Dear Friends and Family of Laparoscopic Associates of San Francisco,

Welcome to our March 2005 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

The Docs of Laparoscopic Associates of San Francisco
Dr. Jossart and Dr. Cirangle want to welcome you to our March Newsletter... Please watch for news about our support groups participating in the Bay to Breakers. We want to see you out there!!
To learn more about the doctors, click here.

SUCCESS STORY : Mark Gets His Life Back with Weight Loss Surgery
At 37 years old, after years of childhood dieting under Dr. supervision, teenage eating plans, diagnosis of hypothyroidism and treatment, self directed and supervised diet and exercise programs, the drugs Phen Phen and Redux I was still obese. Not just a obese but morbidly obese and beginning to experience the real health effects of it. Obesity was something seldom spoken about in our family. “We were big people” (big people with health issues).

The fall of 2002, I made the “decision” once again to lose the weight and get healthy. After 7 months of regular exercise 3 days per week and a good diet I had lost some weight. I went from 308 to 295. I talked with my primary care physician about what was happening and was honestly frustrated with the problems I was experiencing. I had sleep apnea, hypertension, lower back, knee and foot pain. Simply stooping over to put on socks and tie my shoes was difficult. My family medical history includes Type II diabetes and heart disease. Four of my grandfathers died as a result of heart disease, two before fifty-five years of age. The odds of making that age were not in my favor. Something had to happen soon. I asked my Dr. about a gastric bypass and what was involved. He gave me a brief overview and said that if I was serious and considering my family history, he would refer me to a good Bariatric practice.

Three weeks after getting the referral, I had an appointment with Dr. Cirangle of Laparoscopic Associates of San Francisco in their Eureka office. I brought a binder with everything that was downloadable from the LAPSF website and had been doing my homework about weight loss surgeries on the Internet. I had a list of questions that needed to be answered before making such an important decision for my life. Dr. Cirangle answered all the questions I had. He talked about the different surgical options, what was involved in each one. He answered the questions I had about each of them. In the end I decided the Roux-en-y surgery would be the best surgery to meet my needs to get where I needed to be. Over the next two and a half months I went through a series of pre operative tests. My surgery date was set for June 30, 2003.

Monday morning, June 30, 2003, I called the LAPSF office and they told me to come on I bit early. I drove to St. Luke’s in San Francisco where my surgery was scheduled. This was my first experience as a patient in any hospital. The SOMA nursing staff and everyone involved in my care was very helpful and reassuring. My expectations for care were surpassed. They made accommodations for my wife Candy. She was able to stay at the hospital in my private room. After surgery, the transition from recovery to getting around happened smoothly. Walking was an activity that was started with out delay. Four hours after surgery nurses had me up walking around the floor station. I did this 4 or 5 times each day in the hospital. Dr. Jossart came in early each morning to check on my progress, answer questions and see that all my needs were being met. Thursday morning when I was discharged, Dr. Jossart gave me a package of information including nutritional and medication instructions to follow in my transition period as I learned to use my new system. He also set me up with an online nutritional tracking program the helped to monitor daily nutrition and exercise. That information was so valuable to me over the next weeks and months ahead!

Over the next month my weight loss was rapid. I went from 287 to 256. By week two my sleep apnea was gone and I slept through the entire night. I had learned that changing from liquids to full liquid, soft to solid food was an experimentation process. By week five, I was eating some solid foods. I did experience some challenges in keeping some foods down. When I ate something my system wasn't ready to handle yet I would vomit it back up or have a response from it blocking off my pouch. It was a process that took come patience getting through. Exercise continued when I got home. At first it was a big effort to walk from my home to the stop sign up the street. Soon I was walking half a mile twice a day. Next I was exercising in the gym and swimming at the pool. Now mountain biking, running and roller blading are activities I enjoy doing.

There have been a few challenges over the past seventeen months. When traveling in Ohio, I experienced a severe dumping situation. It was the most intense syndrome I have experienced. Fortunately I was traveling with some companions who were able to help me get in contact with Dr. Cirangle. He responded quickly and we figured out what was happening and how it happened. I followed a course of care the next few days and got my system back on track. It was awesome to get support when I was far away. When I’ve had questions about vitamins, nutrition, discomfort/pain or other concerns, the office staff and the Dr.’s at LAPSF have always been there to help. It’s great to be able to email your doctor and get a response very soon concerning you question or situation. One evening I had a response within a few minutes after sending my message. That’s being available and responsive to patients!

After care is vitally important to a patient’s long-term success and health. In Eureka our Dr.’s facilitate patient support groups. These are valuable for several reasons. As a potential bypass patient inquiring about weight loss surgery, I attend a support meeting and was able to learn what people were dealing with in their losing process. In this forum people can ask questions they might have including diet, exercise, challenges, differences in the procedures or anything else. Some of these things are best learned from others in the process. There is a collective knowledge that we can access by participating in these groups. It’s good to have a community of people that you can identify with. Encouragement and the shared experiences of other patients is mutually beneficial. Many of us active in support groups get together for activities outside of the formal group setting, exchange email and even call one another. Positive friendships are developed in the process.

Having this surgery was a major life choice. I’m pleased with the results. It hasn't been an easy process but it has been a worth while effort to get to a good state of health. All my co morbidities are gone, my risk for diabetes and heart disease are reduced. Now I live a healthy, high quality of life.

I'm so thankful to Dr. Jossart and the fine people that have worked with great care and skill to make my surgery successful. Making necessary changes after the surgery takes commitment. Dedication to make the right choices, to develop the habits of diet and exercise are needed to make this a life long success. What I do to make this work from here on out will be determined by my commitment. I believe the benefits are worth it.

June 29, 2003 – Preop 287lbs BMI 46 XXXL Shirts/46 Pants

July 31, 2003 – 1 month 256lbs BMI 41 XXL Shirts/42 Pants

September 30, 2003 -3 months 220lbs BMI 36 L Shirts/36 Pants

December 31, 2003 – 6 months 188lbs BMI 30 M Shirts/32 Pants

November 25, 2004 177lbs BMI 29 S Shirts/30 Pants

Current skin caliper measurements:

Chest: 5 mm
Back: 12 mm
Hip: 8 mm
Abdomen: 16 mm
Tricep: 6 mm
Thigh: 9 mm

Total: 56 mm
10.6% or 11% fat mass
20 pounds fat mass
162 pounds lean mass
Category: <12% = Excellent for men 30-39 years

Find out more about the Vertical Gastrectomy Procedure

Image March 2005 High Protein Weight Loss Surgery Recipe - Asian Grilled Turkey

Asian Grilled Turkey

3/4 Cup plain barbecue sauce
1/4 Cup sliced green onions, white and green parts
3 Tablespoons reduced-sodium soy sauce
2 Tablespoons sesame seeds, toasted
1 Teaspoon minced garlic
1 Teaspoon fresh gingerroot, peeled and minced
2 Pounds TURKEY THIGHS, skinned and excess fat removed

In 2-cup measure combine barbecue sauce, onions, soy sauce, sesame seeds, garlic and ginger. Remove 1/3 cup, cover and refrigerate.

Pierce holes in turkey thighs using tines of fork.

In self-closing plastic bag combine turkey thighs and remaining marinade. Seal bag and refrigerate overnight, turning occasionally to marinate evenly.

Prepare grill for indirect heat cooking. Cook thighs over medium heat 25 to 30 minutes per side until food thermometer, inserted in thickest portion of thigh, registers 180 degrees F.

During last 10 minutes of cooking, brush with reserved marinade.

Serve hot with a vegetable, if desired.

Calories 231

Total Fat 8g

Total Carbohydrate 9g

Protein 28g


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 - We have a NEW SUPPORT GROUP IN STOCKTON!!!
We have monthly seminars and support groups in now 7 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 location has changed! We are now at the Doubletree Hotel 2001 Point West near Arden Fair in Sacramento. We will meet in April on Wednesday the 20th at 7pm and in May on Saturday the 28th at 9am. 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.

STOCKTON: WE NOW HAVE A NEW SUPPORT GROUP IN STOCKTON!! We will meet on April 19th at 7pm at St. Joseph's Hospital at 1800 North California in Classroom 3. May meeting will be on May 24th. See you then!

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.

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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