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Dear Friends & Family of Laparoscopic Associates of San Francisco and the Surgical Weight Loss Center of Hawaii

The last newsletter discussed the importance of exercising. Now we'd like to give you some ideas on how to switch up your normal routine to help burn even more calories. Fit some extra exercises in this holiday season by taking trips to the local park with your visiting family and friends. Spending time outside will take away from time spent at (or tempted by) the snack table.

Image Best of Sacramento!

Your very own Laparoscopic Associates of San Francisco is sponsoring the "Best of Sacramento" party benefiting the March of Dimes. Get a ticket and join us! Here are the specifics...

What: Sacramento Magazine's Best of Sacramento Party - March of Dimes Benefit.

When: Thursday, 12/4/08, 4:30PM PST

Where: Sacramento Convention Center Exhibit Hall
Sacramento, CA

Ticket Price: $75

*Must be 21 or older!

click here to buy tickets

Revolutionary new procedure for GERD

ImageDr. Cirangle has become the first and only specialist in San Francisco to be trained on the EsophyX™ procedure. This is the first device for incisionless reconstructive surgical treatment of gastroesophageal reflux disease (GERD) and heartburn, and is based on the principals of surgical repair of the gastroesophageal junction. With millions of Americans diagnosed with GERD and not fully satisfied with their treatment options, EsophyX offers an excellent alternative. Recent studies of EsophyX have shown that the procedure can reduce patients’ dependency on medications with 80% of patients remaining symptom free after two years and experiencing a dramatic improvement in their quality of life. We are very excited to be able to offer our patients the same incredible benefits with minimal risk. EsophyX is a 30 minute procedure, with a one night stay in the hospital. The procedure avoids incisions altogether and never requires internal dissections. Because of this reduced invasiveness, EsophyX lowers the hurdle for receiving an anatomical restoration of the antireflux barrier and allows earlier intervention. Read the recent press release at:

Go to our blog to see what it's all about!

Thanksgiving Foods

ImageIf you are going to sit down for Thanksgiving dinner, think ahead and have a plan....what can I eat out of all this food? The best thing to focus on will be the turkey for the good protein content. Aim for the turkey and vegetables to fill you up. Mashed potatoes, yams, corn, peas, bread rolls, green bean casserole…that’s where all the carbohydrates are.

For beverages, 1 cup of Martinelli's Sparkling Apple Cider= 140 calories, 35 grams carbohydrate. A glass of red wine (4 oz) = 90 calories. So don't waste the calories on fluid, stick to water or sugar free crystal lite.

Enjoy spending time with family and friends. Focusing on the conversation & company can take attention away from the food.

Happy Thanksgiving!

Image 10 Cooking Substitutions

When cooking, there are many ways we can make simple substitutions to yield a healthier and lower calorie recipe.

Try one or all of the below substitution ideas and enjoy!

1. Substitute equal parts Applesauce vs. Oil when baking

2. Non Fat Milk vs. Whole Milk

3. Use 1/4 cup Egg Substitute or 2 Egg Whites vs. an Egg.

4. Use 1 cup Non Fat Sour Cream, Non Fat Cottage Cheese (pureed) or Non Fat Yogurt vs. 1 cup mayonnaise .

5. Thicken sauces without adding fat: Swap the usual culprits used to thicken sauces such as a butter roux or double cream, using instead a puree of a mild flavored vegetable such as carrot or cauliflower.

6. Use chicken broth to stir-fry instead of oil.

7. In place of butter, use non-fat cooking spray.

8. Replace bacon with turkey bacon.

9. Make sure to use extra lean ground beef for burgers and meatballs, or substitute ground turkey.

10. No-Sugar-Added fruit spreads taste more fruity than jam, and are plenty sweet.

Where to Shop
During the weight loss process, it is hard to find clothes to fit along the way. You don’t want to spend too much money on clothes until you get to your goal weight. But in between you can find much more affordable clothes at places like Ross, T.J. Maxx, Marshal’s, and Nordstrom’s Rack. The clothes are pretty affordable to begin with but start at the Clearance rack for some great deals that are most likely under $10!

Switch it Up!

Cross training means to change your usual work out routine. It is a good way to constantly shock the body, says Bryce Noble, Certified Personal Trainer. Try different activities like running, walking, the stair-master, classes, weight training, etc. By changing your workouts the body never fully adapts so you can continue to challenge your fitness. Weight training, in particular, is important for building bone density, increasing metabolic rate, burning more calories even after a workout, and changing the shape of the muscles for a lean toned look. Strength training is not going to necessarily bulk you up, rather it will boost your metabolism and therefor burn more calories.

Changing your work out does not have to mean getting a personal trainer or even joining a gym, though these are both very helpful for motivation to exercise. Change up your own personal routine by reading a fitness magazine or looking online for a new weight lifting move or exercise idea.


A Success Story
My name is Gary Millar and I am 38 years old. My life had spun out of control and before I knew it I weighed 338 lbs. I was concerned with my future, my health, and my life and how I was going to be able to get CONTROL of my life from here on out. After a great amount of research I made up my mind and decided to have weight loss surgery. I was referred to Dr. Cirangle and had the Vertical Sleeve Gastrectomy on February 13, 2008. The surgery has been an amazing gift and I am very thankful to Dr. Cirangle and his staff who have all played a big part in the entire experience. The care was excellent. It changed my life in every aspect, from A to Z. It has now been 9 months since the surgery and I weigh 188 lbs, losing a total of 150 lbs, and I feel great! Thank you Dr. Cirangle.

Thank you for sharing your story Gary!

Vitamin Update

Many patients taking ADEK have had trouble locating the Scandipharm version of them over the last year. This is because Scandipharm has made the new and improved AquaDEK as a replacement for the ADEK. The new version has a water soluble form of Vitamin A as well as the fat soluble. This new vitamin is also a multivitamin. It completely replaces the multivitamin. The one major problem is cost. A bottle costs about $41.00. A duodenal switch patient needs to take three of these per day to replace both the multivitamin and ADEK. An alternative choice is to stay with an affordable multivitamin and then buy the A, D, E and K vitamins separately. The most common deficiency that all patients with malabsorption(DS and RNY) are at risk for is Vitamin D deficiency. This can be prevented and treated with Biotech's Vitamin D3 50,000 IU tablet. One bottle has 100 tablets and costs $20-25. We recommend you start with one per day for one month then weekly after that. The A, E and K deficiencies rarely occur and are easily avoided with any basic over the counter A,E and K supplements. For those of you who are interested, we do have some of these supplements available in our office.

Electronic Medical Record

Many of our patients are aware that we are slowly converting to a secure electronic medical record that will allow electronic transfer of many of your test results, most importantly-LABS. We will also slowly be implementing a patient portal that will allow for secure online communication between the office and patients. We apologize for any inconvenience or confusion that may have occurred or might occur over the next several months.


Support Groups

Eureka Seminar & Support Group
Thursday, November 20th from 7-9 pm
Red Lion Hotel, 1929 4th Street (4 blocks from downtown)

Honolulu Seminar & Support Group
Saturday, December 6th from 10am - 12pm
Oahu Veteran's Center, 1298 Kukila Street, Honolulu.
10am for pre-op patients
11am for post-op patients

San Francisco Seminar & Support Group
Monday, December 8th from 5:30-8pm
2333 Buchanan St, Board Room
*Set up your follow up appointment with Dr. Jossart and stay for support group!
*Tara Griffith, Clinical Psychotherapist will be talking at 5:30pm
*Amy Ingols, RD will be talking at 6:00 pm

Monterey Seminar & Support Group
Saturday, December 13th from 1-3 pm
Hyatt Regency Monterey, 1 Golf Course Road

San Jose Seminar & Support Group
Wednesday, December 17th from 6-8 pm
Good Samaritan Hospital, 2425 Samaritan Drive in the teleconference trailers in the East parking lot.

Sacramento Seminar & Support Group
Saturday, December 20th from 9-11 am
Red Lion Hotel at Arden Village
1401 Arden Way

Stockton Seminar & Support Group
Saturday, December 20th from 1-3 pm
Courtyard Marriott, 3252 West March Lane, Stockton CA

Petaluma Seminar & Support Group
Saturday, December 20th from 9am-12pm
Sheraton Sonoma County, Petaluma, 745 Baywood Drive.
New Patient Seminar at 9am.
Support Group at 10:30 am

--The Team at Laparoscopic Associates of San Francisco

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Laparoscopic Associates
2100 Webster Street, Suite 110
San Francisco, California 94115

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