Monday, April 11, 2011
Friday, April 8, 2011
Quit Smoking—Smoking Cessation
Free Patches...No Classes
The WHMC Tobacco Quit Line Research Study is available to Active Duty Members, Reservists, Guard, Retirees, and Dependents. The study aims to assess the effectiveness of a tobacco quit line in the military. The research project will include telephone counseling sessions and nicotine patches at no cost to the participant. For more information, please call 1-877-726-6211.
**** All patients must be smoke free for 6 months before they will be given a surgery date
The WHMC Tobacco Quit Line Research Study is available to Active Duty Members, Reservists, Guard, Retirees, and Dependents. The study aims to assess the effectiveness of a tobacco quit line in the military. The research project will include telephone counseling sessions and nicotine patches at no cost to the participant. For more information, please call 1-877-726-6211.
**** All patients must be smoke free for 6 months before they will be given a surgery date
Wednesday, April 6, 2011
Liquid Protein
Original content at http://www.5daypouchtest.com/recipes/days1_2.html
Mocha Smoothie by Andie Jamari
Page 6 - Neighborhood Cookbook
Page 6 - Neighborhood Cookbook
Ingredients:
1/2 cup decaffeinated coffee
1/2 cup skim milk
2 Tablespoons vanilla or unflavored protein powder
1 Tablespoon cocoa
4 teaspoons Splenda (or sweetener of your choice)
5 ice cubes
1/2 cup decaffeinated coffee
1/2 cup skim milk
2 Tablespoons vanilla or unflavored protein powder
1 Tablespoon cocoa
4 teaspoons Splenda (or sweetener of your choice)
5 ice cubes
Directions: Place all ingredients in blender container, cover and blend until smooth. Serve immediately.
**Serves one. Per serving: 110 calories, 15 grams protein, 11 grams carbohydrate and a trace of fat.
Ingredients:
1 cup water
2 packets Splenda
2 scoops vanilla protein powder
8 ice cubes
1 teaspoon pineapple extract
1/2 teaspoon coconut extract
1 cup water
2 packets Splenda
2 scoops vanilla protein powder
8 ice cubes
1 teaspoon pineapple extract
1/2 teaspoon coconut extract
Mix all ingredients in a blender until smooth and creamy.
**Recipe Note: protein count will vary depending upon the brand of protein powder used. Please consult product label for nutritional information.
Ingredients:
1 cup skim milk
1/4 teaspoon ground allspice
1/4 cup Splenda
1/3 cup unflavored or vanilla protein powder
3 teaspoons instant tea mix, unsweetened
3/4 teaspoons vanilla extract
3/4 teaspoons cinnamon
8 ice cubes
1 cup skim milk
1/4 teaspoon ground allspice
1/4 cup Splenda
1/3 cup unflavored or vanilla protein powder
3 teaspoons instant tea mix, unsweetened
3/4 teaspoons vanilla extract
3/4 teaspoons cinnamon
8 ice cubes
Directions:
Place all ingredients into blender container; cover and mix until smooth. Pour into glasses and serve immediately.
Place all ingredients into blender container; cover and mix until smooth. Pour into glasses and serve immediately.
**Serve 2. Per serving: 110 calories, 16 grams protein, 11 grams carbohydrate and no fat.
Ingredients:
1 (4 servings per package) package Jell-O sugar-free instant pudding, any flavor
2 cups fat free milk
2 scoops Unjury unflavored protein powder
1 (4 servings per package) package Jell-O sugar-free instant pudding, any flavor
2 cups fat free milk
2 scoops Unjury unflavored protein powder
Directions:
Measure 2 cups of cold fat free milk and add two scoops of unflavored Unjury. Shake or stir until Unjury is completely dissolved into milk. Place the sugar free pudding mix in a medium bowl and slowly whisk in milk mixture. Whisk until smooth. Cover and chill.
Measure 2 cups of cold fat free milk and add two scoops of unflavored Unjury. Shake or stir until Unjury is completely dissolved into milk. Place the sugar free pudding mix in a medium bowl and slowly whisk in milk mixture. Whisk until smooth. Cover and chill.
**Serves 4. Each 1/4 cup serving has 14 grams protein.
Tuesday, April 5, 2011
Frequently encountered post operative problems
Nausea/Vomiting: This is the most common problem after GBP, and is almost an expected outcome in the first few weeks. In this early post-operative period the new stomach pouch and the attached small bowel don't function very well, and this causes symptoms of poor function. In some patients this occurs because they are trying to eat too much at once, and the resulting "stuffing" of the gastric pouch causes pain and nausea.
On days when patients have N/V, they should be instructed to "fall back" to clear liquids only, and the problem will usually pass in 12-36 hours. If the N/V persist to an extent that the patient is becoming dehydrated, arrangements should be made to be evaluated.
Keeping a food diary will help you figure out if vomiting is caused by food.
Bowel Changes: Liquid stools for the first 3 weeks after surgery. If they become too frequent, you may take the anti-diarrheal products that are liquid or chewable, such as Imodium AD.
Pain: Incisional pain is usually nearly resolved by the time the patient is discharged from the hospital. Patients commonly have persistent discomfort at the left rib margin, secondary to intra-operative retraction- this is benign but can require 1-3 months to resolve.
Ventral Hernia : Approximately 20% of patients will develop an incisional hernia after open GBP, and is much more rare after laparoscopic GBP. This is usually manifested three months or more after the surgery, with patient complaints of midline abdominal pain and a bulge under the incision.
Hair Loss: Many patients report that in the 2-4 month time period their hair brush begins to fill up with huge clumps of hair. This hair loss is very common, and is due to a relative protein deficiency. As long as you maintain your protein intake the hair loss will resolve-no patients have yet gone bald due to GBP.
Flabby Skin: Unfortunately, skin does not always shrink as fast as you lose weight. This frequently results in bothersome and unsightly folds of skin on the abdomen, thighs, and upper arms. This extra skin can be removed by plastic surgical procedures. Arranging to have this done by military plastic surgeons is only sometimes possible. The copayment for this surgery at BAMC or WHMC is approximately $3,800.00 for the abdominoplasty alone.
Lactose Intolerance: Dairy products frequently cause cramping and diarrhea after GBP, because the surgery has bypassed the part of the bowel that has most of the enzyme (lactase) necessary for digestion of mild sugar. On the other hand, dairy products are desirable because of their protein content. Patients generally appreciate a substantial improvement in their ability to consume dairy products with the addition of Lactaid, which can be purchased over the counter in drug stores and supermarkets. Patients can also anticipate improvement in milk tolerance over a period of months following surgery, as the bowel adapts to the new nutritional flow. This may be short or long term. Only time will tell.
Dehydration: Watch your urine for a dark color or strong odor, or watch for bad taste in your mouth, with nausea. These are signs of dehydration that tell you to drink more. As a gastric bypass patient, you can become easily dehydrated. Your goal the first day home is to drink a minimum of 42 ounces of fluids. Then increase your fluid intake you intake daily until you are drinking closer to 72 ounces of fluids.
Constipation: In the long term you may have difficulty with constipation. This is usually due to relative dehydration and the patient should remember frequent small volume fluid intake. Another option is to purchase over-the-counter products such as Milk of Magnesia, Colace, or Dulcolax, taken as directed. You may also opt for a stool bulking agent such as Metamucil or Benefiber daily.
Metabolic Changes: Two to four weeks after surgery, your body reacts to the smaller amount of food. You feel tired, lethargic, and often depressed. Your body wants to slow down until the old food supplies returns. The best way to deal with this is to recognize the symptoms and know they are normal. Start exercising so your body gets used to using body fat as source of energy. As your body adjusts, the hibernation syndrome will end.
Hypoglycemia: You may feel lightheaded, shaky, faint, or have a headache. This could be caused by hypoglycemia
(low blood sugar) and can be helped by drinking milk or orange juice, or by eating a graham cracker, a granola bar or a piece of hard candy. It is a good idea to carry one of these products with you at all times. You may experience this if you have skipped a meal, or did not eat before exercising. You can also suffer from what is called rebound hypoglycemia, if your diet is high in carbohydrates. If this condition continues contact your bariatric surgeon.
(To prevent hypoglycemia eat a well balanced meal that includes proteins, whole grains, fruits and vegetables).
Dumping Syndrome: This is the result of an intolerance to foods that are high in sugar (sweets), fats or grease. When you eat these foods, they now enter your intestines without being partially digested by the gastric juices of your old stomach. You may then become lightheaded or dizzy and have cramps, diarrhea, flushing, or sweating. Some patients may even suffer from nausea and vomiting. This reaction can last for 30 minutes or a day. Once a patient experiences this very unpleasant reaction, they will want to avoid foods that caused the dumping syndrome.
Possible complications of lesser frequency
Gastroenterostomy stenosis:
The anastomosis of the stomach to the bowel is made a certain size to restrict the rapid emptying of your new stomach. In some patients, excessive scarring can occur at this site and will shrink this opening further. The patient usually complains of inability to tolerate solid foods and may have retching or vomiting. This complication is managed by performing an endoscopic dilation (enlarging the opening via an upper GI endoscopy). It may require multiple dilatations at different times to manage the problem.
Marginal ulcers:
Erosion occurring at the anastomosis between the small intestine and stomach pouch. Patients usually complain of pain, nausea and occasional vomiting of blood. Treatment is usually consists of antacid medications, however, refractory cases may require re-operation and reconstruction of the connection between the stomach and small intestine.
On days when patients have N/V, they should be instructed to "fall back" to clear liquids only, and the problem will usually pass in 12-36 hours. If the N/V persist to an extent that the patient is becoming dehydrated, arrangements should be made to be evaluated.
Keeping a food diary will help you figure out if vomiting is caused by food.
Bowel Changes: Liquid stools for the first 3 weeks after surgery. If they become too frequent, you may take the anti-diarrheal products that are liquid or chewable, such as Imodium AD.
Pain: Incisional pain is usually nearly resolved by the time the patient is discharged from the hospital. Patients commonly have persistent discomfort at the left rib margin, secondary to intra-operative retraction- this is benign but can require 1-3 months to resolve.
Ventral Hernia : Approximately 20% of patients will develop an incisional hernia after open GBP, and is much more rare after laparoscopic GBP. This is usually manifested three months or more after the surgery, with patient complaints of midline abdominal pain and a bulge under the incision.
Hair Loss: Many patients report that in the 2-4 month time period their hair brush begins to fill up with huge clumps of hair. This hair loss is very common, and is due to a relative protein deficiency. As long as you maintain your protein intake the hair loss will resolve-no patients have yet gone bald due to GBP.
Flabby Skin: Unfortunately, skin does not always shrink as fast as you lose weight. This frequently results in bothersome and unsightly folds of skin on the abdomen, thighs, and upper arms. This extra skin can be removed by plastic surgical procedures. Arranging to have this done by military plastic surgeons is only sometimes possible. The copayment for this surgery at BAMC or WHMC is approximately $3,800.00 for the abdominoplasty alone.
Lactose Intolerance: Dairy products frequently cause cramping and diarrhea after GBP, because the surgery has bypassed the part of the bowel that has most of the enzyme (lactase) necessary for digestion of mild sugar. On the other hand, dairy products are desirable because of their protein content. Patients generally appreciate a substantial improvement in their ability to consume dairy products with the addition of Lactaid, which can be purchased over the counter in drug stores and supermarkets. Patients can also anticipate improvement in milk tolerance over a period of months following surgery, as the bowel adapts to the new nutritional flow. This may be short or long term. Only time will tell.
Dehydration: Watch your urine for a dark color or strong odor, or watch for bad taste in your mouth, with nausea. These are signs of dehydration that tell you to drink more. As a gastric bypass patient, you can become easily dehydrated. Your goal the first day home is to drink a minimum of 42 ounces of fluids. Then increase your fluid intake you intake daily until you are drinking closer to 72 ounces of fluids.
Constipation: In the long term you may have difficulty with constipation. This is usually due to relative dehydration and the patient should remember frequent small volume fluid intake. Another option is to purchase over-the-counter products such as Milk of Magnesia, Colace, or Dulcolax, taken as directed. You may also opt for a stool bulking agent such as Metamucil or Benefiber daily.
Metabolic Changes: Two to four weeks after surgery, your body reacts to the smaller amount of food. You feel tired, lethargic, and often depressed. Your body wants to slow down until the old food supplies returns. The best way to deal with this is to recognize the symptoms and know they are normal. Start exercising so your body gets used to using body fat as source of energy. As your body adjusts, the hibernation syndrome will end.
Hypoglycemia: You may feel lightheaded, shaky, faint, or have a headache. This could be caused by hypoglycemia
(low blood sugar) and can be helped by drinking milk or orange juice, or by eating a graham cracker, a granola bar or a piece of hard candy. It is a good idea to carry one of these products with you at all times. You may experience this if you have skipped a meal, or did not eat before exercising. You can also suffer from what is called rebound hypoglycemia, if your diet is high in carbohydrates. If this condition continues contact your bariatric surgeon.
(To prevent hypoglycemia eat a well balanced meal that includes proteins, whole grains, fruits and vegetables).
Dumping Syndrome: This is the result of an intolerance to foods that are high in sugar (sweets), fats or grease. When you eat these foods, they now enter your intestines without being partially digested by the gastric juices of your old stomach. You may then become lightheaded or dizzy and have cramps, diarrhea, flushing, or sweating. Some patients may even suffer from nausea and vomiting. This reaction can last for 30 minutes or a day. Once a patient experiences this very unpleasant reaction, they will want to avoid foods that caused the dumping syndrome.
Possible complications of lesser frequency
Gastroenterostomy stenosis:
The anastomosis of the stomach to the bowel is made a certain size to restrict the rapid emptying of your new stomach. In some patients, excessive scarring can occur at this site and will shrink this opening further. The patient usually complains of inability to tolerate solid foods and may have retching or vomiting. This complication is managed by performing an endoscopic dilation (enlarging the opening via an upper GI endoscopy). It may require multiple dilatations at different times to manage the problem.
Marginal ulcers:
Erosion occurring at the anastomosis between the small intestine and stomach pouch. Patients usually complain of pain, nausea and occasional vomiting of blood. Treatment is usually consists of antacid medications, however, refractory cases may require re-operation and reconstruction of the connection between the stomach and small intestine.
Monday, April 4, 2011
Medical ID Tags
MEDICAL ID TAGS
What should I engrave on my Medical ID Tag?Select the most important medical information, in case you cannot speak for yourself. Having your medical condition(s) listed is important to alert Medical Emergency responders! You will be limited by the number of characters per line on the tag you have selected. Many choose to have their first name or full name and an "ICE" (In case of emergency) telephone number, rather than the medication taken, as that can change. You should also carry an Emergency Wallet Card that has the medicines you take, doctor's phone numbers & more listed.
This is a general guide, and these are only suggestions. Please consult your physician for the most critical information to put on your medical identification tag.
Information to list:
FIRST & LAST NAME Example: JOHN DOEMEDICAL CONDITION &/or PROCEDURE ROUX-EN-Y or LAP BAND or GASTRIC SLEEVE, etc.ALLERGIES &/or OTHER INSTRUCTIONS DM / ASTHMA / PCN ALLERGYICE #1 or MILITARY FACILITY MILITARY FACILITY ICE #2 ICE 123-456-7890
Google: "medical alert bracelets"
American Medical ID – http://www.americanmedical-id.com/
Titanium, Stretch, Sports Bands, Sterling Silver, 10K gold, Lynx, and more.
Creative Medical ID – http://www.creativemedicalid.com/Stainless Steel, Beads, Italian Charms, Stretch, Leather, Allergy Free, Crystals, Designer, and more.
Lauren's Hope – http://www.medicalert.org/www.laurenshope.com (largest assortment of styles/colors)Men's: Stainless Steel, Sterling Silver, Leather, Black Tube, Dog Tags, Guitar Picks, Waterproof Bands, Combo Sets, and more.
Women's: Sterling Silver, 14K Gold, Pearl, Natural Stones, Crystal Beads, Leather, Black Dress, Custom, Watches, Seasonal, Combo Sets, (bracelets are interchangeable with tag) and more.
MedicAlert - Sports Bands (assorted color/pattern bands), Stainless Steel, Stretch Bands, Sterling Silver, 14K Gold, and more.
Disclosure: This is for informational use only. Department of the Air Force and the Department of the Army do not support or disclaim the views and products of the websites provided within. The use of these websites, products, items, materials and information within those sites is at the patient's discretion.
Work the tool
The surgery does not work for the patient; the patient works for the surgery.
The surgery does not make our food choices.
The surgery does not drink our water.
The surgery does not do our exercise.
The surgery does not choose to follow or break the rules.
The patient makes the choices; the patient works for the surgery.
~Kaye Bailey
Friday, April 1, 2011
Post-Op Follow up Appointments
It is important to meet with a provider for follow up appointments after surgery. If you cannot make your appointment, please reschedule. Follow up appointments and labs are the best way to assess the continuing health of you the Bariatric patient. Your provider will discuss with you at the follow up appointments:
Two Week Post-Op (about one week after discharge)
One-Month Post-op (4th week)
Three Months Post-op
Six Months Post-op
One-Year Post-op and Yearly
***Fasting LAB blood draw required 1 week before: 1, 3, 6 month and yearly appointments, the orders are in the system.
Two Week Post-Op (about one week after discharge)
- Check tolerance to oral intake, and adherence to diet. Emphasize maintenance of fluid status.
- Advance to Stage III diet as appropriate. Be sure patient has a copy of diet
- Be sure patient is on vitamins.
- See Nutritionist in General Surgery Clinic
One-Month Post-op (4th week)
- Re-discuss feeding tolerance. Re-emphasis on fluid and vitamin intake.
- Specific problems? Energy level, hair loss….
- Advance to Stage IV diet as appropriate.
- See Nutritionist in General Surgery Clinic
- Labs 1 month follow-up, drawn 1 week prior to appointment
Three Months Post-op
- Diet discussion to include emphasis on protein intake. Re-emphasize limitation of sweets and fats.
- Specific problems? Energy level, hair loss…..
- See Nutritionist in General Surgery Clinic
- Labs for 3 month follow-up, drawn 1 week prior to appointment
Six Months Post-op
- Repeat sleep study if on breathing apparatus
- Specific problems? Energy level, hair loss….
- See Nutritionist in General Surgery Clinic
- Labs 6 month follow-up, drawn 1 week prior to appointment
One-Year Post-op and Yearly
- To be seen at WHMC if possible. If not, specific arrangements for data to be sent to WHMC by local physician.
- Specific problems? Energy level, hair loss….
- See Nutritionist in General Surgery Clinic
- Labs for yearly follow-up, drawn 1 week prior to appointment
***Fasting LAB blood draw required 1 week before: 1, 3, 6 month and yearly appointments, the orders are in the system.
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