February 4 , 2005

<Moderator> Welcome to tonight's chat with Dr. Simpson. 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. Thank you!

<Dr. Simpson> Hi all. I am ready for the lighter side of life where we spend Friday afternoons making light the heavy subject of weight loss surgery.

<Kelly> Who determines what type of surgery a patient will have. The surgeon, the ins company or does the patient have the choice?

<Dr. Simpson> The insurance company may not cover all surgeries and if they do, then it is up to them. The surgeon may only do one or two surgeries -- and may have a preference and if he/she does- - then that is what they do. So there are constraints. If, however, you pay cash -- you can probably go where and get what you want done.

<Ralph> How soon after surgery are we allowed to go back to work?

<Dr. Simpson> It depends on the type of surgery that you have, and if you have your own occupation. Self employed you will be back to work in no time. If you work for the government you will be back in six to twelve weeks. If you have an open surgery it is longer than laparoscopic.

<Lee> I am 5 days post op and I am having a hell of a time getting my water in. Any suggestions?

<Dr. Simpson> Drink - sip sip sip sip sip. You can sip a half an ounce every five minutes while awake and you'll keep hydrated.

<anew me> I already have low iron deficiency anemia how would WLS be affected by that will I be required to take more iron pills.

<Dr. Simpson> Depending on the type of WLS --- will depend on the iron if you need it. For example, a RNY will need more iron, and a DS will need less, and lap band as much as a normal person -- whatever normal is, it isn't me.

<Kara> I am 4 yrs post op, maintaining a weight of about 123 lbs. I have a fear I will gain weight and eat very little. My psychologist tells me I am bordering on a eating disorder. Is this common after surgery and losing your excess weight?

<Dr. Simpson> That is not common, and I don't know much about eating disorders, but remember, unless you have a psychiatrist that specializes in eating disorders, they don't know much about it either. And some psychologists think that an eating disorder applies to anyone with a BMI of 19 to 21 --- which is a normal BMI -- and remember, thin people don't eat much. So, you have to put it in perspective with everything. So your psychiatrist probably knows what they are talking about. But remember, sometimes you have to talk to a specialist if that is what you are concerned about and if you are concerned then see a nutritionist to get an idea of what you should be eating and how much, and find a psychiatrist that specializes in eating disorder to see if that is what you have. Is it common -- no. It is more common for patients, far more common, for them to never get to goal and to regain after four years. But, get a second opinion from a couple of specialists.

<JB-2 Wks PO: -22 lbs> I would like to know about diarreha during the weeks after surgery...should I be worried.....

<Dr. Simpson> Only if you run out of toilet paper. Diarrhea is defined as multiple watery liquid stools. Not a few loose stools --- so, if you have it, see someone. Most have constipation but, keep some nice wipes around, and around, and around.

<Rosa> Can you tell us the difference between the bypass surgery? I have seen three types but don't know how to decide which one is right for me

<Dr. Simpson> Rosa, you go to the surgeon, and you talk to them about the surgeries that they do. If you have to go to multiple surgeons then you do that. You get the information that you need from the specialists. The Internet is NOT a research tool for patients.... The best book on the subject, by the way --- is written by yours truly, so go to a library and check one out or www.obesitydr.com to order one if you want but go for it. Talk to the surgeons, and get a better idea.

<Ellen> How much protein, fat grams, sugar grams and carbs should a rny patient be taking in daily?

<Dr. Simpson> There is a whole table in the appendix of my book about that. In terms of protein, that is very specific depending on size and the surgery. Otherwise 00 processed foods -- minimum. Good luck.

<Lisa> I have decided I want this surgery. Now, I need to find a surgeon. What should I be looking for in the surgeon I choose?

<Dr. Simpson> One that has a good aftercare program and one that cares about their patients. One that is more than a factory.

<JB-2 Wks PO: -22 lbs> Having had surgery a little while ago...when does the scar and muscles underneath the scar heal

<Dr. Simpson> They do heal, and they do well and they get better.

<Jessica> I had rny 3.5 yrs ago. I am now back up to my original weight of 244lbs. I lost only 100 lbs maintained that for one year and now am back up. My staple line broke down and surgeon says I need a revised surgery. He is suggesting lap band. Have you heard of this.....?

<Dr. Simpson> Yes, I have, and I have done that before. It is a good way to do things, and works well.

<Tammie> How far out should you be before you start eating salad?

<Dr. Simpson> As soon as you want -- or your surgeon says.

<Linda> I am only about 65 lbs over weight. Would I qualify for the surgery?

<Dr. Simpson> If you are four foot ten inches, otherwise, no.

<Wilma> What is the maximum age limit for this procedure?

<Dr. Simpson> Depends on the surgeon and it depends on the procedure. Medicare won't pay for some procedures, but if you wave that and self pay then things can be done.

<Corrine> 17 yrs old. 377 lbs. I can't find a surgeon who will take me as a patient. any suggestions?

<Dr. Simpson> Depends on a lot of things. The age isn't a problem - there are a number of surgeons who perform this surgery on 17 year olds. However, not all insurance companies cover that age group. In addition, you will find that there are different procedures, some of which might be more appropriate. So, it will take time. I suggest you find out what your insurance will cover, if you are paying for it yourself, or finance through something, then there are a lot of surgeons who will offer to help you. Start with the physician directory at obesityhelp.com and good luck.

<SandyG> I am 7 months post op and I miss real coffee. Why is caffeine a no no after WLS?

<Dr. Simpson> It isn't a "no no" and many of my patients drink coffee immediately post op but I am Norwegian and it is one of the essential food groups. Caffeine is an appetite SUPPRESSANT, not stimulant, although not enough of a suppressant to be of consequence. So, if you were in my practice, you would have been drinking coffee the day after surgery while walking the hallway.

<Danielle> I had surgery 7 mos ago. I have lost about 95 lbs. I am afraid I am losing too fast. Is this a valid concern?

<Dr. Simpson> The only way to lose too fast is to have cancer, TB, AIDS or some other disease. As long as your nutritional parameters are in good shape, it is not a problem. Check with your nutritionist, surgeon, and go from there. Good luck.

<JB-2 Wks PO: -22 lbs> Should there be things that those whoo have had the surgery should look out for in the distant future...like 10-20 years out

<Dr. Simpson> No, you should look out for them NOW. Have your vitamin levels checked, your blood counts and iron checked, your B12 checked, get a bone scan, and keep on top of those things. Better to prevent a problem than it is to fix a problem.

<Dawna> is there any documentation or studies that show that carbonation will enlarge the pouch?

<Dr. Simpson> No, there is nothing of the kind, because it doesn't do that. As long as you can burp or burp from the other end, you will be fine. However, carbonation forces food out of the pouch into the intestine, or stomach (depending on your surgery) which will make you hungry sooner. So avoid it, except for carbonated waters, which are lightly carbonated, are fine.

<Ronnie> What are some of the complications that men suffer after gastric bypass surgery?

<Dr. Simpson> Too many women chasing them.

<JB-2 Wks PO: -22 lbs> Is there research that looks at the long-term effects of this surgery

<Dr. Simpson> Long term is a vague word, but, not really longer than five to seven years. After that there is not much good data. However, there is good data about obesity in the long term, and that is pretty bad so better skinny than fat, better rich than poor.

<andrea> High blood pressure and stroke have been within the women in my family for generations and I am the next premenopausal woman who faces this family threat. I have been a weight watcher all of my life and I have adhered to nearly every kind of diet. I had my thyroid removed in 1991 because of a cold spot (a couple of them) and I am on synthroid. I am 5'6 inches tall and in the past year I have gone from 229 pounds to 190 pounds. This was with much effort and with so much focus and so i have been told that I am not eligible for wls-- I could eat my way into wls in 2 weekends. How can we who have syndrome x and other maladies become eligible for wls?

<Dr. Simpson> Keep working at it and if you are concerned because you are a woman, then get a sex change.

<Alan> I weight 377 lbs at one time. I lost about 100 on my own and I still have about another 100 to lose. Would I qualify for surgery even though I have lost some on my own?

<Dr. Simpson> It is a job to do weight loss and it is not easy to do, and what you have done is remarkable and difficult, whether you have the tool of wls or not. You have to do the same work, limit calories .It is just easier with wls, because of the tool. If you have done it on your own, keep working at it. Keep exercising, keep eating well and if you have some ice cream in your house, send it to me so you won't be tempted. Good luck.

<Jackie> If a person has a history of self inflicted abuse, will that prevent them from being approved for surgery?

<Dr. Simpson> No, it won't. There are many kinds of psychopathologies which we operate on -- well, not the psychopathology , just their stomachs and guts - but much like any disease, which has been treated, it isn't an issue. But you might want to have an ongoing relationship with a shrink to help you if you need it and if you want to abuse yourself again, then buy my books.

<andrea> what is the significane of the gall bladder in all of this? Why in some cases is the gall bladder removed?

<Dr. Simpson> The gallbladder can form stones in some cases, and if it has stones it needs to be removed. If it does not have stones, and you are doing certain types of surgery, it needs to be removed. Some remove all of them, and some wait because we like repeat customers but not everyone has a problem with their gallbladder and taking out gallbladders is fun -- that is how I afford the high priced dog food for my mutts.

<andrea> how much is this procedure without insurance?

<Dr. Simpson> For you, Andrea, I have a special deal --- seriously, every hospital and surgeon has different prices, and structures for it. Depends on the surgery, it can go from about 15 grand for a lap band up to 20 to 30 grand for RNY ---- it is worthwhile to price shop, then see if the surgeon is any good and go from there.

<Cathy> What are some of the pros and cons associated with lap rny vs open rny?

<Dr. Simpson> If your surgeon does open, then the cons are great for lap. If they do lap then the cons are great for open. Open has a larger scar, more recovery time, and more chance of hernia and adhesions. Lap has a higher leak rate, for some, not for all. More and more surgeons are doing lap, and fewer dinosaurs do open.

<Lori> I am scheduled for surgery on March 14th. I am hoping to have lap bypass. What can I do now to make sure that I do not have complications?

<Dr. Simpson> You should walk after surgery, before surgery, but not during surgery. Eat well, but not too much, and start taking vitamins. Good luck.

<Cheryl G.> Hello Dr. Simpson. I will be having wls soon and would like to know if complications can occur years after having the surgery and what are they.

<Dr. Simpson> Yes, they can occur, and they are as follows: You can have adhesions develop which cause bowel obstruction, which can occur after any abdominal surgery. If you do not take vitamins, you can develop dementia, and other problems. You can develop osteoporosis if you do not take calcium. You have a higher incidence of lead poisoning from a jealous lover. Oh, and hernias, too.

<Jean> How soon after surgery can I start exercising in the form of aerobics?

<Dr. Simpson> Jean, great question -- start now.

<Erica> I am 5 mos post op and just found out I am 3 mos pregnant. I thought my cycle was off due to the surgery. I am very scared and want an opinion of a surgeon on what I should do now? I can't find a ob that will take me on, since I had gastric bypass.

<Dr. Simpson> You need to find an OB -- a perionatalogist, who will help monitor you, particularly you need to be monitored for folate levels. Otherwise you can get spina bifida - well, the kid can and you need an OB -- if you cannot find a perinatologist, you need some care during your pregnancy. So, good luck, and name the kid after someone you like. And for the rest of you reading this ---- do not have sex for 17 years after weight loss surgery.

<andrea> we know that this is major surgery but shouldnt more people be considered eligible for wls in light of the fat epidemic and the diseases caused by being obese?

<Dr. Simpson> There is no epidemic. You do not get fat by standing next to a fat person who sneezes on you. You get fat from eating french fries, and the like. In terms of that, the best medicine is not surgery - surgery is not preventative. The best medicine is education, physical education, moving more and eating less. But once you have obesity then the best is surgery, cause that is what we have to offer that works until we find a pill, diet, or something that works better and insurance companies won't open their flood gates because they don't care about health of their clients. They care about corporate bottom line -- I know this is a shocking revelation.

<Ashley> I am only 15 yrs old and I weight 267 lbs. I can't find any surgeons who will do the surgery. All say I am too young but i have seen people younger than me that have had it. why wont they help?

<Dr. Simpson> Not every surgeon operates on teenagers --- some do not, and because they do not that is ok. You need to find one who will, and then go through that program. You may have to travel to do that, but that is what is needed. In the mean time do these things: Enroll in weight watchers, develop more physical activity, stop watching television for more than one hour per night, do not eat from any fast food places --- EVER --- and learn to eat those green things on the plate called vegetables -- I just discovered those last week...always thought they were decoration, they are not.

<Jenn> What benefit does a b12 shot provide pre op?

<Dr. Simpson> Money for the person giving it, and a way to bruise your backside.

<Nadine> I am so bad about taking my vitamins. I know I am supposed to. But, what are some of the symptoms you can have if you don't take them like you should?

<Dr. Simpson> You can -- seriously -- go blind, you can develop dementia ----- and one day it will just happen. You can open up your surgical site. You can do many things, and once they are done, it is hard to undo them so take them, unless you want to be blind, demented, weak, and slobber on yourself.

<Lindy> What are some of the major complications associated with this surgery?

<Dr. Simpson> Death, bleeding, infection, leaks, hernias and meeting amazing doctors with piercing blue eyes.

<thinking it over> Can you recommend a site which will locate a reliable local surgeon for Lap-Band surgical procedure? I live in Northern New Jersey. Thank you, Dr. Simpson

<Dr. Simpson> Dr. Val Andrei is in Northern New Jersey, and I would highly recommend him. He is in Livingston, NJ. www.inamed.com has the list.

<Kimber> What is a takedown?

<Dr. Simpson> That is what happens on Super Bowl Sunday when the quarterback, that Brady fellow, finds the turf while backing up. For wls, it is what happens when we attempt to "reverse" the surgery. Same thing -- a tackle.

<Kimber> I need a revision since I have gained back about 50 lbs, but my surgeon says I should look into a take down. What do you think?

<Dr. Simpson> I think you need to figure out what you are eating, and why, and make good choices. It is not the surgery that causes you to lose weight -- surgery is simply a tool to help. If you don't make good choices, then the honeymoon is over. You gain weight, so you need to figure that one out.

<Catherine 7 mo -107> Will putting flax seed on my cereal or oatmeal every morning help constipation and dry hair?

<Dr. Simpson> It sure won't help the taste of the cereal. Constipation and dry hair are more likely secondary to not drinking enough water. So, I don't care how much you are drinking -- drink two more bottles of water a day and see what happens. Flax seed oil is vile.

<Janine> I have a jp drain in. I go in next week to have it taken out. Will it hurt?

<Dr. Simpson> It won't hurt me a bit. Wear old clothes, because you might get some "drain" sauce on you. Comes out like linguine and drain sauce.

<Jenny Johnson> I have had a history of binge eating. My psych evaluation showed this to be a bad thing in the long term success of the surgery. Isn't this a common problem with overweight people?

<Dr. Simpson> No, not binge eating -- eating too much, or eating the wrong thing. You will need to have ongoing relationship with your shrink, because you want to have this monitored carefully. I have had plenty of patients with this diagnosis and they have done fine but they keep seeing my buddy, our team member, the shrink, who specializes in this sort of thing. Good luck.

<Mandy> Is gastroparesis possible following weightloss surgery? Can it be treated?

<Dr. Simpson> No, that is from something else, and gastroparesis can always be treated. We have some medicines for it like reglan.

<Jill> Are there any long statistics that show which surgery (lap or open) has the best success rates

<Dr. Simpson> Statistics are for a large group of people -- not for a single individual. You have to do what you want, and you can be successful with either operation. It is up to you and your work ethic. Good luck.

<Mandy> How long is it safe to be on TPN? I have been on it for 6 months now......

<Dr. Simpson> Sorry you are on TPN Mandy. I hope you are able to eat and get off of it soon. I know some patients who have been on it for years because of problems with their guts. So it can be a life long thing. Good luck.

<melody kleintank> Hi doctor I had my roux n y on 4/21/04 and have lost 90 pounds, but am really slowing down to about 2 pounds every other week. Is this normal and how do I jumpstart myself to lose more weight? I don't want to be finished yet!

<Dr. Simpson> Walk, walk, walk, walk, walk, walk, walk, walk, walk like a cop to a donut shop. Don't stop walking, exercise more, and make good food choices. Stop fast foods, stop white bread, white flour, white sugar, eat vegetables, and then go for a walk. Oh, did I say exercise -- if not, do that.

<glenna> Why do so many people have narrowing stoma?

<Dr. Simpson> Ten percent.

<cindy Coite> Can you say something about pregnancy at 2 years post op?

<Dr. Simpson> Something. Oh, sorry. After two years is when we like people to wait. Although some seem to get pregnant sooner, because they don't follow my advice about abstaining for 17 years. Why is that? After two years we feel it is safer, but you still need good prenatal care.

<r_good> Through my readings, I have seen indications that the Lap-Band would not be suitable for an individual with an inflammation disease. I have been diagnosed with Bechet's (a rare, chronic, rheumatic illness resulting in the body's immune system over-reacting and producing unpredictable episodes of inflammation -- mostly involving the small blood vessels). I am on methotrexate and also 10 mg/daily of prednisone. Prednisone is very effect for flairs. Could I have the Lap-Band surgery?

<Dr. Simpson> Sure you can, although the company does not recommend it. You just need to know that it is not in their list of indications, and in fact is contraindicated. I might write to Inamed and ask them for their reasoning about that. Good luck.

<Allison> Dr. I am having a hard time eating. 4 weeks post op and all I do is throw up. My surgoen says nothing is wrong, but something is. What could be wrong with me that I cannot keep anything down. Should I get another surgeon since mine won't listen to my concerns?

<Dr. Simpson> The most likely cause of throwing up at four weeks is overeating your pouch. If you are overeating it, and not paying attention to the amount going in then you will continue to throw up. Vomiting is not a good thing, not at all. You might have a stomal narrowing, and if you do then it will need to be dilated. So you might want to see a gastroenterologist to have them scope you and see if it needs to be dilated. Measure what you eat -- measure twice, eat once, vomit never. Good luck.

<Laura> After gastric-bypass will you always have dumping when eating sugar, even in the long term?

<Dr. Simpson> Forty per cent never have dumping after bypass, and of the sixty per cent who do, most of the time it will get better with time. So, eventually it will get better.

<cathy_p> Do you believe in diet medication for prefill lapbanders?

<Dr. Simpson> No, I do not. You don't need meds if you have a lap band. You need to make good choices.

<Theresa D> Is colon cancer connected to gastric bypass

<Dr. Simpson> No

<Moderator> Last question of the evening goes to...

<Joy> I am 3 weeks p/o of RNY and I lost 8 pounds the first 2 weeks and only 2 pounds this week. Does this seem too slow?

<Dr. Simpson> No, it does not. Walk, make good food choices, and keep walking. You will do just fine. Do not compare yourself with others...that will make you vain and bitter. Enjoy the ride, enjoy the journey and good luck. You are all my heroes.

<Dr. Simpson> For those who want, we have two books out ---- both on www.obesitydr.com, including "Getting to Goal and Staying There: Lessons Learned From Successful Patients." Thank you and good night.

<Moderator> Thank you, Dr. Simpson. And thank you, members, for joining us this afternoon.

<Dr. Simpson> Have a good weekend. Go Philly!

<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.