document_title: Bo Brady

question_text: when did bo leave days of our lives

question_tokens: when did bo leave days of our lives

root

text: Bo Brady

text: Storylines[edit]

text: Bo was born on November 5, 1962[9] and is the only son of Caroline Brady (Peggy McCay) and Victor Kiriakis (John Aniston).[10][11] However, Bo is raised as the youngest child of Caroline and her husband Shawn Brady (Frank Parker) until his paternity reveal in 1985. Bo returns to Salem in 1983 and marries Hope Williams (Kristian Alfonso) shortly after. The couple later welcomes their son, Shawn-Douglas Brady. Bo later becomes a detective at the Salem Police Department.[12] In 2000, Bo and Hope welcome another son, Zack. During the Salem Stalker storyline, Bo loses his mother and older brother Roman (Josh Taylor). He rejoins the police force to help solve the case and is forced to arrest his former sister-in-law, Dr. Marlena Evans (Deidre Hall). Fortunately, all the victims are discovered on a mysterious island and Bo is on the rescue team. He is also reunited with his ex-wife, Billie Reed (Julie Pinson). On New Year's Day in 2006, Zack is hit by a car driven by Bo and Billie's daughter, Chelsea (Rachel Melvin). To protect Chelsea, Bo hides the truth believing it would destroy his family. In 2008, Chelsea saves Bo's life by donating part of her pancreas when his begins failing. Bo suffers a concussion and temporarily experiences psychic visions.[13] In 2012, Bo quits the force after budget cuts and accompanies Caroline to California for Alzheimer's treatment. Caroline eventually returns, but Bo decides to go sailing as it is a lifelong dream of his. Hope and their daughter go sailing with him for a brief vacation however all the boat scenes only include Hope and Ciara in the cabin by themselves.

tag: p

text: In late 2013-early 2014, Hope reveals that Bo went to Europe to continue investigating the DiMeras on his own. However, as time went on and his investigation took on a wider scope (ostensibly as part of a larger ISA mission), so did his absence from home, and Hope.

text: In March 2014, John Black delivered a message to Hope that Bo's investigation had branched off into a larger, more powerful, and more dangerous criminal organization than even the DiMeras, and is working deep undercover in Europe to bring them down, and may not be back for another year or more. Bo's situation even precludes him from contacting friends and family, and a letter to Hope is the last known contact any Salemite has had with him.

text: Beginning September 2015, Bo is seen being held captive and tortured in a dirty prison, later revealed to be in Mexico. When Steve, with John's help, begins to track him down, he is moved to an equally filthy hospital-looking facility. Steve, John, and Victor uncover that Bo was working with Victor to help Dr. Salinas find a cure for Caroline's Alzheimer's-type condition. This may have also been at the same time that he was involved in an investigation that may or may not have involved the ISA which took him to northern Europe. He was then lured by a Britta Englund-lookalike to Mexico. In November 2015, Bo starts to blackout and experience headaches, Thanks to his sister, Kayla, he undergoes testing and is diagnosed with an inoperable terminal brain tumor and doesn't have long to live. In the location of their first kiss, Bo tells Hope of his condition. Bo and Hope passionately repeat their wedding vows to each other as Bo becomes extremely pale and weak. Hope told Bo that his niece Sami's son Will was murdered last month, which he was devastated, and then, Bo loses consciousness and dies in Hope's arms, while snow starts to fall on them.


document_title: Gastric bypass surgery

question_text: when was the first gastric bypass surgery performed

text: Gastric bypass surgery

text: Uses[edit]

text: Gastric bypass is indicated for the surgical treatment of morbid obesity, a diagnosis which is made when the patient is seriously obese, has been unable to achieve satisfactory and sustained weight loss by dietary efforts, and suffers from comorbid conditions which are either life-threatening or a serious impairment to the quality of life.

text: Prior to 1991, clinicians interpreted serious obesity as weighing at least 100 pounds (45 kg) more than the "ideal body weight", an actuarially-determined body-weight at which one was estimated to be likely to live the longest, as determined by the life-insurance industry. This criterion failed for persons of short stature.

text: In 1991, the National Institutes of Health (NIH) sponsored a consensus panel whose recommendations have set the current[update] standard for consideration of surgical treatment, the body mass index (BMI). The BMI is defined as the body weight (in kilograms), divided by the square of the height (in meters). The result is expressed as a number in units of kilograms per square meter. In healthy adults, BMI ranges from 18.5 to 24.9, with a BMI above 30 being considered obese, and a BMI less than 18.5 considered underweight.[4] (BMI is by itself not a reliable index of obesity: serious bodybuilders or strength athletes have BMIs in the obesity range while having relatively little body fat.)

text: The Consensus Panel of the National Institutes of Health (NIH) recommended the following criteria for consideration of bariatric surgery, including gastric bypass procedures:

text:
people who have a BMI of 40 or higher[5]
people with a BMI of 35 or higher with one or more related comorbid conditions

tag: ul

text: The Consensus Panel also emphasized the necessity of multidisciplinary care of the bariatric surgical patient by a team of physicians and therapists to manage associated comorbidities and nutrition, physical activity, behavior, and psychological needs. The surgical procedure is best regarded as a tool which enables the patient to alter lifestyle and eating habits, and to achieve effective and permanent management of obesity and eating behavior.

text: Since 1991, major developments in the field of bariatric surgery, particularly laparoscopy, have outdated some of the conclusions of the NIH panel. In 2004 the American Society for Bariatric Surgery (ASBS) sponsored a consensus conference which updated the evidence and the conclusions of the NIH panel. This conference, composed of physicians and scientists of both surgical and non-surgical disciplines, reached several conclusions, including:

text:
bariatric surgery is the most effective treatment for morbid obesity
gastric bypass is one of four types of operations for morbid obesity
laparoscopic surgery is equally effective and as safe as open surgery
patients should undergo comprehensive preoperative evaluation and have multi-disciplinary support for optimum outcome

text: Surgical techniques[edit]

text: The gastric bypass, in its various forms, accounts for a large majority of the bariatric surgical procedures performed. It is estimated that 200,000 such operations were performed in the United States in 2008.[6] An increasing number of these operations are now performed by limited access techniques, termed "laparoscopy".

text: Laparoscopic surgery is performed using several small incisions, or ports: one to insert a surgical telescope connected to a video camera, and others to permit access of specialized operating instruments. The surgeon views the operation on a video screen. Laparoscopy is also called limited access surgery, reflecting the limitation on handling and feeling tissues and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision—with the option of using an incision should the need arise.

text: The Roux-en-Y laparoscopic gastric bypass, first performed in 1993, is regarded as one of the most difficult procedures to perform by limited access techniques, but use of this method has greatly popularized the operation due to associated benefits such as a shortened hospital stay, reduced discomfort, shorter recovery time, less scarring, and minimal risk of incisional hernia.

text: Essential features[edit]

text: The gastric bypass procedure consists of:

text:
Creation of a small, (15–30 mL/1–2 tbsp) thumb-sized pouch from the upper stomach, accompanied by bypass of the remaining stomach (about 400 mL and variable). This restricts the volume of food which can be eaten. The stomach may simply be partitioned (like a wall between two rooms in a house or two office cubicles next to each other with a partition wall in between them - and typically by the use of surgical staples), or it may be totally divided into two separate/separated parts (also with staples). Total division (separate/separated parts) is usually advocated to reduce the possibility that the two parts of the stomach will heal back together ("fistulize") and negate the operation.
Re-construction of the GI tract to enable drainage of both segments of the stomach. The particular technique used for this reconstruction produces several variants of the operation, differing in the lengths of small intestine used, the degree to which food absorption is affected, and the likelihood of adverse nutritional effects. Usually, a segment of the small bowel (called the alimentary limb) is brought up to the proximal remains of the stomach.

text: Variations[edit]

text: Gastric bypass, Roux en-Y (RYGB, proximal)[edit]

text: This variant is the most commonly employed gastric bypass technique, and is by far the most commonly performed bariatric procedure in the United States. The small intestine is divided approximately 45 cm (18 in) below the lower stomach outlet and is re-arranged into a Y-configuration, enabling outflow of food from the small upper stomach pouch via a "Roux limb". In the proximal version, the Y-intersection is formed near the upper (proximal) end of the small intestine. The Roux limb is constructed using 80–150 cm (31–59 in) of the small intestine, preserving the rest (and the majority) of it from absorbing nutrients. The patient will experience very rapid onset of the stomach feeling full, followed by a growing satiety (or "indifference" to food) shortly after the start of a meal.

text: Gastric bypass, Roux en-Y (RYGB, distal)[edit]

text: The small intestine is normally 6–10 m (20–33 ft) in length. As the Y-connection is moved further down the gastrointestinal tract, the amount available to fully absorb nutrients is progressively reduced, traded for greater effectiveness of the operation. The Y-connection is formed much closer to the lower (distal) end of the small intestine, usually 100–150 cm (39–59 in) from the lower end, causing reduced absorption (malabsorption) of food: primarily of fats and starches, but also of various minerals and the fat-soluble vitamins. The unabsorbed fats and starches pass into the large intestine, where bacterial actions may act on them to produce irritants and malodorous gases. These larger effects on nutrition are traded for a relatively modest increase in total weight loss.

text: "Mini-gastric bypass" (MGB)[edit]

text: The mini gastric bypass procedure was first developed by Robert Rutledge from the US in 1997, as a modification of the standard Billroth II procedure. A mini gastric bypass creates a long narrow tube of the stomach along its right border (the lesser curvature). A loop of the small gut is brought up and hooked to this tube at about 180 cm from the start of the intestine

text: Numerous studies show that the loop reconstruction (Billroth II gastrojejunostomy) works more safely when placed low on the stomach, but can be a disaster when placed adjacent to the esophagus. Today thousands of "loops" are used for surgical procedures to treat gastric problems such as ulcers, stomach cancer, and injury to the stomach. The mini gastric bypass uses the low set loop reconstruction and thus has rare chances of bile reflux.

text: The MGB has been suggested as an alternative to the Roux en-Y procedure due to the simplicity of its construction, and is becoming more and more popular because of low risk of complications and good sustained weight loss. It has been estimated that 15.4% of weight loss surgery in Asia is now performed via the MGB technique.[7]

text: Endoscopic duodenal-jejunal bypass[edit]

text: This technique has been clinically researched since the mid-2000s. It involves the implantation of a duodenal-jejunal bypass liner between the beginning of the duodenum (first portion of the small intestine from the stomach) and the mid-jejunum (the secondary stage of the small intestine). This prevents the partially digested food from entering the first and initial part of the secondary stage of the small intestine, mimicking the effects of the biliopancreatic portion of Roux en-Y gastric bypass (RYGB) surgery. Despite a handful of serious adverse events such as gastrointestinal bleeding, abdominal pain, and device migration — all resolved with device removal — initial clinical trials have produced promising results in the treatment's ability to improve weight loss and glucose homeostasis outcomes.[8][9][10]

text: Physiology[edit]

text: The gastric bypass reduces the size of the stomach by well over 90%. A normal stomach can stretch, sometimes to over 1000 mL, while the pouch of the gastric bypass may be 15 mL in size. The gastric bypass pouch is usually formed from the part of the stomach which is least susceptible to stretching. That, and its small original size, prevents any significant long-term change in pouch volume. What does change, over time, is the size of the connection between the stomach and intestine and the ability of the small intestine to hold a greater volume of food. Over time, the functional capacity of the pouch increases; by that time, weight loss has occurred, and the increased capacity should serve to allow maintenance of a lower body weight.

text: When the patient ingests just a small amount of food, the first response is a stretching of the wall of the stomach pouch, stimulating nerves which tell the brain that the stomach is full. The patient feels a sensation of fullness, as if they had just eaten a large meal—but with just a thimble-full of food. Most people do not stop eating simply in response to a feeling of fullness, but the patient rapidly learns that subsequent bites must be eaten very slowly and carefully, to avoid increasing discomfort or vomiting.

text: Food is first churned in the stomach before passing into the small intestine. When the lumen of the small intestine comes into contact with nutrients, a number of hormones are released, including cholecystokinin from the duodenum and PYY and GLP-1 from the ileum. These hormones inhibit further food intake and have thus been dubbed "satiety factors". Ghrelin is a hormone that is released in the stomach that stimulates hunger and food intake. Changes in circulating hormone levels after gastric bypass have been hypothesized to produce reductions in food intake and body weight in obese patients. However, these findings remain controversial, and the exact mechanisms by which gastric bypass surgery reduces food intake and body weight have yet to be elucidated.

text: For example, it is still widely perceived that gastric bypass works by mechanical means, i.e. food restriction and/or malabsorption. Recent clinical and animal studies, however, have indicated that these long-held inferences about the mechanisms of Roux en-Y gastric bypass (RYGB) may not be correct. A growing body of evidence suggests that profound changes in body weight and metabolism resulting from RYGB cannot be explained by simple mechanical restriction or malabsorption. One study in rats found that RYGB induced a 19% increase in total and a 31% increase in resting energy expenditure, an effect not exhibited in vertical sleeve gastrectomy rats. In addition, pair-fed rats lost only 47% as much weight as their RYGB counterparts. Changes in food intake after RYGB only partially account for the RYGB-induced weight loss, and there is no evidence of clinically significant malabsorption of calories contributing to weight loss. Thus, it appears RYGB affects weight loss by altering the physiology of weight regulation and eating behavior rather than by simple mechanical restriction or malabsorption.[11]

text: To gain the maximum benefit from this physiology, it is important that the patient eat only at mealtimes, 5 to 6 small meals daily, and not graze between meals. Concentration on obtaining 80–100 g of daily protein is necessary. Meals after surgery are 1/4–1/2 cup, slowly getting to 1 cup by one year. This requires a change in eating behavior and alteration of long-acquired habits for finding food. In almost every case where weight gain occurs late after surgery, capacity for a meal has not greatly increased. Some assume the cause of regaining weight must be the patient's fault, e.g. eating between meals with high-caloric snack foods, though this has been debated. Others believe it is an unpredictable failure or limitation of the surgery for certain patients (e.g. reactive hypoglycemia).

text: Complications[edit]

text: Any major surgery involves the potential for complications—adverse events which increase risk, hospital stay, and mortality. Some complications are common to all abdominal operations, while some are specific to bariatric surgery.

text: Mortality and complication rates[edit]

text: The overall rate of complications during the 30 days following surgery ranges from 7% for laparoscopic procedures to 14.5% for operations through open incisions. One study on mortality revealed a 0% mortality rate out of 401 laparoscopic cases, and 0.6% out of 955 open procedures (6 deaths). Similar mortality rates—30-day mortality of 0.11% (364 deaths), and 90-day mortality of 0.3%—have been recorded in the U.S. Centers of Excellence program, the results being from 33,117 operations at 106 centers.[12]

text: Mortality and complications are affected by pre-existing risk factors such as degree of obesity, heart disease, obstructive sleep apnea, diabetes mellitus, and history of prior pulmonary embolism. It is also affected by the experience of the operating surgeon: the learning curve for laparoscopic bariatric surgery is estimated to be about 100 cases. Supervision and experience is important when selecting a surgeon, as the way a surgeon becomes experienced in dealing with problems is by encountering and solving them.

text: Complications of abdominal surgery[edit]

text: Infection[edit]

text: Infection of the incisions or of the inside of the abdomen (peritonitis, abscess) may occur due to release of bacteria from the bowel during the operation. Nosocomial infections, such as pneumonia, bladder or kidney infections, and sepsis (blood-borne infection) are also possible. Effective short-term use of antibiotics, diligent respiratory therapy, and encouragement of activity within a few hours after surgery can reduce the risks of infections.

text: Venous thromboembolism[edit]

text: Any injury, such as a surgical operation, causes the body to increase the coagulation of the blood. Simultaneously, activity may be reduced. There is an increased probability of formation of clots in the veins of the legs, or sometimes the pelvis, particularly in the morbidly obese patient. A clot which breaks free and floats to the lungs is called a pulmonary embolus, a very dangerous occurrence. Blood thinners are commonly administered before surgery to reduce the probability of this type of complication.

text: Hemorrhage[edit]

text: Many blood vessels must be cut in order to divide the stomach and to move the bowel. Any of these may later begin bleeding, either into the abdomen (intra-abdominal hemorrhage), or into the bowel itself (gastrointestinal hemorrhage). Transfusions may be needed, and re-operation is sometimes necessary. Use of blood thinners to prevent venous thromboembolic disease may actually increase the risk of hemorrhage slightly.

text: Hernia[edit]

text: A hernia is an abnormal opening, either within the abdomen or through the abdominal wall muscles. An internal hernia may result from surgery and re-arrangement of the bowel, and is a cause of bowel obstruction. Antecolic antegastric Roux-en-Y gastric bypass surgery has been estimated to result in internal hernia in 0.2% of cases, mainly through Petersen's defect.[13] An incisional hernia occurs when a surgical incision does not heal well; the muscles of the abdomen separate and allow protrusion of a sac-like membrane, which may contain bowel or other abdominal contents, and which can be painful and unsightly. The risk of abdominal-wall hernia is markedly decreased in laparoscopic surgery.

text: Bowel obstruction[edit]

text: Abdominal surgery always results in some scarring of the bowel, called adhesions. A hernia, either internal or through the abdominal wall, may also result. When the bowel becomes trapped by adhesions or a hernia, it may become kinked and obstructed, sometimes many years after the original procedure. An operation is usually necessary to correct this problem.

text: Complications of gastric bypass[edit]

text: Anastomotic leakage[edit]

text: An anastomosis is a surgical connection between the stomach and bowel, or between two parts of the bowel. The surgeon attempts to create a water-tight connection by connecting the two organs with either staples or sutures, either of which actually makes a hole in the bowel wall. The surgeon will rely on the body's natural healing abilities and its ability to create a seal, like a self-sealing tire, to succeed with the surgery. If that seal fails to form for any reason, fluid from within the gastrointestinal tract can leak into the sterile abdominal cavity and give rise to infection and abscess formation. Leakage of an anastomosis can occur in about 2% of Roux-en-Y gastric bypass and less than 1% in mini gastric bypass. Leaks usually occur at the stomach-intestine connection (gastro-jejunostomy).

text: Anastomotic stricture[edit]

text: As the anastomosis heals, it forms scar tissue, which naturally tends to shrink ("contract") over time, making the opening smaller. This is called a "stricture". Usually, the passage of food through an anastomosis will keep it stretched open, but if the inflammation and healing process outpaces the stretching process, scarring may make the opening so small that even liquids can no longer pass through it. The solution is a procedure called gastroendoscopy, and stretching of the connection by inflating a balloon inside it. Sometimes this manipulation may have to be performed more than once to achieve lasting correction.

text: Anastomotic ulcer[edit]

text: Ulceration of the anastomosis occurs in 1–16% of patients.[14] Possible causes of such ulcers are:

text:
Restricted blood supply to the anastomosis (compared to the blood supply available to the original stomach)
Anastomosis tension
Gastric acid
The bacteria Helicobacter pylori
Smoking
Use of non-steroidal anti-inflammatory drugs

text: This condition can be treated with:

text:
Proton pump inhibitors, e.g. esomeprazole
A cytoprotectant and acid buffering agent, e.g. sucralfate
Temporary restriction of the consumption of solid foods

text: Dumping syndrome[edit]

text: Normally, the pyloric valve at the lower end of the stomach regulates the release of food into the bowel. When the gastric bypass patient eats a sugary food, the sugar passes rapidly into the intestine, where it gives rise to a physiological reaction called dumping syndrome. The body will flood the intestines with gastric content in an attempt to dilute the sugars. An affected person may feel their heart beating rapidly and forcefully, break into a cold sweat, get a feeling of butterflies in the stomach, and may have an anxiety attack. The person usually has to lie down, and could be very uncomfortable for 30–45 minutes. Diarrhea may then follow.

text: Nutritional deficiencies[edit]

text: Nutritional deficiencies are common after gastric bypass surgery, and are often not recognized. They include:[15]

text:
Secondary hyperparathyroidism due to inadequate absorption of calcium may occur for GBP patients. Calcium is primarily absorbed in the duodenum, which is bypassed by the surgery. Most patients can achieve adequate calcium absorption by supplementation with vitamin D and calcium citrate (carbonate may not be absorbed—it requires an acidic stomach, which is bypassed).
Iron frequently is seriously deficient, particularly in menstruating females, and must be supplemented. Again, it is normally absorbed in the duodenum. Ferrous sulfate can cause considerable GI distress in normal doses; alternatives include ferrous fumarate, or a chelated form of iron. Occasionally, a female patient develops severe anemia, even with supplements, and must be treated with parenteral iron. The signs of iron deficiency include: brittle nails, an inflamed tongue, constipation, depression, headaches, fatigue, and mouth lesions.[16]
Signs and symptoms of zinc deficiency may also occur such as: acne, eczema, white spots on the nails, hair loss, depression, amnesia, and lethargy.[17]
Deficiency of thiamine (also known as vitamin B1) brings the risk of permanent neurological damage (i.e. Wernicke's encephalopathy or polyneuropathy). Signs of thiamin deficiency are heart failure, memory loss, numbness of the hands, constipation, and loss of appetite.[16]
Vitamin B12 requires intrinsic factor from the gastric mucosa to be absorbed. In patients with a small gastric pouch, it may not be absorbed, even if supplemented orally, and deficiencies can result in pernicious anemia and neuropathies. Vitamin B12 deficiency is quite common after gastric bypass surgery with reported rates of 30% in some clinical trials.[18] Sublingual B12 (cyanocobalamin) appears to be adequately absorbed. In cases where sublingual B12 does not provide sufficient amounts, injections may be needed.
Protein malnutrition is a real risk. Some patients suffer troublesome vomiting after surgery, until their GI tract adjusts to the changes, and cannot eat adequate amounts even with 6 meals a day. Many patients require protein supplementation during the early phases of rapid weight loss to prevent excessive loss of muscle mass. Hair loss is also a risk of protein malnutrition.
Vitamin A deficiencies generally occur as a result of fat-soluble vitamins deficiencies. This often comes after intestinal bypass procedures such as jejunoileal bypass (no longer performed) or biliopancreatic diversion/duodenal switch procedures. In these procedures, fat absorption is markedly impaired. There is also the possibility of a vitamin A deficiency with use of the weight-loss medication orlistat (marketed as Xenical and Alli).
Folate deficiency is also a common occurrence in gastric bypass surgery patients.

text: Nutritional effects[edit]

text: After surgery, patients feel fullness after ingesting only a small volume of food, followed soon thereafter by a sense of satiety and loss of appetite. Total food intake is markedly reduced. Due to the reduced size of the newly created stomach pouch, and reduced food intake, adequate nutrition demands that the patient follow the surgeon's instructions for food consumption, including the number of meals to be taken daily, adequate protein intake, and the use of vitamin and mineral supplements. Calcium supplements, iron supplements, protein supplements, multi-vitamins (sometimes pre-natal vitamins are best), and vitamin B12 (cyanocobalamin) supplements are all very important to the post-operative bypass patient.

text: Total food intake and absorbance rate of food will rapidly decline after gastric bypass surgery, and the number of acid-producing cells lining the stomach increases. Doctors often prescribe acid-lowering medications to counteract the high acidity levels. Many patients then experience a condition known as achlorhydria, where there is not enough acid in the stomach. As a result of the low acidity levels, patients can develop an overgrowth of bacteria. A study conducted on 43 post-operative patients revealed that almost all of the patients tested positive for a hydrogen breath test, which indicated an overgrowth of bacteria in the small intestine.[19] Bacterial overgrowth causes the gut ecology to change and induces nausea and vomiting. Recurring nausea and vomiting eventually change the absorbance rate of food, contributing to the vitamin and nutrition deficiencies common in post-operative gastric bypass patients.

text: Protein nutrition[edit]

text: Proteins are essential food substances, contained in foods such as vegetables, fruits, legumes, nuts, meat, fish, poultry, dairy products and eggs. With reduced ability to eat a large volume of food, gastric bypass patients must focus on eating their protein requirements first, and with each meal. In some cases, surgeons may recommend use of a liquid protein supplement. Powdered protein supplements added to smoothies or any food can be an important part of the post-op diet.

text: Calorie nutrition[edit]

text: The profound weight loss which occurs after bariatric surgery is due to taking in much less energy (calories) than the body needs to use every day. Fat tissue must be burned to offset the deficit, and weight loss results. Eventually, as the body becomes smaller, its energy requirements are decreased, while the patient simultaneously finds it possible to eat somewhat more food. When the energy consumed is equal to the calories eaten, weight loss will stop. Proximal GBP typically results in loss of 60–80% of excess body weight, and very rarely leads to excessive weight loss. The risk of excessive weight loss is slightly greater with distal GBP.

text: Vitamins[edit]

text: Vitamins are normally contained in foods and supplements. The amount of food eaten after GBP is severely reduced, and vitamin content is correspondingly lowered. Supplements should therefore be taken to complete minimum daily requirements of all vitamins and minerals. Pre-natal vitamins are sometimes suggested by doctors, as they contain more of certain vitamins than most multi-vitamins. Absorption of most vitamins is not seriously affected after proximal GBP, although vitamin B12 may not be well-absorbed in some persons: sublingual preparations of B12 provide adequate absorption. Some studies suggest that GBP patients who took probiotics after surgery are able to absorb and retain higher amounts of B12 than patients who did not take probiotics after surgery.[citation needed] After a distal GBP, fat-soluble vitamins A, D, and E may not be well-absorbed, particularly if fat intake is large. Water-dispersed forms of these vitamins may be indicated on specific physician recommendation. For some patients, sublingual B12 is not enough, and patients may require B12 injections.

text: Minerals[edit]

text: All versions of the GBP bypass the duodenum, which is the primary site of absorption of both iron and calcium. Iron replacement is essential in menstruating females, and supplementation of iron and calcium is preferable in all patients. Ferrous sulfate is poorly tolerated. Alternative forms of iron (fumarate, gluconate, chelates) are less irritating and probably better absorbed. Calcium carbonate preparations should also be avoided; calcium as citrate or gluconate (with 1200 mg as calcium) has greater bioavailability independent of acid in the stomach, and will likely be better absorbed. Chewable calcium supplements that include vitamin K are sometimes recommended by doctors as a good way to get calcium.

text: Alcohol metabolism[edit]

text: Post-operative gastric bypass patients develop a lowered tolerance for alcoholic beverages because their altered digestive tract absorbs alcohol at a faster rate than people who have not undergone the surgery. It also takes a post-operative patient longer to reach sober levels after consuming alcohol. In a study conducted on 36 post-operative patients and a control group of 36 subjects (who had not undergone surgery), each subject drank a 5 oz. glass of red wine and had the alcohol in their breath measured to evaluate alcohol metabolism. The gastric bypass group had an average peak alcohol breath level at 0.08%, whereas the control group had an average peak alcohol breath level of 0.05%. It took on average 108 minutes for the gastric bypass patients group to return to an alcohol breath of zero, while it took the control group an average of 72 minutes.[20]

text: Pica[edit]

text: There have been reported cases in which pica recurs after gastric bypass in patients with a pre-operative history of the disorder, which are possibly due to iron deficiency. Pica is a compulsive tendency to eat substances other than normal food. Some examples would be people eating paper, clay, plaster, ashes, or ice. Low levels of iron and hemoglobin are common in patients who have undergone gastric bypass.[21] One study reported on a female post-operative gastric bypass patient who was consuming eight to ten 32 oz. glasses of ice a day. The patient's blood test revealed iron levels of 2.3 mmol/L and hemoglobin level of 5.83 mmol/L. Normal iron blood levels of adult women are 30 to 126 µg/dL and normal hemoglobin levels are 12.1 to 15.1 g/dl. This deficiency in the patient's iron levels may have led to the increase Pica activity. The patient was then given iron supplements that brought her hemoglobin and iron blood levels to normal levels. After one month, the patient's eating diminished to two to three glasses of ice per day. After one year of taking iron supplements the patient's iron and hemoglobin levels remained in a normal range and the patient reported that she did not have any further cravings for ice.[22]

text: Results and health benefits of gastric bypass[edit]

text: Weight loss of 65–80% of excess body weight is typical of most large series of gastric bypass operations reported. The medically more significant effects include a dramatic reduction in comorbid conditions:

text:
Hyperlipidemia is corrected in over 70% of patients.
Essential hypertension is relieved in over 70% of patients, and medication requirements are usually reduced in the remainder.
Obstructive sleep apnea improves markedly with weight loss and bariatric surgery may be curative for sleep apnea. Snoring also reduces in most patients.
Type 2 diabetes is reversed in up to 90% of patients[23] usually leading to a normal blood-sugar level without medication, sometimes within days of surgery.[24][25] Furthermore, Type 2 diabetes is prevented by more than 30-fold in patients with pre-diabetes. All these findings were first reported by Walter Pories and Jose F. Caro.[26]
Gastroesophageal reflux disease is relieved in almost all patients.
Venous thromboembolic disease signs such as leg swelling are typically alleviated.
Lower-back pain and joint pain are typically relieved or improved in nearly all patients.

text: A study in a large prospective study of 2010 obese patients showed a 29% reduction in mortality up to 15 years following surgery (hazard ratio 0.71 when adjusted for sex, age, and risk factors), compared to a non-surgically treated group of 2037 patients.[27]

text: Concurrently, most patients are able to enjoy greater participation in family and social activities.

text: Cost of gastric bypass[edit]

text: The patient's out of pocket cost for Roux-en-Y gastric bypass surgery varies widely depending on method of payment, region, surgical practice and hospital in which the procedure is performed.

text: Methods of payment in the United States include private insurance (Individual & Family coverage, Small Group coverage through an employer (Under 50 full-time employees) and Large Group coverage through an employer (50 or more full-time employees), public insurance (Medicare and Medicaid) and self-pay. Out of pocket costs for a patient with private or public insurance that specifically list bariatric surgery as a covered benefit include several insurance-policy-specific parameters such as deductible levels, coinsurance percentages, copay amounts and out of pocket limits.

text: Patients without insurance must pay for surgery directly (or through a third party lender), and total out of pocket costs will depend on the surgical practice they choose and the hospital in which the surgical practice performs the procedure. On average, the total cost of gastric bypass surgery is about $24,000 in the United States, although on a state-specific level it ranges from an average of $15,000 (Arkansas) to an average of $57,000 (Alaska).[28]

text: In Germany a gastric bypass operation, if not covered by health insurance and therefore paid privately, costs up to €15,000;[29] in Switzerland CHF 20,000-25,000.[30]

text: Living with gastric bypass[edit]

text: Gastric bypass surgery has an emotional and physiological impact on the individual. Many who have undergone the surgery suffer from depression in the following months as a result of a change in the role food plays in their emotional well-being.[31] Strict limitations on the diet can place great emotional strain on the patient. Energy levels in the period following the surgery can be low, both due to the restriction of food intake and negative changes in emotional state.[32] It may take as long as three months for emotional levels to rebound.

text: Muscular weakness in the months following surgery is also common. This is caused by a number of factors, including a restriction on protein intake, a resulting loss in muscle mass and decline in energy levels. Muscle weakness may result in balance problems, difficulty climbing stairs or lifting heavy objects, and increased fatigue following simple physical tasks. Many of these issues pass over time as food intake gradually increases. However, the first months following the surgery can be very difficult, an issue not often mentioned by physicians suggesting the surgery.[citation needed] The benefits and risks of this surgery are well established; however, the psychological effects are not well understood.

text: Even if physical activity is increased, patients may still harbor long term psychological effects due to excess skin and fat.[citation needed] Often bypass surgery is followed up with "body lifts" of skin and liposuction of fatty deposits. These extra surgeries have their own inherent risks but are even more dangerous when coupled with the typical nutritional deficiences that accompany convalescing gastric bypass patients.[citation needed]

text: Surgeon accreditation[edit]

text: The American Society for Metabolic & Bariatric Surgery lists bariatric programs and surgeons in its "Centers of Excellence" network,[33] while the American College of Surgeons accredits providers through its Bariatric Surgery Center Network.[34] For listings of surgeons and centers in other countries, the International Federation for the Surgery of Obesity and Metabolic Disorders lists medical associations by country.[35]


document_title: Leaders of the Vietnam War

question_text: who was the leader of vietnam during the cold war

text: Leaders of the Vietnam War

text: Ho Chi Minh (19 May 1890 – 2 September 1969)[edit]

text: Ho Chi Minh whose real name is Nguyen Sinh Cung and also known as Nguyen Tat Thanh and Nguyen Ai Quoc was a Vietnamese revolutionary leader following the path of communism.

text: He left his country on a French steamer in 1911 and traveled extensively around the world participating actively in the Communist International before returning to Vietnam in 1941. He then organized and led the Viet Minh to fight for Vietnamese Independence. He became more popular for his declaration of Vietnam independence from France, which paraphrased a part of the U.S declaration of independence that says “All men are created equal…” Since 1945, he became a prime minister and president of the Democratic Republic of Vietnam (North Vietnam). In the late 1950s, Ho Chi Minh organized another communist guerrilla movement widely known as Viet Cong in South Vietnam.

text: Ho Chi Minh was the key figure and held the main leadership of North Vietnam during both wars in the country. He remained as a great source of inspiration for the Vietnamese who were fighting for a united Vietnam as in his wish after he officially stepped aside in 1965 and even after his death in 1969. The final offensive against Saigon – the capital of South Vietnam in 1975 was named after him (the Ho Chi Minh Campaign). Vietnam was reunified under the Communist rule after the fall of Saigon in April 1975, nearly 30 years after Ho's declaration of independence and 6 years after his death. Soon after that, Saigon was renamed Ho Chi Minh city in honour of his vast contributions to Vietnam.

text: Vo Nguyen Giap (August 25, 1911 – October 4, 2013)[edit]

text: Vo Nguyen Giap was a General, Commander in Chief of the Vietnam People's Army (VNA) and Vietnamese politician. He played a major role as a commander in the First Indochina War (1946-1954) and the Vietnam War (1960-1975) in which he involved directly in many important campaigns such as the Border Campaign in Fall–Winter (1950), the Battle of Dien Bien Phu (1954), the Tet Offensive (1968), the Easter Offensive (1972), the final Ho Chi Minh Campaign (1975) which led to the fall of Saigon and South Vietnam. Giap, together with Ho Chi Minh, was the most prominent figure of North Vietnam during the wars in the country.

text: After the war, he was still the Minister of Defence until 1980 and served as a member of Political Bureau of the Communist Party of Vietnam until his retirement in 1991. Giap celebrated his 100th birthday in 2011 and becomes the oldest Vietnam political and military figure that have ever lived. He is also considered by both his partisans and opponents as one of the greatest military commanders in history.

text: Ngo Dinh Diem (3 January 1901 – 2 November 1963)[edit]

text: Diem was a Vietnamese politician served as an officer in the Nguyen Dynasty. Because of his drastic ideological of anti-communism, Diem received support from the United States and became the first President of the Republic of Vietnam in 1955. However, as a Catholic, Diem pursued the persecution of Buddhists which led to many religious protests notably the self-immolation of Thich Quang Duc in 1963. As a result, Diem gradually lost U.S support and was assassinated, together with his brother Nhu, in a coup in 1963

text: Nguyen Cao Ky (8 September 1930 – 23 July 2011)[edit]

text: Nguyen Cao Ky was a senior army officer and a former politician of Republic of Vietnam. He served as a prime minister (1965-1967) and Vice President (1967-1971) of the Republic of Vietnam. From an ally, he then became the opponent of President Nguyen Van Thieu and was mostly sidelined during Thieu's presidency. Ky had been seen as an aggressive anti-Communist person in the period before 1975 and but then was regarded as a symbol of national reconciliation by the Vietnamese Communist Party since 2004 when he became the first South Vietnamese leader returning to the country.

text: Nguyen Van Thieu (5 April 1923 – 29 September 2001)[edit]

text: Thieu was the Leadership Committee Chairman (1965-1967) and President of the Republic of Vietnam (1967-1975). In 1963, Thieu joined a military coup to overthrow Diem. During his years as president, Thieu was accused of indulging in corruption. His struggle for power with Ky led to the decisions of side-lining Ky's supporters and choosing loyalists instead of decent commanders to lead the Army of Public of Vietnam (APVN) forces. He strongly opposed the Paris Peace Accords (1973) and publicly blamed the U.S not keeping its promise for fall of Saigon and South Vietnam in 1975.

text: Anti-Communist forces[edit]

text: South Vietnam[edit]

text: Political[edit]

text:
Ngô Đình Diệm was the President of South Vietnam from 1955 until his assassination in 1963.
Ngô Đình Nhu was Diệm's younger brother and generally regarded as the architect of the Ngô family's rule.
Dương Văn Minh led the South Vietnamese Army under President Diệm and was briefly leader of South Vietnam in 1963 and 1975. He was the last president.
Nguyễn Thành was a general who was in power from early 1964 to 1965.
Nguyễn Văn Thiệu was the President of South Vietnam from 1967 to 1975.
Nguyễn Cao Kỳ was the Prime Minister of South Vietnam from 1965 to 1967 and the Vice President from 1967 to 1971.
Trần Văn Hương was the second to last President of South Vietnam before its surrender in 1975.

text: Military[edit]

text:
Hoàng Xuân Lãm was a general in the Army of the Republic of Vietnam, commander of I Corps.
Lê Nguyên Khang was the commander of the Republic of Vietnam Marine Corps.
Ngo Quang Truong a lieutenant general and commander of the I Corps.

text: United States of America[edit]

text: Political[edit]

text:
Dwight D. Eisenhower was the 34th President of the United States from 1953 to 1961.
John F. Kennedy was the 35th President of the United States from 1961 until his death in 1963.
Lyndon B. Johnson was the 36th President of the United States from 1963 to 1969.
Richard Nixon was the 37th President of the United States from 1969 until he resigned in 1974.
Gerald Ford was the 38th President of the United States from 1974 to 1977.
Robert McNamara was the 8th Secretary of Defense, serving under Presidents John F. Kennedy and Lyndon B. Johnson from 1961 to 1968.
Clark Clifford was the 9th Secretary of Defense, serving under President Lyndon B. Johnson from 1968 to 1969.
Melvin R. Laird was the 10th Secretary of Defense, serving under President Richard Nixon from 1969 to 1973.
James R. Schlesinger was the 12th Secretary of Defense, serving under President Richard Nixon and Gerald Ford from 1973 to 1975.
Henry Kissinger was the 8th National Security Advisor and the 56th Secretary of State, serving under Presidents Richard Nixon and Gerald Ford from 1969 to 1977.

text: Military[edit]

text:
Earle Wheeler was a United States Army General who served as Chairman of the Joint Chiefs of Staff from 1964 to 1970.
Thomas Hinman Moorer was a U.S. admiral who served as Chairman of the Joint Chiefs of Staff from 1970 to 1974.
William Westmoreland was an American General who commanded American military operations in the Vietnam War from 1964 to 1968.
Creighton Abrams was an American General who commanded American military operations in the Vietnam War from 1968 to 1972.
Frederick C. Weyand was a U.S. Army General who was the last commander of American military operations in the Vietnam War from 1972 to 1973.
Elmo Zumwalt was an American naval officer and commander of American naval forces in Vietnam.
William W. Momyer was commander of the U.S. Air Force Tactical Air Command and the commander of the 7th Air Force.
John S. McCain, Jr. was an American admiral and Commander-in-Chief of the Pacific Command.
George Stephen Morrison was an American Rear Navy Admiral in Command during the Gulf of Tonkin incident, which escalated the U.S involvement in Vietnam.

text: Republic of Korea[edit]

text:
Park Chung-hee was the President of South Korea from 1963 until his assassination in 1979.
Chae Myung-shin was the Commander of the Republic of Korea Armed Forces in Vietnam from 1965 to 1969.
Lee Se-ho was the Commander of the Republic of Korea Armed Forces in Vietnam from 1969 to 1973.

text: Australia[edit]

text:
Sir Robert Menzies was the Prime Minister of Australia from 1949 to 1966.
Harold Holt was the Prime Minister of Australia from 1966 to 1967.
John Gorton was the Prime Minister of Australia from 1968 to 1971.
Gough Whitlam was the Prime Minister of Australia from 1972 to 1975.
Air Chief Marshal Sir Frederick Scherger was Chairman, Chiefs of Staff Committee from 1961 to 1966.
Lieutenant General Sir Reginald Pollard was Chief of Army from 1960 to 1963.
Ted Serong was a senior officer of the Australian Army and commander of the Australian Army Training Team Vietnam from 1962 to 1965.
Donald Dunstan was an Australian Army officer, who was commander of Australian Forces in Vietnam in 1971 and 1972.

text: New Zealand[edit]

text:
Keith Holyoake was the Prime Minister of New Zealand from 1960 to 1972.
Jack Marshall was the Prime Minister of New Zealand in 1972.
Norman Kirk was the Prime Minister of New Zealand from 1972 to 1974.

text: Philippines[edit]

text: Ferdinand Marcos was the President of the Philippines from 1965 to 1986.

text: Thailand[edit]

text:
Sarit Thanarat prime minister of Thailand from 1958 to 1963 against the communist Pathet Lao guerrillas in the neighboring Kingdom of Laos. During his years as prime minister Sarit was a patron of his cousin, the Lao strongman General Phoumi Nosavan, against the communist Pathet Lao guerrillas in the neighboring Kingdom of Laos.
Thanom Kittikachorn was the prime minister of Thailand from 1963 to 1973 and Royal Thai Armed Forces in Vietnam from 1967 to 1972.

text: Khmer Republic[edit]

text:
Lon Nol was the Prime Minister of Cambodia from 1966 to 1967 and then again in 1969 to 1972, after which he was President until 1975.
Sosthene Fernandez was the commander-in-chief of the Khmer National Armed Forces of Lon Nol's Khmer Republic.

text: Kingdom of Laos[edit]

text:
Souvanna Phouma was the prince of Laos and a political figure.
Vang Pao was a major general in the Royal Lao Army and commander of the Hmong guerrilla forces that had a large impact on the war.

text: Spain[edit]

text: Francisco Franco was the Caudillo of Spain from 1939 to 1975.

text: Communist forces[edit]

text: North Vietnam[edit]

text: Political[edit]

text:
Hồ Chí Minh was prime minister from 1946 to 1955 and president from 1945 until his death in 1969 of the Democratic Republic of Vietnam (North Vietnam).
Lê Duẩn was the General Secretary of the Communist Party of Vietnam and leader of North Vietnam and later the unified Vietnam from 1969 until his death in 1986.
Tôn Đức Thắng was the second and final President of North Vietnam and the first President of the Socialist Republic of Vietnam.
Phạm Văn Đồng was the Prime Minister of North Vietnam from 1955 to 1976.
Lê Đức Thọ was a Vietnamese politician who, as North Vietnam's representative, negotiated the Paris Peace Accords.
Trường Chinh was ranked in the top 3 of the Vietnamese Politburo from 1941 to 1986 and both preceded and succeeded Le Duan as General Secretary.

text: Military[edit]

text:
Võ Nguyên Giáp was the Vietnamese General in the Vietnam People's Army (NVA), Commander-in-Chief of PAVN and was one of the most prominent military leaders during the war.
Văn Tiến Dũng was a Vietnamese general in the People's Army of Vietnam (PAVN), PAVN chief of staff (1954–1974); PAVN commander in chief (1974–1980); and Socialist Republic of Vietnam defense minister (1980–1986).
Hoàng Văn Thái was the General Staff formed National Army, after holding The first Chief of General Staff of the People's Army of Vietnam.
Nguyễn Hữu An was a general in the Vietnamese People's Army, commander of the 2nd Army Corps.
Lê Trọng Tấn was a general and key figure of the Vietnamese People's Army, he was the deputy commander of the Viet Cong and held senior commands in the Easter Offensive and the Ho Chi Minh campaign.
Hoàng Minh Thảo was a general and military theorist of Vietnamese People's Army and an advisor to the Viet Cong.

text: Viet Cong (National Liberation Front)[edit]

text:
Nguyễn Hữu Thọ was the chairman of the National Liberation Front of South Vietnam.
Hoàng Văn Thái was one of the leading commanders of the National Liberation Front of South Vietnam (1967–1973, during the U.S. buildup in South Vietnam), during the Tet Offensive he was the most senior North Vietnamese Officer in South Vietnam.
Trần Văn Trà was one of the leading commanders of the National Liberation Front of South Vietnam and a member of the Central Committee of the Lao Dong Party.
Tran Do was the deputy commander of the Viet Cong.
Nguyễn Văn Linh was a political leader of the Viet Cong during the Vietnam War who served as party secretary of South Vietnam for Communist Party of Vietnam.
Võ Chí Công was a Vietnamese Communist political figure who was one of the founding members of the Viet Cong.
Huỳnh Tấn Phát chairman of the Provisional Revolutionary Government of the Republic of South Vietnam from 1969 to 1976.

text: Khmer Rouge[edit]

text:
Pol Pot was the leader of the Cambodian communist movement known as the Khmer Rouge.
Khieu Samphan was the head of the CPNLAF, the Khmer Rouge armed forces.

text: Pathet Lao[edit]

text:
Souphanouvong was the figurehead leader of the Lao People's Revolutionary Party, and upon its successful seizure of power in 1975, he became the first President of the Lao People's Democratic Republic.
Phoumi Vongvichit was a leading figure of the Pathet Lao and an elder statesman of the Lao People's Democratic Republic.
Kaysone Phomvihane was the actual head of the LPRP from 1955 to his death in 1992 and Prime Minister and then President after the takeover.
Khamtai Siphandon was the military commander of the Pathet Lao and Defense Minister after the takeover before succeeding Kaysone Phomvihane.

text: People's Republic of China[edit]

text: Mao Zedong was the leader of the People's Republic of China from 1949 until his death in 1976.

text: Soviet Union[edit]

text:
Nikita Khrushchev was the leader of the Soviet Union from 1953 to 1964. He was the leader of USSR when JFK was U.S. president.
Leonid Brezhnev was the leader of the Soviet Union from 1964 until his death in 1982. He was leader of USSR when Lyndon B. Johnson was U.S. president.
Rodion Malinovsky was the Marshal of the Soviet Union and Minister of Defense of the Soviet Union in 1957–1967.
Andrei Grechko was the Marshal of the Soviet Union Minister of Defense of the Soviet Union in 1967–1976.
Anatoliy Hiuppinen was the commander of the Soviet forces stationed in Vietnam.

text: North Korea[edit]

text: Kim Il-sung was the leader of North Korea from 1948 until his death in 1994.

text: People of the Vietnam War

text: Articles lacking sources from January 2012All articles lacking sources