April 2008 Summer/Autumn Newsletter

Booth's Babble

April Summer/Autumn Newsletter 2008

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Greetings. I hope you are all well and have had a fantastic summer. It looks as though winter is now on top of us and I am pleased at least the farmers will be happy with the deluge that we have just had.

Patients often complain of tiredness after weight loss surgery and there can be any number of reasons for this. First of all, it is important that you are getting an adequate protein intake. This is something that many of you will be well-versed with, but if you have any doubts please contact our Dietitians to discuss this with them. Lacking in protein will often rapidly lead to reduced energy levels. Multivitamins are also crucial. If people forget to take these they will soon note that they begin to feel tired. Rarely, patients can develop severe complications of not taking multivitamins in the long term. Occasionally, people need to take two multivitamins a day during the rapid weight loss phase. Iron deficiency is probably one of the commonest causes of tiredness as well. As a general policy, if we see people with iron levels reducing or at a low level prior to surgery, it is a good idea to start iron supplementation sooner, rather than later. It is sometimes very difficult to build iron levels up after surgery and occasionally, people may resort to requiring injections. Vitamin B12 is a common reason for tiredness and people often know when they need an injection. Measuring B12 levels will give us an indication as to whether you may be low in B12, but often patients may experience tiredness before their levels drop below the lower limit of normal.

We not uncommonly have patients who have complained of tiredness, but on pinning them down, they are actually doing a lot more than they ever used to do prior to their weight loss. I think it is important to keep things in perspective. We are not robots, and it is normal and natural to feel tired sometimes, particularly after a long, hard day's work.

Myself, Nikki, Catherine and Lyn are off to a major international surgical weight loss conference in June in Washington DC. As such, we will be away for two weeks, picking up on the latest developments in all aspects of weight loss surgery. We will report back in our next newsletter any developments that may be relevance or interest to you. I hope you are all well, and look forward to catching up with you all soon.

Michael

PS We gave Elizabeth a jolly good send off but will be dusting her off occasionally and bringing her back when Nikki is away.

Constipation...

Inevitably with the reduced intake of food, bowel activity will decrease. This is normal especially as roughage is reduced.

Helpful Hints

Keep you fluid intake between 1.5 and 2 litres per day. Water, prune juice and kiwi fruit crush will help and avoid caffeine.

• A good laxative is Alpine tea, found in most major supermarkets.
• Dietary Fibre includes food and supplementary fibre such as Benefibre-which is a pure form of roughage without any food value. Remember to adapt foods to your stage post-operatively.
• Getting regular daily exercise is a good way to induce a regular bowel movement.
• Stool softeners are occasionally required, so check with your SWS team for the best options
• And remember any problems please call the dietitian

Post operative fluid phase: It is best to dilute the kiwi fruit crush to ¼ strength. Benefibre can be added to your post operative drinks 2tsp up to 4 tsps/day

Puree stage: Bran cereal flakes can be softened with prune juice and added to your puree. Choose fruit and vegetables to add to daily fibre intake

Soft/Mashed stage: All food is chewed very well

Foods to choose

• Very high in fibre; Bran cereal, baked beans - pureed 1st month, then each bean chewed individually
• High in fibre: Peas, spinach- remove stalks, pear, kiwi fruit, pawpaw, prunes, banana, apricots, lentils; chickpeas & kidney beans very well cooked pureed 1st month & mashed 2nd month
• Contains fibre: Carrot, broccoli

Lyn
lyn@surgicalweightsolutions.co.nz

Support Group...

Great support often leads to greater success following weight loss surgery but not everyone can access the type of support that they need from family and close friends. For that reason, support groups are invaluable in providing a place where you can discuss the changes that occur after surgery; changes in diet, appearance, behaviour, identity, socialising and relationships. Support groups provide access to people who are understand what is happening, are supportive with the issues that you may be struggling with and have been successful themselves. The groups are run by Catherine Kissel, psychologist and either Lyn Pearless, nurse or Nikki Talacek, dietitian who can also offer advice and support.

Group attendance is recommended for up to a year following surgery as this is when the most change occurs. However people booked into surgery have also attended and had an opportunity to ask questions and obtain advice and reassurance which has been beneficial. And those who are further out from surgery but haven't had the opportunity to discuss this with others are also welcome. The support group is a great place to get both short term answers and long term support.

The dates for 2008 for the Takapuna based group at the Waitemata Specialist Centre in Shea Tce are:

Wednesday 23rd April, 08
Wednesday 28th May, 08
Wednesday 25th June, 08
Wednesday 30th July, 08
Wednesday 27th August, 08

Many men have suggested providing a men's only group, which are common overseas, this provides men an opportunity to ask questions and discuss issues that focus on a men's perspective of weight loss surgery.

Therefore we now have the resources to have a monthly group for men that will be at the Remuera clinic at 81 Remuera Rd, these are the 2008 dates:

Wednesday 7th May, 08
Wednesday 4th June, 08
Wednesday 2nd July, 08
Wednesday 6th August, 08

Please let us know that you are coming by phoning Sarah or Sandra on (09) 623 3098 or 0508 934 448.

Last Words from Elizabeth...

Dear friends/patients

It is sad to be leaving Surgical Weight Solutions. However it is autumn, and I am in the autumn of my life. Hence I have made the decision to retire.

I have totally enjoyed my experience working with Michael and his wonderful team; Lyn, Catherine, Chris, Sarah, Sandra. It has been one of the most satisfying experiences of my 40 + years as a dietitian. However I leave Surgical Weight Solutions knowing you are in excellent care with our terrific dietitian, Nikki.

I wish you all "good eating, happiness and great health" I will miss you all. You have been marvellous!

Elizabeth
However just a last word...

Multivitamins...

We have had some patients returning with some unusual symptoms:

One chap came in recently with a loss of feeling in his hands. It transpired that he had not been taking his multivitamins everyday, but only "when I remember"

That is not good enough!

• Multivitamins are recommended from one month post surgery, and occasionally earlier.
• Ideally we would have a specific multivitamin for bariatric patients. These are available in the United States. We hope that they will eventually be manufactured for our patients in Australasia. Currently we recommend Centrum multivitamins
• Alternatively Usana are excellent but expensive and Clinicians are suitable (this is a powder mixed with water, and is useful in the first stages after surgery.
• Multivitamins are important for many reasons
  • All the types of weight loss surgery result in restriction of intake. Because less food is being eaten, less vitamins and minerals are consumed.
  • The tendency post surgery to avoid some nutrient rich foods due to intolerance ( ie meat) means that less iron, zinc and vitamin B12 is ingested
  • Gastric bypass patients have the portion of small bowel bypassed which is normally responsible for absorption of iron; zinc; calcium; magnesium; vitamin B12 and folate (another B vitamin), resulting in a significant reduction in vitamin and mineral absorption.
  • For these reasons, you need to have additional vitamins and minerals (in the form of a multivitamin tablet) to ensure you have an optimal intake.
• Get into a routine with your multivitamins - take at the same time every day
  • If you take regular medication, keep with that, so it is just another medicine which is required
  • If you do not need other medication, try keeping them next to your toothbrush, so you see them every morning
  • Have several bottles of multivitamins, one in your bathroom or beside the kettle, one in your handbag or desk drawer so that never a day goes past without your taking your multivitamin
• If you do not take your multivitamins, you are likely to become deficient in vitamins and minerals, some of which can cause irreversible damage (such as memory loss, nerve damage and brain damage).
• This is why it is very important to have your blood tests regularly, as this will highlight potential low vitamin and mineral stores which may require a little extra supplementation over and above your standard multivitamins
• There are some vitamins and minerals we cannot test in your blood. Calcium is one of these minerals. For this reason we ask you to have a bone density scan within the first year. This gives us a baseline measure. We would like you to repeat these two years later. If you have not had a bone density scan, please call us for a bone density form to take to a radiology clinic and get this done. It is for your future good health!

Dietitian's Direction...

Meal Plans

I receive a lot of requests for a 31 day meal plan post surgery. For most of these requests I say no. This is not because I want to be difficult, but rather I want you to learn how to adapt what you prefer to eat to suit your new life post surgery.

Everybody has different tastes, and what one person enjoys another may not. An example of this is a lot of people I see do not like cottage cheese - it is seen as a "diet" food with a lot of negative feelings and memories attached to it. I do however have a lot of people who love it! Some people enjoy spicy foods, where as others prefer food to be plain. For this reason a generic plan for 31 days is not possible. We have a generic plan for three days to give you an idea of what foods are suitable, and amounts you need to eat. From this we would like you to extend this to your life, to suit your lifestyle.

If I provide a 31 day meal plan, I am not actually doing you any favours. It is going to be harder later on for you to adapt food to be suitable at your stage post surgery. However if you are struggling (for whatever reason), please let me know and I will endeavour to help you.

Nikki

Follow Up...

Follow up is vital

• It is your responsibility to organise your follow up (organising your next appointment when you are leaving after your current appointment is an easy way to remember to book). Take your appointment card and put it in place you will not forget.
• Follow up appointments are at: 1 month, 3 months, 6 months, 9 months, 12 months, 18 months and 24 months post surgery.
• Please have your blood tests at least one week before your appointment so we have received the results. If you do not have a blood form for your next appointment, please ring the rooms and we will send you another one to you.
• These appointments allow us to see how are you progressing post your surgery, a time for you to express any problems or concerns you may have (though you are always free to ring or email if information in needed before your next appointment)

Your Stories...

Surgical Weight Solutions are looking to share your weight loss experiences. If you would like to relate your story - good or bad, please forward to info@surgicalweightsolutions.co.nz Please indicate your preference to be named or to retain anonymity.

Surgical Weight Solutions reserve the right to abridge any stories.

Life after Weight Loss Surgery...

Kylie	Bernie

Aimee	Tania

Jacqui	Currently out of stock..

Beth

Appointments...

We request that patients wanting appointments phone the rooms rather than email requests through. The increased number of email requests are becoming unmanageable and the delay in replies mean appointment slots have been taken in the interim period. Our Auckland based patients can call 623 3098, for those based in other regions use our toll free number, 0508 934 448.

Your Experiences Please...

We want to put some statistics together and need your help. We are interested to know if you have experienced any of the following post surgery (if you can pinpoint time post surgery that would also be great).

• Developed a sweet tooth (after not having one pre surgery)
• Taste preference has totally changed
• If you have trouble with reflux
• If your reflux has been "cured"
• If your sleep apnoea has been "cured"
• If you have come off all your diabetes medication and you blood sugars are well controlled
• If you have completed a ½ or full marathon, or triathlons etc

Anything else significant that you would like us to know

Information Evenings...

Many of you have been along to the information evenings we have been providing for interested people over the last year. We welcome any suggestions as to how these may be improved and do appreciate those of you who have given your time to come along and provide prospective patients with your personal experiences. It never ceases to amaze us how well our patients speak and how entertaining you can all be! Start times are 7.30pm, please phone or email for bookings. Up coming dates:

Shea Terrace :

12th May 2008
9th June 2008
7th July 2008
4th August 2008

81 Remuera Rd :

01st May 2008
26 June 08
24 July 08
28 August 08

Contact Details...

Phone 09 623 3098 0508 Weight (934 448)
Fax 09 441 2759

Email info@surgicalweightsolutions.co.nz
Website www.surgicalweightsolutions.co.nz

This website is being continuously updated and any comments or suggestions are much appreciated.

We always look forward to seeing you all for follow-up. If you have any comments or suggestions or would like to write a piece for the next newsletter, please let us know.

Self-respect is the root
of discipline:
The sense of dignity
grows with the ability to say no to oneself

April Summer/Autumn Newsletter 2008

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