Managing Holiday Eating

by Ellen Michal, RD, LDN, CDE—Lifestyle and Disease Management Center, Duke Raleigh Hospital

Holidays are a source of great joy. They can also be a stressful time for people trying to prevent weight gain.

Food is part of our culture and opportunities to celebrate begin with Halloween, peak in December and decline by April. This represents half a year of maintaining a vigil against over consumption. Setting up a strategy for each event can overwhelm even the most organized individual. Strategies are great but they can’t compare to a strong daily routine.

Building a daily routine has a number of benefits to keep the extra pounds away. If we practice anything, whether it’s a sport or musical instrument, we become more proficient. As we improve, that practice becomes more embedded in our behavior. When something disrupts the practice cycle we notice it and can respond with minimal effort. The same is true for food. Having a routine increases our awareness. When celebrations happen we are more likely to notice drifting away from a habit and can adjust quickly. How often have we delayed a change by saying, “I’ll start tomorrow,” knowing that we probably won’t. That does not feel good and does not help our self-efficacy. The reverse is also true. When something has been working well we are more likely to say, “I give myself permission to have a tiny piece of cake, but that’s all I need. The way I feel today is much more important than chocolate flavored flour, butter and sugar.” Success begets success.

Let’s start with our mindset. Our thoughts precede our actions. Start thinking about your routine. Being attentive to these concerns drives the thought that drives the action.

Happy holidays!

Try Duke Regional’s Free Electronic Card Service for Patients

ecardDo you have a friend or loved one currently being cared for at Duke Regional Hospital? Use our free electronic card service to send a thoughtful and encouraging message to brighten their day.

Select a design, enter your message, click send, and a hospital volunteer will personally deliver the card to the patient’s room.

This service is available for inpatients currently staying at Duke Regional. We cannot deliver to outpatients or patients in the emergency room. Cards are delivered Monday through Friday; we are unable to deliver cards on holidays.

Click here to show your support and send a message to a loved one today!

Endoscopic and Surgical Treatments for GERD

Gastroesophageal reflux disease (GERD) is a condition in which the contents of the stomach leak backward into the esophagus, or food pipe, causing irritation. (To learn more about the signs and symptoms check out yesterday’s post.)

Minimally invasive endoscopic and surgical treatments have proved to be safe, effective options to cure GERD for good. Stretta Therapy is a minimally invasive and effective bridge between drug therapy and reflux surgery for GERD. This innovative procedure uses radiofrequency energy to treat the muscle of the esophagus, remodeling the tissue and resulting in improved symptoms and a reduction or elimination of medication.

Stretta does not involve incisions or stitches and is performed in an outpatient setting. Stretta is for select patients who have failed to respond to lifestyle changes and drug therapy, who are concerned about the risks of long-term medication and who are not surgical candidates.

EsophyX TIF is a surgical procedure performed through the mouth, which reconstructs the barrier between the stomach and esophagus to prevent stomach fluids from refluxing up into the esophagus. EsophyX TIF involves no incisions, reduced recovery time and no visible scar.

Nissen Fundoplication is a surgical procedure that strengthens the “valve” between the esophagus and the stomach through the process of wrapping the upper curve of the stomach around the lowest portion of the esophagus. This results in stopping acid from backing up into the esophagus as easily. If a person has a hiatal hernia, which can cause GERD, it will also be repaired during this procedure.

The LINX Reflux Management System is a small flexible band made of interlinked titanium beads with magnetic cores that is placed around the esophagus. The magnetic pull between the beads is intended to help the Lower Esophageal Sphincter (LES) resist opening to gastric pressures, thus preventing reflux from the stomach into the esophagus. When swallowing normally, the LINX system is structured to expand, allowing food and liquid to pass normally into the stomach. The magnetic pull of the device is designed to close the LES immediately after swallowing, thus restoring the body’s natural barrier to reflux.

Weight Loss Surgery may be an effective option for individuals struggling with excess weight as traditional reflux procedures may not be as effective.

Barrett’s Esophagus
Over time, persistent exposure of the delicate tissue of the esophagus to the acid content of the stomach can cause chronic inflammation of esophagitis, which can lead to a potentially serious condition called Barrett’s Esophagus.

The Barrx Radiofrequency Ablation System utilizes high thermal energy delivered using a 3cm-long coil mounted on a balloon catheter. Ablation destroys abnormal cells to allow normal cells to re-populate.

Learn more about treatment of GERD at a free seminar. Click here to register.

GERD Signs and Symptoms

Studies show one in three people suffer from gastroesophageal reflux disease (GERD). GERD is a condition in which the contents of the stomach leak backward into the esophagus, or food pipe, causing irritation.

Symptoms of GERD include:

  • Heartburn
  • Hoarseness or sore throat
  • Chronic laryngitis
  • Regurgitation
  • Frequent swallowing or difficulty swallowing
  • Asthma or asthma-like symptoms
  • Pain or discomfort in the chest
  • Sleep disruption
  • Bloating
  • Excessive clearing of the throat
  • Persistent cough
  • Burning in the mouth or throat
  • Intolerance of certain foods
  • Dental erosions or therapy-resistant gum disease or inflammation

In addition to dietary controls, medications such as non-prescription antacids, proton pump inhibitors (PPIs) and H2 blockers help prevent the acceleration of GERD. Over time these medications may lose their effectiveness, requiring increased dosage. This can become expensive and risk long-term side effects. Check out our blog tomorrow to learn endoscopic and surgical treatments for GERD.

Is the Lap-Band System the right fit for you?

For some people, a healthy diet and rigorous exercise isn’t enough for dramatic weight loss. The Duke Center for Metabolic and Weight Loss Surgery specializes in weight-loss surgery options to fit people in all stages of obesity.

The Lap-Band System may be the right fit for you if:

  • You want to lose as little as 30 pounds.
  • You have a BMI of at least 30 with one or more co-morbidities, or you have a BMI of at least 40.
  • You have not had success with traditional weight-loss attempts through diet and exercise.
  • You are not currently suffering from another disease that may be related to your excess weight.
  • You are prepared to make a healthy lifestyle change.
  • You are at least 18 years old.
  • You do not drink alcohol in excess.

How does it work?
The Lap-Band System is placed around the stomach reducing the amount of food you take in. This allows you to feel full faster and for a longer period of time. This procedure is performed with minimally invasive surgical techniques, which lead to less pain, minimal scarring and a quicker recovery.

Weight loss is gradual, but patients experience significant reduction in obesity-related complications including heart disease, type 2 diabetes, sleep apnea and joint pain. Patients typically lose about 30-40 percent of excess weight one to five years following surgery. The exact amount of weight you lose will depend on your compliance with the dietary instructions and your tolerance to adjustments to the tightness of the band.

Learn more about the Lap-Band System at a free seminar. Click here to register.

A Different Approach to Cardiac Catheterization

Traditional cardiac catheterization procedures are done by a femoral approach, in which a physician accesses the heart through the femoral artery in the groin to diagnose or treat heart problems. Duke Regional now offers a different approach through the radial artery in the wrist.

Entering through the wrist decreases patients’ risk of bleeding after the procedure and can be more comfortable. After treatment with the femoral approach patients have to lay flat on their back for hours while pressure is applied to the site to reduce blood loss. With the radial approach, patients wear a compression cuff to apply pressure, and they are able to sit up, eat and move while they are recovering.

While most patients can have a radial procedure, some with very small or blocked radial arteries and patients on dialysis may be better treated from a traditional femoral artery approach. Before starting the procedure, the physician always checks to make sure there is good blood supply to the patient’s hand through both the radial and the ulnar artery. If there isn’t, the physician will not use this approach.

If you need a cardiac catheterization your physician will discuss your options and decide the best method for your particular case. Not all physicians are trained in the radial method. At Duke Regional, J. Matthew Brennan, MD has been using this method since 2007 and uses it on 90 percent of his patients. Other heart specialists are currently undergoing training.

Click here to learn more about heart services offered at Duke Regional.