<MODERATOR> TINA, YOU HAVE THE FIRST QUESTION FOR DR. SIMPSON.

<Tina> Hello Dr. I'm pre op, have not yet had a consult. On a waiting list right now. Does WLS cause hernias? I've read quite a few profiles that talk about the development of hernia's post WLS. Thank you Dr.

<Dr. Simpson> well weight loss surgery doesn't cause hernias, however a hernia can develop as a result of the surgery

<Dr. Simpson> which is simply this: let us go back to what a hernia is.....

<Dr. Simpson> a hernia is a weakness in the fascia, and having a weakness in the fascia can cause a bulge in the fascia such that....

<Dr. Simpson> the contents which the fascia was holding in start to balloon out. That bulge is the hernia, or the weakness is....

<Dr. Simpson> So, fascia by the way is just another name for gristle, that stuff that is tough in a steak....

<Dr. Simpson> when you cut the fascia, as we have to do to open the abdomen to rearrange the guts....

<Dr. Simpson> and we close that fascia back up with suture -- there is a weakness in the fascia,,,

<Dr. Simpson> and it takes weeks for that fascia to heal properly-- in fact at six weeks the fascia is about sixty per cent of normal....

<Dr. Simpson> which is why we say don't lift anything too heavy for six weeks---- ..

<Dr. Simpson> one of my patients developed a hernia and named it after her son, because it was lifting the little tyke that caused the hernia....

<Tina> lol

<Dr. Simpson> so, it isn't the weight loss surgery, it is rather that the fascia is weak, and after a month...

<Dr. Simpson> when people are feeling pretty well, they sometimes forget and lift something more than they should...

<Dr. Simpson> and they strain it a lot, and develop into a hernia down the road. The hernia only becomes larger with time...

<Dr. Simpson> they do not fix themselves. So, more about hernias than you wanted to know. Good luck.

<Dr. Simpson> ten to fifteen pounds for six weeks.

<Tina> hank you'

<MODERATOR> BRENDA IN WA, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.

<Brenda in WA> What is the difference between a gastric bypass and an open RNY? Which is better?

<Dr. Simpson> Well, in terms of which is better, it isn't like vanilla vs. chocolate, because we all know which is better....

<Dr. Simpson> just that some might disagree that I like vanilla ice cream with a nice reduction of balsamic vinegar, but that is another story....

<Dr. Simpson> a gastric bypass is a bypass of the stomach using a RNY technique, and open vs. laparoscopic is something...

<Brenda in WA> What are the differences?

<Dr. Simpson> that is an old debate which will go on for years. Gastric bypass and RNY are the same thing, the other common weight loss surgeries are:

<Dr. Simpson> vertical banded gastroplasty, lap-band, and duodenal switch....

<Brenda in WA> Bye the way you are almost too funny to be a doctor! Thanks!

<Dr. Simpson> in terms of which is better, that will depend more on the patient than the surgery....

<Dr. Simpson> the better one is the one that your surgeon does, and the program your surgeon has.

<Dr. Simpson> good luck.

<MODERATOR> MADISON, YOU HAVE THE NEXT QUESTION.

<Madison> Dr S....I enjoy Venison very much & like it rare.....is there a lot of protein in it?

<Dr. Simpson> Hello, Madison, and that is a very good question....

<Dr. Simpson> rare is easier on the stomach to tolerate than any well done meat...

<Dr. Simpson> rare, as you know, since you clearly prefer it, has a better taste, and flavor....

<Dr. Simpson> well done is quite hard on the stomach, and difficult, especially early on in the weight loss surgery stomach....

<Dr. Simpson> there is a lot of protein in venison, more in that than in beef, so it is a good choice to have for a protein source, and I highly recommend it 0--- been out hunting lately?

<Madison> not lately Dr S.....TY

<MODERATOR> WENDY, YOU HAVE THE NEXT QUESTION.

<Wendy> I am 6 months post op, have lost over 100 pounds, but at times I still get really hungry, any idea why, I eat a small amount almost every 2 hours. thanks

<Dr. Simpson> Hi Wendy, I think that it is not a good idea to eat a small amount every two hours, you want to...

<Dr. Simpson> graduate to having three meals a day instead of a small amount every two hours, such grazing is a sure way to defeat the operation...

<Dr. Simpson> so increase the amount you eat, slightly, until you are full, and comfortably so, then ...

<Dr. Simpson> go to three meals a day and a couple of high protein snacks-- and by the way, Krispy Kremes are not high in protein...

<Dr. Simpson> then you will be less hungry and have a better result. Good luck.

<Dr. Simpson> Tammy is here and in charge, so don't cross her-- I know her mama

<Wendy> thanks How is eating small amounts defeating the operation

<Dr. Simpson> because you can put a lot in and graze, instead of less in three meals a day. Also, don't eat and drink because

<Dr. Simpson> you can force food down the pouch into the intestine where it will be absorbed as calories and you will not feel full.

<MODERATOR> MARYMT, YOU HAVE THE NEXT QUESTION.

<MaryMT(preop)> Dr. Simpson, i have focal glomerulsclerosis, can you give me any advice as to what i need to do different from the average person, my only clinical manifestations are HTN and protienuria

<Dr. Simpson> and my fingers will be able to do stuff better too

<MaryMT(preop)> and Hi Dr. Simpson :)

<Dr. Simpson> You need no special advice for that, and there are a lot of obese patients who have focal glomerulosclerosis...

<Dr. Simpson> and hi back. in fact, weight loss surgery can help with that process in some people, and I have no idea why...

<Dr. Simpson> but, no, nothing special. Lose weight, you will be happy, your kidneys will like it...

<Dr. Simpson> and you will help the world.

<MODERATOR> ALISA, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.

<Alisa> I am 5'7" tall and almsot 2 years out of surgery. What I want to know is what is the most reliable way to test our body fat as previously high weight people... I have used various methods and get anywhere between 25 an 40%. I am very active (training for 1/2 marathon) and am trying to figure out if I need to lose more wieght or not of this is all muscle (under the skin, of course!)

<MaryMT(preop)> well.. that is my hope, thanks and have a good night

<Alisa> now weighing 195

<Dr. Simpson> Well, Alisa, you need to get down another bit, but the best way to measure body fat is in a...

<Dr. Simpson> vat of water, and there are some gyms which have this-- it is the most accurate method...

<Alisa> if that's not available?

<Alisa> bc I can't findone that has it

<Dr. Simpson> essentially your body fat is checked in the water. There are all of those calipers out there, but they are not as reliable.

<Dr. Simpson> So, check with Gyms, a lot of them have them out there, and that should be available...

<Dr. Simpson> otherwise, they often have the calipers. I prefer high fat in my ice cream and low fat in my waste.

<Dr. Simpson> good luck.

<MODERATOR> DEBBIE BAILEY, YOU HAVE THE NEXT QUESTION.

<DEBBIE BAILEY> HOW DO I GO ABOUT CHOOSING THE RIGHT DOCTOR

<Dr. Simpson> Ah the right doctor, well the first place to start is to check with your insurance policy and find out who is on your insurance....

<Dr. Simpson> because that usually determines where you will go. Often times insurance policies have specific doctors who they work with...

<Dr. Simpson> like those who don't make typing mistakes...

<DEBBIE BAILEY> I HAVE TO GO TO ONE THEY TELL ME TO

<Dr. Simpson> and those ones who are on your insurance panel are the way to go. From that point it becomes an interesting problem....

<DEBBIE BAILEY> TY

<Dr. Simpson> no-- you don't have to, but if you want them to pay for it you will....

<DEBBIE BAILEY> OK TY

<Dr. Simpson> if you have multiple choices, that is a great position to be in, because then you can research not only the surgeon...

<Dr. Simpson> but the operations that they perform, and that opens things up for you....

<DEBBIE BAILEY> DO I NEED LETTERS FROM DOCTORS

<Dr. Simpson> while you should always check their credentials, the important thing is to find out if they mesh with your....

<Dr. Simpson> some insurance companies require it, and some do not, and your surgeon's office can assist with what...

<DEBBIE BAILEY> WILL THEY DO THE SURGERY IF I HAVE LUPUS

<Dr. Simpson> letters you will need. You should get your PCP behind you. Lupus is not a contraindication to surgery...

<Dr. Simpson> but I would have your primary care doctor check you for celiac sprue, because it is associated with that.

<Dr. Simpson> good luck.

<MODERATOR> JONI LABOWITZ, YOU HAVE THE NEXT QUESTION.

<joni labowitz> Is there a big difference in weight loss with gastric bypass rather than adjustable lap band

<Dr. Simpson> Yes and no, the lap band has a lower success rate, but still a good one...

<joni labowitz> how much lower success rate

<Dr. Simpson> the problem is that fewer insurance companies cover the lap band...

<Dr. Simpson> about sixty per cent loss of excess weight at the end of a year compared with RNY which is much higher,,,,

<Dr. Simpson> and long term, lap band is effective less than RNY. The RNY is proven, works well, and has the same risk as lap band,...

<Dr. Simpson> and would be my choice, or the duodenal switch. Good luck.

<Dr. Simpson> that is one of the critical points of the lap band, some insurance companies do not cover it, and the cost of the band alone is three thousand bucks.

<MODERATOR> LOLA67 TX, YOU HAVE THE NEXT QUESTION.

<Lola67Tx (4wks-40lbs> Is there such a thing as loosing toooo much weight, too fast? Any chance my stomach is now too small?

<Dr. Simpson> Well the lose of too much weight is a popular myth, and it just isn't really a problem...

<Lori S. (D/S)> Did i read that you said the stomach grows back with a D/S

<Dr. Simpson> that is too much too fast, so that is something that you have to not worry about...

<Dr. Simpson> you can lose too much weight, if your BMI gets to be less than 18 then you need to have an evaluation...

<Dr. Simpson> but you cannot lose it too fast, although some people try to say that, it just isn't the case at all.. In terms of stomach being too small, no, they are measured at the time of surgery, and over time they all grow a bit, but that is not a problem.

<Dr. Simpson> they will still be smaller than their original 50 ounces. Good luck.

<MODERATOR> JANE AUSTRALIA, YOU HAVE THE NEXT QUESTION.

<jane Australia> At 10 days postop I am vomitting once a day, and it seems like a huge amount compared to my fluid intake

<Dr. Simpson> well, that is something that you need to discuss with your surgeon, because it could be that...

<Dr. Simpson> you have stretched the pouch a bit, it could be that you have a stenosis, there are a lot of reasons, and that will need to be investigated...

<jane Australia> thankyou

<Dr. Simpson> you might want to slow down on the fluids for a bit, and you might want to see if sipping can keep them down a bit. Good luck.

<Dr. Simpson> Australia-- weather ok?

<Dr. Simpson> would love to come and visit someday for a few weeks.

<jane Australia> beautiful

<Dr. Simpson> good day mate!

<jane Australia> it is gods own country

<Dr. Simpson> Unlike Arizona, which is where the devil lives.

<Dr. Simpson> actually, the devil thinks Arizona is too hot in the summer. Even our creatures here have homes.

<MODERATOR> JO, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.

<Jo> I am 48 yr old, had breast cancer 4 yr ago. I had masectomy, chemo & radiation. How would that affect my decision to have the surgery?

<Dr. Simpson> That will not affect your decision one bit, but it is great that you are doing well...

<JO> have gallstones as well

<Dr. Simpson> and surgery for weight loss is a good thing, so you will probably do well, you did well from a major event, and

<Dr. Simpson> weight loss surgery will be a breeze. They will remove the gallbladder at the time of surgery.

<Dr. Simpson> You don't need that damn thing anyway. Good luck. And congrats

<JO> thank you for reassurance

<MODERATOR> AMY, YOU HAVE THE NEXT QUESTION.

<Amy> Is there a limit to how much you weigh or how high your BMI is to be a candidate for the lap-band?In other words can you be too overweight to get the lap-band?

<Dr. Simpson> Well, Amy, there is in terms of the lap band which we have in the US does not fit all stomachs, and...

<Dr. Simpson> for some people who have a weight which puts their BMI over 60 they might consider the DS instead. Good luck.

<MODERATOR> BLAKE, YOU HAVE THE NEXT QUESTION.

<Blake-4wks-46lbs> Dr. Simpson, I have heard that we should expect to lose between 65-70% of excess weight based on charts. Would you say these estimates are conservative or actual results? And considering my massive first month weight loss, should I assume that I will be well within this range?

<Dr. Simpson> Blake, the weight loss will be more up to you than the operation, there are a lot of things you can do...

<Dr. Simpson> to decrease weight loss, you can eat a lot of carbohydrates, you can graze, you can ...

<Dr. Simpson> drink a lot of alcohol, or you can progressively stretch your pouch by putting more and more food into it...

<Dr. Simpson> in terms of the numbers, they are fairly standard, but there is a lot of variation in them and it is more up to

<Dr. Simpson> you than the operation. Good luck.

<Dr. Simpson> Keep walking.

<MODERATOR> ANGEL, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.

<angel> Hi im 3 weeks post op from the D/S.....when is a good time to start eating peanuts (for the protein), and fruit?...or should i avoid these altogether?

<Dr. Simpson> Fruit is high in carbohydrates, but it is low in glycemic index.

<Dr. Simpson> so fruit is something to be careful of. In terms of peanuts, see how your body reacts to them, they are a good snack and good protein source.

<angel> thanks!

<MODERATOR> DEBBIE BAILEY, YOU HAVE THE NEXT QUESTION.

<DEBBIE BAILEY> IS THE LAP BAND THE SAFEST

<Dr. Simpson> No, the lap band is not the safest. The lap band does have a high revision rate and...

<Dr. Simpson> the lap band is a good product, but does not work as well as the other weight loss surgeries....

<DEBBIE BAILEY> OH OK TY

<Dr. Simpson> it has some nice features. It has worked well for Ozzie's wife.

<DEBBIE BAILEY> SHE HAD THAT

<Dr. Simpson> Yes she did. So, if you get one have your husband get a recording contract.

<MODERATOR> SHEPP, YOU HAVE THE NEXT QUESTION.

<Shepp> Im 5'2 320lbs. what would be my ideal weight? I was told there is a 6 month waiting list. how can I speed this up?

<Dr. Simpson> Well Shepp, you cannot speed up the wait list, as there are a lot of people in front of you who have waited and they are just going to want you to not cut in line...

<Dr. Simpson> your ideal weight is going to be with a BMI of 19-25. So, in your case that would be about 110 pounds to 120 pounds, so good luck.

<MODERATOR> JOANNE G, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.

<JO Anne G> can you tell me anything aeot medi care

<Dr. Simpson> Well, Medicare is a program for those who are over 64 years old, and it does cover weight loss surgery, there are those who are under that age who get it...

<JO Anne G> how does the hospital get aapoval?

<Dr. Simpson> but, it will cover the surgery, in some areas. The hospital does not get approval for the surgery...

<Dr. Simpson> the surgeon gets the authorization and the approval.

<MODERATOR> WENDY, YOU HAVE THE NEXT QUESTION.

<Wendy> Can you drink too much water and Crystal Light, ect. would this defeat weight loss or add to hunger?

<Dr. Simpson> water does not add to hunger, however, if you have a RNY bypass the water will

<Dr. Simpson> bring the food out of the pouch and into the intestine, which is why we say to not eat food and drink...

<Dr. Simpson> for a while. No, water does not add to hunger, or inhibit weight loss. Water good.

<Dr. Simpson> donuts bad.

<Dr. Simpson> walking better

<MODERATOR> JO, YOU HAVE THE NEXT QUESTION.

<JO> What is they main type of surgery you perform? I got in late on the chat.

<Dr. Simpson> I mainly do the duodenal switch surgery,and there are only about 40 of us in the country who do it. I did the RNY for a number of years and ...

<Dr. Simpson> still offer it to my patients, although for me, the DS works well, and I like it for my patients.

<JO> Why

<Dr. Simpson> oh there are a lot of reasons, but it is something which is individual by surgeon, and there is no....

<Dr. Simpson> real answer to better or best, it really is the preference of the surgeon, and that is mine.

<JO> ty

<Dr. Simpson> I have a nice comparison chart on my website www.doctorsimpson.com

<MODERATOR> BLAKE, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.

<Blake-4wks-46lbs> Doctor Simpson, Once folks get beyond semi-solid diet, do you tend to recommend more of an Atkins diet approach or Zone type approach. (know that we need our 60 grams of protein in whatever diet) Just curious. Such a wide range of diets.

<Dr. Simpson> There are a lot of diets and a lot of approaches, and if those suit you then that is fine...

<Dr. Simpson> our goal is not to have you on a diet for the rest of your life, but to have you learn what is good to eat, and to know...

<Blake-4wks-46lbs> what do you recoomend for your patients

<Dr. Simpson> that there is no bad food, just bad quantities of food. We have a whole program for our patients...

<Dr. Simpson> where we put them on a limited carbohydrate diet, but we take into account the glycemic index of the...

<Dr. Simpson> carbohydrates, and given those we recommend they avoid certain ones until their BMI reaches a certain level. So, ours is a simple approach...

<Blake-4wks-46lbs> very good thank you..

<Dr. Simpson> early on we want them to eliminate carbohydrates to a large extent just so they can get the protein in...

<Dr. Simpson> but once they have had their stomach stretch a bit, then we liberalize it, and if they are ever...

<MODERATOR> ANGEL, YOU HAVE THE NEXT QUESTION.

<Angel> Hi Dr. Simpson, i hear hair loss is a problem post op...what can i do? Thanks for your time!

<Dr. Simpson> Hair loss is a problem for people only 30 per cent of the time...

<Dr. Simpson> so most of the time don't worry about it. But, for others I am reminded of what my friend said to me, "God made man in his own image,...

<Dr. Simpson> and for those who he did not, he gave them hair."

<Dr. Simpson> Of course I am quite bald, goes with the green teeth.

<MODERATOR> ANNEMARIE, YOU HAVE THE NEXT QUESTION.

<AnnaMarie> I had a DS done 18 months ago. It seems lately that my appetite has died back down to like it was right after surgery.. Is this normal?

<Dr. Simpson> Appetites change, and so that is to be expected for a while. If it continues, and you start...

<Dr. Simpson> to loose a bit of weight more than you like you should go back to your surgeon or your primary care physician.

<AnnaMarie> ha, i still have 100 pounds to go!

<MODERATOR> BLAKE, YOU HAVE THE NEXT QUESTION.

<Blake-4wks-46lbs> Dr. Simpson. IS stricture of the STOMA common with RNY? And does it tend to develop in the 3-4 week range?

<Dr. Simpson> Yes and yes. About ten per cent of people who have the RNY can and do develop a bit of a stricture...

<Dr. Simpson> and it takes two to four times of dilation to get it back open again, and it usually manifests itself early on...

<Dr. Simpson> rarely later, but there is always an exception to all rules.

<Blake-4wks-46lbs> GROAN....

<Dr. Simpson> Hey, vomiting is part of the super model diet-- speaking of motion pictures, so consider it a fashionable thing to do.

<MODERATOR> KATHY PREOP, YOU HAVE THE NEXT QUESTION.

<Kathy pre op> Dr..I started out at 290 pounds Jan. 7th ..today i weight 262..do Doctors ever say..well then lose the rest on your own?? I am due to go back to endo in June..then meet surgeon

<Dr. Simpson> I suggest vomiting in Tupperware like Chrsitina Ricci did. No, they do not say that, Kathy, and we expect once patients begin this journey...

<Dr. Simpson> that they will lose a bit, but remember, we do this surgery because it is a tool to help you lose it and keep it off...

<Dr. Simpson> as opposed to diet which is something that works not well by itself, but better with wls.

<Kathy pre op> Thank you

<MODERATOR> BEV, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.

<Bev> i am 56 yr old female, 385 #'s, with high blood pressure, diabetes, and sleep apnea,i am looking into the surgery. I am so afraid of the high blood pressure in surgery.heaid

<Dr. Simpson> hey, she use to hide the tupper ware in her closets. Nothing like keeping that stuff around. Don't worry about high blood pressure in surgery,...

<Dr. Simpson> the anesthesiologists have lots of good drugs to keep the blood pressure under control, so that won't be an issue...

<Dr. Simpson> and, I think you will do fine with the others too, and the weight loss will decrease apnea and...

<Bev> really, I am so afraid, but am afraid of living like i am now.

<Dr. Simpson> the load on your heart, so you won't have as much of a problem with the blood pressure...

<Dr. Simpson> yes, living like you are now isn't as good as living after weight loss surgery...

<Dr. Simpson> so, go take a walk, a deep breath, and call that surgeon.

<Dr. Simpson> Imagine a mom, where did that Tupperware go?

<Bev> Thank you, I appreciate your talking to me. Bev

<Dr. Simpson> then, most of us hide other things in closets, and here you find the tupper ware.

<MODERATOR> ANNEMARIE, YOU HAVE THE NEXT QUESTION.

<AnnaMarie> When should I conseder having skin reduction surgery. I started at 500, now at 289...18 months out.

<Dr. Simpson> AnnaMarie-- or AM, because clearly your parents thought you were a morning person...

<Dr. Simpson> when your weight stabilizes for several months that is the time to consider having the skin tucked and nipped.

<Dr. Simpson> or you could let Willard and the rats do it, but they are not as good as the plastic surgeons.

<AnnaMarie> ha, i just love you

<MODERATOR> KIM, YOU HAVE THE NEXT QUESTION.

<kim (ma)> Hi I was wondering if a person with sleep apena has greater risks when going under anesthesia?

<Dr. Simpson> Not undergoing anesthesia, that isn't a problem at all, in fact that is quite safe for sleep apnea...

<Dr. Simpson> the issue is after you wake up, because the pain medicine that you get does cause a depression in ...

<Dr. Simpson> the respiratory drive, so they may want to put you into an ICU to make certain that you breathe, and they will want to ...

<Dr. Simpson> follow you carefully for that. So, get up and walk a lot after surgery, it will do you a lot of good.

<kim (ma)> ok, I will, thank you!!!

<MODERATOR> ANGELA, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON.

<Dr. Simpson> Today is the one year anniversary of one of my patients who had severe apena, he weighed 433 lbs, and today, he is 199 lbs an no apnea and a

<Angela> I am deciding between BTC and two other dr's. What is the best way to determine which may be best without paying the consult fees for each dr? I have read several excellent reviews from former patients of all dr's. I am not concerned with in-network and out-of network status ($1500 difference)

<Dr. Simpson> has a new kid.

<Dr. Simpson> It is a matter of who meshes with you, and if they have a seminar you can attend where you get a glimpse of how they interact, that might help...

<Dr. Simpson> most doctors do great work, all have a few patients who are dissatisfied, those who have been doing it for a long time...Angela> so a dr with a good personality would be a benefit?? :)

<Dr. Simpson> will have some complications. The best doctor is the one who you will get a long with and the other thing..

<Dr. Simpson> is find the after care. Personality is a plus. Some of us have more personality than you need, and that is also an issue...

<Dr. Simpson> for example, some patient without a sense of humor should not be a patient of mine.

<Angela> lol-- thanks dr!

<MODERATOR> JEAN, YOU HAVE THE NEXT QUESTION.

<Jean> What happens long term? Like 20 to 25 yeard down the road..Health do people stay healthy? I was told people start getting sick years after the surgery is that true?

<Dr. Simpson> Jean, that is true with the older surgeries which are no longer done, such as the JI bypass, which has not been done since the 1980's....

<Dr. Simpson> in terms of this surgery, there is no evidence that there are long term problems or any long term complications...

<Dr. Simpson> except some get lead poisoning.

<Dr. Simpson> which happens when the new skinny partner gets lead from the gun of the jealous lover.

<Jean> why does that happen?

<Dr. Simpson> Jean, good straight man.

<Dr. Simpson> Vaudeville here we come.

<Jean> lol..thank I need to live to be a 100

<MODERATOR> BLAKE, YOU HAVE THE NEXT QUESTION...... ;-)

<Blake-4wks-46lbs> Dr simpson. You mentioned the drugs they use to put you under. How long after the surgery does the anesthesia stay in the system. I have heard up to 3-4 weeks. And is it responsible for all the bizzare hallucinations, or is that the morphine?

<Dr. Simpson> No Blake, that is from the early years of abuse with the LSD, and getting flashbacks...

<Dr. Simpson> we measure the gases of the anesthesia, and they leave and are breathed out of the system...

<Blake-4wks-46lbs> But seriously folks

<Dr. Simpson> fairly rapidly, and the morphine and other drugs go out within a day or so...

<Dr. Simpson> the metabolic effects of anesthesia last for a b it, however, you have to remember, the more you walk...

<Dr. Simpson> the faster you get better, the more you increase your metabolism and breathe well,

<Dr. Simpson> the better and faster you will recover, and the more you interrupt me,

<Dr. Simpson> the longer it takes to get your surgery.

<MODERATOR> DEB, YOU HAVE THE NEXT QUESTION.

<Deb> Dr. Simpson, is there any truth to what I heard, that laprascopic surgery doesnt last as long as open surgery?

<Dr. Simpson> No truth to that at all.

<Deb> do you prefer one over the other

<Dr. Simpson> Yes, I prefer the one that your surgeon does.

<Deb> lol

<MODERATOR> SHEPP, YOU HAVE THE LAST QUESTION FOR DR. SIMPSON.

<Shepp> How long does it take to do the surgery

<Dr. Simpson> Well, the surgery itself takes two hours or so, it depends, some longer some less, but it is not a race....

<Dr. Simpson> you want a surgeon who is good, careful, and if they take a bit of extra time, I would rather have that than have something left undone, or whatever...

<Dr. Simpson> so, give me a slow meticulous surgeon over one who brags about how fast he or she is...

<Shepp> Thanks Dr.

<Dr. Simpson> although most of us who have done this for a while are pretty good at it. and pretty fast.

<TAMMY> THANK YOU DR. SIMPSON, THANK YOU MEMBERS! PLEASE VISIT DR. SIMPSON AT WWW.ARIZONABARIATRICCENTER.COM!

<MODERATOR> THANK YOU FOR JOINING US, DR. SIMPSON.

<Dr. Simpson> www.doctorsimpson.com

<Dr. Simpson> night all

<Dr. Simpson> sleep well

<Dr. Simpson> water, walk, protein.