March 18, 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!

<HOLLYMARIE> WHICH SURGERY DO YOU LOSE MORE WEIGHT LAP BAND OR OPEN RNY?

<Dr. Simpson> You can lose as much as you want with either surgery. To think it is the surgery is silly, it is the person, it is what calories they eat, it is not the surgery. Simple as that.

<troy> Dr Simpson im 4 months postop lost 70 pounds so far I was 400 pounds, how much protein should i be getting in at this stage? thank you Sir.

<Dr. Simpson> That depends on the surgery you had, how much bypassed, and how tall you are. There is a nice chart about that in the appendix of my first book... "Weight Loss Surgery: A Lighter Look At A Heavy Subject"... which is available from the obesityhelp.com bookstore or my website at www.obesitydr.com.... and you will find that and much more useful information.

<ANN DS @40LBS> i just had a duodenal switch and my husband and i like to party ,can i still drink wine with my DS??????

<Dr. Simpson> You can drink wine with any of the operations, but you will absorb all the calories from the alcohol so be careful. All alcohol has calories, and they absorb so well with any of the wls. So you have to decide if you want to get fat from alcohol, or if you want to be serious about your weight loss...simple choice -- all yours.

<Lovely> Is Laprascopic surgery as effective as open?

<Dr. Simpson> Yes it is. It is just as fine, works just as well... fewer scars, less problems.... go for it. Good luck.

<carolyn faye> What makes the rny not make me dump off sugar so far. Had surgery 01/11/05 Thought the surgery was designed to make the body dump off of sugars and fats?

<Dr. Simpson> Not everyone dumps sugars, and certainly there is no dumping of fats.. It is not designed to dump, it is designed to make you eat less---- it is up to you what you want to eat, it is up to you what you put in your mouth... sad as it might seem, weight loss surgery works best when you are involved in it... it is a lifestyle change as well as a restriction in the amount you can eat... you do not need to dump to not eat sugar... if you think you need negative feedback then hook up electrical leads to yourself and buzz every time you do something bad... better than that, however, is to make good choices about what you eat. Remember, it isn't a diet -- that is long gone. Weight loss surgery allows you to feel full with less and you can make better choices with that. You should not depend on the operation to provide you with some biofeedback. And I really get upset -- not at you, or any patient -- but I get upset at programs that say this is the advantage of RNY, because forty per cent of people will NEVER dump, and the rest who do can overcome most of it with time... alas, if only pre ops would read my book, they would learn all of that and more in 400 pages. So, please -- make good choices -- not that you always will, because we are human, but... you put yourself through this, and it is up to you what you do with it. Like any tool, it has to be used.

<Melanie> Dr. can you tell me what you consider to be a successful wls patient? Someone who loses all their weigh and gets to goal or someone who loses the majority of their weight?

<Dr. Simpson> What I consider success is when I have a Friday afternoon off and can do chats. We ask our patients to set a goal, and we make that goal to be between a BMI of 20 and 24... some are "ok" with less, but if you are ok with less the chances of getting less is not too much... so, success is in the eyes of the patient -- but our goal is to get to a normal BMI. All my patients are my heroes. They are all a success if they bring me their cookies and ice cream. Burrp.

<Deb B> My doctor has done 1500 gastric bypasses. He has had 7 deaths is this considered a good track record?

<Dr. Simpson> Not for those seven. Once again, we have someone who is a "counter" and that means little. There are surgeons who have done a lot but done them poorly, and some surgeons who have done few who are great surgeons... you have to feel comfortable with the surgeon. You have to feel like they care about you and not that you are a number. I always worry when doctors count-- because again, as a patient, there is one of you... so if you are taken well care of by your surgeon, and they care about you, then you have a good doctor, and go with it.

<Rissa> I am about 85 lbs overweight. I really need to have surgery, but I am being told I don't qualify. Do I have any other options?

<Dr. Simpson> You can pay for the surgery yourself, because, sometimes insurance companies have stricter standards than are needed... if you are 85 lbs overweight and are four foot it is one thing, if you are seven foot it is another... but if the insurance company says you do not qualify, and you feel as if you need the surgery, you may find a surgeon who will agree and you will be able to get surgery, although you will have to pay for it.

<Tami> How soon after surgery can I resume normal exercise?

<Dr. Simpson> You mean you exercise now? Here is the simple thing: you can walk the day of surgery, and you can walk miles and miles, and that is how to start.... with regard to lifting weights, your surgeon will have a specific time period for that. But start out walking-- that is the best -- or walk in a pool.

<Deb B> I have a lot of heartburn latley is this something the doctor should know about? I think alot of it is just wht type of food i have eaten.

<Dr. Simpson> That is a difficult question, but here are a few simple things...If you overeat you will get reflux.... but if you are having a lot of it you should have reflux evaluated by a physician, probably a GI doctor who wants to scope you because reflux can cause damage to the esophagus, and we do not want that. So get that evaluated. There are a lot of reasons for that to happen, and if you are doing the simple things, then it is time to see the professional and get it evaluated.

<Rhonda> 5 yrs post op. My weight is starting to increase. I know that it is due to the fact I am craving more carbs and getting less exercise. What is the best advice you can give someone who is fighting this battle? They were so right when they said this is not brain surgery

<Dr. Simpson> Not all carbs are bad, and certainly successful patients do exercise.... vegetables are carbs, and they are just fine-- eat some green leafy ones.... forget processed foods, start to exercise. We just finished a workbook called "Getting to Goal and Staying There: Lessons Learned from Successful Patients," where we outline and work through, with the reader, the tools to make you a success. The workbook is only available, currently, from www.obesitydr.com.

<carolyn faye> When I eat very minimum calories I dint see any weightloss. If I add more calories the lbs come off /2 mths postop. Does this mean that if I continually add xtra calories within reason of couse i will lose weight faster?

<Dr. Simpson> No, that is just backwards... calories are measured perfectly by your body, and they don't come off the minute you starve yourself. If you eat more calories you will gain more weight, it really is that simple. If you eat less you might go into a starvation mode and they might come off a bit slower, because your metabolism slows, but that is the benefit of exercise. Exercise will increase your metabolism, faster than any pill, and safer. So eat less, move more.

<Deb B> What do they do to make sure that there is no leakage before you go home from the hospital. What are the warning sighns of a serious problem?

<Dr. Simpson> Check the radiator hoses, and watch the fluid level.... that you do not have a leak one minute does not mean you won't have one the next-- that is a simple truth about the gut, and even though we can do a "leak test" that is not assurance that one won't happen. The warning signs we tell patients are the ones you already know....all the things that would bring you back to your doctor, like a high temperature...all, of course, outlined in the first book.

<sandy> What types of vitamins are we to take after surgery? and for how long? thank you Dr Simpson

<Dr. Simpson> You will take vitamins for the rest of your life....Forever and ever...halalujah. Any good multivitamin will work just fine, but make certain you are having your blood tested by someone to make certain you are absorbing them. Good luck.

<Deb B> I do not eat any dairy products or fish products. What will i be able to take to make sure i get enough calcium, iron and protien?

<Dr. Simpson> What do you take now? There are plenty of calcium pills in the world...there are plenty of iron pills...protein comes in many forms...and what I would suggest is green leafy vegetables galore, lots of good meat, like elk, for iron, spinach -- ask Popeye...and go from there.

<Fanny> My 18 yr old daughter wants to have surgery. I am unsure about granting her permission. She is 5' 1 and weighs 245 lbs, with no significant health probs. However, I know that will change. What can you tell me that will help me make my decision?

<Dr. Simpson> Well, that is always difficult to think about for your daughter....but there are a lot of programs that deal with teenagers, such as ours in Arizona, and there are others. You should visit one of those and talk to the surgeon about it...in the meantime your daughter needs to begin an exercise program, a serious one, because we do not allow our teenage patients to have surgery without a documented exercise program. And they must learn about nutrition...if they want surgery, but are not willing to give up fast food, then we save them the operation. So, learn about nutrition, begin an exercise program, and the chances are she will need surgery, but the lap band is a great surgery for teenagers. It is safe and reversible. But you do need to have her start with that...again -- if they eat fast food, they are not serious about weight loss. Surgery is more than buying a puppy and promising to walk it. It is about making good, healthy choices and a healthy lifestyle, which is why many of us will not operate on people who smoke.

<Deb B> what can we do to help with getting a blockage?

<Dr. Simpson> Most people I know don't want a blockage, but I suppose a large enough cork placed appropriately would work. To prevent one, however, there is nothing to do at all.

<sassygirl> Hi, my pcp has refered me to a WL surgeon, and my insurance is only covered @ the hospital he attends, but he only does 1 typr of surgery. He does the RNY, and thats not the type that I want. what do you think right now is the best and safest method right now for bariatric surgery

<Dr. Simpson> It is your body, and you should first begin by talking to him about the surgery and your reservations about it. If you are serious about wanting something else, then chances are you will have to pay for it or have the insurance company appeal process work for a while. And if you pay for surgery, chances are you can get what you want, although not always where you want. I had one lady become upset at me because she was a "self pay" and I said no to what she wanted, but she simply was not ready willing or able for what she wanted. But I am certain she will find someone who will operate on her for the cash, but hopefully the next surgeon will tell her the same thing....Besides that, if you are healthy, have reasonable expectations about the surgery, you can probably pay for what you want and get that, but until then, talk to the surgeon about the RNY, and your reservations--- and even though you have an idea about what you want, let that go for a bit, and see if that surgeon can help with your concerns.

<Teresa> I am scheduled to have the Rouen-Y procedure done in May. My starting weight is 340 pounds and I'm 5'6 how fast and how much can I expect to lose?

<Dr. Simpson> You can expect to lose based on your BMR and based on what you will eat, and how much activity you will do. Without knowing that, it is impossible to predict what you will lose. But, if you get our Goal book, you can figure that out, especially if you calculate what you will be eating, and an appropriate activity level. Good luck.

<MaryO> I have had the required upper abdominal ultrasound. In the results they have found echogenic foci, which I believe is gallstones. Will my surgeon want to remove my gallbladder? If not will the stones disipate with improved eating habits?

<Dr. Simpson> The stones will be there until the surgeon removes the gallbladder. They will not go away...so get rid of it.

<Deb B> if you get the dumping syndrom does this mean you have it for the rest of your life?

<Dr. Simpson> Sometimes you will have it, and sometimes you will not have it....sometimes it gets better, and sometimes it gets worse to where you will not tolerate the smallest simple carbohydrate....hard to predict. The beauty of science.

<Tammie> I have moved to a different state and I am looking for a doctor. I am 6 mounth post op and the doctor that I have an appointment with is not listed on any site that I have found. Should I find someone else to see?

<Dr. Simpson> Not being listed on a site means absolutely NOTHING. So if they are listed, great, if not, don't worry -- you can always find out about that person, and you can go talk to them, and interview them...and if they know what they are doing, great-- if not, then get them my first book so they can learn about the surgery and how to take care of you.

<FATEinWI> Do you recommend your post op patients eat fresh fruits and pasta at all, or just foods high in protien? Thank you

<Dr. Simpson> I recommend my patients have a balanced diet. Pasta is not a good choice; fruits are good, vegetables are better....and just foods high in protein is not needed. You need a certain bit of protein, and you need to calculate that.

<20DaysOut> How long after a lap RNY should you wait to have sex?

<Dr. Simpson> 17 years. You can have sex when you feel comfortable and have a willing partner....I have had patients have sex in the hospital...Just remember BIRTH CONTROL--- we do not want patients to get pregnant for a couple of years. Mechanical forms of birth control work well.

<Shawna> How long is the scar for Open Gastric By-pass usually??

<Dr. Simpson> Reminds me of a story...A Texas fellow started a business where he bred those little weiner dogs -- so he decided on a name for his business...."Get a loooooong little doggie." (you have to say it with a Texas accent). Six inches or less, sometimes more if there is more work to do.

<baby> Do you see patients who have already had RNY elsewhere and due to insurance change needs a good dr for followup?

<Dr. Simpson> Most of us who do weight loss surgery want to see our patients for LIFE...for LIFE...whether insurance changes or not. It is simple as that...and if your surgeon doesn't want to see you, then I suggest that you find a different surgeon. Sometimes you have to pay for it, but you need to pay for healthcare anyway. Some move away from their surgeons, and some surgeons move away. But if you know what you need, then you can have a PCP do the lab work, but if you do move somewhere, keep the bariatric surgeon's phone number handy in case you have a problem. Good luck

<Brika(researching)> Will I be able to successfully breastfeed another baby if we concieve after the surgery?

<Dr. Simpson> I hope so. There is no reason why not.

<Kim in Jax> vbg or RNY ? which do you prefer?

<Dr. Simpson> I prefer whatever your surgeon does, does well, and does comfortably.

<Brika(researching)> How long after surgery before I can try to concieve?

<Dr. Simpson> Two years.

<Mandy> I had my DS 18 months ago and have lost 245lbs. My goal weight is 165. I am at 175, but during my plastics consultation they told me I have about 12lbs of skin. Does this mean I should start trying to maintain instead of continuing to lose?

<Dr. Simpson> Mandy you need to do some work. You need to figure out what your basal metabolic rate is, you need to have some exercise going on, and you need to determine what you are eating, and how many calories you are eating, and from there you can determine what and where you should be...all of course, nicely spelled out in our workbook -- and sometimes these topics are in our free newsletter, which you can sign up for at our website... www.drsimpson.com or www.obesitydr.com,

<Andrea> I have multiple Sclerosis and want to know would this be problamatic during or after surgery?

<Dr. Simpson> I hope not. I have operated on patients with MS before, without difficulty. Good luck.

<ANN DS@40LBS> hi doctor i just had duodenal switch,summers comming and my husband and i love to party,can i drink wine with my DS?????

<Dr. Simpson> We answered that as the first question of the night. Simply put, alcohol has calories in it, and you will absorb all of those calories...wine, beer, vodka...doesn't matter if it is high carb or low carb....alcohol contains calories, and you will absorb them. So if you want to lose weight, you want to minimize calories...if you drink, then calculate the calories you are drinking and work them off with exercise. Or don't drink.

<Andrea> Hair Loss, What causes it? Is it lack of protien?

<Dr. Simpson> Lack of protein, zinc, or some vitamins can make hair loss worse. But hair loss happens to thirty per cent of patients and is due to the hair follicles resetting themselves, which means at three months or four months post op. You will have them regrow a few months later. Superglue works.

<tamara11do&-11lbs> i had lap vbg since my doc took out my gallbladder will i be able to eat spicy foods

<Dr. Simpson> Yes.

<bear> im 6' 2" 295lbs how do i know if i'll have excees skin after wls

<Dr. Simpson> Once you have lost the weight, you will see if there is excess skin. If there is, then you will see it.

<Sue> What is the difference in a Proximal RNY and a Distal RNY and what are the benefits of one over the other?

<Dr. Simpson> It depends on how much is bypassed, and there are a lot of good drawings about this in my book. Benefits depend on a few things such as if your calories come from fat. However, if your calories come from processed foods, then proximal or distal won't matter at all. It is the restrictive component of surgery that is the important part, not the bypass part of the intestine.

<Teresa> I have heard that infection and blood clots can be a problem with WLS. How common is it for patients to get these? Thank you.

<Dr. Simpson> Infection can happen in ten per cent, although most of those are simple and small. Blood clots are the most common cause of death, as they can break loose and go to the lung... and for the one in two hundred who die, this is the main cause of death. So walk a lot after surgery.

<Moderator> Last question of the night goes to...

<April> I had gbs on 1/24 and had to have my spleen removed, what does that mean to me as far as getting sick or being around sick people?

<Dr. Simpson> You don't need your spleen after about 18 years old and you won't need it, so don't worry about it. You can be around sick people, you won't get more sick more often, but you will need to get a pneumovax vaccination. Good luck

<Dr. Simpson> Thank you all.

<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. We enjoy your chats every week. We all thank you and have a great weekend. Thank you all for coming. Have a good night everyone.