We are very excited to announce that we are able to introduce a Water Zumba Class for our bariatric patients! What could be more fun than combining the great rhythms of Zumba and the benefits of exercise in the water? Water programs are great, since they are non-weight bearing and therefore are gentle to painful joints. Water fitness can improve strength, flexibility, cardiovascular health, decrease body fat, facilitate rehabilitation after surgery, improve functional living and even enhance other sports skills. But most importantly, you should feel comfortable in the environment. You do not need to be a swimmer, since the class will be held in the shallow end, but you need to feel comfortable in the water. The Shelton Community Center Pool will open a class just for our patients to ensure the most conducive environment.
The class is starting next weekend, on February 5th and pre-registration is required, as the class is limited to the first 20 patients. The class will be held every Sunday morning at 8:30 AM to 9:30 AM and will run through April 1st (there will be no class on March 4th). The cost for the class is $75 for Shelton residents and $80 for nonresidents (wow, can you believe it?). If interested, please register at:
Shelton Community Center
41 Church Street
Shelton CT 06484
203.925-8422
We are very excited to be able to work with the Shelton Community Center. Please let us know if you were able to sign up for the class or if you had difficulty doing so due to class size limitation. We do not want to exclude anyone and would love to offer more classes if the need arises. Let’s do this and have some fun in the pool!

Dr. Rishi Ramlogan

We pleased to announce that Dr. Rishi Ramlogan is joining our surgical team.  Dr. Ramlogan has experience treating patients with a broad range of bariatric, laparoscopic and general surgery concerns. His special areas of interest include laparoscopic gastric bypass, gastric banding, sleeve gastrectomy, revisional bariatric procedures, hernia surgery and anti-reflux surgery. We have gotten to know Dr. Ramlogan very well over the past few months and love the passion he brings to bariatric surgery and the genuine care for our patients.

Dr. Ramlogan was born and raised in Trinidad and Tobago, West Indies. He is a graduate of the University of the West Indies where he received his Medical Degree. He completed his internship and began residency at the Mount Sinai School of Medicine (Cabrini) program in Manhattan. Dr. Ramlogan was named the most outstanding intern of his class followed by the most outstanding resident in the program. Dr. Ramlogan then completed his residency at the New York Medical College (Sound Shore) program where he went on to serve as chief resident. In 2011 Dr Ramlogan completed a fellowship in advanced laparoscopy and bariatric surgery at Danbury Hospital, CT. He is board certified by the American Board of Surgery (ABS).

Dr. Ramlogan currently lives in Shelton, CT with his wife of 5 years, Stacia and their wonderful baby girl Kareena. During his free time Dr. Ramlogan enjoys fishing, basketball and playing with his daughter.

The joining of Dr. Ramlogan to our practice gives us the opportunity to expand our care into Fairfield County.  Starting in March, we will be providing bariatric and general surgery at Greenwich Hospital.  Ehrlich Bariatrics will be providing a revisional bariatric surgery seminar on February 8th, 2012 at 6 PM.  The seminar will discuss how patients who suffer from long-term complications from bariatric surgery, weight gain or malnutrition can be helped with our comprehensive program that focuses on education, nutrition and support and if necessary, revisional bariatric surgery. We welcome everyone to attend our comprehensive and non-judgmental educational seminar.  To register for the seminar in Greenwich or to attend any other of our comprehensive support services, please click here.

The weather has cooled in Connecticut and Thanksgiving is just around the corner. Everyone seems to be getting ready for Thanksgiving. We thought that we would share some tips that we have gathered over the years to make the Holiday season a bit easier.

Thanksgiving Tips

• Don’t forgo your exercise. That said, nobody wants to (or has time to) hit the gym on Thanksgiving Day. Instead, invite your guests to a walk before the meal and another walk before dessert is served. It will keep the dogs calmer, the kids a bit less bouncy and everyone with a healthy appetite.
• Even though you may be up early cooking or doing some last minute tiding up, have breakfast. A protein shake is a good option, since you can easily whip one up and continue with your busy schedule. The protein shake will also keep you feeling satisfied, so you will be less tempted to graze on all the goodies before the Thanksgiving meal.
• If this is your first Thanksgiving after the Lap-Band, Gastric Bypass or Sleeve Gastrectomy, consider serving yourself a little less than what you think you will eat. When socializing and focusing on the guests, you may not realize how much you have eaten and feel very uncomfortable. Serving yourself less will help you avoid this problem. Plus, this gives you opportunity to reach for seconds if you choose to do so.
• Be realistic. Thanksgiving is not about worrying about how much protein you had and how many calories are in the mashed potatoes. Just try to stick to this simple rule: have some protein first. Reach for the juicier dark meat turkey first and add some gravy, if you wish. Enjoy the food and savor the wonderful smells and flavors.
• Go easy on the wine and cocktails. Some patients, especially during the rapid weight loss phase, have a much lower tolerance to alcohol. A little can go a long way. Also a word of caution: Gastric Bypass patients could experience dumping syndrome from alcohol, especially when drinking hard liquors that are mixed in the cocktails.
• Focus on your family and friends. Ultimately, that is what thanksgiving is all about. Enjoy the holiday and the time that you can share with your loved ones.

Support Groups in Connecticut

That said, understand that you do not need to please everyone and that not everyone is always supportive or understanding of your struggles with obesity. Come to the On Track Workshop on Saturday, November 19th from 9 AM to noon at Griffin Hospital where we will discuss ways to deal with unsupportive family members.

Find Out More

If you feel you could benefit from a visit with dietitian Hillary Freedman, RD or one-on-one therapy with a therapist who specializes in bariatrics, please do not hesitate to contact our weight loss surgery clinic, so we may set this up for you. We wish you a happy Thanksgiving and look forward to continue seeing you at follow-up appointments.

References:

• http://www.lapband.com/en/home/
• http://en.wikipedia.org/wiki/Gastric_bypass_surgery

Cheesy Hippie Spätzli

Pasta is probably one of the more difficult things for bariatric patients to tolerate after weight loss surgery, not to mention that pasta tends to be very low in protein and low in nutrition. We propose a modified Swiss-style dumpling recipe that is high in protein (14 grams per serving) and tastes wonderfully nutty.

Makes six servings
1 ½ cups whole grain spelt flour (24 g)
½ cup hemp protein powder (24 g)
2 egg whites (8)
2 eggs (14)
1 cup skim milk (9)
1 teaspoon dried Italian herbs
½ teaspoon pepper
1 teaspoon salt
2 tablespoons parmesan cheese (4 g)

Mix the dry ingredients together. Add the liquid ingredients and mix with a wooden spoon until the dough is glossy. Bring salted water to a boil. Process about a third of the batter at a time with a Spätzli press into the boiling water. You can also use a chef’s knife to drop strips of dough into the water. When the Spätzli float to the top, they are done. Serve immediately with parmesan cheese or toast them in a non-stick pan before serving.

Saffron Mussels

Perfect for those days when you are longing for those summer flavors, but comforting enough for fall temperatures. Easily digested and loaded with protein!
3 pounds fresh, cleaned mussels
1 large pinch of saffron
1 cup dry wine or beer
1 tablespoon olive oil
2 shallots, thinly sliced
2 cloves garlic, thinly sliced
1 small can chopped tomatoes

Steep the saffron in the wine or beer. Meanwhile, heat the olive oil in a large pan and add the shallots, garlic and ½ teaspoon of salt. Cook until translucent. Add the saffron mixture, tomatoes and mussels. Cover the pan tightly and cook until the mussels open.

Chicken in white wine

Chicken can be difficult to tolerate for patients who had the Lap-Band procedure. Regardless if you had a Lap-Band, a Gastric Bypass or a Sleeve Gastrectomy, you will love how moist and tender this fall-off-the-bone chicken is. Chicken is back on the menu!
2 tablespoons olive oil
1 garlic clove, crushed
1-2 fresh rosemary sprigs
1 chicken, cut into pieces
1 bottle dry white wine
Salt and pepper

Preheat the oven to 350℉. Heat oil in a heavy skillet or Dutch oven, add the garlic and rosemary, then add the chicken and cook until golden brown all over. Season with salt and pepper and pour in the wine. Cover the skillet and put in the oven for about 45 minutes. Remove the lid and continue to bake until the wine was evaporated.

About Weight Loss Surgery in Connecticut

Dr. Tim Ehrlich is a board certified surgeon who performed more than 2,000 bariatric procedures, such as Roux-en-Y gastric bypass, LAP-BAND^® adjustable gastric banding surgery, vertical sleeve gastrectomy and revisional weight loss procedures.

References:

• http://en.wikipedia.org/wiki/Dieting
• http://www.lapband.com/en/home/

Approaching Your Dilemmas

Take Halloween, for example. Not wanting to have candy lying around should not be a reason to shut your lights to keep the neighboring goblins from knocking at your door.
How you approach the candy dilemma is your personal choice, with the understanding of how bariatric surgery works. The truth is that if you had a Lap-Band or a Sleeve Gastrectomy, you are still able to eat candy. And, if you eat it slowly enough, will be able to eat quite a bit of it. If you had the Gastric Bypass, you may experience dumping syndrome after eating candy, which should make you never want to eat candy again. But the bigger question really is: what works for you?
Are you someone who can enjoy a small piece of candy and make good food choices the rest of the time? Do you consider yourself a “sugar addict” and understand that having candy lying around the house would lead you down a path of no return? Maybe you do not see the candy dilemma as a personal issue, but your concern about the childhood obesity epidemic is enough for you to boycott Halloween.

Halloween Tips for Bariatric Patients

We all have our own reasons for the choices we make. Whatever your reasons may be, we thought you may want to hear about what some other patients have done on Halloween night:

• Instead of candy, fill the bowl with small toy treats like scary rubber spiders, magic bubbles, eye ball bouncy balls, Halloween-themed pencils and erasers, stickers, etc.
• When your children bring home candy, let them enjoy it on Halloween, but bring the candy on November 1st to a dentist who participates in the Halloween candy buyback. Children will receive $1/pound of candy they bring in. The candy is sent to troops overseas. You get rid of the candy, the kids get money and the troops get a sweet treat – we call this a win, win, win. For more information, visit www.halloweencandybuyback.com
• Give out some Bariatric Advantage Calcium Chews. They come in 5 awesome flavors, are wrapped in festive colors and the kids eat your supply when you are not looking anyway. Once a year you can give them permission to have some and share your treats.
  Halloween is not about depriving yourself. Make choices that work for you. Come on, turn on all the lights, decorate the house and enjoy the little goblins that come to visit this Halloween.

Find Out More on Connecticut Weight loss Options

Dr. Tim Ehrlich performed over 2000 bariatric procedures including, sleeve gastrectomy, Lap Band, gastric sleeve and revision procedures. For more information call (203) 880-5000.

References:

• http://www.lapband.com/en/home/
• http://en.wikipedia.org/wiki/Bariatric_surgery

Why is follow-up important?

Regular, life-long follow-up is important for several reasons:

• It can prevent nutritional deficiencies and leads to earlier intervention of abnormal results
• It addresses clinical issues sooner and can lessen the risk of long-term surgical complications
• It provides accountability and results in greater weight loss and better weight maintenance
• It keeps you informed of the latest nutritional guidelines
• It keeps you updated of the latest support services and exercise programs available and gives you an opportunity to give suggestions
• It provides resources to help with issues such as depression, weight gain, etc.
• It results in better long-term clinical research studies
• Keeps our staff happy because they are not up all night worrying about patients they have not heard from in a while

Be a responsible bariatric patient!

Living with a bariatric procedure requires lifelong responsibility. Maintaining a healthy lifestyle is a balancing act, especially when taking care of a family or needing to travel for business. Remembering to take daily bariatric multivitamins and calcium and ensuring a protein rich diet is not always easy. During these times, it is particularly important to check-in with us so we can ensure proper nutrition and help you find ways of remembering to take the right supplements. We invite you to visit our new office in Shelton, CT where you can sample bariatric products that are too yummy to forget!

Some patients can feel very lonely and can suffer from depression years after weight loss surgery. We understand those challenges and urge you to check in with us, in particular if you are having a hard time. We would love to introduce you back to our compassionate patient community and support services. Please contact Kim Fisher, Bariatric Care Specialist at Griffin Hospital, to find out more about a variety of support services and community events available to our patients.

Letting go of the shame associated with weight gain after bariatric surgery

We are distraught to hear of patients who do not follow-up with their surgeon because they are ashamed of having gained weight back after having a Lap-Band, Gastric Bypass or a Sleeve Gastrectomy. There is no reason to hide. We do not judge, but rather are here to help you find yourself again. We may have some tough words, but we are here to help you through difficult times. We have pioneered new ways of empowering Connecticut patients with support services, like the On Track Workshop, that are particularly tailored for patients who are struggling. We invite you to make an appointment and give yourself the time and attention you deserve!

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References:

• http://www.lapband.com/en/home/
• http://en.wikipedia.org/wiki/Support_group

• continued use despite negative consequences
• unsuccessful attempts to cut down or avoid addictive behavior
• response of brain patterns to drugs and highly palatable foods
• increased tolerance – the need to consume larger amounts to get the “high”
• Existing research into food addictions, which included animal and human studies, show striking similarities in use and withdrawal patterns of sugar and of classic drugs of abuse

The bottom line of these clinical parallels as they relate to food addiction can be simply stated: food addiction is an unhealthy relationship with food. It can occur in people of all ages, races and sexes. It is seen across all income and education levels. Food addiction seems to have a genetic tendency and a relationship to brain chemistry. Food addiction develops over time, particularly in our food culture environment.

Food addition and weight loss surgery

Not everyone who suffers from obesity is a food addict. However, studies have shown that about 70 percent of patients who undergo weight loss surgery have a food addiction. Many patients feel that bariatric surgery will cure their food addiction. Bariatric surgery, be it a restrictive procedure like the Lap-Band or the Sleeve Gastrectomy or a combination of restriction and malabsorption, such as the gastric bypass, does not cure food addiction. The physical changes that weight loss surgery imposes can be a helpful tool in controlling the amount of food consumed at one time; however, it does not address the underlying causes of an unhealthy relationship with food.

Help when you need it

Food addiction is a daily struggle for many weight-loss surgery patients. It may be dormant for a few months to years after surgery, but many patients still struggle with food addiction. The key is to find help and not suffer with it alone. Untreated food addiction can lead to physical problems related to the bariatric procedure, severe depression, weight regain or inadequate weight loss, malnutrition, surgery-induced bulimia, and addiction transfer (alcoholism, etc.).

We understand the difficulty patients face and have introduced extensive pre-operative classes and On Track Support Groups for post-operative patients that specifically address food addiction. Further, we have a wonderful team of specialized healthcare professionals who have many years of experience working with patients who suffer from food addiction. You are not alone. We are here to help. Please contact our office in Connecticut to find out more about food addiction treatment options. To participate in the next On Track Support Group on Wednesday, September 14th at 6:30 PM to 8 PM at Griffin Hospital, please click here. On Track Support Groups are held every second Wednesday evening of the month at Griffin Hospital.

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References:

• http://en.wikipedia.org/wiki/Bariatric_surgery
• http://www.webmd.com/mental-health/mental-health-food-addiction

We invite you to make a dietary consultation appointment with the dietitian Hillary Freedman, RD to ensure that your bariatric diet leads to optimal weight loss and nutrition.

What’s in a bariatric multivitamin and calcium supplement anyway?

The list below shows a sample of foods that have the highest concentrations of the listed micronutrients. To obtain the same nutritional value contained in bariatric multivitamin and calcium supplements, all foods on this list must be consumed every day. Some foods have overlapping micronutrients; however, even when taking this into consideration, the list is only slightly reduced.

• Vitamin A = 1 ounce sweet potato
• Vitamin C = 1 cup broccoli + 3 Brussels sprouts/
• Vitamin D = 1 tablespoon cod liver oil + 2 cups soy milk
• Vitamin E = ¼ cup raw sunflower seeds + ½ cup almonds + I cup cooked spinach
• Vitamin B1 = 1 tablespoon marmite (yeast extract spread) + 5 tablespoon sesame butter + 3 ounces pork chop + 3 ounces tuna + 5 ounces macadamia nuts
• Vitamin B2 = 3 ounces lamb liver
• Vitamin B3 (Niacin) = 3 ounces anchovies + 1 cup peanuts + 3 ounces chicken
• Vitamin B5 (Pantothenic Acid) = 3 ounces chicken liver + 1 cup whey powder + 3 ounces cooked shitake mushrooms
• Vitamin B6 = 3 ounces rice bran
• Vitamin B 9 (folate) = 1 cup raw, chopped spinach + 1 cup soybean sprouts + 1 cup asparagus + 1 cup mung beans + 1 tablespoon dried spearmint
• Vitamin B12 = 3 ounces raw clams + 3 ounces of mackerel
• Calcium = 1 ounce parmesan cheese + 3 ounces tofu + 1 cup skim milk + 1 cup mustard greens + 2 tablespoons flax seeds + 1 cup kale
• Magnesium = 1 tablespoon dried coriander + 2 teaspoons raw pumpkin seeds
• Zinc = 2 tablespoons toasted wheat germ + 3 raw oysters
• Selenium = 3 ounces caviar + 1 ounce Brazil nuts + 8 large shrimp
• Copper = 1 cup sun dried tomatoes + 1 ounce calamari + 1 tablespoon cocoa powder

Advantages of bariatric multivitamins and calcium supplements

• Bariatric vitamins are formulated for optimal absorption, ensuring proper bariatric nutrition
• Cost effective – everything you need and nothing you don’t. Don’t waste money on inferior non-bariatric products that do not give your body what it needs. Obviously, bariatric vitamins are a fraction of the cost of food.
• No pills and conveniently packaged in small chewable doses or water soluble crystals, not a huge mountain of food.
• Ehrlich Bariatrics in Connecticut makes it easy to order vitamins and supplements. Just click here or visit our new office in Shelton and sample vitamins, calcium and protein supplements.
• Delicious flavors – none of the supplements taste like marmite, anchovies or cod liver oil!

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  References:

• http://en.wikipedia.org/wiki/Bariatric_surgery
• http://www.webmd.com/diet/weight-loss-surgery/what-to-expect-after-weight-loss-surgery?page=2

Comprehensive, patient-centered support

We understand the concerns many patients have about support groups and created a support program that patients actually wanted to attend. We wanted to give every patient the opportunity to make the most of their bariatric surgery. We teamed up with Griffin Hospital to create a truly unique support program that includes bariatric exercise classes, support groups, nutrition classes and the On Track Workshop.

If you have never attended a support group or have been disappointed in the past, you may want to give the monthly On Track Workshop a try. The On Track Workshop is engaging, informative, motivating and (dare we say?) fun. It gives patients the opportunity to be real, to try out new things, to be vulnerable, to be excited, and to not be alone with the struggles of weight loss surgery. We see no need to segregate Lap-Band from Gastric Bypass patients to those who had a Gastric Sleeve – ultimately, the long term goal of a healthy lifestyle is shared by everyone, regardless of the type of weight loss surgery. Every On Track Workshop addresses three key components of a healthy lifestyle:

1. exercise
2. bariatric diet and nutrition
3. spiritual and mental well-being

We do so with fun exercise classes (really!), cooking demonstrations and gentle, open-minded support. It is not about doing something right or wrong, but about finding ways to find balance to achieve the best outcomes.

Find Out More

Please come and give it a try! We welcome all patients and their family and friends and look forward to seeing you there! The On Track Workshop is held every third Saturday morning of the month. Register to save your spot for the next On Track Workshop: Saturday, August 20th, from 9 AM to noon. Please contact Kim Fisher, the Bariatric Care Specialist, to learn more about comprehensive, patient-centered support at Griffin Hospital in Connecticut.

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References:

• http://en.wikipedia.org/wiki/Support_group
• http://www.webmd.com/diet/weight-loss-surgery/surgery-for-you

That is great, but it does not substitute the need for calcium supplementation. Bariatric patients who had a Gastric Bypass, Sleeve Gastrectomy or Revisional Surgery have impaired calcium absorption due to the anatomical changes of the respective bariatric procedures. Lap-Band patients also need to take calcium supplements because they are unable to consume the recommended amounts of calcium rich foods.

Calcium is an essential nutrient

We think of calcium to be very important for teeth and bones, which is true. Almost all the calcium is stored in the teeth and bones. However, calcium is most essential on a cellular level. Calcium is needed in the heart, brain, muscles and nerves. Without the proper daily intake of calcium, the body uses its natural stores in the bones and teeth, resulting in brittle bones and loss of teeth. Long term, calcium deficiency can severely affect cardiovascular function, nerve impulses, cell signaling and more.

Because calcium deficiency cannot be felt, many people are unaware that they are not getting enough calcium. Beck McAndrews, PA-C and Dr. Tim Ehrlich weight loss surgeon in Connecticut ask specific questions to assess calcium intake in forms of food and supplements during follow-up appointments. Some patients may need some lab tests to further investigate proper calcium absorption. Sometimes, bone density test are recommended.

Bariatric patients need a specialized calcium formulation

Patients who had weight loss surgery cannot just go to the local drug store and buy any calcium pill. The right formulation of calcium is the key to optimal calcium absorption.

Benefits of bariatric-formulated calcium supplements:

• No pills!
• They taste great! Popular flavors include wild cherry chewables, chocolate chewy bites, raspberry chewy bites and the new caramel chewy bites. The unflavored calcium crystals dissolve easily into a protein shake or water.
• More bang for your buck – for less than the price of a cup of coffee, you can get the daily requirements of the most absorbable types of calcium.
• Contain added nutrients, including vitamin D, to support bone health.
• Bariatric calcium supplements can be taken without food.

The general requirement is for all bariatric patients, including patients who had Revisional Bariatric Surgery, to take 1500 mg to 2000 mg of bariatric-formulated calcium citrate or calcium lactate-gluconate daily. Specifically, either one serving of calcium crystals, one calcium chewable or two calcium chewy bites three to four times every day. You can conveniently order supplements through Bariatric Advantage or pick them up at the new CT location of Ehrlich Bariatrics. Take control of your health and order your calcium supplements now! After all, was it not to improve your health and to be more active that you chose to have weight loss surgery in the first place?

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References:

• http://en.wikipedia.org/wiki/Calcium
• http://www.lapband.com/en/home/