Dear Friends and Family of Laparoscopic Associates of San Francisco,

Welcome to the February edition of our online 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 We want to see your before and after pictures!!

The Docs of Laparoscopic Associates of San Francisco

SUCCESS STORY : Denise Reclaims Her Life with the RNY Gastric Bypass
I spent over a decade morbidly obese. During that time, I tried almost every diet, pill and program available but could never seem to lose more than 50 pounds before I’d come to a screeching halt. I was a classic yo-yo dieter, but I worked out 3-4 times a week so exercise wasn’t really an issue for me. I became so discouraged about my inability to lose weight that I began secretly researching weight loss surgery for 5 months before gathering the courage to make an appointment with Dr. Paul Cirangle at Laparoscopic Associates of San Francisco. In spite of living an hour away from San Francisco, I felt so comfortable after my first appointment with him; with his knowledge, thoroughness and compassion that I decided to travel farther to use a competent surgeon with hundreds of weight loss surgeries under his belt rather than go see the surgeons in my area that had just begun doing weight loss surgeries. I felt no shame or awkwardness in discussing my obesity with Dr. Cirangle, any of the other surgeons at LapSF or his office staff and that amazed me since I was so filled with shame before I went in for my first appointment.
From my first appointment with Dr. Cirangle in November 2003 until my surgery in January 2004, I spent the Holidays wondering if I was about to do the “right” thing. I learned there are several weight loss surgeries available so based upon how much weight I needed to lose (120 pounds) I decided to have the RNY procedure. Dr. Cirangle actually told me I didn’t have that much weight to lose and I still laugh at his comment because I’d never had a doctor tell me anything like that before! The procedure itself was surprisingly easy and I discovered I really didn’t require much pain medication. I now have 5 tiny little scars that have faded to about 1/4” long each. I eat very differently now (and a lot less) than before surgery. I try to concentrate first on getting in enough protein, and I round out my meals with a balance of carbs and fat. I really don’t want to undergo plastic surgery to reduce any excess skin which sometimes accompanies major weight loss so I became very focused on my exercise regime this past year: Thankfully, good genes and my exercise regime has made it possible for me to sidestep plastic surgery. I work out 5-6 times a week; walk 18 miles, and I weight train my upper body as well. I also do Pilates and yoga. I entered my first 10k race last May and completed the race in a centipede with fellow LapSF patients. I’ve gone from a size 24 to a size 6. My family has been very supportive during my transformation (which really helped). My friends were astonished when I recently emailed my “before” and “after” pictures – many of them called me to say they were skeptical of my surgical option for weight loss, but that after seeing me, they think I made the right choice and that I seem to radiate good health. It’s kind of cool to now have my teenage daughter ask to borrow some of my new clothes. My life has changed dramatically for the better over this past year; problems still come and go, but the confidence I now have in my body is amazing and something I’ve learned to accept with grace and humility.

Landmark Study Shows Blockbuster Effects of Bariatric Surgery

A meta-analysis of 136 studies involving 22,094 patients has strongly corroborated the positive effects of bariatric surgery (Buchwald et al, JAMA 2004;292:1724-1737). Henry Buchwald, MD, PhD, professor of surgery, University of Minnesota, Minneapolis, and colleagues found the patients had an average 61.2% excess weight loss. The greatest average weightloss occurred for biliopancreatic diversion or duodenal switch, at 70.1% excess weight loss, followed by %68.2 for gastroplasty, 61.6% for gastric bypass and 47.5% for gastric banding.

The team found an average 30-day postoperative mortality was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass and 1.1% for biliopancreatic diversion or duodenal switch. Moreover, 86% of those with diabetes experienced an improvement or complete resolution of their disease, while 83.6% of those with obstructive sleep apnea experienced this salubrious effect, as well as 70% of those with hyperlipidemia and 78.5% of people with hypertension.

The studies Dr. Buchwald and his colleagues examined in their meta-analysis consisted of five, randomized, controlled trial; 28 nonrandamized controlled trials or series; and 101 case series without controls.

"This is a landmark paper because of its scope and the thoughtful review and analysis," said Kenneth MacDonald, Jr., MD, professor or surgery, East Carolia University Brody School of Medicine, Greenville, N.C. "It will be refererenced and quoted as a classic, from now on. "
Rosemary Frei, MSC.


February's Weight Loss Surgery Recipe, ORANGE GLAZED SALMON


1/4 cup fresh orange juice
2 tablespoons balsamic vinegar
1 teaspoon Dijon mustard
1 tablespoon olive oil
1 tablespoon finely minced shallot or onion
1 small clove garlic, peeled and forced through a press or chopped finely
2 teaspoons each finely chopped cilantro, basil and mint or a combination of your favorite herbs.
1/8 teaspoon salt
Freshly ground black pepper to taste
1-1/4 pounds salmon fillet

Place the orange juice, vinegar, mustard, oil, shallot, garlic, herbs, salt and pepper in a jar or plastic container. Close lid and shake well to blend.

Place salmon in a foil-lined pan and spoon a little of the vinaigrette over the fish. Bake in a preheated 450-degree F. oven 12 minutes per inch of thickness, or until cooked through.

Spoon the remaining vinaigrette over each serving of fish.

Yield: 4 servings

Per serving: Calories 276; Protein 26g; Fat 17g; Carbohydrates 4g;

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!

Seminars and Support Group Dates 2005
We have monthly seminars and support groups in 6 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 meeting is on the third Wednesday of the month at the Sutter Cancer Center at 2800 L Street in Sacramento at the Buhler Board Room on the 7th Floor. It starts at 7pm, we hope to see you there!

PETALUMA: Our Petaluma support group meets the third Saturday of the month at Groverman Hall at Petaluma Valley Hospital on North McDowell in Petaluma at 10:30am. New patient seminar at 9am. The only exeption is April, when the support group will be on the 23rd.

EUREKA: Our Eureka support group meets at 7pm on the Thursday evening that our doctors are seeing patients in Eureka. They meet at General Hospital, in the Burre Conference Room on the roof. Please call or check our website to confirm the date.

EAST BAY: Our East Bay support group meets at 745pm on the second Tuesday of the month at the Mt. Diablo Regional YMCA in Pleasant Hill at 350 Civic Drive in the Lions Den Room.

SAN FRANCISCO: Our SF support group normally meets the last Thursday of the month at 6pm at the Cathedral Hill Hotel in San Francisco, at the corner of Van Ness and Geary. Parking is validated.

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
March 10th and 11th, April 21st and 22nd

Chico - 111 Raley Blvd. Suite 120 Chico, CA
March 15th

Sacramento - 631 Fulton Ave, Sacramento, CA
March 18th and 25th, April 8th and 22nd

Stockton - 415 East Harding Way, Suite G Stockton, CA
March 9th

Petaluma - 1456 Professional Drive, Suite 406 Petaluma, CA
March 18th and 23rd and April 8th

San Jose - 3803 South Bascom Ave, Suite 100 Campbell, CA
March 16th and April 20th

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


There is a company on the east coast named Carb Countdown. Their products have very few carbs and lots of protein.
Now they are starting to bring yogurt to California.

Here are the nutritional values for one 6 oz container of yogurt (that actually tastes good):
Calories 80
Fat Calories 10
Total Fat 1.5g
Sat Fat 1g
Cholest 10mg
Sodium 80mg
Total Carb 4g
Dietart Fiber 0g
Sugars 1g
Protein 12g

If you have tips on good products for weight loss surgery patients, please email them to Thanks!

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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