May heat is here and it is time to get things together for the summer. In this newsletter we will talk about a few issues that have come up with band patients, and how to take care of them

 

For the summer we go to once a month support groups. They will only be held on the fourth Thursday of the month for June, July, and August. In that manner we will be able to keep a good number there.

Reflux after a band is NOT NORMAL. Nor is night cough. These are symptoms that you may be too tight, and a potential early slip.

 
Having reflux, or heartburn, is not a normal situation for a band. It can occur when the band is too tight, meaning  you need a small unfill. Or it could mean something even more dangerous. It could mean that you have expanded the pouch above the band or the esophagus.

If we catch this early - we can correct it. To do that we remove the fluid from the band and get an upper GI. We send you to the x-ray place next door, they have you swallow some barium and take an x-ray. They then give you copies of the x-ray and we can look at it.

It can be corrected. But it means the following: we remove all the fluid from the band. For two weeks you are on soft food -- but MEASURED. Four ounces of fish (the toughest thing we want you to have that two weeks).  This allows your pouch to return to its normal size and then we can refill the band. Sometimes we have to go longer.

The great thing about the band is it is reversible.

Here is what happens-- patients think that the band works by "restriction." It does not. This is confusing because early on after the band is placed it does not allow you to eat too much. So people stop eating early - but that is NOT the purpose of the band.

By eating progressively more and more food the stomach above the band expands. You can fit more in, you eat too fast, and it expands. If this is left unchecked eventually there is so much stomach above the band that is causes the band to slip. The only way we can fix that is more surgery -- good for me, bad for you.

To fix it is easy - we take the fluid out - the stomach and esophagus, if allowed - will return to normal size and once they are we can begin to fill the band again.

The two lessons here: eat slowly. Eating too fast is probably the number one cause of band slips. By eating too fast you put too much food above the band, it does not have time to empty. When this happens - the pouch expands to accomodate the food - or the esophagus expands. So SLOW DOWN.

Second cause is a tight band, and not measuring the food. Packing too much food above the band, not measuring the amount of food-- allows the upper pouch to expand. 

If you have these symptoms (night cough, heartburn, reflux of food, night time slime or mucous) we want to see you asap. We will remove some fluid, get an x-ray and if things are ok - we can refill you. If not, we have you go on a MEASURED soft diet for two weeks. We then recheck an x-ray and if things are ok, we begin the refill process.

DO NOT BECOME DEPENDENT ON THE BAND.  It is your choice what you eat, it is your choice how much you eat. The band works not by RESTRICTION -- the band works by appetite suppression. Trust us - -successful patients eat a small amount of food and walk away.

 

Several major grocery chains will be featuring "rating programs" over the coming months. The intent of these rating or scoring plans to is assist you, the consumer, to make wiser overall food choices rather than focusing on a single nutrition statement such as fiber, low sugar, or zero trans fat. Research has shown consumers want one visual, easy to use, simple icon without doing math. The scientific concept of rating foods is now being called "nutritional profiling" whereas "nutrient density" was previously used.  The goal is to help you achieve the most nutrition for the calories eaten.

A program called Smart Choices appears to be the most popular.  It is working with food packagers rather than supermarket chains and incorporating food industry input. It awards a green check mark of approval, for example, to any fresh, frozen, or canned produce with no additives. The Smart Choice logo, along with calorie and serving information, will appear directly on the front label of products meeting it's nutrition standards, rather than on shelves or point-of-purchase displays. The Nutrition Facts label, with specific nutrients, will still be on the back of the packages. This program was developed by a diverse group of nutrition experts, retailers, manufacturers, and government agencies coordinated by the nonprofit Keystone Center.  Already ConAgra announced it will feature the Smart Choice logo its qualifying products.  Coco-Cola, Kellogg Company, Kraft Foods, PepsiCo, Unilever and WalMart are planning to start this program.

This rating system will be used for 19 different food categories including beverages, cereals, meat, dairy and even snacks. This program will focus on 3 types of nutrients or foods:

Nutrients to Limit per Serving - - 3 grams of total fat or less, 1 gram or less saturated fat, no more than 60 milligrams cholesterol, added sugars no more than 25% of calories, and 480 milligrams or less of sodium.

Nutrients to Encourage -- food must provide 10% or more of the Daily Value of one of the following nutrients which have been identified as lacking in the typical American diet:  calcium, potassium, fiber, magnesium, vitamins A, C, or E.

Food Groups to Encourage -- a food must provide at least a half-serving from one of these groups: fat-free/low-fat dairy, whole grains, vegetables, fruits.

 

 It is recommended we eat 5 or more servings of vegetables and/or fruit a day.  Are you getting that many?  If you are like most Americans today, you probably are not.   Remember, a serving is one half cut measured but even using a few tablespoons gives you a positive boost.  An easy way to add more vegetables and fruit into your meals is to serve a salsa with your entrée, whether it is fish, seafood, beef, steak, pork or poultry.  
 
When you hear "salsa," do you picture the saucy stuff served at your favorite Mexican restaurant?  Today chefs are combing various vegetables, fruits, and seasoning to make a lot of other "salsa" combinations.  These "toppers" or sides not only provide unique flavors, vitamins, fiber, and antioxidants but are a way to add natural moisture to your meal.  There's no need for recipes.  Just combine some of your favorite fruits, vegetables, and herbs or spices.  Salsa can have a tangy, spicy, hot or sweet flavor based on your individual preference or the meal you are serving it with.  Fresh peaches, nectarines, berries, cucumbers, shredded carrots, chilis, black beans, jicama, baby spinach, white corn are all possible ideas.
 
Easy Mango Salsa
Chop a ripe mango, onion, tomato, yellow pepper, and cilantro.  
Place in bowl and squeeze in a bit of lemon or lime juice.  Mix and chill thoroughly.  
Serve with fish or seafood.

There are a lot of resources that we have to help you. Besides the workbook, we have the Lap Band II class with Nancy, as well as our support class.

Check out our schedule at www.drsimpson.com in the patient area section.

 

Sincerely,