March 12, 2004

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

<**MODERATOR**> Welcome to tonights surgeon chat with the famous and lovable DR Simpson from Arizona Bariatric Center. Chat starts at 7pm EST. Please type out your questions and hit enter. I will see them and present them to Dr. Simpson in the order they are received when chat starts. Thank you! Website: http://www.drsimpson.com/ Phone: 602-234-8995 Fax: 602-230-8344

<Nacole Band> I'll be having the Lab Band. I'm concerned about slippage? What techniques are used to prevent this?

<Dr. Simpson> The band can slip, and sometimes does -- there are several things we do: first,we suture the band in place, second we keep you on a clear liquid diet followed by a full liquid diet to allow the band to secure it in place without you vomiting. Late slips -- we don't know why those happen but we do our best.

<kathleen g> Hi Dr. Simpson: I had open RNY 2 1/2 weeks ago. How long before I can walk upright? Thanks.

<Dr. Simpson> You can walk upright now -- boy I bet your knuckles are sore. Walk, stretch, get outside get some fresh air-- it was 88 in Phoenix today. Ice on the belly -- water on the tongue, and protein in the stomach. Go for it.

<Jules> How long is the recovery period?

<Dr. Simpson> Depends on what you mean by recovery ---- In one sense you recover from surgery in a couple of hours -- waking up from the operation on the other hand you are never the same after we operate on you, and you will be forever altered. In between that we have a few good estimates: most are out of the hospital from one day to five: one day if you have a lap band-- five days for uncomplicated open surgery, and in-between for other lap surgery, three weeks to return to work, three weeks to swim and forty eight hours to shower (whew), three months before you wake up and have to remember you had surgery, six months before the scar looks as nasty as it will look, and two years before the scar is a nice line. So, complicated question. If you work for the government-- six weeks off duty, if you work for yourself you will have your work in the hospital with you.

<Kim> Which is safer and has the least amount of complications, lap or open ?

<Dr. Simpson> Ah, Kim-- the million dollar question (that is what the lawyers say), depends on the complications you are talking about. For example, there is a slightly higher leak rate with lap than open, but there are higher rates of hernias and incisional problems with open and, if you are the one with a problem-- then you are the one-- and it is one hundred per cent. So, go with the surgeon you like, go with what they are comfortable doing, and if you are one of their first laparoscopic procedures they have done make certain to reinforce in the surgeon's mind this: "If you have to open -- DO IT, do not hesitate, do not worry, do what is best for me." Good luck.

<tracy> Hi Doctor! Glad to see you this time. I had surgery Dec 31st and I perpetually deal with nausea, I can barely get my water in...items don't get stuck, they sit for an hour and then I vomit. I don't really eat, at all. Do you see a reason to be concerned until after 3 months? I have taken raglen...Im about to pick up marinol to try and get some help. I am also having trouble with protein drinks. HELP! :-) ps. I love you !

<Dr. Simpson> Hi Tracy -- glad you love me, someone should these days. I assume you had a RNY, and yes, you should have yourself off to see a friendly neighborhood gastroenterologist. You might have a stomal problem, that is, you might have scar around the opening between the stomach and the intestine and they can fix that with some stuff, a balloon and some air. So, go see them. In the meantime--- forget about Merinol, and keep up with fluids and vitamins and good luck.

<kathleen g> Dr. Simpson: My gallbladder was removed during WLS surgery. The surgeon said it contained several large gall stones. I didn't know they were there as I did not have pain from them. What's up with that? Thanks.

<Dr. Simpson> Well, some of us remove gallbladders as a matter of routine ---- some of us only remove them if they look like they have a problem, and clearly yours did. Often people who have been on diets and lost weight (I'll bet you did a diet or two before the surgery ) have a set up for making gallstones, now gallstones are soft, and sometimes they don't create problems but sometimes they do create problems and the stones are more precious than diamonds-- and cost more so, be glad they are gone, and glad they are out of there.

<ma> what are some possible negative long term effects of surgery? Any studies ever done?

<Dr. Simpson> No real studies that have looked at this, but there are a lot of patients who have had the surgery. The major long term effects are from those who have not kept up with their vitamins and minerals and those are predictable -- so take the vitamins and follow up with your doctor. The major long term problem is that you die of lead poisoning --- from a jealous lover.

<Cecile> I had ROUX-EN-Y surgery 5 weeks ago and was doing fine until yesterday. I seem to be experiencing some heartburn or reflux, even drinking hot tea. Any suggestions?

<Dr. Simpson> Don't drink tea. Sometimes there are alternating periods of reflux, and so, I would be careful about what you eat and make certain. If you have problems to see the gastroenterologist.

<Sunny> what is your experience with patients' mourning the loss of their comfort - food?

<Dr. Simpson> Now, food loss and mourning-- sure sometimes, but more than that most patients are so happy to have lost fat, that they don't mourn so much as find out that some foods or the quantities of foods were things that were killing them. A little food is all right. A lot of food will kill you.

<JustMe> Hi Dr. S. I'm 19 months post op and had lost approx 198 lbs. Recently I've been really struggling w/ eating all the wrong foods.. the wrong amounts.. and the scale is creeping up. Any suggestions other than wiring my mouth shut? It's really concerning me, but I just can't seem to get on track. *sigh*

<Dr. Simpson> Ah yes, this is a common problem and there are a few little tricks and of course all of them are in my book which will be out in a couple of weeks but for those who want a sneak preview here is a few tips. If you have something that is "bad" that is a carbohydrate such as candy, cookies, or the other-- make certain you combine it with a low glycemic index carb (see my website for the lists and the explanation) for example-- girl scout cookie with an apple that way you won't get the high from the sugar and won't get the come down low that will want you to eat more. So, go for combinations of foods-- it will work better for you.

<stcynghty1> i had surgery on june 4 2003 i have had a hard time feeling when i am full since i had surgery, i will sometimes feel a slight pressure in my abdomen when i eat but not always and it's not very noticeable it has me worried that i might have a staple line disruption is that possible?

<Dr. Simpson> You don't have a disruption of your staple line. You are feeling full, and that is more full than you should and you have overeating syndrome. You are overeating the pouch, and it feels full later -- because it takes 20 minutes to feel full. So: measure twice, eat once, vomit and stretch NEVER. Oh, then take a walk.

<DrPrettySlim> I understand after WLS it is common to have a drop in seratonin - but that eventually it returns to what ever is normal for the patient. Do you know the usual time frame of this seratonin drop and the general time frame of its return? Thanks for any opinion....

<Dr. Simpson> Well, there are a lot of speculation-- and this question -- for the rest of you is: do we get depressed when we lose weight -- the answer-- many patients do 'is it from some neurochemical? or a hormone? who knows -- are there good studies -- well, some but not great. Simply put-- if you are depressed, you should be on medication for a month before the surgery and continue the medication after the surgery -- and most of those medications will help. So -- the answer is : yup.

<ming> How much weight can a person expect to lose each month after wls?

<Dr. Simpson> It depends on how much they start out with --- while we say anywhere from 5 to l0 lbs per month, on an average, a lot is lost the first month, also depends on the surgery-- some lose more early on-- like DS, some lose in a steady fashion over time-- like the lap band and some eat cookies, drink beer, and eat ice cream and never reach their full potential. START THE GROUND RUNNING, don't misuse that early time period, get in a walking program, maximize your weight loss.

<DrPrettySlim> Who collected the figures that 10% of the WLS patients "fail" i.e. regain weight thru non compliance?

<Dr. Simpson> I did. Sorry, couldn't resist. Non-compliance is a funny word, because it means that we have given you something to comply with, if we have not, then you are not non-compliant, probably mis-compliant or mr. compliant. Anyway--- weight loss surgery can "fail" if you eat the wrong stuff and continue to do that and that is the most common cause. Simply put, the ten percent cent figure comes from the air.

<Chris> could someone without the surgery eat the same diet plan and have the same outcome? Kind of PRETEND to have had the surgery??

<Dr. Simpson> No-- because if you don't have a smaller stomach you could NEVER eat those small amounts and feel satisfied. Why? because it is biology -- not psychology --- try eating a lean cuisine before you have weight loss surgery. It is an appetizer to a larger meal after weight loss surgery it will last you three dinners.

<morrie> is there a benefit to having open versus lap rny?

<Dr. Simpson> If your surgeon does more open and feels comfortable doing them --- then yes, that is an advantage. Do what they are comfortable with.

<suzzette> I am 6 weeks out and have lost 24 pounds. This seems so little compared to other people.

<Dr. Simpson> Yea--- it is soooo little-- and tell me, when was the last time you lost 24 pounds in six weeks. My son here -- Crow -- lost a lot in six weeks, but he was a big boy, you are probably not quite at that point ---- and trust me-- wherever you ended up after 24 pounds in six weeks, I'll bet Crow would have traded you places. That is I'll bet Crow wished after six weeks he weighed 250 lbs instead of something else. What were you at six weeks Crow?

<CROW -430# Lost> i lost 115 in 30 days, was 745, lost 400 in 22 months it can be done.

<Dr. Simpson> So-- you start out higher, you lose more weight. You start out lower, you lose less. Weight loss is a per cent of excess body weight, so don't worry about those who start out higher and seem to be lapping you. Eat right, walk a lot-- and have some fun with shopping.

<PreopJuly> what are the stat's on wls patients being able to maintain their weight 5-6 yrs. out?

<Dr. Simpson> Depends on the surgery that they have, and a lot of other factors: let me answer it in this way: weight loss surgery is a TOOL, not a solution, you have to work the tool. If you don't work the tool, you can overcome any weight loss surgery --- even the duodenal switch but it is easier than ever before to work it and it is easier to lose weight and it works well: just a few simple rules: all of which will be in Dr. Simpson's book (shameless promotion here).

<Chris> Is there "rumors" of other surgeons around the country, like doctors not respecting other doctors? Is there like black ball list in the doctor world?

<Dr. Simpson> No black list.

<Chris> what guidelines should a patient use to selecting a surgeon?

<Dr. Simpson> Find someone who is well trained (if they are young) well respected (if they are new to the field and have done surgery) and you like, and has a good set of hands, I like the french manicure.

<suzzette> I am having trouble NOT drinking when I eat! The food will not go down. I know we are told it's a no no to drink.... how much will it really hurt if I do?

<Dr. Simpson> Well, some of us say no drinking-- but most sip a bit. Seriously--- DO NOT GULP.

<Sadie> what is diff /benefits between distal and proximal rny

<Dr. Simpson> Well, a distal has more malabsorption: on the plus side you will absorb less fat, on the minus side you will not absorb some vitamins well like A, D, E, and K, and calcium and probably a few others that we don't know about yet so, you have to keep those monitored with a healthy set of labs,the majority of weight loss comes from the restrictive part of surgery, not malabsorption.

<DrPrettySlim> Whats the ballpark date your book will be able to be ordered? (I am already in line for an autographed copy)

<Dr. Simpson> ...the book.... should be ready in a couple of weeks, check my website, and we can autograph it easily, we will have a website up for it, and the store at obesityhelp.com will have copies also.

<cherblues> What is the most important thing to watch for after surgery

<Dr. Simpson> girls, oh sorry. We watch for a number of things in the early post operative period, but the most important thing that you can do is: WALK walk and walk some more. Then when you are done walking-- walk again and keep walking until you cause the floor to have your own persona footsteps, that is the best preventive measure against all the bad stuff.

<suzzette> I have to have a CT Scan next week... will I be able to tolerate 3 glasses of barium?

<Dr. Simpson> sure -- slow small and easy. Like me

<BeckyinDothan: HI Doc. If you have had a previous surgery.... such as gallbladder removal....Does that mean you can't have WLS done by lap? Or must it be done by open? Thanks!

<Dr. Simpson> Lap can still be done.

<jessica B> My surgeon provides almost no aftercare at least nutritionally, Im about a month out and have lost 30 pds but I really dont know what to eat. Accept protein and water. How many grams of carbs,protein and fat should I get a day. Thanks!!!

<Dr. Simpson> What you need is some good recipes and such -- so, and I will have a few of those in the book, but here is some stuff you should think about 100 grams of protein per day about 60 grams of carbs per day. Forget about fat- - don't eat it if you can avoid it. Not a good thing, fat -- really not -- unless it is fish fat, love fish fat. Get salmon -- not farm raised either-- get real salmon troll caught salmon -- and don't eat the troll.

<Jane> I had the micro-pouch done 5 months ago. In the last month it seems I can drink faster and now it seems I can eat a little faster and a little more at a time. Why this change?

<Dr. Simpson> Pouches stretch-- no matter what they tell you-- pouches stretch and you can eat more -- but don't eat fast --- enjoy the food, don't throw it down -- guzzle and chug liquids, sip, enjoy food, bit of it.

<PreopJuly> I have been approved for lap rny surgery, if there are not complications I have been told that some people returned to work as soon as two weeks. I do a lot of driving approx.150-200 miles a day, is it ok to go back to that after two weeks?

<Dr. Simpson> Two weeks is a bit soon --- see how you do, and remember, you want to have your reaction time back, after all we have enough truckers in the world who don't react well to getting out of my way. Damn it. oh, sorry. So wait until your reaction time is normal.

<donna> DR. my biggest fear is mal-nutrition, can you give me a percentage of people who die because of it?

<Dr. Simpson> Very very very very very small. Not an issue.

<aprilkids> how long do you have to take the vitamins and minerals?

<Dr. Simpson> for the rest of your life if you don't then you will have problems.

<sandi> Hi DR! Who do you see if you do think that you are having gallstones?

<Dr. Simpson> A surgeon.

<?Sue> I have not had my surgery yet but I am concerned that I only have one kidney will this be a problem.

<Dr. Simpson> No -- one kidney is just fine --- probably better for that kidney,to lose some weight.

<Melissa> I recently had RNY 9 weeks ago. I went for my annual physical and my TSH level is low. It wasn't low before surgery. Is this common in gastric by pass patients?

<Dr. Simpson> Nope, not at all. But that means your thyroid is working well, not that it isn't -- so, they will watch it for you, and you will be fine.

<thinwomaninside94> When it comes to insurance do you find that many people who are in the severe obese category still have trouble getting the insurance company to cover the surgery?

<Dr. Simpson> Some insurance companies are just a pain in the neck, and some are not, it doesn't matter how big or small you are some companies are great-- Blue Cross, is generally (once you get them to agree) a good company. United Health Care can be great (in California)

<Kim> Im afraid of dying on the table, but more afraid of living in this ticking time bomb of a body, what do you tell your patients to reassure them?

<Dr. Simpson> We don't like people to die on the table because we don't like to have to fill out the paperwork so we will keep you alive, don't worry.

<Chryssie> What do you think about RNY and type 2 diabetes? What happens in the body after RNY that allows people to come off meds so quickly with out loosing any weight yet?

<Dr. Simpson> Because they eat less, and since they eat less, they don't need the insulin, or the pills. So, we often don't put patients back on pills, and cut their insulin, and watch it carefully.

<Cookie> calcium- how important and how much daily?

<Dr. Simpson> Depends on which surgery you have-- if you have a DS, then about 1800 mg per day, otherwise is 1200 per day.

<Cris> What tests are generally done while in surgery to prevent leaks, and should one occur after surgery, are they always life threatening?

<Dr. Simpson> Sometimes we do a dye test during surgery, some do endoscopy during surgery, some do a barium swallow after surgery. They are not always life threatening, but they are treated that way and they can cause a problem for more than a while. So, we work hard to prevent them, we use the radiator gunk.

<donna> what does a filter do exactly?

<Dr. Simpson> filters things, if it is a vena cava filter it allows blood to go through to the heart, and keeps the big clots from getting lodged in the lungs.

<Corina> Can you explain the .2% mortality figure with this surgery...does it entail a certain time period, or does it include death from co-morbidities?

<Dr. Simpson> It is in the first 90 days, the figure is one in two hundred, pulmonary embolism is the major cause.

<Cindy in CA> Is it normal to have weight loss stop or drastically slow soon after surgery?

<Dr. Simpson> It can happen, but weight loss is a simple formula-- less calories in-- more weight loss.

<Sabby> Does the quick change in weight hinder the performance of birth control shots (Depo Provera)?

<Dr. Simpson> Don't know about Dep Provera --- but oral contraceptive agents are not a good things so, use mechanical birth control condoms, diaphragms, IUD, and the like and don't have sex for 17 years after surgery

<Deniselj> Dr. Simpson, I am having a terrible time with carbs. I know that if I quit eating them for 3 days the craving will pass but I can't seem to get started doing without them. How do I conquer this headhunger?

<Dr. Simpson> Head hunger -- feed the head -- Eat carbs that have a low glycemic index: lentils So, head hunger is something a lot suffer from...and again, it is a matter of combining some good carbs with them apples, cheese, and the such

<Dr. Simpson> Thank you all, time to go to the hospital.

<**MODERATOR**> Thank you for joining us tonight, Dr. Simpson. Dr. Terry Simpson - Arizona Bariatric Center - Website http//www.drsimpson.com, phone number 602-234-8995.