Penn Metabolic & Bariatric Surgery Program

Penn Metabolic & Bariatric Surgery Update

Tuesday, June 30, 2015

Meet Renee Bearman, MSN, CRNP with Penn Bariatrics

Renee Bearman
Renee Bearman, MSN, CRNP is not new to Penn Medicine. She's been at Penn Presbyterian Medical Center for about 10 years and has worked in many facets of patient care. She started her career working with Dr. Korus in the OR and is now back to working with him in bariatric surgery. You can find Renee all over Penn Medicine: at Penn Presbyterian Medical Center, the Perelman Center for Advanced Medicine, Penn Medicine University City and Penn Medicine Bucks County.

What sets the Penn Bariatric Surgery program apart?

The education we provide our patients sets the program apart. One of our roles as providers is to educate, and I think we do a very good job in making sure our patients are prepared. The information sessions that we hold offer a very good explanation of the three procedures and the expectations of those procedures. By preparing our patients before we actually see them in the office, they have a chance to process the information. They come in with the understanding that weight loss is a lifelong commitment, that bariatric surgery is not a quick fix and that different variables come into play depending on which procedure they do.

You’ve been seeing bariatric patients for 10 years. Have you noticed a difference in how much patients know about bariatric surgery or the Penn program?

I think that there is much more awareness now simply because so many people have had the surgery. Almost everybody who comes in can reference a friend, a neighbor, a coworker or even a celebrity who has been through this. A lot of people use those individuals as their support group, which is great.

Once a patient has gone through the information session, what's your first meeting like?

Most people are anxious and excited and scared. A lot of people say that attending the information session is the hardest step. Then some people feel that the first appointment can be overwhelming. It lasts anywhere from two to three hours. They meet everyone on the team. They're asked a lot of questions, some of them personal. We go back to the very beginning, asking things like, "When do you first remember being overweight?" For many people, it was being picked on during their childhood.

What’s your advice for patients?

Just showing up is a big deal! Literally half the battle is showing up and taking ownership of the situation. It shows us a lot: That you're committed and that you're willing to take the "downs" and can turn them around.

Also, if you gain a pound or two pounds, that does not mean don't come back. If you need to quit smoking and you haven't, that doesn't mean don't show up again. We have the resources as a program and as a health system to get you any type of help and support that you want or need. We're here for you.

What do you like best about your job?

Patients go through this process, anywhere from three to six to 12 months, and I'm actually with them the entire time. The best part of this job is on Mondays when a patient who is one year out comes in, and the sticker says "at goal weight." I walk in and the patient is smiling and happy. They tell me that they do Zumba and take their kids to the park. That's the best part of this job: When somebody gets their life back.

Personal Favorites

Favorite healthy food?

My favorite food is cheese.

How do you exercise?

I actually am a huge fan of kettle bells; my basement is full of them.

Favorite music?

I love jazzy blues. New Orleans music is actually my favorite.

Meet Renee and the Penn Bariatric Surgery Team

Let Penn Medicine help you lose weight. See if weight-loss surgery is right for you at a free information session.

Monday, June 22, 2015

Summer Salads for Bariatric Surgery Patients

Nicole Giguere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers her favorite summer-inspired salads for before and after weight-loss surgery.

Salads are a great way to add fresh fruits and veggies into your mealtimes. Eating fiber is important for maintaining healthy bowel function and also helps to keep you fuller for longer. Plus, the antioxdiants in fruits and vegetables help to fight cancer-causing free radicals. Choosing high protein ingredients to top your salad creates a well-balanced summertime meal.

Try one of these summer-inspired salad recipes when you are looking for a fresh, healthy summertime meal.

Salmon Strawberry and Feta















Makes 1-2 servings

Ingredients

2 strawberries
1 Tbsp feta cheese
8 walnuts
3oz salmon
1 cup baby spinach

Dressing

1 Tbsp balsamic vinegar

Method

  1. Bake or grill salmon until cooked through. 
  2. Slice strawberries. 
  3. Mix sliced strawberries, feta cheese, walnuts, and baby spinach together with balsamic vinegar. Top with cooked salmon and enjoy!

Nutrition Facts*

317 calories
20g fat
8.3g carbohydrates
26.6g protein

Taco Salad















Makes 1-2 servings

Ingredients

2 ounces shredded chicken (made from chicken breast)
2 Tbsp black beans
2 Tbsp sweet corn kernels
1 Tbsp low fat shredded cheddar or Monterey Jack cheese
1 cup shredded Romaine lettuce
¼ avocado, mashed with garlic powder, salt and pepper
2 Tbsp salsa
2 Tbsp fat-free sour cream
1 lime wedge (optional)

Method

  1. Boil chicken breast in water until cook through. Cool, then shred chicken either with two forks (insert fork prongs with backs facing each other, then gently pull forks away from each other creating long, shredded pieces) or by using your fingers. 
  2. Place avocado in a bowl and mash together with garlic powder, salt, and pepper to create a quick guacamole. 
  3. Top shredded romaine lettuce with shredded chicken, black beans, corn, low fat cheese, mashed avocado, salsa, and fat free sour cream. If desired, squeeze lime wedge over salad before eating. Enjoy!

Nutrition Facts*

295 calories
15g fat
17.7g carbohydrates
20.5g protein

Mango Shrimp Salad










Makes 1-2 servings

Ingredients

¼ mango, diced
¼ avocado, sliced
1 cup spring mix
6 large Shrimp
2 Tbsp edamame
3 cherry tomatoes, halved
1 tsp red onion, chopped

Dressing

1 Tbsp lemon juice
1 tsp extra virgin olive oil
½ Tbsp cilantro, chopped
Salt and pepper

Method

  1. Sautee, bake, boil, or grill shrimp until no longer pink. 
  2. If using frozen edemame, defrost or cook using package instructions. 
  3. Top spring mix with cooked shrimp, mango, avocado, edamame, cherry tomatoes, and red onion.
  4. To make dressing whisk lemon juice, extra virgin olive oil and cilantro together, adding salt and pepper to taste. Pour dressing on top of salad and enjoy. 

Nutrition Facts*

256 calories
14.4 g fat
21.2g carbohydrates
14.8g protein

*Nutrition facts are for one prepared salad using all ingredients listed. All nutrition facts are approximate.

Let Penn Medicine help you lose weight.
Register for a free information session.

Thursday, June 18, 2015

Meet Nicole Giguere, MA, RD, LDN, Clinical Dietitian with Penn Bariatrics

Nicole Giguere
Nicole Giguere, MA, RD, LDN is a clinical and bariatric dietitian at Pennsylvania Hospital. As a bariatric dietitian, she sees patients through every step of the process: pre-surgery, post-surgery and follow ups. She does nutrition counseling (medical weight management) for patients, which helps them get ready for surgery and for all their life changes after surgery.

We sat down with Nicole to learn more about her role in the program and with patients. Here are the highlights of our conversation.

What’s the process when a patient first meets you?

At our first meeting, patients get a binder that has information on nutrition for the whole bariatric surgery journey. I go over that and teach them about what to expect after surgery. Then we start to make small changes because they see me for three to six months before surgery. We try to tweak their diet and get them on the right path before they actually go in to surgery.

What's your favorite part about your job?

I like that I get to see people throughout the whole process. I love the counseling aspect and being there, helping people. And of course seeing their success. That's the best part. You're working with them so closely and then to see all of this weight comes off. They're usually happier, more upbeat and just so excited that they did this. It’s such a good feeling that you get to be part of that with them.

What tips do you have for keeping off the weight and weight loss?

Exercise is key for a lot of people – it’s important to keep moving. Before surgery it's hard for a lot of people to exercise because of their weight, but after surgery, as people start to lose more, it seems like it's easier for them to move around. We’re not asking them to run a marathon or anything – just to get up and start moving. If your knees hurt, then you can move your upper body – whatever you can do to get your heart beating a little faster is great. It's a good way of making sure you're burning extra calories.

What do you think sets Penn apart?

I love our program! Not to sound cheesy, but I really do. Some patients have started at other hospitals and then they've switched over because other programs aren’t as involved or comprehensive. At Penn, we have a huge Bariatrics binder with bunch of different resources. I think we have a lot to offer everybody, and we're super involved. Our program truly has the whole Penn Medicine system supporting the patients, clinicians and staff.

Personal Favorites

Favorite healthy food?

I have too many! I love avocados on whole grain toast. I love eggs too. I can eat them any way; they're delicious. And they're a perfect source of protein – really good for Bariatric patients.

How do you exercise?

I do P90X 3, and I really love it. That's what works for me. Whatever exercise people do is great.

Where is your happy place?

I like to be out and about! I'm from the beach and am a beach girl. Whenever I can dunk in the ocean, that's my favorite thing to do.

Hidden talent?

I used to make jewelry. Haven't done it that much in a while, but yeah, one of my hidden talents.

Meet Nicole and the Penn Bariatric Surgery Team

Let Penn Medicine help you lose weight. See if weight-loss surgery is right for you at a free information session.

Monday, June 1, 2015

Ray's Story: Air Force Veteran Turns Life Around with Gastric Sleeve Surgery

Raymond Zirilli is a US Air Force veteran who lost 90 pounds with gastric sleeve surgery. Here he tells his story and how he resists temptation now, a year and half post-surgery.

When I was in my twenties, I was recently married and had just entered the US Air Force. Married life with my family was very different from the life I had running with my single friends. I became very sedentary on my time off from work and began to see the results of that inactivity. At six-feet tall, my weight rocketed from 165 pounds to 210 pounds in four short months during my USAF basic and technical training.

The military had weight standards. The maximum weight standard for my height was 205 pounds; however, the only time I recall weighing as low as 205 pounds was on weigh-in days. Mandatory weigh-ins in the military are conducted every six months, and in order to make weight, I’d begin a crash diet a month before. After making weight, I’d spend the next five months, mostly sedentary and eating as I pleased.

Of course, I gained even more weight. It fluctuated between 215 pounds and 255 pounds over the next 18 years, and then it ballooned to 285 pounds after leaving the military, where it remained for the next 20 years.

At 57 years old, and with weight-related high blood pressure and type 2 diabetes, I decided I had to do something. I was tired of yo-yo dieting and dealing with weight-related health issues. I learned about bariatric surgery at Penn Medicine, and after meeting with my surgeon there, I decided to have gastric sleeve surgery.

Bariatric Surgery: Not the End-All Cure

I had my gastric sleeve surgery in December of 2014, and the procedure itself was easy. I was up and walking the morning after, released from the hospital after a short two-day stay, and recovering at home for just four weeks before returning to work.

After reaching my goal weight of 195 pounds, complacency set in as I began to drift back to my old eating habits, especially in the winter months. Instead of going to the gym at night, I’d sit and watch my favorite TV program and eat things that weight-loss surgery patients typically don’t eat.
I recognized I had a problem when I stepped on the scale and saw I had gained back 15 pounds. The honeymoon was over, and it was time to get back to work.

How I Turned My Life Around

I quickly got back to the support groups at Penn, where someone suggested I reboot and get back to the basics. It was a great reminder, and something I needed to hear. One of the things I learned during this time is: when no one is watching, you can get away with bad habits.

Today, I’m back on track thanks to some wonderful help and support from my friend Lou, the Penn staff, and the awesome folks in the weight management support group.

I stay busy chasing my grandsons (I can keep up with them now!), I walk more and faster than ever before, and I recently started riding my bike again. I am no longer on any medications for type 2 diabetes or high blood pressure. I feel great.

My Suggestions to Pre- and Post-Op Patients

  1. Attend support groups. They’re the reason I’m back on track, and I learn something new at every meeting. 
  2. Reach out to other patients in the support group and become Facebook friends with as many folks as possible, so they can look after you. I use Fitbit and My Fitness Pal, so I can add friends who can cheer me on when I make progress. It holds you accountable, not only to yourself, but to others who also share your struggles. 
  3. The Penn Bariatric Surgery staff, along with the post-surgery patients, have a wealth knowledge and experience and can provide advice and guidance to overcome obstacles to losing or maintaining weight. Use them.
Here I am before surgery (285 pounds) and after surgery (195 pounds):
     

Friday, May 8, 2015

Bariatric Surgery Nurses

It’s National Nurses Week, a time to raise public awareness of the value of nursing and to educate the public about the vital roles registered nurses play in health care. To express our gratitude to our nurses, we wanted to tell you a bit about them.

The nursing staff of Penn Medicine Metabolic and Bariatric surgery program includes nurse practitioners and registered nurses who provide care throughout all phases, before and after surgery.

Renee Bearman, MSN, CRNP
“Education is our role, and I think we do a very good job with our patients in making sure they are prepared [prior to surgery],” says nurse practitioner, Renee Bearman, MSN, CRNP.

Out of everyone on the team, patients probably have the most contact with and work the most closely with nurses. They give their expertise at office visits and support groups to address the concerns that are unique to the bariatric surgery patient population. They're with you through every part of your journey, sharing your most important milestones and your toughest days with you.

“With this particular job, I like the amount of interaction,” Renee says. “If you have a hernia, we see you, we fix your hernia and you go away. Here, the patients are going through this process for anywhere from three to six to twelve months, and I'm actually with them. The best part of this job is on Mondays when a patient comes in, and they're one year out and the sticker says ‘at goal weight.’ That's the best part of this job.”

The nursing staff attends national conferences, so the support and education you receive is based on the most current research in obesity and weight loss surgery.

Moreover, the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center and Chester County Hospital have achieved Magnet® status—the highest institutional honor awarded for nursing excellence—from the American Nurses Credentialing Center (ANCC). In fact, all of our nurse practitioners and registered nurses are board-certified and have professional certifications, such as Certified Diabetes Educator (CDE) and Certified Bariatric Nurse (CBN). That means you can trust in their care and advice because these nurses are the best of the best.

To take advantage of the amazing nursing staff, attend a free information session. There, they and other members of the team will give you an in-depth look at the bariatric surgery process and what to expect. You'll see just how dedicated and compassionate these nurses truly are.

Monday, May 4, 2015

Eating Healthy on Cinco de Mayo

For most people in the US, Cinco de Mayo is less about the Mexican’s army’s victory at the Battle of Puebla and more about hitting piƱatas and tossing back margaritas. As a result, summertime barbeques and parties like Cinco de Mayo can be a danger zone for those trying to eat sensibly. Typical party fare is high in fat and calories and low in beneficial nutrients.

The good news is that there are plenty of ways to celebrate while still eating healthy. Here are some tips from our registered dietitians:
  • You know you need to avoid regular sodas, alcohol and fruity beverages that are loaded with sugars. Unfortunately, there's no healthy virgin margarita alternative. Instead of high-calorie, high-sugar, “skinny” drinks, add sliced strawberries and mint into a pitcher with cold ice water. You'll get a refreshing, aromatic and hydrating beverage that your guests will love. 
  • Serve green leafy salads or fruit salads instead of mayonnaise-based salads. Potato, coleslaw and pasta salads are very high in fat and calories. Experiment with watermelon and jicama salad, or a quinoa salad with mango and sliced almonds.
  • If you’re attending a party, bring your own healthy side dish to share with other guests. The hosts will be thankful that they have one less thing to prepare. Having a nutritious option available will make sticking to your healthy eating plan that much easier.
  • Instead of chips, serve raw non-starchy veggies like cucumber, carrots, celery sticks, cherry tomatoes and broccoli with a low-fat dip or hummus. 
  • Consider using fat-free plain Greek yogurt in place of sour cream in dips. As a bonus, Greek yogurt will boost the protein content. 
What’s a fiesta without guacamole? Here’s a healthy guac recipe for you to test out:

Greek Yogurt Guacamole (adopted from californiaavocado.com)

Serves 8

4 ripe avocados, seeded and peeled
4 tsp. fresh lemon juice
1 tsp. fresh dill, chopped
1/2 Tbsp. garlic salt
3 Tbsp. medium-hot salsa
1 cups nonfat plain Greek yogurt

Most importantly, don’t put so much pressure on yourself. Remember to have fun and not think so much about the food. Enjoy catching up with old friends and making new ones.


Monday, March 9, 2015

What a Registered Dietitian Can Do for You

Nutrition is an important part of the before and after weight-loss surgery process. But making changes to something as personal as what you eat can be a real challenge. That’s why at Penn Medicine, our registered dietitians work with and support you, so you can achieve and maintain your weight-loss goals.

The most qualified healthy eating advice

Colleen Tewksbury, RD
Registered dietitians (RDs) or registered dietitian nutritionists (RDNs) are the food and nutrition experts. All registered dietitians are nutritionists, but not all nutritionists are registered dietitians. RDs are the only nutrition professionals who are regulated by law and governed by an ethical code to ensure they provide the best care. Nutritionists, on the other hand, can work without providing any formal certification.

When RDs help you set diet goals, rest assured they actually know what they’re talking about.

“The RD at the end of our names lets you know the information you are getting has been proven, not our opinion,” says Bariatric Surgery program manager, Colleen Tewksbury, MPH, RD, LDN.

They have to earn a bachelor’s degree with course work approved through the Accreditation Council for Education in Nutrition and Dietetics (ACEND) accredited Didactic Program in Dietetics or Coordinated Program in Dietetics. They also must complete 1200 hours of a supervised practice program, or internship, that is accredited by ACEND and pass a national examination overseen by the Commission on Dietetic Registration.

Guidance for the long haul

When you first see your RD, the last thing you’ll get is a one-size-fits-all-diet. He or she gets to know your eating habits and behaviors to make a more tailored plan that will most effectively help you. Each visit builds on the last to keep the patient moving forward and strengthen the earlier learning’s.

“The weight loss surgery journey is a marathon, not a sprint. Life happens. We’re here to help you reach your diet and weight goals when it does,” says Colleen.

The weight loss surgery program fosters this ongoing support by making sure that we always have dietitians available during our clinic hours, as well accessible via phone, email and MyPennMedicine.

Personally tailored plan for your needs and condition

At Penn, our RDs specialize in different conditions and treatments, like obesity and bariatric surgery, so they can customize nutrition advice specifically to patients’ needs.

It’s easy to get overwhelmed by what you think you can’t eat and end up with a boring diet. RDs can help you take the foods you like and fit them into your new lifestyle.

The idea is that you can still eat foods you enjoy while being mindful of your overall health and accomplishing your goals. It has to be sustainable for patients to have long-term success. This goes for exercise as well as diet. You don’t want to get burnt out in the first few months and lose interest.

“Every person is different,” says Colleen. “Every person’s diet should be, too.”

Safe and creative strategies

RDs are actually required to stay up to date on the most current developments in food and nutrition science. Following successful completion of the registration exam, they must earn continuing education credits on a regular basis to complete a re-certification process. This process makes sure they increase their knowledge of the rapidly changing nutrition trends and stay on top of the latest nutritional research.

By working with someone you know is an expert, you get a weight-loss program that is safe and effective. Your RD can use creative ways to help with meal planning, grocery shopping and food journaling. They can help you make changes, so you can reach your weight loss goals.

Check out our Facebook page, where you can get more weight-loss tips. On Wednesday, March 11 from 12 to 1 p.m, Colleen Tewksbury will answer all your nutrition questions live in a Facebook chat on our page.
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