Rudolf Weiner

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: I’m Professor Weiner’s, Frankenstein, he created me. It’s been wonderful, it’s really changed my life, and I really want to talk to you.

: See I turned out good, I kept e-mailing him and telling him there was really a good looking woman under all that fat, and I had to come back to Frankfurt and show him.

: That’s great. Hi, this is Roberta Speyer; I’m President of MediSpecialty and home of OBGYN.net. This is another series in our follow-up of my surgery. I had the lap band surgery at the end of December of 1999 and now it’s the middle of or close to the end of August so it’s been about eight months since I had the surgery, and a lot has happened since then. I’m back in Frankfurt, and I’m going to have a fill procedure that’s going to help me lose the final amount of weight that I want to lose. I’m here with Professor Rudolf Weiner who performed the surgery and who is one of the innovators of this procedure. We’re going to talk a little bit about what’s been going on since then. How have you been doing? Have you been doing more procedures since me?

: Everyday, everyday another fat girl. Is it mostly women that have the surgery?

: Yes, more than 80% are women and 15% are men but mostly between the ages of 20-40 years.

: Twenty and forty years, wow, I was a little bit old then for the procedure but I’ve certainly been happy with the results. You can see the difference, yes?

: I lost twenty-five pounds in the first month and a half. I wasn’t eating very much at all and then I started to be able to eat more but continued to lose weight, and then I felt like I was eating perhaps too much and stabilized at about two and a half months in the middle of March. At that point, you exchanged some e-mails with a radiologist in Austin. We had our Publisher, Dr. Marshall Smith, looking for someone and we found someone and you all got connected. He was willing to try it and I went in. It was interesting when he put the needle in, all the fluid blew out in his face and he didn’t realize that it was under pressure apparently but you had suggested at that time that they put in 3 cc’s. They had me swallow afterwards and the fluid was stacking in the esophagus, and he suggested especially because I was leaving the very next day for a week for a business trip that I didn’t want to be in a position where I was out of town so he would only do two and if that didn’t work I could come back. What actually happened was after I had the fill with just the 2 cc’s - it was perfect. I have had a few instances maybe in the last five and a half months probably ten times where I’ve eaten something, and maybe I was talking or I swallowed too quickly, and I’d feel like it was stuck. Then if I ate something else before I realized that, I would end up going to the ladies room and throwing up but not very much because you know it’s really just what’s stuck there at that point. But that’s really not bad, I mean I don’t find that difficult.

: If you have a band, you have to learn to eat slowly and…

: I’m in good but you know I’m in sales, Professor Weiner, and sometimes I’m there closing someone over a business dinner and all I’m thinking about is the sale, I’m not thinking about the band and that’s when it happens.

: In the first six months you’re losing most of the weight and then it slows down but you have time - two years.

: To find out what your optimal weight is.

: I have hit a plateau with my weight; I weigh about 202 pounds. What would 200 pounds be in European weight?

: That’s not too much, 200 would be 110 kilograms. A lot of our patients have more than 150 kilograms so normally more than 150 for 300 pounds or more.

: But I weigh 115 kilograms now. I’m not sure how much I weighed, about 270 pounds, so that would be how many kilograms? I was right on the borderline for the procedure.

: I’ve lost the 70 pounds but now it’s started to plateau. It’s very frustrating to me because it’s 202 pounds, and I just want to get it below 200. I just want that big thing on the scale not to have to get moved over, it would make me very happy. So I really think at this point my idea is, and I want to discuss it and see if you think it makes sense, I think when we do this fill that we’re going to do today, it’s going to be very restrictive for me. I’m probably not going to eat normal food, and right now I eat normal food.

: But food or the energy is one problem but when you lose a lot of body weight you are able to have more movement so it is necessary to have sports or physical activities.

: I dance and have sex. So it’s sports for the sex...

: Walk everywhere and don’t use elevators, this is very important.

: I do, I get much more physical activity - bicycling, walking, and dancing. I dance in my office at home to music; I don’t like doing exercises but I like dancing so I play music and I dance very strenuously. I find my energy level is so much higher and, also, I don’t sleep as much. I have much more energy during the day and I only sleep five hours a night instead of seven now. I was never a person who required a lot of sleep now I require practically none. I think the fill is going to be very restrictive but I think it may work and I want your advice if I do this. I would like to lose 40 more pounds, and I’d like to weigh about 160.

: No problem, what you need is some time, maybe it’s better to lose this forty pounds in six or nine months and not too fast.

: Why is that? Because I like to do things fast so why do I not want to do this fast?

: If you have a fast weight loss, you can have some other problems.

: If you lose body weight fast, you can have problems with your heart function, maybe problems with liver function, and you’ll have cosmetic problems of the skin. If you have a slower decreasing of your body weight, plastic surgery might not be necessary because the skin can move.

: I was going to ask you about that, I do have this loose skin on my arms.

: And on the side right there, I’m wondering is this ever going to go away or am I going to have to have an operation and have that tucked, what do you think, or is there an exercise I can do? What’s the story with the bat wing?

: Exercise is not necessary, you have to use creams on your skin and you have swimming and other things but the decision for plastic surgery we can have two years after the procedure. If you are stable, we can look at what is necessary.

: God, you just keep making me more and more beautiful. It will be frightening, I’ll be so good looking by then I’ll be ready to be fifty years old and it will all fall apart anyway. But you think that losing this next forty pounds I shouldn’t try to lose it too quickly, that would not be a good idea?

: You have enough time, it is better to have a long stable period and then you can find your best optimal weight. Don’t look to the scale, look at what your body type is, don’t try to be like Twiggy.

: I don’t think I could be a Twiggy. I don’t think I’m the Twiggy type but I think from my experiences in my life when I was younger, I think 160-165 pounds even though that is fairly heavy for a woman that’s about 5’5. I think it would be good for me for several reasons, one - I have very large bones, I have size 10 feet, and I have a large head. I’m not a small petite built person. Also, I’m afraid that if I did lose too much weight then I would have the problem with me looking more wrinkly so I’d rather leave a little adipose tissue in there so we don’t have to see how old I really am. With the next weight loss, after I have this, is there a possibility that I might then take back some of the fluid back out or will I always leave it at whatever I am at?

: Normally, the patient has one or two fillings when we still want less body weight, and after the stabilizing no change is necessary and no filling and…

: Removing, but if you have a situation like a pregnancy, it is necessary to remove it.

: Oh, my God, let’s hope we’re not removing it because the President has become pregnant. I think that’s hardly likely but what if someone has a fill and it’s too restrictive, they’re vomiting a lot, and they’re hardly able to eat? They’ll certainly lose weight quickly but…

: This is a reason, yes. If you are vomiting, you need instruction on how to eat, this is necessary.

: Right now I can eat almost anything, I just eat very small amounts of it. I can eat meat and I can eat asparagus.

: No hunger feeling and I also have no desire for sweets. For some reason I’ve lost any interest, I don’t even eat ice cream anymore.

: That’s good, because if you have a lap band, you can have an increase of your body weight with using soft drinks which is a danger.

: I find sometimes that carbonated beverages, especially if I’m having food, do not agree with me. Beer - I used to love to drink beer but I don’t drink beer anymore, of course, a nice vodka gimlet straight up with Stolichnaya vodka nearby goes down very well still. So now we’re going to go in and we’re going to do some filming of the actual procedure. 

: All right, I’m in for the fill. They told me to get up on the table and lay down and promised they’re not going to hurt me but we’ll see, it’s all going to be filmed if they’re lying.

: Oh, my goodness, all my fans on OBGYN.net she opens the gown. At least she’s not as fat as she was the last time. Professor, I have the film of when I was being wheeled into the operating room, it looked like the Queen Mary pulling into the port. So what am I seeing up here? Is that my band?

: This is your back bone, this is the lower part of the lung, your heart, and this is the band and now you take a drink.

: No, only a mouth full and don’t swallow. Now please swallow it down and we can see the contrast media on the screen.

: That stuff tastes terrible. We have much better tasting barium in the United States.

: This is pure dye. Stand on your feet please. Take another.

: This stuff is just so good I just can’t quit. Can I have all of this?

: Quick, some lime. So what are we looking at here, what’s happening, is it going anywhere?

: It’s just going through the band into your stomach.

: I think it’s slow enough, this is the part before the band and this is the part after the band and I think it’s not too much.

: In my opinion, the size of the stoma is correct.

: So you think I shouldn’t get a fill. I should just not be so eager to lose the weight quite so fast again? 

: Yes, slowly in this period for your weight loss. We sometimes have a period of three or four weeks where your stable and you don’t lose weight, it’s because you’re moving more and you have more muscle.

: I’m happy, I can eat. I eat very little and I have up until a few weeks ago been losing weight. I don’t vomit which I don’t want to because that’s not something that anyone would want and if you think that I will continue to lose weight especially if I perhaps stayed away from fried foods which I do like.

: No, sometimes there’s a period of one month, for example, after you’re losing your weight again because you are able to have more movement and you’re walking so you actually have more muscles. You’re losing fat but you’re getting more muscles.

: Interestingly to what you’re saying, in the last month I haven’t lost any weight, but I’ve changed my clothing size because you think the shifting around, I guess, and it’s more muscle.

: The best thing if you are changing your body composition, nutrition, and your movement behavior is you should measure the composition of your body. In Germany we now have the possibility to buy body fat monitors because it is a scale or a little device to put between your fingers and this machine measures by sending some electricity through your body. It measures the composition - if it’s too much fat, too much liquid, or how much muscle is in the composition of the body. So you can track the alterations of your body composition and so you have control. If your weight is stable it might be that you built up more muscle and use that anyway. If you only go on the scale everyday or every week, it’s not enough.

: I think with the increasing lean body mass and the fat mass is decreasing, we have a change and sometimes we have a stable body weight but you have a loss of body fat. But this stable body weight is caused by an increase of lean body mass, muscles, for example. You’re able to have sporting activities and, in fact, there’s the filling of the band. To summarize, it’s correctly at the very nice small pouch and you have good transportation and I’m sure you’ll be able to lose weight next month.

: Do you think it’s realistic for me to expect in the next year to lose this other forty pounds? Do you think that will happen?

: What recommendations do you have for me to help make that be the best possible way for losing it? Are there certain foods I should be trying to avoid? Is there activities that I should be increasing like my cardiovascular activity?

: There are two points - no fats in your meals because that’s your high energy of fat, the other point is to increase the sporting activities. You’ll have more energy for your muscles and you take up a lower rate of energy.

: I was thinking of taking up tennis, would that be a good activity?

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OBGYN.net Broadcasting present Part VIII of a series on Weight Loss Surgery. This series is unique in that we follow the patient from pre-op to one year post-op.

PART VIII - 9 Month Follow-Up Visit Text

 <a href="surgery_part_viii.rm"> Click here to experience the presentation </a> 


OBGYN.net Broadcasting present Part VIII of a series on Weight Loss Surgery. This series is unique in that we follow the patient from pre-op to one year post-op. Funding for this project was made possible by InnerDyne®, Inc., BioEnterics, Corp., and Richard Wolf Instruments. The patient is Roberta Speyer, Publisher of OBGYN.net and her surgeon is Dr. Rudolf Weiner.

At this time, three years post-op, Roberta is satisfied with the outcome of her surgery and hopes you have found her story helpful in your search for answers. Please direct any questions about LAP BAND surgery to your personal physician, or email the product makers directly at: 

http://www.inamed.com/contact/bio_patient.cgi

.  Due to time restraints Roberta Speyer and the OBGYN.net team cannot respond to personal emails. 

See Professor Rudolf Weiner's website about Weight Loss Surgery to see if this option is right for you. Visit 

click on the play button above to start the video

You will need RealPlayer to download the streaming video of this presentation. If you need a FREE copy of RealPlayer you can download it 

PART VIII - 9 Month Follow-Up Visit Video

 "Hello, I'm Mark Smith and it's now been four months since December when Roberta had her surgery in Germany. We're sitting here today to talk with her a little bit, we want to get some follow-up on how she's doing and, basically, what has happened in the four months since she and I went to Germany and she had the surgery - Roberta."



 "The first thing that I think everybody wants to know is did I lose any weight, and I hope you can tell from this film - yes, I've lost 43 pounds which is absolutely phenomenal to me. I've never lost 43 pounds in my life, the most I every lost when I was starving and dieting and taking diet pills was maybe 30- 35 pounds. So this is the single largest weight loss I've ever experienced. There's been a lot that's gone along with it, and that's what I think is important for me to share with all of you. When you watched my other interviews, especially the one right before the surgery, I talked about what it was like being fat and what it was like growing up as a fat kid. I talked about the fact that I had a wonderful life, a wonderful career, and a wonderful family. Yet, this fat issue was something that you carried with you everyday and people saw that you were fat before you even were able to open your mouth, and people made assumptions about you and how difficult it was. I guess technically I'm still fat; I weigh 225 pounds now instead of 268. But the funny thing is if you weigh 225 pounds on the way up it's terrible, but when you weigh it on the way down it's marvelous, so I guess everything is you're perspective at the time. I realized some things now that I didn't realize before, and that was it wasn't just how other people perceived me that was difficult to live with, it was how I perceived myself. The weight loss has given me so much more confidence, it's made me much more happy to be inside my own body. I dress better, I wear makeup, I do my hair, I'm happier, and I have more patience with people. A lot of things have changed, I think. Have you noticed these changes working with me?"



: "Everyone is commenting on just how happy you seem these days."



 "I am, it's changing my life and it's a feeling almost like being released from some sort of prison that I was trapped in, and now I can see endless possibilities. I can see that Dr. Weiner was correct, if I've lost 43 pounds in four months, it's not unbelievable for me to think that I'll lose 100 pounds in a year. But really the most wonderful thing about having had the lap band is knowing that I won't lose it and that it will come back. It's truly a loss and it will be gone forever. I don't have a particularly high fill; a fill is when they go in after the surgery and they put fluid into the port that they inserted during the surgery that you saw. I believe the port holds up to 5 mm's?" 



 "Five cc's, five mm's - what would that be like - a martini? Five cc's and that is absolutely full and most people don't have it that full at any point, but I only have two so I actually have a lot more room for even more appetite suppression. I haven't felt and Dr. Mark hasn't felt that I need to do that because I'm having such good results with the two cc's that I have now. If I start to plateau, if that starts to become a problem, then I have that option. The good thing about only having the 2 cc's for me is that I'm not suffering from problems with eating foods and having trouble with emesis or vomiting, as we all know it to be. It's happened a few times, maybe five, since I had the surgery. Usually when it happens, it's because I've eaten something out at a restaurant that is fairly fibrous like meat or one night it was steamed mussels. I'm a very animated person and I'll be talking and not chewing my food well enough and you swallow it and you're really swallowing a piece of food that's rather large. It would come down to that point of restriction and get stuck there, then you'd have a  drink and another bite before you realized things weren't moving. At that point, the only way for it to move is up and out but it's not as bad as it sounds because most of us when we think of having a problem of vomiting, it's usually because we're really very sick or we have food poisoning, and it's just a horrible thing. This isn't like that at all because the food isn't processed food in any way, and it's almost like if you coughed something back up because you swallowed it the wrong way, so it's not that offensive. I do have a funny story about that though, the first time it happened I was with our CEO of our company, Jim Edlund, and we were at the top of the Rockefeller Center at the Rainbow Room. They had these beautiful fillet mignons at this party we were at, and I thought I'd just try a little bit; it's very tender. Immediately after eating it, I knew I shouldn't have eaten it. So I went into the restroom and it's a very posh restaurant and they had the lotions and the attendant. I went in and I couldn't get it up so I finally decided I had to put my finger down my throat and make myself throw this stuff up so I could go back to this party, and I'd been in there for fifteen minutes. So I did and I finished what I had to do, opened the bathroom door, and I walked out. A woman looked up and her eyes opened up and I suddenly realized she thought I must be bulimic so she was expecting this skinny little girl to come out of the stall, and I came clomping out. Our Editor, Barbara, said I should have said to her - well, you have to start somewhere.

We thought that was kind of a funny joke that I wanted to share with you. But really I would say that the main points for me that this weight loss has accomplished is a feeling of control over my own life, a feeling of satisfaction with myself, and also from a health standpoint, let me hit on that, I'm not as tired as I was. I have far more energy, I get into work early, and I stay late. I don't have to take a little nap in the afternoon like I used to want to after lunch because I don't have lunch. I don't have the obsession or the constant thoughts of food. After I first had the surgery, I still think I felt the same way about food and wanted food, I just couldn't eat as much. But over the four months, especially I would say maybe in the last month, I've noticed a real evolution in my attitude towards food. If I go to a party and there's food sitting around, I talk to the people first and then eventually I wander over to the buffet table and have something to eat. I'm not focusing on the food. I don't enjoy grocery shopping as much as I used to, I just don't care about it. I like nice food, I've always liked nice food but I'm very satisfied with incredibly small portions. I think I probably eat about a quarter of the volume of food.

So have I been dieting a lot? Two things that were stressed to me before this surgery was that I had to diet and I had to exercise. I have to tell you, I've just been a very naughty girl. I travel an incredible amount for work and other than the fact that when I'm in Europe and on the road I'm walking a lot and carrying all that computer equipment, I haven't exercised. I haven't done that, and I think maybe that's something in the next four months I want to try doing more of now that I feel better about myself. It's pretty hard to put on a leotard and go into a gym when you feel like a cow so now that I'm starting to feel a little better about myself, I'm going to try to push that as my next goal and do more exercise. But no, I really don't diet because I don't eat that much. If I want to have a little bite of something, it doesn't really matter what it is. Do you understand what I'm saying? If I see a dessert and I want to taste it, I'll have one spoonful. I'll taste it, that was nice and it satisfies me, and I don't have any cravings for food. My whole attitude about food and the importance it plays in my life and just the amount of brain cells I devoted to thinking about it, I really think all that has now been freed up for other things - maybe for thinking about how I look, doing my hair, doing things with my career, or my family. So it's like it's given me back time, which is an interesting revelation. What do you think? Because Mark and I work together everyday, of course, I work far more than he does but what have you noticed about me?"



 "What have you noticed different in these four months in this evolution because what I'm talking about is how it feels being inside this body and looking out but you see it from a different perspective. Would you mind sharing that with our viewers?"



 "Sure, I think in watching Roberta for years before - I knew her before the surgery - and then watching the change over the last four months, there's really been some very dramatic transformations. You can just tell she's happier; she's happier with herself, her job, and her life. Little things don't bother her, not that they ever really bothered you but..."



 "They always bothered me, they still do."



 "But she laughs much more, she's just happier. We've all gone through periods like that but we can tell. People that are around her have commented she's just happier with herself, and I think that stems from what she mentioned and alluded to earlier about her own self image. There's no question on the health benefits or the decreased disease conditions with the loss of weight but in all levels of attempts at weight control, whether it's under or over, the person's self-image is a very, very important part of that. Even the people that try to lose weight below the normal body weight have the same types of problems, and that's what's so critical. It's become very, very obvious that her own self-image of herself has really improved, and we're very happy to see that."



 "Of course, they were living with the beast. Interestingly enough, after I had the fill I was leaving for a business trip for two weeks to Europe. We had discussed that maybe I had reached a plateau for about a month - I was at 25-pound weight loss and hadn't lost any weight - and we were thinking maybe it was time to have another fill. The paradigm shift really started to happen while I was in Europe, and I think it was because I was away from my usual lifestyle. I was away from my family, having to cook, and having to be around food so much so I had two weeks where I was really out of my usual routine, and during that time I now have noticed is when I really started to change my attitude about food. Then because of that attitude change where food started to be playing a less significant role in my thought process in my life, I went from maybe eating a third as much as I usually did to a quarter. Then it kicked in and I had another weight loss without having another fill. So I think that's a very telling and interesting point for people to consider, and that is there's the restriction that the lap band surgery provides for you and that's a tool to help you control your appetite. But as you start to lose weight and change your feelings about yourself, food, and the importance it plays in your life, there's another whole benefit that you gain in your ability to lose weight that is beyond just the restriction."



 "That brings up two good points, Roberta. I think the first is the fact that anyone that works with weight control and attempts at weight loss know very well that it's not just the function of losing weight, it involves behavioral changes. Changes in behavioral habits, modifications of your whole way of looking at food, eating food, and the thing that's so difficult to that is that it's very hard to make those changes and a whole set of habits and behaviors that we have unless there's positive feedback. So until you start losing the weight and you get the positive feedback, then it's very difficult to undergo those changes and be motivated to make those internal behavioral type changes. The second thing is that it takes a while when people start dieting that we say - you have to undergo mental changes. You just can't do that overnight, it takes a while to develop those changes and modify them inside, like you say. So what you're seeing is the thing that everyone requests when they work with people that are trying to lose weight and that is you've got to accompany it with behavioral changes itself. I think you've done a very good job of losing weight, and I think the audience is probably astounded right now."




: "You started with the adjustable band, but it was replaced?"



: "It was adjustable. The rubber band was developed in the eighties by the same company that also produced it, and then we made adjustments. They made it better by changing the sizes. Now we have this lap band in three sizes, and we have a safe technique with very good experience."



: "I'm very, very happy I did this. I know when they were wheeling me down to the surgery, I had that moment when I was thinking, 'why am I doing this?' But now that it's over, I really have to say that it was not as difficult as I feared it would be. I can already see that it's going to make a huge difference in my life, and it's going to improve it greatly. I'm really just delighted that I chose this procedure over any of the others. I think I'm going to have a much better outcome because of it."



: "I have one comment on the topic of pain. You really don't have pain, but it is important that we are using no-cutting trocars, or non-sharp trocars. We are using dilation techniques, the step system, and there is no cutting of your muscle."



: "That's the InnerDyne trocar, correct?"



: "What is different about that than a traditional trocar? Why is that causing me less pain?"



: "There's no cutting of the tissue of the abdominal wall - it's only dilation. After removal of this trocar, of this step system, you have a very small defect and, therefore, less pain. This technique is also much safer. You have very little danger of organ injury or of muscular injury, so this is very safe technique."



: "The highest incidence of morbidity is trocar injury with this procedure, if you don't use this, isn't it?"



: "Yes. But we have this step system now, and morbidity is 0%."



: "Fabulous. Thank you very much. Thank you for taking on this case and doing such a wonderful job with me. I really appreciate it very much, doctor, and I'm looking forward to seeing you again. We'll be following up in the future with the new and improved Roberta!"

OBGYN.net Broadcasting presents Part VII of a series on Weight Loss Surgery. This series is unique in that we follow the patient from pre-op to one year post-op.

Part VII -  4 Months Post-Op Text

At this time, three years post-op, Roberta is satisfied with the outcome of her surgery and hopes you have found her story helpful in your search for answers.

Author | Rudolf Weiner

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