March 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!

<Dr. Simpson> Greetings all.

<Moderator> Welcome Dr. Simpson

<phoebe> I am due to have a lap sleeve gastictomy. I have just had my upper gi and found out that I have a hiatus hernia (sliding length of 5cm). I was wondering if it is standard procedure for surgeons to mend them during this op. Would you recommed that it is attended to? Thanks

<Dr. Simpson> I think that having a hiatal hernia is not a problem for doing the lap sleeve gastrectomy. First, they can repair the hernia at the same time, and second, it is something that they would normally do anyway. So, I would not worry too much about it, a good surgeon will take care of it, a bad surgeon will wonder what to do. You will be fine. Good luck.

<Amy> I am 23 years old and weigh 329 lbs. I am trying a diet currently, but if it isn't effective, I'm considering surgery - I've heard that there are serious risks involved, especially for someone my age. Is it more dangerous for someone as young as I am to have the surgery?

<Dr. Simpson> 23 isn't young, but then again, you are talking to someone who operates on younger kids than you. There are risks for any surgery, and you should be aware of them, and what to do about them. However, your weight is a larger health concern over your life. So learn about the different types of surgery, the risks involved, and what to do. The best book to read about surgeries is "Weight Loss Surgery: A lighter look at a heavy subject" by yours truly, which, while it does have some humor, has some comprehensive material about the operations, diagrams of them, as well as what to expect, and how to expect them and what to take care of them.

<Me> I'm 8 days out of open RYN do you think it's safe for me to walk on my treadmill..thanks for your time :0)

<Dr. Simpson> Walk on the treadmill. Walk walk walk walk walk walk walk.

<Phi> My doctor is wanting to do my DS surgery in two as I have a fairly high BMI (over 55). I have read that if one has had previous abdominal surgery it is more difficult for the surgeon to do the operation. I was wondering what happens when the DS is done in two parts as I believe the same trocar placement sites are used in both ops. Concerend that this will impede the second op.Greatful for your input

<Dr. Simpson> The DS can be done in one or two parts, and that is something the surgeon will determine at the time of surgery. That is a safety issue, which is something we cannot decide before surgery, but can once we are inside. Of course, sometimes we get in and it is difficult to get out. Once I was inside someone for three days --- but we got a lot of work done.

<Steve> Could you recommend a dietitian in Zionsville that can help me. I am a 43 year old male with a 33 BMI that has played college sports can't seem to keep the weight off. This is after a number of attempts with Atkins and South Beach diets. I am contemplating Hypnosis and heard that the effectiveness is questionable.

<Dr. Simpson> Zionsville -- hmmm. I think that Atkins and Southbeach are too silly to have as a diet and hypnosis is no substitute for making good choices. I have many patients who have had Southbeach and Atkins, so what does that say about them? It is always difficult when someone was an athlete in college and then becomes sedentary. You need to learn some new habits, you need to eat differently. Here are a few simple tips: first, if you want to lose you need comprehensive program, much like we give to our post operative patients. You need to eat a balanced diet -- and fruits and vegetables are fine. It is not what you eat during meals, it is what you eat between meals. So, as we tell our patients -- forget snacks, and if you cannot forget them, then at least plan them, so you know what you are eating. Second, avoid processed foods-- consider them pre-chewed, they don't help you, they have a lot of calories. Third, weigh yourself weekly, you can see how you are doing, weighing in more than that is just silly. Remember, it isn't a diet, diets don't work, it is a choice, and you have choices you can make. Finally, you will need to find time to exercise, DAILY-- there are two phases here, one phase is losing weight, the other is maintaining that weight loss. My next book is called "Losing the Last Tthirty Pounds" which is a companion book for our workbook. I think you will like it. So, go for it.

<Luann> When can I discontinue the glucotrol, glucophage and actos after surgery?

<Dr. Simpson> Ask your surgeon, but we have them stop the night before surgery and not to continue them until your blood sugar gets high, although often it will not. But talk with your surgeon, and hopefully he/she will do the same as we do. They probably will. Good luck. Of course, it is all in the first book we wrote.

<lisa> My surgery was almost 3wks. AGO. and I started my period on march 2, 2005 and still on it. My periods usually last 3-5days. Is that normal or is something wrong?

<Dr. Simpson> Well, sounds like your period has become a comma. That is normal, as these things change from time to time, but if your period is particularly heavy you might want to see your gynecologist and they may want to put a stop to it. But having heavy long periods, or no periods following surgery is normal and remember, you are still fertile, so use mechanical birth control or you can name your son after me.

<Luann> Do you suggest liquid protein for a week prior to the surgery to shrink the liver?

<Dr. Simpson> If your liver is larger, it is something that can help. It is not something we do as a matter of routine, unless we have evidence that the liver is enlarged and if it is, then we do that. I like small livers with onions and fava beans and a nice Chianti.

<Theda> What does foaming mean?

<Dr. Simpson> Rabies. Foaming can mean a number of things. It can mean that you are not getting in enough fluid. It often means you are putting too much in your pouch but it often goes away after a month or two. Check your tags.

<Keri> Hi,I'm 5 mths P/O RNY and have lost only 70lbs.I started out at 268#s.I am loosing motivation .Need some advice.HELP

<Dr. Simpson> We have a whole program for patients who are wanting to get back on track. It was put together in our workbook "Getting to Goal and Staying There: Lessons Learned From Successful PAatients," which is available exclusively through our website. It is the basis of our support group, and what we use to bring people back to goal, and get them motivated again. It is a great book, but there are some simple tips we can start with. First, log all your foods you eat and calculate the calories of them. Second, daily see your caloric intake, and keep track of exercise. If you are not walking, then you need to start an exercise program, both a walking program and a weight program - you need them both. Weigh yourself once a week, and keep track of your measurements. If you snack, plan your snacks, don't do it randomly. Do not skip meals, and finally send your ice cream to me.

<lisa> Another question it's about sex I'm afraid to have sex because I feel as if I'll loosen up the staples inside of me ,or pull something.because of all the shaking is it safe to have sex or should i wait longer I had open gastric bypass and my insiion was larger because my liver was so large

<Dr. Simpson> I think that you can have sex when you are comfortable with it and you do not have to worry about things inside - after all, that is where the fun is.

<Luann> How will I know if I have a leak from the old stomach?

<Dr. Simpson> Only through an upper GI test.

<RONNIE> I AM HAVING A FEW ISSUES, AND WOULD LIKE SOME MEDICAL ADVICE IF POSSIBLE! I AM 2 MONTHS AND 2 WEEKS AFTER A LAP BAND. IM 24 YEARS AND OVERALL PRETTY HEALTH. TO DATE I HAVE LOST 37 POUNDS, MY GOAL WOULD BE 120. SINCE MY SURGERY, I HAVE EXPERIENCED A VERY STRANGE SENSATION IN MY THROAT. I DONT BELIEVE THIS TO BE A SENSATION, BUT MY DOCTORS SAY IT IS DUE TO STRESS AND ANXIETY. THIS SENSATION IS A LUMP IN MY THROAT. IT ACTUALLY FEELS LIKE A PHYSICAL OBJECT THAT IS SHARP AT TIMES AND CAN FEEL IT TRAVEL ALONG MY ESOPHOGUS WHEN I SWALLOW. I HAVE HAD AN ENDOSCOPY AND ALSO A BIOPSY...AND BOTH TESTS CAME OUT NEGATIVE.

<Dr. Simpson> Then it is hard to imagine what it is, but if someone has looked, then there is probably only some mild inflammation there, and you might try some hot liquids, and see how that goes. It will probably go away after a bit of time.

<wshaw> hello, my question is i am obses for years yet at 230pds 5'2" with comoridities my physican isnt that happy about helping me with this how can i change his mind?

<Dr. Simpson> It isn't your physician who is having the surgery, it is you. He/she might not be comfortable with it because they are not familiar with the modern era of surgery but it is you who needs to be comfortable with it, not them

<becky> Hi Dr. About a year ago I regained some weight. I was eating the wrong things and just got lax in my eating habits. I have since been back on the right track and eating the right things, watching my calories, but the weight is not coming off. I'm almost 4 years out. I do excersise daily. Do you have any suggestions to help me get this weight off? I am very healthy othewise.

<Dr. Simpson> I suggest that you first start an exercise program. You should pick up my workbook and work through the exercises in it. You should see a surgeon to make certain that you don't need a revision, and there is a great article in the new ObesityHelp magazine, by yours truly, so get a subscription to that, and finally, walk walk walk walk walk.

<Nancy B> greetings! Has there been any consistant deaths because of the patient being near 60 years old? or do the majority of that age do well?

<Dr. Simpson> I only get death threats from terrorists, not surgery. As with all patients, we need to do a work up of them. I turned down a 59 year old recently who had some severe health issues, and is seeing another surgeon but I operated on a 68 year old before that. Age is a number, but we do need a good history and physical in order to figure out the relative risks.

<Steve> What is the success rate of the gastric bands versus others

<Dr. Simpson> The lap-bands -- adjustable laparoscopic bands, are now showing, at three years similar success rates, if not better success, than the RNY gastric bypass. It is really all about the after care. It is not the operation... it is not the surgeon... it is learning to care for oneself after surgery, making good choices... and all of those things which are an important part of a successful patient. We have studied successful patients from all operations, from all surgeons, and they all have things in common and we made a simple workbook out of it. But bottom line -- it is the patient that makes the difference between getting to goal and not getting to goal. Good luck.

<bridget lambrecht> Are birth control pills effective after rny gastric bypass?

<Dr. Simpson> It does depend on the length of the bypass, and often times we think that the first year patients should use mechanical forms of birth control, not the pill. In fact, I ask patients to avoid sex for the first 17 years after surgery.

<stcynghty1> hello doc i will be 2 years post op on june 4 and today for lunch i weighed out 8 oz of chili with 1 oz of cheese on top and had 10 tortilla chips and was able to eat it all and i felt full it took me 20 minutes to eat it all, i know chewed down it's alot less but doesn't that seem like alot?

<Dr. Simpson> That you can eat more is what normal people do, but let us look at what you ate: The one ounce of cheese --- while some like to look at cheese as a source of protein, I like to think of it as lard. The chili could be good or bad, depending on the fat and quality of meat in it. The chips are few, and moderate. So, now you have a choice; if what you eat allows you to maintain your weight, then that is good, but if you find that you are creeping up on the scale, then you need to re evaluate your choices and make different ones. Certain things are considered to be "ok" but they are not. For example -- peanut butter as a source of protein -- when you add up the fat, the sugar, and other other stuff in it, it really is not a great source of protein. That is just one example. Doesn't mean you cannot have peanut butter, simply don't fool yourself into thinking if you coat something with peanut butter that all is ok.

<Steve> What is the success rate for the gastric bands?

<Dr. Simpson> That is an odd question, because an individual is NOT a statistic. A person can lose all their excess body weight in a year, and keep it off, with the right combination of diet and exercise or a person can make poor choices and not lose any weight at all, or just a few pounds. We have patients who have lost over 150 lbs in a year, and they did it with hard work, but it takes hard work. So, success rate depends on several things: first, what do you consider success. What you consider success is not what I might consider success. For example, in surgical literature, some times success is getting rid of 65% of excess body weight, sometimes it is getting to a BMI of less than 26, and sometimes different. So, those are simply apples and oranges. Bottom line is this: The lap band works as well as any of the weight loss operations do and, as with all surgeries, works best when combined with making better nutritional choices and exercise. There is no operation that allows you to do otherwise.

<Amy> Any thoughts on the SlimFast Optima diet?

<Dr. Simpson> It causes me gas.

<carolyn faye> ello Dr. Can staying constipated cause an intestinal blockage? I'm 2 mths postop and no matter what I take I stay constipated and I am also following the rules.

<Dr. Simpson> No. If you are constipated then you are either 1) not drinking enough water -- because the job of the colon is to remove water, and if you give it enough water things will go through or 2) the other issue is not enough fiber. Get those straight and you should be fine.

<Nancy> WHAT ARE THE STATISTIC OF WEIGHT GAIN AFTER SURGERY ?

<Dr. Simpson> Again a statistical question, and you have to remember - you are an individual, you are not a statistic. You can gain or lose weight after weight loss surgery, because surgery only is a tool. If you do not use the tool, then it is wasted, that is totally up to the individual. Statistics are good for studies, to prove that wls is better than nothing, and we have proven that. For an individual they have to figure out the following: Is the diet and exercise program I am on working or not, and will it sustain me or not, and if I have wls will I commit to making better choices and doing some exercise. It is that simple, not complicated.

<Samantha Bobbitt> What does she mean by foaming?

<Dr. Simpson> Mr. bubble. You know it if you have it. If you don't, then don't worry.

<Ezpy_DS> I'm scheduled for DS surgery in two weeks at USC and have a pre-op appointment with my surgeon and his PA in 10 days. Can you suggest a good question or two? I feel kind of at a loss to come up with something that doesn't sound stupid.

<Dr. Simpson> I think the questions to ask are simple: What is the after care like, should I continue to see a shrink, and what choices do I need to make to stay healthy. You can always ask how many have they done, and since Anthone left they have not done as many as they use to do. USC has become more of an RNY place since he left, so you might want to make certain that they will do that. Finally, you want to know if you will see the surgeon for aftercare, or if it is given to the office staff and he is done with you once you are healed.

<Amy> I have fatty liver - can diet and exercise help, or is it a permanent condition?

<Dr. Simpson> It is reversible with weight loss, mostly our best answer to it.

<carolyn faye> Is it ok to drink a cup of reg coffee everyday if it can help keep your bowels regular?

<Dr. Simpson> I drink regular coffee so I don't get grumpy. Coffee is a mild appetite suppressant, not a stimulant as some folks have been misinformed about, so drink some. But what you need to be regular is to drink lots of water and have some fiber in your diet. Coffee is simply an essential ingredient to life -- but hey, I am Norwegian.

<Cheryl G.> Hi Dr. Simpson! I am on 15 different prescription meds. Many of them do not come in liquid form and/or cannot be crushed. Should I just not take them after surgery?

<Dr. Simpson> You should consult with your doctors and your pharmacist about each and every one of them. Do not simply discontinue medication. Most operations will allow you to take what you need. You do need to be careful. There are some you will not need, but go over that with your doctor -- DO NOT STOP a medicine, unless some doctor says so, and if I am your doctor, great, but if I am not then find one who is. Good luck.

<wshaw> Thanks for that statement about the doctor, i have changed doctors for 6months diet to complete my insurance requirements yet again all my history for health is with the first doctor. I am ready. It isnt cosmic it is health needed. I am cancer survivor of 8 years with thryoid. I will keep trying for the surgery. Just was curious if this was an issue with other doctors not supporting the patients

<Dr. Simpson> Unfortunately it is, and that is why I wrote the book. While it has humor for patients, it has a lot of information for doctors, and is written at their level, although the humor is probably at 7th grade (which means it is above most doctors). Many doctors don't know or understand weight loss surgery. They remember the bad days about weight loss surgery, and oftentimes when they have a patient who is successful, they become advocates of weight loss surgery. So spread the word, and go to your old doctor after a few months for a check up and they will see what a great result is and become a believer. I would rather see a sermon than hear one any day.

<Diane> What should I do if my primary care physician won't give me a referral?

<Dr. Simpson> There are a lot of primary care physicians in the world, not just one. So, if yours won't give you one, then change doctors.

<Luann> I don't know Dr. Simpson. What is the name of his website?

<Dr. Simpson> www.drsimpson.com, www.obesitydr.com, www.doctorsimpson.com. You should be able to find us there or at the Improv on select nights.

<Tabatha> Hi Dr. Simpson I have heard from alot of people that after two years you will gain back weight from your stoma stretching is this true also someone on the internet said that there are hardly any gastric bypass patients that have lived for more than 15 years. Is that true? That got me scared.

<Dr. Simpson> Tabatha, I am sorry someone is spreading such awful rumors like that. I have been doing weight loss surgery for 14 years, and I have plenty of healthy patients from back then I don't see them so much because they are going on with their busy and productive lives and don't need to see me, although I would love to see them, and we ask them to come in. Stomas can stretch, but it isn't common, and weight gain after surgery is something that happens to some folks for a variety of reasons. The most common is not learning and changing behaviors after surgery. Although stoma stretch is one, pouch stretch is another but, if you take care of yourself, you will do just fine with the operation. Good luck, and the most common cause of death after surgery is being shot by a jealous lover.

<Nancy> What is the difference between a RNY and a VGB

<Dr. Simpson> The RNY and VBG are two different operations with different things that we do for them, and they are outlined well online here at obesityhelp.com or in my first book.

<diana> have you heard of a surgry that dosn't take any of the stomach out it rearranges the instenstines instead and removes some of them .... i seen it on discovery health

<Dr. Simpson> No...well, yes - it is called RNY gastric bypass. We don't take out stomach, we rearrange intestines. It is the most common weight loss surgery done in the United States today. Where the VBG bands the stomach, the lap-band is an adjustable band around the stomach and the DS removes stomach and rearranges a lot of intestines.

<Janelle> What Are the Pros & Cons to the RNY(LAP)

<Dr. Simpson> Pros -- great surgery, weight loss, need to learn about aftercare. Cons -- it is surgery, surgery does have risks, and you have to learn about them. You have to eat better, you have to take vitamins and supplements, and you have to keep close follow up with your surgeon or some other health care professional to monitor so you don't get into trouble. Good luck.

<gail> where is the workbook available?

<Dr. Simpson> Exclusively on our website www.obesitydr.com.

<cassandra> dear dr.simpson i am about 550 would you be able to help me

<Dr. Simpson> We would be able to help you, as would a number of other surgeons who do weight loss surgery. So find some nice surgeon, and start the process.

<Kit> Hi. Do you list correct food choices in your book?

<Dr. Simpson> Yes.

<Tabatha> what do you consider good protein? good fruit? good vegetables?

<Dr. Simpson> Good protein would be high quality protein which has little fat in it. For example, fish is high quality protein, as is some lean beef, egg whites, and soy proteins, and even whey based proteins. I have no problem with patients eating vegetables, although I consider potatoes, and rice to be more of a starch, but anything that is green is in as far as I am concerned. Fruits have more calories per gram, but they do fine, and I would rather have patients eat fruits and vegetables as opposed to processed foods like Twinkies or donuts -- which should be sent to me immediately for disposal.

<sharon> hi Dr. Simpson.....had gastric bypass 12 days ago and having a very difficult time with the protien shakes....any suggestions for other ways to supplement protien???

<Dr. Simpson> There are a lot of protein shakes out there, and some of them go down better than others. Whey based shakes are most bioavailable, and easiest to tolerate, better than soy. Isopure works well for some of my patients, although it is soy but often times patients can get in enough protein through food, which is how we prefer you get the protein in. You need protein, it is essential for healing, but you cannot get it all in at once. I have a problem with protein shakes in that they taste like sawdust and are not as good as a real milkshake.

<Dee> I am considering the Mini Gastric Bypass. I have heard that there is a greater risk of bile reflux with it. Is this risk reduced or increased any if I don't have a gallbladder?

<Dr. Simpson> No it is not. Why get an operation that is inferior to a better one?

<Moderator> The last question goes to...

<cassandra> my name is cassandra i live in detroit no one here can seem to help me with surgery so do you think you could

<Dr. Simpson> There are a lot of fine surgeons in Michigan and Detroit who can help you. There is the CORI Center, which can help. There are surgeons there who do the duodenal switch who can help and surgeons who do the lap band. So check the obesityhelp.com section for surgeons and you will find someone there. Good luck.

<Dr. Simpson> Thank you all for your time.

<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. Be sure to catch Dr. Simpson next week.