Las Vegas Bariatrics Health & Wellness Magazine Vol 8 2016

“Your Leader in Surgical Weight Loss”

Harsha’s Wellness Corner – ‘carbs’ How Gastric Sleeve affects Hunger Hormones A Lesson on Restraint My Travels – Positano, Italy

LVB App

IE T RICAN SO AME C

vol. 8

702-384-1160

Bariatric Surgery

CENTER OF EXCELLENCE

SURGERY

lasvegasbariatrics.com

Y

RIC AT RI A

Free Download

ETABOLIC A ND RM B FO

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bariatrics

Dr. Hanna Bio As an ASMBS accredited Bariatric Centers of Excellence, Dr. Bernie Hanna, Director of Las Vegas Bariatrics, is a well-respected Las Vegas bariatric surgeon.

Having practiced in the Las Vegas Valley since 2000, Dr. Hanna and Las Vegas Bariatrics strive to create a service-oriented environment focused on quality and commitment.

Dr. Hanna completed his undergraduate work at Barry University in Miami, Florida and graduated from Howard University Medical School and General Surgery residency program.

Dr. Hanna received “Top Surgeon” honors in 2002, 2003, 2011 and achieved the “Top Doctor” award for 2006, 2007, 2012 and 2013.

He is a diplomat of the American Board of Surgeons, a member of The American Society for Metabolic and Bariatric Surgeons, American College of Surgeons, Nevada State Medical Association and the Clark County Medical Society.

Jocelyne Angela Rae Carmen Rose Jeanny Kyra

Medical Assistant Medical Assistant Medical Assistant

Practice Manager Medical Assistant Bariatric Coordinator

Rae

Carmen

Rose

Jeanny Kyra

Medical Assistant

702-384-1160 2

Jocelyne Angela

6140 S. Fort Apache Rd., #100 Las Vegas, NV 89148

Se Habla Español ~ Marunong ng Tagalog website: lasvegasbariatrics.com

Las VegasBariatrics

3

from the

EDITOR

C herish The Moments

There are no words more precious than a mother's, when describing the actions, accomplishments and milestones of her child….Memories that will last a lifetime.

We all strive to do great things. But in this nite life we have only so much time….

The words still echo in my ears, of one individual who quoted Polonius in Hamlet, 'To Thine Own Self – Be True.” Few months later, he was tragically killed in an industrial accident.

He was a husband, brother, son, and father of young children.

Each day we go through life not knowing what awaits us around the corner. All we can do is hope for something good.

I ask people, 'What is your goal in life?' The answers are all so varied, some have no answers. Mindlessly going through life…with no denite purpose and direction.

In my generation, we were raised in a world to think that hard work is the only way to live life. I 4

am sure many of you may have heard this-'Without hard work, you won't accomplish anything'. Work-work-work, then one can retire and reap the rewards of one's hard labor.

So many times I see my colleagues, coworkers, acquaintances retire at the ripe age of 65, only to nd out months later that they have some illness that will consume them just when that trip to Europe is planned. What a Bombshell! “I saved up my whole life for this”.

I see patients that tell me 'Doc, I have so much stress'. I ask- Where is the stress? Then I get an earful of a life lled with triggers. What's my answer? 'Stress is within. Stress is your perception of whatever is going on in your life'.

My wife tells me to slow down and focus, because I am always trying to do more than one thing. Slowing down opens one's eyes wider. It allows you to focus on the task at hand. You can actually accomplish more than when trying to multitask and not nishing anything. It's like the speeder who zips by you on the road only to have you pull up right next to them at the next stop light.

from the

EDITOR Experts estimate that our mind has about 50,000 to 80,000 thoughts each day. That's 2100 to 3300 thoughts each hour. .These thoughts frequently distract us. Only when you start to focus on something do you realize how many thoughts are actually distracting you. In a previous editorial I wrote about meditation (vol. 6), which talked about taking a few minutes each day to train your mind to be in touch with your consciousness.

So what is Life?

Life is a journey that is lled with precious moments! And I always say 'Life is about choices'. Take the time to do what makes you happy. Spend time with loved ones. Take that trip that you've been putting off forever. Tell your signicant other 'I love you'…. over and over again and again. This can't be said enough.

At the end of the day Life should be A Life Without Regret.

inside LVB magazine page

6 8 9 10

Staff Surgical Procedures BMI Chart Frequently asked Questions

12 Harsha’s Wellness Corner....Carbs

16 18

Success Stories Revision Surgery

20

Hunger Hormones

21 22 24

A Lesson on Restraint Recipes – Protein Nevada Kidney ‘NKDHC’

26

My Travels – Positano Italy

Of course, continue to work, continue to save, but know that there is a Balance. Don't put off until tomorrow what you can enjoy today.

The moment is now!

As the great Zen Master Thich Nhat Hahn says-Be present. Be mindful. Live in the moment.

'Drink your tea slowly and reverently, as if it is the axis on which the Earth revolves – slowly, evenly, without rushing toward the future. Live the actual moment.

Only this moment is life.' ~Thich Nhat Hanh BH

5

las vegas

– Las Vegas Bariatrics –

bariatrics

Se Habla Español ~ Marunong ng Tagalog Dr. Hanna operates out of an ASMBS accredited Bariatric Center of Excellence. At LVB we have created an environment that is friendly and service oriented. Our staff is always approachable and available to meet your needs.

FOCUS ON QUALITY We are committed to our patients over the long term and follow them indefinitely, which increases your chances of long-term success. In sticking with the program our patients will experience excellent outcomes over time.

OFFICE MANAGER As practice manager, Carmen with her many years of experience sees that LVB runs smoothly and efficiently making sure that our patients experience the warm and friendly service that's expected. In addition to being bilingual in English and Spanish, Carmen brings many attributes to the practice to ensure that our patients are given the best in quality care that anyone can provide. Her passion and commitment are tireless, leaving no stone unturned. This sets us apart.

Carmen carmen@lasvegasbariatrics.com

BARIATRIC COORDINATOR

Jeanny

As the practice Bariatric coordinator for the past 10 years, Jeanny has seamlessly guided hundreds of clients through the process. Insurance approvals can be challenging and frustrating for clients, which can take several months. Jeanny has experience and passion for the field, and knows what obese individuals face. She gives our practice the personal touch of compassion that patients should expect. Jeanny is bilingual 'English and Tagalog'. Again, this sets us apart. jeanny@lasvegasbariatrics.com

MEDICAL ASSISTANT Angela is a graduate of Everest College. She is bilingual in English and Spanish.

She is Doctor Hanna's right hand and personal assistant when patients come in for their visit. She will greet you and make sure that all of your needs are met during your visit. Her extensive knowledge of the surgical procedures and how our office runs allows her to coordinate patients’ flow from start to finish.

Angela angela@lasvegasbariatrics.com

Kyra

MEDICAL ASSISTANT Kyra graduated from Carrington College as a Certified Medial Assistant, top of her class with a 3.9 GPA. She is Dr. Hanna’s assistant in the exam room while patients are being interviewed.

She is fully knowledgeable of the questions and answers that patients have regarding Bariatric procedurs. She’s also in charge of medical records and gives a helping hand around the office to assist anyone with anything they need.

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www.lasvegasbariatrics.com

kyra@lassvegasbariatrics.com

las vegas

bariatrics

– Staff – MEDICAL ASSISTANT

Rose is a graduate from Nevada Career Institute. She is a very well qualified, confident, high-spirited assistant who is knowledgeable in both our front and back office when it comes to patient care. She is always willing and able to help any patient in all areas of the experience here at Las Vegas Bariatrics. She is a highly punctual team player that is able to handle multiple tasks simultaneously. Rose is bilingual in English and Spanish.

rose@lasvegasbariatrics.com

MEDICAL ASSISTANT Scheduling & Insurance Benefits

Rae is a confident and fully qualified medical assistant with 9 years experience in the medical field. She is responsible for verifying insurance coverage and benefits as well as triaging patients during their time of appointment. She is well trained in managing our on-line scheduling and having the knowledge to perform other administrative and clinical tasks to help keep our office running smoothly. Her proper attitude and experience with friendly customer service gives our office a better work environment.

Rae is Bilingual in English and Tagalog.

Rae rae@lasvegasbariatrics.com

MEDICAL ASSISTANT Clinic Scheduler Jocelyne is a graduate of Milan Institute. As a Medical Assistant she has the knowledge and skills to provide quality patient care. She is bilingual in English and Spanish. She is the friendly voice on the phone that will schedule your visits and collect the important information required to see Doctor Hanna. During your visit she will be the first one to greet you and ensure that your visit with Las Vegas Bariatrics is a smooth one.

Jocelyne jocelyne@lasvegasbariatrics.com

REGISTERED DIETICIAN Joey Sjostrom is our Registered Dietitian. After graduating from the University of Nebraska in Lincoln with her Bachelors Degree in Nutritional Science and Dietetics, she completed her Dietetic Internship in Stockton, California.

Joey will work with you closely every step of the way on this journey. You will see Joey before and after surgery and she will give you all the information you need to know to maintain a healthy diet before and after surgery.

Joey www.lasvegasbariatrics.com 7

laslasvegas vegas

bariatrics bariatrics

SURGICAL PROCEDURES SURGICAL PROCEDURES Description

Sleeve Gastrectomy

Reversible

no

The Gastric Sleeve Procedure is The Most Popular procedure. There is no foreign body, and the intestine is not re-routed.

During the sleeve gastrectomy procedure, a thin vertical stomach is created into a narrow tube using a stapling device.

The sleeve is like the size of a banana.

Up to 2/3 of the stomach is removed.

How it works?

Digestion

By creating a smaller stomach pouch, a sleeve gastrectomy limits the amount of food that can be eaten at any one time.

You feel full sooner and stay full longer.

As you eat less food, the body will stop storing excess calories and start using it’s fat supply for energy. We also decrease the number of receptors for the hunger hormone Ghrelin which causes a decrease in appetite.

Allows for normal digestion and absorption.

Food passes through the digestive tract in the usual order allowing for normal digestion.

Adjustable Gastric Band The adjustable Gastric Band B y c r e a t i n g a s m a l l e r Allows for normal digestion

Reversible

yes

Gastric Bypass

Reversible 8

no

wraps around the upper part of the stomach, dividing the stomach into a small pouch that holds about ½ cup of food and a larger lower stomach.

The degree of band tightness affects how much food you can eat and the length of time it takes for food to leave the stomach pouch.

stomach pouch, the Band limits the amount of food that can be eaten at one time, so you feel full sooner and stay full longer.

In this procedure, the surgeon creates a small stomach pouch and attaches a section of the small intestine directly to the pouch.

This allows food to bypass a portion of the small intestine.

By creating a smaller stomach pouch, a gastric bypass limits the amount of food that can be eaten at one time, so you feel full longer. By bypassing a portion of the small intestine, it also causes your body to absorb fewer calories.

As you eat less food, your body will stop storing excess calories and start using its fat supply for energy.

a n d ab so r pt ion . Food passes through the digestive tract in the usual order, allowing it to be fully absorbed in the body.

As you eat food, your body The band is being phased will stop storing excess out. calories and start using its fat energy supply.

Changes the body’s normal digestive process to reduce the number of calories and nutrients that are absorbed.

HEIGHT

WEIGHT (LBS)

5’0” 5’2” 5’4”

5’6” 5’8” 5’10” 6’0” 6’2” 6’4”

120

23

22

21

19

18

17

16

15

15

130

25

24

22

21

20

19

18

17

16

140

27

26

24

23

21

20

19

18

17

150

29

27

26

24

23

22

20

19

18

160

31

29

28

26

24

23

22

21

20

170

33

31

29

27

26

24

23

22

21

180

35

33

31

29

27

26

24

23

22

190

37

35

33

31

29

27

26

24

23

200

39

37

34

32

30

29

27

26

24

210

41

38

36

34

32

30

29

27

26

220

43

40

38

36

34

32

30

28

27

230

45

42

40

37

35

33

31

30

28

240

47

44

41

39

37

35

33

31

29

250

49

46

43

40

38

36

34

32

30

260

51

48

45

42

40

37

35

33

32

270

53

49

46

44

41

39

37

35

33

280

55

51

48

45

43

40

38

36

34

290

57

53

50

47

44

42

39

37

35

300

59

55

52

49

46

43

41

39

37

310

61

57

53

50

47

44

42

40

38

320

62

59

55

52

49

46

43

41

39

330

64

61

57

53

50

47

45

42

40

340

66

62

58

55

52

49

46

44

41

350

68

64

60

56

53

50

47

45

43

Calculate your Body Mass Index: To nd your BMI locate your Weight on the Left and your Height on the Top. Follow it to the intersection to locate your BMI.

9

las vegas

bariatrics

BARIATRIC SURGERY

FAQs What procedure is right for me?

Dr. Hanna will make a recommendation during your evaluation based on your medical conditions and your weight. He will discuss the advantages and disadvantages of each procedure. The final decision is yours to make.

However, the most common procedure that we do now is The Gastric Sleeve procedure.

Does Insurance cover it?

This varies by different health plans. You may check with your insurance provider regarding this.

But for the most part many insurances do cover Bariatric surgery. The staff at Las Vegas Bariatrics are experts at this.

What do I have to do to get approved?

Each insurance has its own criteria. In addition to meeting these criteria, each patient requires a nutrition and psychiatric evaluation. We help you get these evaluations.

Are there any age restrictions for weight loss surgery?

For our program, at least 18 years old, and we look at the overall health of the individual. Patients over 65 may also be good candidates.

Do I have to be on a special diet before surgery?

Depending on your weight, Doctor Hanna may require you to be on a low-calorie diet for a few weeks before surgery.

Do I have to lose weight before surgery?

It is beneficial for all patients to lose some weight 10

prior to surgery because this allows for a safer, easier operation.

How much weight will I lose?

Depending on the procedure, on average one can lose 60-90% of the excess weight. It’s important that you understand how the procedure is supposed to work for you. It is also very important to follow up with your comprehensive Bariatric program to maximize your results.

Will my health problems go away?

There is no guarantee, but the majority of heath problems caused by obesity either improve or resolve.

For example, up to 80% of type 2 diabetes resolves after weight loss surgery and patients come off their diabetic medications.

Will I need to crush my pills after surgery?

It is preferable that all medications be in a crushable or liquid form after surgery. Your pharmacy and your doctor will help you with this.

Can I gain the weight back after surgery?

It’s unlikely but this is always a possibility. Hence it is very important to follow the program as instructed by your surgeon and maintain good dietary habits, exercise and follow-up with your Bariatric team.

What about smoking?

We instruct patients to stop smoking at least 30 days before surgery, since smoking increases risk of complications during and after surgery.

las vegas

bariatrics

BARIATRIC SURGERY

FAQs What about loose skin?

How long is this procedure?

All of the procedures are minimally invasive and take from 30 minutes up to one hour.

How long am I in the hospital?

Depending on the procedure, you may go home the same day or the following day after an overnight stay.

All of the surgeries are minimally invasive.

When can I go back to work?

For gastric band and gastric sleeve patients, you may return to work in 1 - 2 weeks. For gastric bypass patients, you may return to work in 2 - 4 weeks.

As individuals lose weight there may be loose skin.

The degree depends on several factors: age, race, skin type, elasticity of the skin and activity level. It is recommended to exercise and do muscle toning during your weight loss journey. After 18 months post surgery you can assess the degree of loose skin. If you are concerned about this we will refer you to a cosmetic surgeon for an evaluation.

Safety First We see that every patient gets the appropriate preoperative evaluation and clearance prior to surgery.

Can I drink soda?

What about pregnancy weight loss surgery?

AUTUMN before and after

It is advisable not to drink carbonated beverages due to the new stomach being the size of an egg, this can cause a lot of discomfort and pain.

after

The first 12 - 16 months, with rapid weight loss, it is unhealthy to carry a baby due to potential nutritional deficiencies. It is advisable to wait at least 18 months after surgery to attempt pregnancy.

Why do I have to exercise after weight loss surgery?

In a comprehensive center of excellence program we incorporate diet and exercise as an integral part of the success of the surgery. Exercise burns calories and builds muscle tissue. This allows you to burn energy more efficiently and replace fat with muscle.

BARIATRIC SURGERY adds years to your life!

FINANCING AND INSURANCE Most insurances cover weight loss surgery once the criteria are met.

We also offer financing for those who have no insurance coverage.

Contact:

702-384-1160

website: lasvegasbariatrics.com 11

Harsha’s Corner

Carbs, Carbs, Carbs.....

To Eat or Not To Eat

What are carbs, or CARBOHYDRATES? Here is the MedicineNet definition:

Carbohydrates can be defined chemically as neutral compounds of carbon, hydrogen and oxygen. Carbohydrates come in simple forms such as sugars and in complex forms such as starches and fiber. The body breaks down most sugars and starches into glucose, a simple sugar that the body can use to feed its cells.

Carbohydrates: Simple versus Complex Simple carbohydrates are sugars. All simple carbohydrates are made of just one or two sugar molecules. They are the quickest source of energy, as they are very rapidly digested.

Some food sources of simple carbohydrates:

�

� � �

Table sugar Brown sugar Corn syrup Honey Maple syrup �

�

�

�

�

�

Molasses Jams, jellies Fruit drinks Soft drinks Candy

Complex carbohydrates may be referred to as dietary starch and are made of sugar molecules strung together like a necklace or branched like a coil. They are often rich in fiber, thus satisfying and health promoting. Complex carbohydrates are commonly found in whole plant foods and, therefore, are also high in vitamins and minerals.

These whole plant foods are great sources of complex carbohydrates: Green vegetables Whole grains and foods made from them, such as oatmeal, pasta, and whole-grain breads Starchy vegetables such as potatoes, sweet potatoes, corn and pumpkin Beans, lentils, and peas

12

Why are carbs so bad?

Two bad things happen when your biology is damaged by sugar and processed foods.

1. First, your body becomes ins ulin resistant, so you have to pump out more and more insulin in an attempt to keep your blood sugar normal. Insulin is a powerful fat-storage hormone, one that encourages your body to pack on dangerous belly fat.

2. Second, you become leptin resistant.

That means that no matter how much of this fabulous appetite - suppressing hormone your body makes, your brain cannot read the signals. It is “resistant,” or numb, to the signals from leptin.

But wait… it gets worse. High levels of insulin produced through all the sugar and fructose consumption (from high-fructose corn syrup and other sugars) block the leptin signals in your brain, so your body thinks it is starving even after a Big Mac, fries, and a large soda. Ever wonder how you can still be hungry right after a big meal? It is the insulin surge and the leptin resistance

This is how sugar and junk food hijack your brain chemistry and your metabolism. Unfortunately, the story doesn't

end there. The fructose (mostly from highfructose corn syrup) gets directly absorbed from your gut and goes to the liver without passing through the normal controls that glucose has to deal with.

Insulin is required to get glucose into the cells, but

fructose gets mainlined directly into the liver. This switches on lipogenesis, the mechanism that turns sugar directly into fat. Think fatty liver. A fatty liver is an inflamed liver. This, in turn, causes even more insulin resistance. Your cells become numb to the effects of insulin, but your body desperately wants to get the sugar into your cells. The body then pumps out more insulin, creating more belly fat and inflammation. This is the cause of most heart attacks and strokes, many cancers, and even dementia. In fact, insulin resistance is the very cause of aging itself.

(Taken from: Hyman, Mark (2014-02-25). The Blood Sugar Solution 10-Day Detox Diet)

·

· ·

100–150 grams: Weight maintenance

or frequent high-intensity exercise.

There's room for plenty of fruit and even some starchy foods like potatoes.

50–100 grams: Slow and steady weight loss or weight maintenance. There's room for plenty of vegetables and fruit.

Under 50 grams: Fast weight loss. Eat plenty of vegetables, but limit fruit intake to low-glycemic berries.

2. Ketogenic Diet The ketogenic diet is a very low-carb, high-fat diet. It is often referred to as keto.

The goal of a ketogenic diet is to keep carbs so low that the body goes into a metabolic state called ketosis.

When carb intake is very low, insulin levels go way down and the body releases large amounts of fatty acids from its body fat stores.

A lot of these fatty acids are transferred to the liver, which can turn them into ketone bodies.

Ketone bodies, or ketones, are water-soluble molecules that can cross the blood-brain barrier and supply energy for the brain.

Instead of running on carbs, the brain starts running largely on ketones. The little glucose still required by the brain can be produced by the body via a process called gluconeogenesis.

Types of Low-Carb or No-Carb diets:

1. A Typical Low Carb Diet This diet tends to be lower in carbs, and higher in protein, than a typical “Western” diet.

(A western diet is your typical American diet- meat and potatoes, burger and fries, pasta and garlic bread followed by dessert, chicken and rice, sandwich and chips, cereal, etc.)

A typical low carb diet is usually based on meats, fish, eggs, nuts, seeds, vegetables, fruits and healthy fats.

It minimizes the intake of high-carb foods like grains, potatoes, sugary drinks and high sugar junk foods.

The recommended carb intake per day generally depends on the person’s goals and preferences, but here is a popular guideline:

A ketogenic diet involves high-protein, highfat foods. Carbs are generally limited to less than 50 grams per day, and sometimes to less than 20-30 grams.

A conventional ketogenic diet is referred to as a “standard” ketogenic diet (SKD).

However, there are other variations that involve strategically adding carbs:

·

Targeted Ketogenic Diet (TKD):

Add small amounts of carbs around workouts.

13

·

Cyclical Ketogenic Diet (CKD): Eat a

ketogenic diet on most days of the week, but switch to a high-carb diet for 1–2 days each week.

3. Low-Carb, High-Fat (LCHF)

This is a fairly standard very low-carb diet, except an even greater emphasis is put on eating whole, unprocessed foods.

The LCHF diet has become very popular in Sweden, as well as other Nordic countries.

It focuses mostly on meats, fish and shellfish, eggs, healthy fats, vegetables, dairy products, nuts and berries. The recommended carb intake on this diet can range from under 20 grams per day, to 100 grams per day.

4. Low-Carb Paleo Diet

The paleo diet is currently one of the world’s most popular “diets.”

This diet involves eating foods that were likely available in the paleolithic era, before the agricultural and industrial revolutions.

A paleo diet is not low-carb by definition, but in practice it tends to be fairly low in carbs.

It involves eating meats, fish, seafoods, eggs, vegetables, fruits, tubers, nuts and seeds. A strict paleo diet eliminates processed foods, added sugar, grains, legumes and dairy products.

5. The Atkins Diet

The Atkins diet is the best known low-carb diet plan.

Phase 1 — Induction: Eat under 20

14

grams of carbs per day for 2 weeks.

Phase 2 — Balancing: Slowly add more nuts, low-carb vegetables and fruits to your diet.

Phase 3 — Fine-tuning: When you get close to your goal weight, add more carbs until weight loss becomes slower.

Phase 4 — Maintenance: Eat as many

healthy carbs as your body tolerates without gaining back the weight you lost.

The Atkins diet was originally demonized, but modern science has now shown that it is both safe and effective. This diet is still popular today.

6.

Eco-Atkins Diet

7.

Zero-Carb Diet

8.

Low-Carb Mediterranean Diet

A diet termed Eco-Atkins is basically a vegan version of the Atkins diet.

It includes plant foods and ingredients that are high in protein and/or fat, such as gluten, soy, nuts and plant oils.

It tends to contain about 25% of calories from carbs, 30% from protein and 45% of calories from fat. This is a bit higher in carbs than a typical Atkins diet, but still much lower than a typical vegan diet.

One 6-month study showed that an Eco-Atkins diet caused more weight loss and greater improvement in heart disease risk factors than a high-carb lacto-ovo-vegetarian diet.

Some people prefer to eliminate all carbs from their diet.

This is called a zero-carb diet, and usually includes only foods from the animal kingdom.

People who follow a zero-carb diet eat meat, fish, eggs and animal fats like butter and lard.

Some of them also add salt and spices.

There are no recent studies that show a zerocarb diet to be safe. Only one case study exists, from 1930, where two men ate nothing but meat and organs for a year but remained in excellent health. A zero-carb diet is lacking in some important nutrients, such a vitamin C and fiber. However, it seems to work for some people.

The Mediterranean diet is very popular especially among health professionals.

It involves selection foods that were (supposedly) consumed in the Mediterranean countries earlier in the 20th century.

Studies have shown that this diet can help prevent heart disease, breast cancer and type 2 diabetes.

A low-carb Mediterranean diet is basically like a Mediterranean diet, except that it limits higher-carb foods like whole grains.

It is similar to a regular low-carb diet, except that it emphasizes more fatty fish instead of red meat, and more extra virgin olive oil instead of fats like butter.

A low-carb Mediterranean diet may be better for heart disease prevention than other low-carb diets, although this needs to be confirmed in studies.

Which Low-Carb Diet Plan is Best?

If you're going to do a low-carb diet, pick a plan that suits your lifestyle, food preferences and personal health goals.

What works for one person may not work for the next, and the best diet for YOU is the one you can stick to.

It becomes a lifestyle!

Harsha

15

Las VegasBariatrics before

after

Dr. Hanna is a brilliant man. He saved my life. I was sick with hypertension and snored too much.

After my surgery my life has changed, no more sickness. I have a beautiful life and a happy husband. Thanks Doctor Hanna!!

Maria C.

before

after

A quality of life was not mine. Weighing almost 300 pounds with diabetes, out of control on medicines. Doctor Bernie Hanna saved my life. I’m down from wearing 3x and size 22 dresses. I tried every diet that didn’t work.

Now I’m down to size 9/10 pant jeans and presently weigh 130 pounds. Thank you! Thank you! Dr. Hanna.

Janice S. 16

Success Stories before

after

I put on probably an extra 10 to 15 years to my life and not in pounds. I was in a power chair, and now I'm in my shoes and walking.

Thanks to Dr. Hanna and the Good Lord directing him, thanks to both of them I’m still here!!!

James F.

before

after

Seeing Dr. Hanna started me on a journey for better health. Terrific staff and very helpful.

I have sleep apnea and used a CPAP device for over 20 years. The air pressure setting was 15 and now it’s 8. CPAP device is no longer extra luggage on short trips.

I was on insulin and 3 other diabetes pills and soon to be free of diabetes.

Floyd S. 17

Las Vegas Bariatrics

Revision

weight loss surgery

The Gastric Band is now falling out of favor.

In recent years surgeons have been turning to The Gastric Sleeve as the procedure of choice for weight loss.

For many patients undergoing gastric band surgery the weight loss has been disappointing and unrewarding. Even after having multiple band fills patients have not successfully lost weight or have actually regained weight.

If your gastric band has failed, doctor Hanna has a solution for you.

Patients travel from all over the country and internationally to be under the care of Doctor Hanna.

Doctor Hanna has been voted 'Top Surgeon” by his peers in 2006, 2007 and 2013.

His experience and reputation sets him apart as one of the leading Bariatric surgeons in The Las Vegas area.

As a leading very experienced weight loss surgeon in Las Vegas, and director of Las Vegas Bariatrics Center of Excellence Program, Doctor Hanna will make your experience a truly memorable and pleasant one. We have a fully integrated staff that focuses on your safety.

We evaluate for band slippage, erosions and device failure.

Having done hundreds of revision procedures, we have the solution.

Band to Sleeve revision surgery is becoming a very popular procedure with great success leading to better weight loss and improved health.

GASTRIC BAND FAILURE?

· · · · ·

18

Gastric Band

·

After having gastric band surgery, some patients can have problems.

Are you having dif iculty with the weight loss?

Are you having frequent bouts of emesis and throwing up?

Are you having dif iculty tolerating certain foods?

Are you only able to tolerate liquids?

Are you having severe Acid Re lux?

Band to Sleeve

Revision

If this sounds like you or someone that you know, then experiencing any of these symptoms can be caused by one of the following: 1.

Device failure

2.

Gastric band slippage or migration

3.

Gastric Band erosion

4.

Gastric Band obstruction

What’s the solution?

At LVB we’ve perfected the art of Revision Surgeries.

On a monthly basis we do several Gastric Revision procedures with amazing success and outcomes.

Gastric Sleeve

Options include: 1.

Remove the Band

2.

Revise the stomach to Gastric Sleeve

This can be accomplished in one stage but there is less risk when done in 2 stages.

Why Sleeve? · · · ·

Sleeve Gastrectomy has proven better weight loss.

Has a great safety pro ile.

No maintenance issues like band ills that can be costly.

Better resolution of health problems.

When we do a Band revision, it’s a very safe procedure. It’s a minimally invasive, laparoscopic procedure. You may be home on the same day.

Most patients after having a Band to Sleeve Revision Surgery do Great!

At LVB we’ve done numerous successful Revision Surgeries with excellent results.

Call now to schedule your visit:

702-384-1160

lasvegasbariatrics.com

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Hunger hormones:Grehlin & Leptin How can Sleeve surgery play a role?

How does our hunger and appe te affect us?

Lep n is a hormone, made by fat cells, that decreases your appe te.

Ghrelin is a hormone that increases appe te, and also plays a role in body weight.

Lep n is a mediator of long-term regula on of energy balance, suppressing food intake and thereby inducing weight loss Ghrelin is a fast-ac ng hormone, seemingly playing a role in meal ini a on. Telling us when we are hungry.

In obese individuals the circula ng level of the anorexigenic 'appe te suppressing' hormone lep n is increased, whereas surprisingly, the level of the orexigenic 'appe te promo ng' hormone ghrelin is decreased. It is now established that obese pa ents are lep n-resistant.

Levels of lep n -- the appe te suppressor -- are lower when you're thin and higher when you're obese.

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So why is it that obese individuals have a hard me loosing weight? Many obese people have built up a resistance to the appe te-suppressing effects of lep n, says obesity expert Mary Dallman, PhD, from University of California at San Francisco.

With weight loss surgery such as The Ver cal Sleeve Gastrectomy, a por on of the stomach is removed in effect decreasing the number of receptors for Grehlin the hunger hormone. This can counter balance the lack of lep n effects which leads to a decrease in appe te. So many individuals post Sleeve gastrectomy have a decrease in their appe te and maintain sa ety a�er a small meal. This leads to less snacking and long term weight loss success once they understand and follow proper ea ng behavior.

B.H.

A Lesson on

Restraint

It was Friday- the day before July 4th weekend. I've really wanted to try out this new BBQ joint that I hadn't been to before. I was craving ribs given the nostalgia surrounding the time of year. I drove down there late afternoon, pulled up to this really local-looking, hole-inthe-wall joint. I could smell the aroma of charcoal, grilled meat, and BBQ sauces even before I walked inside. There were wooden table benches inside and a small walkup counter to order. The anticipation was intense as I looked at the menu to place my order.

Now understand that my wife and I are just the two persons in our household. During the drive there, I spoke with her to have an idea of what she would like since she was still at work. She said “Now make sure you don't go nuts—you know you” My response- “Well it's a new place and I heard that it's so good. I want to try several things.” Her reply- “You can always go back another time to try something else.”

So here I am at the counter, the choices are endless. Beef ribs, regular pork ribs, baby back pork ribs, smoked chicken, beef brisket, pulled pork, chicken wings, spicy sausage links and endless sides. What's a man to do!!?

Sir, what are you having?

I'll have ½ rack of pork ribs, ½ rack of baby back ribs, ½ rack of beef ribs, ½ smoke chicken and ½ pound of spicy sausage links.

Anything else? No….Oh yes some uhhhh…a side of BBQ beans.

What was I thinking? My wife's going to kill me!

My order is ready and I take my two large takeout bags, and begin the drive home. The aroma in the car is unbearably delicious. The only things stopping me from digging into one of the bags to grab a rib was: 1) I was driving 2) It was in the back seat and 3) My wife always tells me to focus while I'm on the road.

I made it home safely. I went into the house and eagerly unloaded the goods onto the kitchen island counter. The spread was ridiculous. A Smö rgå sbord! I took a picture and sent it to my wife. Why?

Maybe I'm trying to soften the blow for when she actually sees this feast in person. She calls me and says I'm planning to do yoga when I get home so if you're thinking of joining me, maybe you want to wait a bit. I was thinking, I'd have a little taste before she gets home. But I held off. I couldn't imagine doing a down dog just after having a rib.

So my wife gets home, we do a 45-minute yoga class. The whole time I'm thinking BBQ, but I got through the vinyasas, up dogs and warrior poses. Refreshing, I must say.

After a quick shower, I got ready for dinner. By now it's been over two hours since I picked up the food. We each dished a plate. I picked one single pork rib, one single baby back rib, half of a single beef rib, and 3 slices of the spicy links with a small serving of the side of beans for starters, thinking to myself that I'll be back.

We sat at our dining table and dug in. Rather than sitting at the TV, we sit at the dining table where we can have good conversation. We took our time and really enjoyed the meal. It was amazing. After about 30-45 minutes of enjoying our meal I found that my partial beef rib was still sitting on the plate only partly eaten. I was actually full.

Didn't even want to inish it because I was really and truly satis ied. And the food was fantastic too.

It was a revealing moment that taught me RESTRAINT. Well, my wife played a huge role here. Which is why I'm writing about this experience. Every day we learn. Life is a learning process. We're born, we live and we die. We have this one chance to do it right.

Hara Hachi Bu: This Japanese phrase is a Confucian teaching that teaches people when eating to “stop when you're 80% full.” It's a self-imposed habit/practice in calorie restriction. This is what I tell many of my patients.

I say pause, just pause for a moment! All we need is a short moment to think about what we're doing. It allows us to experience what our bodies really need. It allows us to be more in touch with mind, body and spirit.

We are all human in that we have primal urges and instincts that may push us to overdo it now and then, however we need to think about our bodies when it comes to health and wellness.

Do I want that chip? Do I need that chip? Should I eat that chip? It's amazing, the dialogue that we have in our heads when we see something that we like or want.

If you want overall health and wellness: Just think Hara Hachi Bu. Happy eating!

BH

21

Recipes Millet with

Sardines Millet is a ‘Gluten Free’ grain that’s rich in dietary fiber, protein, iron, calcium, and B vitamins.

It goes well with many pairing options. Here I paired it with a wild caught canned fish. You can use sardines, Mackerel or anchovy as these are great sources of healthy omega 3 and protein.

Millet is cooked like one would cook grits or rice. Boil it in water until cooked.

There are different types of Millet so follow instructions.

Shrimp and

Grits Cook grits.

Stir fry red peppers, onions, parsley and shrimp with seasoning of choice.

22

B.H.

Protein

Breakfast þ

Fried Egg

þ þ

Fig

Heirloom Tomato

23

Why Us NKDHC is rapidly becoming Nevada’s largest premier group of private practice physicians specializing in the field of Nephrology.

We provide superior care to individuals with renal (kidney) disease. We are considered experts in the treatment of Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD), Acute Renal Failure (ARF), Kidney Transplantation, and creating and maintaining accesses for dialysis therapies.

NKDHC has enjoyed the trust of patients and the respect of the local communities in the Las Vegas and surrounding areas for greater than 30 years.

We employ Registered Nurses, Registered Dieticians, Radiology Technicians, Medical Assistants, and qualified and credentialed Administrative and Business Team Members.

Professional Services General Nephrology Care Hypertension Management Anemia Management Renal Unltrasound Clinical Research Vascular - Dialysis Access Acute Hospital and Sub-Acute

24

702-732Central Office 1750 E. Desert Inn Rd., ste 200, Las Vegas, N David Makil, MD Harsha Mulchandani, MD Peilin Wei, MD Teena Tandon, MD Zeeshan Fatima Syed, MD

Henderson Access Center 702-7262850 W. Horizon Ridge Pkwy, ste. 100 Henderson, NV 89052 Basker Periyasamy, MD Benjamin Rudnitsky, MD Sundar Sankaran, MD

702-851Northeast Office 2425 N. Lamb Blvd., ste 120, Las Vegas, NV 8 Maria Vornicu, MD Sam Kantor, MD Qin Fang, MD Gene Ong, MD

702-853Northwest Office 2420 Professional Court, ste 150, Las Vegas, NV Sam Kantor, MD Sujatha Raju, MD Jeffrey Ryu, MD Benjamin Rudnitsky, MD Marwan Takieddine, MD Pailin Wei, MD Gene Ong. MD

702-726Southeast - Henderson Office 2850 W. Horizon Ridge Pkwy, ste 100 Henderson, NV 89052 Trang Nguyen-Le, MD William King, MD Basker Periyasamy, MD Sundar Sankaran, MD Irfan Sohail, MD Qin Fang, MD

702-588Southwest Office 6970 W. Patrick Lane, ste 140, Las Vegas, NV 8 Arvin Gupta, MD Radhika Janga, MD Ashraf Mohammed, MD Teena Tandon, MD

Las Vegas Medi-Spa

Maintaining A Beautiful You! Elite MPX Laser Treatments Vascular Treatments for Spider Veins Pigmented Lesions (brown/red spots, Rosacea, Melasma) Hair Removal Facial Rejuvination

Las Vegas Medispa Phone: 702.750.1134

www.lasvegasmedispa.ning.com/

□

BOTOX

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Facials

We carry the IMAGE skin care line that is all organic and suited for all skin types 25

My Travels

Positano’s Amalfi Coast ~ Italy I recently traveled to Italy. It was an experience that tantalized all of the senses.

Traveling through Europe takes a little planning nowadays, with the hoards of tourists and travelers.

One has to have one’s itinerary planned in detail to enjoy the experience. It is not easy to wing it. Years ago, when I trekked through Europe on a budget, it was easy staying in small B&B’s & hotels on the spur of the moment. But nowadays one needs to make reservations in advance. The timing of travel is crucial. I try to avoid the peak season.

Whether you are in Rome, Amalfi, Sorrento or Positano, these towns all have their individual charm and flair. Italy is the playground of the rich and famous; but don’t forget the adventurous trekker. To do it justice, one needs more than ‘just a little time’.

How to get there: Fly into Naples or Rome. If time permits, explore these historic cities; but that could be an entire trip in itself!

Rome has the iconic landmarks like The Vatican,Trevi fountain, the Colosseum, the Forum, and the Catacombs. Walk along stoned roads where Caesar once tread. Fashion boutiques along the grand avenues and restaurants abound.

Naples is synonymous with the word Pizza, as it originated here.The famous and delicious Neapolitan pizza and cuisine is the culinary influence of the eclectic cultures of the region.

26

Naples is a UNESCO world heritage site. History is obvious as one walks the cobbled stone streets with numerous ancient buildings throughout the city. Just driving in this densly populated city is an adventure in itself. Numerous restaurants and shopping options abound. Meandering the busy streets you will find venders selling nougat, a chewy candy made of a variety of ingredients like honey, nuts, pistachio, almonds, hazelnut, walnuts, candied fruit, and chocolate. But let's move on to the Amalfi coast.

Our main destination is Positano; but on the way, you may want to stop for a day and visit Sorrento. This region of southern Italy is the Campania area known for it's ancient ruins, Mount Vesuvius, dramatic coastlines of the Amalfi coast, olive groves, citrus groves, and tasty buffalo Mozzarella.

You can rent a car, take a train or hire a driver. If you have a car be sure to sort out parking before you get there. Parking can be a nightmare.

Positano This very picturesque town holds a special place in my heart.Whether you are a backpacker, budget traveler, beach lover, culinary explorer, fashionista, jetsetter or high-rolling, Ferrari-wheeling playboy, Positano has it for you!

Where to stay: Rent out a fully equipped villa with gourmet kitchen and housekeeper included, with panoramic views of the blue Mediterranean Sea. Or choose one of several posh hotels or smaller B&Bs for an easier budget.

The main street 'Via Positanisi D'America' comes to life in the evenings. It is lined with fashionable boutiques, gelaterias, pizzerias, and trattorias.

Locals and tourists alike sit at the Piazzas enjoying gelato while pedestrians stroll by.

Artists have their easels mounted; painting and selling colorful, hand painted artful scenes of the town.

Images that capture the moment!

What to do: Meander through the small streets, climb stairwells, pass by homes, hotels, trattorias and cafes. An early morning walk for a cappuccino is a joy, as you take in the breathtaking views of the Mediterranean. Shop at the local markets for fresh Buffalo mozzarella, locally grown olives, tomatoes and the freshest prosciutto.

Not to mention the fresh bread and ricotta cheese.

Cuisine: If you love food as I do, this is a place to explore the limits of your palate. The freshest seafood abounds.

Fresh fruits and vegetables are readily available. They keep it simple here, with the most aromatic olive oil, herbs, and freshest ingredients. The margarita pizza 'Basil, Mozzarella and Tomato' is a classic favorite.

Day Trips from Positano Take a bus, private car or ferry boat to historic towns.

There is a small beach 'Spiaggia Fornillo' and a big beach 'Spiaggia Grande' where sunbathers soak up the sun.

The church of Santa Maria Assunta with its Duomo at big beach is the iconic landmark cathedral.

Capri A day trip to this island starts with an early 30-minute ferry ride from Spiaggia Grande. Sip on prossecco during the short journey.

When you arrive at Marina Grande, the view of the marina and colorful buildings will wow you.

You can hire one of many tour guides to take you around, or do the self-guided tour and ride a funicular 'rail car' up to the main square. Explore the town with its cobblestone streets. Visit one of many chic boutiques like Ferragamo and Gucci. Have a snack al fresco in the square. Caprese salad or prosciutto and mozzarella with a cold beer.

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Amalfi To drive along the Amalfi coast one has to have a strong stomach for adventure- as the narrow, winding, and hairpin curves with scenic cliffs can be an adrenalin rush.

The experience is a must, whether you drive or go by sea.

Amalfi is a small town, but can get packed with tourists during the summer. It's known for it's beautiful hand painted ceramics.

Make your way by bus up to the town of Anna Capri where you can browse small shops and visit the architectural landmark Villa San Michele. With its frescoed walls, mosaic tiled floors, statued gardens and breathtaking views it is a truly spectacular place.

You can also visit the Limoncello factory and do tastings of liquors and chocolates made from the lemons that grow in abundance on terraced gardens all over the Amalfi coast.

If you have time, consider a boat tour to the Blue grotto.

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Visit Duomo di Amalfi and the piazza where tourists and locals alike stroll while munching on gelato.

Pompeii A day trip to Pompeii is an adventure well worth exploring. Captured in time, this historic city was destroyed by the volcanic eruption of MountVesuvius in 70AD. Recently unearthed were well-preserved artifacts, buildings, and even volcanic ash mummified bodies frozen in time. These scenes are emotionally moving. The city is a well-preserved museum with beautiful frescoed walls; mosaic tiled floors and even a Colosseum.

Praiano A quaint side trip is a short drive to Praiano.This is a small village by the sea, where locals sit on benches in courtyards. You may hear footsteps pattering along cobblestoned piazzas. A beautiful ancient cathedral overlooks the ocean. We found a cozy kitchen with two tables and a singing chef who tossed pasta and grilled seafood that made you feel like you were dining in his home.

The path of the Gods This is a 13-mile trail that starts at Bomerano/Nocelle, a small district in the hills of Positano. It is one of the most breathtaking panoramas on earth. It runs through gorges and cliffs in the mountains of the Amalfi coast.

You will walk through quaint towns, vegetable gardens, lemon groves and old vineyards. It's a hike worth doing at least in part.

As time is always a limiting factor, make sure not to wear yourself out. The excitement to see everything can be overwhelming. Just know that a return visit will be even more enjoyable as there are many unexplored areas to enjoy.

So keep your trekking shoes handy---- and Safe

Travels.

B.H.

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A Healthy You

Find the word in the puzzle.

Words ca n go in a ny direction. Words ca n s ha re letters a s they cros s over ea ch other.

alcohol appetite balanced calories carbohydrates cycling dairy

diabetes diet disease energy exercise fat fiber

fitness friendship glucose happiness health jogging leisure

lifestyle muscles oxygen posture protein relaxation sleep

strength sugar training vegetables yoga

GENERAL SURGERY SOLUTIONS

ANTI REFLUX / HIATAL HERNIA SURGERY Minimally Invasive Surgery

WHAT IS A HIATAL HERNIA? A Hiatal Hernia is a space in the diaphragm. Your diaphragm is the muscle that separates the chest and belly. Your stomach may bulge through this hole into your chest and this can make Acid Reflux symptoms worse.

WHAT IS GERD? GERD is a condition that allows food or stomach acid to move from the stomach up to the esophagus. This is called reflux. It can cause discomfort in the chest called heartburn. This happens because there is a weakness in the muscle between the esophagus and the stomach.

WHAT ARE THE SYMPTOMS? Burning and heartburn in the stomach, chest and throat especially after meals.

CAUSES: The cause can be due to several factors. Increasing age, obesity, and smoking are known risk factors in adults.

HOW IS GERD TREATED? This is usually treated medically with diet modifcation cessation of tobacco and alco hol and with weight reduction.

WHEN IS SURGERY INDICATED? When medical treatment fails. Usually patients are on medication for a long period of time and the medication doesn’t control the symptoms anymore. You may develop aspiration pneumonia, hoarseness or chronic cough.

WHAT IS ANTIREFLUX SURGERY? The surgery for GERD is called a Nissen Fundoplication. It is a procedure that tightens the junction between the esophagus and the stomach. This is a minimally invasive surgery that takes about an hour to perform. Usually a Hiatal Hernia Repair is performed in conjunction with the fundoplication. Patients can go home the same day of surgery depending on your overall health.

HIATAL HERNIA

OVERALL PROGNOSIS Anti-refux surgery repair is a safe operation. Heartburn and other symptoms should improve after surgery. There may still be some residual refLux symptoms that will require you to still take antireflux medication after surgery.

There is a possibility of recurrence which means that some people will need another operation in the future to treat new reflux symptoms. This may happen if the stomach was wrapped around the esophagus too tightly, the wrap loosens, or a new hiatal hernia develops.

Possible complications of surgery include difficulty swallowing (dysphagia), difficulty belching if the wrap is too tight and inability to eat certain foods in the future.

ANTI REFLUX SURGERY

45 minute Out Patient Surgery You can go home on the same day

702-384-1160 31

LIFE’S CHOICES......

Be Happy and Free!

B.H.