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Winter 2012 edition

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Our Staff Makes the Difference ... But Our Patients Tell the Story

It's All About Attitude: Cass Lang Changed Hers and Continues to Find Success

By Linda Trainor, RN, BSN

At 28 years of age, Cass Lang realized that she was fighting a losing battle with obesity.

“Since I was a young child I witnessed both my mother and grandmother cycling with extreme weight loss and weight gain,” she said.

She also recalls them suffering from other medical problems associated with obesity, causing emotional, physical and financial stress throughout their lives. Watching them struggle, Cass confesses that she developed eating issues of her own.

“I alternated between starving myself, working out like a freak, popping diet pills and receiving comfort from boxes of Milk Duds,” she admitted. “These were behaviors that did not maintain a healthy weight.” Cass Before and After

Consequently, Cass’s weight began to spiral out of control.

“I pushed back to reclaim my boundaries, only to find that the next bump on the road knocked me down yet again,” she said.

Over the course of 10 years, Cass went from weighing 118 pounds to 270 pounds.

“I have a lot of clothes in my closet, some of which I have never worn,” she said. “They come with a lot of memories, but you cannot tie your self-esteem to a clothing size.”

Remembering that she felt the same way about herself at 118 pounds as she did at 270 pounds, Cass added, “The simple truth is if you don't like yourself, the weight part does not matter. I firmly believe I had to get that heavy [270 pounds] because only when my weight reached this critical point was I truly forced to be honest with myself about eating issues and my own sense of self-worth.”

Cass believes that she used weight as an excuse to not fully live her life. When things were not going right, it was easy to hide behind her weight. She was accustomed to being haunted by questions: “Why doesn't the guy I like, like me back?” “Why did someone else get the promotion?” The list of questions went on and on.

“Because the truth is I didn't see myself as worthy of anything,” she explained. “I was uncomfortable with myself and I did not want people to see me. Why else would I put a 150-pound cocoon around myself? I had to become comfortable with people seeing the real me.

“For those who are prone to being heavy, becoming thin requires a lot of bravery,” Cass added emphatically. “It is all about self-esteem and self-worth.”

Cass reports trying a myriad of diets. From Jenny Craig to Atkins to South Beach to Weight Watchers, she says the problem she faced with these programs was that none of them were going to be a permanent part of her life.

“I tried and tried to lose weight; if it was out there I have tried it, more than once,” she said. “What is permanent in my life is stress, the curve balls life throws my way, and the women I keep seeing in the mirror. I could not use someone else’s plan. I needed one of my own.”

Along the journey, Cass says she forgave herself for not taking better care of herself. She stated that it was also very important that she forgave the people who “started her on the path in the first place.”

“I also realized that the statute of limitations for [complaining] about what my mom did or did not do right for me had expired if I wanted to get on with my life and deal with an addiction for poor food choices,” she explained.

Knowing the time had arrived for her to take care of herself, Cass used every possible resource possible to manage her lifelong weight issues. Prior to having weight loss surgery, she also did a lot of emotional homework on dealing with life without turning to food.

“I learned in therapy that there are some issues you are never completely done with; you pick it up, you put it down, and work on it a little at time,” she said.

Though she used to waltz around issues, Cass says she now makes decisions and stands by them for better or worse, moving forward with life’s challenges. As a result, she sees a huge difference in her life today.

Cass on New Year's EveOnce believing that everything she wanted was needed, Cass says that her wants naturally take care of themselves as long as she pays attention to what she needs.

“Weight loss surgery is not what I had wanted to do,” she said. “It is what I needed to do for myself. I struggled going into surgery with feeling like I failed myself not being able to fix this on my own, but I also realize that thought process was limiting me from moving forward. It’s never weak to ask for help.”

During the past six months, not only has Cass gained a new attitude about life but has lost 107 pounds, causing her to see her toes again and get out of bed without assistance. She happily gets dressed for dinner without seemingly having to try on thousands of dresses.

“Seeing my girlfriends does not make me want to cry any more of embarrassment,” she said. “It turns out that the cocoon weighed a lot more than 150 pounds.”

Cass is aware that she cannot get back the days she missed earlier in life but, she says, “I am not going to miss out on the days to come knowing fully well that attitude is the accessory no outfit can do without.”

All photos courtesy of Cassaundra Lang

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Expert Advice

Winter Tips: Stay Warm and Stay Healthy

By Edward Hatchigian, MD, MS

Edward Hatchigian, MDSeasons Greetings and best wishes to everyone for the New Year!

Knowing the winter months are upon us, I just want to mention a few important tips to stay warm and healthy for the upcoming months. First and foremost: dress warmly with layered clothing and avoid falls by making sure driveways, sidewalks and steps are well sanded and free of ice.

Since we will all be exposed to various “bugs,” colds and viruses, it is important to practice good hand washing techniques as well as covering your nose and mouth when sneezing and coughing.

If cold symptoms appear with a runny nose, sneezing, cough, headache, fever or muscle aches, it is important to incorporate the following into your daily routine: Drink plenty of fluids, such as non-sweetened juices; eat hot soups (especially homemade chicken noodle); and get plenty of rest.

You may also try over the counter cold/cough/flu medications to help. Among the most common are cough medicines such as Robitussin and Vicks. Besides being a cough suppressant, they can be an expectorant to bring mucus up and a decongestant to clear sinuses.

sick personBut remember, if you have had the Roux-en-Y gastric bypass, it is important to purchase these products labeled as “sugar free” and “alcohol free” to avoid the nasty dumping syndrome.

It is also important for anyone who has had weight loss surgery to avoid plain aspirin and the non-steroidal anti-inflammatory drugs (NSAIDs) such as Motrin, ibuprofen, Aleve, Advil, naproxen and even Celebrex, as they can lead to gastritis, ulcerations and even serious complication of GI bleed (as well as band erosion for those who have a lap band).

The safest preparation for fever and headaches is still Tylenol, as long as you do not have an allergy to acetaminophen or have liver issues. Dosage is one to two tablets every four hours as needed (maximum 4 grams per day), and many have been able to tolerate the small gel cap but not the solid caplet. It is also available in liquid preparation; take 5 to 10 cc every four hours as needed.

If antibiotics are warranted, remember that they need to be taken crushed, or in a liquid or chewable form. Several antibiotics, such as Amoxicillin, Keflex, Ciprofloxacin and Bactrim, come in liquid forms. You can also try a large capsule that you can open and sprinkle into yogurt or sugar-free apple sauce.

Just a word of caution about Sudafed or pseudoephedrine, often taken for congestion and sinus allergies: It can cause palpitations and “racing" heartbeats and is often contraindicated if you are taking other, similar medications.

Please call our multi-disciplinary bariatric clinic at 617-667-2845 if you should have any questions.

And, by the way, if you have not yet received a flu shot, there is still time. Stay healthy and stay warm!

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Nutrition Corner

A New Year, A New Me

By Kate Otto, RD, LDN, Bariatric Dietitian

new year new meDecorations are coming down from store windows, houseguests are making their way back home, and social calendars are starting to settle down. With a new year comes new resolutions … what’s yours? Maybe this New Year’s Day was the first time you didn’t wake up with the resolution to lose weight? Maybe the holidays made weight difficult to manage and your goal is to get back on track? If this is the case, you are not alone. Whatever your goal may be, today is the day to start.

Long term visualization (a number, a size, a fitness goal, securing that dream job, getting out of debt, etc.) helps set the stage for short term motivation. Looking an entire year ahead can make any task seem daunting. Have you ever tried looking a day, week, or month ahead? Once you have established what your resolution may be, try adjusting your focus on the short term. Let’s say your goal is to finish a 5K race, and with the hustle and bustle of the holidays, your treadmill looks more like a clothing rack — we’ve all been there. Start long term by committing to your goal and registering for the race. Then, once you clear off the treadmill, focus on the short term. Start with 10-minute walks, three times per week, and increase to 15 minutes three times per week. The key is that your goals are specific, measurable and maintainable, achievable, realistic, and timely.

When it comes to eating, figure out what approach works best for you. If you are a “cold turkey” kind of person, try removing all temptations from your home. Or, if that method won’t fly with your family, many people find it helpful to designate a cabinet or area of the pantry or fridge for trigger foods — and try to avoid it. On the other hand, if you feel completely deprived without an occasional treat, try planning a specific day to allow yourself a little wiggle room. For example, if you have found yourself reaching for the cookie jar or candy bowl once a day (or more), try allowing yourself one treat per week. Again, think specific and plan it. Like, “Wednesday is cookie day. I am going to eat one, savor each bite, and move on until next Wednesday.”

Write it, type it, jot it down. Whether you use a smart phone, a computer, a notebook, or a piece of scratch paper, tracking can help you focus your goals. Research shows those who keep a journal (food, fitness, weight) tend to have more success, even if you don’t initially like what you see.

Here are a few free resources many patients find helpful:

Never underestimate the power of visualization. Imagine you have reached your goal. Picture yourself crossing the finish line, wearing that size, or not worrying about that medication. How do you feel? Maybe try something a little less conventional: write down a daily affirmation and say it aloud each morning. Keep these thoughts in mind while you are making decisions about food and activity.

Revisit goals of New Year’s past. Think back, but only for a second. Whether you are years out from weight loss surgery or just starting to research it, think about what you want to accomplish or what you have accomplished so far. Remind yourself why you started this journey in the first place and of the great strides you have already made. You could try making a list of these things. For example, “My clothes may be fitting a little more snug after the holidays. But I can still tie my shoes, use a seatbelt without an extender, take the stairs without getting short of breath, and keep up with my grandkids.”

Every voyage has road blocks and detours, and sometimes you find yourself off course. Remember that your Weight Loss Surgery team is here for you every step of way. Look forward and do not give up. You are worth it!

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On the Lighter Side

Are You Ready for Fantasy Food Bowl?

By Linda Trainor, RN, BSN

Fantasy Food BowlFantasy football is a fun-filled, competitive online sport that provides entertainment and enjoyment for many. Playing fantasy football gives one an opportunity to become the general manager of their own football team; those who invest time in playing know exactly what they need to do to put themselves in the best position to win. Creating a successful game plan also nourishes a great sense of pride with inclusive bragging rights.

The analogy of the fantasy football game can easily be applied to a fantasy food bowl game. You too can enjoy becoming the general manger for your Super Bowl of Super Goals for 2012. Have fun playing the fantasy food bowl, as it can provide the opportunity for an entertaining way to drop those extra pounds while also nourishing a sense of pride. Investing time as the GM of your fantasy food bowl team can put you in the best position to be successful.

First and foremost, to begin the game, know your team and your opponents. Strategize for a winning game plan. Since it is an offensive and defensive game, become skilled in understanding the players’ strengths and weaknesses. Use this to your advantage to score in your own field of dreams. Simply put, in the fantasy food bowl game, your opponent is bad behavior. Your team is healthy behavior.

Practice, practice, practice while you huddle at work or play. Use the same strategies that are used in one of American's favorite sports. Put your best foot forward with exercise, draft the right food choices and recruit the best products for your plate. With these good strategies and good management, you’re well on your way to the goal line.

At the end of the day, bench behaviors that will not result in pounds down. Some days, you may even have to throw in the cookie instead of the quarterback; but ultimately, ask yourself: would you replace Tom Brady with Ronald McDonald as the quarterback for your fantasy food bowl? I think not! Play to win in your Super Bowl of Super Goals for 2012. You may not get the actual Lombardi Trophy … but, I am told, the bragging rights are worth it.

Three seconds left, fourth down, tie game … kick the winning food goal!

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Signature Series

Meet Our Bariatric Nutritionists

By Christie Roy, BIDMC staff

Bariatric Dietitians Michelle Davis and Kate OttoMichelle Davis, RD, LDN, and Kate Otto, RD, LDN, are Bariatric Nutritionists in the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center. Collaborating with a multidisciplinary team, they focus on promoting good health while also providing the framework for comprehensive nutritional support for our bariatric patients.

Michelle and Kate are specially trained in nutrition management for bariatric patients. Each patient meets with a dietitian before and after surgery to receive a tailored nutrition plan, education, and support to ensure long-term positive outcomes.

Both dietitians agree that one of the best things about their jobs is knowing that their patients are becoming happier and healthier.

“I feel like I am helping people on a life transformation and am also learning lots from my patients on the way,” Michelle says.

“It is so humbling to see patients’ mobility and quality of life improve,” adds Kate.

Both had an interest in nutrition from a young age, which led to their college studies and eventual career path.

Michelle joined the Bariatric team in April of 2011 after completing her dietetic internship program at BIDMC. She earned a Bachelor’s of Science in Nutrition and Dietetics from the University of Delaware.

From the beginning, Michelle was excited to train and eventually work at BIDMC. She worked in the Weight Loss Surgery Center on a rotating basis and affirmed her interest in bariatric surgery.

“When I took a tour of the facility, I met lots of warm and friendly people and just knew this was the place for me,” she says. “After finishing my internship, I wanted to stay and work here because I love the positive and caring environment and friendliness of all the staff members I’ve encountered.”

Seeing a nutritionist herself when she was younger also played a role in Michelle’s career decision.

“Getting to help people in the same way that my dietitian helped me is very rewarding,” she says.

Kate has been a member of the Bariatric team since December of 2009, and also completed her dietetic internship program at BIDMC. She is a graduate of Miami University in Ohio, where she earned a Bachelor’s of Science degree in Health and Sports Studies while also completing a Didactic Program in Dietetics.

Originally from the Midwest, Kate was excited to come to Boston for her internship and experience life somewhere else in the country. She explains that her interest in BIDMC peaked when she learned that, as an intern, she would get to rotate through several different dietetic areas and explore each.

“I had such a great experience as an intern here and really felt that BIDMC exemplified patient-centered care, something that I value as a practitioner,” Kate says.

Kate says she can’t imagine a more rewarding position for a registered dietitian than working with bariatric patients.

“I try my best to practice what I preach because my patients constantly inspire me to,” she states. “The work I do with patients and seeing them succeed is one of the main reasons why I love my job.”

In their free time, both nutritionists enjoy spending time with their family and friends as well as in the kitchen: Michelle likes to cook and bake; Kate especially likes trying out new recipes. Kate also says she has fun with volleyball, golf, and scrapbooking while Michelle, once an aspiring Broadway actress, adores singing.

Whether you are a past, present, or future patient of the Weight Loss Surgery Center, Michelle and Kate are here to help you with all of your nutritional needs. You can reach them by calling the Center at 617-667-2845.

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Ask the Trainer

Lift Weights Before or After Cardio?

Q. Is it better to lift weights before or after an aerobic workout?

hand weightsRick DiScipio, Med, CSCS, NSCA-CPT, NASM-PES: Whether you lift weights before or after an aerobic workout depends on your energy level and your fitness goals. An aerobic workout can be a good warm-up for weightlifting, but if your goal is to increase muscle size and strength, you should lift weights first, when the body's main source of energy for muscle contraction (glycogen) is high. If you do a hard cardio workout before lifting, you deplete glycogen, which will leave your muscles fatigued.

If your goal is to increase aerobic endurance and you use weight lifting to supplement your training, you should perform aerobic activities first.

In general, exercise you perform when you have adequate energy is performed at a higher intensity with more focus and efficiency. Exercise you perform when your energy supplies are low is less effective and more likely to result in injury.

Please consult a physician before beginning any exercise program.

Basic Resistance Training Recommendations for Post-Bariatric Surgery Patients

from Strength and Conditioning Journal, Vol. 30, Issue 3; 2008 

Given that most patients experience significant and rapid weight reduction, it would benefit the post-bariatric patient to maintain as much lean muscle mass as possible through resistance training. Patients should follow the basic resistance training recommendations.

Frequency - Two to three non-consecutive days per week

Modes - Specific machines (where appropriate), free weights, resistance bands, body-weight exercises such as wall squats or push-ups, and other exercises such as those that use medicine balls.

Exercises - Emphasize multi-joint exercise, complimented with single-joint exercises; perform exercises for all major muscle groups.

Sets and Repetitions - One set per exercise initially; progress to multiple sets. Complete 8 to 15 repetitions per set.

Rest Intervals - Rest for one to two minutes between exercises, depending on the exercise that is performed and the amount of exertion.

An Exercise Physiologist or certified personal trainer can help design a program and ensure proper body alignment and technique. Patients should always receive medical clearance from their surgeon and/or physician prior to starting a resistance training program.

Rick DiScipio is an exercise physiologist at BIDMC's Tanger BeWell Center

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Ask the Dietitian

Healthy Yet Delicious Super Bowl Food

Q. It's easy to feel supersized after Super Bowl Sunday. Is there a lighter version of any party favorite?

Michelle Davis, RD, LDN: There are plenty of ways to indulge during the big game without ruining your eating plan. Try this recipe for chili cheese nachos for healthy yet delicious Super Bowl snacking!

Chili Cheese Nachos

chili cheese nachos6 servings


One 7-oz. bag baked tortilla chips
1 cup low fat turkey or veggie chili
3/4 cup salsa
1/2 cup light soymilk or skim milk
3 oz. fat free block cheddar cheese
1 wedge The Laughing Cow Light Original Swiss cheese
2 Tbsp fat free cream cheese
2 Tbsp fat free sour cream


Melt all three cheeses in a saucepan with the milk; stir to combine. Heat chili and set aside. Microwave chips until warm, and place on a large platter. Pour the low fat cheese sauce all over the chips and cover with chili. Spoon salsa on top along with a few dollops of fat free sour cream. Serve and enjoy!

Nutrition Facts per serving: Calories: 216, Fat: 3.5g, Sodium: 671mg, Carbs: 36g, Fiber: 4g, Sugars: 3g, Protein: 13g

Recipe adapted from

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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 January 2012