NEWSLETTER 2 OF 2010

 

Netcare
 

NETCARE ST ANNE'S HOSPITAL

 

 

 

How time flies – it is again time for our latest update on the banding newsletter. 

 

The news from the Banding Team is that we have now got 182 patients who have undergone a Laparoscopic Adjustable Gastric Band.  We have now also introduced the Laparoscopic Sleeve Gastrectomy and for more information on this please visit the website which gives a complete and detailed overview of this operation (www.kznsurgeons.co.za).

 

The Laparoscopic Sleeve Gastrectomy to date is being offered to those patients who have had the full benefit of the Laparoscopic Adjustable Gastric Band but have run into problems in the form of an erosion.  These patients face the dilemma of having to have the band removed and then possibly going back to their original weight which is really very unacceptable where they have lost their weight and had all the health benefits of having a normal body mass index.  For these patients the Laparoscopic Sleeve Gastrectomy has been introduced and it is certainly gratifying to know that a band erosion is no longer the end of the road for them.

 

The happy outcomes still far exceed the unhappy ones which are the band erosions or the stomach slippages and in essence it remains very exciting as a Team to see patients walking in at goal weight or even lower who 2 years before had never thought they would move out of the ranks of being morbidly obese.

 

One remains absolutely grateful to Anlie Evetts for her sterling work in putting together this our second newsletter as well as being available and giving all the support to the patients in the pre and post op periods.

Here’s wishing all the band patients well and do keep in touch.

 

Kind regards
Dick Brombacher

 

A letter from Louis Joubert: Hospital Manager, Netcare St Anne’s Hospital

SIXTY-one percent of South Africans are overweight, according to a survey released on Wednesday the 7th of September 2010. Cape Town was the worst affected with 72 percent of those surveyed there overweight, obese or morbidly obese. This was followed by Pretoria (68 percent), Johannesburg (59 percent) and Durban (52 percent). GlaxoSmithKline interviewed 500 people in the study. Of those surveyed, 47 percent said the government should play a more active role in targeting obesity, and 46 percent felt obesity would economically affect South Africa. The survey found that 60 percent of obese, and 62 percent of morbidly obese people considered themselves merely overweight; 49 percent of South Africans did not exercise; 71 percent had never dieted; and that lifestyle, food, poverty and demographics played a role in the weight of the nation. Of those interviewed, 65 percent had the perception that healthy food was more expensive than unhealthy food; 39 percent looked at cost when purchasing food; and 87 percent ate a home cooked dinner. SAPA, 9 September 2010.

 

Understanding the problem is half the battle won. Dr D. Brombacher a resident General Surgeon at Netcare St Anne’s with one of his specialties being performing Gastric Banding Surgery (A procedure that reduces the capacity of food intake) has made a huge impact on changing peoples lives that have been living with obesity. Not only do these patients no longer have the urge to be eating so much anymore but they also get educated in ensuring that they change their lifestyle and diet to give them a new lease on life. The Dietician and other team members all play an important part in their lives to ensure that they follow a healthy diet and to ensure that their weight loss is sustainable.

Louis Joubert
Hospital Manager
Netcare St Anne’s Hospital

 

Did you miss the 1st Newsletter and still want to read it, not a problem, click here!

You can also download the latest Newsletter in Word format.

 

WHAT IS IN THIS NEWSLETTER:

News from the East

Rapid Review

Diet Wise by Anlie Evetts

A book review: “Women, Food and God” by Geneen Roth

Eating Mindfully by Sarah van Niekerk

Feedback from a Fellow Band-Patient

Questions and Answers

 

 

NEWS FROM THE EAST

Taken from research done in Singapore by Ganesh, R et al (2006) on their review of the first 5 years of their experience of Laparoscopic adjustable gastric banding (LAGB) for severe obesity, the following is noted:

 

Cartoon

 

Rapid Review:

 

It’s estimated that more than 180 000 Ontarians (Canada) are morbidly obese (BMI ≥ 40, or at least 35 kg/m2  with co-morbid conditions like diabetes, high blood pressure, high cholesterol, sleep apnoea). Where diet, exercise, behaviour modification or medications have not been successful, bariatric surgery may be considered as an intervention.

 

Ontario Health Technology Advisory Committee (OHTAC) met in Sept 2009, for an evidence-based review on the use of bariatric surgery for the treatment of morbid obesity. Due to concerns over the safety over complications following LAGB insertion, safety was the focus of this rapid update.

 

Some of the findings:

  • Some of the studies steered higher risk patients into their LAGB arms instead of the LRYGB (Gastric bypass) arms.

  • Follow-up periods varied across studies (LAGB were followed up longer and more frequently than LRYGB)

  • Complications were defined differently across studies (e.g. some studies considered LAGB slippage, erosion and port problems to be “major” complications, others considered them “minor” complications).

  • Some studies switched techniques or carried out device modifications midway (e.g. perigastric vs pars flaccida technique where the latter appears to have less slippage)

 

Conclusions:

  • Short-term complications are lower with LAGB than with LRYGB.

  • Long-term complication rates (e.g. band slippage and erosion) vary considerably (procedure chosen can play a role).

 

OHTAC recommendations(shortened):

  • Bariatric surgery should be considered an effective technique for the treatment of morbidly obese people in whom prior non-surgical approaches to weight loss have failed.

  • Adjustable gastric banding should be made an insured service (!!!)

 

 

 

 

 
DIET WISE
Anlie Evetss RD (SA)
 

 

Lets start at the very beginning – you’ve made the big decision, gotten the all clears and you are going to get the LAGB !
How can you best prepare yourself even before the operation?

 

Firstly your medical health is very important. If you are diabetic, you must ensure that you get your blood sugars under control. Do not adjust your medication without your specialists input.  As smoking slows healing and increases the risk for blood clots, infections and other serious complications after surgery, you must stop smoking at least one month before and after surgery (ideally permanently).  Also avoid garlic, Ginseng and Ginkgo Bilobo for at least two weeks pre-op, as they can increase bleeding tendencies. Confirm with Dr if you are taking Warfarin, for specific instructions. Avoid Aspirin and aspirin containing products for two weeks before surgery.

 

Follow the green diet for three days prior to surgery to make the liver easier to manoeuvre during surgery (a fatty liver makes surgery more difficult). Do not take anything after 12 midnight pre-op.

 

You can also get yourself ready by starting to practice the new way of eating:    

 

After the operation it is important to follow the various diet stages.
I sometimes have patients phoning about dizziness initially, which is often related to dehydration. Make sure you drink enough, but watch the quantities. You have to check how YOUR pouch is feeling. Go for smaller quantities, but often. Remember to start off and proceed slowly as the fullness sneaks up on you. Stop before you feel full.

 

By the time you get to the puree stage, you may feel more settled. Remember to only eat when you are hunger and to stop when you are full. Fluids should be stopped 15 – 30 min before meals and only restarted 30 – 60 min after meals. (The more “solid” the meal, the longer it takes in the pouch, and if you overfill with fluid you may vomit).

 

Some patients find that the initial fullness they had after the op has worn off by week  5 – 6 and they have the urge to eat huge meals. Remember, the band is still settling in and you only have a small pouch above it. If you overeat, you will do damage. Vomiting (frequent, uncontrolled) at this stage is not good. If you are really battling, have 3 small meals, with small snacks in-between, until your band is filled and you get the proper effect. HOWEVER, make sure that you are eating slowly to make sure that your body has time to register that you are getting full. Remember also that you are getting used to a totally new way of eating i.e. you are now seeing the small plate of food that previously would have registered as “deprive” on the diet scale of doing things. (See my book review later in the newsletter).

 

Once the band fill has taken place you will get the full effect. You will be able to cope and feel satisfied with smaller meal portions. Check the guidelines, as these will now be very important. I always tell my patients that I don’t like the word “rules” because true to human nature, when we see the word “rules”, we want to break them….. right?  In this case, one could say it’s a case of look after your band, and your band will look after you !

 

When we look at studies done to explain why some patients didn’t have successful weight loss after LAGB, they found that some patients were not aware of their own role, while others couldn’t effectively turn their awareness into action. The practical implication of this is that patients  are all individuals and should not hesitate to make use of the multi-disciplinary team, so that their post operative guidance can be tailored to ensure continued weight loss within their individual situations.

 

Geneen Roth’s book: “Women, Food and God” takes a very fresh, powerful and candid look at why people have compulsions with food.  From her book:

 

“When you eat when you are not hungry, you are using food as a drug, grappling with boredom or illness or loss or grief or emptiness or loneliness or rejection. Food is only the middleman, the means to and end. Of altering your emotions. Of making yourself numb. “

 

She begins with her most basic concept that the way we eat is inseparable from our core beliefs about being alive. She explains with various examples how people turn to food when they are hungry for a connection to what is beyond the concerns of daily life.


It is not a book about “fixing” ourselves, but rather about being ourselves, about understanding our beliefs and what shaped them.
“When you believe in yourself more than you believe in food, you will stop using food as if it were your only chance at not falling apart”.

She examines “The Voice” in our head telling us we are no good and doomed for failure, as well as other negative factors that set us up for failure  (like needing to stay wounded and damaged to be loved, resistance to change, staying stuck in unchallenged-outmoded ideas etc).

 

Although Geneen warns that labels can become excuses and exist because it is a relief to find ourselves in descriptions, and should not be used to distance ourselves from a thorough understanding of the behaviour we are naming, she divides compulsive eaters into two groups: Restrictors and Permitters.


Restrictors believe in control (themselves, their food, their environment etc. For them deprivation is comforting as it gives a sense of control and the chaos stays away (anorexia being the extreme pole). They would be the ones who knew exactly how many calories, grams of fat etc, were in what food item. They love lists and rules.


Permitters hate rules, guidelines and eating charts. They prefer going through life in a daze, so as not to feel pain. Unlike restrictors who try to manage the chaos, Permitters merge with it. It’s better to join the party and have a good time.
Restrictors react to perceived  lack by depriving themselves  before they can be deprived, Permitters react by trying to store up before the bounty / love / attention runs out. They are the ones from whom the (distorted) stereotype of “fat and jolly” is derived, because it often appears as if they are having fun. They look like they are carefree, but only because they refuse to include anything that that impinges on their protective orb of numbness.
Restrictors control. Permitters numb.


A compulsion is a survival mechanism to protect ourselves from feeling what we believe is unfeelable / intolerable.
Since Permitters use food to leave their bodies, they are not conversant in the language of hunger and fullness. They eat because it is there and because they feel like it, not because their bodies speak to them.

 

Her book deals in great detail about ending the compulsion with food. About listening what your body (not mind) wants. Eat when you are hunger and stop when you have had enough. Freedom from obsession is not about something you do; it’s about knowing who you are. It’s about recognizing what sustains you and what exhausts you. It’s about being truly alive. Once you glimpse the possibility of freedom, taste the ease of soaring, you can’t go back.


Note: ISBN: 978-0-85720-136-2

 

 

 
EATING MINDFULLY
Compiled by Sarah van Niekerk, Clinical Psychologist
 

 

When asked about eating patterns and the triggers for emotional eating, many of the patients with whom I’ve worked have commented on their difficulty discerning and perceiving hunger signals and their sense of fullness and satiety. Indeed many have commented on their difficulty distinguishing hunger from thirst from other internal experiences, such as their shifting emotions. Further exploration often reveals a more general pattern of difficulty with internal monitoring and regulation, including the ability to identify and detect shifts in ones’ emotional states, resulting in difficulty responding to the changing internal emotional landscape.

The pattern of compulsive over-eating as a form of emotion regulation is well-known (whether we’re eating in response to anger, fear, anxiety, excitement or boredom), but it would seem that such automatic patterns take hold in the context of poorer skills of self-awareness. The following article, sourced in the Bariatric Times November/ December 2007, deals with the concept of mindfulness as a psychological skill and tool that can be taught to bariatric patients, with positive effects on the maintenance of adaptive lifestyle and weight-loss goals.

 

“Although bariatric surgical procedures are powerful tools in the treatment of obesity, patients and healthcare providers alike can feel frustrated by the difficulties of actually achieving postoperative weight loss objectives, particularly postoperative weight loss maintenance. One result of these surgical interventions is to bring the feeling of fullness into the patient’s consciousness in a dramatically amplified way. However, many obese patients have learned to actively ignore their inner regulatory signals concerning eating. Well established habits of disordered eating and dieting are supported by, and inextricably connected to, a chronic lack of attention to the psychophysiologic experiences of hunger, eating, and satiety. Although surgery can be extremely helpful in reversing these habits, it has limitations in combating years of dysfunctional eating patterns. In order to fully benefit from surgery, patients must retrain themselves to be attentive to their subjective experiences of hunger, eating, and satiety. Learning to eat mindfully—with full attention to the experience of eatingis an invaluable skill for individuals who have had, or are considering, bariatric surgery.

 

WHAT IS MINDFULNESS?

The word mindful is synonymous with paying attention or taking care. Mindful eating can be a powerful tool for individuals embarking on lifestyle changes. The Centre for Mindful Eating published The Principles of Mindful Eating, which describes mindfulness as being composed of three parts. The first aspect of mindfulness is deliberately paying attention, without judgment, to one’s experiences. The second aspect of mindfulness is cultivating an openness to, and acceptance of, all experience. The third aspect of mindfulness is that it happens in the present moment.

 

Most individuals who have struggled with obesity for much of their lives are accustomed to judging themselves, their food cravings, and their food choices. Consequently, these individuals tend to experience strong emotional responses to anything involving food, eating, or weight. This emotional activation can interfere with the ability to make deliberate, wise decisions. Becoming a non-judgmental witness to one’s own thoughts and reactions is an important step in creating the opportunity for change. When incorporating mindfulness, a person begins to train the mind to non-judgmentally observe reactions during the stages of meal planning, food preparation, and eating. This lack of internal self criticism supports the ability to increase, sustain, and broaden his or her awareness, leading to more empowered decisions with regard to food.

 

The second aspect of mindfulness is cultivating an openness to and acceptance of all experience. Thus, mindful eating involves an awareness of the whole eating experience, including emotions, thoughts, judgments, tastes, colours, aromas, and textures. By remaining more receptive to the multi-layered experience of eating, an individual can learn what foods might satisfy his or her hunger, be guided to stop eating by his or her own inner experience of satisfaction and satiety, and, finally, experience the pleasures of eating. Both preoperative and postoperative patients can benefit from learning what it feels like to be satiated rather than “full.”

 

The third aspect of mindfulness is to put aside events from the past and thoughts and hopes for the future, and instead focus for the moment on the here and now. Eating then becomes the activity of the moment and the mind is fully engaged in it. The individual attempts to recognize and let go of worry, anger, fear, rushing, or other mental states that distract from the eating experience. By doing so, he or she can be truly attentive to his or her experiences while eating and can be guided by the understanding of nutritional needs, hunger, and satiety, rather than by hopes, fears, and past experience. The benefits of eating slowly and chewing fully also become apparent.

 

To help patients bring the concept of mindfulness into their daily eating habits, they are encouraged to adopt an understanding that they have the power to make their own food decisions, even immediately postoperative. Although these choices may be extremely limited at first, choice does exist. Awareness of choice is essential in encouraging the individual to take control.

 

BRINGING MINDFULNESS TO PROBLEMATIC EATING

Long-term patterns of disordered eating can diminish an individual’s capacity to attend to cues about appetite, enjoyment, and fullness. Many people, including postoperative patients, find it difficult to stop emotional eating. This coping mechanism is not always broken by surgery. Fortunately, using mindfulness to teach awareness of the emotional states surrounding eating has been shown to be effective. Mindfulness skills are a critical foundation for emotion regulation and distress tolerance. Frequently, mindful eating is taught in conjunction with meditation and relaxing breathing techniques, which increase the tolerance of difficult emotions. Furthermore, patients are encouraged to explore new behaviours that may lead to the resolution of those emotions that they are currently using food to relieve.

 

MINDFULNESS TRAINING FOR THE PRE-OPERATIVE PATIENT

Given its ability to bring awareness back into the eating process, mindfulness can be especially helpful with binge eating in preoperative patients. There is still controversy regarding the prevalence of eating disordered behaviour among the obese, as well as the impact of this behaviour on postoperative outcomes. Many studies have found a higherincidence of disordered eating in preoperative patients than in the general population, and many bariatric professionals prefer that the patient address this behaviour prior tosurgery. While the prevalence of binge eating disorder (BED) is estimated to be approximately 1.5 percent among females in the general population, a study by Dymek- Valentine, et al., found that 14 to 27 percent of bariatric surgery candidates in their sample met full criteria for BED. Powers, et al. found a BED prevalence rate of 16 percent in their sample of 116 individuals presenting for surgery. Other studies have found a high rate of “grazing” in preoperative patients.

Burgmer, et al. found that 19.5 percent of its preoperative patients were engaging in regular grazing behaviour. Although grazing is not necessarily a diagnosable eating disorder, it can still be classified as “disordered” or “mindless” eating, and can definitely lead to weight gain both before and after surgery. For these reasons, it is important to consider more structured preoperative interventions, such as mindfulness training, to help these patients following surgery.

 

Kristeller, et al. reported in their original study of 20 women who met criteria for BED that both the rate of bingeing and the amount of food consumed during binges dropped significantly following seven sessions of manualised mindfulness training. Furthermore, these participants reported that their control over eating, mindfulness, and the recognition of hunger and satiety cues increased, while their levels of depression and anxiety decreased. The authors also showed that the magnitude of binge eating decreased substantially with mindfulness training. They found that the strongest predictor of improvement in eating control was the amount of time participants reported engaging in eating related meditations.

 

Patients who have learned to practice mindfulness often report that it is impossible to engage in binge eating behaviours when they are eating mindfully. Typically, participants in mindful eating programs report a greater sense of control over their eating behaviours. Given these findings, mindfulness training may prove to be an effective tool in assisting weight loss surgery patients who struggle with binge eating, which would in turn greatly benefit patients’ health, wellbeing, and weight loss results, both preoperative and postoperative.

 

MINDLESS DIETING

As noted, disordered eating comprises a wide spectrum of behaviours that prevent one from becoming aware during the meal. Compulsive dieting, at the other end of the spectrum, has an equally deleterious impact on an individual’s ultimate ability to regulate his or her eating. Chronic dieters often have complex views of, and barriers to, the integration of hunger and fullness cues. It is not uncommon for the caregiver to
meet resistance from an individual who has had an extensive dieting history. Diets utilize external guides, such as caloric content, portion size, or planned or pre-packaged meals, to dictate food choice. These experienced dieters may be externally motivated by the specific numerical weight that they see on the scale.

 

Following surgery, the restrictive postoperative meal plan and the tendency for patients to focus on the number on the scale can reactivate the same dysfunctional beliefs and views of themselves and their weight loss efforts. Moreover, individuals who have a history of chronic dieting may not trust their own internal cues and may believe that listening to them is what causes weight gain. These individuals are actually unable to include their subjective experience in their decisions around eating and can feel controlled by the weight loss plan, rather than feeling in charge of their own food choices.

 

Exploring, accepting, and learning to utilize body cues is an evolving process that increases with practice. Even though it is an essential aspect of healthy eating, diet-fixated individuals may find it challenging to consider the possibility of eating with awareness and making food decisions based on internal awareness, hunger, satiety cues, and their own wisdom. Feelings of anxiety may surface when an individual is asked to be aware of hunger. During counselling, patients may disclose a personal narrative in which, during much of their lives, they have felt that their weight status and wellbeing has depended on their ability to suppress their awareness of hunger and fullness. In fact, these individuals may have difficulty paying attention to any emotional distress or discomfort. Incorporating mindfulness training may offer these diet-hardened individuals a new tool to include subjective information regarding food, fullness, and eating into their decision-making process.

 

It is important for the bariatric clinician to remember that patients may need a great deal of help learning to mindfully respect the new feelings of fullness that are generated by the surgery. Postoperative patients still have ingrained habits of ignoring fullness and will gradually do so after the surgery unless they can learn to honour and guide themselves with this experience. As an additional benefit of mindfulness, taste satiety, which can lag far behind fullness—especially for the postoperative patient—is increased by actually paying attention to the whole experience of eating. Mindfulness helps people derive more pleasure from eating and reduces the need to continue eating beyond fullness.

 

CONCLUSION: MINDFUL EATING IS HEALTHY EATING

Mindful eating can be the cornerstone of a new relationship with food for the bariatric patient. Awareness of the present moment often helps an individual gain insight into achieving specific health goals. This happens in part because he or she becomes more attuned to the direct experience of eating and his or her own feelings of health and wellbeing. Introducing the concept of mindfulness systematically to individuals pre- and postoperatively may benefit many patients.

 

These concepts are uncomplicated and accessible, and yet their impact on an individual’s life can be profound. As is commonplace now, patients are also asked to have between 3 and 12 months of a nonsurgical, structured weight loss program prior to bariatric surgery. Weaving these principles into existing programs for people battling overeating or eating disorders prior to surgery can facilitate a more joyful eating experience, one of our primary life pursuits.

 

As new research emerges, mindful eating can be seen as a viable option in helping to satisfy these requirements. Patients will inevitably benefit from this training after surgery, especially as they begin to feel hunger again and a wider range of food choices
is available to them.

 

Additionally, the individual may apply these concepts beyond food, allowing them to help shape a new approach to daily life in general. Promoting broader integration of these principles can assist in improved self care after weight goals have been achieved. Mindful eating training has been shown to promote self acceptance, which is necessary for our patients both before and after weight loss surgery, to help them achieve maximum success”.

 

Steps for Individuals to Eat more Mindfully
• Mentally arrive at the meal. This often means decreasing external distractions while  eating, such as television, phone, computer, or driving.
• Attempt to focus on the benefits of a food selection – how eating that specific food will help him enjoy the bite, meal selection, or feelings of health that may arise during the change process.
• Create a committed practice to eat in a more mindful way. The use of the word practice indicates that there are normal and expected setbacks that are part of eating mindfully but the intent is to return to the bite before them.

 

Steps to Assist Providers in Bringing the Concept of
Mindful Eating to Bariatric Patients
• Take steps to create a culture free of judgment with regard to dietary change. Often this requires bariatric programs to shift their focus away from specific weight goal outcomes and rely on other objective measures, such as sense of control with food, feelings of health, and reduction in the severity of co-morbidities.
• Review the tone of educational programs and handouts. Encourage increased freedom and personal choice with regard to food and lifestyle issues to resolve emotional polarization of food beliefs and foster objective self-assessment
skills regarding health.
• Routinely include mindful eating training in both pre- and postoperative phases of bariatric interventions.

 

REFERENCES

1. The Centre for Mindful Eating. Principles of Mindful Eating. 2005. Available atwww.tcme.org.
2. Linehan M. Cognitive-behavioural treatment of borderline personality disorder. New York: Guilford Press; 1993.
3. Gotestam KG, Agras WS. General population-based epidemiological study of eating disorders in Norway. Int J Eat Disorders 1995;18:119–26.
4. Dymek-Valentine M, Hoste R, Engelberg M. Psychological assessment in bariatric surgery candidates. In Mitchell JE & de Zwaan M (Eds). Bariatric Surgery: A Guide for Mental Health Professionals. Oxford (UK): Routledge. 2005:101–18.
5. Powers PS, Perez A, Boyd F, Rosemurgy A. Eating pathology before and after bariatric surgery: A prospective study. Int J Eat Disorders 1999;25:293–300.
6. Burgmer R. The influence of eating behaviour and eating pathology on weight loss after gastric restriction operations. Obes Surg 2005;15(5):684–91.
7. Kristeller J, Hallette C. An exploratory study of a meditation-based intervention for binge eating disorder. J Health Psychology 1999;4(3):357–63.

 

ABOUT THE AUTHORS

Terri Elofson Bly, PsyD, conducts preoperative psychological assessments for surgical weight loss programs in the Minneapolis-St. Paul area and leads several monthly bariatric support groups.
Megrette Hammond, MEd, RD, CDE, is a registered dietitian and diabetes educator with Wentworth-Douglass Hospital in Dover, New Hampshire, and the Executive Director of the Centre for Mindful Eating (www.tcme.org).
Roger Thomson, PhD, is on the faculty of Northwestern University Feinberg School of Medicine and is Codirector of Integrative Health Partners, a practice group which offers mindfulness-informed psychotherapy and courses in mindful eating. He can be reached through his website, www.integrativehealthpartners.org.

 

 

 
Feedback from a Fellow Band-Patient
 

Hello fellow Band-Patients

My name is Di and I’ve been asked to put my ten cents worth in regarding food and life of a person with a band.

 

Firstly you need to know two things:

  1. Food is not the enemy, we are, we make it bad!
  2. Slow and steady wins the race.

For my son and I it’s been a challenging experience. We’ve discovered that it’s not the amount of food for us, but it’s rather the tastes and textures that attract us. It’s hard to tell you what to eat because as you know, depending on how tight your band is, depends on what you can consume.

 

Steamed food seems to work well for us. It isn’t tough and seems to be tastier, especially when Blaine sneaks the herbs and spices in!

Gluten – this is no good for a bandit – it’s like eating a whole potato – it seems to expand in your stomach and make you more uncomfortable and want to vomit. Sushi is loaded with gluten.

 

For low fat options, try fat-free plain yoghurts as dressings, use Weigh Less option sauces and gravies if you need to reduce the dryness of food. (You will get used to the taste - trust me!)

 

Portions – Dishing up small portions is always difficult. I’ve found dishing up in a saucer / side plate with a teaspoon helps (no, I haven’t lost my mind). If you’re still hungry after that and haven’t vomited, you either need to see Dr Brombacher for tightening or you ate too fast and didn’t give your body time to register the food.

 

Hydration – Very important this, especially since we are re-entering a warmer season. I’ve found that instead of milling over breakfast in the morning when I wake up, I can drink up to a litre of fluid over a period of an hour. I use a straw as it stops me from gulping down more than I can cope with and causing discomfort. I like cranberry juice and water it down half / half.

 

Those of you who are having a problem eating meat – “sorry for you”, seafoods are a good option – NO FAT. Try tuna in 2-min noodles, calamari steamed also just slides down and try and avoid yet again the oils / butters / tartar sauces. Instead try herbs and sea salt and maybe lemon juice if you don’t get reflux or heartburn. Poached eggs sometimes goes down well too, helps with protein replacement.

Salads are good food for the warmer weather. When making your salad chop everything up finely – makes it easier to chew and less chance of some stray lettuce leaf getting stuck! Use balsamic vinegar as a flavourant or low fat mayo. Avoid tomatoes as the skin doesn’t break down so well. Put different things in, don’t stick to the norm. Try Rocket to give a peppery taste, lentils and sprouts for texture and sweet peppers for a sweet taste.

 

Okay, enough about food now. I often get phone calls from fellow patients about the following two topics: Hair loss and constipation.

 

Constipation – the solution – Benefibre – you get it at Clicks and it’s a colourless, tasteless powder that I even put in my tea twice a day and it works like a charm. Even if you put it on your food, you won’t taste it or see it! Prune juice also works, but that’s like swallowing medicine to me!

 

Hair loss – every women’s nightmare!  The expensive solution – Omega 3 & 6 capsules daily. The cheap option that works well – linseed / flaxseed oil, about a teaspoon a day, but please remember to take it on an empty stomach in the morning to allow it to “pass” through and avoid food for about ½ hour so as not to vomit it up.Cat

 

Well that’s about it from me – for now.
See ya
Dianne

 

 

 

 

 

 

 

 

 
QUESTIONS AND ANSWERS
 

 

Is it true that I’ll never be able to enjoy my food again? No – if anything, because you are eating slower and being more conscious of what you are eating, you will enjoy your food more after surgery. Patients find the flavour is more pronounced, they enjoy their food more because they can be picky and don’t have to feel guilty. (And, yes, you can have a social life).

 

Are the band adjustments painful? No, it really is just a brief scratch of the skin with a small needle and then some mild discomfort as pressure is put on the access port. It takes a few minutes and no anaesthetic is required.

 

Can I fly with my band? Sometimes there are small bubbles in the band that don’t matter at normal pressure (ground level), but when flying the cabin pressure may be inadequate and some people may find their band is slightly tighter when flying (more difficult to swallow solid food). This normalises when one is back on the ground.  Incidentally, you will not set off any scanners etc with your band.

 

How long can my band last? Life long if well maintained.

 

Can I still burp after the band? Yes. If it is a problem being able to burp initially, it will improve after the first couple of months.

 

When I reach my goal weight, must I remove the band? No, remember the band is adjustable. Fluid can be removed, so your portion sizes can be adjusted and you will find that you will plateau around your goal weight. Most banded patients can regain their lost weight if the band is removed.

 

Why must I walk after the operation? Deep vein thrombosis (DVT) or blood clots which could lead to lung (pulmonary) embolism (PE) are complications that could occur after surgery. It is very important to keep the circulation moving and walking is one way to do this. You will be required to get up and walk shortly after surgery, while you are in hospital and you must continue this at home to minimize your risk. If you have swelling and pain in the leg, or red and discoloured skin on the affected leg, contact doctor.  Symptoms of PE include shortness of breath, chest pain, coughing – again contact doctor.

 

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 What other topics would you like covered in the newsletter?
Do you have information you would like to share?
Any questions you need answered?
Please feel free to contact us regarding future newsletters: aevetts@stannes.netare.co.za

 

 

 

 

THE TEAM TELEPHONE
Dr GD Brombacher (Specialist Surgeon) (033) 342-3536
Dr D Gounder (Specialist Physician) (033) 345-8440
Dr Redfern & Partners (Anaesthetists) (033) 345- 7720
Anlie Evetts (Dietitian) (033) 897-5000
Shannon Lang (Psychologist) (033) 343-4408
Sarah van Niekerk (Psychologist) (031) 566-3230
Jitesh Gopal (Physiotherapist) (033) 394-4708
   

 

 

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