February 11, 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!

<Beth> It's been 1 year, and I'm having a super hard time eating small amounts and proper food. It seems I can eat anything - literally. What is the best way to get back on the program, so I can feel successful again and continue progress like I once had. Thank you.

<Dr. Simpson> Well, what you put in your mouth is what you want. That will always be your choice... it is no one else's choice. In terms of making choices, that is all up to you. But in terms of eating properly, there is NO surgery that will help with that but that is something that you can do, and I think that is one of the features of success. So, I think that the thing you need to do is this: First you need to make good choices, that is entirely up to you, and especially when you have a small pouch and are making critical choices. If you make bad choices when you have a full size stomach then what you do is compensate for bad food by eating more, and eventually enough junk might have enough good stuff in it. After weight loss surgery you have to be a picky eater. Eat something that is good for you -- there is room for bad stuf,f but right now you need to put the good stuff in first, then the bad stuff. Good luck.

<jim> Hi i am a post op RNY bypass 8 out and every time i try to eat some thing my stomach hurts

<Dr. Simpson> Well, that is not a normal feeling at all and there are a number of reasons for that, one of which is ulcers. But the best thing that you can do is to see a gastroenterologist and have an evaluation. Just today I saw a nice lady in my office with the same issue. We did a Clo test -- a breath test to check for the bacteria that are responsible for ulcers and it was positive. She also had some nausea but that is attributed to her listening to country western music. So we prescribed some antibiotics for the bacteria and asked her to listen to Usher for the other.

<Laurie> Why does our hair fall out after WLS....what is the physiology of that? I have lost 115 lbs,and at least 5 lbs of it has been from hair!!!

<Dr. Simpson> Hair falls out because of a the follicular reset. That is, when someone has a stress, the hair follicles end up resetting. So several months afterwards the hairs fall out. The hair then starts to regrow and when it regrows, takes a few months but comes back thicker and fuller than before. It can be made worse by several things: If you do not have enough protein, zinc, or if you have too many perms. So eat well, take your vitamins, avoid hair salons. Good luck.

<MikeD> I don't do well exercising. My ribs pop since I had a lung resection. Will this hamper the results of surgery?

<Dr. Simpson> Of course, the more you burn the faster you lose weight -- it is simple math. But hopefully as you lose weight and have less weight,you will begin to exercise. All exercise is a matter of degree and involves a bit of pain. So, with the help of a physical therapist, and perhaps someone from pulmonary rehab, you will be able to increase your endurance and begin a slow but steady progress. Remember, this is a race, this is not a sprint -- so start slow and slowly get better. You will do just fine, and be slim and trim and ready for action.

<Pat> I am currently 56 yrs old and weigh 268. About 12 yrs ago, I was weighed underwater and told that my IDEAL weight would be 117lbs. But, my surgeon says I will not get that low but only to around 150 lbs. Why can I not get to 117 lbs now vs, then?

<Dr. Simpson> You can get to that weight, it is always a bit of work but you can get to that weight. If you do not plan to get to a goal, you won't make it there. If you settle for something less, then that is where you will get. So set your goal,learn about your BMI and go for it. I think you will get there just fine. My ideal weight involves less ice cream, but that is another story.

<misskrissyk> Do you have to do the 2wk protein diet before wls?

<Dr. Simpson> I don't know what a two week protein diet is. Prior to weight loss surgery some surgeons like patients to have a low carb diet to decrease. Their liver size, which can be a problem for laparoscopic surgery. So, it depends on the surgeon, and what they want. Always believe your surgeon. Those who don't lose their hair.

<vickie> I am two years out, I have gained 16 lbs back. Is it normal for some people to gain this much weight back?

<Dr. Simpson> You gain weight back when the calories burned is less than the calories consumed. So it is "normal" to gain weight if you eat more than you burn. If you want to change that then you need to count calories and you need to start some exercise and you probably need to get my last book "Getting to Goal and staying there: lessons learned from successful patients. So, go walk.

<Robin B> I lost 62 lbs the first 5 months after being banded. For the last month I haven't lost anything. HELP!!!

<Dr. Simpson> If you have not lost a pound or two a week then it is time to have your band adjusted. There are two reasons for not losing weight -- if your band is perfectly adjusted then you should be able to eat less and stay full longer. Otherwise, it might be a matter of what you eat. Again, weight loss is very simple, calories in and calories out ---- eat less and move more. So, have your band checked. Good luck.

<Kristin> i was looking for thoughts on when my energy levels are gonna get better....am just at 8wks out and 40lbs down....getting a little better but my patience is wearing thin

<Dr. Simpson> Well, at eight weeks you are still going to feel like a truck ran over you. I usually tell people that the first day after surgery is like been driven over by a MAC truck by the end of the first week it is a small Toyota --- then I had a very nice young lady who actually had a Toyota run over her and she said I was right. It takes three months with the RNY or DS before you feel your energy level back but there are things you can do to help in the mean time. First, walk -- you should be walking at least one mile a day by eight weeks. Second, make certain you have and are getting in enough protein. Third, take your vitamins daily and finally, eat good food -- proper food, not junk.

<Nurse Tina> What is the percentage of post-op wound infections that have to be admitted for I.V. abx.

<Dr. Simpson> Less than one percent -- but they do happen, and it can be bad infections.

<Greg E> I am wondering about supplements and absortation? can i take pills or should I use liquad vitamins?

<Dr. Simpson> You can take either one -- regarding vitamins I think that you should find those that are chewable or ones that are designed for weight loss surgery patients ----- have those that do not contain a lot of fillers -- like lactose or gluten. Good luck.

<Nurse Tina> What is the % of deaths from WLS nationwide?

<Dr. Simpson> The rate for RNY and DS is estimated to be between one in fifty and one in two hundred fifty depending on the center and lap band is one in two thousand to one in ten thousand.

<Alice> Dr. Simpson, What are your treatments for strictures? What is the most you have perrsonally seen a patient have? What do you think causes them?

<Dr. Simpson> Strictures are simply scar tissue that obstructs the outflow of the stoma and the treatment for a stricture is dilation done by an endoscopist -- or gastroenterologist. Their cause is simply the way people scar and some patients require multiple dilations-- most require at least two, the average is four dilations.

<cherisse/VA> I am 10 months out and have lost 90.5 Ive noticed my weight loss has really slown down? Will I continue to lose more?

<Dr. Simpson> You can lose a lot more, but it does slow down and the slow down is normal. There are several things you should be doing: first, use this period of time to learn to eat good food, not junk. Second, begin an exercise program, such as a walking program, and finally eat three meals a day, and do not skip meals.

<deb> I appreciate (walking more) your website, and feel it is helping me plan more realistically for surgery, scheduled 2/22 (walk walk walk). I am on a 2 wk pre-op liquid diet, having difficulty tolerating milk (nausea, diarrhea), Slimfast (gross!) and have not been able to take in 1200 calories as specified. Determined to comply w/ this, do you (walk walk) have any suggestions to make this more palatable (walk) and less upsetting to my churning stomach?

<Dr. Simpson> Slimfast is milk based and if you have a lactose intolerance then you will have problems with those sorts of things. If you are on a liquid protein diet, then I am sorry -- I suggest you liquefy a steak, and the best way to do that is to chew it and let your stomach liquefy it but hey -- I hate liquid protein, I think liquid protein is a bit like sawdust. Although sawdust tastes better most of the time.

<Alana> Dr., I am worried that my depression will stop me from getting ok'd by my PCP. The problem is that alot of my depression stems from my morbid obesity. Will this stop me from getting WLS?

<Dr. Simpson> Having depression is not a contraindication to weight loss surgery, and there are a lot of patients who have depression and who are treated for it. A psychiatric evaluation is not to "screen" people for weight loss surgery. The examination is to provide a bridge to patients so that after weight loss surgery. They have a professional that they can rely on if they have any problems. Good luck, and don't tell them about the voices.

<Jen> Hi Dr Simpson, I have the following question. I'm over 2 years post op and have been sick all week, I can't keep fluids in me. I saw my GP and he said I'm dehydrated but it will eventually work it's way out. Should I be more concerned than the average person due to the surgery?

<Dr. Simpson> Dehydration is not good. I live in Arizona, and when you dry out here you die. So, whether you have surgery or not, do not get dehydrated, and if you do you might need to go to the emergency room and have them pump you up with some fluids. Pump pump pump. Good luck.

<Lisa B> I have a question. I was told that if my hemoglobin does not go down, I cant have wls. How can I get it down?

<Dr. Simpson> To get your hemoglobin DOWN you need to be bled or you can get a vampire to suck your blood. I would suggest you see a hematologist, a blood doctor, and have this worked up so you can see what is going on.

<Wendy> How does someone not get bored with what they eat? So that they dont eat junk foods and go back to their old lifestyle?

<Dr. Simpson> Well, junk food is boring to me. Why eat the same damn burgers, and fries. It is far more fun to eat things like fresh salmon, scallops, and to have food such as fresh vegetables, and such. Fast food is boring, not good food. Which would someone rather have -- a junior whopper from Burger King with its 400 calories, or a four ounce piece of salmon made with a nice recipe -- with 250 calories (and can be made in about ten minutes). If you want to eat junk, then you have a problem -- there is a lot of good food out there and good choices. Every month we have great recipes on our free newsletter, which you can sign up for on our website www.drsimpson.com and we have those recipes in our books we publish. Good luck.

<Patty> How hard is it to get insurance approval?

<Dr. Simpson> It depends on your insurance carrier. Some are easier to get than others. Some are downright impossible, and if you have an exclusion to weight loss surgery then it is a bit tougher.

<Jen> Is it ok to continue to take chewable kids vitamins to ensure I'm absorbing them? I normally chew 2-3 of them a day and sometimes 4 if i'm feeling "off"?

<Dr. Simpson> More is not always better, and it is just fine to take any chewable. There are a lot of good vitamins out there that you can take such as Bariatric Advantage, Vista Vitamins, or Vitamist.

<ChgoSue> How long would I have to wait after surgery to go golfing?

<Dr. Simpson> Well it is raining this weekend -- and my golfing buddy begged out on the game so come on to Phoenix and we will go out on Sunday. Otherwise, six weeks.

<Bettie M.> I'm 59 years old and going to have surgery in April. I am approximately 130 lbs over weight. what can I do to maximize the surgery?

<Dr. Simpson> Start a walking program, learn about good nutrition, learn some good recipes. Buy my first book , and when you are done walking, walk some more. Get a good vitamin and start taking them TODAY. Good luck.

<just me> if you had an obese wife, would you recommend this surgery to her?

<Dr. Simpson> Of course I would.

<Rena> Dr.- My BMI is 38.8, I am 27 yrs old and was diagnosed w/Post Partum Cardiomyopathy. My heart is better, I am on no more meds. and my EF is 65 %...would I qualify for weight lose surgery?

<Dr. Simpson> Yes, you would. And I think the sooner you get it the better you will be. So go for it.

<Naomi> You have to follow a special diet after surgery. Why can't you follow that type of diet without the surgery... What I mean is, what significance does the surgery make in weight loss? Does it make you feel full and in turn make you not want to eat more?

<Dr. Simpson> Surgery is a tool, and there is no "special" diet after surgery, although with some types of surgery you have to eat more protein because of the potential malabsorption. Surgery is a tool that makes you feel full with less. Have you ever eaten a Lean Cuisine dinner??? How did you feel after that - I'll tell you, you felt hungry. After weight loss surgery Lean Cuisine is enough for two dinners and guess what -- if you eat less, you lose more. Simple math. That is hard to do with a fifty ounce stomach, that is what we are normally issued.

<Patty Justice> Why am I having trouple keeping my sugars up to normal?

<Dr. Simpson> Well having low sugar isn't a problem IF those sugars are above 50 or so. My blood sugars run about high 40's to low 70's and if I want to eat a lot of processed food and sugar I can get them up higher but I don't feel any better, and I don't do well with junk food and junk food becomes an addiction and a way of life. So better to eat well, eat less, and have lower sugars.

<Alice> Do you have a calorie amount you recommend to 1 year post ops?

<Dr. Simpson> It all depends on your basal metabolic rate and what you want to achieve. If your BMR is 1900 calories to maintain your weight, and you want to lose more weight, then you have to eat less, exercise more, and you can determine how long it will take. It is 3500 calories to the pound, no matter what your insides look like. So it is something that you can do, Good luck.

<rebecca> I have just spent 2 days writing to my pcp, will he be surprised? I want him very educated for that referral, think it will help.

<Dr. Simpson> I certainly hope so. It is nice that you spend so much time with that and I hope that your PCP appreciates the effort that you have put in. I wrote a whole book for PCP doctors and their patients, and a number of patents have purchased two books, one for them, and one for their PCP. Good luck, and that is a labor of love.

<Bj Keil> I just had the Laproscopic surgery.. I am a bit confused as to why some physicians say that you should eat strictly 3 meals, no snacks.. And other doctors say you eat small meals throughout the day. This is for the same, exact procedure. My doctor says 3 meals; friend's doctor says mini meals. Why the difference with the same, exact procedure?

<Dr. Simpson> Here it is: Three meals a day --- do not skip meals --- if you eat a lot of small meals you will --- eat too many calories. If you want to experiment on yourself do this: Get a log book (available at www.obesitydr.com) and use it to write down what you eat. Do one method for several weeks and see the average number of calories and then do the other method --- see where you consume less-- the answer is (because we have done this) three meals a day. More meals, more snacks is more calories.

<Cheryl G.> Hi Dr. Simpson! What are some of the medical conditions that would make a patient a "high risk"patient for doing WLS? Or are we all "high risk" due to our co-morbitities?

<Dr. Simpson> Hi risk are people with the same diseases that make people high risk for any surgery. For example, if you have had a dozen heart attacks, it might be a high risk. That is it.

<Anita<-127/8mo/post> Why is it so hard to find a plastic surgeon willing to remove excess skin and say its medically necessary when you have documentation to prove it

<Dr. Simpson> There are plastic surgeons who will do that. They just want to be paid for it. If you pay for it, they will remove it.

<Lisa B> Is it true that after 2 yrs out, your stomach starts to stretch back to the norm and the weight will come back? How can you avoid this?

<Dr. Simpson> You can avoid this by following the simple rules: which are set out in our second book "Getting to Goal and Staying There: Lessons Learned From Successful Patients" which is a compilation of what we learned from patients who have been out at least four years and kept to their goal (a bmi between 20 and 24) and they do it by the following mechanism: they weigh themselves weekly to make certain they are not gaining. They exercise, they make good choices for food, and they avoid excess alcohol and there are a number of other things that they do all, available for you.

<Bj Keil> What is a stricture dilation? And at what point after surgery do "most patients have this procedure"? I have never been told about this.

<Dr. Simpson> Most do not need this. It is only needed when you cannot swallow food anymore.

<Greg E> Dr Simpson what is your website address? ty

<Dr. Simpson> www.drsimpson.com and for the books www.obesitydr.com -- thanks mom.

<adrienne> What are the steps to get your insurance to approve the surgery?

<Dr. Simpson> Your surgeon will help you with that, and they have a process for that so go with them. Otherwise, before you get to them do the following. Start a physician supervised diet with your primary care doctor and have them document this: Weigh in two times a month and see your surgeon to find out specifics about your insurance plan.

<Ralph Layton> Dr. Simpson, I would like to ask a question that has troubled be for a while. It concerns my unused stomach. Although it is still attached to the blood supply it is not of any use after surgery. I makes all the acids and digestive juices it has always made. Over the long term how is this going to affect my overall health?

<Dr. Simpson> It should be just fine -- it will function and your body will still use those digestive juices, they are just separated a bit -- you can see great drawings in my first book --- long term -- you will be thin.

<prettymissy> How much affect does metabolism has ones final result in weight loss after gastric bypass?

<Dr. Simpson> Metabolism can be increased by exercise -- that is simple, proven, and effective. Sitting on a couch with a remote control does not increase metabolism, other wise at this point I would be thin as Ally McBeal. The more you move, the higher your metabolism goes...Tthe more muscle mass you have, the higher your metabolism will go., So build some more muscle. Go for it.

<Rhonda> I am 7 mos. post-op DS. I have been taking calcium citrate--1500 mg/day. But, I think I read off of your website that you recommend calcium carbonate for DS patients. Did I read this correctly? If so, what research supports the carbonate over the citrate for DS patients?

<Dr. Simpson> In DS patients you make plenty of acid, so you do not need the acid supplied by the citrate. If you take your calcium with meals, and not at the same time as iron, you should be fine. We have plenty of patients with great levels, no evidence of osteoporosis, no kidney stones, and normal labs to prove it.

<Naomi> Are people with binge eating disorders bad candidates for WLS?

<Dr. Simpson> If they continue to binge and are not treated for it -- yes.If they are over that phase in life -- and no longer listen to country western music, then they should be fine.

<Rhonda> What criteria do you use with your patients to determine which WLS to recommend--lapband, RYN or DS? If you had a family member that needed WLS, which surgery would you recommend--RNY or DS?

<Dr. Simpson> I would recommend the surgery that is done by the surgeon which I choose to do the surgery. The surgeon and his/her aftercare program is the key ---- the type of surgery is nice, but you want to have a good surgeon first, and follow that program. So, for example, if I needed it and I lived in San Francisco I would have my buddy Dr. Rabkin do a DS; if I lived in New Jersey then Dr. Andrei would do a lap band. All depends --- which reminds me of a joke. When they asked Bob Dole if he wore Jockey's or Boxers, he said "depends."

<Anita> Is there alot of surgeries needed after gastric bypass surgery? Like repairs or anything like that? I guess my question is really am I going into something I should be scared of as far as future surgeries?

<Dr. Simpson> Be afraid, Anita - be very very afraid. Some people do have multiple surgeries after weight loss surgery. For every surgery there are complications and for some people they have every complication, no matter how good the surgery, no matter how talented the surgeon, no matter where the surgery is done. So for some, there are a lot of surgeries, and for some there are not.

<Alana> I am 5'4" and 253 lbs, BMI 43.1. Will I qualify for WLS?

<Dr. Simpson> Yes.

<Patty Justice> I am a diabetic and eat properly, exercise 60 min. every day and need to keep my sugar above 70 in order to not feel bad. I am unable to do this. Do I have an absorption problem?

<Dr. Simpson> No, not at all. I suggest that you make an appointment with a nutritionist -- dietitian -- and go over your diet history. Keep a record of everything that you eat and bring that record to your appointment, and they will have some suggestions for you.

<just me> I had open rny in Phx, on the inside...I healed awesome. Never have thrown up, no strictures, no problems. On the outside, my scar is nasty, keloid and looks like a grub worm. Why would i heal so poorly on the outside?

<Dr. Simpson> Sometimes people just do but those scars can be modified, changed, and altered to look better. It could be the "sunshine" because sun makes scars worse and we have a lot of sun in Phoenix -- except for the last couple of days, when we have had some rain. One of the reasons that scars on the "outside" with weight loss surgery heal so poorly is this: Your weight in the abdomen put stretch on that wound closure and with stretch you get a bad looking scar. Often these patients have scar revisions, or abdominoplasty and after they have lost the weight, the new scars are in better shape, so bad abdominal scars are just one of the problems that can occur because of obesity.

<Rhonda> I have a sister in the Mesa area considering the DS. Unfortunately, her PCP is not WLS-friendly. Can you recommend a PCP that you work with that is supportive of WLS?

<Dr. Simpson> Regarding a PCP that is friendly - There are a number of them in the area, and if you call your surgeon's office they will give you the names of those that are helpful with that.

<deb> Thanks for your response regarding lactose intolerance. If I'm only able to average about 600 daily calories instead of 1200 preoperatively, am I putting myself at greater risk for surgery itself because I haven't been able to "eat" well, and secondly, with my stomach so upset, could that complicate the procedure?

<Dr. Simpson> You need to be well nourished in order to heal properly. So make an appointment with a dietitian, and go over things with him/her and get some better suggestions.

<Moderator> Last question goes to...

<DallasStacie> i'm 200 lbs over ideal body weight - how can I improve my chances of having a healthy outcome on my surgery date June 6?

<Dr. Simpson> Simple: First start an exercise program -- simple walking. Second, learn about good nutrition and learn to eat well. Finally, start taking some good vitamins. So, eat well, exercise, and take vitamins and good luck.

<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 for a nice Friday. See you all next week. Good night.