Dear Friends and Family of Laparoscopic Associates of San Francisco,

Welcome to our April 2005 newsletter. We hope to offer lots of helpful tips for weight loss surgery patients as well as success stories and invitations to our events! Please feel free to submit your tips or your success story with pictures to

The Docs of Laparoscopic Associates of San Francisco
Dr. Jossart and Dr. Cirangle want to welcome you to our April Newsletter. After all the rain, spring brings lots of opportunities for you to get outside and exercise. Make sure you take advantage of the sunshine this summer. Any tips that you have for great outdoor activities are always welcome, we will put your suggestions in our summer newsletters, extra credit for pictures!!

Happy Spring,
Dr. Jossart ~ Dr. Cirangle
To learn more about the doctors, click here.

SUCCESS STORY : Allen gets his life back with Weight Loss Surgery
My name is Allen. I am 44 years old and I live alone here in Northern Sonoma County. My life wasn’t that bad before surgery. No, I take that back it wasn’t a life. I was sitting around the house doing nothing but watching TV all day long when I wasn’t working. I was eating all the time. Even though I was a big guy I could always handle the extra weight OK. I could do my job whether I had to tarp my loads of lumber in the rain or chain up in the dead of night in the middle of winter. I just would be totally out of breath and sometimes wish I was dead to stop the pain. Being a truck driver I never ate right to begin with. I ate snacks all the time, Pepsi and donuts in the morning for a sugar high to keep me awake.
In October 2002 I met Dr. Greg Jossart. I knew in my heart here was a man who could get things done. He was always available. Every time I wrote him an email it was answered within a very short time. I once sent him a question around 11:30 at night and within 15 minutes I had my answer back. He has been my best doctor and friend throughout this journey. He sent me to another specialist there in the city to check on my esophagus, a Dr Snape. While with Dr Snape, he performed a Barium swallow, an upper endoscopy, a pH test, and a Esophageal Motility Study. The results were that my stomach was making 4 times as much acid as it was supposed to be making.
During one of my return appointments with Dr. Snape, I was sitting in the lobby of CPMC waiting for my appointment. I was talking to another gentleman who was waiting for his wife, when I heard, "Hey Allen, How are you doing". It was Dr Jossart. He came over and sat down and talked with me for about five minutes finding out what was happening so far with Dr Snape. I’ve never in all my life had a doctor like Dr Jossart. Most doctors the only way they will talk to you is in their office and making sure you pay for their time.
After all the results were given to Dr Jossart I came back in for another consultation and was told the only way to fix my problem was to have the RNY gastric bypass. I told him whatever it takes, to give me back some sort of life. He sent all the paperwork in to Blue Cross and then came the waiting. We all know about the waiting game. My surgery was scheduled for Tuesday March 4, 2003 at 11AM. My highest weight was 422 pounds, but had come down to 404 pounds the day of surgery due to depression and not eating. I was so ready for this surgery. To me the surgery was a snap, no problems. I had no pain following surgery, just was tired. I tried to sleep but as we all know who have had the surgery the nurses don't want you to sleep they want you up and walking.
Drinking nothing but beef and chicken broth, sugar-free popsicle, water, and Crystal Light, after those first couple of weeks I was so tired of broth. YUCK!!! I followed my diet guide to the letter making sure I stuck with everything the doctors wanted. It was so strange first thing in the morning when I woke up and got a drink of cold water, I could feel the pouch fill up, then a few seconds later feel a small pop and then feel the water slide all the way down to my mid section. I moved up to thicker liquids around the 3rd week. At last something other than broth, but still had the broth along with some soups.
For the past two years I have eaten mostly the same foods day in and day out, just because it worked. I hate going grocery shopping anymore. There are some people that have had this surgery that after 6 or 7 months they started feeling hungry and had to fight the urge to eat. With me it's the other way around, I have no desire to eat. It has gotten to the point where I must set the alarm on my wristwatch to tell me when it's time to eat.
Here it is almost at my two year mark, everything is coming along fine. My high blood pressure is gone, (BP is 100/82) no diabetes, my knees or back never cause me any problems. My total cholesterol level is at 173. I have lost a total of 228 pounds since I started this journey way back in February of 2002. I have lost a total of 30 inches off my waist. I have gone from a size 64" waist down to a 34" waist. I have gone from 6XL shirts down to a large shirt. My BMI is now down to 24.0. I owe my life to Dr Jossart for without him I know in my heart that by now I would probably have died from cancer. Dr Cirangle was also a good source of help with questions at the support groups.
The support groups are the second most important people to have in this journey. There are those that have come before you that give the greatest advice for what you are going through, either some advice on what to eat or a swift kick in the head cause you’re NOT doing what your doctor has told you to do. We are very important to each other. If you have this surgery, do whatever it takes to find a local support group and it will help you in ways you never dreamed of.

Find out more about the Roux En Y Gastric Bypass that Allen had.

Lap-Band patients: When do you need a Band adjustment or fill?

Image Patients who undergo the Lap-Band procedure know that the Lap-Band is adjustable. Sterile salt water or saline can be injected into the reservoir port to help tighten the Band around the upper stomach. The Lap-Band balloon/reservoir system is usually empty at the time of surgery to avoid any problems with obstruction from the swelling of the upper stomach after surgery. About 3 weeks after surgery, patients begin progressing their diet from the liquid fast phase. At this time, many but not all patients begin to feel hungry and not significantly restricted soon after a meal. Of course, to help prevent Band slippage, patients are eating no more than 3 ounces of food at each meal.

The meal needs to be mainly protein since it is this type of food that allows the patient to better use their Band as a tool. The reason for this is that solid protein such as eggs, fish, chicken, beef and lean pork needs digestion to be broken down and absorbed. Thus, protein is more likely to stay in the stomach pouch above the Lap-Band for a longer period of time, resulting in a prolonged sensation of fullness. Thus, if a patient who is not losing weight, exercising, and is eating the 3 ounces of protein as prescribed but feels hungry within 1-2 hours after the meal, that patient needs a band fill. These patients sometimes describe that they feel like they are “struggling with dieting,” and end up eating snacks between mealtimes.

On the contrary, if a patient is not losing weight because he or she is eating carbohydrates or sweets mainly, or drinking a lot of high calorie liquids, and not exercising, he or she doesn’t need an adjustment. That person needs to change their behaviors and habits. If a small quantity of protein helps you feel full for hours, you do not need a fill. Carbohydrates and liquids do not help you feel full.

The Lap-Band is a tool for weight loss and requires a strong commitment to using it as such, probably more so than the other weight loss procedures. It allows a person to feel full with a small meal for a long period of time with the right adjustment level. Eating right - protein first in a meal, exercising, taking your supplements, drinking plenty of liquids, getting adjustments, seeing your surgeon, and going to support group meetings are all integral parts of optimizing your weight loss results.

For the answers to your questions, feel free to join our online chat every Thursday evening (except the last Thursday of the month when the docs are at the SF support group) at 9pm for our chat with one of our surgeons.

Follow this link to our Thursday night chat room.

Don't Forget to Get Your Yearly Lab Work Done Early!

Image We are busy gathering yearly lab statistics from our patients. Believe it or not, the lab where you get your lab work done takes 3-4 weeks to get us the results of your complicated one year labs. This means that you should schedule your one year lab tests at least one month before your one year appointment. Don't forget to stop taking your vitamins 3 days before your annual lab tests. Please see our website or the link below for an annual lab form. If you cannot download it, call our offices and speak to Michelle. We appreciate you getting your labs done on time!

Click here for your annual lab form.

Seminars and Support Group Dates 2005 - NEW SUPPORT GROUPS IN STOCKTON AND HAWAII!!
We have monthly seminars and support groups in 8 different locations.

SAN JOSE: We meet on the third Wednesday of the month at 6pm for pre-ops and 7pm for post-ops. All meetings are at the
Courtyard Marriott by the San Jose Airport, 1727 Technology Drive in San Jose.

SACRAMENTO: Our support group location and date has changed! Our support group meeting will change from the third Wednesday of the month at 7pm to the 4th Saturday of the month at 9am. The location will be the Doubletree Hotel at 2001 Point West Way in Sacramento near Arden Fair.
5/28/05~6/25/05~7/23/05~8/27/05~9/24/05~10/22/05~11/19/05~Dec CX’d

STOCKTON: We now have a Stockton Support Group! Our new Stockton Support Group will meet in Classroom 2 or 3 at 7pm at
St. Joseph’s hospital at 1800 N. California Street in Stockton.

PETALUMA: Our Petaluma support group meets the third Saturday of the month. New patient seminar at 9am, support group at 10:30am. Please meet at Groverman Hall at Petaluma Valley Hospital on North McDowell in Petaluma.

EUREKA: Our Eureka support group generally meets at 7pm on the third Thursday of the month. They meet in the Burre Conference Room on the roof. General Hospital in Eureka.

EAST BAY: Our East Bay support group meets at 8pm on the second Tuesday of the month in the Lion’s Den the
Mt. Diablo Regional YMCA in Pleasant Hill at 350 Civic Drive.

SAN FRANCISCO: Our SF support group normally meets the last Thursday of the month. Parking is validated. We usually meet in the Telegraph Room at 6pm at the Cathedral Hill Hotel in San Francisco, at the corner of Van Ness and Geary.
5/26/05~6/30/05~7/28/05~8/25/05~9/29/05~10/27/05~Nov Cx’d~12/1/05

HONOLULU: We have a new monthly support group in Hawaii! We meet the second Saturday of the month at the Diamond Head Room - Kapi‘olani at Pali Momi at 10am.

Click here to see our Seminars and Support Groups listed on our website.

Image Satellite Office Locations

We have office locations in 6 different Northern California areas. The doctors see patients in most of these offices once a month. If you live near one of these locales, feel free to call our main office number to make an appointment for a satellite clinic day. We'll see you there!

Eureka - 2607 Harrison Street, Suite B Eureka, CA

Chico - 111 Raley Blvd. Suite 120 Chico, CA

Sacramento - 631 Fulton Ave, Sacramento, CA

Stockton - 415 East Harding Way, Suite G Stockton, CA

Petaluma - 1456 Professional Drive, Suite 406 Petaluma, CA

San Jose - 3803 South Bascom Ave, Suite 100 Campbell, CA

Click here for a list of our locations and driving directions.

April's Weight Loss Surgery Recipe: Turkey Diane


Non-stick cooking spray
1 Pound TURKEY BREAST CUTLETS, pounded to an even thickness
2 Teaspoons lemon pepper seasonings
2 Tablespoons freshly squeezed lemon juice
1 Tablespoon Worcestershire sauce
1 Teaspoon Dijon mustard
1 Teaspoon fresh parsley, chopped
Lemon wedges for garnish

Coat a large skillet with cooking spray and heat pan over medium heat for 30 seconds.

Sprinkle both sides of turkey cutlets with lemon pepper. Place turkey in hot skillet and saute for 3 to 5 minutes on each side until browned and no longer pink in the center.

Combine remaining ingredients in a small mixing bowl, mixing well. Add to pan and cook until heated through.

Garnish with lemon wedges and parsley.

Calories 129

Total Carbohydrate 1g

Protein 28g

Click here to send us a recipe!

Thank you for your support to date, see you at the next support group meeting!


Dr. Gregg Jossart ~ Dr. Paul Cirangle
Laparoscopic Associates of San Francisco
2100 Webster Street, Suite 518
San Francisco, CA 94115
866-957-3627/(415) 561-1713 fax

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