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Summer 2014 edition


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Splashing Success

Jerome Leslie Turns the Tide with 75-pound Weight Loss


By Linda Trainor, RN, BSN

It is much easier for Jerome Leslie to make waves this summer after experiencing a 75-pound weight loss.

“I just finished the Boston Light Swim,” he says proudly, adding that this was his most challenging and longest swimming race to date.

Not many swimmers over the last 100 years have been able to complete the race in the allowed time of five hours. However, on July 26, 2014, Jerome was one of 24 solo swimmers who not only started the eight-mile swim, but stroked past seven harbor islands and fought through the ocean swells to finish the race in South Boston.

Jerome Leslie competed in the Boston Light Swim in 2014 after bariatric surgery and a 75-pound weight lossJerome admits that this accomplishment would have been highly unlikely prior to having weight loss surgery, which he underwent in November of 2010 with Dr. Daniel Jones, Director of the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center.

“Getting the gastric band placed has made such a difference in my life,” says Jerome. “It actually propelled me back into the water to rekindle my lost love of swimming.”

Over the past four years, Jerome has not only succeeded in improving his swimming technique, but in making healthier food choices, decreasing portion sizes and eating mindfully. These lifestyle practices helped turn the tides, as Jerome’s body-mass index (BMI) has gone down from 41.4 to 34.1.

Jerome admits to struggling with weight for his entire life before having the gastric band procedure. Standing nearly 7 feet tall throughout his high school and college years, his BMI never quite escalated to an unhealthy point, despite his poor food choices, because he was an avid competitive swimmer.

Jerome Leslie and his dog on the beach“I have always been the embodiment of the ‘Big and Tall’ individual since the day I was born,” Jerome says. “But I was never really conscious about my eating habits at that age because I was burning so many calories swimming.”

This changed in early adulthood when he stopped his rigorous, six-day-a-week swimming activity. With decreased exercise and unchanged eating habits, Jerome gained 75 pounds. He vividly recalls how his eating was out of control, and how disheartening it was to realize that his choices did not support the sport he had grown to love and cherish.

“I did not eat like a competitor or champion,” he says, “and my body was under a considerable amount of physical stress from this weight gain, even though I had been a competitive swimmer since I was five.”

Jerome developed several comorbidities related to his weight gain, including high blood pressure, sleep apnea, high cholesterol, and back and knee pain. He also began to suffer from decreased self-esteem, panic attacks, and situational depression related to obesity.

“I just didn’t feel good, I knew I was in deep waters with my health,” he says. “I couldn’t even swim a mile due to shortness of breath and decreased stamina. Finding clothes was next to impossible. I lived out of jeans and wore oversized sweatshirts and always carried an extra sweatshirt to change if I sweated too much because of the extra weight.”

From 2003 to 2010, Jerome challenged himself with a series of self-directed and formalized diets that resulted in losing 20 pounds, then regaining 30.

But he didn’t drown in his struggles. With the true soul and sheer stubbornness of a competitive athlete, Jerome refused to give up, no matter how many times he failed in reaching his weight loss goal. He knows that his futile dietary attempts were very much a part of his eventual success, and he learned from those losing/gaining experiences.

“I learned that the options of doing what I loved were all slipping away due to being overweight,” he says.

With the help of a therapist to address his emotional triggers to eating, as well as his decision to have the adjustable gastric band procedure, Jerome came to a realization that nothing tasted as good as becoming physically active again.

Jerome Leslie exits the ocean to applause after completing the 2014 Boston Light Swim“Now, I am doing very well,” says Jerome. “But one thing is for certain: the swimmer I was at 18, I am not at 36 — but I have a whole new set of goals to accomplish in the sport that I love.”

Not to mention a whole new appreciation for and a new perspective of that sport, as well as a newfound confidence.

“At 18 I swam fast and furious for sprint races, I did not have the technique or mentality to be an endurance swimmer. But after my weight loss, I discovered what was actually considered to be a negative effect on my body literally became better for my age,” Jerome explains. “I know that I never am going to win an ocean race or be the fastest marathon swimmer, it doesn’t matter. What matters is that I can still accomplish and complete the race within the parameters, and I let that be my ultimate swimming goal.”

While Jerome’s weight has finally stabilized, his life is soaring. Upon finishing the Boston Light Swim, Jerome and his wife packed all their belongings and headed to Seattle for a new life with new adventures. In or out of the water, whether he’s living on the East Coast or West, nobody is going to break Jerome’s championship stride for healthy, happy living.

All photos courtesy of Jerome Leslie

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Up Front with Our Farr 9 Staff

Striving to Support, Educate and Cheerlead Our Bariatric Patients


By Christie Roy, BIDMC staff

Having surgery is not usually something that fills a person with excitement and happiness. There is often anxiety and discomfort about the procedure, the outcome, the rehabilitation. But for those patients undergoing weight loss surgery at Beth Israel Deaconess Medical Center, the inpatient team who cares for them says the level of enthusiasm from this patient population is unmatched.

“Our patients all are very eager because they want to have this surgery, they’ve gone through all the preparation and are excited to take the next step,” says Kim Maloof, RN, Unit-Based Educator on Farr 9, the floor where all bariatric patients stay after they leave the recovery room. “Patients will tour the floor before they have surgery, make friends with the other patients and help each other while they’re here. We’ve even had friends, both planning to have the surgery, call ahead to see if they can be roommates.”

Always smiling: Staff who care for bariatric surgery inpatients on Farr 9 at BIDMCFarr 9 itself carries an air of optimism, with its cheery displays of information for patients and an upbeat attitude that resonates not just among the patients, but from one staff member to the next.

“Usually, bariatric patients are trying to make a positive change in life and have already gone through a lot,” Chris Gervino, RN, says. “It’s great to help them through to reach their goal, and our goal is to make their stay with us as enjoyable and productive as possible, and get them home as quickly and as safely as possible.”

Kao Saephanah, the floor’s Unit Coordinator, previously worked in the outpatient bariatric clinic and now recognizes many inpatients as folks he met while they took their initial steps towards weight loss surgery.

“Most of our patients are really enthusiastic to begin with, but for us to be able to be positive with them and share positive words, that helps too,” he says, echoing the sentiments of his colleagues. “It takes a lot of commitment to their plan after surgery, and I commend our patients for devoting themselves to it, I like seeing their ‘old-to-new’ transformation.”

John Ryan, RN, Nurse Manager for Inpatient Surgery on Farr 9, is proud of his team and the good reputation they have in attending to this patient population.

“Everyone on our staff is a real expert in the care of bariatric patients,” Ryan says. “Having this unit-specific staff is really beneficial for our patients — they know they will be cared for well and safely, and are confident that we will recognize any subtle changes that could indicate a problem. We also have a good working relationship with our surgeons and residents, they all know the expertise of our nurses.”

The time a patient spends on Farr 9 after having weight loss surgery varies depending on the procedure, but generally inpatients stay for one to three days. This time period has decreased over the years as the procedures have become less invasive. With such a short amount of time, it’s up to the nurses to begin working with the patient right away to get them on the right track.

“Our patients are usually very well-versed in what to expect after surgery — the diet progression, the activity level,” explains Ryan. “Our outpatient clinic does a great job in getting the patients ready, but it’s still important for us to go over their routine with them, round with all of the nurses and the surgeons, and reinforce the teaching the patients have already had.”

As Ryan alludes to, each patient follows a “surgical pathway” — a specific plan for diet, activity, supplements, and general recovery to which they need to adhere. The pathway begins with the patient’s arrival on Farr 9 and continues after they leave. If a patient wavers from that pathway, their nurses are ready to step in.

“We can all help explain to them what’s happened if they go off that pathway and how to get back on right away,” says Maloof. “Family members are also very involved right from the get-go, and we try to educate to help alleviate any fears they might have.”

The nursing team works together to keep each patient following their pathway, handing off information to each other and to nursing assistants during shift changes, and working closely with the surgeons, clinic staff, and case manager to determine if anything additional is needed, such as meetings with other specialists or social workers. Sharing patient notes online has also been helpful to the entire staff, Maloof says, as well as bedside computers that allow for quick answers to patients’ questions about diet and medications.

None of the Farr 9 staff members hide the fact that they are very dedicated to caring for their bariatric patients, and sensitive to their needs.

“They’re here because they want to be,” Ryan says of his staff. “I look for people who are interested in the population that we’re taking care of, who can provide quality, compassionate care. We all understand what our patients are going through, and think about them as if they are our own family members.

“It’s wonderful to see our patients have that satisfaction of working towards a goal and getting better,” he adds. “All of us work hard to help them get there, and it’s always rewarding to hear good, positive words from our patients after they’ve left our floor.”

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Nutrition Corner

Fun with Summertime Grilling


By Michelle Davis, RD, LDN
Bariatric Dietitian at BIDMC

We New Englanders have been basking in the warm sunshine this summer, our cold and snowy winter all but forgotten. Most of us dusted off the grill as soon the temperatures began to climb, to use as a cooking staple throughout the summer. What foods do most of us think of when grilling — probably hot dogs and hamburgers? Well, there is much more beyond burgers when it comes to the grill! Check out these tips for a fun twist on summertime grilling.

Flatbread Pizza and Quesadillas

grilled pizzaWho doesn’t love wood-fired pizza? With the grill, you can make it at home! Thinly roll out whole wheat dough and top with your favorite vegetables, lean meats and low fat cheeses. Throw it on the grill and cover until the cheese is melted and the bottom of the crust is lightly browned. Remove with a large spatula/oven mitt and enjoy.

Looking for a quick and easy yet delicious dinner? Place one whole wheat tortilla on the grill, top with low fat cheese and your favorite veggies and/or lean meat, and top with a second whole wheat tortilla. Grill both sides and enjoy with your favorite salsa and low fat sour cream or Greek yogurt.

Fruit

Another store-bought fruit salad? No, thanks! Try putting sliced peaches, peeled bananas, apples, pineapples and pear slices on the grill for a fun twist on fruit salad, or to add to salads and side dishes. Make fruit skewers with your favorite fruits and serve with veggie and meat skewers for a themed BBQ.

Vegetables

grilled veggiesSkewer tomatoes, onions, peppers, and summer squash. Grill for a quick and easy side dish.

Try making foil packets to grill veggies that may be too small, such as potatoes, carrots, green beans, asparagus, artichokes, garlic cloves, mushrooms and peppers. Cut your veggies into uniform sizes so they cook evenly. A splash of water may be needed for veggies like potato and carrot to create some steam for even cooking.

Ready to ditch the grilling standards and try something new? I hope so! Happy Summer and grilling to all!

Source: SparkPeople.com

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On the Lighter Side

Scream-Worthy Swimsuit Selfies


By Linda Trainor, RN, BSN

I scream. You scream. We ALL scream when we see ourselves in any photo, including our very own “selfies" when we are wearing only the bare necessities on a public or private beach. Following the screams of OMG, the self who has taken the selfie examines their picture more closely than Sherlock Holmes, noticing every dimple, pimple and wrinkle.

swimsuit selfie illustrationVery rarely do you hear anyone comment, "I look darn good in this picture with my bathing suit on!" or "I can't wait to show my perfect beach body to everyone at the seashore, I think I will share it with all my friends on Facebook and Twitter.” #SwimsuitSelfie

HA!

Nope, quite the contrary. Instead you can hear the sighs from Aqua-Woman complaining about her thighs louder than a foghorn. Tummies are the target for Aqua-Man's critical comments.

Oftentimes this type of self-criticism can lead folks to quickly seek deep cover in the freezing ocean waters of New England, long before their toes even slightly warm to the temperature of the shore. Some beachcombers even wear layers of clothing over the dreaded bathing suit in order to hide imperfections — which only serves to make them hotter than heck at an already sunny beach.

Bottom line, if you think your "swimsuit selfie" is scream-worthy, you’re not alone.

swimsuit selfie illustrationIt is no secret that more than one-third of Americans are overweight. Ninety-nine percent of the population are NOT swimsuit models who are airbrushed prior to hitting the beach. So when you take a selfie or someone surprises you with a picture of yourself in your bathing suit, don't dunk the iPhone in the salty waters!

Take a deep breath of the sea air, and then think of about this story that I recently read. It was about a woman whose child took a picture of mom wearing her bathing suit, while she was sleeping on her beach towel. The mother was apparently very upset that her child took a picture of her in a bathing suit without her knowing. The mother questioned why the child did such a thing. To her surprise, her child replied, "I took the picture because you looked so beautiful."

However, all the mother could see in the picture were her imperfections — criticizing her arms as "fat," her thighs “too big" and more. But then she looked at the picture more closely to see what her child was seeing. She still could not help but judge all her imperfections until she tried seeing the snapshot through her (at that point, sea-fearing) child's eyes. Then and only then, her perception changed.

The woman saw a new picture.

She saw a loving, tired mother, who was resting after playing with her kids all day at the beach. She saw a caring mother who, in spite of her imperfect swimsuit body, dared to go where the dared do not go — to the beach with no cover-up.

Perhaps one day soon she will see herself as her child did: a real-life bathing beauty.

Lesson learned?

Grab your iPhone for a smile-worthy swimsuit selfie. Perhaps you will change your perception, too!

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Signature Series

Meet our Inpatient Unit-Based Educator


By Christie Roy
BIDMC staff

Kim Maloof, RN, has cared for many patients in her 14 years as a nurse — a career to which she never really gave a second thought.

Kim Maloof, RN, Unit-Based Educator on Farr 9"I remember taking care of people even when I was little," she says. "And, my mom's five sisters were all nurses, so it kind of runs in the family."

Kim joined the Weight Loss Surgery team at Beth Israel Deaconess Medical Center about nine months ago as the Unit-Based Educator on Farr 9, the floor where bariatric patients are cared for immediately after surgery. She has been at BIDMC for 10 years now, previously working with transplant surgery patients and in labor and delivery.

"I was ready to make some changes," Kim says of her new-ish role. "I missed working with surgical patients. As a unit-based educator, I get to train new nurses, and get really involved in the nursing curriculum and how we take care of the bariatric surgery patients."

Before coming to BIDMC, Kim taught as a clinical instructor at UMass Boston, where she also went to school. There, she found herself teaching a handful of young students everything she knew about being a nurse.

"You try to teach everything that you see," she says. "I love to educate, and in the past I've really been 'molding' new nurses, but now I also get to work with a lot of more established nurses. It can be a challenge, but everyone here is so friendly and we all stand up for each other."

Here at BIDMC, Kim works hard to make sure all the nurses on her floor stay up-to-date on policies and procedures regarding patient care. A very thorough person by nature, she puts together an education binder for everyone to study and reference, and sends out monthly newsletters to the nurses with new information and tips to remember.

"Everyone has their own way of doing things, but it's important for me to teach what I see, to follow up on any errors and to make sure everyone understands what went wrong and how we can avoid it the next time," Kim says. "We've all been there and we just try to work through it together."

When she's not busy at BIDMC, Kim stays busy at home doing schoolwork — she's just a few classes away from earning her Master's degree in nursing education and received a BIDMC Nursing Scholarship earlier this year — as well as cooking (and eating) new recipes, and caring for her nearly three-year-old daughter.

"She's starting pre-school soon and is involved in dancing school, so it's a fun time," Kim says with a smile of her little girl.

Kim and her co-workers are quick to blend their home and work lives, planning frequent get-togethers and enjoying the added camaraderie it fosters.

"Everyone brings their families and we just have fun," Kim says. "We're having a pool party next week!"

Kim appreciates the closeness of the Farr 9 nursing team and the fact that she has seen so many positive outcomes in the time she has worked with bariatric surgery patients. She points out that these patients only spend a few days on the floor (the amount of time varies depending on the procedure), but knows that she and the other nurses have an impact on them as they take their first steps after surgery, begin following their new diet plan, and transition into this new phase of their lives.

"Patients come back to the floor to say hello and thank us, and we won't recognize them at first due to their weight loss," Kim says. "But it's great. It's nice to know you've made a difference in someone's day, in someone's life."

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Trainer Tips

Monitoring Your Exercise Intensity


By Derek Walczak, Exercise Physiologist
Tanger BeWell Center at BIDMC

When you’re starting a walking or other type of exercise program, it’s important to take things easy at first and slowly increase the amount of exercise and exertion. For bariatric patients with a high body-mass index (BMI) and/or other conditions such as knee osteoarthritis, the Weight Loss Surgery Center recommends walking in intervals at a slow pace and increasing speed as tolerated:

Time Duration
5 minutes 6 times per day
10 minutes 3 times per day
15 minutes 2 times per day 

As you increase the time and speed of your exercise, there are three ways to measure your intensity: the Rate of Perceived Exertion (RPE), the Talk Test, and Target Heart Rate.

Rate of Perceived Exertion

RPE is based on a 10 point scale, which allows an exerciser to determine their intensity level by choosing a number that best represents how he/she is feeling during a workout. While walking, you should aim to make it feel “Moderate to Somewhat Hard.” Exercising between the 4 to 6 range will place the body at an appropriate level to continually improve your fitness.

0-1
Nothing
2-3
Light
4
Moderate
5-6
Somewhat Hard
7-8
Hard
9-10
Very Hard
Normal breathing Breathing a little faster Breathing a little faster and deeper Breathing heavier Breathing heavy, barely able to talk Panting and unable to talk
No unusual muscle activity Muscles warming up Muscles feel like they are working Muscles feel strong and able to continue Muscles feel tired, barely able to continue Muscles hurt or feel weak

Talk Test

You should be able to carry on a conversation while walking or working out (but you should not be able to sing). If you find yourself barely able to talk while exercising, decrease the intensity.


Target Heart Rate

Exercise should be maintained between 55 and 85 percent of your maximum heart rate range. To calculate your target heart rate:

  • Subtract your age from 220
  • Multiply that number by .55, and also multiply it by .85 to determine your working heart rate range

person checking their pulse with two fingers on their wristFor example, if you’re 43 years old, your working heart rate range is between 97.35 and 150.45 beats per minute:

  • 220 – 43 = 177
  • 177 x .55 = 97.35
  • 177 x .85 = 150.45

If you are a beginner, start exercising at the lower end of your target heart rate.

Keep in mind that walking up stairs and hills (or on a treadmill incline) will increase the intensity of exercise. You can use these methods to add variation to your workout and increase difficulty in short bouts. Always be aware of how these bouts affect your heart rate and RPE. If you find yourself short of breath or unable to talk, slow down and return to flat ground.

If you are taking heart medications or have other medical concerns, you should utilize the RPE method or Talk Test to monitor intensity.

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

Great on the Grill


By Michelle Davis, RD, LDN
Bariatric Dietitian at BIDMC

Back away from those burgers and dogs for a change, and fire up the grill for these tasty fruit and veggie bites instead! 

Grilled Garlic Parmesan Zucchini

grilled zucchiniServes 4

Ingredients

3 zucchini
3 Tbsp butter, softened
2 cloves garlic, minced
1 Tbsp chopped fresh parsley
1/4 - 1/2 cup grated parmesan cheese

Directions

Preheat grill for medium-high heat, and lightly oil the grate. Cut the zucchini in half crosswise, and then slice each half into 3 slices lengthwise, making 6 slices per zucchini.

Mix the butter, garlic, and parsley in a bowl, and spread the mixture on both sides of each zucchini slice. Sprinkle one side of each slice with Parmesan cheese, and place the slices, cheese side up, crosswise on the preheated grill to keep them from falling through. Grill the zucchini until the cheese has melted and the slices are cooked through and show grill marks, generally about 8 minutes.

Adapted from AllRecipes.com


Grilled Pineapple-Avocado Salsa

Serves 6 (1/2 cup servings)

Ingredients

salsa with pineapple and avocado1 Tbsp olive oil
1 Tbsp honey
1 pineapple, peeled, cored, and cut into 1/2-inch-thick slices
Cooking spray
1/3 cup finely chopped red onion
1/4 cup minced fresh cilantro
1 Tbsp fresh lime juice
1/2 tsp salt
1/2 tsp ground red pepper
1/4 tsp ground cumin
1 serrano chile, minced (optional)
1 avocado

Directions

Preheat grill to high heat. Combine oil and honey, stirring well. Brush oil mixture over pineapple. Place pineapple on a grill rack coated with cooking spray; grill 2 minutes on each side or until golden. Remove from grill; cool 5 minutes and chop.

Combine cooled pineapple with all remaining ingredients, except for avocado, in a bowl; toss gently. Peel, seed, and dice avocado. Add avocado to the pineapple mixture, and toss gently.

Source: Cooking Light magazine (June 2011)


Grilled Eggplant with Caramelized Onions and Fennel

Serves 8

Ingredients

1 (1 1/4-pound) eggplant (about 4-inch diameter), peeled
grilled eggplantCooking spray
1/4 tsp salt, divided
1/4 tsp freshly ground black pepper, divided
2 3/4 cups chopped fennel bulb (about 1 large bulb)
2 cups finely chopped yellow onion
2 cups arugula
1 tsp white balsamic vinegar (use regular balsamic vinegar if white isn't available)
1 tsp extra virgin olive oil
1 cup quartered cherry tomatoes
1/2 cup (2 oz.) crumbled goat cheese
2 Tbsp chopped fresh basil
1 Tbsp chopped fresh thyme

Directions

Preheat grill to medium heat. Cut eggplant crosswise into 8 (1/2-inch-thick) slices. Lightly coat both sides of eggplant slices with cooking spray; sprinkle with 1/8 teaspoon salt and 1/8 teaspoon pepper. Place on a grill rack coated with cooking spray; grill 7 minutes on each side or until browned. Set eggplant slices aside.

Heat a large nonstick skillet over medium-high heat. Coat pan with cooking spray. Add fennel and onion; sauté 8 minutes or until vegetables are tender and lightly browned. Combine remaining 1/8 teaspoon salt, 1/8 teaspoon pepper, arugula, vinegar, and oil in a medium bowl; toss gently to coat. Divide arugula mixture evenly among 8 plates; top each with 1 eggplant slice. Add about 1/3 cup fennel mixture on each eggplant slice; top with 2 tablespoons tomatoes and 1 tablespoon cheese. Sprinkle the chopped basil and thyme evenly over cheese.

Source: Cooking Light magazine (June 2011)

Michelle Davis is a bariatric nutritionist in the Weight Loss Surgery Center at BIDMC.

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All 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 August 2014