Is that gross, is that too much? I'm going to have an ultrasound on my Gall Bladder. Will they take it out? Everyone I've talked to that has had the procedure has said they just remove it. Don't I need it? Doesn't it produce the bile by which I digest? Here is what I found:

The adult human gallbladder stores about 50 millilitres (1.8 imp fl oz; 1.7 US fl oz) of bile, which is released when food containing fat enters the digestive tract, stimulating the secretion of cholecystokinin(CCK). The bile, produced in the liver, emulsifies fats in partly digested food.

After being stored in the gallbladder, the bile becomes more concentrated than when it left the liver, increasing its potency and intensifying its effect on fats.

Bile secretion and gallbladder function

1. Composition and function of bile Bile contains bile salts, phospholipids, cholesterol, and bile pigments(bilirubin).

a) Bile salts: are amphipathic molecules because they have both hydrophilic and hydrophobic portions. In aqueous solution, bile salts orient themselves around droplets of lipid and keep the lipid droplets dispersed (emulsified), aid in the intestinal digestion and absorption of lipids by emulsifying and solubilizing them in micelles.

b) Micelles Above a critical micellar concentration, bile salts form micelles. Bile salts are positioned on the outside of the micelle, with their hydrophilic portions dissolved in the aqueous solution of the intestinal lumen and their hydrophobic portions dissolved in the micelle interior. Free fatty acids and monoglycerides are present in the inside of the micelle, essentially "solubilized" for subsequent absorption.

2. Formation of bile Bile is produced continuously by hepatocytes. Bile drains into the hepatic ducts and is stored in the gallbladder for subsequent release. Choleretic agents increase the formation of bile.

Bile is formed by the following process:

a. Primary bile acids (cholic acid and chenodeoxycholic acid) are synthesized from cholesterol by hepatocytes. In the intestine, bacteria convert a portion of each of the primary bile acids to secondary bile acids (deoxycholic acid and lithocholic acid). Synthesis of new bile acids occurs, as needed, to replace bile acids that are excreted in the feces.

b. The bile acids are conjugated with glycine or taurine to form their respective bile salts, which are named for the parent bile acid (e.g., taurocholic acid is cholic acid conjugated with taurine).

c. Electrolytes and H20 are added to the bile.

d. During the interdigestive period, the gallbladder is relaxed, the sphinc- ter of Oddi is closed, and the gallbladder fills with bile.

e. Bile is concentrated in the gallbladder as a result of isosmotic reab- sorption of solutes and H20.

3. Contraction of the gallbladder

a. CCK: is released in response to small peptides and fatty acids in the duodenum. tells the gallbladder that bile is needed to emulsify and absorb lipids in the duodenum. causes contraction of the gallbladder and relaxation of the sphincter of Oddi.

b. ACh: causes contraction of the gallbladder.

4. Recirculation of bile acids to the liver.

The terminal ileum contains a Na+-bile acid cotransporter, which is a secondary active transporter that recirculates bile acids to the liver. Because bile acids are not recirculated to the liver until they reach the terminal ileum, bile acids are present for maximal absorption of lipids throughout the upper small intestine. After ileal resection, bile acids are not recirculated to the liver, but are excreted in feces. The bile acid pool is thereby depleted and fat absorption is impaired, resulting in steatorrhea.

Neat. I will wait to hear what the Doc has to say. Yet, I can't wait. For those who don't understand what I am having done, here it is:

How is the Roux-en-Y gastric bypass performed?

In Roux-en-Y, the stomach is divided, and a small pouch, which limits calories that can be taken in on a daily basis to less than 1,000, is formed as simultaneously the majority of the stomach is sealed off. A portion of the small intestine is then divided and sewn to the newly created small stomach pouch. This process limits the body’s ability to absorb calories. This procedure can be performed as a standard open surgery, or as a laparoscopic surgery.

How is a laparoscopic procedure performed?

Laparoscopic (minimally invasive) surgery involves several very small incisions rather than open surgery, which uses one large incision. Once the patient, who has been given general anesthesia, is asleep, a harmless gas is introduced into the abdomen to move the organs so that the surgeon can work in increased space and can see more when a tiny camera (a laparoscope) is inserted into one incision through a narrow hollow tube (a trocar).

This technique allows the surgeon to view images of the surgery site on a video screen. Then through other trocars inserted into the remaining small incisions, the surgeons introduce and manipulate long narrow surgical instruments that allow performance of the same procedures that take place in traditional open surgeries.

What are the advantages of the laparoscopic approach?

At the University of Maryland Medical Center, we only use the laparoscopic approach for Roux-en-Y because of the many advantages, including quicker recovery and shorter hospital stays, as well as a significantly reduced risk of wound infection. Patients also report less pain and quicker return to normal activity.

Thanks for reading. More soon.