Happy 4th of July!!!!!

VOLUME 14
July 2013
Happy 4th of July!!!!!
Editorial Notice
This newsletter is published
monthly for Dr. Parham Mora
645 McQueen Smith Road.
Suite 205
Prattville, Alabama 36066
Editorial Staff:
Melissa Grant
And
Kayla Pfeil
Items for the newsletter must
st
be submitted by the 1 of the month
for consideration for publication in
the upcoming issue!
submit items to:
[email protected]
If you no longer wish to
Bariatric
Coordinator.
receive
Bariatric
Bulletin,
contact:
[email protected]
Bariatric Bulletin,
What It Means to Be an American
To believe in the promise
of a better tomorrow,
and stand united in our efforts
to give a peaceful nation
to our children...
To honor each other's differences
and cherish the richness of our history,
even as it continues to unfold
from sea to shining sea...
To love deeply
our friends and family, day by day,
and never take for granted
the privilege of calling ourselves American
NUMBER7
Reactive hypoglycaemia post gastric bypass
What is it?
Reactive hypoglycaemia (non-insulinoma pancreatogenous hypoglycemia
syndrome) is a seemingly rare and potentially serious complication following
gastric bypass. Normal glucose levels are between 4.4 to 6.1 mmol/L (82 to 110
mg/dL). The brain can only use glucose to function. If the blood glucose level falls
too low, the brain cannot function! Diabetics who inject themselves with too
much insulin, can develop reactive hypoglycaemia because insulin drops their
blood glucose to very low levels. Low blood glucose levels can occur in certain
patients after gastric bypass (exact number not known) and this can produce
several symptoms of varied severity.
Mild Hypoglycaemia (~ blood glucose down to 4.0 mmol/L [75 mg/dL])






Increased or sudden hunger
Feeling shaky, dizzy or nervous
Pounding heartbeat
Sweating (cold and clammy)
Numbness or tingling around the mouth
Headache or stomach ache

Moderate Hypoglycaemia (~ blood glucose 2.5 – 3.9 mmol/L [40-74 mg/dL])





Headache
Anxiety
Nausea
Confusion and/or difficulty concentrating
Slurred or slow speech
Severe Hypoglycaemia (~ blood glucose 0 – 2.4 mmol/L [0-39 mg/dL])






Dizziness
Irritability
Drowsiness / Fatigue
Seizures and / or convulsions
Loss of consciousness
How do I find out if I have it?
If you think you may have low blood sugar after eating, you should measure your blood sugar level using a
glucometer available at any pharmacy. Do the test an hour before a meal, a few minutes after eating, an hour
afterward, two hours after, etc. Keep a food log and keep track of your blood glucose readings at all the various
times before and after meals. Also track your symptoms and your glucose level during these symptoms.
How is reactive hypoglycaemia treated?
You and the bariatric team need to understand what’s going on with your body. Your food log including
the times you eat and any blood sugar highs or lows on that same log will be used to spot any patterns
that might develop. Over time you’ll be able to spot trends and understand how your body is working a
bit better.
Reactive Hypoglycaemia is manageable! Make sure you are following our dietary guidelines and instructions –
eat protein first, then the complex carbohydrates and lastly the healthy fats.
You will need to experiment with foods and figure out what YOUR triggers are, and what foods work BEST to
bring you back from a sugar crash.
Here is what happens in experiment A, when 12 patients 2 years after gastric bypass suspected on Reactive
hypoglycaemia, are given a high carbohydrate meal of 8 oz. of orange juice, 1 slice of toast with 1 tsp. of
margarine and 2 tsp. of jam (79% carbohydrate, 11% fat and 10% protein, 405 calories) and their glucose and
insulin levels are measured every 30 minutes for 3 hours:
Note the high peak of glucose (red) and insulin (purple) levels at 30 minutes and the drastic
fall in glucose to below normal levels (<82 mg/dL) at 90 minutes.
Here is what happens when the same patients are given a low-carbohydrate meal was composed of
decaffeinated black coffee or tea without sugar, 1 egg, a 1-oz. sausage patty, and a 1/2 oz. slice of
cheese (2% carbohydrate, 74% fat and 24% protein, 415 calories).
Note how the glucose level and the insulin level stay within normal levels and DO NOT
SPIKE WIDELY as in experiment A.
(The scientific reference for this study is: T. A. Kellogg et al. / Surgery for Obesity and Related
Diseases 4 (2008) 492– 499)
These experiments show us why we should not treat reactive hypoglycaemia like we do in diabetics. For
example, diabetics are asked to eat candy to bring their blood sugar up quickly from an overdose of insulin (the
cause of their hypoglycaemia).
That doesn’t work well in reactive hypoglycaemia post gastric bypass. It will just cause a new cycle of crashes
and sugar spikes.
You need a BALANCE of nutrients, not sugar! For most patients peanut butter crackers – or – a handful of grapes
and a slice of cheese or a granola bar works the best. The rule-of-thumb is a bit of simple carbohydrates to bring
the crash up quickly, then a balance of protein and fat to keep the glucose up. When out of the house carry a
granola bar for emergencies.
In cases of severe hypoglycemia with loss of consciousness, immediate treatment with
3-4 glucose tablets (5 g each) or 3-4 tsp of honey should be given to patients who can
swallow. In no response call 911.
http://www.weightlosssurgery.ca/before-after-surgery/reactive-hypoglycaemia-post-gastric-bypass/
The New Reason To Strengthen Your Knees

And exactly how to do it
By Bari Lieberman
If you’ve ever tripped over a few steps, or barely saved yourself from doing a face-plant on the sidewalk,
you know the importance of being quick (and staying steady) on your feet. Strong, healthy knees are
vital to capable legs—but new research warns that the way women are going about knee strengthening
could be upping their risk of injury.
An estimated one in four women experience knee pain on a daily basis, and women are also more prone
to knee injuries than men, earlier research has shown. Given that data, researchers at the Loyola
University Medical Center sought to explain this increased risk. After analyzing the jumps of several
athletes, they determined that the leaping positions of female athletes increased their odds of injuries,
particularly tears of the ACL, one of four major knee ligaments.
“Women tend to land with the knees straighter and feet rotated inwards, compared to men who tend to
land with more of a bend in the knee and the feet rotated slightly outward,” says Dr. Patrick McCulloch,
an orthopedic surgeon with the Methodist Center for Sports Medicine in Houston who was involved in
the research. “This puts the knee in a better position to absorb shock.”
When these same experts put female athletes through a six week training program designed to recalibrate
their jumping technique, those women reduced the likelihood of ACL injury by up to 50%.
That program included plenty of exercises to strengthen the muscles around the knees, which is one
vital part of reducing injury risk, Dr McCulloch says. “A training program which (among other things)
focuses on landing with good technique and learning to develop and recruit the hamstrings can create the
muscle memory that stays with the athlete going forward,” he advises.
Unfortunately, some of the factors that put us at increased risk of knee injury—smaller ligaments than
men, and different hormones—can't be changed. But exercises to strengthen the quads, hips, and glutes
can all help eliminate pain and keep knees safe from future injury. “When the surrounding muscles are
strong, they take pressure off the joints, which allows for greater activity with fewer aches and pains,”
says Jordan D. Metzl, MD, sports medicine physician at the Hospital for Special Surgery in New York
City.
Exercises like squats and lunges are must-dos (If you hate squats, use a resistance band and focus on the
3 knee-saving exercises in the following article instead.
And be smart about your fitness routine. While we love plyometric exercises, like jump squats, they're
not a good idea for anyone with degenerative conditions or arthritis, Dr. McCulloch says. Instead, he
recommends a low-impact fitness program.
Read more: http://www.prevention.com/fitness/strength-training/risk-knee-injury-increaseswomen#ixzz2YqOOjGe4
Best Cure for Knee Pain
By Natalie Gingerich
The jury is in: "Bad knees" aren't sidelining your workout; your hips may be the guilty party. According to a
review of 28 years' worth of research on common exercise injuries, hip strength is the biggest predictor of knee
pain. So grab a resistance band and do these moves daily, working up to 3 sets of 10 reps on each side.
Side Swing: Anchor band on left side at floor height and loop band around right ankle. Balancing on left
foot (hold on to something if needed), raise right leg out to side; lower.
Front Kick: Turn so band is anchored behind you and around left ankle, foot flexed. Swing left leg
forward about 12 inches, keeping it straight, and return to start.
Seated Rotator: Sit so band is anchored to right and around left ankle. Cross ankles. Keeping knees
together, rotate left leg outward about 12 inches. Return to start.
Read more: http://www.prevention.com/fitness/strength-training/best-cure-knee-pain#ixzz2YqNM1uJw

Just some intresting fun facts:
Men can read smaller print than women; women can hear better than men.
Bullet proof vests, fire escapes, windshield wipers, and laser printers were all
invented by women.
Lemon Herbed Chicken Breasts
This recipe gives new life to the tired chicken breast. It
is prepared with the skin. Please discard the skin
before eating - chicken skin is nothing but fat and even
a little will derail a weight loss surgery patient's weight
loss/weight maintenance effort. You can often find a
fresh herb blend at the supermarket - if available use 5
teaspoons of the chopped mixed herbs in place of the
rosemary, sage and thyme.
Prep and Cook Time: 20 minutes
Ingredients:
4 boneless chicken breasts with skin on
2 medium cloves garlic pressed
Juice and Zest of one lemon
2 teaspoons chopped fresh sage
2 teaspoonschopped fresh thyme
1 teaspoon chopped fresh rosemary
1/4 cup low-sodium chicken broth
salt and cracked black pepper
Directions:
Preheat broiler on high. Place ovenproof metal pan under broiler to get hot. Do not use glass or Pyrex
for this.
Season chicken with a little salt and pepper. When pan is very hot, about 5 minutes, put chicken in pan,
skin-side up, and return to broiler. Turn heat to low. Don’t put too close to flame. It is best to put in
middle of the oven, about 7 inches from the heat source. Broil for about 15 minutes, or until done,
depending on thickness of chicken. Keep an eye on the chicken so it does not burn.
While chicken is cooking chop herbs.
In a separate small skillet add chopped herbs, lemon juice, broth, pressed garlic, salt and pepper. Heat
on medium heat for just ½ minute.
When chicken is done remove skin, slice, and place on platter. Drizzle herb sauce over chicken. Garnish
with lemon zest.
Note: A post-surgical weight loss person should be sated with 3-4 ounces of this delicious chicken. The
leftovers are a healthy convenient lunch. Package in 3-4 ounce servings and enjoy!
Protein Coleslaw
Ingredients:
For the slaw:
1 bag Coleslaw mix (in the packaged salads
section of the produce department, I used Dole)
OR shred 1 small head green cabbage, 2 carrots,
and 1/2 small head red cabbage with your food
processor
1/2 red onion, finely diced or grated (this is optional, I had some on hand that
needed to be used)
1 bunch fresh Italian parsley, finely minced or snipped up with kitchen shears
For the dressing:
3/4 cup Greek Yogurt
1/4 cup light mayonnaise (DO NOT use fat free, it has lots of added sugar)
3 tablespoons Splenda
2 tablespoons white vinegar
1 tablespoon dry mustard (I didn't have any, I used prepared Dijon mustard this
time)
2 teaspoons celery salt
Salt and pepper to taste
Directions:
Place your coleslaw mix (or fresh shredded veggies) in a big bowl and set aside.
Combine the dressing ingredients in a bowl and whisk them together until well
combined. Taste it and add more Splenda/salt/seasonings to suit your tastes.
Sometimes you have to adjust the amounts a bit, depending on the greek yogurt
and mayo you use to get the flavors right.
Whisk the parsley and red onion into the dressing. Pour the dressing mixture
over the vegetables and stir until thoroughly combined. Store in a sealed
container in the fridge.
This tastes best if it has a little time to sit in the fridge before serving. I usually
make a double batch of the Coleslaw dressing, because I use it all the time in
many different veggie slaws and salads. The broccoli slaw mix is also delicious if
you aren't a fan of cabbage slaw.
Peach Mango Protein Frozen Pops
Ingredients
6 oz. unflavored Greek yogurt (I used non-fat)
1 c. really ripe mango, diced
1 c. really ripe peach, diced (I used fresh for both)
2 scoops vanilla or unflavored protein powder
1/2 stick sugar-free orange drink mix
1/2 tsp ground ginger
2 oz. water
no-calorie sweetener, to taste
Directions:
Combine all ingredients in a blender and mix well.
Pour into popsicle molds and freeze until solid.
http://bariatricfoodie.blogspot.com/2011/06/peach-mango-protein-frozen-pops.html
Quote of the Day
"I, not events, have the power to make me happy or
unhappy today. I can choose which it shall be."
– Groucho Marx
About Grouc ho Marx
Julius Henry "Groucho" Marx was the wisecracking central figure of the Marx Brothers comedy
team, waggling his eyebrows in movies like Duck Soup and A Night at the Opera. He was born
in New York in 1890. His mother organized the family into a vaudeville act, which didn't become
successful until Groucho began ad-libbing jokes and insults. In the forties and fifties, he hosted
the wildly successful radio and TV quiz show You Bet Your Life. He died in 1977.
Melissa's Corner
Well, where has this summer gone? It seems like just yesterday
the kids got out of school, and now, everywhere you look there is
school supplies for sale. I can't believe my little Ian is already two
months old. I usually keep him every weekend and he changes so
much from week to week. Before I know it he'll be starting school.
I hope everyone had a great 4th of July, even though it rained for
what seemed like an eternity. We did get to go see the fireworks.
We took Ian with us and he did very well. This month is one of my
favorite months of the year. I love celebrating Independence Day.
I love the parades, the food, getting together to celebrate our
country's freedom and especially the fireworks. I would like to
thank all the veterans! If it weren't for your sacrifices we would not
be able to celebrate every year!!
As always if anyone has any questions or concerns you can call
or email me anytime. See you next month.
IMPORTANT
IF YOU ARE A WEIGHT-LOSS SURGERY
FOLLOW-UP PATIENT, YOU WILL
ALWAYS HAVE BLOODWORK DRAWN
PRIOR TO YOUR APPOINTMENT WITH
DR MORA.PLEASE MAKE SURE TO HAVE
THIS DONE AS IT ALLOWS US TO TAKE
BETTER CARE OF YOU.THIS WILL ALSO
ALLOW US TO DETERMINE WHETHER
WE CAN ADVANCE YOUR DIET AS WELL
AS CHECKING FOR ANY DEFICENECIES IN
THE BLOOD. FAILURE TO COMPLY CAN
RESULT IN HAVING YOUR
APPOINTMENT RESCHEDULED.
You can now hear our commercial on Bama
Country 98.9 and Q96
We have also changed our office email addresses. To reach me it is
[email protected]. Please make a
note of this and change it in your address book. If you don’t have Email
please make sure I know. This is how I do a lot of my communication
with you.
Search morasurgicalclinic
Don't forget about our website www.morasurgicalclinic.com
We will feature a new weight-loss story every month.
IMPORTANT!! IMPORTANT!!
IMPORTANT!!
1. Maintain a healthy, low calorie diet that is
low in carbs and fat, but rich in protein. Your
water intake should be at least 64 oz. per day.
2. Exercise (walking, jogging, swimming, biking,
cardio, etc.) 1 hour per day, 5 days a week.
3. Take vitamins and prescribed minerals without fail.
4. Seek out help from a mental health care individual (psychiatrist, psychologist)
to learn new ways of coping with stress as needed.
5. If you are a lap band patient and you have had an adjustment to your band,
and start having problems keeping foods or liquids down that day, that night,
or the next day, CALL US IMMEDIATELY and let us know. Adjustments are
usually done on Mondays and Wednesdays when Dr. Mora is in clinic. You
MUST let us know by Friday if you are experiencing problems so Dr. Mora can
evaluate you before the weekend. Do not go over 24 hours without reporting
problems to us or you can damage your band.
6. If you are a gastric bypass patient, 3 months or more out from surgery,
have your lab-work done one week prior to your follow-up appointments.
7. Regularly attend support group meetings.
Please write a story of YOUR weight loss
story with pictures and submit to Melissa
@ Dr. Mora’s office for publication in
the newsletter. Submit to
[email protected] or call
the office @ 361-6126, ext 2
IS THERE A TOPIC YOU WANT TO
SUGGEST FOR OUR NEWSLETTER OR SUPPORT
GROUP MEETING? IT’S A GREAT TIME TO LET US
KNOW!!! WE WANT TO HEAR FROM YOU! The
support group meetings and newsletters are for you,
our patients. We want to make sure you’re getting the
information you want from both the meetings and the
monthly newsletters. Send your suggestions to
Melissa at [email protected] or call the
office
361-6126, ext 2
UPCOMING SUPPORT GROUP MEETINGS
**PLEASE NOTE! WE HAVE THE DATES LISTED BELOW FOR SEMINARS THROUGH SEPTEMBER 2012
NOW, SO MARK YOUR CALENDARS TO ATTEND!
LOCATION:
Prattville Doster Community Center
124 South Northington Street, Prattville, AL.
TIME: 6:00 P.M. -7:00 P.M.
DATE:
2013 July 22, August 26 and September 23
PLEASE note all dates are subject to change due to availability of Dr. Mora or other
extenuating circumstances. We encourage you to call to check that the date has not
been moved ahead of time each month, especially if you live out of town!
GUIDELINES FOR SUPPORT GROUP MEETINGS

Everything said and heard in the group will be treated with respect for the
participants’ privacy. What is said in the group stays in the group.
• Silence is acceptable. No one needs to say anything she/he does not wish to say.
The group is supportive rather than judgmental.
• The group offers respect for individual choices and experiences.
• Only one person talks at a time.
• Turn off all mobile phones and pagers.
• No one is allowed to dominate the conversation.
• The group facilitators’ roles must be respected.
• Begin and end meetings on time.
• The group is a safe place to share feelings, and to obtain and provide support,
information, reassurance and encouragement.
• The group is broadly defined. It is flexible; flowing with the participants’ needs
and interests, and provides an opportunity to reduce feelings of isolation.
• Bariatric surgery support groups are open to all persons going through the
surgery process, including family members and others in a supporting role.
• Although the results of going to the group can be therapeutic, the group is not
meant to replace individual behavior therapy.
• Every effort should be made within the group to resolve conflict arising from or
during group interaction.
If you have any concerns or questions after attending one of our meetings, please feel free to contact Melissa
confidentially by email at [email protected]