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<**MODERATOR**> KOLLADY YOU HAVE THE FIRST QUESTION PLEASE:)
<kollady pre-op> Dr. I'm having a really hard time on the stop
smoking thing and my surgery is 10 days away. I have went to a pack every
2-3 days is it going to cause to much trouble with my surgery?
<Dr. Simpson> Smoking is something that inhibits
the wound healing after surgery. It is something that increases the risk
of pulmonary problems....
<Dr. Simpson> as well as other things which
heal. So, if you can it would be good to stop smoking....
<kollady pre-op> what if I can't
<Dr. Simpson> you can quit for a few days,
and you should-- you are having your body changed for a life change...
<kollady pre-op> ok ty
<Dr. Simpson> so make the full move. You
won't be able to smoke in the hospital, and you will never be able to
...
<Dr. Simpson> smoke in the operating room-=--
too much gas....
<Dr. Simpson> some of us don't operate on
patients who smoke-- so you have to ask your surgeon about that...
<kollady pre-op> ok ty
<Dr. Simpson> if my patients cannot quit,
we do not operate. Simple. So, good luck. Change your life, stop smoking...
<Dr. Simpson> good luck.
<**MODERATOR**> OHIODAVE YOU HAVE THE NEXT QUESTION PLEASE:)
<OhioDave 3lbs2Goal> Dr Simpson, Whats the quickest way to get
off a plateau so I can shed these 3 pounds and get to goal?
<Dr. Simpson> WALK......
<Dr. Simpson> you need to walk, walk some
more, and walk again....
<OhioDave 3lbs2Goal> already doin it
<Dr. Simpson> the longer the faster=-=
<Dr. Simpson> well guess what-0
<Dr. Simpson> walk even more
<OhioDave 3lbs2Goal> ok lol
<Dr. Simpson> there is no end-- you are in
Ohio, I am in Arizona, see you in a day or two...
<OhioDave 3lbs2Goal> ty
<Dr. Simpson> keep walking, that is the fastest
way to do it. Oh, and limit carbohydrates to 40 grams per day
<Dr. Simpson> good luck-- also=-- lots of
protein, lots of water, and lots of walking. Walk 45 minutes, fast, every
day.
<Dr. Simpson> good luck.
<**MODERATOR**> MARILYN NYC YOU HAVE THE NEXT QUESTION FOR
OUR GUEST:)
<Marilyn-NYC 2 weeks> I'm having surgery in 2 weeks, is it a good
idea to have my gallbladder removed at time of surgery? I hear that its
a good thing to do because it's going to get stones anyway from the nutrition
change.
<Dr. Simpson> Some surgeons remove them,
some do not. Altogether, about 40 per cent of people who have the surgery
and do not have their gallbladders...
<Dr. Simpson> removed will end up with stones
and problems, and will have their gallbladder out. So, check with your
surgeon....
<Marilyn-NYC 2 weeks> ok thanks
<Dr. Simpson> I take gallbladders out as
a matter of routine with the surgery, but I think that you should....
<Dr. Simpson> consider that some surgeons
do not. Hey-- gives us something to do later. Good luck
<Marilyn-NYC 2 weeks> i want it out
<Dr. Simpson> Take it out
<Dr. Simpson> out it goes. Makes good soup.
<Marilyn-NYC 2 weeks> lol ok ty
<**MODERATOR**> STEPHI AZ YOU HAVE THE NEXT QUESTION:)
<StephiAZ(-90/21wks)> Not a question just a comment: This is the
first time I have looked forward to the New Year. Thank you for saving
my life Dr S! You are the best!!
<Dr. Simpson> Thanks mom
<StephiAZ(-90/21wks)> LOL
<Dr. Simpson> no, that is Stephi, she is one
of my patients...
<Dr. Simpson> thanks.
<**MODERATOR**> KATHIE/HI YOU HAVE THE NEXT QUESTION PLEASE:)
<Kathie/HI(-110/5mos)> Dr. Simpson... Aloha!! My question has to
do with the volume of food that I should be eating at five months out.
How much food in volume and calories should I be consuming at this point
in time. There are days when I feel like I can eat a whole lot and worry
that I might be eating too much. I try to keep it in perspective, but
it still worries me. Any suggestions? Also, PROTEIN!! How much of our
diet should consist of protein, carbs, etc. ?? My loss is slowing down
and I want to make sure that I do as much as I can to optimize my weight
loss. Thanks!! (I know!! WALK, WATER, PROTEIN!! Will walk to Arizona too!
lol)
<Dr. Simpson> Hi Kathie-- Kathie would have
been my patient but we couldn't get he operating room to go on the 17th
hold of one of the golf courses in Hawaii....
<Marly/NJ> my consultation is in two months-can't wait
<Kathie/HI(-110/5mos)> Dr S... lol
<Dr. Simpson> you should continue to watch
the volume of food you eat, and eyeball everything. The pouch does stretch
over time...
<MelissaNY> Good Evening Dr. Simpson
<Dr. Simpson> and I think that you might
be up to two ounces by now. In terms of protein, you need at least 40
grams per day, although you can have more...
<Kathie/HI(-110/5mos)> I try to aim for 75... too much?
<Dr. Simpson> if you had a distal you certainly
can have up to 80 grams of protein a day, even more. In terms of carbohydrates,
that is where the weight will come ....
<Dr. Simpson> so, limit carbs to less than
40 a day to lose, and less than 60 a day to maintain...
<Dr. Simpson> 75 grams of protein (not ounces)
is not too much.....
<Dr. Simpson> forget calories. Just walk
a lot. Walk the course, don't take the carts-- I'll drive the cart. Good
luck.
<Kathie/HI(-110/5mos)> Dr. S. Thanks! You are a doll!!!
<**MODERATOR**> BIG GIRL YOU HAVE THE NEXT QUESTION:)
<BIG GIRL> I am a 43 yr. female wt.406 ht 5'9 what will i feel
when i wake from the surgery, i also have hypertension and sleep apnea
, what changes can iexpect after surgery,i HAVE a bmi of 60 this scares
the heck out of me, my gallbladder was removed 20ys ago will this make
the surgery longer or shorter?
<Dr. Simpson> When you wake up from surgery
you will be happy that it is over, and now you have to work on the program.....
<Dr. Simpson> your gallbladder removed will
not either save time, or take more time......
<BIG GIRL> how do i handle the fear of anes
<Dr. Simpson> in terms of changes after surgery,
it will take about 150 lbs to get rid of the apnea, although it might
be less...
<Dr. Simpson> you need to follow the hypertension
medicines with your primary care doctor....
<Dr. Simpson> in terms of anesthesia---YOU
WILL WAKE UP--- honest
<Dr. Simpson> If you don't, then come see
me.
<BIG GIRL> thank you i feel better
<BIG GIRL> lol
<Dr. Simpson> Seriously-- you will do fine--
it is the best thing you can do for yourself. If you wake up in a hot
place, it is like Arizona, don't worry, I will be along soon.
<**MODERATOR**> MORY YOU HAVE THE NEXT QUESTION:)
<Mory> What is MGB and how is it different from RNY?
<Dr. Simpson> :Miller Genuine Beer???
<Dr. Simpson> I don't know what MGB is--
thought it was a studio in Hollywood-- oh that is MGM.....
<Dr. Simpson> Mini gastric bypass is what
it is....
<Dr. Simpson> and it is not a Roux en Y loop,
it is not a surgery which is recommended....
<Dr. Simpson> by the American Board of Bariatric
Surgeons, it allows too much bile to end up in the pouch causing a
<Dr. Simpson> bile gastritis-- and can lead
to a lot of problems. Not a surgery we would recommend, and not a way
you want to go.
<Dr. Simpson> good luck.
<**MODERATOR**> CT-CHERYL YOU HAVE THE NEXT QUESTION:)
<CT-Cheryl> does everyone have to have a drain put in post RNY
and why?
<Dr. Simpson> Every surgeon is different,
some do put drains in their patients, with the idea if there is a leak....
<Dr. Simpson> then the leak is contained,
and can drain without having to go back to the operating room....
<Dr. Simpson> however, it is unnecessary,
some other surgeons feel, so some do not do it. ..
<CT-Cheryl> doesn't sound very pleasant, but thanks for the info
<Dr. Simpson> I never put one in, but I have
a lot of good friends who do. Habits are hard to break.
<Dr. Simpson> They are not unpleasant, they
are fine. They work well if you need them, and if you do not-- well, then
they are a bit of a nuisance.
<CT-Cheryl> well thanks!
<Dr. Simpson> Surgeons do follow what they
do with their own patients-- and you don't want to change what they do.
<**MODERATOR**> KELLI YOU HAVE THE NEXT QUESTION:)
<kelli> What is your best recommendation for dealing with head
hunger. I'm afraid of falling back into old habits. Therapy? Behavior
modification meds? I'm 8 months post-op, 20 lbs. from goal. Thanks.
<Dr. Simpson> Change heads.
<Dr. Simpson> Head hunger is where the body
is starting to process the fat, and it is thinking...
<kelli> ... if only!
<Dr. Simpson> that it needs food to sustain
that. So, when you feel the head hunger, realize it is your body metabolizing
its fat stores...
<Dr. Simpson> and wanting to replace them.
If you want your body to replace those fat stores, then eat, if you do
not, then ...
<Dr. Simpson> listen to your stomach, keep
it full with good quality protein, like tuna, fish, etc. and realize...
<Dr. Simpson> that you want your body to
not only get rid of the fat, but reset its own internal fat thermostat
to "skinny."
<Dr. Simpson> good luck
<**MODERATOR**> STACI YOU HAVE THE NEXT QUESTION PLEASE:)
<Stacy> > What is the difference between distal and proximal?
<Dr. Simpson> Proximal bypass is what is
most commonly done in the US>, and most people who are at goal....
<Dr. Simpson> such as Madison here, had a
proximal bypass. That is where about 15 per cent of the gut is bypassed....
<Dr. Simpson> allowing malabsorption of about
ten per cent. Distal is about 60 per cent of the gut is bypassed...
<Dr. Simpson> which you don't need unless
you have fat as a high portion of your diet....
<Dr. Simpson> or you have a duodenal switch,
where we do that as a matter of the operation....
<Dr. Simpson> both surgeries work well for
weight loss.
<Stacy> Ok thanks that helps clear things up a bit =)
<Dr. Simpson> also we do distal for patients
who live in the south.
<**MODERATOR**> JOAN YOU HAVE THE NEXT QUESTION PLEASE:)
<joan> How long are the tubes left in you for breathing after
lap surgery??, Also, how often does lap surgery turn into an open surgery
<Dr. Simpson> breathing tubes are taken out
usually before you get to the recovery room unless there is some reason
to leave them in....
<Dr. Simpson> such as a prolonged surgery,
or concern that the patient will not be able to breathe without the tube....
<Dr. Simpson> and lap surgery conversion
is surgeon dependent... all surgeons keep their own statistics...
<joan> so, I shouldn't wake up with them in me,
<Dr. Simpson> so, some surgeons convert ten
per cent of the time, some only three per cent. It is dependent on the
patients...
<Dr. Simpson> and how well versed the surgeon
is, or how comfortable they feel, or a lot of things over which you have
no control...
<Dr. Simpson> no, you won't wake up with
the tube, or you won't remember it.
<joan> How long is the recovery trully from lap surgery
<Dr. Simpson> Your recovery time from lap
surgery is dependent upon you, and what happens to you....
<Dr. Simpson> sometimes we say that patients
can be back at work in three weeks-- although that is a bit of a stretch...
<Dr. Simpson> You will feel a lot better
in three months than at one month, and you will be able to do a lot early
on....
<joan> i don't understand, I thought I could be back at work in
2 weeks not true??
<Dr. Simpson> but recovery is altogether
an individual thing. Depends on the type of job that you have....
<Dr. Simpson> and you cannot make a lot of
universal statements. Surgery does cause alterations in people's bodies,
some of which...
<Dr. Simpson> last for a long time. When
I had knee surgery, it took some time before I was able to ....
<Dr. Simpson> do some things as a surgeon.
But I probably could do some things as a rock and roll star, except sing...
<joan> ha ha
<Dr. Simpson> so, you can go back to work
early, but you may not be as productive as you would like to be....
<joan> I sit and do therapy for people
<Dr. Simpson> you may not want to make life
changing decisions, like when to go to war with Iraq...
<joan> I am a social worker not to labor intensive
<Dr. Simpson> well, you might want to have
a clear head for some people-- or maybe not. You can be back at work in
two weeks...
<joan> I like your sense of humor
<Dr. Simpson> but sometimes, you have to
give yourself a break. You have had major surgery, it isn't cut and dried...
<joan> thanks, you are wonderful
<Dr. Simpson> although I still wish I was
a rock star. ....
<joan> me too could use the money
<Dr. Simpson> although I think I don't like
modern music. Anyway. Good luck.
<**MODERATOR**> DIANNE YOU HAVE THE NEXT QUESTION PLEASE:)
<Dianne> What is the pros and cons of the Roux en Y versus the
Mini Gastric Bypass? Also what are the chances of my being approved with
a BMI of 36.3? I have several comorbids, DM II x 10 years, hypercholesterolemia,
neuropathy and onset of diabetic retinopathy. Looks like my first question
was answered....
<Dr. Simpson> Mini gastric bypass should
be relegated to the trash can of surgeries that we shouldn't do, because
it has the POTENTIAL to have a lot of problems...
<Dr. Simpson> you have co-morbidities which
are such that many insurance companies would consider you a candidate
for...
<Dr. Simpson> weight loss surgery. SO, I
think that this is something you should pursue. Good luck.
<Dianne> Thanks!!!!!
<**MODERATOR**> THEATRE YOU HAVE THE NEXT QUESTION PLEASE:)
<theatre(NH) -105> Dr. S-I am 8 months out now, and my staple
lines are starting to become red around the area of my hernia, is this
normal?
<Dr. Simpson> take the stapes out theatre!!!!!
<theatre(NH) -105> lol
<theatre(NH) -105> they are long gone
<Dr. Simpson> seriously--- the scar is stretching
a bit, and it is becoming red...
<theatre(NH) -105> yes
<Dr. Simpson> so, you need to get the hernia
fixed.
<theatre(NH) -105> Doc wants to wait until i get to goal
<theatre(NH) -105> should I wait
<Dr. Simpson> so, fix the hernia, take out
the staples-- well, we would love people to wait until goal, but if the
hernia is bothering you-fix it.
<theatre(NH) -105> Ok, thanks Dr. S!
<Dr. Simpson> To prevent blood clots we use
heparin, and sometimes low molecular weight heparin. We do not always
use filters...
<Loraine> what are the statistics regarding gaining back weight-say
after 5 years? A Dr. said I should ask
<Dr. Simpson> as most of the emboli are small
and would not be caught by the filter, and there is a certain morbidity
in the placement
<Dr. Simpson> of the filters. Some patients
we use filters in, depending on a variety of factors. But for the patient--
walk, walk more, and walk even more. Ten laps around the nurses station
the day of surgery, twenty the next day...
<Dr. Simpson> and if there is a cute nurse
you won't need the motivation.
<Dr. Simpson> Those nurses always got me
in trouble.
<**MODERATOR**> CHRISTINE YOU HAVE THE NEXT QUESTION:)
<Christine> I have read that the odds of dying are 1 in 1000 for
the lowest risk patient to 1 in 4 for the highest risk patient. What is
your experience, and could you describe a low risk patient? I am 5'9 and
weigh 249. In numbers, where would you put my risk? (normal BP, low cholesterol)
Would you consider me a good candidate? On the drain thing, why not put
one in? Better safe than sorry, no?
<Dr. Simpson> Christine, every surgeon has
their own way of doing things, and if they don't normally put a drain
in, then don't make them do something they don't normally do....
<Dr. Simpson> you sound like a great candidate.
The thing about statistics is that you are a statistic of one-- if something
happens to you, then it happens, and that is 100 per cent or zero....
<Christine> right
<Christine> but.....?
<Dr. Simpson> dying is actually closer to
one in 200 patients , and that is from the risk of blood clots which can
travel to the lung and...
<Dr. Simpson> zap. Then you meet me in Arizona--
or some hot place----.
<Dr. Simpson> Oh, you want odds, eh...
<Christine> how about leaks? They killl, right?
<Christine> YES!!!
<Christine> I want odds
<Dr. Simpson> Leaks do not kill, leaks can
make you miserable but they do not kill...
<Christine> badly so!!
<Dr. Simpson> fine, I will give you odds---
your odds are that you will do great, and your risk is....
<Dr. Simpson> as;dlfkgj;asldkfj;/100
<Christine> yikes
<Christine> i was afaraid of that
<Dr. Simpson> unless you have surgery on
Tuesday
<Dr. Simpson> then it is less.
<Christine> then its more?
<Christine> ;)
<Dr. Simpson> More on Thursday.
<Christine> ok
<Christine> TY Dr.
<**MODERATOR**> CHAPPY YOU HAVE THE NEXT QUESTION PLEASE:)
<Chappy> I am 8 weeks out of surgery and still have nausea, but
only foam comes up, why foam? I have this even if I don't eat
<Dr. Simpson> Chappy -- because we all evolved
from the sea, what is coming up is salt water-- and it is from the incoming
tides....
<Chappy> please explain more
<Dr. Simpson> oh, you don't believe that
one, eh. Well, it is salt water, trust me.
<Dr. Simpson> no, it is common that you have
some build up of material in the stomach....
<Chappy> from what
<Dr. Simpson> or the pouch, and it can cause
nausea. 8 weeks is about when this will start to get a little better,
and hopefully it will soon.
<Dr. Simpson> that is normal stomach production,
...
<Dr. Simpson> the normal stomach produces
about a liter and a half of stuff every day, sometimes more...
<Dr. Simpson> the pouch makes a little also,
so you normally make stuff-- like I normally make up stories...
<Dr. Simpson> you need to drink more water,
and walk more. You will feel better.
<Chappy> thanks doc, this helps alot, there is a light at the
end of the tunnel
<Dr. Simpson> its a freight train.
<Chappy> haha
<**MODERATOR**> CRAIG YOU HAVE THE NEXT QUESTION PLEASE:)
<Craig> Hi Dr. Simpson
<Dr. Simpson> Hi Craig
<Craig> Ok I will reveal a whole lot about me here.
<Dr. Simpson> go ahead, you have our full
attention
<Dr. Simpson> unless of course I get lost
in some explanation of something...
<Dr. Simpson> and start talking about the
evolution of the human mammalian species, or being a rock star...
<Dr. Simpson> or perhaps even I could talk
about the relationship of the lunar cycle to weight loss surgery, but
you probably have a question for me...
Craig> I have found that after losing 154 pounds since the end of
last January I have absolutely zero sex drive although my Tetesterone
levels are normal is this normal will it go away I am begining to date
a bit still love to flirt but absolutely no desire for sex?
<Dr. Simpson> ah-- that is a great question,
and you are a handsome fellow-- are you married?
<Dr. Simpson> It is quite normal that sex
drive is decreased after surgery for a while...
<OhioDave 3lbs2Goal> please have your questions typed, so when
called on you will be ready
<Dr. Simpson> in fact, it is more normal
than not. Although after the surgery you will find out that....
<Dr. Simpson> as you feel better about yourself,
you might have a hyper sexual drive. The reason I ask if you are married
is that there are a lot of....
<Dr. Simpson> interactions which make sex
a very complicated subject....
<Dr. Simpson> if you are single, it may be
that Pamela Anderson hasn't knocked on your door yet, although I hear
she is now...
<Craig> divorced actually
<Dr. Simpson> teaching Sunday School, and
many dads are bringing their kids to Sunday school-- nice to know that
<Dr. Simpson> dads are taking such an interest
these days in their kids religious education.
<Dr. Simpson> Over all, you have to remember
that you are a young man, your life has changed, and now you might need
to talk with a
<Dr. Simpson> professional about these things.
I think you will benefit a lot. Depression after surgery is more common
than not...
<Dr. Simpson> and I think you will benefit
from a little therapy. Good luck.
<**MODERATOR**> KIM YOU HAVE THE NEXT QUESTION PLEASE:)
<Kim (ma)> Hi, Is there anything a person can do pre-op to reduce
the chances of complications during and after surg? I am set to have a
lap rny in 04/03.
<Dr. Simpson> To reduce the risks of complications
after surgery I think you should do the following:
<Dr. Simpson> walk
<Dr. Simpson> walk more
<Dr. Simpson> don't smoke.
<Dr. Simpson> follow your surgeons instructions
to the letter
<Dr. Simpson> and walk even more. Good luck.
<Kim (ma)> I will do all that then, thanks
<**MODERATOR**> MAYA YOU HAVE THE NEXT QUESTION:)
<maya> I have chronic glomeriunephritis and a history of DVD and
PE, could I still have this surgery?
<Dr. Simpson> Yes, you could and should have
the surgery. I am still waiting for
<Dr. Simpson> my DVD, but have only VHS.
<maya> thanks-will I need a cath?
<Dr. Simpson> No, probably not. But it is
something that you will need to go over with your surgeon and other doctors.
Good luck.
<maya> Thank you
<**MODERATOR**> J. MURPHY YOU HAVE THE NEXT QUESTION:)
<J Murphy> Does everyone who has the surgery go thru an upper
GI type of test after surgery to check for leaks?
<Dr. Simpson> No, not every surgeon does
that. Some do, and some check for leaks at the time of surgery...
<Dr. Simpson> some patients are too large
for the equipment to test them for leaks....
<kathleen> why do some unfortunate individuals end up w/ hepatic
failure after bypass surgery???
<Dr. Simpson> some surgeons do this as a
matter of routine, and some wait and see. The test does not mean that
the following day...
<J Murphy> the drink makes me very ill...so I wasn't looking forward
to it.
<Dr. Simpson> you won't have a leak or a
problem, but it does make some of us feel better.
<Dr. Simpson> Good luck.
<Tammy> PLEASE HAVE YOUR QUESTION TYPED AND READY TO HIT ENTER
WHEN MODERATOR CALLS YOU
<**MODERATOR**> KATI YOU HAVE THE NEXT QUESTION PLEASE:)
<Kati> I had the RNY back in April and have only lost 117 pounds
so far...I have about 80 more to loose...It seems as if most loose faster
than I do, what can I do to loose faster?
<Dr. Simpson> Kati, comparing yourself to
others is a rough way to go,...
<Dr. Simpson> that is a great weight loss,
what other program have you been on with that kind of result...
<Dr. Simpson> to loose faster you need to
do a few things: first limit carbohydrates to 40 grams per day, second...
<Kati> I know, I'm just anxious...
<Dr. Simpson> walk, walk, walk, walk....
<Kati> I've done everything...
<Dr. Simpson> and then walk some more 45
minutes per day, four days per week, and more if you need to...
<Kati> Thanks, I need to walk more...
<Dr. Simpson> well, walking more will do
it, Trust me you cannot resist. Unlike my girlfriend who can always resist...
<Dr. Simpson> so, good luck. Keep walking;
<Kati> Thanks, I will...
<**MODERATOR**> LYNN YOU HAVE THE NEXT QUESTION PLEASE:)
<Lynn> I think you somewhat answered my question, but..Why is there
such a difference in the amount of intestine which is bypassed, I am concerned
with anemia, should I ask my doc to bypass a lesser amount? btw-you're
a funny guy! where are you from?
<Dr. Simpson> I am from my mom. Anemia and
the length of intestine have very little to do with one another...
<Dr. Simpson> anemia is a rather complicated
subject, which has to do with a lot of various factors and vitamins...
<Lynn> well why is it that so many people seem to be so anemic
<Dr. Simpson> but not what is bypassed. So,
I think that you have to not worry about the length of intestine which
is bypassed, and just enjoy the experience. Good luck.
<Dr. Simpson> iron, and vitamins. Keep taking
them
<Lynn> thanks
<**MODERATOR**> MARY ANN YOU HAVE THE NEXT QUESTION
<Mary Ann> Can one take aspirin, or in my case, imitrix, once
I've had surgery - AND will the meds work okay? Thanks & Rock on with
your badself -nice to run into a sense of humor Dr. S. - keep it up! :)
<Dr. Simpson> imitrix is not contraindicated
after the surgery, and it is something that you can take no matter what.
In terms of....
<Dr. Simpson> aspirin, some surgeons don't
mind. In terms of Marian, vs. Mary Ann I will take care of both of you...
<Dr. Simpson> being the man I am
<Dr. Simpson> but, you can have a filter,
and you will need to be watched carefully. So, talk to the surgeon...
<Dr. Simpson> weigh your risk (pun intended).
Good luck.
<**MODERATOR**> KATHY M. YOU HAVE THE NEXT QUESTION PLEASE:)
<Kathy M.> Hi Dr. Simpson! 2 questions: What happens to the larger
unused portion of the stomach after RNY surgery and is there any need
to be concerned with it afterward-medically? Is it stapled down to some
other part of the body? I have had two major surgeries in the past 18
months and want a clear picture of what will go on inside of there. The
other surgeries were Exploratory laparotomy and a total hysterectomy,
generally speaking, would you consider a lap RNY on someone with that
type of history? I had seromas each surgery on the scars and they had
to be opened to drain---the thought of open incisions to pack again irks
me!
<Dr. Simpson> well, there are a lot of questions
there, and the answer is yes, no and sometimes....
<Dr. Simpson> the unused portion of the stomach
can still get an ulcer, which is why some surgeons don't want you to have...
<Dr. Simpson> certain medicines. In terms
of a lap, you are still a candidate, for some laparoscopic surgeons, so
that is...
<Dr. Simpson> a possibility. I would consider
you a candidate for a lap, but you might have to be opened....
<Dr. Simpson> and nothing wrong with opening.....
<Dr. Simpson> in terms of seromas-- well,
sometimes they happen. Hopefully this time they won't
<Kathy M.> I understand that possibility but if there is hope,
eh?
<Dr. Simpson> There is hope.
<Dr. Simpson> Keep hope alive!
<Kathy M.> Thank you! Always!
<**MODERATOR**> BLINDLABLOVER YOU HAVE THE NEXT QUESTION:)
<blindlablover> I am curious how weight gain is possible after
a RNY, since the part of the intestine that absorbs calories has been
by passed? What kind of failure rate are you aware of? thank you
<Dr. Simpson> The failure rate depends on
what you consider a failure....
<blindlablover> re gainingf weight
<Dr. Simpson> most of the intestine is still
available to absorb calories. In terms of the per cent of those who will
regain all of their lost weight...
<Dr. Simpson> that is around 5 per cent.
In terms of those who will regain weight to a bmi of over 35, that is
25 per cent...
<Dr. Simpson> for RNY. It is less for the
duodenal switch. What you need is a good cook book, and one is coming
out soon at...
<Dr. Simpson> a bookstore near you for weight
loss....
<Dr. Simpson> diet cooking. But that is another
story. Good luck.
<blindlablover> I need my brain operated on
<**MODERATOR**> BIG GIRL YOU HAVE THE NEXT QUESTION:)
<BIG GIRL> in the next 20 yrs what will obese patients do to lose
weight? still surgery ? pills? any ideas? p.s. dr. have you ever thought
of comedy as a second career?
<Dr. Simpson> in 20 years obese patients
to lose weight will be given a prescription of ....
<Dr. Simpson> my neighbors cooking-- and
trust me you will lose weight....
<Dr. Simpson> there will be no magic pill
or injection for a while, probably for about ten or twenty years...
<Dr. Simpson> so I have a few years left
to rearrange guts....
<BIG GIRL> thank you have a great weekend!
<Dr. Simpson> but there is always bad cooking,
and that is the best thing you can do to prevent weight gain...
<Dr. Simpson> if you eat good stuff, you
will really lose weight. If you eat other stuff-- well, like drinking
cheap wine,
<Dr. Simpson> why do it?
<**MODERATOR**> MISSY WV YOU HAVE THE LAST QUESTION FOR TONIGHT:)
<Missy*WV>1 mo.post> Dr. How easy is it to stretch the pouch?
I am one month out and worry I could stretch it easily by overeating.
I don't throw up, but get nauseated when I eat a little too much.Also,
how common is an ulcer after surgery? I had them before surgery.
<Dr. Simpson> Just as common after surgery
as they are before surgery....
<Dr. Simpson> in terms of stretching-- it
is quite easy to do, and quite hard to return that to normal, so don't
<Dr. Simpson> just keep your portions the
right size and don't stretch it too much.
<Dr. Simpson> because
<Dr. Simpson> So, thank you all.
<**MODERATOR**> THANK YOU SO MUCH TO DR. TERRY SIMPSON FOR
JOINING US HERE TONIGHT! THANK YOU MEMBERS AS WELL! HAVE A GREAT WEEKEND
EVERYONE!
<Mary Ann> Thank you Dr! :)
<Kim (ma)> Thank you Dr Simpson!!
<Kathie/HI(-110/5mos)> Thanks Dr. S.!!! Come into the main room
and chat with us! We have missed you!!
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