June 2010 Winter Newsletter

Booth's Babble...

June Winter Newsletter 2010

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Winter is now upon us and the instinctive action of hibernation can be a force to reckon with. The key to weight loss is to persevere with your goals of eating good quality food and getting regular (3 to 4 times per week) exercise. So wrap up and maximize your weight loss!

Recently the SWS team was pleased to sponsor the Round the Bays after function. It was a great day and all participants struggled in eventually. The barbeque and drinks at the end were appreciated by all.

In this newsletter there are some interesting articles which raise important questions. What are 'The 10 most common mistakes weight loss surgery patients make' and 'Relationships with significant others' provide some common roadblocks you may experience on your weight loss journey.

Interesting facts are revealed in the overview of 'Worldwide Trends of Bariatric Surgery' such as the percentage increase in operation since 1998 is 761%. However why in the face of this evidence is the global rate of increase of bariatric surgery decreasing?

Currently we are making plans to attend the International IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) Conference in Long Beach, California. We will report back in our spring edition.

Special thank you to those of you who make time to speak at our info evenings, we really appreciate it, so do the prospective patients.

Michael, Catherine, Lynn and Nikki

Pregnancy and WLS...

I thought this newsletter I'd talk about pregnancy. This is always a topic people (especially women) want to know more about.

Pregnancy is safe after weight loss surgery (for all the procedures), though there are special considerations to think of. Despite the special consideration, studies have shown that pregnancy is safer after weight loss surgery (when the mother is thinner) than pre weight loss surgery.

First and foremost a woman needs to wait for at least 12 months after surgery to try to become pregnant. This is because:

• The first year after weight loss surgery is the rapid weight loss phase (especially with the gastric sleeve and gastric bypass), and being in a catabolic state (churning through the body's own energy stores) is not good during pregnancy.
• Food tolerance is much better at a year than prior to this, and generally a wide variety of foods is able to be eaten without too many issues. This is especially true for protein.
• Most have achieved their weight loss goal at a year, which means after pregnancy the weight loss is only pregnancy weight, not other weight
• There are decreased surgical complications after the first year

I advocate people prepare for pregnancy at least three months before trying to become pregnant.

• This includes taking additional folic acid (the folic acid in Centrum is insufficient), to 800mcg daily. This means an extra 600mcg per day. However, too much folic acid is not a good thing, as it could mask vitamin B12 deficiency, so the total amount of folic acid consumed daily should not be more than 1000mcg per day (1mg).
• When thinking about pregnancy, let me know and we will do some routine blood tests to look for any deficiencies prior to conception and correct before conception occurs
• Ensure diet is what I would consider optimal. Protein with each meal, minimal refined carbohydrates and fat. Plus having additional iron and calcium is a good idea.

During pregnancy:

• Let me know as soon as pregnancy is confirmed
• Weight gain is vital during pregnancy, to ensure the health and wellbeing of the growing baby and mother. This is healthy weight gain, and not weight gain as you have "known it" in the past.
• I check bloods again (if the last lot was a little while ago) to see what is going on
• I like to review every month to six weeks to keep a check on how things are going. This includes checking food tolerance, morning sickness and blood tests.
• The regular "rules" of weight loss surgery still apply, so they need to be followed.
• There are other foods which need to be avoided to ensure a safe pregnancy and minimise the risk of food poisoning and listeria which can have devastating effects on the growing baby.
• Protein intake is vital, and is higher than pre pregnancy. For this reason I recommend either an additional Optifast (which is safe as an addition to regular diet during pregnancy) or Complan or other protein supplement daily.
• Iron and calcium needs are also higher than pre pregnancy, and additional supplementation is common.
• I recommend at least two glasses of calcium fortified milk daily, which contributes to both protein and calcium intake
• Diet during pregnancy is hard, but it's worth it, and remember at the end of it all you have a lovely baby to show for it.

A few of our latest additions:

Nikki

Relationships with significant others...

Relationships with significant others often have an impact on your progress and at each stage of your journey there may be some changes in relationships. Emotions tend to be very strong the first year. Try to focus on your own health in the short term and save any big decisions regarding relationships for several months down the road.

Beginning of journey

Whether or not you elect to call on your family and friends to support you on your journey is an individual choice

• What to say to others: Some people like to be open about their surgery others don't as they feel it is a private matter. The most important thing is to be aware of your needs and plan your strategy with that in mind.

Relationships and how they may change after surgery

• Sabotage: Communication with the family is important they may be very proud of you and the changes you have made but they may also have a hard time adjusting to those changes. Bariatric surgery is almost as hard for the family as it is for you. This can result in either deliberate or unconscious sabotage which is a natural tendency to want to put things back the way they were. Often family members do not realize they have subconscious motive for bringing "cheat" foods into the house or putting obstacles in the way of exercise commitments. Persevere with your needs , explain the importance of the change to them so that they become aware of the consequences of their actions
• Family anger: Anger and resentment can occur at some point after surgery. The family is asked to make changes; they worry about the health and moods swings of the patient. “ It was my choice to have bariatric surgery but my family was drafted” Even if they are supportive and loving they may perceive that your obesity is due to lack of prior action and feel that the surgery has put undue pressure on them. Encourage your family to tell you how they feel. If it does not improve, the problem runs deeper you should consider family or relationship counseling.
• My friends are jealous of my weight loss: Some people will be jealous of your weight loss Perhaps the subject was ignored because you all had a weight problem and now the group dynamics have changed. Friends may feel uncomfortable around you because you have succeeded and they have not, especially if they have attempted weight loss themselves. There is resentment that you have regained control of your life. Try to be mindful of their needs as well as your own, weight loss can change others perceptions of themselves and your weight loss will have a psychological effect on others. Gravitate towards friends who can celebrate you success along side you.
• Others concerned with your weight loss
  It is a strange phenomenon when you do lose weight that people around you start discussing how you should “fatten up a little bit” or tell you that “you’re too thin”. This often occurs at the height of your weight loss; between 6‐12 months. Remember surgical weight loss is dramatic, and they are often expressing concern or fear of loss of control for you in this way. For these people it is difficult for them not to talk about your weight because sudden dramatic weight loss is so unusual. They may also make comments such as “you look so much better now” that may unwittingly hurt your feelings. Discuss these comments with them. They may not realize what they are saying or how it makes you feel.

Tips for attending social activities

• Have a workable plan prior to the party, and it should be a comfortable strategy.
• You can be motivated to discuss your journey with others
• You can discuss your weight loss or not
• You can ask for the subject of weight loss to change
• Keep a glass of water or other non‐caloric drink in your hand.
• Have your conversations away from the food
• Plan to exit the party after 2 hours if you feel overwhelmed
• It is important to normalise your socialising as much as you can

Lynn

Worldwide Assessment of Bariatric Surgery.

A recent study has highlighted the latest Bariatric surgery statistics. In the study, 33 nations and national groupings were involved.

There were two design components to the study:

one involved a questionnaire, which was sent as an email and included the following questions:

• Approximately how many bariatric surgery operations being done in your country each year?
• Approximately how many surgeons practice bariatric surgery in your country
• What is your estimate as to the relative percentages distribution of bariatric operations in your country? (Adding up to 100%)
• The other component involved data analysis

Bariatric Surgery 2003-2008

• 1998 total operations : 40,000
• 2003 total operations: 146,301.
  • Gastric bypass: 95,257.
  • Adjustable gastric band: 35.712
  • Sleeve gastrectomy: Nil
• 2008 total operations: 344,221
  • Gastric Bypass: 168,597
  • Adjustable gastric band: 145, 563
  • Sleeve gastrectomy: 18.000

Percentage increase in operations since 1998 761%

Australia/New Zealand:

• Number of operations 2003: 2750
• Number of operations 2008: 11,914

Global trends:

In comparison with the 2003 survey, all procedures apart from biliopancreatic diversion/duodenal switch increased in numbers performed. Although, the percentage of Laparoscopic Gastric Bypass Roux-en-Y procedures decreased from 65.1% to 49%; whereas Laparoscopic Adjustable Band increased from 24.4. % to 42.3%; and Sleeve Gastrectomy rose from 0.0% to 5.3%

Conclusions

1. Globally, the laparoscopic approach to operations is preferred to the open method
2. The most common procedures were: Adjustable Gastric Banding (42.3%), Open plus Laparoscopic Roux-en-Y gastric bypass (49.3%); and Laparoscopic Sleeve Gastrectomy (5.1%)
3. New questions were formulated:
   • Why, in the face of the world pandemic of obesity has the absolute rate of bariatric surgery decreased over the past 5 years (135%), in comparison the preceding five years (266%) increase?
   • Why has Sleeve Gastrectomy captured 5.3% of the global frequency of bariatric procedures?

4. In response to the plateau in the number of bariatric procedures, this cannot be explained by an overall lack of patients since we have operated on > 1% of the morbidly obese patients worldwide.

   The answer therefore must be denial of patient access to bariatric surgery by private or government payers for health care, lack of knowledge of the bariatric option for surgery in some communities, misunderstanding about the management of obesity as a disease, and the continuing underlying prejudice against the disease

5. Future trends should include monitoring the accuracy, reliability and universality of the essential global data with the recommendation that bariatric practices establish an international registry.

10 Most Common Mistakes Weight Loss Surgery Patients Make...

National Association for Weight Loss Surgery

In a November 2005 poll conducted by National Association for Weight Loss Surgery the following were identified as the top 10 mistakes WLS patients make:

1st Mistake: Not Taking Vitamins, Supplements, or Minerals

Every WLS patient has specific nutritional needs depending on the type of surgery you have had. Not only is it a good idea to ask your surgeon for guidelines, but also consult with an experienced WLS nutritionist. Some conditions and symptoms that can occur when you are deficient in vitamins, supplements, or minerals include:

Osteoporosis; pernicious anaemia; muscle spasms; high blood pressure; burning tongue; fatigue; loss of appetite; weakness; constipation and diarrhoea; numbness and tingling in the hands and feet; being tired, lethargic, or dizzy; forgetfulness, and lowered immune functioning.

Keep in mind, too, that some conditions caused by not taking your vitamins, supplements, or minerals are irreversible.

2nd Mistake: Assuming You Have Been Cured of Your Obesity

A "pink cloud" or honeymoon experience is common following WLS. When you are feeling better than you have in years, and the weight is coming off easily, it's hard to imagine you will ever struggle again. But unfortunately, it is very common for WLS patients to not lose to their goal weight or to regain some of their weight back.

A small weight regain may be normal, but huge gains usually can be avoided with support, education, effort, and careful attention to living a healthy WLS lifestyle. For most WLSers, if you don't change what you've always done, you're going to keep getting what you've always gotten -- even after weight loss surgery.

3rd Mistake: Drinking with Meals

Yes, it's hard for some people to avoid drinking with meals, but the tool of not drinking with meals is a critical key to long-term success. If you drink while you eat, your food washes out of your stomach much more quickly, you can eat more, you get hungry sooner, and you are at more risk for snacking. Being too hungry is much more likely to lead to poor food choices and/or overeating.

4th Mistake: Not Eating Right

Of course everyone should eat right, but in this society eating right is a challenge. You have to make it as easy on yourself as possible. Eat all your meals--don't skip. Don't keep unhealthy food in sight where it will call to you all the time. Try to feed yourself at regular intervals so that you aren't as tempted to make a poor choice.

And consider having a couple of absolutes: for example, avoid fried foods completely, avoid sugary foods, always use low-fat options, or only eat in a restaurant once a week. Choose your "absolutes" based on your trigger foods and your self knowledge about what foods and/or situations are problematic for you.

5th Mistake: Not Drinking Enough Water

Most WLS patients are at risk for dehydration. Drinking a minimum of 1.5 litres of water per day will help you avoid this risk. Adequate water intake will also help you flush out your system as you lose weight and avoid kidney stones. Drinking enough water helps with your weight loss, too.

6th Mistake: Grazing

Many people who have had WLS regret that they ever started grazing, which is nibbling small amounts here and there over the course of the day. It's one thing to eat the three to five small meals you and your dietitan agree you need. It's something else altogether when you start to graze, eating any number of unplanned snacks. Grazing can easily make your weight creep up. Eating enough at meal time, and eating planned snacks when necessary, will help you resist grazing.

Make a plan for what you will do when you crave food, but are not truly hungry. For example, take up a hobby to keep your hands busy or call on someone in your support group for encouragement.

7th Mistake: Not Exercising Regularly

Exercise is one of the best weapons a WLS patient has to fight weight regain. Not only does exercise boost your spirits, it is a great way to keep your metabolism running strong. When you exercise, you build muscle. The more muscle you have, the more calories your body will burn, even at rest!

8th Mistake: Eating the Wrong Carbs (or Eating Too Much)

Let's face it, refined carbohydrates are addictive. If you eat refined carbohydrates they will make you crave more refined carbohydrates. There are plenty of complex carbohydrates to choose from, which have beneficial vitamins. T ry using your complex carbohydrates as "condiments," rather than as the centre point of your meal. Try sprinkling a tablespoon of brown rice on your stir-fried meat and veggies.

9th Mistake: Going Back to Drinking Soda

Drinking soda is controversial in WLS circles. Some people claim soda stretches your stomach or pouch. What we know it does is keep you from getting the hydration your body requires after WLS--because when you're drinking soda, you're not drinking water! In addition, diet soda has been connected to weight gain in the general population. The best thing you can do is find other, healthier drinks to fall in love with.

They are out there.

10th Mistake: Drinking Alcohol

If you drank alcohol before surgery, you are likely to want to resume drinking alcohol following surgery. Most surgeons recommend waiting one year after surgery. And it is in your best interest to understand the consequences of drinking alcohol before you do it.

Alcohol is connected with weight regain, because alcohol has 7 calories per gram, while protein and vegetables have 4 calories per gram. Also, some people develop an addiction to alcohol after WLS, so be very cautious. Depending on your type of WLS, you may get drunker, quicker after surgery, which can cause health problems and put you in dangerous situations.

If you think you have a drinking problem, get help right away. Putting off stopping drinking doesn't make it any easier, and could make you a lot sicker.

Catherine

What is the cause of hair loss (telogen effluvium)

In a normal healthy person's scalp about 85% of the hair follicles are actively growing hair (anagen hair) and 15% are resting hair (telogen hair). A hair follicle usually grows anagen hair for 4 years or so, then rests for about 4 months. The resting or telogen hair has a club or bulb at the tip. A new anagen hair begins to grow under the resting telogen hair and pushes it out.

Thus, it is normal to lose up to about 100 hairs a day on one's comb, brush, in the basin or on the pillow, as a result of the normal scalp hair cycle.

If there is some shock to the system, as many as 70% of the anagen hairs can be precipitated into telogen, thus reversing the usual ratio. Typical precipitants include:

• Illness, especially if there is fever
• Surgical operation
• Accident
• Childbirth
• Nervous shock
• Weight loss or unusual diet
• Certain medications
• Discontinuing the contraceptive pill
• Overseas travel resulting in jetlag
• Excessive sun exposure

The resting scalp hairs, now in the form of club hairs, remain firmly attached to the hair follicles at first. It is only about 2 months after the shock that the new hairs coming up through the scalp push out the "dead" club hairs and increased hair fall is noticed.

Thus, paradoxically, with this type of hair loss, hair fall is a sign of hair regrowth. As the new hair first comes up through the scalp and pushes out the dead hair a fine fringe of new hair is often evident along the forehead hairline. At first the fall of club hairs is profuse and a general thinning of the scalp hair may become evident but after several months a peak is reached and hair fall begins to lessen, gradually tapering back to normal over 6-9 months. As the hair fall tapers off the scalp thickens back up to normal, but recovery may be incomplete in some cases.

Because nail and hair growth are under the same influences, an arrest in hair growth is often mirrored in the nails by a groove across them coinciding with the time of the shock to the system. This is called a Beau's line. The time of the shock can be estimated from the fact that a finger nail takes 5 months to grow from the posterior nail fold to the free edge. So if the groove in the nail is half way down the nail then the shock must have been 2 1/2 months ago.

Chronic telogen effluvium

In some patients, hair shedding continues to be intermittently or continuously greater than normal for long periods of time, sometimes for years. The hair cycle appears to be reset so that the anagen period is shortened.

Chronic telogen effluvium often presents in women that actually continue to have quite thick and moderately long hair - this is because they notice the shed hair more than those with finer or shorter hair. Telogen effluvium does not cause complete baldness, although it may unmask a genetic tendency to genetic balding i.e. female pattern hair loss , or in men, male pattern hair loss.

What is the treatment for telogen effluvium?

Telogen effluvium is self-correcting. It is really not influenced by any treatment that can be given. However, gentle handling of the hair, avoiding over-vigorous combing, brushing and any type of scalp massage are important.

You should also ensure a nutritious diet, with plenty of protein, fruit and vegetables.

The doctor may check your thyroid function, and levels of iron, vitamin B12 and folic acid, as any deficiency in these can slow hair growth.

Click here to view on telogen effluvium

Catherine

SWS Round the Bays...

Congratulations to the SWS team on completing Round the Bays!

The opportunity for a well deserved barbeque, drink and catch up at the SWS tent was a welcome touch.

It was really good to catch up with everyone.

A big thank you to Chris Wilkins our practice manager for once again pulling a rabbit out of the Hat..................not the SWS hat which was a nice gift thank you Michael.

It was great to see Elizabeth Buchanan and her husband Roger who helped with the barbeque. Along with Chris's husband Deryk. Thank you for your help.

Lynn

Chicken and Mushroom Pate

Ingredients:

• 250g Chicken Livers
• 3 shallots or 1 small onion
• 2 large flat brown mushrooms or a handful of white button mushrooms
• 2 tsp olive oil
• 1 egg
• salt and pepper
• small bunch of fresh thyme
• garlic (optional)

Instructions

1. Clean livers by rinsing them under running water. Pat dry on a paper towel.
2. Brown livers in 1 tsp of olive oil in non-stick pan. Brown both sides. Cooking should only take 2-3 minutes. When cooked put livers in food processor.
3. Finely dice shallots and mushrooms
4. Soften shallots and mushrooms in 1 tsp of olive oil in non-stick frying pan. Add salt and pepper to taste. Dice leaves of the thyme (not the stalks) and add along with the mushroom mixture
5. Crush garlic and add
6. Put cooked shallot and mushroom mixture in the food processor
7. Boil egg til hard, peel and place in food processor
8. Blend all ingredients into a smooth pate
9. Put pate in serving dish and serve with some low fat crackers, cruskets or crisp bread.

Preparation time 5 minutes
Cooking Time 10 minutes

Bariatric Surgery Notes:

1. Most French pate receipts use cream and alcohol to blend the pate to smooth. Both have been removed to help reduce calories.
2. This pate has a very smooth texture and was able to be eaten 3-4 weeks post-op.
3. The receipt will make the equivalent of 2-3 supermarket punnets of pate.

Support Group...

These groups have become an important part of a successful outcome with weight loss surgery.

They are at their most valuable in the first 12 months after surgery in order to optimise your weight loss goals and provide support through any frustrations and pitfalls. In 2010 we have developed a more comprehensive programme where each week there are different topics for discussion. Times remain on Wednesday evenings at 6.30 please contact Sarah or Sandra for more information and bookings on 09 441 2790.

Shea Tce, Takapuna:

• 28th July
• 25th August
• 29th September
• 27th October
• 24th November

81 Remuera Road:

• 7th July
• 4th August
• 1st September
• 6th October
• 3rd November

Information Evenings...

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.

Start times are 7.30pm, please phone or email for bookings.

Shea Tce, Takapuna:

• 14th July
• 18th August
• 13th October
• 17th November
• 8th December

81 Remuera Road:

• 29th July
• 16th September
• 28th October
• 16th December

Contact Details.

Phone 09 441 2750 0508 Weight (934 448)
Fax 09 441 2759

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

June Winter Newsletter 2010

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