March 25, 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> Thank you for your patience. I am actually doing this from the operating room lounge where I have a small bit of work to do between here and there.

<VIKKI> my question is: is there a published mortality rate on the Lap Band?

<Dr. Simpson> There is. It is about one in two thousand to one in ten thousand. It is quite a bit safer than the other operations available.

<Irene> it's the one about the ds and leaving my common channel longer.

<Dr. Simpson> Your common channel is something that the surgeon will determine. We have a set routine and it is not always possible to change that, nor should you think about changing that. That would not be a DS, it would be something else, and we would not always know what the results would be. If your surgeon does one thing the same way, they probably do a good job with it. If you don't want the malabsorption, consider a partial DS or another operation.

<Christine Prieur> Will I be able to take my anti-depressant & anti-psychotic post-op?

<Dr. Simpson> You may have to crush them, and different surgeons have different routines. Before the surgery see your surgeon about that, and go through your medications. Sometimes you have to change a long-acting medicine to several doses of short acting, as the long acting may not absorb as well. Good luck.

<rhonda> I am platueing how can i break through this ?

<Dr. Simpson> Walk, walk, walk, and more walking. You also need to keep track of what you eat, and how much and the caloric content. Do not skip meals, and plan snacks, if you need them -- to be nutritious and not calorie rich.

<vickie> Does everyone get an abodominal hernia? and what precipitates this ?

<Dr. Simpson> 22 percent get them, and it happens because the fascia is weakened by surgery. And combine that with some protein calorie malnutrition after the operation and you have a set up for a hernia. We recommend no lifting over 14 lbs for six months to a year, for malabsorptive procedures; six weeks only for lap band. But hernias do occur, and they need to be fixed.

<Natasha> In your experience - have you seen many patients who have an elevation in their liver function tests either rom the surgery or rapid weight loss? Is this a common occurrence? Thankyou!

<Dr. Simpson> That is a complex question, more than you can imagine. Some liver function tests, such as alkaline phosphates, may indicate other things going on. So, it depends on which enzymes. If they go up, often it might be related to some protein calorie malnutrition. So that has to be watched. It is something that we need to know a bit more about and in the context of other labs to make certain you are healthy.

<Joe V> How would I know if the connection from the new pouch to the intestine has been stretched?

<Dr. Simpson> With endoscopy you can look at it, or you can get an upper GI test. Otherwise, we guess that might happen if you can eat a lot.

<tess> Why do some patients have Lap RNY while others have the Open RNY...what should determine which procedure you should have?

<Dr. Simpson> The surgeon will. What they are comfortable with...some of us do just open, and some of us do just lap, and some of us do a bit of both. Whatever we are most comfortable with is what we will do.

<mark> what is the long turn effect of this type of surgery 15 years etc?

<Dr. Simpson> There are no great studies that show that, there are about obesity. So it is a good question, and we really don't have a great answer for you. Although many of us who have been doing this for a while. Have long term patients who are alive, well and thin and some who are alive well and not so thin. Those who don't follow up with surgeons and become malnourished or vitamin deficient are not in such great shape.

<les> Why do some people gain the weight back??

<Dr. Simpson> There are technical failures of the operation. There are failures of patients. Poor choices of foods, fast foods, alcohol are the predominant ones for patients. Enlarged stomas or pouches are the technical things that we can fix. The line is that successful patients do both a lifestyle change and have surgery, and do well and if there is a technical reason a surgery will fail, then we get to operate again.

<Robin L> I'd like to know about the least invasive bariatric surgery

<Dr. Simpson> lap band

<paula> i am having this operstion in two weeks, open what should i expect ?

<Dr. Simpson> You can expect four days in the hospital. You can expect about three months before you feel like your old self, but much thinner, and you can expect a few months where foods will taste different, and you will need to learn to eat differently, and possibly read my book in order to learn the rest.

<RUSS> how much weight are you able to lose with the lapband, what is the time frame for the weight loss and how hard is it to remove when satisfied with results and maintenance?

<Dr. Simpson> First, you can lose as much as you want with the lap band, and the weight loss is probably the most sustained of any of the weight loss operations because patients have to change lifestyle. Whereas some other operations patients like the honeymoon phase and don't change their habits. Anyway, in terms of taking it out-- we do not recommend that because then you have the same biology that got you there. That is, a stomach that doesn't suppress appetite too well. Weight loss surgery is a tool, and it is not something that is an end in itself. There is no operation that will allow you to eat what you want, and still lose weight. All of them, to get to your goal, take some work, and they all work just fine. The lap band, however, takes longer simply because weight loss doesn't usually start at the time of surgery as much as it starts six weeks later when the first fill is done -- so the lap band frequently lags behind other operations in the first year but by year three the studies are pretty convincing that it catches and passes others.

<betty rashann> is there anything that I can do to help improve my chances of having less sagging skin- ie- take supplements, drink loads of water etc...

<Dr. Simpson> No, there is not -- Nothing you can take. But the more exercise you do, and replace that fat with muscle, the better off you will be. So start working out, and build some great muscle mass.

<Jan Torres> After one year will you need your gallbladder removed?

<Dr. Simpson> Probably not, depending on the operation. You probably will not need to have it gone. Some do, some do not. We have some medication that will help with that.

<Jamie> how many calories should someone a year out or more have?

<Dr. Simpson> It depends on your objective. If you want to lose weight, then you need less than your basal metabolic rate. If you want to maintain, then you maintain at the BMR. You can eat a huge number of calories with any operation, or you can choose a sensible nutritious food and that is the joy of the operation -- it is about choice. Do those nachos mean more to you than weight loss? This is why we wrote our workbook for patients to learn what their basal metabolic rate is and calculate those things. "Getting to Goal and Staying There: Lessons learned from successful patients." Available from our website now, and Amazon in a few weeks, also obesityhelp.com bookstore sometime soon.

<cass-DS-4yrsPO> hi Dr. Simpson, I am four years post op and still waiting for all my labs to come back. Ferritin is still missing but iron is slightly low. 48 normal is 60+ what kind of iron is best to boost my levels?

<Dr. Simpson> Various irons have various absorptions, and different things can inhibit them. For example, tea can inhibit iron absorption, as can calcium. There are a variety of them out there, and the over the counter stuff works well. So that is one choice. Try one of them, and if your iron isn't moving in the right direction, you may need a prescription or a different type.

<amber> what vitamins do I need to be taking?

<Dr. Simpson> A simple multivitamin daily as a minimum, and from there you might need to add things depending on the operation that you have. Your levels of vitamins, and other things, like blood count, need to be checked. It is easier to prevent a problem then it is to fix one.

<trotter> why would someone have to use the bathroom so much after surgery, is that normal?

<Dr. Simpson> Because they become teenagers, and have to fix hair and makeup. Some patients who have a malabsorptive component of their surgery will eat things that will not digest, and they will have loose stools and there are many more reasons, most of which we can help with, if given a chance. So check with your surgeon and keep track of what you eat.

<mary> when is a patient considered a success?

<Dr. Simpson> When the patient is happy with their weight loss, and I consider it a success when their BMI is between 20 and 24.

<barb> Hello. I am 24 months post op and I am finding myself having no energy and very dizzy every time I stand up. Could I be lacking Iron?

<Dr. Simpson> You could be lacking any one of a number of things, and it means you need to have some labs drawn and checked by your doctor ASAP -- if not sooner. You could have anemia, you could have protein deficiency, you could have teenagers. Lots of reasons to be tired.

<Kris> Is there any cream that can be used to make the scar smaller (I had an open RNY)

<Dr. Simpson> Ice cream, oh -- that will stretch it. No, there is not, although people will sell you anything to get it smaller. Over time, the scar remodels and will become smaller. You can always have the scar revised after weight is lost, and it will heal better then.

<jess> Do WSLers ever get to eat "normal" foods again? Can we not have a treat here and there ever?

<Dr. Simpson> If normal is considered to be what was eaten before surgery, then the answer is NO -- what got you there once will get you there again. Smaller portions are ok, and can be used and eaten, but again, being aware of what you are eating and how much is a key to weight loss and to maintaining it.

<Randie> I have not lost much, only 34 or so in 6 weeks, is this normal or has this failed me?

<Dr. Simpson> I would love to lose 34 lbs in six weeks, and I will be that...before surgery you would have also. So be happy -- walk more, and eat nutritious food. Get a haircut.

<barry> how long after surgery can we have sex?

<Dr. Simpson> A minute, oh -- when you comfortable.

<lapbander> Dr. Simpson do you have any experience with the lap band ?

<Dr. Simpson> Yes

<Kenneth> have you ever had a patient get C. difficile after surgery? Did it take them long to get over it?

<Dr. Simpson> Yes, often that has occurred and sometimes it takes a few courses of treatment to get them over it. It is a pesky little bug.

<cass-DS-4yrsPO> Dr. Simpson-I've just been diagnosed with hyperthyroidism on my 4 year labs- could this be caused by my DS? and any suggestions on treatment?

<Dr. Simpson> It is not caused by the DS, and there is some good treatment for it --- that is why god made endocrinologists.

<Jack> Hello Dr. Simpson. I am scheduled to have the surgery on May 19th. I was wondering what your experience and understanding of patients with hypothalamic-pituitary axis dysfunction is when having gastric bypass

<Dr. Simpson> They need to have the hormones replaced, and it is not too complicated. Simple as that. Levels checked, replaced, and checked again.

<lapbander> I am not sure if I get a saline fill if will be okay . My Pa said that if I could eat a 6 inch sub that I was ready for one. Last night I eat three pieces of pizza . Today I was only able to eat half a sub.

<Dr. Simpson> Why on earth, if you want to lose weight, would you eat pizza -- which is basically lard-topped processed carbohydrates? That is about the last thing you need to be eating. I mean let's be realistic here -- you are either serious about weight loss or not. If you are serious, then eat nutritious foods, and if you eat some protein, like turkey or chicken, and it doesn't keep you filled then you can get a fill. But if you want to eat processed foods filled with lard, well -- weight just won't come off like you want it. So ask yourself -- do I want to lose weight, or eat pizza -- cause you cannot have them both.

<Joe V> Is there a self test to check if the connection between the pouch and intestines has been expanded?

<Dr. Simpson> Endoscopy from a GI doctor.

<Lynn L.> I am getting a pain at the top if my incession I am 29 days out

<Dr. Simpson> You should see your surgeon to see what is going on...could be a number of things, but see someone to make certain all is ok and that you're not getting a hernia, or an infection, or halitosis.

<Jack> Im on a testosterone replacement therapy - will i still need this post-gastric bypass?

<Dr. Simpson> Yes. Bypass does not replace testosterone, although you may be able to see where it comes from easier. You may require less, however.

<Christy> Dr. Simpson, I have psorasis that is getting worse. I'm nearly 4 years out and weight 108 lbs. Would it be safe for me to start getting the new shots that help with that? Also, I have next to no desire for sex. My husband thinks I'm having an affair. Is this a result of the surgery:?

<Dr. Simpson> Affairs are not the result of surgery. You can get shots for your psoriasis and sexual desire is a funny thing -- which is out of my range of expertise. Good luck.

<Janet> I know everyone swears by a certain vitamin, shampoo, etc. Do you know what is the best thing to use to prevent or slow down hair loss?

<Dr. Simpson> It will not prevent or slow down hair loss, but it is expensive, and if you have some extra money. Then buy a good book, cause in a few months the hair will come back richer and fuller and do I have some good books for you!

<pip> How much weight can one exepect to loose with first stage sleeve gast (DS) I have about 150 pounds to loose in total?

<Dr. Simpson> You can lose it all, but it is up to you. Still takes work, like making good food choices, and some exercise and avoiding things like the stuff I eat.

<Christine Prieur> Should I be concerned that my preferred surgeon is going to be an eight hour drive away from home and in another country?

<Dr. Simpson> Yes, because how will you get back to them if you need them? This is the reason that some of us do not take out of state patients.

<penny> I'm a type 1 diabetic and about 125 overweight is it safe for me to have surgery?

<Dr. Simpson> It is quite safe for you to have the surgery and your insulin requirements will decrease a bit. So go for it.

<Gerry> If you have had cholecystectomy in the past, would that preclude lap RNY?

<Dr. Simpson> Not at all -- just means one less thing to do.

<abby> do your patients go on any special diet pre surgery?

<Dr. Simpson> Mine do not, unless I know of an issue with them, or if they have gained weight before the operation. If they have known fatty liver, we put them on a special diet -- like my doggies -- Science Diet (actually that stuff is more expensive than Porterhouse).

<M.J...E> I have always had a sinus drainage issue - is this going to be a problem post surgery with the new pouch? I'm having open RNY in two weeks.

<Dr. Simpson> The small pouch will fill up with snot -- so get a spitoon.

<jonitta> what about taking the birth control pill after surgery will i be able to swallow it in the first 2 wks

<Dr. Simpson> Are you talking about birth control pills? Depends on your operation -- most of us do not want those on board when we do the surgery and prefer you be on mechanical birth control after surgery, as the hormones may increase the risk of Deep Venous Thrombosis -- blood clots

<erin> hey doc.. this past week I was in the hospital with massive pains in my lower right and left sides just under the ribs, the pain is in waves, they did cat scans, upper and lower GI series, barium swallows and radioactive iodine IV, barium enema, infultrated 6 veins and still have no clue whats wrong with me.. I am 15 months lap post rny, pains are still here, on vicodin and demeral for pain and now fever has set in.. any clue as to what this maybe or why its happening...

<Dr. Simpson> Not a clue. I am sorry you are having a problem, and hope that you feel better. I would suggest they do a spiral CT scan of the chest -- to rule out a pulmonary embolism, and check your heart. Good luck

<Debbie> how do you feel about Drs doing revision surgery?

<Dr. Simpson> I do revision surgery often, but it is for specific indications. We do not do revision surgery if the patient has a working weight loss operation and isn't losing the weight, but for technical issues with the original operation, that is what we do it for.

<down91> A patient isn't a success with a bmi over 24?

<Dr. Simpson> No, that is a bit simplified -- but it was my definition of success. I think all can get to a BMI under 24, and it is a healthy place to get, but it is some work. Clearly people who lose 450 lbs, like my son, are a success -- but he has another ten pounds to lose - then we go to the amusement park for his reward.

<happytrucker280> Have you ahd any trucker's as patients? If so, did they do well, even though we have a sedentary lifestyle?

<Dr. Simpson> I think most of my patients have a sedentary lifestyle, and I have had truckers as patients. One of my deals is this-- they have to exercise, and somehow it does become a priority and they do that, as with all the rest of my patients.

<g> Hi Dr.Simpson - I have an ulcerated ankle and endema in my right leg - would that prevent me from having surgery right away.

<Dr. Simpson> If the ankle is infected, it will. Otherwise, probably not. Better safe than sorry.

<Moderator> Last question goes to...

<Amanda> I am considering RNY, In '96 I had ovarian cancer at the age of 28. I have had a total of 4 surgeries ending with a total hysterectomy, and I have been told and know that I had adhesions. Is there any chance of being turned down for WLS because of adhesion buildup, if not turned down, would there be more chances of complications?

<Dr. Simpson> No chance about being turned down for adhesions -- none at all, at least with a good surgeon. So, go for it, and glad to see you are over that nasty stuff and can move on with life.

<Moderator> Dr. Terry Simpson, Arizona Bariatric Center. Website: http://www.drsimpson.com/. Phone: 602-234-8995. Fax: 602-230-8344. Books available at www.obesitydr.com.

<Dr. Simpson> Thank you all for your patience, and hope to see you next week.

<Moderator> 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.

<Dr. Simpson> Good Friday everyone.