January 30, 2004

<**MODERATOR**> Welcome to tonight's surgeon chat with the ever lovable and always entertaining Dr Simpson. Please type in your questions and hit enter. I will be able to see them though you wont. I will present them to Dr Simpson in the order they are received. Thank you!

<Jessica H.> Hi, I was wondering if you have to have a staple disruption on an RNY to have a revision? How do you go about finding a surgeon who will do a revision on a RNY which only has an enlarged pouch?

<Dr. Simpson> No, that is not the need to have a revision, there is a number of other reasons. There are a lot of anatomical reasons with which you can have a revision. For example: you could have a stomal enlargement, a pouch enlargement, and so forth.

<sabrina> I'm in my last 3 days before surgery. I can't have bulky and fibrous food such as meats, salads, vegetables,no fatty or greasy fried foods or milk products no high calorie carbohydrates. I'm kind of hungry, what can I eat?

<Dr. Simpson> Anything but those generally we like to give you things that you can eat instead of things that you cannot eat. High carbohydrate foods are not good-- and I think things like tuna fish is good, unless it is Charlie, as he might object a bit. I would suggest you have some lean chicken, some fish, you know healthy things. Good luck

<donna> Have you ever had a patient wanting surgery with ulcerative colitis and has the patient been able to have it done?

<Dr. Simpson> Yes, and yes. Sometimes ulcerative colitis is best cured by having a colon removed, which can also be done at the time of surgery. However, there is no specific contraindication to having your colon have its own problems. So, have the surgery, and if later you need to have your colon removed, your surgeon will be thankful that you had the weight loss surgery.

<snuggles> After Lap gastric bypass surgery how long is a person usually off of work?

<Dr. Simpson> It depends. If you work for the government --- a long time. If you work for yourself, you will be back the day later. Generally we say three weeks if you have no heavy lifting or six weeks if you do. If you have a job which requires minimal mental function such as a politician, or president of the US, you can resume work even on narcotics, because no one will be able to tell.

<ERIN 12/8/03=58lbs> i have a question... it seems like i vomit with most of the foods I eat.. toast, eggs, protein bars, drinks.. i had a violant vomit with a chicken wing the other night and fractured my finger running to the bathroom

<Dr. Simpson> Next time use your feet to run, instead of running on your hands. You need to find those foods which your stomach can tolerate, and sometimes that is not easy. If you vomit you need to go back to liquids, in addition, you need to make certain that there isn't a reason for the vomiting, such as you having a stomal stenosis which can account for that. So, go to clear liquids, introduce gentle foods first. How do we know if they are gentle???? First month if they swim in water, that is good. Second month anything that flies, or has wings (except bat wings from your fellow patients with WLS) and third month anything that walks on the ground. Good luck.

<joe> can i get government assistance to help pay for lap-band surgery since my insurance will not cover?

<Dr. Simpson> No, save your pennies, and you will be able to get it covered.

<Jo K> What are potential causes for mechanical reflux after surgery for a new post-op?

<Dr. Simpson> Many, many, many causes --reflux is a complicated issue, and one which is not always solved immediately with surgery. Sometimes after surgery the main reason is that you are overfilling your stomach or pouch. So measure twice, eat once and vomit never.

<Katrina> After surgery what is the max carbs a person should have a day?

<Dr. Simpson> There are two ways of looking at carbohydrates. One way is to count them, and if you do that then about 60 grams per day. The other way is to only eat those carbohydrates which have a low glycemic index which is less than 55, click here to read more about the glycemic index and to download a helpful chart. But mainly -- protein in first, water, and go take a walk.

<AMY> TIPS ON PREVENTING STAPLE LINE RUPTURES?

<Dr. Simpson> Walk a lot-- don't eat too much, and don't live in Seattle where the rain will cause the staples to rust.

<Sonja> I am concerned with the difficulty the surgeon may have cutting through my tissue(fat)should I be?

<Dr. Simpson> No, we have sharp knives and good teeth.

<crystal> Does anyone know a HIP doctor in ny that i can switch to that would help me be approved for this surgery

<Dr. Simpson> The hip doctor doesn't help you get approved for the surgery, if you need a hip, than any orthopedic surgeon who specializes in joint replacement can do that. Such as Hospital for Special Surgery in NYC. That is not the key to getting approval, although it helps

<Kim CAb> I am a lightweight will my weight come off slowly and what about recovery?

<Dr. Simpson> Weight comes off as fast as you burn the calories, not how heavy you are. You require a certain number of calories to maintain a heavier weight, which is why someone will lose weight quickly. For example, Crow here at ObesityHelp.com-- was a big boy and his weight has come off fairly quickly, but if you are only 100 lbs over the ideal body weight, think of it as coming off as a percent of your excess weight.

<Jeanne> I had a Laproscopic gastric bypass and am 6wks post op is there any on thing other than sugar and fried food you should really not eat alot of?

<Dr. Simpson> You should learn about nutrition, and eat a balanced diet, concentrating on getting in your required protein first. In terms of what you shouldn't eat, we have a saying in Arizona -- There are no bad foods, only bad quantities of food. Eat a lot of venison, that is good.

<Jeanne> when do you think it is ok to start adding peanuts or peanut butter to your diet ?

<Dr. Simpson> Well, if you are allergic to them then never. If your wife or husband is allergic to them -- they should not have them either otherwise, fairly early on in the post op period if you can tolerate them.

< tiggerone> Dr. Simpson, what could cause fluid retention at one month post op? My rny was 12/31/03.

<Dr. Simpson> Not enough protein is one simple cause, but there are a lot of other causes and I would see your surgeon. For example, you could have developed a clot in the leg and it has some edema as a result of that. You could have had a lot of fluid in the surgical period, and they still have the edema. So go see your surgeon, and get it figured out-- good luck.

<melody> My mom is severly obese and i want to help her live to see her grandchild grow is there any info you can send me?

<Dr. Simpson> You can get a lot of information on this website, and you can through my website also, which is www.drsimpson.com It is easier to get it off the website than send it to you, however, I think that once my book is out-- you can get a copy of that book and I might even autograph it for you. My book will be out in eight weeks or less, depending on the printer.

<**MODERATOR**> Website> http>//www.doctorsimpson.com Phone> 602-234-8995 Fax> 602-230-8344 Email> simpson.office@gmail.com

<ChryssieD> Do you prefer open or lap RNY?

<Dr. Simpson> I prefer whatever your surgeon is comfortable doing.

<ERIN 12/8/03=58lbs> i am not over eating, so why am I vomiting so much with foods and drinks

<Dr. Simpson> That is not something that I can answer over the internet, that is something that you have to work on with your surgeon. You may need to have some tests done. When you say that you are not over eating, that is what they all say. You cannot tell that, we have to have some tests, and unless you can put a scope down you and download the photos on the internet, we cannot diagnose that. See your surgeon.

<drivrsed28> I am awaiting insurance approval but I have a question, What are the percentages of Complications from this surgery and which is better open or Lap?...Thank You

<Dr. Simpson> Your surgeon should have gone over the complications of surgery, of which there are many. There are always things that we don't think of that can happen. The percent is in the ballpark like this one in two hundred people die from the surgery, if it is a RNY, much less for the lap band about ten percent of folks have some complication which will prolong their hospital stay or cause them to have to go back into the hospital. That is fairly broad. In terms of which is better. You should have the surgery which your surgeon does. If they do open, then that is what you get. If they do lap, that will be fine also.

<violetstar> I have read that RNY causes gall stones. Is there any recent discoveries on how to prevent this?

<Dr. Simpson> The surgery does not cause gallstones, and some surgeons take out the gallbladder as a matter of routine. You can take some medicine the first few months to decrease the incidence of gallstones -- called Actigall but what causes the gallstones is the change in the concentration of cholesterol, lecithin, and bile salts in the biliary fluid. It become supersaturated, much like a string in highly concentrated salt water and forms stones -- this happens when people are on diets, lose weight, and so forth.. So, good luck. I like taking out gallbladders.

<ERIN 12/8/03=58lbs> whats the max proteins you need so your hair wont fall out..

<Dr. Simpson> Hair won't fall out if you use a special ingredient that you put in your hair, super glue. Otherwise, there is no protein, no shampoo, no supplement, and plenty of snake oil salespeople who will want you to have something and the bootee line is that hairloss can occur with a number of things, but it is mainly caused by the hair follicles resetting themselves in a time of stress.

<Snuggles> after surgery can a person ever be able to drink alcohol again?

<Dr. Simpson> Depends on the alcohol-- if you have some very fine French Red Wine. The answer is no, and you should send all of that to me. You can drink after surgery, but beware, you will get intoxicated faster and remember, there are a lot of calories in alcohol, and if you want to keep weight off avoid it for about six months at least. THEN MODERATION. Again-- fine wine--Dr. Terry SImpson, Phoenix AZ

<Maryk> Will we ever be able to use alieve or Advil? One surgeon, last week said asprin was ok. Why is that so?

<Dr. Simpson> With the RNY, but not the lap band or DS, some do not want you using some drugs like motrin, advil, naprosyn, because they can cause an ulcer in the excluded part of the stomach and that cannot be diagnosed or treated with a scope, therefore, you have to have surgery if you get an ulcer. If you take a proton pump inhibitor, such as Nexium, that is generally protective against ulcers, but not completely. Patients who have the DS, don't have that as an issue, or the lap band.

<April S.> I've heard that too much protein can cause damage to the liver... My goal is 90gr a day because of my height, how much is too much?

<Dr. Simpson> Protein will not damage the liver. If you eat too much -- which is kind of hard to do you will simply expel it out of. ... er.. you know.

<AMY> IS EVERYONE HAPPY WITH THE SURGERY THEY HAVE HAD?

<Dr. Simpson> No, not by any means. Some want it reversed and many people after they wake up from surgery, wonder what on earth they have done it, those who are happy, who never have a problem tend to post alot on chat room boards and find their way into chatrooms, but ignore them -- they are evil.

<Sonja> How long should an asthmatic be off of prednisone before wls? And would you operate on a server asthmatic and is anesthesia safe for one?

<Dr. Simpson> Anesthesia is quite safe for asthma, as the general anesthetic agents cause the bronchioles to dilate, and you will find that you will breathe easier. In terms of predinsone, I have operated on folks who are still on prednisone, that is something we can work with.

<donna> do you know if medicare and medicaid is covering the surgery?

<Dr. Simpson> You have to go through the surgeon's office and see if they accept this for payment for surgery or not and if they do, it will generally cover it, although you might have to go through a few things. For example, in Arizona the local Medicaid program requires six month of physician supervised diet plans. So, you might need that.

<ChryssieD> Do you have any tips on getting approved for WLS?

<Dr. Simpson> Yes -- have a physician supervised diet, have a BMI of over 40, and have an insurance policy which does not exclude the process then find a wonderful surgeon in Arizona -- who is charming, handsome and has a good sense of humor. oh, sorry -- The surgeon will help you with the paperwork, and get the approval with you.

<kathleen g> Dr. Simpson: Why is fat not removed at the time of surgery? One would think that as long as you are in there, why not scoop it out? Or would this rob the plastic surgeons of their livelihood?Thanks?

<Dr. Simpson> It isn't scoopable -- it is living tissue, and it is not something that can be done like trimming a porterhouse for dinner. We don't mind it if we could take some out we would, but not something we can do

<zuri> Do you recommend for or against using straws and sports bottle, etc. to consume beverages. Some say no to straws, others say its a good idea, to reduce gas/air.

<Dr. Simpson> I think you should always have a bottle of water with you and sip all day long. I don't care about straws-- except it is difficult to sleep on a bed of straw-- although when I was tossed out of that house and born in the manger -- nevermind.

<Tracy> Would having a termination of pregnancy (T.O.P) several years ago, cause me to have lots os scar tissue, that could prevent me from having the LAP done?

<Dr. Simpson> I have no idea what a top is, unless it is a toy that spins but no-- scar tissue is something that sometimes happens, and sometimes does not and the only way that we can find out if the scar tissue would be preventing you from having it is to look. Having a top, in that case, would not be an issue.

<Tinker> How bad is it that I can eat anything with surgar in it?

<Dr. Simpson> Don't know. How bad is it? The response to sugar is individual. I had one patient who dumped severely, and couldn't look at sugar without having a problem then I had another patient who called me one week after RNY and was upset because she was eating a cookie and not dumping. I asked why she was eating a cookie, and she said that she wanted to do to see if she would dump. Well she didn't and she kept eating cookies and she hasn't dumped yet, but only lost 40 of her 200 lbs.

<J.J.> I have heard after WLS for women there may be a need for plastic surgery i.e. breat implants and butt lfit are you finding many who need both?

<Dr. Simpson> Well, I have done this for a long time, and I still don't have a butt, perhaps I need an implant back there or can get a transplant from J Lo. Some need it some do not. It is impossible to tell. Like pregnancy, some women after their fifth child will wear a bikini and look great, and others after one will look like the roadmap to New Jersey.

<Jeanne> how many oz is the bare minmum you would suggest on fluids in a day, I am afarid of kidney damage from not drinking enough.

<Dr. Simpson> Then drink more ---- you should have two quarts a day.

<J.J.> Does this surgery help with people who are not overeaters but are obese?

<Dr. Simpson> If you are obese how did you get that way? Hmmmmmm overeating -- or did the air around you absorb calories. People are never aware of what they eat, and often have no idea how many calories but the body is a great calorimeter, and it will tell you what you overeat, because if you do it will store it effectively - and that storage is called fat. Yes, it will help. You will also learn to eat less, because if you don't you won't feel well.

<Jeanne> have you heard of people taking biotin to help prevent hair loss?

<Dr. Simpson> Yes, I have also heard of them shampooing their hair with some weird stuff. Again-- many snake oil salesmen out there, who want to peddle anything. I suggest Dr. Simpson's super vitamin complex--- which you can buy as soon as I make up some labels to put over the Flintstone vitamins here and only fifty bucks a bottle.

<Lori Jean -146> I am hoping you can give me some tips to jump start more weight loss

<Dr. Simpson> Jumping is good. Several simple things to jump start weight loss, the first is WALK, walk, and walk some more, and when you are done walking, then start a walking program. Get the idea. Your body is still perfect at counting calories. AVOID fast food places--- AVOID alcohol , and AVOID bread, potatoes, high carb snacks and avoid me when I am driving, because I don't drive too well.

<tiggerone> Dr. Simpson could you recommend the best way to get in the recommended 60 grams of protein at one month post op?

<Dr. Simpson> Food. You need to learn high quality proteins, such as tuna, fish, egg whites and you need to learn how much is in them, and you need to eat three meals a day, not six, and you need to get in the protein, first, and you will be happy and healthy and wise. Pass the donuts, I mean peanuts.

<Angie> Hello. I'd like to know if I can wear an elastic belly band after lap surgery? I had 2 c-sections, and found this extremely helpful as I recovered.

<Dr. Simpson> Yes you can wear a band. I like Coutnting Crows myself.

<Lori Jean -146> I believe I have a hernia, is it possible to get insurance to pay for a tt and do the hernia at the same time?

<Dr. Simpson> Anything is possible-- at least that is what my friend who is the handyman says when we ask if we can hang some heavy wall painting. So yes, that is a matter for the insurance company and you, and the surgeon can help all things that you can do. Good luck.

<Slim Trina> Is Nyquil okay for congestion after surgery?

<Dr. Simpson> Nyquil is fine-- but be careful about it-- it will go through you fast and you might want to OD on it-- also, do not take Tylenol if you take Nyquil as Nyqul contains a fair bit of tylenol and you might end up needing a liver and when your liver is so bad that you will settle for Mickey Mantel's old one, that is a problem.

<zuri> isn't it true that obese people have diseased livers to begin with? and the rapid weight loss stresses them even more, thus the reason to stay away from alcohol?

<Dr. Simpson> There are some people who have fatty liver, but not all patients, and if you eat more carbohydrates you will increase the problem with the liver so, a protein based diet is what we recommend more than anything and that is one of the reasons why some livers are so bad that we have to do certan things to prevent them from being a problem but that is another discussion.

<J> back to the advil and alieve question, im confused, did you say with a RNY that you can NOT take them?

<Dr. Simpson> Some recommend AGAINST taking them. Some do not. Check with your surgeon, for what you should do .

<jenifer hobbs> how do you find out how much was bypassed? I had open rny 8/22/03

<Dr. Simpson> You ask your surgeon. I'll tell you, though, you had 100 cmbypassed just a guess.

<Romas> Hi I had the surgery 7 months ago, It didn't work. My hole closed up and they can't find it. What can I do now.

<Dr. Simpson> Your hole closed up???? what on earth do you mean-- are you a whale and cannot spout? I don't understand what that means, but sounds like it didn't close, sounds like it opened widely. Sounds like you need a revision. Sounds like you need a good surgeon who doesn't mind revisions.

<Romas> I had the surgery about 7 months ago but it did not work. My hole closed up and the doctor told me he would not do the surgery a 2nd time. What can I do. The hole to my intest .

<Dr. Simpson> It didn't close, honest, because if it did you would be vomiting all the time. Honest, you would, really I wouldn't lie to you. I would tell you a good story every now and then, though. Sounds fishy-- speaking of stories.

<perky> If you were extremely obese would you have the surgery yourself?

<Dr. Simpson> It would be very hard for me to do that because I would want to operate on me and having to do that through the mirrors and backwards would require some new skills but I would be willing to give it a try. Then there is the anesthesia. Well, I could just bite a bullet.

<slynch> Is the restriction of NSAIDS for RNY patients permanent or temporary?

<Dr. Simpson> Yes. Well, to quote Bob Dole, when asked -- After President Clinton was asked if he wore boxers or briefs, and he said boxers, they asked Dole and he said. Depends . For some it is permanent, for some temporary. I didn't give that restriction to my patients.

<Tinker> Is it true that your body can only absorb 30 gms of protein at 1 time?

<Dr. Simpson> Yes and no. How much is one time. Is it in an hour, in a day, in a minute and is it with the full intestine, or part of it? Lots of questions to answer. Basically it works like this if you have a long limb bypass, like a duodenal switch, then you want to have that common channel hit with as much protein as you can to absorb it in that last yard before it gets to the colon or if you have part of your colon out, the semi-colon so, that is one of those statements I see floating around, which makes no sense, but is always brought up by someone.

<deb> have you heard of the gastric bypass being performed on anyone the age of 66 or 67 who has medicare and medicare supplement insurance we live in the ohio area

<Dr. Simpson> I am not familiar with Ohio, other than it is cold as the dickens there right now. At that age I might recommend you obtain a lap band.

<Lynda> Does a previous heart attack, and placement of a stent, mean you can't have wls?

<Dr. Simpson> Nope-- not at all. Just don't have a heart attack while we are doing the procedure.

< frances> I am 4 months post-op.Lost 70 lb. I have a serious problem with gas. I have tried all the gas x products.I ordered some Devrom it does't seem to help.My husband is desperate for relief. My pcp has limited my fluids .My weight has stopped for the last 3 weeks. Any help will be appreciated Thanks

<Dr. Simpson> OK-- well, gas is a problem, and I have several solutions. The first is to determine what you are eating that is causing the excess gas and often it is not the gas, but the malodor that is thought to be a weapon of mass destruction. Devrom helps quite a bit, use two tablets with each meal, and should help otherwise, you will have more gas with carbohydrates, or oily foods.

<Sonja> Did you perform your son's surgery?

<Dr. Simpson> No, wouldn't do my son's surgery-- but I am very proud of him and his weight loss.

<Merita> My sister just recently had the gastric bypass, less than 2 weeks ago and is experiencing alot of clear, bloody seepage from her insecion. Is it normal?

<Dr. Simpson> Sometimes that is normal, but sometimes it is not, hard to tell through the internet. Although we should open up an internet clinic here where people can send JPG of their various body parts for my analysis. See your surgeon is the bottom line.

<carrie> after wls are we able to eat pulpy fruit like oranges and friut with skin like apples etc

<Dr. Simpson> You can eat those pulpy fruits although you have to be careful, sometimes they can not go through and hang up in the pouch and collect and become like a hair ball that a cat gets then you cough up a bunch of pulp, or throw it up, or a surgeon goes in and gets it so, use that with caution, please.

<Buglady2GOAL> At what point should i be concerned about too much weight loss. I am rny out aug 02.

<Dr. Simpson> When your BMI is 18 and your weight is still going down, when Calista Flockhart looks like she is fat, or when you think that the blueberry might be too much for you to eat today.

<perky> I am 5'1", 310 lbs...58 yrs old..my kids are afraid that I might die if I have the surgery, but I'm afraid I will die if I don't...which is riskier?

<Dr. Simpson> well, I think you having kids was the riskiest behavior you could have done, can they be put back? oh, sorry, I flunked OB GYN. It is a real risk, seriously, and one that you have to measure when you think about this. Some people will die, and for reasons that you might not know. These things just happen. So, know the risks, and then when you feel as if YOU are willing to accept them, go for it. It is something that you have to do, then it is your decision.

<J> how long after surgery before lifting weights can be started

<Dr. Simpson> SIx weeks to six months depending on if you are eating your protein.

<Annapanda> Dr. How do think of the LAP-Band? Considering getting it???

<Dr. Simpson> I love the lap band think it is a great device, and that it will take over as the primary weight loss surgery in the United States much like it did in Europe and Austrailia

<Sonja> How soon after surgery can sexual intimacy be resumed?

<Dr. Simpson> 17 years, For some reason none of my patients ever seem to follow that and I have had patients resume relations in the hospital room. When you feel comfortable -- use birth control-- NOT THE PILL, do not get pregnant. Condoms, IUD< diaphragm. NO BABIES. They are a pain to travel with anyway.

<nancy> dr. simpson will i get my love back for sex surgery 7months ago

<Dr. Simpson> No-- your love will stay away. These things happen-- often our loves drift away never to be seen or heard from again. Alas, I have lost so many wives that way. They just drift off wish they wouldn't stand so close to the falls at Niagra--- course I shouldn't be putting so much wax on their shoes.

<kristina welicki> is it possible to restretch out you stomache after bypass surgery?

<Dr. Simpson> It is very possible to stretch the stomach out by chronically over eating food, So measure twice, eat once, never vomit and never stretch.

<Jo K> What are the possible causes of reflux getting worse immediate post open RNY?

<Dr. Simpson> Jeez- more tequila. Overeating will do that. --- use pepcid, or protonix, and measure what you eat. There are some mechanical reasons, so check with your surgeon. Good luck.

<**MODERATOR**> And the last question of the night goes to.....

<carrie> i am breastfeeding 14 month old planning on having wls in a month or 2 will i be able to nurse post op

<Dr. Simpson> You should not nurse after surgery---- at least for about six months, there are too many other changes which are going on for that to happen. So--- pump away from now till then, and save it all. Good luck.

<**MODERATOR**> Website> http>//www.doctorsimpson.com Phone> 602-234-8995 Fax> 602-230-8344 Email> simpson.office@gmail.com

<**MODERATOR**> Thank you Dr Simpson, thank you members, once again a fantastic chat.

<Dr. Simpson> Thank you all for a wonderful way to spend a Friday evening and letting me into your homes, computers, and hearts. Night all.