Monday, October 29, 2007
Incisionless Treatment for Patients With Inadequate Weight Loss Following Roux-en-Y Gastric Bypass
This study is currently recruiting participants.
It is estimated that up to 20% of patients who have Roux-en-Y Gastric Bypass (RYGB) surgery will not meet their weight loss goal, or may even regain some of the weight they initially lost. One possible explanation is that the opening between the stomach pouch and the intestine becomes stretched. If this opening becomes too wide, food may be able to pass from the stomach to the intestine too quickly - causing patients to feel less full after eating.
For some patients, doctors may recommend additional invasive surgery to tighten the opening between the stomach pouch and the small intestine. Although this may help patients resume their weight loss, the risk of complications during a second surgical procedure is significantly higher than the risk during the original gastric bypass.
The purpose of this study is to evaluate an incisionless procedure for patients who have either had inadequate weight loss or have regained weight following gastric bypass. The procedure is designed to tighten the opening between the stomach pouch and the small intestine, which may slow down the passage of food to help patients feel full longer after eating.
Locations: Denver, Colorado; Baltimore, Maryland; Boston, Massachusetts; St. Louis, Missouri; Lebanon, New Hampshire; New York City; Cleveland, Ohio; Philadelphia, Pennsylvania; Dallas, Texas; Milwaukee, Wisconsin.
Read more and get contact information
Sunday, October 28, 2007
First let me say that I'm not a sports enthusiast and have only a vague understanding of professional sport strategy and politics. Even so, I enjoy the World Series of Baseball: have enjoyed it since I was a kid when we attended the LA Dodgers games in the early hay-day of record making manager Tommy Lasorda.
So it has been with enthusiasm and wonderment that I've watched the first three games of the 2007 World Series as the Boston Red Sox have literally kicked the wind out of Colorado's Rocky Mountain High. Pre-series it seemed Colorado, who had won 21 of their 22 previous games, appeared unstoppable.
What went wrong in this young team's first run for the world championship? An Associated Press report said, "One reason the Rockies have gone from winning to their tough position now might well be the eight-day wait they had between the National League playoffs and the start of the World Series. They simply haven't rediscovered the ingredients that got them here."
An eight-day delay between winning the National League pennant and stepping up to bat for Game 1 stalled the Rockies, even put them in slump. The Associated Press reports a World Series comeback is unlikely.
Observing the psychology of "winner's edge" I cannot help but link it to long-term management of a healthy weight by way of weight loss surgery. (You knew this was coming, right?) At LivingAfterWLS and in the Neighborhood we speak often of grit determination, the storm of enthusiasm and being hell-bent to work our weight loss surgery tool. We want to keep the winner's edge because when we lose control of the tool we feel like losers (not weight losers, life losers) and feelings of failure perpetuate a hopeless slump.
Here are some quotes from the Neighbors in a thread titled Storm of Enthusiasm:
"For me (although far from perfect) what creates that feeling of enthusiasm is "BEING IN CONTROL" and watching the pounds come off! . . . But all in all....I know that losing and doing what we KNOW is right for us....leads to the weight going down and feeling better!"
-- Julie S aka Sunshine
"I am still in the weight loss phase and am seeing all the benefits that come with it! The rapidly changing body, the new clothing sizes, shopping! Reeling over the health benefits, the attention, the high of it all! It will be good to look back at the responses here once the high wears off!"
"I MAKE my storm of enthusiasm. Turning the weaknesses that caused self-destructive behavior into strengths that encourage self-empowering behavior creates a storm of enthusiasm. If I sense the winds starting to drop, I am moved to fan them! I just don't want the adventure to end. I'm not perfect by any means! But I've looked at life from both sides now, as the song says. This side is better. I shall not be moved!"
"You know, just coming to the Neighborhood storms up my enthusiasm. Reading what the Newbies have to say always takes me back to that initial "thrill". It is why I am here so much!"
The Rockies only have one more chance to recapture their winner’s edge. But a person with weight loss surgery receives the gift of a new chance every day. It is highly possible to rediscover the ingredients that made your weight loss surgery storm of enthusiasm in the first place. If you are in a slump muster all the enthusiasm and brew a storm of enthusiasm, the same storm you enjoyed in the early stages of your weight loss surgery experience.
Seek support. Pursue knowledge. Make a plan. Grow desire. Empower yourself.
Sunday, October 21, 2007
Given these benefits having eggs for dinner seems a healthy protein rich choice for the gastric bypass patient and their family. This Ham and Vegetable Torta is a delicious dinner casserole that sneaks in some extra veggies but still very high in protein. This recipe packages well and is very good reheated the following day.
Day 3: 5 Day Pouch Test
Ham and Vegetable Casserole
1 pound zucchini, sliced (about 4 medium)
1 package (10 oz.) frozen chopped spinach
1/2 pound fresh mushrooms, sliced
1 clove garlic, minced
1 cup (8 oz.) low-fat (1%) cottage cheese
1 teaspoon dill weed
1/4 teaspoon pepper
4 ounces cooked lean ham or turkey ham, diced (about 3/4 cup)
1/2 cup (2 oz.) shredded Monterey Jack cheese
In large skillet over high heat, cover and cook zucchini, spinach, mushrooms, and garlic, until spinach starts to thaw, about 3 or 4 minutes. With fork, break spinach apart. Uncover and cook, stirring occasionally, until zucchini is crisp-tender, about 5 to 6 minutes. Drain well. In large bowl, beat together eggs, cottage cheese, and seasonings until well blended. Stir in ham and cooked vegetables.
Lightly spray 12 x 7 1/2 x 2-inch baking dish. Pour in egg mixture. Sprinkle with shredded cheese. Bake in preheated 350ºF oven until knife inserted near center comes out clean, about 25 to 35 minutes. Let stand 5 minutes before serving.
Tuesday, October 16, 2007
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Sunday, October 14, 2007
Since we have been talking about the 5 Day Pouch Test so much the word "slider foods" has become a regular part of our vocabulary. Slider Foods is a commonly used term in the bariatric community to describe foods that simply slide through the pouch without providing the sensation of fullness.
In a malabsorptive procedure the pouch is made and the stoma or outlet is attached to the lower part of the middle intestine called the jejunum. The majority of caloric absorption takes place in the jejunum, so depending upon where your surgeon created the outlet the level of absorption can vary. Skilled surgeons will adjust the length of intestine bypassed according to their patient's projected needs based on dieting history and pre-op psychological screening.
Helpful Video: Eating After Weight Loss Surgery
Slider foods slide right through the stoma into the jejunum. My first test of the slider foods was graham crackers and coffee for my after work snack. Now imagine, I could eat a stack of graham crackers and wash it right through the pouch with the coffee and never feel any satiation. What resulted was an easily absorbed slurry that my jejunum sucked up like a sponge - it didn't have to do any work to absorb this simple carbohydrate slurry. Of course, weight gain resulted and I had to give up this little indulgence. Another popular slider food is pretzels. I speak with post-ops all the time who are addicted to pretzels - again, this is a simple carb that your jejunum is very happy to receive and convert to fat. Traditionally dieters are encouraged to eat pretzels or popcorn - fat free and fiber, right? But that doesn't work so well for us. Giving our re-routed bodies these simple carbs is dangerous because our bodies have spent years perfect the art of fat storage - slider foods are to the body a great big lotery win.
Read more about the carb cycle
Tuesday, October 09, 2007
Read more: Potassium Rich Food
Of course we have heard all our lives to eat a banana when low on potassium. But did you know there are many foods rich in potassium, which are better tolerated than the banana by most weight loss surgery patients? Foods such as apricots, butternut squash, grapefruit, salmon, halibut and chicken are all potassium powerhouses. By incorporating these foods in our meals after gastric bypass we benefit from flavor, variety and healthful nutrients and perhaps stave-off some of the food boredom we all complain about. In addition, we know WLS patients are at risk of potassium deficiency so why not get some the old fashioned way – delicious home cooked food.
One of my favorite potassium rich recipes includes salmon and grapefruit, ingredients that are available year round and easily digested by the weight loss surgery patient.
Prep: 20 minutes/ Cook: 10 minutes
This WLS friendly recipe tastes great and is nutrient dense with vitamin C, potassium and dietary fiber from the grapefruit and heat-friendly Omega 3 fatty acids in the salmon. A normal serving of Grapefruit-Broiled Salmon contains about 40% daily value potassium. The salad is good served cold the next day.
3 grapefruits (or one jar canned grapefruit)
1 red bell pepper, diced
1 celery stalk cut into ¼-inch dice
¼ cup finely chopped red onion
2 teaspoons olive oil
1 teaspoon Dijon mustard
½ teaspoon salt
4 boneless salmon fillets, with skin (6 ounces each)
½ teaspoon dried oregano
¼ teaspoon black pepper
1. With a small paring knife, peel the grapefruits. Working over a bowl to catch the juice separate the grapefruit sections from the membranes; reserve any juice that collects in the bowl. Halve the grapefruit sections crosswise and transfer to a salad bowl. Add the bell pepper, celery, oinon, oil, mustard, and ½ teaspoon of the salt. Toss to combine and refrigerate until serving.
(to save time I have used the bottled pre-sectioned grapefruit from the produce section.)
2. Preheat the broiler. Place the salmon, skin-side down, on a broiler rack. Sprinkle 3 tablespoons of the reserved grapefruit juice, the oregano, black pepper and remaining ¼ teaspoon salt over the salmon. Broil 6 inches from the heat for 8 minutes or until just cooked through. Serve the salmon with the grapefruit salad. Serves 4 (normal)
Per serving: Calories 402; Fiber 2g; Protein 35g; Total Fat 21g; Saturated Fat 4g; Cholesterol 100mg; Sodium 430 mg.
Sunday, October 07, 2007
Today's postcard is about the personal empowerment that group support brings us. I know, you probably roll your eyes and think, "Here Kaye goes again pushing all that huggy-touchy empowerment talk." Perhaps some days I do get a little sentimental-corny about it, but trust me, when we travel together we become an empowered force to be reckoned with. Morbid obesity and the world that thinks we took an easy route to good health will NOT get the best of us. Not when we band together.
With that in mind I present empowerment from the LivingAfterWLS Neighbors, the very people who lift my spirits and make me believe that everything is possible. You will see that empowerment is not just a word I toss about lightly - it is a belief and a creed practiced by many people who want to do the best they can on any given day, for themselves and for their Neighbors.
a very positive site
truly a safe haven...
"This is a very positive site with LOADS and LOADS of helpful information - I do wish that I had found this site sooner as it has lots of information for pre-oppers that is just not available on this side of the pond. What it has helped me with is to confirm that I made the right choice for me in having Berty the Band fitted and also to gee me up and making me feel that this time I WILL be successful with my weight loss. Why this time? Becasue most of the neighbours here have already shown that it is possible to lose the weight and keep it off."
--Xandra (Cheshire, UK)
In the Neighborhood: What Brought you here?
"I am enjoying this community! It's the first place that I have found that puts a focus on self empowerment and I really like that."
After I looked through the amazing list of topics that asked and answered so many questions that I had, I just had to come and see if the neighborhood was too good to be true. The very fact that the approach is that of a neighborhood made me feel that this site was going to be different. I was so right on that one! From the first post I made I was not only welcomed, but people actually answered my questions candidly and from their own experience and encouraged me to continue asking questions. I learned more in a week here than I ever have or will anywhere else. It truly is a safe haven where we can all meet and discuss any issue that we fancy. True, it is WLS based, but that is the best part. Most of us not only don't have a family member that has had surgery, we don't even know anyone that has. Now, we all have an entire new neighborhood that we can 'live' in any time we choose with countless experts on the subject.
at first reluctant to join
coming here has been a life saver
"I was very reluctant to join after viewing other sites. I had encountered very negative members of other groups. Some who I think joined to simple tell people who have chosen to take their lives back by WLS that they are quitters. So coming here has been a life saver. I feel better and more confident the more I read here. Everyone is welcoming and friendly. The help everyone offers is great. I have alot to learn, but now I feel I have a sounding board I can visit to have all my questions answered. With the support of my family and this board I fell much more sure of my decision. In the beginning you can second guess your decision to have this life altering surgery, but hearing everyone else's stories I feel so much better."
"You are all awesome. I feel very blessed to have wandered into this neighborhood. I have been on a very lonely journey!!! I haven't been this excited about a support group and where to find answers since i had surgery on 9/7/05."
Read Deb's Introduction: Good Morning ev1, deb from ohio here
"Welcome everyone, new or not, we need each other and the positive reinforcement and helpful tips. I thank you all. I'm soooo happy. I'm on my way to loosing the next 20. When I get down to my goal weight I'm gonna do something big. Maybe have a huge party or something!!! Te amo!! If I can do it so can you!!!"
Wednesday, October 03, 2007
What happens after the 5 days?
After the 5 Day Pouch Test is when things get exciting. Having successfully broken a carb-cycle, regained a feeling of control over the surgical gastric pouch and possibly losing a few pounds one is ready for re-entry into a compliant way of eating. This means focusing on protein rich meals, observing the liquid restrictions and avoiding starches, particularly processed carbohydrates and slider foods. Three meals a day should be two-thirds protein, one third healthy carbohydrate in the form of low-glycemic vegetables and fruits. Consumption of whole grains is not forbidden, but should be limited to one serving a day.
If necessary, due to hunger, between meal snacks should be protein dense. Natural food protein is great including hard-cooked eggs, lean low-sodium deli meats, and limited servings of nuts or low-fat cheese. In addition, protein bars or beverages may be used for between meal supplementation. Liquid restrictions should be observed.
Patients should drink at least 64 ounces of water a day and take their prescribed supplemental vitamins. Caffeinated beverages should be limited to one or two a day and carbonated drinks are discouraged. Alcoholic beverages should be limited to one per day or less.
Patients should commit to this way of eating for their lifetime.For more Q&A's visit: 5 Day Pouch Test FAQs
Tuesday, October 02, 2007
This is the bullet list of guidelines provided by my center. Again, I realize they may differ from other programs and present them here as an example of one center's counsel for LIFETIME weight control. I know personally that when I follow these rules I feel terrific, my weight is stable and I feel confident and proud of my tool ownership.
Chose foods high in protein, moderate in carbohydrates and low to moderate in fat
Eat slowly in a relaxed setting. Chew all food well.
Eat no more than three small meals per day. The first 1/2 of each meal is protein.
Stop eating when you first notice the sensation of fullness!
Do not snack. A snack is any food consumed between meals or eaten in a hurried fashion.
Drink at least 64 ounces (2 quarts) of water every day.
Do not drink liquids 30 to 60 minutes before or after meals.
Avoid/limit sugar. Sugar will only sabotage your success.
Avoid/limit milk and milk products. Think of milk as a liquid form of sugar.
Avoid greasy, spicy and fast foods.
Avoid carbonated beverages and alcohol.
Take the nutritional supplements as prescribed.
Exercise for 20 minutes, aerobically, every day.
Monday, October 01, 2007
Lately I've received several letters from people who are suffering from dumping syndrome or constant feelings of a low-grade dump. It's hard to pinpoint the symptoms but can be described as simply feeling "off". A return to the high protein diet that worked for weight loss will often diminsh the symptoms of dumping. Several people have successfully returned back to basics of WLS eating by following our 5 Day Pouch Test. It concentrates on the elimination of processed carb snacking, focuses on high protein and quickly advances through the post-op eating stages to help one feel a tightening of the stomach pouch.
Below is a previously published article the describes the feelings and causes of weigth loss surgery dumping syndrome:
By Kaye Bailey
Weight loss surgery patients who have gastric bypass can suffer from what is called dumping syndrome. Dumping syndrome is described as a shock-like state when small, easily absorbed food particles rapidly dump into the digestive system. This results in a very unpleasant feeling with symptoms such as a cold clammy sweat, pallor, butterflies in the stomach and a pounding pulse. These symptoms may be followed by cramps and diarrhea. This state can last for 30-60 minutes and is quite uncomfortable.
A small percentage of long-term post-operative patients build a tolerance and do not dump on foods that would normally cause dumping syndrome with the malabsorptive gastrointestinal system. However, most patients learn to avoid the foods that cause dumping because it is so unpleasant.
Foods that typically cause dumping are sweets, fats and processed carbohydrates. If a person is dehydrated the symptoms of dumping will be exaggerated.
The most efficient way to avoid dumping is to maintain the strict regimen practiced during bariatric infancy: follow the four rules. Eat protein first making sure it comprises one-half of every meal. Avoid snacking. Avoid all sources of simple sugar; and yes, this includes cookies, cakes, candy, sodas, ice cream and sorbet. Sip water throughout the day. When you practice this eating behavior your blood sugar will not fluctuate and you will not dump. Most patients, who crave a taste of something sweet, have learned they can tolerate a bite of fruit at the end of the meal. Each person must proceed with caution and discover what works for their body.
It is important to note that the dumping experience is different for every person. Some will always have extreme dumps and others more mild episodes. Individuals will notice dumping episodes will vary by incident. No two people experience dumping syndrome the and no two dumping episodes are the same.
Dumping is a bittersweet result of the malabsorptive gastric bypass surgery. Because patients are challenged daily to retrain their eating habits an occasional dumping episode is likely to occur. Adherence to the four rules will prevent dumping in most cases. However, every now and again we will be blindsided by a dump caused by a food never suspected. Keeping a list of poorly tolerated foods will help you avoid them. The acutely dramatic event of dumping is a convincing motivator to follow the rules and avoid the foods that have trigged a dumping episode.