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<MODERATOR> CJK, YOU HAVE THE FIRST QUESTION FOR DR. SIMPSON.
<CJK 267/137 10/16/01> I am 16 months post op open RNY. Is it
true that our intestines start to absorb nutrients, fats, and calories
again after a periord of 18 mo to 2 yrs post op?
<Dr. Simpson> well they hopefully absorb
them now.
<Dr. Simpson>there is nothing we do to make
them not absorb nutrients, what we do is we might bypass a few feet of...
<Dr. Simpson>intestine so that they don't
see the food, hence they don't absorb it...
<Dr. Simpson>but, after a few years the small
bowel will "accommodate" that is, the small bowel will become
better at absorbing more things...
<Dr. Simpson>for example, while we stopped
doing the jejuno-ileal bypass years ago (1980's) it worked solely by malabsorption...
<Dr. Simpson>and there was only about 18
inches of small bowel which absorbed food. These patients lost large amounts
of weight...
<Dr. Simpson>usually 100 lbs in a few months,
but then, over ten or twenty years, they gained it back....
<Dr. Simpson>and when we look inside of them
the small bowel has become larger, fatter, and is better at absorbing
things....
<Dr. Simpson>so, you will be able to absorb
food better after a few years, that is true. But if you limit the quantities
you should do fine...
<Dr. Simpson>and the part of the surgery
which works well is the limitation of the amount you can eat.....
<Dr. Simpson>so-- change how you eat. Eat
protein first, limit carbohydrates, and if you have carbohydrates make
certain...
<Dr. Simpson>they are the type which have
a low glycemic index, and drink lots of water.
<Dr. Simpson>and WALK
<CJK 267/137 10/16/01> Thank you.<Dr. Simpson> walk a lot.
Good question, thanks
<MODERATOR> ALLY 327, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.
<ALLY327> I WAS WONDERING WHAT MAKES U DECIDE WHAT TYPE OF SURG
SOMEONE HAS?
<Dr. Simpson>To answer a previous question--
gaining weight after bypass surgery does not mean that you popped a staple
or two. Well, I do one type of surgery predominantly...
<Dr. Simpson>the duodenal switch, although
I do the RNY for those patients whose insurance company will not allow
us to do the DS, and RNY...
<Dr. Simpson>is what I did for about ten
years. In terms of the options, that is something to talk to with the
surgeon...
<ALLY327> DOES ONE TYPE WORK BETTER THAT OTHERS FOR SOMEONE WHO
IS ALMOST 400LBS
<Dr. Simpson>all of the weight loss surgeries
work, and they can all work well for someone who is 400 lbs, which is
almost a pediatric patient in my book....
<Dr. Simpson>you have to see who is in your
insurance premium and who they will cover, and talk with them.
<Dr. Simpson>good luck.
<ALLY327> OK THANK U
<MODERATOR> CANDY, YOU HAVE THE NEXT QUESTION.
<Dr. Simpson>Candy, what a great name for
someone in this chatroom.
<candy> What is considered an acceptable weight loss the first
month? I am doing everything by the book and I am losing very slowly.
2. Is it ok to chop instead of crush vitamins before taking?
<Dr. Simpson>Well, weight loss is something
which is individual, and typically we say that someone should lose about
ten per cent of their weight by six weeks after surgery....
<Dr. Simpson>after weight loss surgery it
is almost impossible not to lose weight if you do things according to
what your surgeon's program is....
<Dr. Simpson>in terms of the pill, you have
to make it small, how you make it small is for you to decide, some like
chewable vitamins...
<Dr. Simpson>some like the vitamins mixed
in water, some like to crush them with splenda and a drop of water....
<Dr. Simpson>so, you can figure which you
like. Good luck.
<MODERATOR> JULIE PRE-OP, YOU HAVE THE NEXT QUESTION.
<Julie/preop/IN> What does it mean by shrinking your liver before
surgery, would it be smart to go on a liquid protein diet before surgery
to clean your body out?
<Dr. Simpson>liquid protein doesn't clean
the body out, the only thing that cleans the body is soap and water...
<ALLY327> LOL
<Dr. Simpson>some patients have a fatty liver,
and they have a fatty liver because of too many carbohydrates in their
diet...
<Dr. Simpson>so we recommend that some patients
limit carbohydrates before surgery in order to allow their liver to shrink
a bit...
<Dr. Simpson>this is especially true if you
are having a laparoscopic procedure...
<Julie/preop/IN> how do I know if its fatty
<Dr. Simpson>after surgery, if you follow
a high protein diet, or a protein first diet, you will shrink your liver...
<Dr. Simpson>an ultrasound can tell, or Cat
scan-- although I don't like cats.
<Dr. Simpson>well, with barbecue sauce
<Julie/preop/IN> lol
<Julie/preop/IN> so for how long be on low carbs
<Dr. Simpson>forever
<Julie/preop/IN> thank you!
<MODERATOR> ALLIE, YOU HAVE THE NEXT QUESTION.
<Allie> How many calories should we try to stay under after WLS?
I am a post op5 mo and down 93. I had the divided RNY. I thought I was
doing well and then I heard I should not eat potato and carbs, but I truly
gotta wonder how 2-3 bites of a baked potato with my peice of fish can
be so detrimental? I want to succeed, but I didnt think I was supposed
to have to live on Atkins post op for eternity. Thanks
<Dr. Simpson>No Allie, you do not have to
live on Atkins, even I, who believe that man was not meant to have vegetables....
<Dr. Simpson>find that I get tired of steak.
There are different types of carbohydrates, and there really is NO BAD
food, there are bad quantities of food, and....
<Dr. Simpson>you have to understand in terms
of carbohydrates, there are those which are converted by the body to blood
glucose almost immediately...
<Dr. Simpson>and they cause a rapid rise
in insulin, which will cause your body to store that as fat, which is
counterproductive....
<Allie> haha I hate veggies myself! but calorically how much?
<Dr. Simpson>so, we recommend that you first
have protein, and get that in because you need it to heal. Then we think
in terms of carbohydrates you need to have....
<Dr. Simpson>low glycemic carbs, not the
high glycemic carbs, for example:
<Dr. Simpson>potatoes and bread are high,
but apples and yogurt are low...
<Dr. Simpson>there are lists of these if
you want them, and the list will be on my website soon--- if Tammy has
anything to do with it...
<Dr. Simpson>you shouldn't worry about counting
calories, in stead count carbohydrates, that is much easier...
<Dr. Simpson>and keep the carbs below about
60 per day.
<Dr. Simpson>good luck.
<Allie> Thanks Dr., I appreciate your help.
<MODERATOR> HILARY, YOU HAVE THE NEXT QUESTION
<~Hilary in SW MN~> I don't have a date for surgery yet. I got
my writting authorization yesterday. I came down with the flu this week.
How long should I wait to recover from the flu before having surgery?
I will ask my surgeon of course...but I was just curious. Thank you.
<Dr. Simpson>Well, you shouldn't have active
symptoms when you have surgery, not only will you be miserable, but you
could give the flu to patients in the hospital...
<Dr. Simpson>and funny thing about hospitals,
they have sick people in there....
<Dr. Simpson>so, if you are symptom free
(Tammy bounced back, she must not have seen my comment)....
<TAMMY> LOL
<~Hilary in SW MN~> At least 2 weeks?
<Dr. Simpson>and you are not going to give
the flu to anyone, then have surgery. ..
<Dr. Simpson>two weeks, four weeks, six weeks
a dollar, all for weight loss-- never mind.
<~Hilary in SW MN~> This doc is funnier than the last one. ;)
<Dr. Simpson>well the men in white coats
didn't catch me today.
<TheresaC-pre> his jokes make sense LoL
<~Hilary in SW MN~> thank you.
<MODERATOR> LIZ, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.
<Liz> I have three children under 5 - what is the major reason
things go badly during open RNY?
<Dr. Simpson>Well-- that is an interesting
question. Most people who die from surgery die because they develop a
blood clot in their leg or pelvis, called a deep venous thrombosis (DVT)...
<Liz> is it preventable in anyway?
<Dr. Simpson>which travels to their lung
and they die. The best thing you can do to prevent that is walk after
surgery, walk again, and again, and again...
<Dr. Simpson>it isn't totally preventable,
but you can do a lot by getting out of bed and using your muscles so the
blood doesn't pool in your legs and clot....
<Liz> what about during the operation itself?
<Dr. Simpson>so that is the best thing you
can do. During the operation very little goes wrong, you are under the
total control of...
<Dr. Simpson>someone else, and they are very
good at what they do. You could bleed a bit, but we can stop that, all
bleeding stops eventually....
<Liz> wow! Thank you so much.
<Dr. Simpson>but during surgery there is
very little bad that happens unless they play country western music.
<Liz> so it's up to me
<Dr. Simpson>walking is.
<Dr. Simpson>we cannot walk for you.
<Dr. Simpson>we can chase you a bit though.
<Liz> ha ha - sounds fun!
<MODERATOR> PAUL, YOU HAVE THE NEXT QUESTION.
<Paul J (WY, RN)> What can a person do to prepare for surgery
1 year away (insurance will be rewritten to include WLS in the fall, she
is approved by RMA SLC pending insurance)
<Dr. Simpson>Paul, the best thing you can
do is to learn a lot about nutrition, there is a lot to know, and a lot
that you need to learn...
<Dr. Simpson>it will help you decide your
post operative diet, and you can learn to cook some good food which is
good for you and provide you with some...
<Dr. Simpson>substitutes for the evil stuff
which is lurking in your kitchen-- like that bowl full of M and M's, which
you should send to me....
<Dr. Simpson>and you can also start taking
some vitamins, because you need a supplement anyway, so find one that
you like....
<Dr. Simpson>and you can start a walking
program, because it is good for you. In fact tomorrow I am taking some
of my patients for a walk...
<Paul J (WY, RN)> LOL - what is an M&M?
<Dr. Simpson>although I have no idea how
many will show. Might just be me.
<Dr. Simpson>good luck.
<Paul J (WY, RN)> Thank you
<MODERATOR> CANDACE, YOU HAVE THE NEXT QUESTION.
<Candace> Does support garments help the skin when your losing
weight. They have people who get liposuction wear them for a while.
<Dr. Simpson>the best thing for patients
following surgery is to, about six weeks after surgery...
<Dr. Simpson>begin a program of light weights
and exercise. They will help tone the muscles in your arms and legs...
<Dr. Simpson>and they will prevent a lot
of the sagging skin, bat wings,and so forth.....
<Dr. Simpson>if you don't do that you may
have a lot of wrinkles, and might need some surgery, some need it anyway,
but that is one of those things...
<Dr. Simpson>that you can do to help yourself
following surgery, and it will help your weight loss too.
<Candace> But you don't know if they help or not?
<Dr. Simpson>They help some people, they
do not help all. The garments don't help.
<Dr. Simpson>moo mooos help
<Candace> Ok Thanks
<MODERATOR> GLORIA ACOSTA, YOU HAVE THE NEXT QUESTION.
<Gloria Acosta in CA> i have a date scheduled for 4/8 and know
this falls right around the last day of my menstral period. Will this
be a problem for surgery? And YES I know that through my neather regions
is not the route to my stomach...lol =)
<Dr. Simpson>Yes Gloria, that is quite true....
<Dr. Simpson>it should not be a problem at
all, and I would not worry about it. So, I suggest that you don't give
it a second thought...
<Dr. Simpson>and have your surgery, and from
there, not to worry.
<MODERATOR> GINNY IL, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.
<GinnyIL> I may have adhesions after surgery. Will you please
describe how it may feel and how I may get rid of them?
<Dr. Simpson>Ginny, everyone who has surgery
develops adhesions, adhesions...
<Dr. Simpson>are nothing more than scar tissue,
and they are not something that are usually a problem...
<Dr. Simpson>however, if you happen to be
one of the lucky few they might develop in a manner such that....
<Dr. Simpson>they cause the bowel to kink.
There is, as of today, no way to rid yourself of them. They do not have
nerves in them, so you cannot feel them...
<Dr. Simpson>although, if they bind some
parts of your intestine together they can cause a problem.
<Dr. Simpson>Patience-- my book isn't out
yet-- but wait a couple more months-- it will be perfect.
<GinnyIL> Do they require surgery if a problem?
<Dr. Simpson>we will advertise the book on
this site.
<Dr. Simpson>If there is a problem with the
adhesions, yes they will require surgery.
<Dr. Simpson>good luck.
<GinnyIL> thanks
<MODERATOR> JENNIFER, YOU HAVE THE NEXT QUESTION.
<Jennifer> I weighed 435 when I had my open RNY. I am down 60
pounds in 8 weeks. Is this good or bad? How much weight should I expect
to loose within the first year if I follow the diet that BTC gave me?
I just want to make sure that I am keeping up. Thank you
<Dr. Simpson>Jennifer that is a great weight
loss and you should be proud-- everyone, clap for Jennifer.
<Dr. Simpson>in fact, get out of the chair,
stand up and bow...
<Dr. Simpson>besides, getting up helps the
circulation...
<Jennifer> thank you
<Dr. Simpson>see, Jennifer, they are giving
you a clap....
<Dr. Simpson>anyway, you are doing well and
you should continue with the BTC program, because it is a good one...
<Dr. Simpson>of course mine is better, --
just kidding...
<Dr. Simpson>Bariatric treatment center,
they are a group of docs who got together to market themselves...
<Jennifer> Sorry, I didn't know you at the time
<Dr. Simpson>no problem, it is just fine.
Anyway-- keep up the good work. Remember. Protein first.
<Dr. Simpson>lots of walks and water.
<MODERATOR> HELEN OH, YOU HAVE THE NEXT QUESTION.
<Helen/Ohio> My Doctor gave me a green filter during surgery ....
Is this widely used?
<Dr. Simpson>It isn't widely used, but it
is a good idea for those individuals in order to help decrease the incidence
of pulmonary embolism....
<Dr. Simpson>some patients need it, some
do not, but it is something which is useful, and some surgeons use it
as a matter of routine.
<Helen/Ohio> TY
<Dr. Simpson>I like Dr. Greenfield.
<Dr. Simpson>his first name is laser
<Helen/Ohio> LOL
<Dr. Simpson>imagine what his folks were
thinking.
<MODERATOR> DEB, YOU HAVE THE NEXT QUESTION.
<Deb> Is it safe to have a mixed drink or a glass of wine after
you have had the surgery? like one or two a year?
<Dr. Simpson>Deb, alcohol is just fine, it
isn't a problem at all. Some say that you get a bit buzzed faster....
<Dr. Simpson>but that it goes away faster.
But, hi Rose-- a little wine is fine...
<Dr. Simpson>a lot is not. And remember,
alcohol is a source of calories, so keep it moderate. If you have extra
good stuff send it my way.
<Dr. Simpson>guess the roads won't be safe
in Deb's town tonight.
<Deb> LOL
<MODERATOR> CHATTY KATHY, YOU HAVE THE NEXT QUESTION.
<chattykathy> Do you know the mortality rate for open surgery
for insertion of bag at opening of stomach?
<Dr. Simpson>Mortality rate for open surgery
is the same as lap, which is one in two hundred, and the majority of those
die from....
<Dr. Simpson>Deb's car after she had too
much alcohol...
<janet> lol
<Gloria Acosta in CA> lmao
<Dr. Simpson>oh, no the majority die from
a pulmonary embolus...
<Deb> LOL LOL
<Dr. Simpson>so, after surgery WALK.
<Dr. Simpson>or dance
<chattykathy> what about pneumonia?
<Dr. Simpson>Don't get it
<chattykathy> funny
<chattykathy> i dont want it
<Dr. Simpson>good-- keep it away from me.
I had enough of that as a kid.
<MODERATOR> CJK, YOU HAVE THE NEXT QUESTION.
<CJK 267/137 10/16/01> Is it OK to be taking jel tab vitamins
post op? Does the pouch have the acid to break them down?
<Dr. Simpson>gel tabs are just fine, there
is acid which is produced in the pouch, and there are some vitamins which
are gel tabs which are...
<CJK 267/137 10/16/01> long term post op that is
<Dr. Simpson>specifically formulated for
Bariatric patients...
<Dr. Simpson>so, those would be just fine.
Pneumonia can be a problem, which is another reason to get out of bed
and walk, so you expand those lungs.
<Dr. Simpson>I like gel caps, get tired of
Flintstones.
<Gloria Acosta in CA> the the bambam ones are GRAPE flavor
<Madison> i love fred
<Dr. Simpson>One of my weight loss friends
tries to get vitamins through food, but as much venison as you eat you
still need vitamins.
<CJK 267/137 10/16/01> Hey! I really do eat a lot of venison. Thanks,
doc.
<MODERATOR> ALLY 327, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.
<ALLY327> WILL HAVING TYROID DISEASE GO AWAY AFTER WLS?? AND HOW
LONG AFTER SURG IF ALL GOES WELLCAN WE GO TO WORK?
<Dr. Simpson>Thyroid problems do not go away
after weight loss surgery. If all goes well then you can go back to work
in about three weeks, although some take longer...
<MODERATOR> PATSY, YOU HAVE THE NEXT QUESTION.
<patsy> i have seen my surgeaon for the first time today in uk
and i am suitable for banding and bypass but cant decide which one to
have
<Dr. Simpson>Well Patsy, I think that bypass
has a better record than banding....
<Dr. Simpson>and so in terms of success,
there is a better success record, although both are doing well these days...
<patsy> which has more post op problems
<Dr. Simpson>Ozzy's wife had the band, and
so if you get the band I think you should have your significant other
get a
<Dr. Simpson>recording contract. In terms
of post op problems, well, that is a matter of conjecture, both can have
them...
<Dr. Simpson>and if you don't have any from
them, then it isn' t a problem, however, if you ...
<Dr. Simpson>need a lot of band adjusting,
and so forth, that might be a problem...
<patsy> ok
<Dr. Simpson>if you get a leak from a bypass,
that is a problem. So, in terms of the anesthesia, they are the same,
so good luck.
<patsy> thanks
<MODERATOR> GINNY IL, YOU HAVE THE NEXT QUESTION.
<GinnyIL> Dr. Simpson, how soon after surgery is ok to have a
glass of wine?
<Dr. Simpson>Ginny, I think you can have
a glass of wine almost anytime, although that is a lot of liquid for a
pouch, but it should go right through....
<Dr. Simpson>so, sip some, and go from there.
Your best weight loss is the first few months, so you might want to...
<GinnyIL> Thanks I have already had some some!
<Dr. Simpson>take advantage of that fact.
Hope the wine was good. If it was, send me some.
<GinnyIL> thx
<MODERATOR> ROSE@GOAL, YOU HAVE THE NEXT QUESTION.
<Rose@Goal> Dr, hello :) I was wondering is it ok to take Slo
Mag for severe leg cramps? I walk 4 miles a day and I am getting them
alot. Do we do ok with it after surgery?Or how about Magnesium Oxide,
is that better?
<Dr. Simpson>Hi Rose-- Either of those would
be fine. But I wouldn't take it just because you have leg cramps, you
can have leg cramps from a number of things...
<Dr. Simpson>and you should have a lab test
telling you that your MG is low before you do it, so that is one of the
things you might consider....
<Dr. Simpson>get a comprehensive metabolic
panel, and a magnesium level and see how you are doing....
<Rose@Goal> ty Doc :)
<Dr. Simpson>otherwise, keep walking, keep
chasing the kids around the house, and you will do fine, four miles is
good...
<Dr. Simpson>you should do that in about
an hour.
<Dr. Simpson>nice to see you Rose.
<Rose@Goal> lol yes 5 in an hour and you too DR :) take care
<MODERATOR> CHATTY KATHY, YOU HAVE THE NEXT QUESTION.
<chattykathy> is catching pneumonia one of the mortality risks
for surgery?will diabetes go away after surgery?
<Dr. Simpson>well, pneumonia can occur if
you don't take deep enough breaths following surgery, and don't get up
and walk, but it is not a major cause of mortality following...
<chattykathy> good
<Dr. Simpson>weight loss surgery. Diabetes
can be improved following surgery, but it cannot go away....
<chattykathy> will i still need shots?
<Dr. Simpson>you may not be taking any medicine
for it, but it is still there, so it is best to ....
<Dr. Simpson>follow your blood sugars with
your diabetes doctor. Often shots are not needed after surgery. Good luck.
<chattykathy> thnks very much
<MODERATOR> KRYSTN, YOU HAVE THE NEXT QUESTION.
<Kristyn -110> HI Dr. Its Kristyn Hodges from Tucson......How long
after surgery do I need to wait to color my hair... it has stopped falling
out finally but looks dull. And when can I buy your book????
<Dr. Simpson>Hi Kristyn, nice to see you--
yes, color your hair....
<Dr. Simpson>how are you, how much weight
have you lost-- Kristyn is one of my nice ladies who had ds....
<Kristyn -110> 110
<Kristyn -110> since august
<Dr. Simpson>my book will be available soon,
but, keep your eye out here. Wow-- the century club, that is great...
<Kristyn -110> I feel awesome and thank you every morning
<Dr. Simpson>so, color your hair. Mine is
light blonde now-- some think it is grey, but that is just their eyes
playing...
<Dr. Simpson>tricks on them, it really is
blonde, not grey. Right Kristyn?
<Kristyn -110> I am thinking Platnum
<TAMMY> LOL
<Kristyn -110> he is a toe head
<Kristyn -110> bye
<MODERATOR> GLORIA ACOSTA, YOU HAVE THE NEXT QUESTION.
<Gloria Acosta in CA> I carry the majority of my weight in my stomach,
to the point where I have a low apron look going, how will this effect
the incision and healing process? Will it cause more pain from the weight
of my stomach? What can be done to alievaite this? ALSO how safe are sit-ups
after surgery to tighten the skin?
<Gloria Acosta in CA> that was a mouthful =)
<Dr. Simpson>Gloria, most of us have a bit
of a belly, in fact I was told I have TB= tremendous belly.....
<Gloria Acosta in CA> lol
<Dr. Simpson>no, the weight of the belly
should not add to discomfort of the incision in surgery....
<Dr. Simpson>in terms of the weight loss,
some patients find they need a tummy tuck following surgery...
<Dr. Simpson>sit ups are generally OK after
about six weeks. The other thing which helps is that if you have had a
tummy tuck try to not get too pregnant following it...
<Dr. Simpson>but sometimes those things just
happen. Good luck.
<Gloria Acosta in CA> thank you Mister MD
<MODERATOR> PAUL, YOU HAVE THE NEXT QUESTION.
<Paul J (WY, RN)> What are the medical necessity reasons for paniculus
surgery (tummy tuck) I spent so long getting it (and did have it when
6' & 160), I might miss it *NOT* - My surgeon said I should have the
PS, and insurance will cover if there is medical nec..
<Dr. Simpson>IF you have recurrent skin infections
following the surgery, or if there are rashes on the tummy...
<Dr. Simpson>those are the general reasons,
or if there are sores-- or if you find that when you lift the tummy there
is a small...
<Paul J (WY, RN)> Multiple scars from rashes
<Dr. Simpson>colony of creatures, that might
be a reason.
<Dr. Simpson>rashes are a reason
<Paul J (WY, RN)> TY - I have one foliculitis site for x3 years
<Dr. Simpson>it would be irrational to not
have a it
<Dr. Simpson>sorry-- couldn't resist.
<Paul J (WY, RN)> LOL
<MODERATOR> JUDY, YOU HAVE THE NEXT QUESTION.
<Judy S.> Would a DS rather than RNY help a middle aged person
to have a better quality of post surgical life?
<Dr. Simpson>Judy that is a good question,
and that is one that you get to sort out with the surgeon who will do
your surgery...
<Dr. Simpson>there are only about 40 of us
in the nation who do the DS, as the primary surgery, but there are a lot
of surgeons who say they will offer it,
<Dr. Simpson>but once you get into their
consult room they talk patients into the RNY, which is an easier surgery
to do,
<Dr. Simpson>and we call this a bait and
switch. If you have a choice of a surgeon and want to explore the DS then
you should talk about it with...
<Dr. Simpson>a surgeon who does this as the
primary surgery in their practice, not as something they offer with a
wax job on the side...
<Judy S.> OH NO thanks anyway, i think he only offers RNY and
my ins causes me limitations
<Dr. Simpson>they have their plus and minus
of both surgeries, but they both work quite well, and those who have one
or the other,
<Dr. Simpson>are a bit like religious zealots,
seeking to convert the lost to their enlightened way of thinking....
<Judy S.> Thank You Dr. S :)
<Dr. Simpson>so, you will belong to one camp
or the other, and whichever one your surgeon does is the one for you...
<Dr. Simpson>and you can join that camp,
and think poorly of the unfortunates who had the other surgery. Good luck.
<MODERATOR> PAM MI, YOU HAVE THE NEXT QUESTION.
<Pam >MI> having my surgery probably about lst of april, have
heard alot about dumping syndrome, is there anything post-op that I can
do to prevent that? And how much sugar are we allowed after RNY?and, what
do u tell your patients about presurgery jitters-- am really scared
<Dr. Simpson>Michigan is a great state, with
a great football program at U of M--- in terms of preventing dumping,
don't eat carbohydrates...
<Dr. Simpson>in terms of pre surgical jitters,
well, that is something which we expect, and I am scared of patients who
are not nervous at all...
<Pam >MI> so no carbs at all
<Dr. Simpson>so, when you get them think
about how good you are going to look, how healthy you will feel in a year,
how much more energy you will have....
<Dr. Simpson>well, keep the carbohydrates
to those which digest well, and you will discover those as you go along...
<Pam >MI> when i think of all of those things, i can't wait
<Dr. Simpson>some patients cannot tolerate
any carbohydrates, some can tolerate any, everyone is different and it
is..
<Dr. Simpson>impossible to determine which
category you will fall into. So, good luck. Is it snowing there?
<Pam >MI> how about sugar amounts ?
<Dr. Simpson>very little. 40 grams of carbs
a day to start, at the very max
<Pam >MI> we had 6 inches on tues. and go to go snowmobiling
YIPEE!!!
<Pam >MI> thank you Dr.
<MODERATOR> CJK, YOU HAVE THE NEXT QUESTION.
<CJK 267/137 10/16/01> Please doc, if you can answer this, my
family will see to it that you are sainted. How do I deal with this bloating
and constant gas at 16 months post op RnY? Will it ever be less persistent?
<Dr. Simpson>What surgery did you have?
<CJK 267/137 10/16/01> Open Rny
<Dr. Simpson>In terms of bloating, and gas,
they are generally caused from undigested food, so you might have had
a distal RNY...
<CJK 267/137 10/16/01> Prox
<Dr. Simpson>there are certain foods which
will increase that, such as carbohydrates..., and ....
<Dr. Simpson>there are some things which
you can take to help rid yourself of the gas, like Devrom, which is available
online at.
<Dr. Simpson>www.parthenoninc.com --- it
is a deodorizer for the bowel and works quite well...
<Dr. Simpson>the main thing is that gas and
bloating come a lot from the food that you eat. If you still have your
gallbladder, that can also cause some problems...
<Dr. Simpson> so you might want to have that
evaluated. Good luck-- St. Terry
<CJK 267/137 10/16/01> No gb! Thanks, CJK.
<MODERATOR> JANET, YOU HAVE THE NEXT QUESTION.
<janet> Thank you I'm 5 weeks post op Lap RNY and my doc has me
opening capsules to take meds... I take generic prozac and it's TERRIBLE....
if I take the capsule without opening it, will I get enough of the meds?
<Dr. Simpson>It isn't the meds that they
are worried about, it is that the pill can become lodged in the stoma...
<Janet> oh
<Dr. Simpson>which is the anastomosis they
created between the stomach and the small bowel, that is why he is having
you open the pill....
<Janet> is this forever??
<Dr. Simpson>one thing that helps the bitterness
is to open the pill on a teaspoon, and have the contents on that...
<Dr. Simpson>then put some splenda in the
teaspoon and a drop of water, then swallow with some water chaser...
<Janet> thank you...good idea!
<Dr. Simpson>it will help it al alot which
is my favorite song-- a spoonful of splenda helps the medicine go down..
the medicine go doooown...
<Dr. Simpson>the medicine go down...
<Janet> lol
<Dr. Simpson>yes-- your stoma is small--
forever.
<MODERATOR> MELISSA G, YOU HAVE THE NEXT QUESTION.
<Melissa G> I am just begining the process and I think that I
am borderline for surgery at 40.8 BMI. I work out a lot with a trainer
(my weight usually does not budge) but I would like to loose before surgery
that could be months away. If I manage to loose a little and get to 40.0
do I disqualify myself from surgery? Also, how quickly can I resume workouts
after Lap surgery? Perhaps I can finally get my moneys worth and feel
like my early morning bonding with my trainer was worth it.
<Dr. Simpson>Well I hope your trainer is
good looking, and what you do with them-- bonding and all, is up to you....
<Melissa G> lol
<Dr. Simpson>it is the weight that you have
when you are evaluated that makes you into the category of eligibility...
<Dr. Simpson>if you lose a few pounds they
are not going to turn you away at the operating room door---
<Melissa G> ah, I see
<Dr. Simpson>i can just see it now-- oh,
Melissa, down a pound, well out you go, have a twinkie and come back in
the morning
<Dr. Simpson>that won't happen. So, keep
working out=- besides, muscle weighs more than fat so it is a good thing...
<Dr. Simpson>and you will make it better
for the post operative recovery if you are in better shape, so I applaud
you...
<Dr. Simpson>standing up now and applauding.
<Melissa G> twinkiesyum
<Melissa G> thanks
<MODERATOR> TSHAYLOR 72, YOU HAVE THE NEXT QUESTION.
<TShaylor72> What is the average cost if insurance does not cover?
I'm over all a healthy person and want this done for future health issues
not to arise.
<Dr. Simpson>It can cost anywhere from 12
thousand on up, depending on the state and how they act...
<Dr. Simpson>the cheapest is not always the
best-- and the most expensive isn't always the best either...
<Dr. Simpson>most run about 17 grand for
the works-- even with mayo.
<TShaylor72> lol
<TShaylor72> thank you
<MODERATOR> DEB, YOU HAVE THE LAST QUESTION FOR DR. SIMPSON.
<Deb> Do past smokers have a greater chance of developing pneumonia
after surgery?
<Dr. Simpson>No, past smokers are good people
who saw the light and are doing great things for their bodies and minds
and spirits...
<Dr. Simpson>past smokers do well, because
they tend to be reasonable normal, healthy individuals who have a wonderful
world view..
<Dr. Simpson>they tend to be quite handsome,
or pretty, and they make good pets.
<Deb> Thank you. LOL
<Tammy> THANK YOU DR. SIMPSON, THANK YOU MEMBERS! YOU CAN VISIT
DR. SIMPSON AT: WWW.ARIZONABARIATRICCENTER.COM
<Allie> You were GRRRRREAT Doc., Thanks for all of your humor
and good advise. Have a wonderful weekend!
<~Hilary in SW MN~> ty doc
<Dr. Simpson>thanks
<Dr. Simpson>goodnight all
<Dr. Simpson>sleepwell
<Dr. Simpson>be good
<TShaylor72> thank you
<shelby> thanks doc
<Patience> Bye Dr. S
<MaineMom-pre> thanks Dr Simpson
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