Synergy Bariatrics

Synergy History and Mission

To provide caring, patient centered medical and surgical care to our community, using proven therapeutic modalities while searching for answers to the causes of obesity and its related diseases.

Synergy Bariatrics had its origins in the surgical practice of Dr. Joseph A. Caruana. After leaving full time academics for private practice in 1991, he specialized in surgery of the liver, biliary tract, stomach, and intestine.

Because of increasing evidence that weight loss surgery, specifically gastric bypass, was beneficial to patients with serious obesity and encouraged to begin performing this surgery by patients and colleagues, he performed his first gastric bypass at Sisters of Charity Hospital in June, 2000. He has now performed over 4000 of these procedures and his published outcomes of safety and successful weight loss are among the best in the world.

During the past decade, Synergy Bariatrics has been joined by Dr. Mark Cavaretta and a number of talented caring professionals, dedicated to the management of obesity and its related health issues.

The mission of Synergy Bariatrics remains to provide caring, patient centered medical and surgical care to our community, using proven therapeutic modalities while searching for answers to the causes of obesity and its related diseases.

Our Surgeons and Providers

JOSEPH A. CARUANA, MD

Joseph A. Caruana, MD is Medical Director of Synergy Bariatrics and Chief, Bariatric Surgery at Sisters of Charity Hospital in Buffalo, New York. He is certified by the American Board of Surgery and is a Fellow of the American College of Surgeons. He is a member of the American Society for Metabolic and Bariatric Surgery and several other National and International surgical societies. Dr. Caruana has published over 40 articles in peer reviewed medical journals. He performs gastric bypass and laparoscopic vertical sleeve gastrectomy.

MARK CAVARETTA, MD

Mark Cavaretta, MD is a bariatric surgeon, who joined Synergy Bariatrics in 2010. A native of Western New York, he performed a fellowship in bariatric surgery at the Geisinger Health System in Danville, Pennsylvania after completing his surgical residency in New York City. He is eligible for the American Board of Surgery and a member of the American Society for Metabolic and Bariatric Surgery. Dr. Cavaretta performs laparoscopic gastric bypass, laparoscopic vertical sleeve gastrectomy, laparoscopic adjustable gastric banding.

MARC MCCABE, RPA-C

Marc McCabe graduated from D'Youville College in 1999 with his Bachelor of Science degree as a Physician Assistant. He joined the Synergy Bariatrics team in 1999 and currently serves as one of our Physician Assistants. His role in your care is to assist the surgeons with your surgery and to provide you follow-up medical care after your surgery.

NICOLE ROSSNEY, RPA-C

Nicole Rossney graduated from D'Youville College in 2007 with her Bachelor of Science and Master of Science degree as a Physician Assistant. She joined the Synergy Bariatrics team in 2010 and currently serves as one of our Physician Assistants. Her role in your care is to assist the surgeons with your surgery and to provide you follow-up medical care after your surgery.

MISTY DENNIS, RPA-C

Misty Dennis graduated from D'Youville College in 2010 with her Bachelor of Science and Master of Science degree as a Physician Assistant. She joined the Synergy Bariatrics team in 2011 and currently serves as one of our Physician Assistants. Her role in your care is to assist the surgeons with your surgery and to provide you follow-up medical care after your surgery.

Our Surgeons and Providers

ANN MARIE LICAUSI, LMSW

Ann Marie LiCausi, LMSW, is an eating behavior specialist and is Executive Director of the Eating Disorders Association of WNY. Ms. LiCausi provides patient education and counseling for prospective patients of Synergy Bariatrics, as well as for those needing assistance with life adjustments after surgery.
Phone: 716-565-3991

SCOTT V. MONTE, PHARM.D.

Dr. Scott Monte graduated from the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in 2006 with his Doctorate in Pharmacy. He joined the Synergy Bariatrics team in 2009 and currently serves as our clinical pharmacist. His role in your care is to review your medications before surgery and to help prepare you for the changes and requirements following surgery.
Phone: 716-565-3990 ext. 119

Our Staff and Support Team

CYNTHIA LAWSON

Cynthia joined the Synergy Bariatrics team in 2012 and currently serves as the practice's switchboard operator and café attendant. Her role at the practice is to answer all incoming patient phone calls and help service your nutritional needs before and after surgery.

KRYSTAL FLORET

Krystal Floret joined the Synergy Bariatrics team in 2012 and currently serves as the practice's receptionist. Her role at the practice is to verify your insurance coverage, accept your co-pays and schedule appointments with the surgeons, physician assistants, or pharmacist.

LINDA BROUGH

Linda joined the Synergy Bariatrics team in 2011 and currently serves as the other new patient intake coordinator. Her role at the practice is to help you address any questions about the practice and insurance requirements to become a new patient. She can assist you with any questions or difficulties you may have with completing the InfoSurge educational seminar.

MISSY BENKER

Missy Benker joined the Synergy Bariatrics team in 2007 and currently serves as the practice's new patient coordinator. Her role at the practice is to review all your registration materials and help you schedule an initial visit with one of our surgeons.

GAIL CHRISTOPHER

Gail Christopher jointed the Synergy Bariatrics team in 2001 and currently serves as the practice's office manager and billing specialist. Her role at the practice is to oversee policies and procedures and to help assist you with any financial considerations surrounding the surgery or your follow-up care.

JACKIE DIAZ

Jackie Diaz joined the Synergy Bariatrics team in 2009 and currently serves as the practice's medical assistant and surgical scheduler. Her role at the practice is to help educate you on the practice and insurance requirements so that you safely and successfully reach surgery.

Our Staff and Support Team

AMANDA MAYLE

Amanda Mayle joined the Synergy Health & Fitness team in 2012 and currently serves as an administrative assistant to Ann Marie LiCausi, LMSW. Her role is to help with scheduling and coordination of all the services available through Synergy Health & Fitness.

Why Bariatric Surgery?

A tool to help you when diet and exercise are not enough.

It is well known that taking in fewer calories, making better food choices, and increasing the amount of daily exercise are cornerstones for losing weight and improving disease such as high blood pressure, high cholesterol, and diabetes. Through years of research trying to help people lose weight it has been repeatedly shown that many people can be successful losing weight for a short period of time, but even the most motivated will often regain or increase their weight from where they started. It is important to understand that the body has many ways of regulating body weight and that new research shows the body may try to counteract weight loss by altering certain hormones that help to regulate hunger, appetite, and metabolism. People undergoing Bariatric Surgery have a more proper hormone response to weight loss and therefore are able to lose a greater amount of weight and maintain the weight loss more commonly than people who try through traditional diet and exercise strategies alone.
PDF: Weight Adaptations Article NEJM 2011

Improving your chronic diseases and reducing the number of medications you need to take.

It is common for people undergoing Bariatric Surgery to see an improvement in blood pressure, cholesterol, and type 2 diabetes. Below is a link to the summary of information and full article to a study published in the New England Journal of Medicine (2012) that shows the average change in blood pressure, cholesterol, blood sugar, and the reduced need for medicines following Gastric Bypass surgery. It was found that people undergoing Gastric Bypass or Gastric Sleeve surgery were able to achieve better control of their diabetes in comparison to people not having surgery. Remarkably, people undergoing surgery were able to accomplish diabetes control and maintain control of their blood pressure and cholesterol while significantly reducing their number of medications.
PDF: Information Summary/Chart
PDF: Full Article NEJM 2012

Increasing your lifespan and your quality of life.

In a study of approximately 10,000 obese people it was found that there were 40% less deaths over a 7-year follow-up period in people undergoing Gastric Bypass versus those that did not have surgery. In particular, the group of people that had Gastric Bypass had 56% fewer deaths from coronary artery disease (CAD), 60% less deaths from cancer, and 92% less deaths from diabetes. Research has also shown that people undergoing Gastric Bypass have a remarkable improvement in their quality of life and level of functioning. Most commonly, people that are motivated to continue with follow-up visits, lose the most weight, and actively participate in their treatment of other medical conditions have the greatest improvement in their quality of life.
PDF: Long-term Mortality 2007
PDF: Am J Medicine QOL 2009

Gastric Bypass Surgery Study Summary

	Before Surgery	6-months after Surgery	12-months after Surgery
WEIGHT AND BODY MASS
Weight	235 lbs	193 lbs	170 lbs
Body Mass Index	37.0 kg/m2	28.2 kg/m2	26.8 kg/m2
BLOOD PRESSURE
Systolic Blood Pressure	135 mmHg	-	132 mmHg
Diastolic Blood Pressure	82 mmHg	-	72 mmHg
On Blood Pressure Medicines	78%	-	33%
CHOLESTEROL
LDL (Bad Cholesterol)	92 mg/dl	-	94 mg/dl
HDL (Good Cholesterol)	46 mg/dl	-	59 mg/dl
Triglycerides	167 mg/dl	-	95 mg/dl
On Cholesterol Medicine	86%	-	27%
DIABETES
Fasting Glucose	193 mg/dl	96 mg/dl	99 mg/dl
Hemoglobin A1C	9.3%	6.3%	6.4%
On Diabetes Medicine	98%	-	22%

Am I Eligible for Surgery?

Professional Criteria to be eligible for surgery.

The criteria for surgery are based on your body mass index (BMI) and your history of attempts at sustaining weight loss through diet, exercise, or medicines. You must also be able to understand and be motivated to adhere with lifestyle changes that go along with the surgery.

Calculate your BMI (Input Height, Weight to get BMI, http://www.nhlbisupport.com/bmi/)

Criteria for Surgery
Option 1		Option 2
Age > 18		Body mass index of > 35
Body mass index of > 40		With other chronic diseases such as high blood pressure, diabetes, and sleep apnea.
A history of unsuccessful weight loss attempts through diet, exercise, or medication therapy		A history of unsuccessful weight loss attempts through diet, exercise, or medication therapy

It is very important that you have an understanding and motivation to work with our staff, follow-up regularly after surgery, and adhere to lifestyle changes we will teach you.

The Synergy Bariatrics Surgeons will meet with you to assess your personal risks and benefits and to determine if surgery is a safe option based on your medical history

INSURANCES ACCEPTED BY OUR OFFICE

Blue Cross/Blue Shield	RMSCO
Independent Health	Medicare & Medicaid
Univera	VA Healthcare (must have a referral from the VA)

***At this time Synergy Bariatrics does not participate with Humana***

CASH PAYMENT OPTIONS

Synergy Bariatrics provides a cash payment option for patients interested in any surgery.
Please contact Gail Christopher at 565-3990 ext. 104

INSURANCES ACCEPTED BY OUR OFFICE

Complete Listing Below

Blue Cross/Blue Shield
Community Blue                                
Traditional Blue                                                                     
Senior Blue
BCBS PPO (verify that your policy has bariatric coverage)
Blue Cross/Blue Shield Family Health Plus (valid insurance referrals are required)
Community Care (valid insurance referrals are required)
Healthy New York

Independent Health
Medisource (valid insurance referrals are required)                                       
Family Health Plus (valid insurance referrals are required)   
Encompass 65
NOVA

Univera
Univera PPO                                      
Univera PPS                                       
Univera Family Health Plus
Buffalo Community Health
Univera Senior Choice (valid insurance referrals are required)

RMSCO
Medicare
Medicaid
VA Healthcare (must have a referral from the VA)

***At this time Synergy Bariatrics does not participate with Humana***

Surgical Procedures

• 

  Roux-en-Y Gastric Bypass

  The Roux-en-Y gastric bypass is the GOLD Standard of Bariatric Surgery. During the Roux-en-Y gastric...

  video & more
• 

  The Sleeve Gastrectomy

  During the Sleeve Gastrectomy procedure the surgeon removes about 80% of the stomach leaving a small...

  video & more
• 

  The Adjustable Gastric Band

  During the Adjustable Gastric Band procedure the surgeon implants two devices: a silicone band and...

  video & more

What to expect for weight loss

Surgical Options : Roux-en-Y Gastric Bypass

The Roux-en-Y gastric bypass is the GOLD Standard of Bariatric Surgery. During the Roux-en-Y gastric bypass procedure a small upper stomach pouch is created (about the size of a golf ball), dividing it from the lower stomach. Food will only come into the smaller pouch and therefore it can be limiting to the volume of food that can be eaten. The small intestine is also divided so that food "bypasses" the lower stomach and first part of the small intestine. The shape of this change results in a "Y". The Roux-en-Y gastric bypass is the Bariatric Procedure with the longest history of success for weight loss and affects the body's metabolism leading to improvement in blood pressure, cholesterol, and type 2 diabetes.

Surgical Options : The Sleeve Gastrectomy

During the Sleeve Gastrectomy procedure the surgeon removes about 80% of the stomach leaving a small, "sleeve shaped stomach". The Sleeve Gastrectomy differs from the Roux-en-Y gastric bypass in that no alterations are made to the small intestine and the stomach pouch is larger than Roux-en-Y gastric bypass (about the size of a banana). While the Sleeve Gastrectomy has not been performed as a stand-alone procedure for as long as the Roux-en-Y gastric bypass it has been shown to produce weight loss and have a similar metabolic effect on blood pressure, cholesterol, and type 2 diabetes that are remarkably similar to the Roux-en-Y gastric bypass.

Surgical Options : The Adjustable Gastric Band

During the Adjustable Gastric Band procedure the surgeon implants two devices: a silicone band and an injection port. The silicone band is placed around the upper part of the stomach creating a small pouch that is still connected to the remaining chamber of the stomach. The injection port is attached to the abdominal wall, underneath the skin. Fluid is injected into the port to fill the band and create restriction. The fluid can be increased or lessened to an optimal point that helps to promote the sense of fullness. The Adjustable Gastric Band has been shown to help patients lose weight with resulting improvement in their blood pressure, cholesterol, and type 2 diabetes. It does not have a significant effect on metabolism.

Surgery - What to Expect

Most commonly, people that are motivated to continue with follow-up visits, lose the most weight, and actively participate in their treatment of other medical conditions have the greatest improvement in their quality of life.

Here are the expected results after the surgical procedures:

Excess Body Weight Loss
	3-months	6-months	12-months	18-months
Roux-en-Y Gastric Bypass	30-35%	45-50%	50-65%	65-70%
Sleeve Gastrectomy	25-30%	35-40%	50-60%	60-65%
Gastric Band	15%	22%	33%	40%
Excess Body Weight is the amount of weight over your ideal body weight. Your ideal body weight is based on your gender and height.  Please note that these are average responses and that you may see greater or lesser response.

Become a Patient Today!

Step 1: Attend a no obligation, FREE information seminar

Start Anytime: Click and Complete the Seminar On-line
Schedule a Time to Attend In-Person: Contact 716-565-3990 x 103

Step 2: Complete the registration packet and get it to our staff

If you completed the seminar on-line you may print the packet out at the end after taking a quiz. If you are attending the seminar in-person it will be mailed to you when you sign-up!
*Please contact 565-3990 if you have questions or need a registration packet mailed to you. 

Step 3: Await our office to contact you for an appointment with one of our surgeons

Once the registration packet has been received, our new patient coordinator, Melissa Benker will contact you to schedule an appointment with one of our surgeons.  In order for us to help you obtain a surgery date in the timeframe you desire, we highly recommend that you begin working on the health insurance plan and Synergy Bariatrics practice requirements for surgery approval.  These include:

A completed primary care physician documentation form for bariatric surgery approval (this can be found in your registration packet)

A thyroid laboratory test known as a TSH (Independent Health members only)

A pre-surgical psychological evaluation from a provider specialized in bariatric surgery (a list of providers in your area can be found in your registration packet)

Attend a nutrition class (Dr. Caruana hosts a FREE session at Synergy Bariatrics)

Attend the Fundamentals Workshops at Synergy Bariatrics (716-565-3991)

You MUST not be smoking cigarettes

Our surgeons and staff are here to help you through all steps in the process before and after surgery.
Please do not hesitate to contact us at 565-3990 with any questions.