Lap Band Doctors

Here’s what you need to learn about diabetes from Paula Deen.

ronhekier — Fri, 20 Jan 2012 15:43:07 +0000

Posted by Dr. Ron Hekier+

Texas Weight Loss surgeon

There is a tremendous debate about the recent revelation by Food Network star and celebrity chef Paula Deen as suffering from Type II diabetes. Paula is know for her decadent recipes, such as deep-fried cheesecake and the bacon cheeseburger in a doughnut.
From news reports we hear that she was diagnosed with Type II diabetes 3 years ago. When she made her announcement that she had diabetes, she simultaneously announced that she was going to be a paid spokesperson for a pharmaceutical company that makes diabetes medication.
There are two main lines of comments:

Due to the fact that she has made a healthy living off recommending unhealthy foods, she bears a responsibility to her viewers to turn over a new leaf and moderate her recipes.
Others say her health is a private matter and she should be given privacy and freedom to do as she wishes.

To be honest with you, I don’t think she owes us anything. But as a physician who has treated countless of people with complications from diabetes I see a golden opportunity for education.

First of all, diabetes is not a simply having high sugars. Diabetes is not simply about taking a medicine to get a lab value, your blood glucose level, to be lower. Diabetes is a disease and it is an awful disease.

Can you read this blog post? Well guess what, diabetes is the leading cause of blindness among adults in the United States. If you have diabetes, in a few years you might not be able to read this or anything else.
Would you like to have the nickname ‘Skippy? Well, since diabetes has such a bad affect on your circulation and immune system it is the leading cause of leg amputations in adults. We, and every surgeon, has seen countless cases of ‘diabetic foot’. That’s the term used to describe a foot infection in a diabetic that is rarely seen in anyone else. A small blister can progress to a massive wound an even gangrene. It is nasty, and if you want to see what it looks like take a look at these Google Images: images of diabetic feet . Warning, not for the faint of heart, but for doctors, we see this constantly.
People with diabetes are about 400% more likely to have a stroke or heart disease compared to those without diabetes.
Take two people at the same age. One has diabetes. One does not. The person with diabetes is twice more likely to die than the one without. I’d like to think that if I’m standing next to someone, and one of us is going to die, it won’t be me.

These are just some of the things we hope Paula Deen will teach people about. So many people are not aware of the horrible consequences of diabetes, a few of which I listed above. So if Paula Deen can raise awareness and help education, I’m all for it!

And one of the most important to things to remember is what causes diabetes. The most common form of diabetes is Type II diabetes which is 90 – 95% of all cases of diabetes, affecting about 20 million Americans. Being overweight is one of the most significant risk factors for diabetes. For some people, gaining as little as 30 pounds can double your risk. So guess what? Losing a significant amount of weight can reduce the severity of diabetes or even eliminate it. That’s right, many of you know that in many LapBand patients who had diabetes before surgery, they have lost their diabetes and it is in remission. (This is nothing new, studies such as the APEX trial and the report in the Journal of the American Medical Association in January 2008 showed a complete remission in diabetics who underwent LapBand surgery of between 33% – 75%.)

So here is we should learn from Paula Deen:

Diabetes is a horrible disease that leads to blindness, foot infections and amputations, heart disease, stroke and death.
Diabetes is not something you should think about as being a state of having “high sugars” and you will live with it and do just fine. (See above.)
Up to 95% of cases of diabetes in the U.S. are Type II diabetes and one of the most significant risk factors is being overweight. As little as 30 pounds overweight can but you at much higher risk for diabetes.
If you are seriously overweight and have diabetes, significant weight loss can potentially completely eliminate diabetes.

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Exercise, lifting weights, and the LapBand

Dr. Rachael Keilin — Wed, 16 Nov 2011 23:52:43 +0000

Posted by Dr. Rachael Keilin+

I recently shared an insight that I’ve gleaned from my patients – that many women think lifting weights will “bulk them up” and make them bigger. The truth is that muscle is more dense than fat and the bigger the percentage of your body weight that comes from muscle, the smaller and tighter you will be. Professional fitness, figure and bikini models all lift weights – and heavy weights at that!- and only the women who a) take steroids or b) spend half their day in the gym end up looking like a guy you might want to date.
But I also mentioned while sharing this insight in a blog post that walking wasn’t really exercise and I got some flack for that. So I figured that I would clarify my point and hopefully convince even the most die-hard walkers to pick up some iron :)

First, a confession: I walk for exercise. Really. But when I say “walk” I don’t mean “stroll around a path with a friend catching up on the latest goings on in our lives.” I mean “get on a treadmill at 5+% incline at 3 or more mph and walk while barely being able to talk if somebody asks me a question.” Can everybody do that starting out? No, I’ve got years of jogging and exercise behind me that gives me the strength and endurance to do that. But all that jogging gave me a rotten Achilles’ tendon and power walking on a treadmill gives me the elevated heart rate I seek without the injury afterwards. When I do occasionally run, I’m a lot stronger/faster/have more endurance as a result of these power walks so I don’t feel like I’ve lost much.

But as much as I enjoy the treadmill challenges (bonus: it’s a good way to justify watching movies and reading books), they don’t make up a majority of my fitness program because in the end they don’t give me what I want: a lower body fat percentage and a sleeker physique. A six pack is made in the kitchen (by eating good, healthy foods) and on a weight bench but not on a walking path no matter how uphill it may lean. How many bone thin runners have you seen….with a little poochy belly hanging in front of them? “Cardio” or aerobic exercise helps preserve bone density, it burns calories and even helps build some muscle in your legs.

But if you want to look in the mirror and see a flat tummy stare back at you, then you’ve got to pick up some weights, pull on an exercise band or hit the gym machines. You simply can’t be tight and slim without giving your skin a sexy frame to hang upon. If there’s no muscle there, then you’re what I’ve heard referred to as “skinny fat” meaning the number on the scale is low, the BMI is low, but you still don’t want to rock a string bikini anytime too soon.

So yes, walking has a place in any fitness program. But it should be continually more challenging (a little faster, a little farther, a little higher uphill) every week and it should still be complemented by weights or kettle bells or machines or stretchy bands or even squats & lunges with your own body weight. Because the number on the scale is not the only measurement of fabulous.

Protein, protein, protein

Dr. Rachael Keilin — Tue, 15 Nov 2011 23:40:25 +0000

Posted by Dr. Rachael Keilin+

I spend a lot of time talking to bariatric surgery patients about what they eat. One of the most frequent laments I hear is about how hard it is to get in enough protein every day. We ask our patients to eat about 50-70g of protein per day, and in order to do that, they often resort to protein shakes with 20-30g of protein for a snack or maybe breakfast on the go. I admit that I like protein shakes for breakfast sometimes myself cause it’s quick and portable, but when I started thinking about it, I realized there’s a big problem with this mindset. Not the drinking of protein shakes as an occasional meal, but the whole “I’m not eating enough protein in my diet that I need extra help” thing.

What I mean is that eating is a zero sum game – if you’re taking in 1500 calories per day, but only 30g of protein, then that means almost 1400 calories came from fat and carbs and those are what make fat grow, not shrink. That means what you’re eating is mostly unhealthy and you’re trying to shoehorn the healthy part in. Unfortunately, it’s the healthy part that fuels muscle retention as you lose weight, the part that keeps your hair from falling out and the part that makes you feel less hungry.

When you think about what to eat, you shouldn’t think pasta….but I’ll add some chicken. Or a baked potato….but I’ll add some cheese. Protein IS what you should be eating, making up half the volume of every meal. Everything else is just garnish. A chicken breast with a little tomato sauce and some veggies. A pork chop with BBQ sauce and a few tablespoons of beans. The protein is the main part of the meal, the star of the show and everything else is just a supporting player. If protein is the central part of every meal, it is almost impossible to eat less than 50g per day unless you’re eating almost nothing at all. This is true even with snacks – not a small bag of potato chips, but a piece of string cheese and a 1/4 cup of pecans, or beef jerky or a Greek yogurt.

Make protein the star of your culinary show and you’ll be amazed at how little you can eat and still feel satisfied while you lose weight.

After Lap Band surgery, when can I start doing sit-ups?

Mark Watson, MD — Thu, 10 Nov 2011 16:01:37 +0000

Question: After Lap Band surgery, when can I start doing sit-ups?

Answer by Dr. Mark Watson, weight loss surgeon.

This is a great question before surgery. To us, it means that you not only are concerned about taking care of yourself after surgery, but also there is the promise of seeing someone who will be increasing their activity level after surgery.

After laparoscopic band surgery, there are very few absolute restrictions on your activities. One of the beautiful things about laparoscopic surgery is the incisions used are very small. This not only means that there is less pain but also it is unlikely that there will be problems with wound healing, like developing hernias for example. Ideally, patients after having their surgery will be able to get out of bed very quickly. This is very important to prevent the complications associated with prolonged immobility. Problems, such as lung congestion and blood clots developing in the legs, can be greatly reduced or eliminated by early walking after surgery.

Though your activities following surgery may not be prohibited by your surgeon that does not mean you will necessarily want to walk for several miles. You have just had surgery and you will be sore. Everyone’s degree of pain will be a little different, even after the same operation. Once you are comfortable enough to do so, activities like sit ups should not be a problem. We encourage you to be as active as possible. Not only is it unlikely that you will hurt your surgical incisions, it is nearly impossible to dislodge or injure your lap band with activity. The way you protect the actual lap band is by following the post operative diet. Having a lot of solid food right after surgery, which could cause vomiting, can cause your lap band to move. The most important activity restriction following band surgery is staying on the post operative liquid diet.

Be as active as positive, good for your weight loss, good your band, good for you!

Lap Band vacation

Dr. Rachael Keilin — Wed, 09 Nov 2011 12:40:54 +0000

I have a bit of a confession to make: Lap Band doctors aren’t perfect. While we may eat well 80% of the time and exercise more than most people, there are times – sometimes even stretches of time- when we’ll do neither. We’ll indulge in high carb snacks, we’ll slack on our exercising, maybe even (gasp!) stop and eat at an ice-cream parlor. But after a little bit of this slacker frolicking, we’ll lace the gym shoes back up, finish the last cookie and toss the empty box, then get back to the daily routine of living a healthy lifestyle.

Which lead me to the idea of “vacations” from the Lap Band. I don’t believe that it is realistic to expect everyone to be perfect every day of their lives. There are unexpected stresses like the illness of a loved one or yourself, there are work deadlines, there are time and money crunches. And then there are just times when you’ve been eating well and dieting for months on end, lost gobs of weight and want to just relax, and treat yourself for a bit.

I honestly think it’s okay to make a conscious decision and put away dieting for a specified period of time. To acknowledge that while you certainly won’t lose weight, and may even gain, that everything you’ve worked to achieve won’t collapse under the weight of a single eclair, or a single week of long naps on a beach somewhere instead of pounding on a treadmill.

But that only works if you acknowledge it for what it should be – temporary – and are committed to returning to your healthy commitments after taking the break. You can go to Hawaii on vacation, but almost nobody can afford to quit their job and live on the beach staring at the ocean for the rest of their lives without a job. The people who work hard most of the time can afford to take the super holidays and have it not break the bank. So can the person who eats within the Lap Band rules and pushes their body to reach new goals while exercising every week. That person can take a break, and still have a solid base of experience and habits to return to when they’re ready to get back on track.

But if you only choose to work a few hours a day as a temp, is it really surprising that you can’t save enough for the Tahiti extravaganza cruise? Or if you choose day in and day out to snack, to come up with reasons why you’d rather not put in 20 minutes with the stretchy bands in front of the TV, to not give up sweet tea in favor of non-caloric drinks – if you choose to be that person, why you never seem to reach your goals and plateau at about 40% excess weight loss?

The band is only a tool. A powerful tool, but just a tool. Only you can choose how far you’re going to take it and have it help you go. Then you can be the one celebrating a vacation (literally or figuratively) without it compromising what you ultimately achieve.

Posted by Dr. Rachael Keilin+

The final test for all LapBand patients

Mark Watson, MD — Sun, 06 Nov 2011 18:00:14 +0000

When I see patients prior to having their lap bands placed, there is one final test before surgery. It is not a blood chemistry, EKG or weight log; they must correctly answer one question before I will place their lap band;

“When you or anyone else has a lap band placed, what is the one, most important thing that you must do to make the weight to go away?”

I generally get one of three answers. We can start with the wrong answer.

The band is around the top of the stomach and keeps me from eating too much and I will lose weight.

The reason for asking this question in first place is to address this assumption. The band cannot, ever, keep you from eating too much!
You will always be able to pass too many calories past the band, no matter how tight I make it. Unless you are totally obstructed and in hospital, you can easily drink three thousand calories right past the band.
I will eat fewer calories and use the band to control my hunger.
This is the right answer! Though the band cannot keep food (calories) out of your mouth, if you use it right, you will not be hungry while you lose weight. This is the magical thing that makes the weight loss durable. You will not suffer with your new, lower calorie life. But you and your right (or left) arm are the only things that have control of your calorie intake. Not you lap band.

And the final answer;

It is a life style change where I make better food choices and exercise more.
This is, by far, the most common answer I get. Patients are better informed now and this is a frequent sound bite for all weight loss programs.
Though this answer is not wrong, it doesn’t say very much.
When I say this was not the answer I was looking for, I then hear many additional sound bites;
Proteins first,
No drinking with meals,
No calorie liquids,
Take small bites and chew well,

Again, these are all correct, but they all circle around the principle reason;
Eating fewer calories than you use up, every day!!
That is the spot on, on target answer. Keep that idea with you all the time and use all of the other techniques to help cure your hunger. This can work for you, for your new you!!

Posted by Dr. Mark Watson, Dallas based weight loss surgeon.

7 signs that a Lap Band patient has properly eaten a good meal.

ronhekier — Fri, 04 Nov 2011 14:31:27 +0000

Looking for successful weight loss with the Lap Band? I know my patient will lose weight and do well with their LapBand if their meals follow these guidelines.

1) Their meal fit on a salad plate of about 8 inches in diameter and there was an empty rim of plate around their meal. So their meal was about 6 inches in diameter.

2) Their meal had only about 2 tablespoons of carbohydrates. That means only 2 tablespoons of rice, potatoes, pasta, chips, crackers, etc.

3) Half of their meal was protein. Meat, fish, chicken are good solid forms of protein.

4) It took them about 30 minutes to eat their meal. If you are eating much faster, you are probably not eating 4 ounces of meat, fish , or chicken as you should be. You are eating very crunchy food, such as fried food, or cookies, chips, or crackers. These break down into many tiny pieces as you chew on them and go through the LapBand and your stomach easily. Or you are having soft mushy food like chicken salad, tuna salad, mashed potatoes, or liquids such as soup, meal replacement shakes, or chili.

5) At no point did they feel tightness in their chest or the urge to regurgitate. If they did, that person is either taking bites that are too large, or not chewing each bite of food 30 times. It can also mean that their LapBand is too tight and they are foolishly under the belief that they will lose weight if they convince their doctor to keep their LapBand tight to the point that it makes it difficult for them to eat.

6) All of their meal components have come from the periphery of the grocery store. That means meats and produce. Not processed food.

7) They did not drink during their meal nor afterwords for about 30 minutes. If you drink while you eat, you might wash the food through the top portion of your stomach and through the LapBand and feel hungry a short time later.

Posted by Dr. Ron Hekier+

Texarkana Weight Loss surgeon

Some Lap Band patients are like Kim Kardashian

ronhekier — Wed, 02 Nov 2011 19:37:07 +0000

Like Paris Hilton, Kim Kardashian is famous for being famous. Why millions of people (including my mother ?!) would follow her life and watch her reality shows is beyond me. But as proof that I am not immune from popular culture, I am aware that Kim Kardashian’s Hollywood marriage to some basketball player ended after just 72 days. I understand that her wedding was made into a 4 hour TV special and that many magazines had photo shoots from events leading up to the wedding and from the wedding itself.

So after all the hoopla and national press, why does a marriage end after 72 days? My theory is that Kim Kardashian wanted a wedding more than a marriage. She enjoyed the national spotlight and attention to the build up for her wedding. She enjoyed the hoopla surrounding her wedding ceremony. But she wasn’t ready for a marriage. What’s the difference? A wedding ceremony is a fun event where you invite your family and friends and share with them a special moment in which you are the center of attention. A marriage is waking up every morning with your spouse, tying to decide who gets to shower first and get ready for work, who gets the kids ready for school, who cooks the meals and who puts the dishes away. Simply put a wedding is about indulgence and a marriage is about commitment.

Every person who gets Lap Band surgery for weight loss is excited. They believe they are making a step in the right direction. They often tell their family and friends about their upcoming procedure. They feel that this time it will be different than all the failed diets they’ve tried in the past. The reality sinks in after the LapBand procedure. Now it is commitment time. With the Lap Band you have a tremendous tool to help lose weight and regain your life. We have seen patients as young as 18 and as old as 76 years old do great and achieve their goals. But it takes commitment. The LapBand doesn’t lose weight for you, anymore than a fairy-tale Hollywood wedding ensures marital bliss. You have to work at your marriage. You have to change your life and have a new routine once you get married. The Lap Band is the same way. You have to work at it. You have to maintain portion control. You have to decrease your carbohydrate intake and increase your protein intake. You have to exercise. It’s just like a marriage.

So if you aren’t at your weight loss goal with your LapBand. Ask yourself. Did you approach your LapBand the same way Kim Kardahsian approached her marriage?

Posted by Dr. Ron Hekier+

Texarkana Weight Loss surgeon

Is her daughter bulimic with the Lap Band?

lapmin — Wed, 02 Nov 2011 03:30:06 +0000

My daughter had lapband surgery a year ago, she has lost 150lbs which may sound great,but she can’t even keep water down. How much damage is she doing to her body? I’m concerned that she is DYING TO BE THIN!!!!! She is 5ft4in and weighs maybe 110 lbs.

Arvada, CO

Answer by Dr. Ron Hekier, Texarkana Weight Loss Surgeon.

I’m going to have to make some assumptions here since I am not either your or her doctor, and just offering general advice. I’m assuming from your question that your daughter has not been to her Lap Band surgeon recently nor been up front with them. I always tell every patient that if at any time they feel too tight with their LapBand, they need to call our office immediately and get fluid removed from their LapBand to loosen it up. It might be a few days after a fill, it might be months since their last fill. Anytime they are too tight they need to have the LapBand loosened. I assume from your question that your daughter is allowing herself to live with a tight LapBand in the mistaken belief that this is good for her. Nothing could be further from the truth. She is placing herself in a dangerous situation and using the surgery to become bulimic.

I strongly suggest that you personally take her to her Lap Band doctor. They will remove fluid from her Lap Band and perform any other evaluations if they are deemed necessary.

I am sure they will reinforce to your daughter what I would tell her if she were my patient. People lose weight most successfully with the LapBand when it is adjusted to the point that it slows down your food, not stops it. You can find a significant number of patients that have lost over 100 pounds without ever vomiting with the Lap Band. That’s the way it is supposed to be. A simple test for someone to tell if they are too tight is to eat about 3 or 4 ounces of meat or chicken, a few tablespoons of vegetables, and 2 tablespoons of a starchy food. If they can’t get it down, they are probably too tight.

Since your daughter can’t even hold down water, there is no doubt in my mind she is too tight and she is possibly bulimic.
Take her to her Lap Band doctor immediately.
Best of luck.

Posted by Dr. Ron Hekier+

Why am I not losing weight right after my Lap Band surgery?

ronhekier — Thu, 27 Oct 2011 04:20:39 +0000

Please help me….I’ve contacted my doctor about this but they say that if i’m following their diet I should be losing….. as if I’m lying to them!!!!! Here’s my calories minus exercise for the last month…they tell me that “scientifically” I should be losing… I KNOW THAT! the point is I’m NOT, sooooo what’s wrong…. I do not like them just grouping me into numbers. They don’t seem to care that I’m an individual and that my body just may very well be the ONE that doesn’t act like they expect!!! Somebody please tell me why since 10/11 I’ve gained back SIX POUNDS???
9/21/2011 : 516 – 327 = 189
9/22/2011 : 627 – 324 = 303
9/23/2011 : 546 – 372 = 174
9/24/2011 : 624 – 643 = -19
9/25/2011 : 531 – 0 = 531
9/26/2011 : 648 – 523 = 125
9/27/2011 : 520 – 422 = 98
9/28/2011 : 522 – 99 = 423
9/29/2011 : 780 – 98 = 682
9/30/2011 : 776 – 379 = 396
10/1/2011 : 428 – 0 = 428
10/2/2011 : 463 – 636 = -173
10/3/2011 : 580 – 288 = 292
10/5/2011 : 27 – 117 = -90
10/6/2011 : 21 – 96 = -75
10/7/2011 : 144 – 0 = 144
10/8/2011 : 354 – 260 = 94
10/9/2011 : 282 – 0 = 282
10/10/2011 : 385 – 261 = 124
10/11/2011 : 394 – 402 = -8
10/12/2011 : 481 – 247 = 234
10/13/2011 : 665 – 0 = 665
10/15/2011 : 803 – 293 = 510
10/16/2011 : 596 – 312 = 284
10/17/2011 : 379 – 641 = -261
10/18/2011 : 601 – 0 = 601
10/19/2011 : 530 – 0 = 530
10/21/2011 : 282 – 101 = 181

The first number is consumption. It is small because starting the 9/21 was my preop diet. That consisted of 2 protein shakes made with water and one meal consisting of 4oz protein and 1/2 cup non starch veggie. On 10/4 was my surgery. 10/4 – 10/6 Was clear liquids. 10/7-10/11 Pureed protein starting at 3 tablespoonns per meal but able to increase to 4oz by the end. 10/12 On started solid protein. No more than 4oz per meal. My docs plan is protein only till week 9.
The second number is calories burned. I have all my stats in my app so it measures as I walk. Typically one mile walk is about 100 calories. That goes up or down based on my weight and speed. On my treadclimber the burn is based on the resistance, my weight, and heart rate.
I am in my third week postop. But since the end of week one I’ve gained every day. It is now a 6 pound gain in 10 days.

Brookfield, IL

Answer by Dr. Ron Hekier.
I have several observations. In my personal practice, I general tell patients not to focus on their weight until they have had one or two fills. It generally takes a few fills for a person to achieve the feeling of satiety that allows them to eat small meals and as a result have a lower caloric intake that will lead to weight loss.
But I know that is not the answer you are looking for since you are documenting that you are eating less than 800 calories in per day and that is before exercise. Not having the benefit of having all of your information and having a physician-patient relationship, I suspect your weight gain is a result of fluid retention. First of all, it is just about impossible to gain 6 pounds of fat in 10 days. Such drastic swings in weight gain, or for that matter weight loss, are usually signs of fluid shifts. My second point would be that if you are so severely restricting your calories, your body is utilizing your protein for energy and metabolizing it, rather than allowing it to build or maintain muscle mass. With protein depletion, you are more likely to cause your body to retain fluid which can manifest as weight gain.
I would ask your doctor if they felt increasing calories might actually help. My personal opinion is that your calorie restriction is too severe, and also that it is too soon to worry about your weight.
Best of luck.

Posted by Dr. Ron Hekier+