February 06 , 2004

<**MODERATOR**> Welcome to tonight's surgeon chat with Dr Simpson.

<darla> after having rny surgery will it interfere with my every 5 years colonoscopy

<Dr. Simpson> no.

<VR> I've been having a hard time with queasiness and burning. I was scoped and the doctor said everything was ok, that it was esophagitis. I was given Carafate,but it's not really working. It's been a month and it's really affecting my demeanor. What should I do next?

<Dr. Simpson> Change your demeanor and be less mean. The queasiness and burning are due to something. Generally due to overfilling of the pouch with a bit of back up and if you have no erosions, it may be minor but acid in the lower pouch (and you didn't tell me what operation you had, so I will always assume a RNY) cannot be determined by the upper scope so, I would consider talking to your doctor about getting on a medicine for decreasing acid production in the lower pouch, such as prilosec. So, change your demeanor, and I will change my.... never mind. Good luck.

<Lindamarie> How long will it take to get back to work after lap band surgery approximately?

<Dr. Simpson> My nurse had her lap band surgery on a Tuesday and she was back to work the following Monday. I wonder what she was doing on Thursday and Friday.

<Rick> how will this surgery and the subsequent weight loss affect a person who is living with multiple sclerosis?

<Dr. Simpson> I can only answer this way. If you have less weight to carry, it is easier to carry it. The surgery, as far as we know, has no effect on the course of the disease of MS, either positively or negatively but having less weight is always easier to ambulate unless you like to roll.

<tina m. r> Dr. how do they control bp when under anesthesia especially when you have high BP?

<Dr. Simpson> There are a lot of drugs in their tool box to control blood pressure, so, that is rarely a problem. Plus they play music.

<Leahpa> I am 6 months post-op. I keep getting infections in my incision and it has to be reopened every two months. What could be causing this?

<Dr. Simpson> Probably you have an underlying infection which has never been drained or you have a stitch which is chronically infected sometimes we have to open the wound widely and allow it to drain otherwise the skin closes over the wound, you still have bacteria in a pocket and the bacteria will grow, and puss out the wound again. Which is never fun. So, you might need to have the wound opened more, and cleaned out in the operating room. Good luck.

<Zoey> About how much does gastric bypass surgery cost?

<Dr. Simpson> The surgery costs differently depending upon where you live. For example, if you want the surgery done in Tijuana, and want a lap band it is about 8 grand. If you want a RNY in Phoenix it is about 25 grand. If you want me to do some surgery on you, it might be priceless.

<gayle> ive just got my date for keyhole lapband surgery in the uk, im a little unsure as to what pre op tests are needed, can you help ??

<Dr. Simpson> That is great; it depends on the surgeon as to what tests they require, and that would be different for all of us and different for the patients, simply because we all have different ideas, and every patient has different history. For example, some patients need to have a pulmonology (lung doctor), some a heart doctor, some need a stress test, and other things such as that. So, you may have to get that all done overseas. Good luck.

<kathleen g> Dr. Simpson, There seems to be controversy over calcium carbonate v. calcium citrate (post op). My doc told me to get Tums (carbonate). I asked a PharmD. what the difference is. He said citrate is easier on the stomach. Do you agree? Thanks.

<Dr. Simpson> Citrate is better absorbed in the stomach and for RNY that is a good thing. So, for RNY we recommend citrate.

<Amy> Has anyone ever had persistent long term nausea after RNY surgery? And not just related to what they ate Etc? I had persistent nausea and vomiting when I was pregnant and although I know this was hormones I wondered about the surgery.

<Dr. Simpson> It is rare to have persistent nausea and vomiting after surgery. You get that early on, although it isn't always normal, but it is something that is not anticipated or expected.

<rebecca witherington> I have ccn and the out of pocket money is so ridiculous, co pays and deductibles. Almost as if You are paying cash with a 10% discount ha-ha can you help? Please

<Dr. Simpson> Well, there are a number of people who have to pay for the entire surgery because insurance covers none of it and there are two things to say about that it is the best investment you can make, a car costs more, often times, and is only good for an hour a day and a few years. Your body is something that you always have with you, and something you want to keep for a long time. So if you have to pay to have a surgery done which will bring you back so many rewards then save your money and get it done. It is well worth the investment.

<Kathleen g> Dr. Simpson> Someone recently mentioned that they are suddenly dumping at over 2 years out (not having done so for over a year). Is this a life-long surgical complication? Thank you.

<Dr. Simpson> I don't know that dumping is a "complication" of the RNY bypass. It is something that happens to 60 per cent of the people who have the bypass and is often for life. However, if they are dumping now, it may not be that it is dumping, there might be some other causes for it and they should have it worked up by their doctor for other causes of what they think is "dumping" however, for those who are thinking of the RNY surgery, dumping can happen, and can be a lifetime deal.

<maria> How safe is this surgery?>)

<Dr. Simpson> It depends upon what you mean by "safe" and which surgery you are talking about. All the weight loss surgeries have risks which are associated with them and for many patients it is a matter of taking those risks in order to have the surgery to lose weight. Over all, the surgery is quite safe, but it is surgery and with surgery there are complications, including death, or many other complications which can occur. That is a decision that each individual has to make, and they have to feel well informed to make the decision to have surgery.

<JUDY ALLEN> IS THERE AN AGE LIMIT?

<Dr. Simpson> Every surgeon does this differently, in my practice I don't take any patient under the age of 16 years old and my oldest patient, to date, is 64 years old, however, I have a nice lady who is 68 who wants to have the surgery, a lap band, and we will probably do it. Some surgeons do not operate on patients over 55 but one of my favorite ladies is down 135 albs since she had the surgery when she was 63 years old. So, every surgeon is different-- and some would say I am really different.

<debra boyd> I just received my ekg and echo report from my pcp. No one called me with results but i asked them to fax them to me. i had an abnormal ekg due to p? and possible enlarged left ventricle. the echo was all normal except for mid hypertrophy in the left ventricle and a slight regurgitation in one valve. 1 is this life threatening and 2 will it stop me from being able to have my gastric bypass? thank you

<Dr. Simpson> Those are probably questions which are best left to your surgeon. It probably will not be a problem, but it is probably best to have your cardiologist explain what they mean to you.

<Kay>2-17-04> DR Simpson IM having the surgery on 2-17 is there a support group close to Ft. Pierce?

<Dr. Simpson> Don't even know where Ft. Pierce is?

<Sandy> I am 11 days post op Lap RNY. My nutritionist said to eat 3 tablespoons of soft food per meal, however some of the sample menus they gave say 1.5 oz. tuna, chicken, etc. which is more than 3 tbs. Which should I follow?

<Dr. Simpson> You follow your surgeon's advice. You do not want to overfill your pouch and stretch it out. So, follow what your surgeon does.

<Kathleen g> Dr. Simpson, First comes the book. Then comes the cookbook. Will the Simpson WLS spas be far behind? Seriously, something like that would not be a bad idea ... a good way for post-ops to learn the nutritional and exercise ropes (after their initial healing period). Thanks.

<Dr. Simpson> The Simpson spa is opening up in the Birshires first, then in Bocca Raton, and we are thinking of Mexico, Europe, world wide. Thanks. And sign up for the Simpson Spa, now opening in Ocean County.

<Dawana> Do post op have trouble with errosion of espho? I have ring with bypass. I do throw up sometimes if I eat to much.. will that cause esoph. errosion?

<Dr. Simpson> Anytime there is a foreign body there is a chance that it can erode into the stomach, bowel, or esophagus and in terms of reflux causing erosion, or be exacerbated by the band. The band protects against a lot of gastric acid coming up to the esophagus. However, if you OVERFILL your pouch, you will have some reflux so DONT DO THAT.

<MARIE (BOSTON)> WHAT SHOULD i USE ON MY SCARS THERE IS AN OVER GROTH OF SCAR TISSUE?

<Dr. Simpson> Hi Marie-- and I am still waiting for that Boston Cream Pie. Scar tissue looks its worse early on after surgery, and it is definitely at its worse at six months. Some people like putting on vitamin E, or aloe, or all sorts of things. Little evidence they work, but if you want, they are available. I suggest you sign up for a treatment at the Simpson Spa in Marblehead.

<CC> Dr. Simpson, have you ever operated on someone with Sleroderma?

<Dr. Simpson> I have, and that does present a challenge, but it is not a bad challenge so it can be done.

<CC> I was told I have moderate esophagus damage, would you recommend going farther or not?

<Dr. Simpson> I think that is difficult to determine from here--- probably it is something to go over with your surgeon and have the pictures and the reports from the gastroenterologist handy so that they can evaluate them in this condition the esophagus is shortened a bit and that is not always a problem if you are going to have a RNY but it is something to go over with them, before you commit to having surgery. Good luck.

<Tammy> Hello, I am 23, and I weigh 230 pds. I've already been approved for GBS and I was just wondering what you think the complications might be if any, 10 or 20 years down the road?

<Dr. Simpson> Ah, 20 or 30 years down the road. Well, there is the problem that you will have energy and you will be able to chase your teenagers around instead of sitting in a chair wondering what they are doing, or where they are doing it. There is the problem that you will die of lead poisoning from a jealous lover. There are no known long-term complications about this surgery, on the other hand we don't know, we have not seen any, and we have a number of patients who are out this far. So, I think it is probably safe to say that obesity has a worse problem in 10 or 20 years than post op.

<Tammy> I am getting my gallbladder taken out next week and the surgeon who is doing it begged me not to get the GBS, he said that he has had to fix too many complications with it and too many young people are dying from it? What do you think about this?

<Dr. Simpson> I think that some surgeons have seen complications and they stick out in their minds and I don't see a lot of young people dying from this surgery, and I do this surgery a lot and I know a lot of folks who do this surgery a lot and I don't have other people fix my complications so, he/she might be overstating the case a bit. You should ask your bariatric surgeon about their complications. How many, what type, and death rate. All of which we are happy to discuss with our patients, It is a good surgery, and it is done by a lot of very good surgeons throughout the country.

<Cindy> Hello DR Simpson I have been denied by my insurer to have gastric bypass surgery I am in the process of appealing (i'm 5'3" & 346#) If denied again would it be wise to pay for this my self

<Dr. Simpson> The alternative is to not have the surgery. So, paying for the surgery is something that is a great investment in you. It gives you something that you will live with forever. You always wear your body, and you want to keep it around and healthy. Right now you just want a bit less skin and fat that it is carrying, and this surgery will help with that. So, it is a good and wise investment to invest in yourself. I am thinking about investing some money in my golf game.

<Paula> I am 5'2" and 200 lbs (last time I checked). Am I a candidate for band surgery?

<Dr. Simpson> Your bmi is 36.6 and it depends on your comorbidities.

<Ida> I just had my 1st consult today. I used to be a Powerlifter. I do not know how long after surgery i can begin to add resistance exercise to my cardio/walking. I am hoping to use weights to firm up my skin and build some muscle. I also do not want to get too thin.

<Dr. Simpson> Oh, well, in terms of lifting heavy things, all of us have different ideas about that but the earliest you can lift something heavy is two months and some surgeons, because of the relative state of malnutrition that you are going to be in will not want you to lift for a year. So check with your surgeons, in terms of getting too thin--- that is really a very rare problem. Most of the time, the problem is those last 30 pounds.

<Asia> I work in the meat dept. How long will I have to take off from work?

<Dr. Simpson> Send me some porterhouse, will you? Three to six weeks depending on what activity level you will want to return to and how much you will have to lift. Send the porterhouse to Dr. Simpson, of the Simpson Spa in Hawaii.

<Kay>2-17-04> Kay> Dr.Simpson how long do you have to chew pills?

<Dr. Simpson> Til they are chewed up. Then swallow them.

<Tammy> How much can someone expect to loose a month with the band surgery?

<Dr. Simpson> The band surgery, or the adjustable lap band is a procedure which has a weight loss that can be anywhere from 15 per cent of excess body weight in a couple of months to less. Again, it is limiting the amount that you can eat, and it is a simple formula. You know the calories that you have to maintain your weight, or you can figure that out if you have a Tanita scale. Which will tell you that, and however many less you are consuming will determine your weight loss. There is nothing more or less special about the lap band and other surgeries except that you may not have a fill for a couple of months so you may be able to eat a bit more. The next book of mine, will have some good food choices or you can go to the Simpson Spa in Monmouth County. I like this spa idea.

<Sandra Hoffman> IM having the lapband on feb10 how long will I have be on liquids.They I will know when I am ready for the next kind of food.

<Dr. Simpson> Two weeks on liquids. First week on clear liquids, second on full liquids. Then you slowly go to puree and soft foods and I consider coffee a clear liquid. Even as strong as I make it.

<cherylb> Do you think a medic alert bracelet is a necessity?

<Dr. Simpson> Only if you like jewelry, and if you do I think that there are other bracelets that are far nicer such as a nice diamond tennis bracelet-- which I never understood why they call it that because it looks nothing like tennis and I never did see Anna Kornikova wearing one then again, I doubt I was looking at her wrist.

<VR> Hi doctor. Thanks for your previous answer. I'm the guy with the queasiness and burning and poor demeanor. I was diagnosed with esophagitis and put on Carafate which isn't really helping. I forgot to mention that I have been taking prevacid since 1/15/2003. I had a proximal RNY on 12/02/02 I started at 415 and I'm now at 182

<Dr. Simpson> Carafate lines the esophagus, and that you are on Prevacid is interesting because sometimes Prevacid can cause some nausea and what not. So it may be that the drugs you are taking are causing the problem and that is a great weight loss, by the way, I think you would do well at the Spa in Canyon City.

<lizzie> I have keloid scarring--will that affect my internal scarring from a lap rny?

<Dr. Simpson> There is no relationship between the scaring on the skin and the scaring in the abdomen. They are different cells, and a different process and there is very little scarring from a laparoscopic procedure, or less than with an open although there is some, and we all know patients who have had surgery for adhesions, or internal scars, who had laparoscopic surgery.

<Asia> If you have iron poor blood will that stop your Surgery?

<Dr. Simpson> Well, if you have an iron deficiency anemia --or iron poor blood, as the Geritol commercial calls it then you should consider a surgery which will not bypass the duodenum so that you will not have this as a problem. For example, the lap band or VBG would be a good surgery because once you have a RNY, your duodenum, where you absorb iron is bypassed, and you have lost a great place to absorb iron. Good luck.

<Roberto> What kind of diet will you recommend for the first four weeks after surgery ?

<Dr. Simpson> Depends on the surgery that you are talking about. For a duodenal switch patient we put them on a regular diet and recommend they have a diet high in fish the first few weeks, or things that swim. Like shrimp, or things in the water--- but not old tires, they have little nutrition. Some surgeries mandate liquid diets for a while--- in which case I recommend you drink good stuff, like Dr. Simpson's magic formula, available soon at a Walmart near you or at the SImpson spa in Nantucket

<Blessing> Is it possible to have the bypass surgery done over?

<Dr. Simpson> Yes, we call that a do-over, or a revision--- and that can happen if there is an anatomical reason for a failure of the surgery such as the pouch is stretched, or there is a stoma which is too large or some such thing like that. In marriages we call do-over's mulligans, or ex-wives and alimony is ransom that the happy pay to the devil.

<Blessing> How can I know if I have stretch my pouch?

<Dr. Simpson> There is a cottage cheese test where you eat some cottage cheese and see how much you can hold but the easiest way is to have an upper GI, and the best way IS TO MEASURE WHAT YOU EAT TWICE, AND EAT IT ONCE AND DON'T STRETCH THE POUCH. All available in my soon to be released book.

<nichol phelps> hi just had the open bypass last Thurs feel like IM dyeing for something good what can i do

<Dr. Simpson> Don't die. When you say something good, I assume you are thinking of some food which is probably not in your dietary recommended list like candy, cake, ice cream, and the like and those sorts of cravings and hungers are common, and if you can have a bit of something that is one thing, but if you will have to finish that bowel of M and M's then you should avoid it like I avoid picking up my socks. I always thought that peanut M and M's with cream would make a great breakfast cereal so, find other snacks that are better, diabetic hard candies are a good choice. Nuts are not a bad one and if you are having a CMS moment, I am told that sugar free fudgesickles are a good choice and I was told if I don't tell about them I will be sorry.

<LisaLisa> Dr. Simpson Can a person with mitral valve prolapse be considered for lap-band surgery? I also have borderline high blood pressure and am taking Ziac everyday. I am 5ft 11inches and weigh 235 lbs. with no other health problems.

<Dr. Simpson> MItral valve prolapse is not a contraindication to weight loss surgery, whatsoever but you might be under the qualifications for some surgeons. Prolapse is NOT a co morbidity of obesity, although hypertension might be considered to be by some companies. Good luck.

<Joany> I am thinking about WLS after many years of trying and failing at weight loss. right now I am getting into many health problems that are obesity related. What is the failure rate? I am afraid that i will be sorry later.

<Dr. Simpson> Well, that is an easy question to answer. Your failure rate for diets is 100 per cent so far. So if you have a failure rate for surgery which is less than that, and it is much less than that. Surgery might be able to provide you with the tool for weight loss that you will need so, I think that surgery is probably the only tool that we have now that will be a good match for you so failure rate, not too bad much better than Atkins, or Weight Watchers, or Richard Simmons. Although the Dr. Simpson Spa in Carlsbad might be a good place for you to recover.

<Pamela> Are there ways to help minimize certain risks, such as a pulmonary embolism or collapsed lung?

<Dr. Simpson> Pulmonary embolism is not a collapsed lung, a PE is when a blood clot travels to the lung and lodges there, depriving that part of the lung from oxygenating the blood and the surgeons do a lot of things to keep that risk low, including giving some things which decrease the ability of the blood to clot. The danger of that is more bleeding, but it is easier to treat bleeding than a PE. In terms of what the patient can do- WALK, then walk some more, and when you are done walking walk again, then take a walk.

<LisaLisa> How much recuperation time does a patient need after a lap-band surgery? I am a teacher and am wondering how long of a leave of absence will I need.

<Dr. Simpson> Take a week off for you, and then if you teach teenagers, take a week off for every smart aleck kid you have and if you have a kid like I was, retire, because life is too short.

<connie> Dr. Simpson, I am in the process of getting approval for WLS. One surgeon (on this surgeon chat) suggested that maybe duodenal switch would be good for me because of my weight (I weigh 470 pounds.) However, when I went to orientation I learned my surgeon only does RNY. Is distal RNY as effective as DS?

<Dr. Simpson> All surgeries are effective for weight loss, but there is no doubt that the DS is very effective for some. However, one of my favorite people -- and my adopted son, Crow, had the RNY and has lost over 430 lbs so you can lose it with almost any surgery, including the lap band. So, it is a great tool, go for it, and use it--you will be happy, and if you want to lose more weight walk.

<Hanna-RNY_in_6_Days> Hello Dr.Simpson, I am currently 5'8'' and I weigh 280, my goal is to be about 150-160, is this reasonable? Thank you!

<Dr. Simpson> I would say that 135 pounds is a reasonable goal to attain, and you can attain the 150 to 160 also follow the rules, and above all-- protein, water, and WALK, then walk some more.

<darcy> I was told that I need to lose 10% of my body weight pre WLS, is this really necesary and why? thank you.

<Dr. Simpson> Well some surgeons think that if you demonstrate a weight loss that you will be more compliant after surgery. So, for some it is needed. Other surgeons want you to lose some weight in order to do the surgery through the laparoscope, which is a great goal finally, some of us like the jump start for our patients, because unlike any other diet you have been on this weight will be gone forever, and that is a great feeling. So, lose the weight, take up a walking program, and go to a Simpson Spa near you.

<**MODERATOR**> Thank you DR Simpson, thank you Members, great chat as always! Thank you all for being here tonight. To learn more about DR Simpson and his great practice, please visit www.drsimpson.com or call 602-234-8995.

<Dr. Simpson> Yes, please come and see us on line, at our website and also don't forget the book. Good night all. Have a good weekend.