PURSUING PLASTIC SURGERY AFTER BARIATRIC SURGERY

Parham Mora, M.D.

(NOTE) Refer to the graph cited below for reference of periods in your weight loss)

After weight loss surgery, one will lose large amounts of fat from under the skin. This results in a sizeable amount of loose skin that presents itself at six (6) months to one (1) year after surgery. Each individual will have different areas of the body that is affected by this. The most common areas are the neck, arms, breast, lower abdomen, buttocks and thighs. This loose skin will not be changed by exercising; however DO NOT let this discourage you from continuing your exercises. The way to get rid of excess skin is to see a plastic surgeon for removal. You need to wait 1 ½ to 2 years to do this (see period 3 on graph on page 2). At this point, you should notice your weight has stabilized. If you check your weight once a month for three to six months in a row and have not noticed any weight gain or loss, you are ready to see a plastic surgeon. If you have excess skin removed before you complete your weight loss (see period 1 on graph on page 2), you’ll have more loose skin once that process is complete. If you remove excess skin after completion of weight loss but before weight gain and stabilization (see period 2 on graph on page 2), you will tend to get stretch marks and/or stretched skin in those areas. With regards to insurance coverage, removal of loose skin below the abdomen is sometimes covered if shown that the removal is medically necessary. Other loose skin removal usually is only covered by your out-of-pocket expenses.

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VOLUME 11 NOVEMBER 2010 NUMBER 11

Editorial Notice

This newsletter is published monthly for

Dr. Parham Mora, 645 McQueen Smith Rd.

Suite 205 Prattville, Alabama 36066

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Editorial Staff: Tara Grant, Bariatric Coordinator.

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Items for the newsletter must be submitted by the

1st st of the month for consideration for publication in the upcoming issue.

Submit Items to:

morabariatric@bellsouth.net

If you no longer wish to receive Bariatric Bulletin,

please contact: morabariatric@bellsouth.net

PERIODS OF WEIGHT LOSS

Tara’s CornerTara Grant, CPC, Bariatric Coordinator

Happy Thanksgiving! Enjoy your holiday season! Keep moving! Watch what you are eating.

I’ve included an article from WebMD that gives several tips for eating during the holidays. The article applies to both people that have had

bariatric surgery and those that have not.Enjoy your family time!

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Tip of the Month“Be choosey.”

Tis' the start of the too much food season. Be choosey about what you decide to eat. Noone is twisting your arm to try everything or make you eat until you are stuffed. The

choices are yours.Vicki Bovee, MS, RD, LD

Applesauce with Cranberries12 Servings

6 large Granny Smith Apples peeled and cored1 cup fresh cranberries

2/3 cup water2 teaspoons ground cinnamon

1 teaspoon ground nutmeg¼ teaspoon ground cloves

¾ cup *Splenda®Place apples, cranberries and water into a large pot.

Bring to a slow simmer, and simmer for 30 minutes, or untilapples are soft.

Push apple mixture through a strainer.Add cinnamon, nutmeg, cloves, and Splenda, and stir well.

Chill and serve.*Add more Splenda® to make sweeter.

Per serving: 60 calories, 0 g protein, 0 g fat (0 g saturated),0 mg cholesterol, 16 g carbohydrate, 3 g fiber, 10

g sugar, 0 mg sodiumwww.chefdave.org

Sautéed Brussels SproutsServes: 8

¼ cup olive oil1 teaspoon butter

1 pound Brussels sprouts, cut in half1 teaspoon fresh garlic

1 teaspoon fresh thyme leaves½ teaspoon salt

¼ teaspoon black pepperHeat olive oil and butter into a large sauté pan.Add Brussels sprouts and sauté for 5 minutes oruntil the Brussels sprouts are lightly browned.

Add garlic, fresh thyme, salt, and pepper and coverfor 5 minutes or until Brussels sprouts are tender.

Serve.Per serving: 30 calories, 2 g protein, 1 g fat (0 g

saturated), 0 mg cholesterol, 5 g carbohydrate, 2 g

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fiber, 1 g sugar, 160 mg sodiumwww.chefdave.org

How to Get Sexy, Sculpted Arms

Q: My arms are a flabby mess. Do you have a simple exercise to tone them up?

JILLIAN SAYS: Absolutely! I've got just the thing. When you have sculpted triceps you free yourself from having to wear those loose, long-sleeved shirts. Go ahead and fill your closet with short-sleeved shirts. Better yet — go sleeveless! With toned triceps you can wave to your fans all you want (no more upper-arm jiggle!).

Sound good? Then get started with tricep kickbacks, a terrific beginner exercise for sculpting the backs of your upper arms:

Tricep Kickbacks

Hold a dumbbell in each hand and stand with your feet hip-width apart with a slight bend to your knees.

Bend over at the waist so that your torso is slightly above parallel with the floor. Bend both elbows so that your upper arms are locked at your sides parallel to the floor.

Keeping your arms still, straighten your arms behind you until the end of the dumbbell is pointing down toward the floor with your palms facing in towards your body.

Hold for a beat and inhale, slowly lowering your arms back to the starting position, and repeat.

To do this properly, remember to keep your abs tight and your back flat.

www.jillianmichaels.com

10 Tips for a Thinner ThanksgivingEnjoy the holiday feast without the guilt -- or the weight gain.By Kathleen M. Zelman, MPH, RD, LDWebMD Weight Loss Clinic-FeatureReviewed by Louise Chang, MD

Thanksgiving only comes around once a year, so why not go ahead and splurge? Because gaining weight during the holiday season is a national pastime. Year after year, most of us pack on at least a pound (some gain more) during the holidays -- and keep the extra weight permanently.

But Thanksgiving does not have to sabotage your weight, experts say. With a little know-how, you can satisfy your desire for traditional favorites and still enjoy a guilt-free Thanksgiving feast. After all, being stuffed is a good idea only if you are a turkey!

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Get Active

Create a calorie deficit by exercising to burn off extra calories before you ever indulge in your favorite foods, suggests Connie Diekman, MEd, RD, former president of the American Dietetic Association (ADA).

"'Eat less and exercise more' is the winning formula to prevent weight gain during the holidays," Diekman says. "Increase your steps or lengthen your fitness routine the weeks ahead and especially the day of the feast."

Make fitness a family adventure, recommends Susan Finn, PhD, RD, chair of the American Council on Fitness and Nutrition: "Take a walk early in the day and then again after dinner. It is a wonderful way for families to get physical activity and enjoy the holiday together."

Eat Breakfast

While you might think it makes sense to save up calories for the big meal, experts say eating a small meal in the morning can give you more control over your appetite. Start your day with a small but satisfying breakfast -- such as an egg with a slice of whole-wheat toast, or a bowl of whole-grain cereal with low-fat milk -- so you won't be starving when you arrive at the gathering.

"Eating a nutritious meal with protein and fiber before you arrive takes the edge off your appetite and allows you to be more discriminating in your food and beverage choices," says Diekman.

Lighten Up

Whether you are hosting Thanksgiving dinner or bringing a few dishes to share, make your recipes healthier with less fat, sugar, and calories.

"There is more sugar and fat in most recipes than is needed, and no one will notice the difference if you skim calories by using lower calorie ingredients," says Diekman.

Her suggestions:

Use fat-free chicken broth to baste the turkey and make gravy.

Use sugar substitutes in place of sugar and/or fruit purees instead of oil in baked goods.

Reduce oil and butter wherever you can.

Try plain yogurt or fat-free sour cream in creamy dips, mashed potatoes, and casseroles.

Police Your Portions

Thanksgiving tables are bountiful and beautiful displays of traditional family favorites. Before you fill your plate, survey the buffet table and decide what you're going to choose. Then select reasonable-sized portions of foods you cannot live without.

"Don't waste your calories on foods that you can have all year long," suggests Diekman. "Fill your plate with small portions of holiday favorites that only come around once a year so you can enjoy desirable, traditional foods."

Skip the Seconds.

Try to resist the temptation to go back for second helpings.

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"Leftovers are much better the next day, and if you limit yourself to one plate, you are less likely to overeat and have more room for a delectable dessert," Diekman says.

Choose the Best Bets on the Buffet.

While each of us has our own favorites, keep in mind that some holiday foods are better choices than others.

"White turkey meat, plain vegetables, roasted sweet potatoes, mashed potatoes, defatted gravy, and pumpkin pie tend to be the best bets because they are lower in fat and calories," says Diekman. But she adds that, "if you keep your portions small, you can enjoy whatever you like."

Slowly Savor

Eating slowly, putting your fork down between bites, and tasting each mouthful is one of the easiest ways to enjoy your meal and feel satisfied with one plate full of food, experts say. Choosing whole grains, fruits, vegetables, broth-based soups, salads, and other foods with lots of water and fiber add to the feeling of fullness.

Spread out the food and fun all day long. At the Finn family Thanksgiving gathering, they schedule dessert after a walk, while watching a movie together.

"We eat midday, and instead of another meal at dinnertime, we continue the feast with dessert a few hours after the main meal," Finn explains.

Go Easy on Alcohol

Don't forget those alcohol calories that can add up quickly.

"Have a glass of wine or a wine spritzer and between alcoholic drinks, (or) enjoy sparkling water," says Diekman. "this way you stay hydrated, limit alcohol calories, and stay sober."

Be Realistic

The holiday season is a time for celebration. With busy schedules and so many extra temptations, this is a good time to strive for weight maintenance instead of weight loss.

"Shift from a mindset of weight loss to weight maintenance," says Finn. "You will be ahead of the game if you can avoid gaining any weight over the holidays."

Focus on Family and Friends

Thanksgiving is not just about the delicious bounty of food. It's a time to celebrate relationships with family and friends.

"The main event should be family and friends socializing, spending quality time together, not just what is on the buffet," says Finn.

www.webmd.com

IMPORTANT ANNOUCEMENT REGARDING JANUARY SUPPORT GROUP MEETING

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We will have a guest speaker at our January support group meeting. Dr. Jorge I. DelaTorre, M.d., from UAB will giving a presentation on plastic surgery following weight loss surgery. Please make plans now to attend!

Guidelines for Support Group Meetings

Everything said and heard in the group will be treated with respect for the participants’

privacy. What is said in the group stays in the group.

• Silence is acceptable. No one needs to say anything she/he does not wish to say. The group

is supportive rather than judgmental.

• The group offers respect for individual choices and experiences.

• Only one person talks at a time.

• Turn off all mobile phones and pagers.

• No one is allowed to dominate the conversation.

• The group facilitators’ roles must be respected.

• Begin and end meetings on time.

• The group is a safe place to share feelings, and to obtain and provide support, information,

reassurance and encouragement.

• The group is broadly defined. It is flexible; flowing with the participants’ needs and interests,

and provides an opportunity to reduce feelings of isolation.

• Bariatric surgery support groups are open to all persons going through the surgery process,

including family members and others in a supporting role.

• Although the results of going to the group can be therapeutic, the group is not meant to

replace individual behavior therapy.

• Every effort should be made within the group to resolve conflict arising from or during group

interaction.

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Check us out! We’re now on the web!!!www.morasurgicalclinic.com

IMPORTANT!! IMPORTANT!! IMPORTANT!!

1. Maintain a healthy, low calorie diet that is low in carbs and fat, but rich in protein. Your water intake should be at least 64 oz. per day.

2. Exercise (walking, jogging, swimming, biking, cardio, etc.) 1 hour per day, 5 days a week.

3. Take vitamins and prescribed minerals without fail.

4. Seek out help from a mental health care individual (psychiatrist, psychologist) to learn new ways of

coping with stress as needed. 5. If you are a gastric bypass patient, 3 months or more out from surgery, have your lab-work done one week prior to your follow-up appointments.

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6. Regularly attend support group meetings.

Please write a story of YOUR weight loss story with pictures and submit to Tara @ Dr. Mora’s office for publication in the newsletter. Submit to morabariatric@bellsouth.net or call the office @ 361-6126, ext 2.

WANT TO SUGGEST TOPICS FOR OUR NEWSLETTER? IT’S A GREAT TIME TO LET US KNOW!!! We have included a suggestion form for you to complete. Feel free to complete the form and email it to Tara, standard mail it to us, drop it by the office, or drop it off at the next support group meeting. WE WANT TO HEAR FROM YOU! The support group meetings and the newsletters are

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for you, our patients. We want to make sure you’re getting the information you want from both the meetings and the monthly newsletters. Send your suggestions to Tara at morabariatric@bellsouth.net or call the office @361-6126, ext. 2.

Support Group Suggestion and Newsletter Topic FormPlease provide us with some support group meeting topics to help us provide you with the best post-operative support system. We would like to have your needs met and welcome your ideas and suggestions. Please take the time to provide us this feedback about the kinds of support groups and newsletter that are of interest to you. Thank you!

Exercise:Safe exercise Staying motivatedChallenges of exercise Enjoying exercise

NutritionGetting ready for gastric bypass/Lap band surgery Eating real foodReaching your protein requirements Food shoppingGastric bypass/Lap Band nutrition reviewed Long-term healthy eatingStaying on target Eating outEating challenges Dealing with cravings

PsychologyDepression Body imageSelf-esteem Grieving the loss of foodLife-strategies Coping

HealthReconstructive surgery PregnancyVitamins and minerals Calcium and bone lossRegaining weight after weight loss surgery Reconstructive surgery

SocialDealing with obesity DatingRelationship dynamics SexualitySupporting your spouse/partner/friend Asking for support

Other suggestions:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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______________________________________________________________________________________________________________________________________________________

NEXT SUPPORT GROUP MEETING DECEMBER 13, 2010**PLEASE NOTE! WE HAVE THE DATES LISTED BELOW FOR SEMINARS THROUGH SEPTEMBER 2011, SO MARK YOUR CALENDARS TO ATTEND!

LOCATION:Prattville Doster Community Center424 South Northington Street, Prattville, AL.

TIME:7:00 P.M. ON EACH DATE LISTED BELOW

DATE:*2010- September 27, October 25, November 15, December 13*2011- January 31, February 28, March 28, April 25, May 30, June 27, July 25, August 29, September 26

PLEASE note all dates are subject to change due to availability of Dr. Mora or other extenuating circumstances. We encourage you to call to check that the date has not been moved ahead of time each month, especially if you live out of town!

Have a weight loss story? Please write your weight loss story with pictures and submit to Tara @ Dr. Mora’s office for publication in the newsletter. Submit to morabariatric@bellsouth.net or call the office @ 334-361-6126, ext. 2.Want to suggest a topic? We want to hear from you! Send your suggestions to Tara @ Dr. Mora’s office for consideration in the newsletter. Submit to morabariatric@bellsouth.net or call the office @334-361-6126, ext. 2.

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