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I spoke to their coordinator and she is lovely! Certified docs. Etc etc. But when I googled Bariatrics in Tijuana a few deaths popped up but it didn't disclose which exact establishment. The coordinator advised it def wasn't their location but I'm still nervous bc anyone can say whatever they want lol

I weigh 263 lbs. My BMI is 48.2 depending on who's BMI calculator you use. Whoa! That is INSANE! I've got to stop this madness. I attended a lap band seminar at Texas Gastric Banding on Tuesday 9/27/11. The surgeon is Dr. Richard Wilkenfeld, and surgery is done at True Results in Houston. I got a call on Thursday 9/29/11 from TR saying my insurance, CIGNA will approve my surgery based on the information they gave me, however there are things that need to be done. I will be required to have 6 months of weight loss counseling, 1 nutrition counseling, a psych exam, and a letter of necessity from my primary care physician. I also have a pre-existing condition clause that expires Oct 31st. So, I have my first counseling on Nov 1st at TR that will include a nutritionist session. I do have a copay plus some deductible, so I will be upping my medical flex deduction next year. I currently don't have diabetes, sleep apnea, or hypertension. I do have unmedicated high cholesterol and acid reflux that is treated with Prilosec OTC. I have medically diagnosed bone loss, what my last doc diagnosed as Osteopenia or pre-Osteoporosis. I do have painful knees and ankles, and I did break my ankle in a fall last December. This excess weight is not helping. The lap band is my choice, but I am hoping to combine it with gastric imbrication, referred to here as gastric plication. Problem #1: No primary care physician. I did get a couple of recommendations from the surgeon, and have checked and found two are in network with my insurance. So I will call them and see which one fits my needs best. Problem #2: My work insurance will renew, and I have all my fingers and toes crossed that they do not introduce an exclusion for bariatric surgery. If so, I'm toast. I am hoping this surgery will give me what I need to lift me up and defeat my weight problems and my food addiction. This forum, youtube videos, and this blog will be great support and great therapy. I am so looking forward to sharing my journey with y'all.

style="margin:0;padding:0;background-color:#d8dde8;color:#5a5a5a;font:normal 13px helvetica, arial, sans-serif;position:relative;"> Hey BariatricPal Members! I hope you are doing well and making progress towards your goals this fall! As the holiday season gets underway, it may be time to renew your commitment, remind yourself about your motivations, and fortify yourself with a few new strategies to get you through the season. We have it all in this newsletter! Just Getting Started with WLS? Quick Checklist Tips for Staying on Track This Holiday Season BariatricPal in the Community: Updates on Our Efforts! Get what you can from the newsletter, then come talk about it and whatever else is on your mind on the BariatricPal forums! You can find all kinds of inspiration, tips, and support for your stage of the WLS journey and type of WLS. Can’t wait to see you there! Sincerely, Alex Brecher Founder, BariatricPal Just Getting Started with WLS? Start Here! The beginning of the weight loss surgery journey can be a scary time. You have so many decisions to make about whether to get WLS, when to get it, who your surgery will be, and what type of WLS you want. You have a lot to learn about pre-op and post-op preparation, your pre-op and post-op diet, and changing your relationship with food. But you can do it! Here are a few items to consider as you move forward. Put Yourself in Good Hands The WLS journey is a lot easier when you start off on the right foot. That means finding a surgeon and healthcare team who are right for you. Your chances of success are higher when your surgeon has good success rates and your entire healthcare team provides the information you need to prepare for surgery and the rest of your life. Come Hang Out on BariatricPal What do you get when you join a community of hundreds of thousands of people just like you, who are interested in weight loss surgery? Answers to your questions from members who have been there, done that, and members who are going through it at the same time as you. Ideas about how you can make your journey easier, such as recipes, tips for eating out, and packing lists for the hospital. Recommendations about surgeons, bariatric vitamins, protein shakes, and pretty much anything else you could need on your WLS journey. Extra accountability if you choose to use free tools such as a weight tracker, photo gallery for before, after, and along-the-way pics, and a blog. Maybe it would be quicker to answer, “What don’t you get?!” Build Your Support System Aside from the BariatricPal community, who will be supporting you every day? You have an advantage if your family and friends are on board. They can help you by agreeing not to eat too much junk food in front of you and agreeing not to store it in the house; or by taking care of the children a couple of times a week while you hit the gym; or by lending you a shoulder to cry on if you have a down day. Neighbors and coworkers who are trying to lose weight can also be good candidates to be part of your day to day support network. Insure Nutrition We are always thrilled to welcome a new newsletter sponsor into the BariatricPal family, and this month, Insure Nutrition is giving us the pleasure of doing just that. Our latest sponsor, Insure Nutrition, is an online company that specializes in getting health insurance coverage for nutritional supplements. Its Post-Bariatric Surgery Nutrition products includes Premier Protein shakes in chocolate, vanilla, and strawberry flavors and OptiSource High Protein drinks in caramel and strawberry flavors. Checking if you are eligible is easy. Insure Nutrition encourages you to use its online form to find out if you qualify. Our sponsors help make BariatricPal newsletters and other services possible. We encourage you show your thanks by considering them first for your bariatric needs. Tips for Staying on Track This Holiday Season Time flies, and never faster than during the holiday season. If you have not already seen mounds of candy from Halloween, you will soon see all kinds of extra treats pop up everywhere as even more holidays approach. You can be sure that the temptations will not go away until people make their New Year’s Resolutions, so you had better have a plan for keeping your weight in check this season. Set Realistic Goals Weight loss is harder this time of year because of holiday parties, food gifts, family dinners, and treats that mysteriously show up in the office. It is not a sign of weakness to change your weight loss and eating goals during the holiday season. It is a sign of wisdom because you are accepting the circumstances and adjusting to them. You might want to adjust your goals to give yourself a little extra slack while still moving towards WLS success. For example: Postpone WLS until January if you are unable to stick to the liquid pre-op and post-op diets during this season. Change from weight loss to weight maintenance mode temporarily, or adjust your weight loss goals to be a little slower than you have been losing weight. Adopt a “tiny-tolerance” instead of a “zero-tolerance” policy when it comes to treats. Allowing yourself to have small bite of your favorite holiday treats guilt-free can help keep you from losing control and eating the entire pie. Arm Yourself with Healthy Alternatives You know temptations will be everywhere, so you can plan ahead to fight cravings. Just keep a few healthy favorites on hand so you can grab them instead of whatever diet disaster starts tempting you. For example… Protein Hot Chocolate Protein Brownies Nacho Cheese Protein Pasta Peanut Caramel Protein Puffs Make Life Easier for Yourself You are likely to be busier than ever as extra obligations such as gift shopping and spending time with family and friends come up. Don’t let lack of time get in the way of your weight loss! You can make sure that healthy meals and snacks are just minutes away by planning ahead. Use meal helpers such as bagged salad mixes and rotisserie chicken, and cook larger batches of healthy recipes on the weekend to use during the week. Have single-serve Protein Entrees and Protein Pasta Dishes to pop in the microwave for a low-calorie, high-protein meal in minutes. Have ready-to-eat snacks around so you can grab one instantly. Examples include whole and cut fruit, washed vegetables, nuts, hummus, hard-boiled eggs, yogurt, and grilled chicken breast, not to mention Protein Pretzels, Protein Bars, and Protein Chips. The BariatricPal Store can help you stock up on the the foods you need to stay happy and healthy this season. We guarantee lowest prices, and you can use coupon code BPNewsletter10 for a 10% discount off your entire first order! BariatricPal in the Community: Updates on Our Efforts! We’re always working on fighting obesity however we can, and this month started with a bang! We were at Obesity Week in New Orleans this October 31 through November 4. The event is sponsored by the American Society for Metabolic & Bariatric Surgery (ASMBS) and The Obesity Society (TOS), and the list of surgeons, other healthcare providers, and industry reps we met reads like a list of “who’s who” in bariatric care! BariatricPal is working to build all kinds of partnerships to improve our ability to fight obesity through weight loss surgery! BariatricPal was also a partner in National Obesity Care Week (NOCW), October 30 through November 5. The purpose of NOCW is to improve the quality of care in medical settings. We worked to increase awareness of obesity care by spreading the word however possible and by joining the TAKE5 challenge. If you missed NOCW, you can still do your part to advocate for better obesity care! Those are the major updates from recent times, along with a few tips to start you off properly this holiday season. For tons more tips and inspiration, just stop by BariatricPal whenever you are ready. We love having you spend time in the community! · Unsubscribe from all BariatricPal E-Mail.

Hello all, l'm having gastric sleeve surgery and I need help with reviewing the doctor that I'm go with he's Dr Green at Renew Bariatric in Tijuana Mexico...Thank you..

How to get reliable information whether or not Gastric Bypass Surgery is the best surgery for me? Does anyone have any information about Renew Bariatrics? Does anyone have Gastric Sleeve Surgery done in Renew Bariatrics? Would you recommend it to me? Does anyone know any reviews on Renew Bariatrics? Appreciating with thanks any replies to my questions.

Some people were asking about the negative study I found on lap band and here it is-- My Dr put me to ease though he was able to refute most of it with scientific data. This print is small hope you can read it! Dont know how to make it bigger but I will try! Jill Laparoscopic Adjustable Silicone Gastric Banding (LASGB or LAP-BAND):<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p> Recent advances in laparoscopy have renewed the interest in gastric banding techniques for the control of severe obesity. Laparoscopic adjustable silicone gastric banding (LASGB) using the adjustable LAP- BAND, has become an attractive method because it is minimally invasive and allows modulation of weight loss. The claimed advantage of LASGB is the adjustability of the band, which can be inflated or deflated percutaneously according to weight loss without altering the anatomy of the stomach. This method entails encircling the upper part of the stomach using bands made of synthetic materials, creating a small upper pouch that empties into the lower stomach through a narrow, non-stretchable stoma. The reduced capacity of the pouch and the restriction caused by the band diminish caloric intake, depending on important technical details, thus producing weight loss comparable to vertical gastroplasties, without the possibility of staple-line disruption and lesser incidence of infectious complications. However, distension of the pouch, slippage of the band and entrapment of the foreign material by the stomach have been described and are worrisome.<o:p></o:p> The published results of LASGB have been highly variable, perhaps reflecting surgeons' relative lack of experience with this new bariatric surgical procedure. Several studies have reported high rates of complications associated with gastric banding include those associated with the operative procedure, such as splenic injury, esophageal injury and wound infection, and those occurring later, such as band slippage, reservoir deflation/leak, persistent vomiting, failure to lose weight and acid reflux (see e.g., Gustaavson, et al. 2002; Victorzon and Tolonen, 2001; Holeczy, et al., 2001). In studies reported to the FDA, 89% of patients experienced at least one side effect. These included nausea and vomiting (51%), heartburn (34%), abdominal pain (27%), and band slippage or pouch enlargement (24%). Nine percent of patients needed to have another operation to correct a problem with the device. Twenty-five percent had their entire Lap-Band Systems removed, mostly because of adverse side effects. In about one-third of those patients, insufficient weight loss was also reported as a contributing factor to the decision to have the Lap-Band removed.<o:p></o:p> One of the claimed advantages of the LASGB procedure is its reversibility. Kellum (2003) noted, however, that “[t]he fact that two deaths in the FDA study occurred immediately following bend removal (one each from 'mixed drug intoxication' and multiple pulmonary embolism) suggest that secondary operations always carry significant risks.” <o:p></o:p> In addition, the long-term safety of LASGB is undetermined. Kellum (2003) notes that one of the reasons that surgeons may want to proceed cautiously before adopting LASGB is the concern about the long-term problems related to apposition of a foreign body with the gastrointestinal tract. “Older surgeons will recall the many reports of migration and erosion associated with the Angelchick prosthesis for the treatment of esophageal reflux.” Several recent reports have detailed problems with LASGB slippage and erosion (Holeczy, et al., 2001; Silecchia, et al., 2001). Gustavsson & Westling. (2002) provided one of the few reports on the long-term outcomes with LASGB, and concluded that this procedure “will not stand the test of time.” The investigators reported that, after a median follow-up of 7 years, 58% of the patients who had undergone LASGB had been reoperated on, almost always with excision of the banding system and conversion to Roux-en-Y gastric bypass (RYGBP). The reasons for reoperation were esophagitis, band erosion, pouch dilatation, leakage from the balloon, and esophageal dilatation. A lower incidence of band erosion has been reported with the so-called Swedish adjustable gastric band due to the relatively lower pressure exerted on the stomach (Ceelen, et al., 2003). The Swedish adjustable gastric band has not been approved by the U.S. food and Drug Administration, and is currently under investigation. Although the Swedish adjustable gastric band offers the possibility of significant technical improvements over LASGB, it still represents a purely restrictive operation like the vertical banded gastroplasty, which most U.S. surgeons have abandoned in recent years.<o:p></o:p> Because of the lack of direct comparative studies, the comparative efficacy of LASGB with established methods of obesity surgery is undetermined. In studies of laparoscopic adjustable silicone gastric banding reported to the FDA, the mean excess weight loss was 36.2% at 3 years. This figure contrasts with a 40-60% excess weight loss reported in other series of VBG and 50% for RYGB. (Maclean, et al., 1990; Willbanks, 1987; Melissas, et al., 1998) and 50% for gastric bypass (Griffen, et al., 1987; Pories, et al., 1995). Kellum (2003) notes that multiple reports have demonstrated the superiority of RYGB over VBG. Since LASGB, like VBG, is a purely restrictive operation, “one would expect that laparoscopic Roux-en-Y gastric bypass would yield superior long-term weight loss results when compared to laparoscopic Lap-Band placement.” Kellum (2003) cited the report of Belachew and Monami (1996) that concluded that LASGB had an identical weight loss curve to the open VBG performed by the same surgeons. Kellum (2003) concluded that “t is obvious that only a prospective, randomized series would definitively establish which operation is best in terms of safety and efficacy.” <o:p></o:p> Investigators from the Medical College of Virginia, one of the eight original U.S. centers performing LASGB, published their results. (Demaria, et al., 2001). The investigators “did not find LASGB to be an effective procedure for the surgical treatment of morbid obesity.” At the time of the report, LASGB devices had been removed in 41% patients, either because of inadequate weight loss or intolerable side effects. In 71% of patients with bands in place who underwent long-term evaluation, a significantly increased esophageal diameter developed; of these, 72% had prominent dysphagia, vomiting, or reflux symptoms. Of the patients who still had bands in place, more than one-third were reported to currently desire removal and conversion to RYGB for inadequate weight loss. About a third of the remaining patients have persistent severe obesity at least 2 years after surgery but refuse to undergo further surgery or claim to be satisfied with the results. Overall, only about 10% patients who underwent LASGB achieved a body-mass index of less than 35 and/or at least a 50% reduction in excess weight. The authors predicted that the overall need for band removal and conversion to RYGB in their series will ultimately exceed 50%. The researchers concluded that more study is required to determine the long-term efficacy of LASGB. <o:p></o:p> Reporting on the results of a systematic review of the published medical literature on obesity surgery, Gentileschi, et al. (2002) concluded that “the efficacy of [LASGB] cannot be determined because of poor evidence.” An assessment of the literature on obesity surgery conducted for the National Institute for Clinical Excellence concluded that LASGB is both more costly and less effective than RYGB for severe obesity (Clegg, et al., 2001). An assessment of LASGB by the Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S) concluded that the “[l]ong-term efficacy of laparoscopic gastric banding remains unproven and further evaluation by randomised controlled trials is recommended to define its merits relative to the comparator procedures” (Chapman, et al., 2002). The French National Agency for Accreditation and Evaluation in Health (ANAES, 2001) concluded that “n view of the inadequate long-term evaluation of either efficacy or inherent risk of gastroplasty rings (notably risks relating to how the prosthetic material is tolerated, and risk of migration of the ring into the stomach), the working group was concerned about the extensive and unevaluated diffusion of this technique which is currently taking place.” An assessment conducted by the BlueCross BlueShield Association Technology Evaluation Center (2003) stated that there is insufficient evidence to conclude that LASGB either improves net health outcomes or whether it is as beneficial as current established surgery, RYGB. “For laparoscopic gastric banding, the available evidence suggests that weight loss at one year is less than that achieved with gastric bypass. More limited evidence on three-year weight loss suggests that this difference in weight loss may lessen over time. Early adverse event rates are low following laparoscopic gastric banding, and are probably lower than gastric bypass. There is a higher rate of long-term adverse events, and there are a number of potentially serious long-term adverse events such as band slippage or erosion. The incidence of slippage of the device from its intended location, or erosion through the gastric wall increases over time, and can result in visceral organ damage, abdominal pain, and intestinal obstruction. The available data are not sufficient to determine the rates of these longer-term adverse events with confidence.” An assessment conducted by the Australian Medical Services Advisory Committee (2003) concluded that LASGB is as effective as VBG but less effective than RYGB in terms of weight loss. The Canadian Coordinating Office of Health Technology Assessment (CCOHTA, 2003) concluded that “[l]ong-term outcomes data on the effectiveness and safety of the laparoscopic adjustable gastric banding procedure is needed.” In a systematic review of the literature on LASGB, Chapman, et al. (2004) concluded “the long term efficacy of LB remains unproved, and evaluation by randomized controlled trials is recommended to define its merits relative to the comparator procedures.”<o:p></o:p> An assessment of LASGB prepared for the California Technology Assessment Forum (Tice, 2004) concluded that this technology did not meet CTAF criteria. Regarding comparisons of LASGB with other established bariatric surgical procedures, the assessment found:<o:p></o:p> Thus, the mean excess weight loss following open or laparoscopic ASGB appears to be roughly equivalent to vertical banded gastroplasty, but significantly less than Roux-en-Y gastric bypass. None of the comparative trials reported on reductions in co-morbidities. Additionally, in spite of lower peri-operative complications, there seem to be more, and more serious, late complications following ASGB. The lack of well controlled, randomized studies precludes any meaningful assessment of the strengths and weaknesses of LapBand compared with Roux-en-Y gastric bypass. Therefore, it cannot be concluded that LB improves net health outcomes as much as or more than established alternatives of roux-en-Y gastric bypass or vertically banded gastroplasty.<o:p></o:p> An evidence review completed by the Ontario Ministry of Health and Long-Term Care (2005) concluded that, “[r]egarding specific procedures, there is evidence that malabsorptive techniques are better than other banding techniques for weight loss and resolution of comorbid illnesses.”

And me checking in 6 months later. I am where you dream of when you start your journeys. I am finishing up my presurgical/liver shrinking diet. I have lost 15 pounds since August 1st almost a month ago. And next Wednesday September 5th 2018 at 7 AM EDT at,the Ohio State University Hospital- Wexner Medical Center with my Bariatric Surgeon Bradley J Needleman MD I will receive my RNY gastric bypass surgery. Am I excited? You bet I am, I scarcely can wait. But mote than the mere joy, I am deeply humbled. You see,reader, I was a person who things making it difficult to reach,,this day. You see I completed another facilities program twice and then they refused me my surgery. I had to seek another program, complete some facets for a third time, the saying is: The Third Time is the Charm, this is true except I worked very hard, many times thinking it was without hope, and I grew tired, oh so tired! You see I am 72 years old, far beyond the average age, my resilence isn't what it once was, some things do take longer, but i am stubborn, natural strawberry blonde hair, so red-head stubborn, I am dedicated, commuted and do believe in ME, in the rightness of what I am doing. . And I made it through, swamps, roadblocks and nay-sayers but I made it through. If you are reading and think Oh this is TOO HARD. yes it is HARD but it is so so worth it. And never think, oh it's TOO Late, I live as a witness it is NOT! Come join me, it is the JOURNEY OF YOUR LIFETIME, and a renewed life waits you afterward. If you have the dream, the desire, the commitment, YOUR FUTURE AWAITS

Very few pictures exist of me at my heaviest because I always used to avoid being in pictures. Have you ever noticed that a lot of people’s “before” pictures are from weddings (either their own or a part of someone else’s wedding party)? I’m guessing that’s because weddings are among the few times you can’t really refuse to be in pictures. I wish I had more “before” pictures so I can appreciate the difference. It’s certainly jarring to see how big I was. I got passport photos taken when I was at my heaviest (one of the only pictures I have of myself at that weight), but I didn’t get around to renewing my passport until several months later, after I had already lost a lot of weight, maybe 100 pounds, so I decided to get my passport photo retaken, and the side-by-side difference was striking. Well, I look at the SECOND passport photo now and compared to how I look currently (200 pounds down from my heaviest), the difference is incredible. One of the reasons I used to hate being in photos is that I pictured myself as a lot smaller than I was, so seeing myself in pictures forced me to see how big I really was. What’s weird is that now I picture myself as being bigger than I actually am, so seeing myself in photos now is also surprising, but in the opposite way. There’s not that big of a difference between the way I imagine myself now vs. how I imagined myself at my heaviest, even though in reality, I look like a completely different person. The last time I went to my surgeon for a follow-up, the nurse called me back and looked confused when I got up and walked over. She kept looking back and forth between me and my chart and then asked me to verify my date of birth, because my chart had my picture from my initial consultation and she couldn’t see the resemblance. And this is someone who works in a bariatric surgery practice, so it’s not like she doesn’t often see people who have lost a lot of weight!

Here I am so EXCITED and positive and renewed and hopeful... NOW a phone call from the financial counselor - Just got shot down from my cloud by the bariatric clinic saying my surgery has to be converted to self-pay (which I can't afford in four days) or wait several months to be covered. They just don't trust that the "pre-approval" from my insurance is good enough. They think it won't be covered. How dare they!!! NOT FAIR...NOT FAIR...AND JUST TOTALLY MEAN!!! We went back and forth with this place for weeks, had numerous conference calls with the insurance company to get everything taken care of and everyone happy and made SURE it was covered and all going to be fine. The clinic called and told me it was APPROVED, then called and scheduled my surgery for June 4th. My husband had to get vacation time approved. I had to get vacation time approved. Told my family and got all my stuff in order. Ready to start my pre-op diet Sunday. So, I'm shot down and on the ground ~~ but I'll get back up. I'll go forward because I CANNOT GIVE UP! This is a fight and I'm worth it. All this opposition will not knock me down forever. I may not be posting much on this forum for a few days.. (well, at least a little while as I lick my wounds)... but I'll be back. So to all those I joined with to be "June sleeve siblings" and the posts I've made about my surgery being soon... well, never mind. It'll happen, but not likely as soon as I was told and hoping. I'm so sad at the moment.

Hey, BariatricPal Members! Happy Father’s Day! Whether you’re a father, grandfather, son, or someone who has a father in the house, today is your chance to honor the dads in your life. With the tips in this letter, you can Celebrate Father’s Day properly while staying on track. We bet you can even finish the day stronger than you started! Here’s what we have in this newsletter. Renew Your Commitment by Thinking about Dad Today Father’s Day Celebration – Bariatric Style! Is It Time for…”The Talk?” Eat Healthy at the Ballpark! We hope the newsletter gives you a chance to think about the dads in your life, and helps you figure out how you can work to keep everyone healthier together. When you have finished reading the newsletter and you’ve gotten in plenty of high-quality family time, come on over to visit your other “family” at BariatricPal. Happy Father’s Day! Sincerely, Alex Brecher Founder, BariatricPal Renew Your Commitment by Thinking about Dad Today It’s easy to get lost in the regular pattern of daily life. Your actions can almost become automatic as you go through your day. Over time, you might start to lose focus and let some poorer choices slip in. You might eyeball instead of measure your food, let a few bites sneak in without recording them, or go for a little more starch than you know you should. It is normal to become a little less focused on your weight loss surgery after a while if you do not occasionally stop to reconsider your motivations. Father’s Day provides a good opportunity for you to renew your commitment to your weight loss journey. Think about your own father, or a father figure in your life, who gave or gives you unconditional love. How proud would your father be if you set this goal of losing weight and you were able to achieve it? How relieved would your father be to see his son or daughter gain back health and energy? If you are a father – or a parent, or a father figure to anyone – think about the children that you influence. Every day you strive to be the best role model that you can be, and these efforts really pay off! Also consider how your relationships have the potential to become even stronger throughout your weight loss journey. You might have more energy to play with your children. You can teach them healthy habits for life by modeling them. Your children do not need to worry about your health. Dedicating the next stage of your weight loss journey to the fathers and children in your life can help spur you on. Father’s Day Celebration – BariatricPal Style! Father’s Day can be disastrous if it includes a big lunch at a restaurant followed by some down time as you watch television and snack. You’re not doing your dad or yourself any favors by celebrating that way, and you can make the day just as special by making a few healthy changes. Keep Lunch Simple If you want to go out for lunch, skip the buffet. Just order a salad with tuna or grilled chicken, or grilled chicken breast or broiled fish with steamed vegetables on the side. A fruit plate with cottage cheese or yogurt is another option. If a buffet is a Father’s Day tradition in your family, remember that you are not obligated to overeat to get your money’s worth. It is worth far more to enjoy one plate of healthy food and feel proud of yourself for the rest of the day. If you’re eating at home, make sure there is plenty of lean Protein around. Grill chicken breast, turkey burger, or shrimp and serve it with a tossed green salad and some fruit. You don’t need to dig into the bread, coleslaw, and cake as long as you have your own healthy options. Burn a Few Calories Keep the party going by getting moving. Toss around a football, bump a volleyball, or kick around a soccer ball. It doesn’t matter if you’re clumsy. The point is to have fun and remember what it’s like to get moving with your family. The games can inspire you to resolve to lose more weight so that you can enjoy many more moments like this in the future. Is It Time for…”The Talk?” Father’s Day is about relationships. You might want to take some time to strengthen your relationship with your father if he is not yet completely up-to-date on your surgery. Weight loss surgery is a huge part of your life, and today, you can consider having a serious conversation with your father to help him understand a bit more about it. You might talk about the following items, depending on what he already knows and how he feels about your surgery. Why you felt that surgery was best for you. How surgery helps you lose weight, and what you need to do to make sure it works. How your dad can help, whether that means being a sympathetic ear on the telephone or looking after your children for an hour on weekends so that you can work out with your spouse. If you are a parent and are on the weight loss surgery journey, talk to your child about the surgery in terms he or she can understand. You can address the same points as above, but keep them simpler. You might explain that you are trying to get healthy and make sure that your child grows up strong and healthy, and that sometimes you may need your child to help with the chores if you are a little tired. Eat Healthy at the Ballpark “Take me out to the ballgame, Take me out to the crowd. Buy me some peanuts (510 calories) and Cracker Jack (480 calories). I don’t care if I get way off track!” Oh, wait. Yes, I do care! So what can you eat when you go to the game? Most of the traditional options are high-calorie and fatty, sugary or starchy. If you munch on them for nine innings, you can take in thousands of calories and will likely feel sick. Avoid these choices. Nachos and cheese pretzels with or without cheese Ice cream Buttered popcorn pizza Hot dogs, corn dogs French fries Many stadiums now offer healthier options than they used to. Check online before you leave home to see if you can plan a healthy meal or snack at the stadium. Green salads with chicken Hummus with vegetables Veggie burgers or hot dogs (skip the bun) Fresh fruit cup Vegetables with dip If your ballpark doesn’t have many healthy choices, you can still get away by modifying some of the traditional choices. Just stick to your weight loss surgery diet rules of choosing protein first and watching your portion sizes. Order a burger and just eat the beef, grilled chicken, or veggie patty, not the bun. Ask for a cup of shaved ice without snow cone syrup. It gives you something to do. Get a bag of peanuts, count out one serving, and put the rest away. Whether you go to a baseball game, another sporting event, or a show, the goals are to enjoy the event and the company. Focus on the great things about the day instead of worrying about the food that you used to eat. If you plan ahead and go in with a positive attitude, you might find that you have even more fun than you used to! No matter how you choose to spend your Father’s Day, consider how you can make it a healthy holiday that is fun for everyone. We hope this newsletter gave you some good ideas and inspiration!

The Doc: “What made you decide to have Weight Loss Surgery at this particular time in your life?” I ask every patient I see for a pre-surgical psychological evaluation. The responses to this question nearly always revolve around health. “I want to get off so many medications.” “I need to get rid of this diabetes.” “I want to be healthy enough to see my children/grandkids grow up.” “I want to be able to do things I can’t now because of my weight.” “I want to be healthy enough to walk/go places with my family/ride amusement park rides/not have to use a seat belt extender on an airplane.” The vast majority of the time, when people make the decision to have weight loss surgery, their health has become an issue that interferes in their quality of life. Sure, some people are interested in the benefits of being able to wear smaller clothing, many are interested in being less discriminated against, and most are enthusiastic about seeing the scale show a much lower number. It is safe, however, from my experience of having completed over 3000 pre-surgical evaluations, to summarize people’s reasons for wanting to have weight loss as being 1) seeking improved health and 2) seeking an improved quality of life. The Post Op: All I know is, by the time I dragged my size 30 behind into the doctor’s office to talk about getting the weight off, I was sick…and I was tired…and I was sick and tired of being sick and tired. It sounds trite, but it was true. My obesity was mentally, physically and emotionally exhausting, and every day represented weight gained and battles lost. At 320 pounds, I was Alice, and I’d been stuck down the rabbit hole of obesity and poor health for so long, I was willing to do anything to get out – yes, even take a swig from that bottle on the table with the “drink me” tag. In my mind, weight loss surgery was a magic potion and I was about to get really small. I didn’t know how it would feel when I got there, but I knew I’d be set free. I believed my life would get better and I’d be healthier if I could just get…smaller. The Doc: Fast-forward two years after surgery. The weight has melted off! The scale, of, course, never seems to reflect a low enough number. No matter – people are taking many fewer medications than they had to prior to surgery. And they are riding roller coasters and Ferris wheels and they are going on airplanes and not needing seatbelt extenders. They are going bike riding and hiking and playing with their children and grandkids like they have dreamed of doing. In other words, the majority of post-ops at around the two-year mark, do have improved health and do have a better quality of life. The Post Op: Losing large amounts of weight in a short period of time really messes with your head. One day, you’re buying double-digit stretchy pants and tops in the plus-size section, and the next, you’re venturing into the foreign world of single-digit labels on non-spandex jeans and fitted suits. Yesterday, you couldn’t find a single “before” photo but today you’ve got a thousand “after selfies” and attention from people you aren’t even sure you like. It’s exciting and new… and confusing… Somewhere along the way, you lost the plot, stopped focusing on your health and started focusing on your image. Like so many post-ops, you’ve learned that losing weight doesn’t guarantee happiness, hopefulness or health. So, with that said, can you refocus your focus and choose to live in Recovery From Obesity? What do you think, Doc? The Doc: It’s been really interesting observing the journey of post-ops, two of whom are my closest friends. After the initial weight loss and the joys of experiencing many of the NSV’s (non-scale victories, on the off chance you don’t know what NSV stands for, many people start whingeing (pronounced win – jing), a term the Post Op and I learned on our trip to work with bariatric folks in New Zealand. It means whining! “I don’t want to exercise.” “I’m tired of restricting myself.” “But sometimes I just need chocolate.” And then there’s the gossiping. “Have you seen so-and-so? She’s regained so much weight.” “Do you think I look smaller that that woman?” And, of course, there’s a continued? new? renewed? obsession with numbers! ““If I could only fit into a size smaller.” “Just ten more pounds and I would be satisfied. Really.” And what I actually find the saddest is the addiction to food… “I watch all of the shows on the Food Network.” “Look at the ‘bad’ food I ate… I posted it on Facebook!” My, how the focus changes! No longer do people seem to remember the reasons they had surgery… they appear to overlook the fact that their health is improved and the quality of their lives is vastly improved. All of a sudden the numbers on the scale, the size of the clothing and how they compare in size to other people are the focus. And maybe the saddest part from my perspective is that no matter how much weight they’ve lost, so many people are dissatisfied. They either want to lose more weight, hate their body just as much as before weight loss, or find some other thing(s) to focus on that were never mentioned as being important prior to surgery. The Post Op: I’ve seen this play out a thousand times, Doc, and it makes me so sad to realize that many people who desperately want to be free from the prison of obesity actually imprison themselves by the tyranny of numbers, the scale and their clothing size! As you sagely point out, far from living a life in Recovery, many post-ops lose sight of what they said matters most and focus on the food, the food and the food! You call it an unhealthy obsession – I call it addiction, but either way, it’s not the goal of life after weight loss surgery…at least, not in my book. What’s missing from the equation? The Doc: Where’s the gratitude? Somehow, the life-saving, life-enhancing weight loss surgery that was done to improve one’s health and improve their quality of life, and that DID exactly those things, often morphs into what we believe are simply manifestations of that same disease of obesity. Because, as Cari often points out, “obesity is all about the food but not at all about the food.” And she’s right! Obesity includes a mindset, an attitude, an obsessiveness on food, size, and weight. Perhaps most tragically, there is a self-defeating component that lives on when one becomes obsessed with their eating, their weight, their sizes and/or what others are eating, what others weigh and what size others are wearing. Again, I ask, “Where’s the gratitude?” The Post Op: In my case, genuine gratitude was a mystery. I mean, I’d spent a lifetime focusing on my compromised health, physical limitations, poor quality of life, disappointments, shame and failures. Clearly, going to the doctor wasn’t a reason to celebrate, because I believed I’d be “blamed” for my condition, then blithely be told to “move more and eat less.” And I know I’m not alone – I talk to many post-ops who share my misunderstanding about the power of gratitude and the importance of practicing it in everyday recovery. Of course, when the focus is on the negative, it doesn’t even occur to you to consider something positive! Maybe that’s why I view gratitude as the unsung gift of Recovery and work hard to work on it every day. The Doc: Maintaining what is commonly referred to as “an attitude of gratitude” can have a positive overall affect on your life. By focusing on the ways your health has improved, you feel pleased and grateful for the changes in your life, regardless of the weight your body has settled at. Focusing on the ways the quality of your life has improved after weight loss results in being grateful for being able to participate more actively and fully in your own life! Take the time and literally make a list of the things your weight loss has resulted in regarding your health and quality of your life. The Post Op: I get it. Lists are usually filled with work you have to accomplish before the day ends (things to do today), or before you die (bucket list), but they aren’t usually things you look at to feel good. I say it’s time to change that paradigm and start making lists of things you’ve already done (or, get to look forward to!) Your gratitude list doesn’t have to be a thing of literary genius (which means it doesn’t have to rhyme, be written in haiku or iambic pentameter, and doesn’t even have to include complete sentences!) Your list can include positive words, pictures, names of people you love – whatever – but it has to be a real list…so why not start now by considering some of the things The Doc mentioned? In case you’re wondering my list starts like this: 1. I’m eternally grateful for the opportunity to work with an amazing and compassionate friend to help others find the joy of Recovery From Obesity. How about you? ACTION STEP: Download a GRATITUDE APP (any one will do) for your smart phone and make a practice of typing in a minimum of three things each day that represent your improved health and/or the improvements in your quality of life. If you’re open to it, you will experience an overall improvement in your daily attitude.

The Doc: Fast-forward two years after surgery. The weight has melted off! The scale, of, course, never seems to reflect a low enough number. No matter – people are taking many fewer medications than they had to prior to surgery. And they are riding roller coasters and Ferris wheels and they are going on airplanes and not needing seatbelt extenders. They are going bike riding and hiking and playing with their children and grandkids like they have dreamed of doing. In other words, the majority of post-ops at around the two-year mark, do have improved health and do have a better quality of life. The Post Op: Losing large amounts of weight in a short period of time really messes with your head. One day, you’re buying double-digit stretchy pants and tops in the plus-size section, and the next, you’re venturing into the foreign world of single-digit labels on non-spandex jeans and fitted suits. Yesterday, you couldn’t find a single “before” photo but today you’ve got a thousand “after selfies” and attention from people you aren’t even sure you like. It’s exciting and new… and confusing… Somewhere along the way, you lost the plot, stopped focusing on your health and started focusing on your image. Like so many post-ops, you’ve learned that losing weight doesn’t guarantee happiness, hopefulness or health. So, with that said, can you refocus your focus and choose to live in Recovery From Obesity? What do you think, Doc? The Doc: It’s been really interesting observing the journey of post-ops, two of whom are my closest friends. After the initial weight loss and the joys of experiencing many of the NSV’s (non-scale victories, on the off chance you don’t know what NSV stands for, many people start whingeing (pronounced win – jing), a term the Post Op and I learned on our trip to work with bariatric folks in New Zealand. It means whining! “I don’t want to exercise.” “I’m tired of restricting myself.” “But sometimes I just need chocolate.” And then there’s the gossiping. “Have you seen so-and-so? She’s regained so much weight.” “Do you think I look smaller that that woman?” And, of course, there’s a continued? new? renewed? obsession with numbers! ““If I could only fit into a size smaller.” “Just ten more pounds and I would be satisfied. Really.” And what I actually find the saddest is the addiction to food… “I watch all of the shows on the Food Network.” “Look at the ‘bad’ food I ate… I posted it on Facebook!” My, how the focus changes! No longer do people seem to remember the reasons they had surgery… they appear to overlook the fact that their health is improved and the quality of their lives is vastly improved. All of a sudden the numbers on the scale, the size of the clothing and how they compare in size to other people are the focus. And maybe the saddest part from my perspective is that no matter how much weight they’ve lost, so many people are dissatisfied. They either want to lose more weight, hate their body just as much as before weight loss, or find some other thing(s) to focus on that were never mentioned as being important prior to surgery. The Post Op: I’ve seen this play out a thousand times, Doc, and it makes me so sad to realize that many people who desperately want to be free from the prison of obesity actually imprison themselves by the tyranny of numbers, the scale and their clothing size! As you sagely point out, far from living a life in Recovery, many post-ops lose sight of what they said matters most and focus on the food, the food and the food! You call it an unhealthy obsession – I call it addiction, but either way, it’s not the goal of life after weight loss surgery…at least, not in my book. What’s missing from the equation? The Doc: Where’s the gratitude? Somehow, the life-saving, life-enhancing weight loss surgery that was done to improve one’s health and improve their quality of life, and that DID exactly those things, often morphs into what we believe are simply manifestations of that same disease of obesity. Because, as Cari often points out, “obesity is all about the food but not at all about the food.” And she’s right! Obesity includes a mindset, an attitude, an obsessiveness on food, size, and weight. Perhaps most tragically, there is a self-defeating component that lives on when one becomes obsessed with their eating, their weight, their sizes and/or what others are eating, what others weigh and what size others are wearing. Again, I ask, “Where’s the gratitude?” The Post Op: In my case, genuine gratitude was a mystery. I mean, I’d spent a lifetime focusing on my compromised health, physical limitations, poor quality of life, disappointments, shame and failures. Clearly, going to the doctor wasn’t a reason to celebrate, because I believed I’d be “blamed” for my condition, then blithely be told to “move more and eat less.” And I know I’m not alone – I talk to many post-ops who share my misunderstanding about the power of gratitude and the importance of practicing it in everyday recovery. Of course, when the focus is on the negative, it doesn’t even occur to you to consider something positive! Maybe that’s why I view gratitude as the unsung gift of Recovery and work hard to work on it every day. The Doc: Maintaining what is commonly referred to as “an attitude of gratitude” can have a positive overall affect on your life. By focusing on the ways your health has improved, you feel pleased and grateful for the changes in your life, regardless of the weight your body has settled at. Focusing on the ways the quality of your life has improved after weight loss results in being grateful for being able to participate more actively and fully in your own life! Take the time and literally make a list of the things your weight loss has resulted in regarding your health and quality of your life. The Post Op: I get it. Lists are usually filled with work you have to accomplish before the day ends (things to do today), or before you die (bucket list), but they aren’t usually things you look at to feel good. I say it’s time to change that paradigm and start making lists of things you’ve already done (or, get to look forward to!) Your gratitude list doesn’t have to be a thing of literary genius (which means it doesn’t have to rhyme, be written in haiku or iambic pentameter, and doesn’t even have to include complete sentences!) Your list can include positive words, pictures, names of people you love – whatever – but it has to be a real list…so why not start now by considering some of the things The Doc mentioned? In case you’re wondering my list starts like this: 1. I’m eternally grateful for the opportunity to work with an amazing and compassionate friend to help others find the joy of Recovery From Obesity. How about you? ACTION STEP: Download a GRATITUDE APP (any one will do) for your smart phone and make a practice of typing in a minimum of three things each day that represent your improved health and/or the improvements in your quality of life. If you’re open to it, you will experience an overall improvement in your daily attitude.

Andi: You are NOT a failure. You HAVE lost 15 pounds and not gained them back. I agree with getting the book "Weight Loss for Dummies". It is a book that I still refer to at least weekly. Another good one is "Lap-Band for Life". Both these books will help you make wise choices, and review the band "guildlines" with you. It sounds like you are doing many things I have been doing lately, big bites, not chewing, PBing often, blah, blah, blah. I just posed on another thread that this past Sunday I started coughing up "coffee grounds" looking stuff. Talk about scared s*itless! Well after doing some research I concluded that I had irritated my esophugus more than ever and had probably broken a few blood vessels. Sunday evening I put myself back on thin purees and am feeling so much better. The hunger I had been feeling over the past month, while gorging myself, is also gone. Don't let yourself get to this point. If you are hurting or even feeling uncomfortable when you eat, change what you are doing. You can not tell me you enjoy eating when you feel like crap. Here are my suggestions: 1) Get to your doctor for a fill. If they don't want to give you a fill, find another doctor. When I think I need a fill, I call my doc, and get in within a few days, explain why I feel I need a fill, and then get one. No one at my doctors office ever questions why I haven't lost more weight, etc. I have been banded 6 months now and have had three fills. Fills are NOT a bad thing and are another part of the tool we much manage. 2) Once you get the fill, follow the EXACT post fill diet (liquids, purees, mushies, what ever it is). This will help you get back on track. 3) Sit down and reevaluate why you originally got the band. What your goals are and how you are going to acheive them. Make a renewed committment to yourself and your band to continue this weight loss journey. We all mess up at times and need some guideance. 4) See a counselor if you are getting extreamly discouraged/depressed and don't think you can do this on your own. There are counselors out there that work strickly with bariatric patients. You have done a great job by coming to LBT to talk about your difficulties. That is what we are here for. Good Luck!

From Bariatric Times... (http://bariatrictimes.com/2008/09/19/the-latest-on-nutrition-and-hair-loss-in-the-bariatric-patient/) Iron Iron is the single nutrient most highly correlated with hair loss. The correlation between non-anemic iron deficiency and hair loss was first described in the early 1960s, although little to no follow-up research was conducted until this decade. While new research is conflicted as to the significance of ferritin as a diagnostic tool in hair loss, it has still been found that a significant number of people with telogen effluvium respond to iron therapy. Optimal iron levels for hair health have not been established, although there is some good evidence that a ferritin level below 40mg/L is highly associated with hair loss in women.1 It is worth noting that this is well above the level that is considered to be anemic, so doctors would not be expected to see this as a deficiency. Zinc Zinc deficiency has been tied to hair loss in both animal studies and human cases. There is data linking zinc deficiency in humans to both telogen effluvium and immune-mediated hair loss. Zinc deficiency is a well-recognized problem after biliopancreatic diversion/duodenal switch, and there is some indication that it may occur with other procedures such as gastric bypass and adjustable gastric banding. In 1996, a group of researchers chose to study high-dose zinc supplementation as a therapeutic agent for related hair loss2 in patients who had undergone vertical banded gastroplasty. The study administered 200mg of zinc sulfate (45mg elemental zinc) three times daily to postoperative patients with hair loss. This was in addition to the Multivitamin and iron supplements that patients were already taking. No labs for zinc or other nutrients were conducted. Researchers found that in patients taking the zinc, 100 percent had cessation of hair loss after six months. They then stopped the zinc. In five patients, hair loss resumed after zinc was stopped, and was arrested again with renewed supplementation. It is important to note that in telogen effluvium of non-nutritional origin, hair loss would be expected to stop normally within six months. Since the researchers conducted no laboratory studies and there was no control group, the only patients of interest here are those who began to lose hair again after stopping zinc. Thus, we cannot definitively say that zinc would prevent hair loss after weight loss surgery, and further study would definitely be needed to make this connection. A further note: The tolerable upper intake level (UL) for zinc is set at 40mg in adults. This study utilized a daily dose of more than three times that level. Not only can these levels cause gastrointestinal distress, but chronic toxicity (mostly associated with copper depletion) can start at levels of 60mg/day. Information related to this study has made its way to many a support group and chat room—even to doctor’s offices—with the message that “high-dose zinc will prevent hair loss after weight loss surgery.” Patients should be advised that high-dose zinc therapy is unproven and should only be done under supervision due to the associated risks of toxicity. A lab test to check for zinc deficiency would be best before giving a high dose such as this. Protein Low protein intake is associated with hair loss. Protein malnutrition has been reported with duodenal switch, and in gastric bypass to a much lesser degree. Little is known about incidence, as only around eight percent of surgeons track labs such as total protein, albumen, or prealbumen.3 Limited studies suggest that patients with the most rapid or greatest amounts of weight loss are at greatest risk.4 With surgical reduction of the stomach, hydrochloric acid,5 pepsinogen, and normal churning are all significantly reduced or eliminated. Furthermore, pancreatic enzymes that would also aid in protein digestion are redirected to a lower part of the small intestine. It is thus likely that maldigestion rather than malabsorption is responsible for many cases. Some studies have also implicated low protein intake.6 Research also indicates that low levels of the amino acid l-lysine can contribute to hair loss and that repletion of lysine stores may both improve iron status and hair regrowth. In a study of anemic patients with hair loss who were supplemented with 1.5 to 2g of l-lysine in addition to their iron therapy, ferritin levels increased more substantially over iron therapy alone.1 Biotin Many individuals believe that supplementing with, or topically applying, the nutrient biotin will either help to prevent hair loss or will improve hair regrowth. To date, there is no science that would support either of these presumptions. While biotin deficiency can cause dermatitis, hair loss is only known to occur in experimentally induced states in animal models or in extreme cases of prolonged diets composed exclusively of egg whites.7 Other Other nutrients associated with hair health include Vitamin A, inositol, folate, B6, and essential fatty acids. Hair loss can also be caused by systemic diseases, including thyroid disease and polycystic ovarian syndrome (PCOS), and is influenced by genetics. Conclusions Hair loss can be distressing to bariatric surgery patients, and many will try nutrition themselves to see if they can prevent it. Unfortunately, there is little evidence that early hair loss is preventable because it is most likely caused by surgery and rapid weight loss. Later hair loss, however, can be indicative of a nutritional problem, especially iron deficiency, and may be a clinically useful sign. Educating patients about the potential for hair loss and possible underlying causes can help them to make informed choices and avoid wasting money on gimmicks that may have little real value.

I am in the same boat you are in. My doctor on Monday, however, hinted that HPN's PPO service (Sierra Health of NV) "MAY" begin to cover more of the bariatric procedures after October. He said to call around and check in October when the renewals start. He quoted anywhere from "2500-6000" out of pocket. Compared to the 11K that it is now, it is definitely more doable. Good luck!! I will definitely let those on here know when I know more!! In the mean time, I'm going to start saving some cash!!

I meant renew bariatrics also Dr. Jaime Ponce de Leon does it. Dr. Ponce is well know for his expertise. I don't know who does it at renew bariatrics. Hope this helps other's if not you, even though my reply is years later. Hope you found a great Dr. Sent from my SM-G991U1 using BariatricPal mobile app

Well, how did you do? One of the biggest "foodie" holidays of the year just passed us by, which can be a MAJOR trigger for those who struggle with food addiction. If you're one of the lucky few, who is able to look back over the holiday proudly, and say "there is nothing I would have changed," then congratulations! I am genuinely interested in reading your comments below about what worked for you; did you remove yourself from the triggering environments, distract yourself by playing a card game or talking with another family member trying to do the same, did you re-read your bariatric surgery "why's," to reinforce your motivation that day, or was there something else that worked to keep you on track? "It's not how we fall. It's how we get back up again." - Patrick Ness For those of you who are shaking your head in regret this morning, you are not alone. There are thousands of other WLS patients who struggled to stay on track over the holidays. The biggest struggle I've hear throughout the years is that the motivation is dented, diluted, or zapped when one first gets off track from their plan. Enter code CYBERSALE to get my Full From Within Psychological Tools for WLS patients course 50% off today only. There is a lot of psychology behind this. Part of the magic in resolutions is their novelty: an implicit contract within the self that says "this will be unlike anything I've ever done before." When we relapse (or "slip" as I prefer to call it), the self goes "oh wait a minute, I know how this goes, maybe this is no different than before, who am I to think I could do this, I have no willpower, etc., etc., etc." So the idea is to find a new plan. It can be bits and bobs of the one you had before, but it needs to have that new car smell again to have longevity. I am including an excerpt of an earlier article I wrote about how to do just that: What do we do when we fall from grace? The research on relapse (with any addiction; food, drugs, alcohol) is that recidivism is the rule not the exception. So why do we get so down on ourselves when we fall short of our goals? Why is it so hard to get back on the horse with the same vigor we had when we started? And how do we give ourselves a renewed sense of hope and motivation for change once we've fallen? “The secret of change is to focus all of your energy not on fighting the old, but on building the new.” - Socrates Everyone does well out of the gates. We all impress ourselves when we start, what we believe to be, a new lifestyle change. However, "out of the gates," can mean different things for different people; for some it is two months, for others (usually depending on how strong the addiction or habit is) it can be two minutes. But what do we do when we fall from grace? The research on relapse (with any addiction; food, drugs, alcohol) is that recidivism is the rule not the exception. So why do we get so down on ourselves when we fall short of our goals? Why is it so hard to get back on the horse with the same vigor we had when we started? And how do we give ourselves a renewed sense of hope and motivation for change once we've fallen? One magical ingredient in the secret sauce (and one of many concepts I talk about in my book and my wls courses) that is lifestyle change is the novelty effect. The new plan to quit something or change a bad habit is something unlike we have ever done before, so we hope that we can achieve something we have never done before. The problem is that the moment we slip, that novelty loses its magic - and each time we start over, it loses its power to give us hope. So the solution is to cultivate more novelty. Our ability to continually grow and change is largely limited by our creativity. The more creative we become, the easier it is to take a different approach to change. To open a window when life seems to shut the door. In other words- what I am telling you, is that the only secret to long term weight loss maintenance is the knowledge that there isn't only one secret. There is no ONE diet that will forever change someone. Eventually people get tired of eating bacon and eggs every meal on Atkins, or grapefruit, or cabbage soup- but the thread they all share is their novelty. This is why all of them can work initially. Even as powerful as weight loss surgery is- people still find that they start to plateau or even gain the weight back if they aren't simultaneously addressing the behavioral and psychological factors that got them there in the first place. They too, must also continuously be creative about renewing one self throughout their lifetime. So the following is for all of you who are struggling today. Those that feel they have lost their way and perhaps feel disenchanted or disappointed. Below is a recovery "map" I created a long time ago for my clients, some struggling with substance abuse, others with food. It all works the same. Print it out, or copy and paste it in the notes section of your phone and take 20 minutes to fill it out with the things that are personally meaningful for you. This is not THE answer to long term recovery from addiction, but it is a fresh approach for many who feel stale at the moment: Baptism - Some ceremony to signal a renewed sense of hope and a fresh start. One client trying to recover from substance abuse, buried all of his wine and liquor bottles in his yard. Another client had a "garbage party" with her kiddos, and they loved smashing all the processed foods they had in their pantry and throwing them in the trash. Associations/triggers list all of the things that get you into trouble (being at a bbq, wanting to Celebrate something, holidays, 7-10pm at night, date night, etc) Coping Skills (what gets you through the crave waves) These are the behaviors that you do INSTEAD of the addictive behavior. Extra credit if you are able to make a coping skill for each trigger listed above. Enter code CYBERSALE to get my Full From Within Psychological Tools for WLS patients course 50% off today only. Higher Desires/Vision of Self when you let go of your attachment to food and all the self loathing, mental, and physical heaviness it brings- what are you freeing your life up for? will you write a book? will you do more outdoor activities with your kids? do you want to resume an activity you once loved as a child? Is there a role model that inspires you that has done what you want to do? Cons Why are you doing this in the first place? These are the things that are hard to keep in mind when our reptilian mid brain (see last article) is at the wheel. What is personally meaningful? Does it age you? Does it make you feel out of control? Do you dread going on airplanes because you know you'll need an extender? does it prevent you from going to amusement parks with your kiddos? Spirituality (religion gets us into heaven, spirituality gets us out of hell) All addiction is what disconnects us from our deeper self and edges us further and further away from God (or whatever you like to call it) and our deeper spirituality. Spirituality is what allows us to move into the unknown, be comfortable with discomfort, and have faith that everything will be ok. It can include a gratitude practice, volunteering, play, aligning one self with nature, connecting with a spiritual e newsletter (mind body green, daily om, etc), generosity, etc. Daily Recovery Ritual (symbolic gesture to self every day that we are consciously devoting time to our recovery) What are the things you can do daily to symbolize to yourself that today is a new day? Keep it realistic or you won't do it. Vitamins, meditation, lemon Water, supplements, self care, reaching out to a loved one, exercise, etc. Reward System What will you do for yourself if there is a certain period of time reached where you meet your goals? Will you get a massage at the end of every month? Will you plan a vacation after three months of solid goal hitting? Will you reward yourself with one day per week of going to the movies in the middle of the day and playing hooky if you're on the straight and narrow for five days? Strategy This is your "what." What are you doing daily to ensure that you are in alignment with your goals? Are you reading something fresh all the time? Do you make a timeline of your addiction and how it has affected your life? Do you go to local support meetings each week? Do you keep in touch with an online community? Do you make sure to give yourself small breaks while with the kids every day? Do you have a self care space set up in your house? Do you talk to a partner about how to change behaviors of theirs that might be hindering your efforts? can they get a mini fridge? Do you do acupuncture to balance your chi? Do you do yoga to manage your depression? Do you find a therapist? Recovery Resources (try to hit one each morning) what resources are in your pocket when you are feeling weak? bariatricpal.com? WLS journeys on Instagram? The Fix, Reddit, unique blogs documenting their weight loss journey, wls and vsg searches on Pinterest, etc. Good luck on your fresh start! Need extra motivation? Use code "CYBERSALE" to get my course: Full From Within Ultimate Psychological Tools for WLS patients half off today only, or try my FFW mini for free.

Are you pre-op or post-op? Protein intake following surgery is quite important for a whole list of reasons. Perhaps the most important one being that your body needs a considerable amount of protein to promote healing. And unlike other macronutrients, your body cannot store protein - it must be renewed daily. There may also be post-op concerns regarding changes in metabolism, eating patterns, potential Vitamin deficiencies, swings in blood sugar, etc. in response to fasting. If you are pre-op, now is the time to gather all of the information you can. The unprecedented success of bariatric surgery in the treatment of obesity is indisputable. But that success is based on science. I encourage you to discuss fasting with your surgeon. Get the facts regarding potential benefits and risks of fasting following surgery. Perhaps even seek a second opinion if you feel it's necessary. Once you understand the science, the challenge will be to reconcile it with your faith. A decision that you, and only you, can make.

The Latest on Nutrition and hair Loss in the Bariatric Patient by Jacqueline Jacques, ND Nutrition and Hair Loss A common fear and complaint of bariatric surgery patients is postoperative hair loss. While for most of us as people, our hair is important as part of our self-image and body image, it is not very important to our bodies. For this reason, nutrition can have a great impact on hair health because when forced to make a choice, the body will shift nutritional stores to vital organs like the brain and heart and away from hair. Hair loss has many causes. The most common type of hair loss after weight loss surgery is a diffuse loss known medically as telogen effluvium, which can have both nutritional and non-nutritional causes. Whether you are aware of it or not, for most of your life you are always in the process of both growing and losing hair. Human hair follicles have two states: anagen, a growth phase, and telogen, a dormant or resting stage. All hairs begin their life in the anagen phase, grow for some period of time, and then shift into the telogen phase,which lasts for approximately 100 to 120 days. Following this, the hair will fall out. Typically, about 90 percent of hairs are anagen and 10 percent are telogen at any give time—meaning that we are usually losing a lot less hair than we are growing, so the hair loss is not noticeable. But sometimes this can change. Specific types of stress can result in a shift of a much greater percentage of hairs into the telogen phase. The stressors known to result in this shift, or telogen effluvium, include the following: high fever, severe infection, major surgery, acute physical trauma, chronic debilitating illness (such as cancer or end-stage liver disease), hormonal disruption (such as pregnancy, childbirth, or discontinuation of estrogen therapy), acute weight loss, crash dieting, anorexia, low Protein intake, Iron or zinc deficiency, heavy metal toxicity, and some medications (such as beta-blockers, anticoagulants, retinoids, and immunizations). Nutritional issues aside, bariatric surgery patients already have two major risks of major surgery and rapid weight loss. These alone are likely to account for much of the hair loss seen after surgery. In the absence of a nutritional issue, hair loss will continue until all hairs that have shifted into telogen phase have fallen out. There is no way of switching them back to the anagen phase. Hair loss will rarely last for more than six months in the absence of a dietary cause. Because hair follicles are not damaged in telogen effluvium, hair should then regrow. For this reason, most doctors can assure their weight loss surgery patients that with time and patience, and keeping up good nutritional intake, their hair will grow back. Discrete nutritional deficiencies are known to cause and contribute to telogen effluvium. One should be more suspicious of a nutritional contribution to post-bariatric surgery hair loss if any of the following occurred: 1. Hair loss continued more than one year after surgery 2. Hair loss started more than six months after surgery 3. Patient has had difficulty eating and/or has not complied with supplementation 4. Patient has demonstrated low values of ferritin, zinc, or protein 5. Patient has had more rapid than expected weight loss 6. Other symptoms of deficiency are present. Iron Iron is the single nutrient most highly correlated with hair loss. The correlation between non-anemic iron deficiency and hair loss was first described in the early 1960s, although little to no follow-up research was conducted until this decade. While new research is conflicted as to the significance of ferritin as a diagnostic tool in hair loss, it has still been found that a significant number of people with telogen effluvium respond to iron therapy. Optimal iron levels for hair health have not been established, although there is some good evidence that a ferritin level below 40mg/L is highly associated with hair loss in women.1 It is worth noting that this is well above the level that is considered to be anemic, so doctors would not be expected to see this as a deficiency. Zinc Zinc deficiency has been tied to hair loss in both animal studies and human cases. There is data linking zinc deficiency in humans to both telogen effluvium and immune-mediated hair loss. Zinc deficiency is a well-recognized problem after biliopancreatic diversion/duodenal switch, and there is some indication that it may occur with other procedures such as gastric bypass and adjustable gastric banding. In 1996, a group of researchers chose to study high-dose zinc supplementation as a therapeutic agent for related hair loss2 in patients who had undergone vertical banded gastroplasty. The study administered 200mg of zinc sulfate (45mg elemental zinc) three times daily to postoperative patients with hair loss. This was in addition to the Multivitamin and iron supplements that patients were already taking. No labs for zinc or other nutrients were conducted. Researchers found that in patients taking the zinc, 100 percent had cessation of hair loss after six months. They then stopped the zinc. In five patients, hair loss resumed after zinc was stopped, and was arrested again with renewed supplementation. It is important to note that in telogen effluvium of non-nutritional origin, hair loss would be expected to stop normally within six months. Since the researchers conducted no laboratory studies and there was no control group, the only patients of interest here are those who began to lose hair again after stopping zinc. Thus, we cannot definitively say that zinc would prevent hair loss after weight loss surgery, and further study would definitely be needed to make this connection. A further note: The tolerable upper intake level (UL) for zinc is set at 40mg in adults. This study utilized a daily dose of more than three times that level. Not only can these levels cause gastrointestinal distress, but chronic toxicity (mostly associated with copper depletion) can start at levels of 60mg/day. Information related to this study has made its way to many a support group and chat room—even to doctor’s offices—with the message that “high-dose zinc will prevent hair loss after weight loss surgery.” Patients should be advised that high-dose zinc therapy is unproven and should only be done under supervision due to the associated risks of toxicity. A lab test to check for zinc deficiency would be best before giving a high dose such as this. Protein Low protein intake is associated with hair loss. Protein malnutrition has been reported with duodenal switch, and in gastric bypass to a much lesser degree. Little is known about incidence, as only around eight percent of surgeons track labs such as total protein, albumen, or prealbumen.3 Limited studies suggest that patients with the most rapid or greatest amounts of weight loss are at greatest risk.4 With surgical reduction of the stomach, hydrochloric acid,5 pepsinogen, and normal churning are all significantly reduced or eliminated. Furthermore, pancreatic enzymes that would also aid in protein digestion are redirected to a lower part of the small intestine. It is thus likely that maldigestion rather than malabsorption is responsible for many cases. Some studies have also implicated low protein intake.6 Research also indicates that low levels of the amino acid l-lysine can contribute to hair loss and that repletion of lysine stores may both improve iron status and hair regrowth. In a study of anemic patients with hair loss who were supplemented with 1.5 to 2g of l-lysine in addition to their iron therapy, ferritin levels increased more substantially over iron therapy alone.1 Biotin Many individuals believe that supplementing with, or topically applying, the nutrient biotin will either help to prevent hair loss or will improve hair regrowth. To date, there is no science that would support either of these presumptions. While biotin deficiency can cause dermatitis, hair loss is only known to occur in experimentally induced states in animal models or in extreme cases of prolonged diets composed exclusively of egg whites.7 Other Other nutrients associated with hair health include Vitamin A, inositol, folate, B6, and essential fatty acids. Hair loss can also be caused by systemic diseases, including thyroid disease and polycystic ovarian syndrome (PCOS), and is influenced by genetics. Conclusions Hair loss can be distressing to bariatric surgery patients, and many will try nutrition themselves to see if they can prevent it. Unfortunately, there is little evidence that early hair loss is preventable because it is most likely caused by surgery and rapid weight loss. Later hair loss, however, can be indicative of a nutritional problem, especially iron deficiency, and may be a clinically useful sign. Educating patients about the potential for hair loss and possible underlying causes can help them to make informed choices and avoid wasting money on gimmicks that may have little real value. References 1. Rushton DH. Clin Exp Dermatol. 2002;27(5):396–404. 2. Neve H, Bhatti W, Soulsby C, et al. Reversal of hair loss following vertical gastroplasty when treated with zinc sulphate. Obes Surg. 199;6(1):63–65. 3. Updegraff TA, Neufeld NJ. Protein, iron, and folate status of patients prior to and following surgery for morbid obesity. J Am Diet Assoc. 1981;78(2):135–140. 4. Segal A, Kinoshita Kussunoki D, Larino MA. Postsurgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? A case series. Obes Surg. 2004;14(3):353–360. 5. Behrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity.Dig Dis Sci. 1994;39(2):315–20. 6. Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13(1):23–28. 7. Mock DM. Biotin. In: Shils M, Olson JA, Shike M, Ross AC, eds. Nutrition in Health and Disease. 9th ed. Baltimore: Williams & Wilkins; 1999:459–466.

I copied this post from an old post I found on the site from 2013. What do you think? I kind of a long read, but I has a lot of good information I thought. I was most interested about the parts that talk about the importance of making the most in the first 6 months and not to take them for granted. I am 4 1/2 month out, so It has given me a renewed sense of urgency to make the most of my "honeymoon" period. As my weight loss starts to slow more, the more worried I get about actually meeting my goal. Pouch Rules for Dummies INTRODUCTION: A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren’t really trying to lose weight. The truth is it may be because they haven’t learned how to get the satisfied feeling of being full to last long enough. HYPOTHESIS OF POUCH FUNCTION: We have four educated guesses as to how the pouch works: 1. Weight loss occurs by actually slightly stretching the pouch with food at each meal or; 2. Weight loss occurs by keeping the pouch tiny through never ever overstuffing or; 3. Weight loss occurs until the pouch gets worn out and regular eating begins or; 4 Weight loss occurs with education on the use of the pouch. PUBLISHED DATA: How does the pouch make you feel full? The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness. What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal? For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs. We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible. OBSERVATIONAL BASED MEDICINE: The information here is taken from surgeon’s “observations” as opposed to “blind” or “double blind” studies, but it IS based on 33 years of physician observation. Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe, turned into an advantage as I was able to follow my patients closely. The following are what I found to effect how the pouch works: 1. Getting a sense of fullness is the basis of successful WLS. 2. Success requires that a small pouch is created with a small outlet. 3. Regular meals larger than 1 � cups will result in eventual weight gain. 4. Using the thick, hard to stretch part of the stomach in making the pouch is important. 5. By lightly stretching the pouch with each meal, the pouch send signals to the brain that you need no more food. 6. Maintaining that feeling of fullness requires keeping the pouch stretched for awhile. 7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears. 8. Incredible hunger will develop if there is no food or drink for eight hours. 9. After 1 year, heavier food makes the feeling of fullness last longer. 10. By drinking Water as much as possible as fast as possible (“water loading”), the patient will get a feeling of fullness that lasts 15-25 minutes. 11. By eating “soft foods” patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain. 12. The patients that follow “the rules of the pouch” lose their extra weight and keep it off. 13. The patients that lose too much weight can maintain their weight by doing the reverse of the “rules of the pouch.” HOW DO WE INTERPRET THESE OBSERVATIONS? POUCH SIZE: By following the “rules of the pouch”, it doesn’t matter what size the pouch ends up. The feeling of fullness with 1 � cups of food can be achieved. OUTLET SIZE: Regardless of the outlet size, liquidy foods empty faster than solid foods. High calorie liquids will create weight gain. EARLY PROFOUND SATIETY: Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full. After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time. OPTIMUM MATURE POUCH: The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 � cups at a time. IDEAL MEAL PROCESS (rules of the pouch): 1. The patient must time meals five hours apart or the patient will get too hungry in between. 2. The patient needs to eat finely cut meat and raw or slightly cooked veggies with each meal. 3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure. 4. No liquids for 1 � hours to 2 hours after each meal. 5. After 1 � to 2 hours, begin sipping water and over the next three hours slowly increase water intake. 6. 3 hours after last meal, begin drinking LOTS of water/fluids. 7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called “water loading.” IF YOU HAVEN’T BEEN DRINKING OVER THE LAST FEW HOURS, THIS ‘WATER LOADING’ WILL NOT WORK. 8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness. THE MANAGEMENT OF PATIENT TEACHING AND TRAINING: You must provide information to the patient pre-operatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective. NECESSITY FOR LONG TERM FOLLOW-UP: Trying to practice the “rules of the pouch” before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn’t work. The real work of learning the “rules of the pouch” begins after healing has caused hunger to return. PREVENTION OF VOMITING: Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick. It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patient’s mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth. In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting. Vomiting will occur only after eating of solid foods begins. Rice, Pasta, granola, etc. will swell in time and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes before eating another 1 oz of food. Stop when “comfortably satisfied,” until the patient learns the size of his/her pouch. SIX WEEKS After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1 � hours after meals. REASSURANCE OF ADEQUATE NUTRITION By taking Vitamins everyday, the patient has no reason to worry about getting enough nutrition. Focus should be on Proteins and vegetables at each meal. MEAL SKIPPING Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be Protein, until the patient can eat at least two oz of protein at each meal. ARTIFICIAL SWEETENERS In our study, we noticed some patients had intense hunger cravings which stopped when they eliminated artificial sweeteners from their diets. AVOIDING ABSOLUTES Rules are made to be broken. No biggie if the patient drinks with one meal – as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party – that’s OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up. THREE MONTHS At three months, the patient needs to become aware of the calories per gram of different foods to be aware of “the cost” of each gram. (cheddar cheese is 16 cal/gram; Peanut Butter is 24 cals/gram). As soon as hunger returns between three to six months, begin water loading procedures. THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY 1. Fill pouch full quickly at each meal. 2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 � hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than � of the meal still remained in the pouch after 1 � hours. 3. Protein, protein, protein. Three meals a day. No high calorie liquids. Fluid LOADING Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached. The patient will quickly learn his/her maximum tolerance, which is usually between 8-12 oz. Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time. POST PRANDIAL THIRST It is important that the patient be filled with water before his/her next meal as the meal will come with salt and will cause thirst afterwards. Being too thirsty, just like being too hungry will make a patient nauseous. While the pouch is still real small, it won’t make sense to the patient to do this because salt intake will be low, but it is a good habit to get into because it will make all the difference once the pouch begins to regrow. URGENCY The first six months is the fastest, easiest time to lose weight. By the end of the six months, 2/3 of the regrowth of the pouch will have been done. That means that each present day, after surgery you will be satisfied with less calories than you will the very next day. Another way to put it is that every day that you are healing, you will be able to eat more. So exercise as much as you can during that first six months as you will never be able to lose weight as fast as you can during this time. SIX MONTHS Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat. INTAKE INFORMATION SHEET AS A TEACHING TOOL I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them “back on track.” Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to “get it”, and a small percentage never quite understand these rules, even though they are quite intelligent people. HONEYMOON SYNDROME The lack of hunger and quick weight loss patients have in the first six months sometimes leads them to think they don’t need to exercise as much and can eat treats and extra calories as they still lose weight anyway. We call this the “honeymoon syndrome” and they need to be counseled that this is the only time they will lose this much weight this fast and this easy and not to waste it by losing less than they actually could. If the patient’s weight loss slows in the first six months, remind them of the rules of water intake and encourage them to increase their exercise and drink more water. You can compare their weight loss to a graph showing the average drop of weight if it will help them to get back on track. EXERCISE In addition to exercise helping to increase the weight loss, it is important for the patient to understand that exercise is a natural antidepressant and will help them from falling into a depression cycle. In addition, exercise jacks up their metabolic rate during a time when their metabolism after the shock of surgery tends to want to slow down. THE IDEAL MEAL FOR WEIGHT LOSS The ideal meal is one that is made up of the following: � of your meal to be low fat protein, � of your meal low starch vegetables and � of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health. VOLUME VS. CALORIES The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don’t worry about calories. This is the easiest way to “count your calories.” For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings – it would stuff them way too much. ISSUES FOR LONG TERM WEIGHT MAINTENANCE Although everything stated in this report deals with the first year after surgery, it should be a lifestyle that will benefit the gastric bypass patient for years to come, and help keep the extra weight off. COUNTER-INTUITIVENESS OF FLUID MANAGEMENT I admit that avoiding fluids at meal time and then pushing hard to drink fluids between meals is against everything normal in nature and not a natural thing to be doing. Regardless of that fact, it is the best way to stay full the longest between meals and not accidentally create a “soup” in the stomach that is easily digested. SUPPORT GROUPS It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others “get it” and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes all the difference to help those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a “peer pressure” to stick to the rules that the staff at the physician’s office simply can’t create. TEETER TOTTER EFFECT Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy on the right, the less exercise you need on the left. Now if you don’t concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh. TOO MUCH WEIGHT LOSS I have found that about 15% of the patients which exercise well and had between 100 to 150 lbs to lose, begin to lose way too much weight. I encourage them to keep up the exercise (which is great for their health) and to essentially “break the rules” of the pouch. Drink with meals so they can eat Snacks between without feeling full and increase their fat content as well take a longer time to eat at meals, thus taking in more calories. A small but significant amount of gastric bypass patients actually go underweight because they have experienced (as all of our patients have experienced) the ravenous hunger after being on a diet with an out of control appetite once the diet is broken. They are afraid of eating again. They don’t “get” that this situation is literally, physically different and that they can control their appetite this time by using the rules of the pouch to eliminate hunger. BARIATRIC MEDICINE A much more common problem is patients who after a year or two plateau at a level above their goal weight and don’t lose as much weight as they want. Be careful that they are not given the “regular” advice given to any average overweight individual. Several small meals or skipping a meal with a Liquid Protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets. SUMMARY 1. The patient needs to understand how the new pouch physically works. 2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes. 3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to use their pouch. The goal is for the patient to become an expert on how to use the pouch. EVALUATION FOR WEIGHT LOSS FAILURE The first thing that needs to be ruled out in patients who regain their weight is how the pouch is set up. 1. the staple line needs to be intact; 2. same with the outlet and; 3. the pouch is reasonably small. 1) Use thick barium to confirm the staple line is intact. If it isn’t, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time. Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a reoperation must be done to actually separate the pouch and the stomach completely and seal each shut. 2) If the outlet is smaller than 7-8 mill, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call “soft calorie syndrome.” This causes frequent hunger and grazing, which leads to weight regain. 3) To assess pouch volume, an upper GI doesn’t work as it is a liquid. The cottage cheese test is useful – eating as much cottage cheese as possible in five to 15 minutes to find out how much food the pouch will hold. It shouldn’t be able to hold more than 1 � cups in 5 – 15 minutes of quick eating. If everything is intact then there are four problems that it may be: 1) The patient has never been taught the rules; 2) The patient is depressed; 3) The patient has a loss of peer support and eventual forgetting of rules, or 4) The patient simply refuses to follow the rules. LACK OF TEACHING An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight. She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time gaining a little more back. She then developed a disease (with no connection to bariatric surgery) which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium and the cottage cheese test which showed the pouch to be a small size and that there was no leakage. She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago. DEPRESSION Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for awhile only to return having gained a lot of weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression. A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly. If your patient begins weight gain due to depression, get him/her into counseling quickly. Encourage your patient to refocus on the pouch rules and try to add a little exercise every day. Reassure your patient that he/she did not ruin the pouch, that it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry. EROSION OF THE USE OF PRINCIPLES: Some patients who are compliant, who are not depressed and have intact pouches, will begin to gain weight. These patients are struggling with their weight, have usually stopped connecting with their support groups, and have begun living their “new” life surrounded by those who have not had bariatric surgery. Everything around them encourages them to live life “normal” like their new peers: they begin taking little sips with their meals, and eating quick and easy-to-eat foods. The patient will not usually call their physician’s office because they KNOW what they are doing is wrong and KNOW that they just need to get back on track. Even if you offer “refresher courses” for your patients on a yearly basis, they may not attend because they KNOW what the course is going to say, they know the rules and how they are breaking them. You need to identify these patients and somehow get them back into your office or back to interacting with their support group again. Once these patients return to their support group, and keep in contact with their WLS peers, it makes it much easier to return to the rules of the pouch and get their weight under control once again. TRUE NON-COMPLIANCE: The most difficult problem is a patient who is truly non-compliant. This patient usually leaves your care, complains that there is no ‘connection’ between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the non-compliance that causes this attitude. A truly non-compliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counseling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven’t figured out how to do that yet… Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life.

I had my surgery in Tijuana, Mexico with Dr.Cervantez at Hospital Guadalajara. My stay was very pleasant the nurses and surgeon were very nice and attentive. I am now back home with no issues and no regrets. The hospital was clean and accommodating, I really couldn't ask more for a hospital outside of the states. Nurses didn't speak English to well but thats not on them. Total cost was about 4400 with flight and all. I was very nervous my first day in the hospital but afterwards with all the attention from the staff I felt comfortable and would recommend it. Went through the company renew bariatrics!

. Hello Debs, Didn't ignore you, just very busy in the last 4 weeks. Plenty of visits to the hospital clinic in Denmark Hill. Almost every week! I'm diabetic type 1 on the insulin pump and after my op all settings has to be changed. It's a process done gradually, bit of a trial and error thing! You're asking about my progress. On my last visit, Friday, I lost 2 stone, that's from 16.07.11. For me that translates in going from tops ( I'm top heavy) size 28-30 to 22-24. Bottoms are now size 20 in Next from 22-24 in Evans. I'm very happy with that! It's not as spectacular as others but I was warned that my loss of weight will be slower due to my medical problems. I say when you're 55 ( I'll be in October) slower is better for you. Last week, after being cleared by hospital I returned to my Pilates classes. I'm still the heaviest girl in the group, but who cares! Got to start keeping fit! I renewed my membership in a local gym and this week will start weight training program. My aim is to keep loosing fat not muscles. In regards to my food, I'm eating everything. The key words are: very slowly and chew, chew, chew.....My calories intake is about 1000 to 1500 (weekends only). The biggest difficulty is my intake of Protein. Ideal amount for us a day is around 45-50 grams a day. Sometimes I struggle with it. Generally my energy levels are increasing. That's very good news for me. First 4 weeks after surgery I felt totally washed out. Put this question out on the forum and response was: eat more carbohydrates. Made changes to my diet and things slowly improved. What else.... pain in my shoulders. That's almost gone, too. Comes back only if I'm very tired. I'll say one thing about King's program for candidates for bariatric surgery: IT DOES NOT EXIST. I was left, after my initial consultation with a surgeon, to my own devices. Same thing goes for follow up after a surgery. NOTHING. I hope that you'll get more that I did. All my advice and support comes from staff in my diabetic clinic and pages of this forum. 95% of knowledge I have comes from here. I understand that you have few other medical complications. I hope that staff in those clinics will offer you support as mine did. Try to read about SVG as much as you can find on the Internet. I went to the hospital prepared for all sorts of complications. The truth was I did rather well after my surgery. It's a MIRACLE. One more word, it's about 6 months waiting time from seeing a surgeon to the landing on his table. Good luck! .

This is from a posting by one of my bariatric nurses on the facebook page my doctor has for his practice. Hope you find it helpful. The Latest on Nutrition and Hair Loss in the Bariatric Patient by Jacqueline Jacques, ND Nutrition and Hair Loss A common fear and complaint of bariatric surgery patients is postoperative hair loss. While for most of us as people, our hair is important as part of our self-image and body image, it is not very important to our bodies. For this reason, nutrition can have a great impact on hair health because when forced to make a choice, the body will shift nutritional stores to vital organs like the brain and heart and away from hair. Hair loss has many causes. The most common type of hair loss after weight loss surgery is a diffuse loss known medically as telogen effluvium, which can have both nutritional and non-nutritional causes. Whether you are aware of it or not, for most of your life you are always in the process of both growing and losing hair. Human hair follicles have two states: anagen, a growth phase, and telogen, a dormant or resting stage. All hairs begin their life in the anagen phase, grow for some period of time, and then shift into the telogen phase,which lasts for approximately 100 to 120 days. Following this, the hair will fall out. Typically, about 90 percent of hairs are anagen and 10 percent are telogen at any give time—meaning that we are usually losing a lot less hair than we are growing, so the hair loss is not noticeable. But sometimes this can change. Specific types of stress can result in a shift of a much greater percentage of hairs into the telogen phase. The stressors known to result in this shift, or telogen effluvium, include the following: high fever, severe infection, major surgery, acute physical trauma, chronic debilitating illness (such as cancer or end-stage liver disease), hormonal disruption (such as pregnancy, childbirth, or discontinuation of estrogen therapy), acute weight loss, crash dieting, anorexia, low protein intake, Iron or zinc deficiency, heavy metal toxicity, and some medications (such as beta-blockers, anticoagulants, retinoids, and immunizations). Nutritional issues aside, bariatric surgery patients already have two major risks of major surgery and rapid weight loss. These alone are likely to account for much of the hair loss seen after surgery. In the absence of a nutritional issue, hair loss will continue until all hairs that have shifted into telogen phase have fallen out. There is no way of switching them back to the anagen phase. Hair loss will rarely last for more than six months in the absence of a dietary cause. Because hair follicles are not damaged in telogen effluvium, hair should then regrow. For this reason, most doctors can assure their weight loss surgery patients that with time and patience, and keeping up good nutritional intake, their hair will grow back. Discrete nutritional deficiencies are known to cause and contribute to telogen effluvium. One should be more suspicious of a nutritional contribution to post-bariatric surgery hair loss if any of the following occurred: 1. Hair loss continued more than one year after surgery 2. Hair loss started more than six months after surgery 3. Patient has had difficulty eating and/or has not complied with supplementation 4. Patient has demonstrated low values of ferritin, zinc, or protein 5. Patient has had more rapid than expected weight loss 6. Other symptoms of deficiency are present. Iron Iron is the single nutrient most highly correlated with hair loss. The correlation between non-anemic iron deficiency and hair loss was first described in the early 1960s, although little to no follow-up research was conducted until this decade. While new research is conflicted as to the significance of ferritin as a diagnostic tool in hair loss, it has still been found that a significant number of people with telogen effluvium respond to iron therapy. Optimal iron levels for hair health have not been established, although there is some good evidence that a ferritin level below 40mg/L is highly associated with hair loss in women.1 It is worth noting that this is well above the level that is considered to be anemic, so doctors would not be expected to see this as a deficiency. Zinc Zinc deficiency has been tied to hair loss in both animal studies and human cases. There is data linking zinc deficiency in humans to both telogen effluvium and immune-mediated hair loss. Zinc deficiency is a well-recognized problem after biliopancreatic diversion/duodenal switch, and there is some indication that it may occur with other procedures such as gastric bypass and adjustable gastric banding. In 1996, a group of researchers chose to study high-dose zinc supplementation as a therapeutic agent for related hair loss2 in patients who had undergone vertical banded gastroplasty. The study administered 200mg of zinc sulfate (45mg elemental zinc) three times daily to postoperative patients with hair loss. This was in addition to the Multivitamin and iron supplements that patients were already taking. No labs for zinc or other nutrients were conducted. Researchers found that in patients taking the zinc, 100 percent had cessation of hair loss after six months. They then stopped the zinc. In five patients, hair loss resumed after zinc was stopped, and was arrested again with renewed supplementation. It is important to note that in telogen effluvium of non-nutritional origin, hair loss would be expected to stop normally within six months. Since the researchers conducted no laboratory studies and there was no control group, the only patients of interest here are those who began to lose hair again after stopping zinc. Thus, we cannot definitively say that zinc would prevent hair loss after weight loss surgery, and further study would definitely be needed to make this connection. A further note: The tolerable upper intake level (UL) for zinc is set at 40mg in adults. This study utilized a daily dose of more than three times that level. Not only can these levels cause gastrointestinal distress, but chronic toxicity (mostly associated with copper depletion) can start at levels of 60mg/day. Information related to this study has made its way to many a support group and chat room—even to doctor’s offices—with the message that “high-dose zinc will prevent hair loss after weight loss surgery.” Patients should be advised that high-dose zinc therapy is unproven and should only be done under supervision due to the associated risks of toxicity. A lab test to check for zinc deficiency would be best before giving a high dose such as this. Protein Low protein intake is associated with hair loss. Protein malnutrition has been reported with duodenal switch, and in gastric bypass to a much lesser degree. Little is known about incidence, as only around eight percent of surgeons track labs such as total protein, albumen, or prealbumen.3 Limited studies suggest that patients with the most rapid or greatest amounts of weight loss are at greatest risk.4 With surgical reduction of the stomach, hydrochloric acid,5 pepsinogen, and normal churning are all significantly reduced or eliminated. Furthermore, pancreatic enzymes that would also aid in protein digestion are redirected to a lower part of the small intestine. It is thus likely that maldigestion rather than malabsorption is responsible for many cases. Some studies have also implicated low protein intake.6 Research also indicates that low levels of the amino acid l-lysine can contribute to hair loss and that repletion of lysine stores may both improve iron status and hair regrowth. In a study of anemic patients with hair loss who were supplemented with 1.5 to 2g of l-lysine in addition to their iron therapy, ferritin levels increased more substantially over iron therapy alone.1 Biotin Many individuals believe that supplementing with, or topically applying, the nutrient biotin will either help to prevent hair loss or will improve hair regrowth. To date, there is no science that would support either of these presumptions. While biotin deficiency can cause dermatitis, hair loss is only known to occur in experimentally induced states in animal models or in extreme cases of prolonged diets composed exclusively of egg whites.7 Other Other nutrients associated with hair health include Vitamin A, inositol, folate, B6, and essential fatty acids. Hair loss can also be caused by systemic diseases, including thyroid disease and polycystic ovarian syndrome (PCOS), and is influenced by genetics. Conclusions Hair loss can be distressing to bariatric surgery patients, and many will try nutrition themselves to see if they can prevent it. Unfortunately, there is little evidence that early hair loss is preventable because it is most likely caused by surgery and rapid weight loss. Later hair loss, however, can be indicative of a nutritional problem, especially iron deficiency, and may be a clinically useful sign. Educating patients about the potential for hair loss and possible underlying causes can help them to make informed choices and avoid wasting money on gimmicks that may have little real value. References 1. Rushton DH. Clin Exp Dermatol. 2002;27(5):396–404. 2. Neve H, Bhatti W, Soulsby C, et al. Reversal of hair loss following vertical gastroplasty when treated with zinc sulphate. Obes Surg. 199;6(1):63–65. 3. Updegraff TA, Neufeld NJ. Protein, iron, and folate status of patients prior to and following surgery for morbid obesity. J Am Diet Assoc. 1981;78(2):135–140. 4. Segal A, Kinoshita Kussunoki D, Larino MA. Postsurgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? A case series. Obes Surg. 2004;14(3):353–360. 5. Behrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity.Dig Dis Sci. 1994;39(2):315–20. 6. Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13(1):23–28. 7. Mock DM. Biotin. In: Shils M, Olson JA, Shike M, Ross AC, eds. Nutrition in Health and Disease. 9th ed. Baltimore: Williams & Wilkins; 1999:459–466.

Hey, BariatricPal Members! Happy St. Patrick’s Day, and happy Spring Break! Even if you don’t celebrate St. Patrick’s Day or you are not planning an official spring vacation, spring is still a joyous time of year. What better way to celebrate than with a BariatricPal newsletter? Here’s what we have for you: Are You Ready for Spring Break? St. Patrick’s Day – Give Yourself Something to Celebrate! March Madness: Are You Ready? Keep working towards your goals, whether or not you are Irish and whether or not you have a trip planned this spring. You can reach BariatricPal from anywhere in the world, so come on by and celebrate the season with the other members! Sincerely, Alex Brecher Founder, BariatricPal Are You Ready for Spring Break? You need to plan extra carefully whenever you travel after weight loss surgery. Your preparation should begin now if you are planning a trip this spring or summer so that you can make sure that your needs are met. First, consider where you will be in your weight loss journey and what medical needs you are likely to have. If you have not yet had surgery, you probably will not need exceptional medical care, and finding out what to do in emergencies should be sufficiency. If you already had weight loss surgery, find out the location of the nearest surgeon who can help you if you have trouble. Be sure the surgeon is an expert in the type of surgery that you have. Lap-band patients in particular should know where they can go for emergency fills or un-fills. Since WLS is hard on the body, give yourself ample time after surgery to recover before you travel. You can easily need six or more weeks after surgery before you are recovered. Next, start assembling a packing list. You may need these items addition to your regular belongings. Dietary supplements: multivitamins, calcium, Vitamin D, Iron, and any other dietary supplements that you take. Prescription medications (make sure you have enough to get through your trip) and prescriptions in case you need a refill Protein powder, protein bars, beef Jerky or unsalted nuts just in case you need some protein and are not near a supermarket or trusted restaurant Phone numbers and email addresses of bariatric specialists, including your surgeon, a nutritionist, and an emergency contact Workout clothes (will this be the first vacation when you worked out?) List of high-protein foods as well as foods that you can and cannot eat. This is especially important right after WLS as you progress from a liquid to solid diet. Non-prescription medications, such as aspirin or Tylenol, and laxatives to reduce constipation Finally, do what you can to “scout out” the area. Is there a supermarket near your hotel? Are the restaurants known for being accommodating to guests’ special orders so that you can get the high-protein, low-calorie meals you need? Is there a walking route or a fitness center near your hotel? You will not be able to find the answers to all of these questions before you arrive at your destination, but you can hit the ground running if you do a little background research beforehand. St. Patrick’s Day – Give Yourself Something to Celebrate! Monday, March 17 is St. Patrick’s Day. The holiday can be a day of bar-hopping, green cupcakes, and corned beef, but it can also be an opportunity to enjoy yourself in healthy ways. Make yourself proud by celebrating St. Patrick’s Day using some of these tips. Don’t drink. You’ll consume too many calories from alcohol and lose inhibition so you consume too many calories Enjoy the greenery by making a special effort to get to a park or nearby nature center. Have fun with your children by making a treasure hunt for them to search for a 4-leaf clover. Wear green…and if you have lost weight since the last time you wore green, get yourself a new green outfit to celebrate! Find naturally green food and skip the artificial dyes and unnecessary calories in decorated cupcakes, shamrock Cookies and green beer. Instead, add spinach to your scrambled eggs, snack on edamame (green soybeans) or kale chips, and make cabbage soup. Instead of corned beef stew with potatoes, roast some lean beef and turnips. This healthier dish is less watery, so it is better for WLS patients who should not drink fluids at meals, and it is lower in calories, carbohydrates and fat. Participate in local events, such as watching a St. Patrick’s Day parade or completing a Shamrock Run 5k. If you are not yet up to a road race, consider volunteering and cheering on the runners and walkers. Take these suggestions instead of drinking alcohol and eating high-calorie foods, and, Irish or not, you really will have something to celebrate this St. Patrick’s Day! March Madness – Are You Ready for the Tourney? You may think you’re all ready for the NCAA basketball tournament to start on March 18. You’ve studied the teams, filled out your brackets, and placed your bets. There’s one more thing to consider before you are truly ready for the tournament, aka March Madness. What will you eat? Watching sports on TV can lead to serious overeating, and it is worse when the tournament includes dozens of games, as does the NCAA tournament. Chowing down on pizza, fried chicken, chips and dip, and cookies can quickly stall your weight loss and throw off your blood sugar levels, not to mention make you feel extra sick because of your weight loss surgery. Instead of choosing junk, try these WLS-friendly ideas for your March Madness parties to have fun and stay healthy. Line muffin cups with turkey or ham slices and fill them with a mixture of spinach, ricotta, egg whites and garlic powder. Bake. Play up the basketball theme by serving spherical food, such as meatballs made with lean ground turkey, mozzarella balls served with tomato sauce, and cantaloupe balls. Lettuce cups filled with lean ground turkey and served with salsa. Substitute cooked peas, broccoli, zucchini or cauliflower for half of the avocados when you make guacamole. Serve it with cut veggies yourself, and tortilla chips for your guests Place slices of non-fat American cheese on turkey breast slices. Cut them into circular shapes using an upside-down glass. With a clean brush or toothpick, draw designs on the cheese so that it looks like a basketball. Of course, playing basketball can help your waistline, too. Why not start a tradition of shooting hoops or practicing your dribbling skills for a few minutes before each game? If you eat well and exercise, you will be a true winner during the NCAA tourney regardless of whether your team comes out on top. Spring is a joyous time of growth and renewal. We hope that this spring finds you making progress toward and renewing motivation for your own goals. If you need some inspiration or have some to share, or you just want to hang out, come by BariatricPal! See you on the boards!

TIME TO THROW OUT SOME OLD MYTHS It’s time to throw out some old myths about the adjustable gastric band, but before we start flinging those myths around, let’s all agree on what a myth is. The traditional definition is that a myth is an ancient story of unverifiable, supposedly historical events. A myth expresses the world view of a people or explains a practice, belief, or natural phenomenon. For example, the Greek god Zeus had powers over lightning and storms, and could make a storm to show his anger. If you think myths are dry stuff found only in schoolbooks, think again. They surround just about every aspect of our lives, and travel much faster now, in the age of technology, than they did in the dusty old days of ancient Greece and Rome. They’re a way for us to make sense of a chaotic world, both past, present and future. They affect thoughts, beliefs, emotions and assumptions in our everyday lives, coming alive in our minds as we, and the people around us, seem to act them out. Some myths are helpful because they give us a shared sense of security and express our fundamental values and beliefs, but some myths are just plain wrong and can be harmful to us and to others. A good example is the myth that having weight loss surgery is taking the easy way out. Every time I hear that one repeated, I want to laugh and scream at the same time. If you’re a post-op, you know why. Weight loss is hard no matter how you do it (surgery, diet pills, prayer, magic cleanses, and so on). On the other hand, WLS is supposed to be easy, compared to the dozens or hundreds of weight loss attempts in our past. Why on earth would I put myself through a major surgery if it wasn’t going to help me lose weight and keep it off? Now that we’ve shared a little laugh (or scream) over a WLS myth we can all agree upon, let’s test out some band myths whose validity may not be as clear. This kind of examination can be uncomfortable, but believing in a falsehood is almost guaranteed to make your WLS journey bumpier than it needs to be. Let’s start with the myths that are easiest to digest and end with the ones that can be tougher for a bandster to swallow. #1 – THE BAND IS THE LEAST INVASIVE WLS PROCEDURE I believed this one at first, mainly because I knew little about the other WLS procedures back in 2007. It’s still a widely-circulated myth, one that even my surgeon’s well-intentioned dietitian endorses. So, what’s the truth according to Jean? Face it: any surgery done on an anesthetized patient, during which a surgeon cuts into the belly in several places, does some dissection (more cutting) and suturing (stitching) of the internal anatomy, and implants a medical device (the dreaded “foreign object”), is invasive. It is true that band placement generally involves less internal dissection and suturing than other weight loss surgeries, but neither is it on the same level medically as having your teeth cleaned. So while the invasiveness of a surgery is worth considering, you do yourself a disservice if you let that override other considerations. A bariatric surgery might last 45-60 minutes, with recovery lasting a week or so, but its effect on your health and lifestyle last a lifetime. Or I sure hope it does. Some people associate invasiveness with irreversibility. Although the band is meant to stay put once clamped to your stomach, it can indeed be removed if medically necessary. Gastric bypass (RNY) surgery can also be reversed, while the sleeve (VSG) cannot and only the “switch” (malabsorptive feature) of the duodenal switch (DS) can be reversed. Removal or reversal is not as easy as operating on a “virgin belly” (as my surgeon so colorfully puts it), so it’s important to weigh the benefits against the risks of reversal or revision surgery. #2 – BAND WEIGHT LOSS TAKES TOO MUCH WORK Aside from the desire for instant and effortless weight loss (which is a fairy tale if I ever heard one) that so many obese people share (me among them), this is a myth that often turns people away from the band and towards other WLS procedures. While this myth may be true in the first 12-18 months after surgery, eventually everyone ends up in the same boat, rowing hard against the powerful tide of obesity. Weight loss and weight maintenance is hard no matter how you achieve it. A dietitian who spoke at a band support group meeting I attended a few years ago said that while band patients must change their lifestyle immediately in order to succeed, every WLS patient must do that sooner or later. It’s a pay-me-now or pay-me-later deal. You can slice it, dice it, sauté it and serve it on your grandmother’s best china. However you serve it, weight loss and maintenance is a lifetime project because obesity is a chronic disease with no cure. No matter how successful we are as new post-ops, all of us must face the possibility of regain. That’s why I cringe when someone proudly crows, “XXX pounds gone forever!” #3 – THE BAND’S SLOWER WEIGHT LOSS PREVENTS SAGGING SKIN This is a fairy tale. According to several plastic surgeons I’ve heard speak on the subject. The effect of weight loss on skin depends mostly on your genetics and your age (because skin loses elasticity as we age). Other factors can be how obese you were, how long you were obese, how you carried your weight, and how much (and how) you exercise as you lose weight. I’ve heard women say that they’d rather be obese than have sagging or excess skin. To my mind, that’s a sad statement, because I’d rather have sagging or excess skin (as long as it didn’t interfere with my ambulation or activities) than excess weight. Don’t get me wrong: I loathe the excess flab on my midsection (whose nickname is “The Danish Pastry”) and I’m not thrilled about my batwings, throat wattles, or anything else that’s happened to my skin in the past few years (during which I’ve undergone the double-whammy of weight loss and the fast approach of my 60’s). On the other hand, I think I look pretty good for a woman my age, especially when I conceal my figure flaws in flattering clothing which, I might add, no longer needs to be purchased at Lane Giant. #4 – TO LOSE WEIGHT, YOU HAVE TO FIND YOUR SWEET SPOT I used to wonder how the Sweet Spot Myth could survive in the face of so much clinical evidence against it, but last year I heard the “you gotta find your sweet spot” claim uttered by a bariatric dietitian, so apparently this is a myth being validated by medical professionals who ought to know better. Instead of the sweet spot, Allergan (the first to introduce the band in the USA) uses a zone chart to illustrate band restriction, with not enough restriction in the yellow zone, good restriction in the green zone, and too much restriction in the red zone. In other words, restriction happens in a range of experience, not at a single static point. That experience changes over time as we lose weight, deal with ordinary processes such as hormonal fluctuations, hydration changes, stress, medications, time of day, and so on. It’s also affected by our food choices (solid vs soft/liquid food). In my banded days, I traveled through and around a sweet spot many times. It might last for 30 minutes, 3 days, 3 weeks, but it never stayed exactly the same, and yet I still lost weight! I don’t actually want to stay exactly the same for the rest of my life (throat wattles notwithstanding). As any Parkinson’s disease patient will tell you (if they’re able to speak), a body that gets stuck in time is a very big problem (and with my luck, I’d get stuck in the worst sinus infection or case of the flu of my life). Some people who are very sensitive to their band and its fills find sudden or unexpected changes in restriction to be very, very frustrating, and I wouldn’t wish that on anyone, either. To read more about the sweet spot, click here to go to an article, The Elusive Sweet Spot. http://www.lapbandtalk.com/page/index.html/_/support/post-op-support/the-elusive-sweet-spot-r59 #5 – NO SIDE EFFECTS MEAN MY BAND ISN’T WORKING Equating side effects with a properly working band is very common, and potentially very harmful. The two most significant signs of the band’s proper functioning are (1) early satiety and (2) prolonged satiety. Those signs are rarely expressed in large, bold, uppercase letters, such as STOP EATING NOW! Those signs won’t be accompanied by clanging bells or flashing lights, either. In fact, the less noise and distraction (such as “Why don’t I have stuck episodes?”), the more likely you are to be able to recognize early and prolonged satiety. Before I tell you why the no side effects = broken band worry is a sign of mythical thinking, let’s make sure we agree on the definition of a side effect, and how that relates to complications. A side effect is an unintentional or unwanted effect of a medical treatment, and it’s usually exceeded (or at least balanced) by the benefits (the intentional, wanted effects) of that treatment. For example, antibiotics can cause diarrhea. That’s an unpleasant side effect, but an untreated infection can have far worse consequences for the patient. Side effects can often be managed by tweaking or changing the treatment, and they are rarely worse than the original condition. A complication, on the other hand, is a more acute, serious consequence of a medical treatment, and usually needs a more aggressive approach, including surgery to fix the problem. Now let’s go back to the antibiotic example. An allergic, anaphylactic reaction to the antibiotic can be fatal without prompt medical treatment. That’s a complication, and it’s far worse than the original condition. So in the context of all that, it seems strange to me when bandsters long for side effects like regurgitation (PB’s), stuck episodes, and sliming. Instead of looking for more subtle clues from their bodies (like early and prolonged satiety), they go looking for problems, and worse than that, they tend to “test” their band with foolish eating and/or overeating, hoping to provoke a side effect that will signal to them that they really do have a band in there. One of the many problems with that approach is that it can also provoke a complication. And that brings us to the final myth in today’s article: #6 – THE MORE FILL, THE BETTER I’ve heard bariatric surgeons comment that some band patients seem to be addicted to fills. I can identify with that because I had a good relationship with my band surgeon who not only administered my fills but gave me a lot of encouragement as well as answers to my many questions. I left each fill appointment with a renewed sense of commitment and hope. How can you not get hooked on something good like that? The problem with equating fills with weight loss success is that more fill is not always better. In fact, too much fill (which varies from one patient to the next, and also varies in a single patient as time goes on and the patient’s body keeps changing) can be downright dangerous. An overfilled band, and the side effects it causes (see #5 above), can lead to a complication like a band slip, esophageal dilation, or stomach dilation. While complications can come out of nowhere, most bariatric surgeons agree that too much saline in the band puts too much pressure on the stomach. Eventually something’s got to give. That’s often hastened by the patient’s efforts to eat around the problem, and it is absolutely not a guarantee of weight loss. I gained weight several times because of what’s called Soft Calorie Syndrome. My band was too tight and I was dealing with it by consuming mostly soft and liquid calories that offered little or no satiety. The human body is an incredible organism, capable of amazing feats of growth and healing that we take mostly for granted, but it’s not endlessly forgiving. Too much fill in your band, too many eating problems, too much inflammation and irritation in the upper GI tract, can compromise your body’s ability to recover from a complication like a band slip. Sometimes a complication can be treated conservatively, with an unfill and rest period, but sometimes it requires a surgical fix, including removal of the band. And after all you’ve gone through to get that band wrapped around your stomach, shouldn’t you be doing your utmost to treat it (and your body) with respect? Finally, the fill myth can cause us to overlook a very important guest at your WLS party….you. If you are going to succeed with your band, lose weight and keep it off and keep that band safe and sound inside you, sooner or later you will have to take personal responsibility for your success. Expecting your band alone to carry you to your goal weight is like expecting your car to safely deliver your child to school without anybody in the driver’s seat. And I sure hope that you are a very important person in your life!