January 7, 2005

<Moderator> Welcome to tonight's chat with Dr. Simspon. Chat starts at 4pm PST/7pm EST. Please type out your questions and hit enter. We will see them and present them to Dr Simpson at the time of chat in the order we receive them. The room is filling up already. Get your questions in early to have them answered. Thank you!

<Moderator> Welcome Dr. Simpson

<Dr. Simpson> Just finished some surgery, so I am fresh to you from the surgery lounge at Maryvale Medical Center in Phoenix Arizona, where the weather is perfect, the children go to bed by 7 PM, and it only rains in the middle of the night. Well, maybe not all of that, but anyway, I am here and ready to rock or wok and roll.

<frustrated 1yr Post> Dr. Simpson, thanks for taking the time out of your day for us. I am 13 months Post Op and have stopped losing weight for about 2 months. I am excercising and measuring my food (about 1 cup per meal) What can I do ??? ( I have lost 120 pds with another 80 more to go ... and want this OFF .. .please, sugggestions greatly appreciated )

<Dr. Simpson> Well, that is a good question. I think you should give up, eat chocolate and stop the exercise. Sorry, that was my advice, I guess we should help you. Ok, here goes. First, you need to journal what you eat every bit that you eat. Use either www.fitday.com, or if you were smart write it down in a spiral notebook. Write down every calorie -- and before you start write down your favorite foods that you normally eat and the calories that are in there. Then calculate what your BMI is, then calculate what the calories you burn in exercise are. To lose a pound a week you need to burn 1000 more calories than you consume and you will find that you will make some good choices and bad choices, but you will see what you are doing. Good luck, and if you want a good journal to write down your stuff I would suggest you get one from my website www.obesitydr.com, as those are designed to do that. Good luck.

<Trish> What is the average cost of laparoscopic surgery, or banding?

<Dr. Simpson> Depends on where you are and what they charge, it varies around the country. For example, in Phoenix the average RNY lap is about 25k, and the lap band is about 14.5k. Other places are more, and a few less.

<Lilly> How will this surgery effect someone that smokes afterwards. Will it effect them ?

<Dr. Simpson> You won't get surgery if you smoke. So it will effect you if you smoke. So stop smoking

<chelle in tx> how long after open rny can you begin exercising and what form of exercise is best?

<Dr. Simpson> Walking is the best exercise. You can begin in the recovery room by walking to your bed. In our hospital that is from the second floor to the fifth floor.

<dave patt> do you know of any doctor near san antonio accepting medicaid for gastric bypass?

<Dr. Simpson> I do not know of specific doctors and what insurance they take. Sorry, you will simply have to check the list on obesityhelp.com and call them.

<TwinMomma> Hi DR S.; I made it to the other side--am now almost 6 weeks out and my joints have started aching terribly...VERY uncomfortable....any reason related to WLS for this?

<Dr. Simpson> Yup, you need to move them more and get them lubricated and avoid sugar. It grinds the joints up.

<red> whats better to take protein shakes or meats for a better source?

<Dr. Simpson> The best source of of protein is food food food food. Shakes are ok if you need them, but if you can get food in, then do it. To decrease risks, learn about good nutrition. Take vitamins, and start a walking program. Get in good nutritional shape, and go from there.

<Randi> What surgery do you do and can you explain the procedure you do ? thank you

<Dr. Simpson> I do all the procedures, and like them, and explaining them. Well, we make the stomach smaller in some manner so that you don't eat as well and then you don't eat as much, and you lose weight. Simple.

<Lilly> if we are to get so much protin in each day won't that be hard for the digestive I mean won't it constapat you ?

<Dr. Simpson> You only need as much protein as you need, you do not need more. If you are constipated you are not eating fiber and drinking enough water.

<Arlene> Good Evening Dr. Simpson, I had Open RNY on Nov 19. I still can't eat even pureed foods. When I try, I end up throwing up. Why does it come out with mucus or phlem? It doesn't matter what I eat, it always comes back up.

<Dr. Simpson> Then you need to see a GI doctor to have them look at you to make certain that you have not scarred down and get that done asap.

<Donna> Hi DR Simpson Do you have any "numbers" for the percentage of patients that get to goal after two years post op?

<Dr. Simpson> Sure I do, and it depends on what you mean by goal, what I mean by goal is a BMI of 20 to 25. If you have another goal for that then I cannot give you a number.

<LES> IM 440 POUNDS 6'2" CAN HAVING THIS SURGERY PUT ME AT POSSIBLY 220 POUNDS IF I FOLLOW THE PLAN?

<Dr. Simpson> Our rate is 81 per cent at two years. Yes, you can lose that if you follow the plan.

<trea> im having trouble keeping food down even if i eat tiny bites and chew chew what could be wrong i even throw up water please do you have an answer? thanks DR Simpson

<Dr. Simpson> Yes, I think that you should see a GI doctor in order to see if the area has scarred down, ASAP.

<SALLY M> Read your book, loved your book. I would like to know if you have anymore in your future?

<Dr. Simpson> Ah, well we have a new book called "Getting to Goal and Staying There: Lessons learned from successful patients." It is a workbook which was designed from patients who had made it to goal and stayed there at least four years, and my co-author who is a wonderful cook put in the menu plans and recipes -- which are delicious. So that is our latest workbook designed to get you to goal and keep you there and have good things to eat. We also came out with a journal to keep track of what you eat and our final book which should come out is called "Losing the last thirty pounds." So more to come. They are available on www.obesitydr.com. The workbook is not in Amazon yet.

<Lilly> if you had previous C-section & historeomy both bikini line can them musles be fixed what about the open RYN will them muscles be recked or can they fix them at surgery ?

<Dr. Simpson> RNY will not wreck the muscles.

<lisa> What are the percentage of patients that experience leaks or infection

<Dr. Simpson> 1.5 per cent to 3 per cent leak, and infection rate is around five per cent -- minor skin infections.

<chelle in tx> I have talked to ppl who have lost 60+ pounds the first month, is it posssible to lose too fast and create problems?

<Dr. Simpson> If you have cancer, tuberculosis, or HIV you can lose too fast. Otherwise, enjoy the ride.

<William K> what's the difference between promixal and distal in the RNY Surgery? And whats the difference? Thank you Doctor

<Dr. Simpson> Proximal is about a 100 cm bypass and distal is about 400 cm bypass. There are good pictures of it in my book.

<newface> I am concerned about being able to get enough nutrients to stay healthy following surgery.

<Dr. Simpson> Everyone gets enough nutrients, and the problem is too many nutrients. Well, too many calories. So take your vitamins, and you will be just fine. You have enough excess, I promise.

<beth> i had laparoscopic rny on may 19 i started at 285 and am now at 223 i have been told that this is kind of slow do you have any suggestions on boosting that at all i have been at my current weight for 3 weeks

<Dr. Simpson> You need to walk more, and you need to keep your calories down, and you need to not graze. Three meals a day, and walk at least five miles a day

<m7794> Can someone with Diabetes get this surgery? Or are they more at risk for infection?

<Dr. Simpson> Diabetic patients do great with this surgery and they are not at more risk for infection.

<GracieBanded> Dr. Simpson do you do LapBand or only gastric bypass?

<Dr. Simpson> I do the lap band, I like it -- patients do quite well with it.

<lisa> Of the surgeries that you have performed how many leaks and infections have you had?

<Dr. Simpson> My leak rate is far less than one percent and I remember every one of them and will probably always remember them. My infection rate is a bit less than 2 percent and those infections have all cleared up after I started to wash my hands.

<lisa> How many times have people gotten stricture with food stuck?

<Dr. Simpson> The average rate of stricture is about 10 per cent with RNY bypass, and needs to be dilated. Some have more or less, and sometimes it needs to be dilated multiple times before it is ok. Some people have less of a stricture rate, but hey -- better to be lucky. Walk - Walk - Walk and when you are done walking, walk again. If you cannot walk, then walk in a swimming pool for the same duration.

<juanita weis> suggestions for nutrition after lap band surgery?

<Dr. Simpson> Yes, make good choices, eat good food -- vegetables, protein, and avoid starches, lard, cheese, pasta, bread, rice. Good food -- like chicken marsala, my personal favorite.

<Tammy> Do you feel that the RNY cures acid reflux problems?

<Dr. Simpson> There are some who claim that the RNY gastric bypass is a cure for acid reflux, and they are simply mistaken. If you have a bad valve at the junction of the esophagus and stomach you will have reflux. You may not have as much when you have an RNY, as you have a small pouch, but those small pouches can still make acid, and they can still give the esophagus problems. So those who make those statements -- no matter how forceful they make them, and I know some who do, are simply wrong.

<Rhonda Rosenburg> I realize that immediately after gastric bypass you metabolize many drugs differently. After the so called "honeymoon" period does you body start to metabolize drugs in the same manner as before surgery and if so how far out from surgery?

<Dr. Simpson> Your body will metabolize drugs the way it always does, the question is will they absorb, if you have a pill that is time-released and it depends on staying in the stomach for a while and it falls through into the small bowel you may not absorb it as well. If you have a distal bypass you may not absorb as much of the birth control pill and become a parent. So you need to monitor the drug levels, if they can be monitored, or change them to a form that can be absorbed easier, and are not time released, depending on the surgery that you have.

<Sandy> I had a leak in my pouchline that was repaired 2 days after my RNY. I feel fine now but would there be any longterm effects from this?

<Dr. Simpson> Sorry that you had a leak, and I am glad that you are doing well now. There should not be any long-term effect from the leak and its repair, just a bad memory but bad memories are a good thing to have, as opposed to having a bad experience. You survived, and we are glad you are here safely.

<GracieBanded> If I had a small port installed during my banding surgery, what would it feel like when I press on it? A dime? Half dollar? Thank you.

<Dr. Simpson> You may not feel it at all, and if you do not feel it at all then I cannot tell l you what it feels like. If it doesn't bother you, it might feel like a bump, or it might feel like a half dollar, although if it felt like money I would probably try to surgically remove it from you because I can always use the cash.

<Rhonda Rosenburg> All my research has shown the statistics to be 1 in 200 die and 1 in 50 have serious complications from the bypass. Are these statistics accurate?

<Dr. Simpson> Yes and no. The statistics are what they are, but you are an individual, and if you have a problem or if you die then it is 100 percent. So they don't apply to an individual. In some series the death rate is as high as one in fifty and for lap band it is as low as one in ten thousand.

<Tracy pre-op 1-24> have you had any patients that have previously had norplant (birth control) and gained weight from that and if so, how if any was their weight loss different? My left arm is bigger than my right due to Norplant.

<Dr. Simpson> The only weight you gain from norplant is the weight of the device in your arm. You gain weight by what you put in your mouth, not by what is implanted in your arm and I have had lots with norplant.

<bernadette> i lost only 19 lbs in 3 weeks is that ok or i am doing something wrong

<Dr. Simpson> That is a great result.

<Tracy pre-op 1-24> Does everyone lose hair, my surgery is scheduled for the 24th of this month and I was wondering if hair loss can be prevented, I have very thick, long hair and would hate to lose it but the other loss will be worth going bald to me.

<Dr. Simpson> Some lose it some do not. I suggest using super glue to keep it on. There is no way to prevent hair loss. Good luck.

<Carol> If a person already has diabetes, will it slow the healing process?

<Dr. Simpson> It will not slow the healing process at all.

<pammy> Hi Doctor I would like to know if you can have the surgery if you have HEP.C that is in remission?

<Dr. Simpson> Hepatitis C is not a contraindication to surgery at all.

<pammy> Could or would you trust a doctor that has only performed the surgery 18 times?

<Dr. Simpson> The surgery is not that difficult to do, and if the surgeon is a good surgeon with a good reputation, sure.

<Lunaricyn> Post op I know that fish and chicken are preferred over beef and pork. Where does wild venison fall considering it is extremely low fat?

<Dr. Simpson> I love people who love venison. High protein, low fat, and good for you. Some do not tolerate this as well early on, but as time goes on they find they tolerate it better and even like it a lot.

<jg> I am 18 months post RNY, of normal BMI and just 5 lb above my goal. Should i wait to reach goal wt, or am i ready for tt or LBL now?

<Dr. Simpson> Go for the lift, and you should do well. Consult with the plastic surgeon. It sounds like you are doing well. Good luck.

<kacee> Hi, I had my surgery on Feb. 6, 2003, sometimes I have some loud "gurgling" on the left side of my stomach, very loud gurgling, is this normal?

<Dr. Simpson> It is normal. Your stomach is talking to you. It is saying "Hey, don't feed me so much and instead of sitting on the couch and listening to me get up and take me for a walk."

<Dale> Can you explain the PB or "slime"? What is it? Can it be prevented?

<Dr. Simpson> PB is productive burp and it can be prevented by not over eating, and not eating stuff that is bad for you. Slime is something you find in my kitchen sink, and it can be prevented by not leaving dishes in the sink for longer than a day. It is also found when you are not drinking enough water and you feel the slime of the mouth. It also happens when you don't take a shower every day or it might happen in the shower if you have not cleaned the walls in a while or on the swimming pool if the chlorine tablets are not placed and you have been away from the pool.

<ann> Have you ever heard of Multiple Sclerosis being a barrier to gastric bypass?

<Dr. Simpson> No, I have operated on patients with MS before, and they have done just fine.

<Carol> Dr. Simpson, have you had any problems with "nicking" other organs. I have heard about this and it seems quite serious

<Dr. Simpson> I had a problem with my car being nicked by other cars, particularly in parking lots. Nicking is not a good thing -- but sometimes happens when you do surgery and if things are nicked they need to be fixed, or watched carefully. I like Nick at night.

<CINDERELLA> After your tummy tuck with hernia repair how long are you off of work. i am a k-9 stylist. It is a hard job

<Dr. Simpson> Well, you can do the small Maltese doggies almost right away. You can be the specialist who does their nails. The pedicure for puppies, six weeks before you lift more than 15 lbs. Otherwise, take two weeks off work, and paint your own nails and walk.

<Tammy> Back to the reflux issue, what is the answer for an obese person with an les that is virtually gone? I have Barrett's also and have been told that the fundiplication surgery would fail. What do you think?

<Dr. Simpson> I have no idea why someone would tell you that a fundoplication would fail at all. I also have Barrett's and I can tell you two simple things: RNY will help you lose weight which is good, and you will still have to have your esophagus monitored to see if it changes. But you will have reflux, and you will need to continue to take proton pump inhibitors like prevacid or protonix, and good luck.

<melissa vansickle> What are some things that can be done to quick start a plateau?

<Dr. Simpson> Walk walk walk walk quickly. Eat less move more.

<karen> I am 4 days post op...this will be my second night home. I am on a full liquid diet...I have been a bit nauseated all day- not bad, just a bit. I think it might be from the pain in my ribs and the gas (I'm burping about once per minute!). Is there anything that I can or should eat to ease the gas some? Also, how long does this horrific ribcage pain last? My incision pain is doing well but my ribs are killing me!

<Dr. Simpson> Glad you are home. The rib pain will ease up -- sometimes the rib pain is from the diaphragm being stretched a bit from the gas we use in laparoscopy and nothing will help the gas. You need to walk more and walk more and then walk again. So walk -- it will help the pain, it will help your bowels move, and you will feel better. Good luck.

<Amy> Is it ok to drink with your meals?

<Dr. Simpson> If you drink with your meals and you force food out of your pouch you will get hungry sooner and if you get hungry sooner you will probably eat and if you eat more you will lose less weight.

<Carol> Dr. Simpson - Have you personally had any deaths and if so what caused them?

<Dr. Simpson> Pulmonary embolism -- major source of deaths for patients. So walk.

<Amy> What kind of calcium do you think is best?

<Dr. Simpson> Well, it depends on what the surgery was that you had. If you had a surgery which does not have much stomach acid then calcium citrate is good. If you had a surgery which allows your stomach to remain relatively intact then calcium carbonate.

<Leigh Ann> WHAT TYPE OF SURGERY WOULD YOU SUGGEST, RNY OR DS? I AM 5'5 335 LBS -- FEW COMORBITIES

<Dr. Simpson> I suggest the surgery that your surgeon does, and does a lot of, as that will be the surgery that you will do well from and have the support group for.

<Lilly> Has anyone had problems becoming too thin after surgery?

<Dr. Simpson> Yes, people can become too thin after surgery. That is why it is important to follow up with your surgeon and the support group and to keep in contact with those resources and if you need help, psychologically, to get help.

<Amy> What does an average person lose in a year typically?

<Dr. Simpson> Ten to fifteen pounds per month on average -- some more, especially those that have more to lose, and some less -- Make good food choices, and exercise, and you will do just fine.

<Pam> I was wondering in general how many calories should a person who is 10 months post op take in on average.

<Dr. Simpson> Well, it depends on what you want to do and where you want to go. If you are at goal then you should take in what your BMR requires so as to not gain weight. If you want to lose weight, then set the goal and use less calories than your BMR -- your basal metabolic rate, it depends on where you want to go with your body.

<Michelle> i AM 4 MONTHS OUT AND EXPERIENCING A SURGE IN HAIR LOSS, I AM CONSIDERING TAKING GNC HAIR, SKIN, AND NAILS SUPPLEMENTS, YOUR OPINION?

<Dr. Simpson> Save your money. Make certain that you are getting in enough protein for your size, and that you are taking your vitamins and minerals. In a few months you will get your hair back -- it will take three to four months. If you want to take hair skin and nail supplements, send me the money that you would have spent on them, and I will forward it on to the victims of the Tsunami and then you know your money will not be wasted. Or send that money to the Red Cross or Doctors without Borders.

<Moderator> And the last question goes to...

<michellehtml> Michelle post op 20 months what if you have a constant burning in your stomach could it be an ulcer

<Dr. Simpson> It could be an ulcer, and you should have that checked out ASAP.

<Moderator> Dr. Terry Simpson, Arizona Bariatric Center. Website: http://www.drsimpson.com/. Phone: 602-234-8995. Fax: 602-230-8344. Thank you very much, Dr. Simpson. We enjoy your chats every week. We all thank you and have a great weekend.

<Dr. Simpson> Thank you all. Good night. See you next week.

<Moderator> Thank you all for coming tonight. Bye all.