Dear Friends and Family of Laparoscopic Associates of San Francisco,

Although this time can be challenging & tempting when it comes to food, you can still enjoy fun holiday celebrations with a little careful planning.

From all the staff, we wish you & your loved ones a safe, healthy, and joyous holiday!



New Hawaii Support Group Location & Monterey Support Group

Our new Honolulu location will be at the Prince Kuhio Hotel. It's located at 2500 Kuhio Ave. in the Molokai Room- 2nd floor. There is Valet Parking for $6/car. Start time is 10am for pre-op patients & 11am for post-op patients. **Please check the website calendar for future dates.**

Monterey Support group will be held monthly at the Monterey Doctors Surgery Center. It is located at 665 Munras Ave., Suite 100. Seminar starts at 1 pm for new patients & 2 pm for post-op patients. **Please check the website calendar for future dates.**

**Reminders**
Starting January 2007, the Stockton Support Group time will change to the afternoon from 2-4pm.

San Francisco Support Group is now located at the 2100 Webster St. Bldg (1st floor Spivey Room next to the Terrace Cafe). Validated parking available at the Clay St. Garage.
click here to see the LAPSF Calendar

Update on the LAPSF Patient Calendar
Thank you to all those who have responded in wanting to participate in the LAPSF Calendar. We are in the process of ironing out the logistics. Once we are ready to proceed, we will be contacting you for your patient story & pictures. We still have plenty of openings if you would like to take part.
If you are interested in participating, please send an email to weightloss@lapsf.com.

New Protein Drink- New Whey 42g
Introducing the most convenient delivery of protein ever conceived! New Whey delivers 42 grams of pure protein with no carbs or fat in a 3.1 ounce serving! New Whey can be taken anywhere conveniently and easily. No messy mixing of powders, & no messy clean up. New Whey Liquid Protein is the ideal protein supplement for people on the go! Nutrition Info per vial: 176 calories, 0g Fat, 2g Carb, 42g Protein.

LAPSF now carries all 3 flavors of New Whey 42- orange, grape, and fruit punch. They can be purchased through our office by calling the main line at 866-957-3627

Insurance Update

Now that we are at the end of another year, please be aware of the fact that many benefits could change for potential patients.

We highly recommend that pre-op patients call the customer service department of their plan and verify the bariatric surgery benefits. They will be able to tell you whether weight loss surgery is excluded from your plan prior to coming in for a consultation.

If you have specific insurance questions or billing inquiries, please contact Marsha or Marilyn Toll Free at 1-800-704-0028.
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Psychologist Corner- Tips for Ensuring Long-Term Success
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TIPS FOR ENSURING LONG-TERM SUCCESS
Copyright © 2006 Sharon Magar, M.F.T., WLS Choices for Change All Rights Reserved

After the Honeymoon
The first year after weight-loss surgery is a powerful and exciting experience, fueled with amazing changes and a restoration to health and balance of body and mind. For many, this time seems almost effortless in terms of needing to look within for answers of how to lose weight. The physical restriction from our bariatric surgery took care of that for us. We are more easily satiated as our food needs are taken care of pretty quickly and easily each day. Our life no longer revolves so much around food and eating.

During this first stage after WLS, what I call the "honeymoon", we replace the time previously spent with food, with more interesting adventures. It is a time spent enjoying our newly evolving bodies - buying new clothes, receiving compliments from others, beginning to be physically active, traveling, reclaiming all the normal activities of living that slowly slipped away when we were obese.

Eventually, life begins to settle a bit, we get to a normal weight and are then challenged with learning the art of healthy weight maintenance. For most bariatric patients, healthy weight maintenance is not a skill that we've practiced for very long as most of our experience has been based on a past filled with yo-yo dieting and struggling with obesity.

As the initial "melting-away" process concludes, the "honeymoon" begins to end. The compliments begin to recede slightly, our closets are filled to the brim with new clothes, and most of the new adventures and milestones have now been experienced. This period becomes challenging as our external worlds aren't feeding us to keep the euphoria going, like they used to do.

Let's look at the tasks we're confronted with after the "Honeymoon."

This is a time when many people begin to fumble and slip with their weight and food issues. It's when we most often see those old pesky habits returning to our repertoire of coping skills. Some are trying to lose that last bit of weight that is stubbornly holding on, and others begin to see a bit of regain slowly creeping up.

In the ideal, during that first year of post-op life, we would have been digging deep, doing what I call the emotional excavation work, to root out those habits that caused our obesity in the first place; the first year, post-operatively, is the time to do some serious soul-searching to come to terms with our relationship to food, and to develop a strong plan of relapse prevention.

But the first year after surgery is deliciously euphoric, and effortless in some ways, and we often get caught up in the other various aspects as mentioned above. So our skill level, in terms of emotional excavation, might be weak and still undeveloped.

After the "honeymoon" is over, if a person has still not mastered their weight loss, it is imperative to seek out support: 1) to develop insight in regard to one's relationship to food; 2) to learn how to develop a healthy relationship to food, and 3) to learn how to develop and implement a plan or strategy for long-term WLS Success. Being willing to do this work will guarantee a much greater level of success for the long-term the rest of your life!

Emotional Eating

Once adequate insight and self-inquiry has been done, most bariatric patients come away with a list of the ways they participated in emotional eating over the years. Once we understand what our primary emotional eating tendencies are, we are then empowered to begin to create a strategy and plan of action to avoid falling into those vulnerable potholes in the future. We learn to replace food and eating with other, more powerful options for action.

We often begin overeating for emotional reasons because we have not yet developed the skill to tolerate intense feelings. When we are in the throes of disordered eating, the ability to tolerate intense feelings is short-circuited by using food to quell uncomfortable sensations, thoughts and feelings. We resort to food, our drug of choice: the ultimate comfort substance. One of our tasks in experiencing long-term WLS Success is to learn how to tolerate intense emotional feelings to empower ourselves to make other, more life-enhancing choices.

Developing a Plan for Long-Term WLS Success

As we develop the skills earlier discussed, it is important to rely on concrete, tangible tools that will also ensure long-term WLS Success. When we notice that we are unable to just keep it simple and work our tools, it is important to then review the previous steps of developing insight and self-inquiry. And with our new compassionate attitudes, we can do more emotional excavation to get to the root of what's driving us to deviate from our long-term WLS Success Plan.

By following the necessary steps for insight and self-inquiry we can empower ourselves to live our dreams for long-term WLS success.

Long-Term WLS Success Plan

Long-term WLS Success involves engaging in the following, simple but extremely important tasks every single day. (It is Interesting to note that naturally thin people report practicing these same skills in maintaining their weight.)

1.Meal Planning. Stick to a structured eating plan and stay accountable to your dietary intake, using tools such as www.fitday.com, if necessary to get real with what you'e putting in your body.

2. Mindful Eating. Practice Mindful Eating. Put your fork down between bites and develop an awareness in your mind's eye, of what is happening in the moment pressure on the tongue, taste, texture, swallowing, swallowing, swallowing, feeling the food move down your esophagus, taking a few breaths before picking up the fork again, asking yourself Am I satiated?,Am I full?.

3. Inner Dialogue. Develop a growing awareness of your inner commentator in terms of how it supports or does not support your long-term goals, and replace the negative self-talk with more affirming self-talk.

4. Grazing. Avoid grazing behavior once you begin, you may not so easily be able to stop.

5. Weighing. Create a weight-window for yourself and weigh yourself weekly to make sure you stay within your window.

6. Vitamins and Supplements. Be dedicated to take your supplements and vitamins EVERY day.

7. Hydrate. Drink at least 64 ounces of water a day.

8. Exercise. Move your body in some form of exercise at least 3-4 days a week.

9. Restorative Activities for the body mind and spirit. Incorporate restorative activities on a regular basis for yourself. Remember to love yourself as you would love a child. Nurture Yourself.

10. Personal Accountability. Practice Personal Accountability. Refrain from using excuses and recognize when you lapse into excuse making, and then make a course correction and get back on track.


Holiday Recipes

If you have a healthy recipe you would like to share in the next newsletter, please email to Weightloss@lapsf.com. Please include the calorie, fat, carbs, and protein content.

SHRIMP STUFFED DEVILED EGGS

WLS portion 1/2 egg, Calories 65, fat 5gr, carbs .5gr, protein 5gr

6 large eggs
3 tablespoons mayonnaise
2 teaspoons Dijon mustard
1/2teaspoon Old Bay seasonin
1/4pound cooked shrimp finely choppe
3 scallions, finely minced, including tender green tops

Place eggs in a covered pan just large enough for a single layer. Add water to cover the eggs by about one inch. Bring to a boil over high heat, cover pan, reduce heat to low and barely simmer for 16 minutes. Pour off hot water, fill pan with cold water, cooling eggs enough to handle. Crack and remove shells immediately.

Neatly split eggs lengthwise and remove yolks to a medium bowl. Mash yolks with fork until fine textured and fluffy. Add mayonnaise, mustard, Old Bay, shrimp, half of the scallions and blend well. Scrape filling into a medium plastic bag and squeeze into one corner. Snip off corner with scissors about 1/2 inch from tip to use as a pastry bag. Place whites on decorative plate and fill each hollow with a squeeze of filling. Sprinkle with Old Bay and garnish with remaining scallions. Cover platter and chill. Copyright©2006 by Susan Maria Leach www.BariatricEating.com, HarperCollins Pub. Inc. all rights reserved.

CAULIFLOWER MUSHROOM CHEDDAR CASSEROLE
WLS portion: 1/4-1/2 cup; 152 calories, 18g pro, 8g carb
3 cups cauliflower, steamed till soft (~12 min)
1 cup fresh white mushrooms, chopped
5 cloves roasted garlic
1/2 lb low-fat cheddar cheese, diced
butter-flavored cooking spray
2 T ground soy nuts
Preheat oven to 350F deg. In a large bowl, mix cauliflower, mushrooms, roasted garlic, and cheese. Coat a small nonstick baking dish with cooking spray; pour in mixture and sprinkle ground soy nuts on top. Spray top with cooking spray and bake for 30 minutes.

LONDON BROIL WITH HORSERADISH CREAM
WLS portion size: 2-4oz; 182 calories, 28g pro, 8g carb
1 lb lean London Broil (top round or flank steak)
1 1/2 tsp garlic powder
1 T lemon-pepper
1/2 cup fat-free sour cream
1 T concentrated beef broth
2 T prepared horseradish
Sprinkle London broil with garlic powder and lemon pepper. Place in non-stick broiling pan and broil 4 minutes on each side for medium rare. While steak is broiling, combine sour cream, concentrated beef broth, and horseradish in a small bowl. Slice steak thinly on diagonal, pour sauce over it, and serve.

HOLIDAY PUMPKIN PARFAIT
WLS portion size: 4oz; 55 calories, 3g pro, 9g carb, 1g fat
1 cup pumpkin puree
1 pkg Sugar Free instant pudding mix
2 c cold non-fat milk
1 tsp cinnamon
1 tsp allspice
1/2 tsp vanilla extract
6 T nonfat whipped cream topping
6 cinnamon sticks
1/2 tsp ground nutmeg

In a medium mixing bowl, combine the pumpkin puree, pudding mix, and milk. Add the cinnamon, allspice, and vanilla and mix thoroughly.
Evenly spoon the mixture into 6 parfait or martini glasses. Chill in the refrigerator for about 30 minutes, until the mixture sets. Place 1T whipped cream topping on top of each parfait. Garnish each one with a cinnamon stick and nutmeg. Recipe courtesy of "Recipes for Life After Weight-Loss Surgery."


Important- Have you had your annual labs drawn?
Image We cannot stress enough the importance of taking your vitamins consistently EVERYDAY for the rest of your life. In addition, it's necessary to have your labs drawn every year to check for any nutritional deficiencies or lab abnormalities. Untreated vitamin deficiencies can lead to night blindness, osteoporosis, even peripheral neuropathy (paralysis).

You should receive an annual lab letter & lab slip ~1 month prior to your anniversary date for surgery. These usually take 3-4 weeks for us to obtain all the results. Please have your labs drawn at least 3 weeks prior to scheduling your annual appointment. Don't forget- Stop taking all vitamins/supplements 3 days prior to your blood draw.

click here for your annual lab form

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

Sincerely,

Dr. Gregg Jossart ~ Dr. Paul Cirangle ~ Dr. John Husted
Khristi Autajay, RD
Laparoscopic Associates of San Francisco
2100 Webster Street, Suite 518
San Francisco, CA 94115
866-957-3627/(415) 561-1713 fax
www.LapSF.com
weightloss@lapsf.com


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