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Spring 2014 edition


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Half His Size

Dana Credits Support Groups, Bariatric Team for his Success


By Linda Trainor, RN, BSN

At any given bariatric support group at Beth Israel Deaconess Medical Center, attendees can listen to Dana Epstein sincerely share his strength, hope and recovery following weight loss surgery.

Dana Epstein before his gastric bypass surgery (left) and after"I am very pleased, excited and proud to help others who have had weight loss surgery," says Dana.

He claims that having the surgery, in April 2011, was the best decision that he ever made for himself. "My only regret is that I did not have the surgery performed at a younger age.”

His well-meaning family and friends, Dana notes, continually voiced their concerns about the risks and benefits of weight loss surgery. However, after numerous unsuccessful attempts with self-directed and formalized dieting, Dana sought the advice of his primary care doctor about viable options for long-term weight loss. Sure enough, with Dana tipping the scale at 327 pounds and knowing the health risks associated with obesity, his doctor suggested weight loss surgery.

Dana researched the procedures himself and attended a weight loss surgery informational session offered by Dr. Daniel Jones and Dr. Benjamin Schneider at BIDMC — which left him with no doubt that this was the long-awaited answer to his lifelong struggle with obesity.

"I completed the application prior to leaving the session and felt a sense of relief and confidence that before I turned 50, I would finally have help to end my endless battle with being overweight," Dana says.

While researching the Roux-en-Y gastric bypass and its recovery process, Dana also reflected on the possible reasons for his previous, unsuccessful attempts at long-term weight loss.

"Other diets did not yield lasting results because as soon as I stopped buying the food required on popular weight loss programs, or did not attend weekly meetings, old habits returned," Dana explains.

Dana on his first day home after having a Roux-en-Y gastric bypass.Knowing these things contributed to his lack of success, Dana vowed not only to have the procedure, but abide by the healthy suggestions offered by his surgeon and the multi-disciplinary bariatric team for long-lasting success.

Now three years after having surgery and down 120 pounds, Dana remains serious about keeping his regularly scheduled appointments with Dr. Schneider and bariatric nutritionist Michelle Davis, RD. Beginning with his initial post-op period, Dana has faithfully attended the monthly bariatric support groups offered at BIDMC’s Boston campus.

"It is one thing to listen to the excellent professional advice from the bariatric staff, but it is another to relate to others who have experienced having weight loss surgery,” he says. “Along with eating healthy and exercising, I really believe attending support groups, and sharing thoughts and feelings with other people who have had weight loss surgery, has been instrumental in my success.”

Dana's relationship with food has also drastically changed since having weight loss surgery. Boredom or emotions are no longer triggers for eating high calorie foods; instead, Dana says that he has formulated many other meaningful relationships and no longer isolates himself from others to deal with boredom or uncomfortable feelings. He also is proud to be a Bari Buddy for BIDMC’s Weight Loss Surgery Center.

"I have a strong network of support with family, friends and BIDMC staff," he says. "Being a Bari Buddy and going to support groups keeps me honest. Knowing that I have to show up in front of people helps me to not stray from my goals. Now, I certainly have more self-esteem to do all that."

Dana also stays mindful of what he is eating, and how he eats it.

"I never fail to plan my meals," he says, “and I eat slower, and take my time to enjoy food."

His daily routine includes four small meals, which are limited to one cup each. He usually has a protein shake for breakfast, protein and salad for lunch, and protein with vegetables for dinner. Snacks are inclusive of protein and fruit.

"Both nutritionists have been very helpful in guiding me with a workable food plan that includes all food groups," Dana says. "I used to use food for comfort, but now I walk and use other venues for stress relief."

Dana working out at his gymThat includes the gym he joined, where he goes four to five times a week to do cardio and strength training exercises under the guidance of his personal trainer. “I love working out!” he proclaims.

Dana’s diet changes, exercise routine, and build-up of his support system have tremendously improved his quality of life. Gone are the medications for hypertension and the pre-diabetic consideration, as his blood pressure and A1C level are now right where they need to be. He enjoys a lot more activities that he couldn’t before losing 120 pounds — including just climbing a flight of stairs without being winded, as well as walking instead of driving for errands — and finds his calendar more full with social engagements and family outings.

"I have a blast playing with my darling nieces, who are both under the age of nine and very energetic,” Dana says with a laugh. "It means so much to me to have fun with them, to keep up with them. I would never have been able to do that weighing almost 330 pounds.”

When asked if he would recommend weight loss surgery for others who suffer from the physical and emotional effects of obesity, Dana offers a candid response.

"I am a new person thanks to having weight loss surgery," he says without pause, though he cautions those who are considering it. "But it is important to know that surgery is not for those looking for a quick cure. It is not a sprint, but a marathon worthy of each devoted step to obtain a new life. I used to live a half-lived life, and now I am half my size and fueled for success with a full life ahead!"

All photos courtesy of Dana Epstein 

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News

Beyond the Operating Room: The Importance of Support Groups for the Post-Operative Bariatric Patient


By Sue Levy Walker, MSW
BIDMC Bariatric Social Worker
 

gathering of hands in supportThe journey from application to operation is often times a lengthy one. It is a time of preparation, of distancing one's self from behaviors and eating patterns that have become all too familiar, and requires all patients to evaluate their life from many different angles.

Pre-operative life circumstances that rise to the forefront of struggles for patients can include health concerns, limited engagement in activity, disordered eating habits, problematic family systems, past traumas, stressful work environments, troubled social connections, difficulty with time management, and general relationship issues. What gets examined before patients are approved to have weight loss surgery is how each person's connection with food has come to play a role in what are simply normal circumstances of the human condition.

As clinicians we feel, without question, that the time patients spend working on their individual issues in preparation for surgery, along with the support and guidance needed to help each person reach the point of approval, is equal to the post-operative work needed for patients to achieve long-term success.

The value in support being received within the context of a group of patients, all sharing a similar journey, can be a unique bonding experience where patients can connect through a common shared experience. The value of connecting with others who are dealing with the same questions, concerns, and challenges is crucial for patients who can often feel misunderstood, judged and alone on a journey that can all too easily become derailed.

In a dedicated support group focused on continuous reinforcement work on behavior modification, and ongoing education about nutrition and general post-operative needs, an environment is created that offers patients a place to stay focused and feel supported.

Life after bariatric surgery can pose many challenges. There are new issues to deal with, new questions that need answers, and a new life to adjust to. Engagement in post-op support groups with individuals who are working through similar situations can often help patients achieve success in meeting both long and short term goals.

At Beth Israel Deaconess Medical Center’s Weight Loss Surgery Center, we offer a monthly support group program which incorporates many of the disciplines and discussion topics of importance to our patients. The program is open to all of our post-op patients and is free of charge. Our schedule includes a variety of presentations from staff and guests, including cooking classes, general support and open discussion, physician and patient presentations, recipe and clothing swaps, nutritional and medical education, and exercise discussions.

Our schedule can be found online and is also posted in our clinic. For additional information and questions, please call our clinic at 617-667-2845.

We hope to see you soon and help support you in your journey towards health and wellness.

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Nutrition Corner

Goal Setting: One Step at a Time


By Kate Otto, RD, LDN
Bariatric Dietitian at BIDMC

I never liked the spring … that is, until I moved to New England. The wonderful season of new beginnings certainly takes on a whole new meaningnutrition after being buried in feet of snow for what feels like an eternity.

This newfound appreciation was fully realized the first time I experienced the Boston Marathon. I’ll never forget the rush of cheering on runners as they pushed themselves to accomplish a goal they had been working toward for months. This is much like the rush I experience every day as I work with the Weight Loss Surgery team here at BIDMC to assist our patients as they achieve the goals they have been working toward for years.

With every new season comes a new weight loss-related challenge: the temptations of the holidays, the social events of summer, the comfort foods of fall, the exercise-crippling winter weather. While many of us put so much pressure on ourselves on New Year’s Day, I would argue that the spring might be the best time to re-evaluate the goals we set a few months back.

If you are human, it is likely that you haven’t given your resolutions much thought since about January 15. So I challenge you to revisit your “This year I will accomplish …” and consider the more realistic alternative of “This week I will accomplish …”

When we set out to work toward a new goal, with the long-term picture in mind (especially in our world of instant gratification), most of us are quick to run off course. In the spirit of what was the most inspiring Marathon Monday the great city of Boston has ever seen, I encourage you all to contemplate the ever-present weight loss surgery journey cliché: “It’s a marathon, not a sprint.”

Evaluating our weight loss-related goals in the present mindset can make our journey to the finish line seem much less daunting. Those of you who are bariatric patients at BIDMC have had the “goals” conversation with me, or my colleague Michelle, at some point. Yes, we will identify what your ultimate goal is — but we will always follow up with, “How can you work toward that goal this week?” This is crucial when we are seemingly starting from scratch or getting back on track. Let’s continue with that running analogy to better explain.

Say our goal is to finish a 5K charity run. We sign up for the race, but after a brutal winter our current physical activity involves little more than shoveling snow and scraping windshields. Chances are the first training run will result in huffing and puffing after one block, right? How would that make us feel if the goal we have in mind when we leave the front door is to run a 5K? (I don’t know about you, but I would be calling that charity really fast to see if I could cancel my registration.)

nutritionNow, using the same scenario, let’s look at it from the present mindset: What’s more doable for the first training? Maybe a five-minute jog, followed by a 15-minute brisk walk. The positive mentality we walk away with after achieving the initial goal pushes us to move forward to the finish line. Ever searched for a running program online? I can guarantee that none of them start with achieving the ultimate goal on day one.

This same approach can be used with food-related behaviors. For example, are you struggling with craving sweets after reintroducing or overindulging during the holidays? While some of us would like to be able to give them up completely, for most, going cold turkey is much easier said than done.

What about instead of abstinence, we make the goal to reduce: “This week I will have a sweet three times per week instead of seven.” Notice this goal is also specific and measureable — much easier for us to track our progress.

I realize that this type of approach doesn’t work for everyone. You know yourself best, and some adjustments will need to be made along the way. Sometimes we have all the tools but are struggling to put them to use. If this sounds familiar, schedule a visit at the Weight Loss Surgery Clinic to check in with us, or sign up for our support groups, which cover a range of topics that can help you reach your goals.

Every person’s weight loss journey is unique; all roads have peaks and valleys. We are beside you, cheering you on through them all. Remember that any positive behavior change, no matter how small it may seem at the time, gets us one step closer to our goal. As much as we would like them to, weight changes do not happen overnight. But every marathoner’s race starts with one step. What will yours be?

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On the Lighter Side

Game on for Spring


By Linda Trainor, RN, BSN

It's SPRING! Flowers are blooming, birds are singing, the baseball boys are back, and our internal clocks are buzzing.

baseballSpring is that magical time of year that brings us hope and inspiration to move forward. All of our energy gears up with two goals in mind: To remove and replenish. Does this sound familiar? "Honey, it's time to do the yaaaarrrrd work!"

Hour after hour, many of us throw away unwanted stuff, clean indoor windows, doors, floors, and cabinets while raking, pruning, and planting.

So why can’t we apply the same productive principal to ourselves, and do some personalized spring cleaning? It’s time to pop out of winter hibernation and take the first steps towards removing unhealthy behaviors, while replenishing with refreshing healthy routines.

Since it stays lighter longer, why not eat lighter longer? Spring is also the perfect time to resume physical training just like our favorite guys of spring, summer, and (fingers crossed) fall, the Boston Red Sox. The first thing the boys of summer do is stretch to condition their bodies for the long haul of the baseball season. They come out of the winter slumber and pick up the baseball bats of lumber.

Stretch Yourself: Practical Steps to Healthy Spring Cleaning

Remove: Rid cupboards of junk foods.
woman stretchingReplenish: Fill your cleaned refrigerator with fresh fruits and vegetables

Remove: De-clutter your thought process.
Replenish: Use NUTS: Negative Unpleasant Thoughts Stopping.

Remove: Drop the morning doughnut.
Replenish: Enjoy lighter, more frequent meals that include filling fiber.

Remove: Take a swing at getting off the couch.
Replenish: Physically stretch your extremities and emotionally stretch your imagination — morning, noon and night, both in the office and out. Condition your muscles while watching the Sox flex theirs: just use the cans of soup you reorganized in the cabinet as weights!

Remove: The dullness of everyday and seasonal chores.
Replenish: Have fun! Put some energizing music on while you rake, dust, or dish wash. Sing and dance along!

Above all, practice forward thinking:

  • If I can spring clean my house, I can spring clean myself with a healthy diet.
  • Now that the boys are back in town, I can get a jump start to hit the ball out of the park for my own healthy home run.

Let the Spring Cleaning Games begin!

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Signature Series

Meet our OR Clinical Advisor


By Christie Roy
BIDMC staff

Heidee Albano, RN, OR Clinical SupervisorIt is common for patients preparing to have weight loss surgery to feel nervous about the procedure, their post-surgical care, and their results. Here in the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center, we hope those nerves will subside as you get to know Heidee Albano, RN, BSN, CNOR, our Operating Room Clinical Advisor.

Heidee’s role includes ensuring that she and her staff provide the safest and highest quality care to all bariatric surgery patients. That means making certain that everyone is up-to-date with their clinical knowledge of treatment and medical equipment, as well as the latest trends in medical technology.

“We have high quality and care standards here at BIDMC, and this is a very team-oriented environment,” Heidee says. “We know we all have to work together and bring our ‘A’ game every day.”

Heidee has worked at BIDMC for 26 years, and started the Weight Loss Surgery program with Dr. Daniel Jones in 2002. At that time, she was a staff nurse and found immediate enjoyment in caring for bariatric patients.

“They are the most enthusiastic group of patients,” Heidee says. “For them, losing weight is not an easy feat, and surgery is the best option for them to get healthy. It is very rewarding to see them lose weight, and gain back their self-esteem and self-confidence.”

Heidee incorporated a fun method of motivation for some of those patients along the way.

“I always looked forward to talking with my patients in the holding area and would pose a challenge to them,” she says. “I would ask what their weight loss goal was — they would usually say between 80 and 150 pounds. Then I would make a deal with a handshake by saying, ‘I weigh 97 pounds and I challenge you to lose the whole of me!’ They would give me that startled look and would say, ‘you have got to be kidding me.’ Then we would have the biggest laugh ever!”

Many of those patients have lived up to her challenge.

“I try to go to the weight loss reunions and I enjoy listening to their testimonials on how the surgery changed their lives,” Heidee proudly says of her patients. “I get a kick looking at those who I had deals with about losing the ‘whole of me and more,’ because they actually did!”

Heidee’s big heart shines through in all of her endeavors, whether caring for patients at BIDMC or caring for others she has never met. Back in 2005, she led fundraising efforts to help fellow nurses affected by Hurricane Katrina. Late last year, after Typhoon Haiyan hit her home country of the Phillippines, Heidee collected money and, with the help of friends involved in medical missions, medical equipment and supplies. She even asked her colleagues to save all unused OR supplies.

“Fortunately my family in the Phillippines was not directly affected,” Heidee explains. “But I could not just sit and do nothing. I was able to send money and several boxes of equipment and supplies already, and I have more.”

Heidee was also able to help a family in Haiti through her unofficial role as the “swear police” at work.

“I charge a quarter for every swear!” she says with a laugh. “A few years ago I told everyone, if they could in good faith, to add some money to the jar so we could help this boy and his family in Haiti.”

Heidee had read about the little boy, Dumanel Luxama, in the Boston Globe; he was suffering from a rare birth defect — a hole in the skull that allowed his growing brain to bulge outward and into a lump between his eyes. His family’s livelihood depended on farming but, in order to pay for bus tickets to take his son to a medical mission for treatment, the father sold their only possessions, two cows.

“The surgeon at the mission was from Boston Children’s Hospital, and he told the family that he wouldn’t be able to operate unless they came to Boston, but he would do the surgery for free,” Heidee explains. “A charity group paid for him and his dad to travel to Boston but while they were here, their farmland in Haiti was destroyed by a hurricane, everything was washed out. I read about one family donating money to help them buy a new cow, so I decided that we could too. With the money we raised here, we were able to buy the family a new bull — a working cow for their fields — and helped build them more sturdy shelter.”

Heidee knows that she is lucky to be in a position to help others — whether here at BIDMC or thousands of miles away — and believes it is that good fortune that enables her to do what she does.

“My parents were very generous and I was brought up well, but I was fortunate to get a good education and a good job,” she says. “I’m not happy if I just enjoy what I have, knowing that so many others are suffering. I hope I can motivate people to be more giving and generous. For me, it is better to give than to receive.”

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Trainer Tips

Benefits of Group Exercise


By Derek Walczak, Exercise Physiologist
Tanger BeWell Center at BIDMC

group of people exercisingThere is nothing wrong with going for a walk or lifting weights on your own, but having someone (or several someones) regularly join you for a workout can be key to staying motivated and committed to exercising.

On those days when you don’t quite feel up to snuff, a workout buddy can give you that extra push to get outside or hit the gym. Knowing that you and four of your friends already paid for 10 sessions of Zumba is also a good reason not to skip out on class #4.

Here are some other great reasons to join a group exercise program or round up some pals for a regular walk, jog, or gym session:

Save Money

It is often more affordable to work out in a group with a trainer than to hire a trainer for a one-on-one session.

Social

Work out with individuals who have similar goals, interests and possible reservations or fears of beginning an exercise program. This can alleviate some of the stress for everyone and act as a great motivator.

Challenge

Once you’re comfortable with the group, you can use others’ success as a challenge to reach your own. Individuals are also less likely to skip workouts when they know someone else is counting on them being there.

group of people exercisingCamaraderie

Support from your fellow group members, as well as the instructor, can make you feel that you’ve become part of a community; knowing that others are cheering for you to reach your goals is also a great feeling.

Variety

There are countless types of group fitness classes and programs available, letting you and your friends try something new and change up your routine frequently to keep from getting bored. You could even start your own group class.

Safety

Working out in a group with an instructor, or even with just one partner, can help you avoid injury since someone will always be there to monitor your form or keep you from overdoing it. This especially holds true for weight lifting, but applies to most any workout.

Progression

A good exercise group or program will provide proper progression, so all fitness levels can be accommodated. This will keep the inexperienced exercisers safe and the more experienced folks engaged without becoming bored.

Fun

Participants often feel as if the time goes by faster during group workouts, as they are enjoying themselves and having a good time.

One final note: if you join a more formalized exercise group or class, make sure that the instructor or group leader is qualified and offers the workout in a safe environment.

Please consult a physician before starting any exercise program.


Derek Walczak is an Exercise Physiologist at BIDMC's
Tanger Be Well Center. He holds a BS in Kinesiology from UMASS Amherst and is a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association.

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In the Kitchen

Light and Delicious Spring Dishes


By Kate Otto, RD, LDN
Bariatric Dietitian at BIDMC

Here are some light, healthy and delicious recipes that will really put a spring in your step! 

Spring Mix Salad

Serves 1

spring mix saladIngredients

1 cup arugula, mixed salad greens, or spinach
2 to 3 oz. lean protein (plain or honey roasted turkey or chicken, tuna, etc.)
1 oz. crumbled goat cheese
4 fresh strawberries, sliced 
1/4 cup mandarin orange slices, drained
~ 1 tsp each olive oil and balsamic vinegar

Directions

Combine ingredients in a bowl. Drizzle with balsamic vinegar and olive oil, or your favorite light dressing (sweet flavors like raspberry vinaigrette or sesame ginger work best). Enjoy!

Lean Turkey Tacos

Serves about 6

turkey tacosIngredients

1 pound 99% fat free (lean) ground turkey breast
Whole wheat wraps or tortillas
1 can black beans, drained and rinsed (optional)
Spices: onion powder, garlic powder, chili powder, cumin, black pepper and red pepper flakes (optional)
Olive oil or nonstick spray
Fixings: lettuce, plain greek yogurt, salsa, diced tomato, low fat shredded cheese

Directions

Coat skillet with nonstick cooking spray or a drizzle of olive oil. Add ground turkey. While turkey cooks, generously (or to your preference) add seasonings for flavor (using them all is similar to pre-packaged taco seasoning). Just before shutting off the burner once the turkey is fully cooked, add black beans and stir to mix. Build your taco with your favorite ingredients (plain greek yogurt is a healthy substitute for sour cream) or serve over a bed of lettuce for a high protein salad.

Kate Otto is a bariatric nutritionist in the Weight Loss Surgery Center at BIDMC.

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News

Updates from the Weight Loss Surgery Center


Daniel Jones, MDCongratulations, Dr. Jones!

Dr. Daniel Jones, Director of the Weight Loss Surgery Center at BIDMC, has been named Vice President of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). SAGES works to improve the quality of gastrointestinal and endoscopic surgical patient care through education, research and innovation.

Dr. Jones was also recently named President of the Association of Surgical Education (ASE), an organization dedicated to promoting and rewarding innovation, development and research in surgical education.


Bariatric Advantage

Thanks for the feedback! Your continued success and well-being is of upmost importance to our bariatric multidisciplinary team. The feedback and comments that you have provided to our clinical and administrative team, from personal conversations to hospital surveys, have been most helpful to meet your pre- and post-operative needs.

We truly appreciate your terrific suggestions and will continue to implement them whenever possible to improve our program. During the past year, we have received substantial feedback from many patients stating that it was challenging to purchase the required specialty supplemental vitamins and protein supplements.

In response to this request, we currently have a varied selection of Bariatric Advantage products available for purchase in our Bariatric Clinic. Many patients have expressed that it has been very helpful to purchase the vitamins in chewable form and protein supplements at their pre- and post-operative appointments at BIDMC.

If you are interested in learning more about our Bariatric Advantage products, please contact the clinic at 617-667-2845.


Improving Access to Care: General Surgery Clinics

Our surgeons offer a variety surgical services in addition to performing weight loss surgery, including minimally invasive general surgery.

Dr. Daniel Jones and Dr. Benjamin Schneider have specialty training in advanced laparoscopic surgery and are board certified by the American College of Surgeons to perform many other surgeries as well as weight loss surgery, including laparoscopic cholecystectomy, hernia repair, adrenal, spleen, and anti-reflux procedures.

Dr. Schneider, when indicated, will perform some of these procedures robotically. Dr. Jones will also perform an abdominoplasty when accompanied with ventral hernia repair.

Our surgeons also see patients for General Surgery clinics at several locations:

For additional information regarding their clinic or procedures they perform, please contact Dr. Jones at 617-667-5101 and Dr. Schneider at 617-667-5104.

Above content provided by the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Originally Posted April 2014