February 13, 2004

<**MODERATOR**> Welcome Dr Simpson :-)

<bbd> Hi Doctor S is there ANY way besides surgery to fix collasped bowels they are flatting themselves they said need surgery to try to make sling to hold?????????

<Dr. Simpson> Well, if you mean that the bowels are coming out of places that they shouldn't...such as down south...no, generally surgery is what is indicated. You have to make a sling to keep the parts from falling out and making a bit of a mess....But hey, surgery is a good thing.

<jessica> i have a bmi over 40, do you think i would have trouble getting approved by HAP hmo?

<Dr. Simpson> With a bmi of 40 you shouldn't have an approval problem.

<Mylite> I need to know longterm effects of RNY on the liver...

<Dr. Simpson> The liver will be just fine with the RNY...There are no long-term effects, although if you have fatty liver, that probably will get better unless you starve yourself, or don't eat enough protein.

<Debbi R 3DaysToGo> Dr. Simpson. Thank you for coming. I always enjoy your chats. My surgery is in 3 days (Monday) and I am so anxious, I'm having trouble sleeping. What can I take to help sleep that will not cause problems with surgery.

<Dr. Simpson> Read my book....Seriously-- sleep is a difficult problem, but use the time wisely to do things like clean the house, clean the kids rooms, balance your checking account, and all that boring stuff, and pack for the trip...You will be fine. Sleeping pills really don't help that much, and they are a bit addictive.

<kathleen g> Dr. Simpson: Do you take out the appendix when you do an open WLS?

<Dr. Simpson> Sometimes we do, and sometimes we don't. It is not something that we need to do, although sometimes it is sitting in front of us and only takes a bit of time to remove. But sometimes to remove it would mean making a larger incision and that isn't a thing most folks want. Although one poor lady who I didn't do that to ended up with an appendectomy a couple of months later. So, not something need to do.

<Teddy Bruner> How many calories should we be taking in being 5 months post op?

<Dr. Simpson> I don't think you should worry so much about calories, because you should simply keep the volume of food to what you can take in your stomach or your new pouch, and that will be fine. You should make your food choices those things which are low on the glycemic index, such as a glycemic index of less than 55....of course, if you don't know what glycemic index is, you can go to my website and see. And you should concentrate on a good quality protein. Not fatty foods, or fat laden foods....but if you want to you can always take in more food with high glycemic index and high fat. But I don't think that is the place to go. Good luck.

<Debbi R 3DaysToGo> The book is out???

<Dr. Simpson> Book isn't out yet-- publisher tells me a few more weeks -- I am waiting with baited breath - although I am told that if I use the listerine strips that will help the breath.

<Mylite> I have a liver biopsy that is positive for cirrosis but have normal labs for three years now and am totally asymptomatic

<Dr. Simpson> Well, that you have normal labs is a good thing...However, cirrhosis is not, and if your cirrhosis is secondary to a fatty liver there will be some change in the underlying condition. Hopefully your liver will continue to do fine. Good luck

<Jenny Martin> WHATS THE DIFFERENCE BETWEEN PROMAXIAL AND DISTAL?

<Dr. Simpson> Ah, a very good question, and one that I have not had in a few months....a proximal bypass is where you bypass not more than about 100 cm of the 600 cm of small bowel...and a distal is where you bypass about 55 per cent, or anywhere from 150 cm of small bowel on up. However, while the bypassed small bowel will make it so that you will absorb less fat, you must remember this-- a kiss is still a kiss (oh sorry)...the major part of any weight loss surgery is the restriction, not the malabsorption...So, while there is some moderate malabsorption with weight loss surgery and you can lose more weight, the other issue is that with a distal bypass you will need to monitor the fat soluble vitamins ADEK and eat a high protein diet. Good question

<kathleen g> Dr. Simpson: Some docs are very strict with the rules and regs pre and post WLS and some are very lenient. Both seem to result in significant weight loss for their patients. Which side of the fence do you fall on? Thanks.

<Dr. Simpson> I think it is difficult to tell anyone what to do. I n fact, the more you tell someone they cannot do something or they must do something....well, think about it, how effective is that with you???? The idea is that we educate folks, and give them some choices which are both nutritious, easy to prepare, and reasonable given their life. But we are strict about requiring follow up and we do make them stop smoking before surgery. But, generally, we find if we make things a choice instead of an edict, it seems to work a bit better.

<Ben> I cant eat fruit and veggies why is that? i get sick and bad stomach pains

<Dr. Simpson> There are a lot of reasons people have problems with them - but the fiber might be giving you some hang ups, and that is because your new stomach cannot digest that fiber that well, and you might be developing a ball of fiber like a cats hair ball..cough..or, it could be there is something in the fiber that is giving you fits. Some folks who have irritable bowel disease have a hard time with too much fiber and a harder time with too little fiber. Me, I love fiber-- in fact, fiber one is one of my favorite cereals for breakfast...but then again, I am old.

<LucyFromLA> What would make you NOT want to operate on someone...as in what sort of co-morbidities

<Dr. Simpson> I would not want to operate on someone who is too sick to handle the operation...That is, they have such other problems that the operation would throw them over the edge but the standard co morbidities are not a problem. I wouldn't want to operate on a celebrity again. I have done a few of those and they are a pain in the neck.

<Dani> Do you do wls on someone as young as 15?

<Dr. Simpson> On someone who is 15 and they are fully grown, I might consider a lap band...certainly would do that one someone who is 16 years old. However, this is a decision made with some input from family, patient, and a few other folks. But, so far 16 is my youngest patient.

<jimohio-128#s 6mos> Hello Dr. , Thanks for helping so many. Pouch stretching! Can this be done by consuming too much water too fast?

<Dr. Simpson> You will certainly stretch your pouch, or anything by drinking too much. However, to really stretch something where it will not come back is a slow process. That is, it isn't one meal, it is putting just a bit extra in all the time. The next thing you know you have a stretched pouch....and that is something that we can avoid by measuring what you put into your pouch and keeping it from being a bit more. Pouch stretch is chronic, that is, it is from someone putting in too much chronically or from it being constructed incorrectly. But not from an acute event.

<Angela Osborn> Hello, my question is this> now that my stomach is more like a pouch instead of a stomach, does it still have the ability to break down foods/pills?

<Dr. Simpson> Yes and no. Your upper pouch still will make acid, and some digestive products...However, it will not be able to churn food as much as it could before unless, of course you have a duodenal switch, which will allow that process to continue but you can still get plenty of nutrition with a pouch as you can with a regular stomach.

<amy gill> i look at a lot of patient opinions, and the one i chose for the has several complaints about pain med being poor, which concerns me. i don't want to look like a druggie if i ask about his choice before surgery

<Dr. Simpson> Most of the time my patients use little pain medications after surgery...that is, once they leave the hospital they require few pain medications, and often none, so it isn't that bad a surgery. So, don't worry about that. Get a bullet to bite.

<Debbi R 3DaysToGo> My Dr. said if I get a Cold before surgery, we will need to reschedule. Now both my kids have come down with colds and am beginning to panic that I will get it and have to reschedule. Can I have surgery successfully while I have a Cold and not risk serious health problems?

<Dr. Simpson> It is an elective surgery...Therefore, we want you to be in the best shape that you can be in prior to the surgery. While you have been waiting for a while, it is far better to wait, than to have a problem after surgery, like coughing too much and getting a hernia, or getting pneumonia and giving that cold to other sick patients in the hospital. Put your kids up for adoption, or have them stay in a kennel for a while.

<Anissa~96#gone> If we don't drink the 64 oz of water everyday will that slow down our weight loss? I drink 64 oz of liquids but not just water.

<Dr. Simpson> There is nothing magic about water and weight loss than this...If you drink water, it can suppress your appetite for a while, so that you will not eat candy, ice cream, or other high calorie snacks. You also need water to clean you out a bit-- clean the pipes---- and you will become dehydrated if you don't have the water, and you will feel not so great. So, go drink.

<JENNIFER> MY GIRLFRIEND HAS LOST ABOUT 60-80 POUNDS THROUGH A DOCTOR USING A LIQUID DIET. WHENEVER SHE TRIES TO GO BACK TO EATING HEALTHY, SHE JUST GAINS WEIGHT. SHE HAS HAD A TUMMY TUCK AND LIPO AND IS AFRAID OF GAINING HER WEIGHT BACK. SHE WANTS HER DOCTOR IS TRYING TO GET HER IN TOUCH WITH A SURGEON TO TAKE A LOOK AT HER, BUT NO ONE WILL UNLESS SHE GAINS HER WEIGHT BACK. ANY SUGGESTIONS?

<Dr. Simpson> There are no suggestions here--- hopefully she can get on a diet program which will work for her..However, if she is under the BMI needed, then she will have to accept that and work hard to keep it off, it isn't easy, and I don't think any of us would operate on someone who is not close to the qualification. If she gains it back then she should consider weight loss surgery. Until then, she needs feedback about what she eats...So www.fitday.com is a great resource...Finally, tell her to save her pennies, and get a lap band.

<DiannaHenderson> How much protein does your body need?

<Dr. Simpson> It depends on several factors:the first is how large you are, in terms of height... The second is what kind of anatomy you have for absorption of protein....if you have normal anatomy-- no bypassed small bowel, and you are average height, then we can recommend less than if you had a duodenal switch. There is a rough formula for protein requirements, but it goes something like this.... normal size-- about 50 grams per day-- and if you have a DS you might need up to 120 grams of protein a day. It is easy to monitor the pre-albumin level in the blood..and have an idea of how you are doing.

<kathleen g> Dr. Simpson: When you open the first Simpson Spa, will out of state post-ops (non Arizona) be able to check in?

<Dr. Simpson> Ah, well we are looking at opening the Simpson Spa in high class locations near you....for example, the Simpson Spa at the Birkshires, or Ocean County...or the Simpson Spa in Carlsbad California. Until then, you can get our complete line of clothes, food, vitamins, workout tapes from obesityhelp.com.

<linslee> I have terrible constipation problems, must take large amounts of laxatives, how would WLS affect this

<Dr. Simpson> You should not take so many laxatives as that can cause a reliance on them. Increase water, fiber and exercise. Distal bypass is generally more associated with loose stools, where proximal bypass is more constipating. But you can over come it all with fast walks, fiber, and water.

<Angela Osborn> Dr. Simpson - what is your website?

<Dr. Simpson> Website: http://www.doctorsimpson.com, Phone: 602-234-8995, Fax: 602-230-8344 Email: simpson.office@gmail.com

<Janet> My surgery is 3/4 - I am an on and off smoker. My pulmonary test were excellent, yet I worry. What effects will smoking have on surgery day.

<Dr. Simpson> If you were my patient you wouldn't have surgery until you quit. Smoking increases the chance of a leak, it increases the chance of hernia formation... it increases the chance of lung problems after surgery...it decreases the ability of the body to heal well and allows the body to scar worse. So, smoking is a good thing to quit, and if you gain weight when you quit smoking, then think, you have weight loss surgery, and it is gone!

<Cinnamon~WA~> Someone I read about had a RNY in July and is in critical care with bile leakage (she never actually left the Hospital)what is bile and how does this occur?

<Dr. Simpson> Bile is a product made by the liver which is delivered to the intestines by a channel and goes into the first bit of the small bowel, the duodenum...anyone can have a leak, at anytime, once we rearrange the guts...and bile is one of those intestinal products which can leak, and be a mess. There is nothing you can do about that, but you can quit smoking a head of time. And you can hope that the staples and the sutures hold so you don't get in trouble.

<lostangel> Dr. Simpson hi thanks for being here tonight, I am 2 months post op open rny and -60 lbs I am having a difficult time keeping foods down and even my vitamins are causing me problems any suggestions

<Dr. Simpson> You might want to have a gastroenterologist take a look in your pouch to see if it has narrowed a bit where the stomach goes into the small bowel (Called the stoma, or the anastomosis). If it has narrowed too much, then you will need to have that dilated. So, find a good GI doctor.

<Kathy_4months post> Post op how long do you recommend blood work? Is this a life long process? AND when is your book coming out ?

<Dr. Simpson> It is a life-long process, for blood work, you will always need to be monitored to make certain you don't develop a problem. My book will be out in six to eight weeks, depending now on the publisher, who is now getting the first copy ready to print...they will send that to me, and if there are no glaring errors, then we are good to go. Keep an eye on my website for when it will be out. Of course it is the brilliant work of a mad scientist, but should be fun reading, unless you don't like my sense of humor...in which case you clearly need a humor transplant.

<kathleen g> Dr. Simpson: Generally speaking, How long (in time) does a lap surgery take vs. an open (RNY)? Thanks

<Dr. Simpson> All surgeons and all patients are different. I can do an open in about 90 minutes or a RNY in about 90 minutes through the scope, although some people have a bit different configuration, and since most have lost their guidebooks it does take a bit more time for some folks. Other surgeons can be longer or shorter so, they generally take the same amount of time.

<kay> Can you suffer a leak far out of surgery? or is it fused together after a certain time?

<Dr. Simpson> Generally leaks most commonly occur in the first week after surgery, although you can get them two to three weeks later, but that is rare. After that, you have to swallow nails, razor blades or over stretch the pouch by a lot to have a leak....so, use an electric razor. They are easier to digest.

<kay> What are the signs of a bowel obstruction post surgery?

<Dr. Simpson> You cannot pass gas from the rectum (fart); you cannot have bowel movements, and you develop nausea and vomiting. And you blow up like a dead moose on a highway in Alaska.

<kim c> I had an echocardiogram and an arrythmia was seen. Could this be a factor which could preclude me from WLS?

<Dr. Simpson> An arrythmia should be treated, and its source known prior to surgery...most of them are benign, but you should see a cardiologist, and allow them to work that up for you. Heart beats gut. Rock paper scissors.

<Laura> it has been 18 months and I have lost 185 lbs. I am experiencing dumping for the first time is this normal?

<Dr. Simpson> Dumping may not be normal after that time period and you should see a gastroenteroloigst to make certain that you don't have something else going on with you. So, see your friendly GI doc and tell them hi from me.

<rodney> i am 5 month post-op and still not able to hold down meats other than salmon. is this normal?

<Dr. Simpson> That is a strange one, and I thought that I heard them all before. Salmon is just fine. Some stomachs are a bit more tender than others. Try haddock, swordfish, actic char....go slow with new foods, and see how they go. Otherwise, don't get farm raised salmon-- only troll caught -- although the trolls get mad when you take their fish.

<LadyMO> Dr. Simpson, I have been diagnosed with congestive heart failure.. I have to have clear with cardiologist before the surgery.. do you think they'll still let me have the surgery?

<Dr. Simpson> Congestive heart failure can be managed, and it depends on a number of things, so, you should see a cardiologist, and they may have some things for you to do. But heart failure is not a contraindication for surgery, in fact, often times it is made better once we get rid of some of the weight. Good luck.

<kathleen g> Dr. Simpson: Regarding your next book -- the cookbook -- will it have straight-up recipes, and/or will it have substitutions (like a diabetic cookbook)? Thanks.

<Dr. Simpson> Well there are a few books here--- the first one which is coming out is a guide to WLS and has some great menu plans and recipes in it....the next book is a pocket guide with information about carbs, glycemic index, and protein values...and the third book is a cookbook with some of my patients and others, favorite recipes. So we have three books coming out in the next year a series. Wish I wrote mysteries. Maybe that will be next on my agenda.

<Mylite> Would increasing water intake help with fiber digestion

<Dr. Simpson> Water doesn't digest fiber - fiber doesn't digest. Fiber and water help you have less constipation, and it also helps with diarrhea....so, get it.

<S. Jones> Is there any hope for obese people with crohns disease

<Dr. Simpson> Sure there is. That is a fairly rare disease to go along with obesity however...and if you think you have that and have obesity, I would get that diagnosis double checked, because it is probably in error. Most patients with Crohns disease are a bit malnourished...So get that checked. You can have surgery with Crohns disease.

<Cheryl> my Dr. said he might not be able to do RNY because of adhesions but will do gastroplastry is this as good

<Dr. Simpson> That is strange-- well, sometimes you cannot do one surgery, and have to do another surgery...and there are a lot of reasons, but you can do an RNY even if you have adhesions, so, I don't understand that. But probably he was telling you that if your small bowel cannot reach the upper part of your stomach he will not be able to do the RNY and will do the other surgery. The VBG is not as effective as the RNY. However, you can lose every bit as much weight with it. Good luck.

<DiannaHenderson> Earlier you was talking aboout the book what is the name of the book

<Dr. Simpson> Weight Loss Surgery: A lighter look at a heavy subject--- you can see the cover for the book on my website www.drsimpson.com

<kathleen g> Dr. Simpson:I make home-made babyfood for my triplet grandchildren (10 months) and look at it and think YUCK. Is this what I can look forward to? Thanks.

<Dr. Simpson> Look in the about the surgeon part. No, that is not what you can look forward to although there is a phase when that is what you might eat for a bit. But, weight loss surgery will not get you triplet grandchildren.

<Michele> Will the pouch shrink

<Dr. Simpson> The pouch doesn't usually shrink, it does expand and there is nothing you can do once a pouch stretches except have more surgery to get rid of it. So avoid the pouch getting big by measuring your food instead.

<Sandi> do you feel lap is more dangerous than open roux n y

<Dr. Simpson> Risks are something that are weighted in surgery -- pardon the pun -- all the time, and there are increased risks with one for a part and others for other parts. For example, with open surgery there is an increased risk of adhesion formation, and other such things, which, when we think isn't so bad, unless you get the one critical adhesion. There is a slightly increased risk of leak with laparoscopic surgery, which is fine unless you are that leak. It is all a matter of being informed and taking risks you can understand clearly.

<kitty> Generally speaking, approximately what percentage of calories eaten are not absorbed because of the bypass?

<Dr. Simpson> It all depends on a lot of factors, which cannot be completely calculated. For example, early on there will be fewer calories absorbed than later... and some foods are absorbed quickly -- like the candy that I had while waiting for my computer to re boot that was absorbed and doesn't matter how much of a gut would be bypassed, it will be absorbed easily...so....not an easy question to answer. Perhaps the way to answer it for one self is to do this. Calculate how many calories you eat, and how many you expend daily...to determine what you expend you will need to have a device to determine that, you can get one from www.healthwear.com ---- then if you are losing more weight than you would be by the calorie deficit you are clearly not absorbing as many, and it can be a backward calculation.

<ann(-185#@08/02)> Dr. Simpson, I had gastric bypass surgery-08/02. I've lost 185#'s. I've exercised since and drink a lot of water, therefore, I have almost no xcess skin. However I have a problem. I love to run now and just started training for a marathon in June. My pouch has always been really small and I have trouble getting in protein (w/ running 5-7 miles a day). I just had bloodwork done-protein low and I'm mildly anemic. Daily right now = 90 g. protein/day - How do I get in more protein

<Dr. Simpson> You might have to use supplemental modular protein, such as isopure type, or a whey based protein, which will go through the pouch fast, and allow you to increase your protein intake without stretching the pouch. Or you can forget the marathon and instead do the Simpson Triathalon----- remote control, pressing the remote control, swearing at the television.

<Shelley> Would having a hernia below my navel make me need open rather than lap surgery?

<Dr. Simpson> Nope, not at all.

<kathleen g> Dr.Simpson: Does it help to protein load the few weeks prior to surgery? Thanks.

<Dr. Simpson> No, protein is not stored as anything at all, so if you are protein malnourished it would help. But protein loading makes no physiological sense. It won't help, you cannot store it--however, the best thing you can do before surgery is to start a walking program and get into shape.

<**MODERATOR**> Thank you for joining us tonight, Dr. Simpson. You can reach him at http//www.drsimpson.com, ph# 602-234-8995.

<Dr. Simpson> www.drsimpson.com

<Dr. Simpson> www.doctorsimpson.com

<Dr. Simpson> Thanks. Good night all.