April 02, 2004

<**MODERATOR**> Welcome to tonights surgeon chat with 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

<**MODERATOR**> Welcome Dr Simpson.

<Lissy> What are the risks of gastric bypass surgery?

<Dr. Simpson> The risks of bypass surgery are that you will lose weight and become so sexy that you will be unable to hold off men (or women) with a stick and will need a gun, therefore will be in trouble with the law, but not Charleton Heston....seriously, the risks of surgery are the risks of all surgery: anywhere from wound infections, to death and a few things in-between. It is a real issue, and there are real risks, they are not to be minimized... especially Mr. Heston.

<dadude4> how long until you can eat solid food after gastric bypass surgery

<Dr. Simpson> That depends on the surgery you have and the protocol of your surgeon. If you have a lap band it will be a couple of weeks, and if it is a DS might be in a few days or if you are vomiting, you will be on clears for a while. Go slow, this isn't a race, this is a time to let your stomach get use to its new anatomy, it has been cut, mutilated, spindled, and a few other things, so it will be in more of a rebellious state than your average pre-teenage undergoing PMS for the first time.

<desperate> Hi 29f toronto here....desperate to know how I can get Canadian healthcare to pay for surgery in The U.S.? I am at the end of my rope.

<Dr. Simpson> You cannot, it will not happen and if you are at the end of the rope, save your pennies, and come on down. Although you need more Canadian pennies than American ones. Plus yours don't work in our vending machines-- so change them in at the border.

<Barb> What are the factors that allow for insurance to cover the surgery?

<Dr. Simpson> First is whether the insurance company has an exclusion to weight loss surgery or not... some do, and some do not. Then the criteria are that you must have a BMI of 35 with comorbidities, which include heart disease, hypertension, diabetes, and joint disease, as well as sleep apnea, -- or bmi of 40 without all of those things. Some insurance companies will require you to have SIX MONTHS of a physician... 'supervised diet-- that means more than your primary care doctor saying you have to lose weight... that means you have to have a SUPERVISED diet , with weigh ins and all that jazz, so read your policy and start working with your family doctor. Good luck.

<kathleen g> Dr. Simpson> First, I would like to thank you for sharing your valuable time and expertise with us. It is such a treat to participate in your Friday night chats. As an open RNY post-op (5weeks) when can I look forward to getting in all of my protein? It is so difficult to eat as much as it takes each day. Thanks.

<Dr. Simpson> That is the struggle that all patients face who have weight loss surgery.... early on it is to get he protein in, and you must keep at it.... do not give up--- protein is essential, and the faster you get it in, the better you will feel and... the faster you will heal, and the better I will like it, because the more meat you buy... the less expensive my steak becomes, and I like steak.

<Linda Combs> I am very nervous about the surgery due to the risk of major problems and death. Approximately how long after the surgery will I be "out of the woods" as far as a chance for major infection, pulmonary embolism, or death?

<Dr. Simpson> You will probably die sometime in the next 70 years, so that is the outer limits of that one.... in terms of the others, you cannot say that for certain, but you can say a few things.... WALK, WALK, WALK, WALK, AND WHEN YOU ARE DONE WALKING\] WALK SOME MORE. That will prevent a lot of the problems.

<Nancy> Do you do gastric banding?

<Dr. Simpson> I do the adjustable lap band -- yes.

<christina> how long of recovery is the normal??

<Dr. Simpson> That depends on the surgery that you have... my nurse had the lap band (I did it to her, of course) she had the band on Tuesday and was back to work the following Monday.... some patients are out of work for months because of complications of surgery and the disease.... and some patients, after an open surgery are back to work in three weeks... so, depends ==== the more you walk, the faster you recover. The faster you get your protein in the better you feel, and you have to drink.... hence my favorite saying === water, walk, protein.

<justglenna> does each surgeon have his own food guidelines?

<Dr. Simpson> Well, some do, and some do not. The best guidelines are mine-- and they will be available in my book in a couple of weeks.

<Dr. Simpson> modesty peaks out again

<kathleen g> Dr. Simpson> What can we do about family members who try to trip up our efforts post-op? Thanks.

<Dr. Simpson> Well, you didn't listen to your mom when you were a kid, why now???and you didn't listen to them when you married the first loser, so why now? why when it comes to food, we listen to them, but everything else... we don't pay attention. Instead-- eat right, listen to them about relationships, and... don't stay out too late, I will be waiting up for you.

<christina> what is the basic amount of weight that you can lose without losing too much im at 294 what would be my ideal goal?

<Dr. Simpson> well, if you are 7 foot tall you are probably there right now----- a reasonable goal is to have a BMI between 22 and 24 of course, I am probably going to be a BMI of 16 because I am such an athlete, but that is another story.

<Julie> Dr. I am researching WLS and was wondering what the best procedure would be for someone who has approx 150+ lbs to lose. Ht is 5'2 and I weight 330lbs.

<Dr. Simpson> The best procedure is the one that your surgeon recommends for you... they all can work well, and they all are better than what you have been doing... so go with what they do, and embrace it. At 5 foot two inches you should aim to be 115 lbs, by the way.

<christina> can i still drink coke?????

<Dr. Simpson> NO COKE -- things do not go better with COKE.... even Brittany drinks Pepsi. ... Soft drinks are evil, calorie laden devices that should not be drunk by anyone... ignore my desktop here (two empty cans sit).... drink water--- not coke.

<Jessika> I had RNY surgery 3 yrs ago and have not lost all my weight. Is a revision necessary, since I have stopped losing weight?

<Dr. Simpson> No, you need to instead determine what you are eating, and how many calories that you are using. So, I would suggest you get a device like you find on www.healthwear.com and use that to determine what you eat and what you do for calorie use... you do not need a revision.

<Kayla> I've heard about hairloss after surgery is there a way to not have this happen to u? or does it happen to everyone?

<Dr. Simpson> It happens because when you sleep during surgery we rub your head.... and if you lie to your surgeon you become so guilty that the hair falls out.... there is nothing you can do to prevent hair loss except use super glue.

<Karen> is there a mortality rate for the year 2003?

<Dr. Simpson> yes there is. A lot of people died last year. Bob Hope, Jack Lemon, and a few others.... but for surgery the mortality rate goes between one in ten thousand for the adjustable lap band to.... one in fifty for some open surgeries in places.

<kathleen g> Dr. Simpson> What's with the tennis ball stuck in mid sternum every time I eat? Thanks.

<Dr. Simpson> might be a tennis ball, I was wondering where that went -=== was it in bounds? ACE! That is a sense of "satiety" or fullness-- and could be that you.... are eating too fast, not chewing well enough, or cutting it small enough... or gulping liquids... measure twice, eat once, vomit never. Oh-- then take a walk.

<desperate> How much does it cost...for a Canadian?

<Dr. Simpson> A lap band is about $14,500 for a Canadian, and $15,000 for someone from Jersey we charge them more because of pollution, and give you a break cause we pollute your air.

<jaflenn> I'm scheduled to have gastric bypass in July and am worried about getting enough nutrients w/out getting too many calories. I don't want to feel tired and sick all the time afterward.

<Dr. Simpson> Then eat properly.

<Linda Combs> I have heard through a date line special that with the new overwhelming flood of people having gastric bypass surgery, that now surgeons only have to attend a seminar to do this surgery. Is this true, or, would surgeons not have to have some formalized training for a surgery as serious as this?

<Dr. Simpson> I don't know what dateline was talking about, because the surgeons who I know that do bariatric surgery are pretty good surgeons... and the seminar is only an hour long.... seriously ---- any competent general surgeon can do bariatric surgery, there is no special training that is required for it... however, those who have been doing it for a few years, and have a good program and offer good follow up are the types of surgeons that you want to get.... not someone who doesn't have a long established program good luck

<xeni> I am 6 weeks post-op RNY LAP. My hunger has returned a bit and I never feel full, even though I eat protein first. Is it possible that my new pouch has stretched, or the opening to the intestine is too large?

<Dr. Simpson> those things are all possible, but you probably have stretched a bit-- and the only way you stretch a pouch is by CHRONIC OVERFILLING IT---- and not by.... a one time deal. The only way you stretch a stoma is to challenge it with lots of . oversized food--- so CHEW..... and the only way you get hungry is if .... you are eating too fast, too furious.... this is not a race -- take at least a minute to eat your food.... and finally ---- when you get the protein first, the next thing is....VEGETABLES---- mmmmmmmmmmmmmm.

<cheryl> I ma 1 yr post op and have lost 160# but find the last 30 are tough,,,is this normal?

<Dr. Simpson> Very normal, welcome to the human race, where we ALL struggle with those last 30 pounds. Measure what you eat, increase your activity --- try the www.healthwear.com website and see that device. Also--- my next book is written just for YOU -- and those who struggle after having surgery.... and that should be out in six months. Of course, the first should be out in two weeks.

<lories> After a lifetime of being told to "eat my vegetables" I now just don't have room. I am 3 months post-op and always get in my protein, but am concerned I am missing nutrition with no veggies. Are we really okay as long as we get in protein and take our supplements daily?

<Dr. Simpson> You need to get those supplements, and hopefully your physician will test you for vitamin levels... if you want the list of what to be tested for you can download it from my site, www.drsimpson.com

<Sheila> I am almost six months out from Lap RNY and have lost 70 pounds so far. That seems very slow compared to others who had surgery at the same time. I started at 240 and now weigh 169. Is that pretty good? I am very active and eat according to my surgeons plan.

<Dr. Simpson> Well, you have lost probably half of your excess body weight and that is a great result.... remember it is per cent of excess body weight, not total pounds that count. Good job. Walk more.

<dana> after the surgery do you just continually lose weight and if so when does it stop, i dont want to be a rail

<Dr. Simpson> I don't think that you will ever be a rail.....in fact, most patients find it is the last 30 lbs that are the hardest, not that they have to struggle to put on weight.... so, don't worry -- not a problem. Honest. And if it is, trust me, I can help you gain weight. Where did I put that Krispy Kreme

<Linda Combs> I am undergoing the surgery on April 20th and I at this time have absolutely NO ENERGY. What can I do to make myself have more energy for exercise besides vitamins?

<Dr. Simpson> walk more, walk more, walk, walk, walk, walk, walk, and then..... walk not wok (an Asian cooking utensil)... walk.

<Amanda> I am currently 5'6 380lbs but i am healthy as can be and cant seem to loose weight on my own with a family history of heart disease and diabetes is that enough to make me a candidate for surgery?

<Dr. Simpson> You are a candidate. Now if you can fix the economy, take care of Iraq without lying to us and fix the medical tort reform issue you can be president also. If you can't, then you probably can be nominated by the party anyway.

<Miki> How frequent is obstruction/stricture likely to occur?

<Dr. Simpson> ten per cent.

< Karen> Will the regularity of bowel movements change postop?

<Dr. Simpson> regularity??????.... are you a grandmother.....????? my goodness, never have so many been so concerned with bowel movements as patients of bariatric surgeons.... === drink plenty of water, eat a balanced diet, and use your fiber and you will not have a problem.... (he says, after spending most of the morning on the john). Benefiber is my best friend >)

<kathleen g> Dr. Simpson> Why is it that post-ops get strictures months after surgery? One would think that food going through the stoma would keep it open> Thanks.

<Dr. Simpson> Because scar happens-- just like other things happen (or don't as the case might be-- fiber again)the opening does scar, and if it does scar then it will be a stricture.

<Miki> How is stricture fixed? Painful?

<Dr. Simpson> Not painful at all-- a gastroenterologist puts a scope down your gullet and inflates a balloon to a certain pressure and breaks up the scar.... breaks it up faster than dancing with your date's best friend at a prom.

<dana> i have polycystic ovaries will getting this surgery help get rid of it??

<Dr. Simpson> Some seem to think that it will, although some do not. I have a number of patients who had that as a complaint and now... no longer need epilady on their face and no longer have pelvic pain, and....have a lot of other things that make their life happy -- one has a new kid (which she thought... would make her life happy but wait til the kid grows up).

<suzie nosal> what about excess skin do you have to get to goal weight and do you know if blue cross covers it

<Dr. Simpson> Blue cross does not cover your goal weight.... excess skin happens, and you may need plastic surgery to get rid of it,,..And that may not be covered either by surgery. THINK OF IT LIKE THIS==== finance the surgery, and your plastic surgery -- it is like paying for a car... but after five years -- you won't need a new one, you always have your body with you, and... if you like it-- you will like it better than any Mercedes or lexus, or Rolls Royce....best investment you can make-- for YOU> or me, if I am your surgeon.

<Robin_Ga> Why do you think the insurance companies are pushing not to cover this surgery ?

<Dr. Simpson> Because they are not in the business of insurance for your health. Look, they want the bottom line for this year, and the chances are that... by the time you have problems from obesity... you won't be their policy holder anymore...so they DONT CARE ABOUT YOU. Hard to believe isn't it.... look at their corporate profits---- they made that money by NOT paying for things like weight loss surgery. By the way, insurance companies just love me. Of course, I like them about as well as the Exxon Valdez and other oil companies.

<dana> i've heard people lose control of there bowels after the surgery is that true?

<Dr. Simpson> No.

<Liz> Dr. can you tell me the difference between RNY and DS surgeries?

<Dr. Simpson> Yes I can--- better yet, I can show you. Go to my website www.drsimpson.com and you willl see... a complete description of both surgeries, as well as a bit of comparison.

<dana> im 25 5'5 280lbs will I have trouble with the excess skin?

<Dr. Simpson> sorry just listening to Jim Morrison and the doors. Cannot tell if you will have problems with excess skin or not, I can say this, however.... skin is better than fat, and easier to deal with.

<Kathleen> I am a distal and bruise like the elderly..my skin is like paper thin...also I have very dark uneven skin color on my arms..like under the skin bruising..what..I have asked ever Doc I see what can be the problem and no one knows ..best guess is malabsorbtion and I am Protein deficient and low irons and anemic all the time..what will help this condition..my arms look terrible..I am afraid people will think they are lesions and that I have aids..

<Dr. Simpson> hence the term --- skinny

<Dr. Simpson> sounds like you need some laboratory work done to see what you are absorbing and what you are not.... and that you may need some supplements, and so forth... you need to check your labs and see your physician to see what you need to do.... check my website for the annual labs, and get those drawn----then see your physician and you will need to be checked for vitamin K levels... which is best checked by having them order a PT/PTT for you. Good luck...

<Patty G> why is a psychiatric evaluation necessary before surgery?

<Dr. Simpson> because if you are going to be a patient of mine I want to make certain you are crazy,... because I would not know what to do, or how to relate to normal people...the psych eval is another way that we can determine if there is some underlying psychiatric disorder that.... needs treatment before surgery, much like cardiac testing is done to see about that.... that is all it is. There is no contraindication to operating on people who have...any mental illness, but they, like many, need to be on treatment for it.

<bb> I have had a vag. hysterectomy and a c-section. Can I have a lap RNY?

<Dr. Simpson> yup

<Jim> If you have had a previous Gastric Bypass can you have a revision and have the lap band put in?

<Dr. Simpson> yup

<TW> Is there something in the works to have obesity declared and official disease where insurance companies will have to provide coverage? I have researched on the internet, but have hit a dead end. Thanks.

<Dr. Simpson> IT is a disease, and treatment is tax deductable...but no insurance company can be obligated to pay for it. But you can save your pennies and... get some financing and have it paid for.... although, I think that most insurance companies do pay for it.

<Denise> What about the new statistics that are coming out about wls..about the death rates???What is the correct information???

<Dr. Simpson> Well, the first question is what do you mean correct..... because statistics are just that. They are statistics.... if it happens to you, then it is a problem, if it does not happen to you.... then it isn't a problem. Statistics have NO MEANING when it comes to an individual.... but they have meaning to large groups.... further, there is no way to tell who will have a problem and who will not,.... nor is there a mechanism to determine how to prevent some things.... the best thing you can do is the following> be in good shape before surgery, walk a lot after surgery, and follow your surgeon's recommendations to the letter.

<Erin> I have PCOS and thought that with the surgery, the symptoms would go away. My surgeon said that this would be the case. I have yet to see any difference in my symptoms. Am I waiting on something that will not come?

<Dr. Simpson> PCOS is a complicated entity that has MORE than obesity as a cause for it.... further, until you have come down to your goal weight.... you cannot say it has not helped.... all diseases are improved with weight loss, but that does not mean...that you will be disease free... skinny people have heart disease, skinny people have diabetes... skinny people need their joints replaced, have asthma....and skinny people die young too.... so, while many things are improved with surgery they are not always cured.... simple as that.

<suzan> I had my surgery march 1st and have lost 47 pounds so far, my question is..how important is it to get all the water in, I am having a real problem with this.

<Dr. Simpson> if you don't drink enough water you will be constipated, slowly lose energy and die otherwise, no problem.

<Tracey from PA> Is there a huge risk of getting a blockage in your openings that could cause complications after surgery? If so. how can you avoid this?

<Dr. Simpson> There isn't a huge risk of a bowel obstruction, and there is nothing you can do to prevent that.

<Jessika> Do you recommend protein shakes or protein in the form of foods for your post op patients?

<Dr. Simpson> Not usually unless they cannot get it in any other way.... I think most protein supplements taste like sawdust without the beauty of the tree.... so I prefer my patients eat real food, like chicken, beef, turkey, elk, haddock, arctic char, shrimp...bocca burgers, venison, ostrich, emo, kangaroo pouch, salmon liver.... chitlens, sweetbreads, and other such foods.

<suzie nosal> what is the name of your book ? Will we be able to get it in the ObesityHelp.com store?

<Dr. Simpson> yes it will be in the obesityhelp.com bookstore and you can get it from them..the name of the book is "Weight loss surgery: a lighter look at a heavy subject.." you can imagine it has a bit of humor, a lot of cartoons and drawings, and it is... actually fairly comprehensive with 390 pages of wit and wisdom.... and a few recipes to boot.

<Kerri> Is there a higher complication rate with RNY as any other laproscopic surgery?

<Dr. Simpson> No there is not.

<Rebecca> Dr. Simpson, explain the length of the RNY limb, my Dr. does a 200cm, what does that mean ? I am BMI 42

<Dr. Simpson> well, at 200 cm what???? difficult to know, but the limbs of the RNy can be any length... and some standardize the length of their limbs-- actually, it is fairly difficult to explain it in words.... and is covered in my book-- however, in the website which will advertise my book.... which is www.obesitydr.com-- we actually have those drawings so you won't have to pay... for the very expensive book 00 which is worth its weight in tin foil.... that site should be up in the next couple of weeks, or even next week.

<Synthia> What is dumping syndrome? I have heard it talked about so often. Is this where you lose the bathroom a lot after you eat?

<Dr. Simpson> No--- if you dump what happens is that carbohydrates hit the small bowel and they cause a reaction which can be.... anything from diarrhea, lightheadedness, abdominal pain and bloating, or other such things....' dumping is NOT Fun, and it is NOT related to weight loss, and I think, and believe it is something that we really DO NOT WANT.

<Paula> Dr. Simpson, what are the chances of infection after surgery and what can be done to prevent this from happening?

<Dr. Simpson> 5 to ten per cent develop an infection and the surgeons do a lot to prevent it....you can do some stuff to prevent it> before surgery wash with antibacterial soap on your abdomen... after surgery -- shower --- well a couple of days after surgery-and don;'t let that grimy stuff build up on your body. And finally === WALK

<barb> i am a little over a year post op and i can't seem to stay away from popcorn (white chedder) i seem to tolerate that better then regular food. could that cause weight gain for me after time.

<Dr. Simpson> yup a calorie is a calorie they add up, honest

<Joanne Donaldson> Dr. Simpson - I am 18 months post op and run a support group. Question> are there statistics anywhere on the internet showing follow up information -- for instance, how many people are keeping their weight off. Also, is there anywhere to get information for folks that are a couple of years post op to help them continue to use the pouch to keep weight off.

<Dr. Simpson> There is not a lot of good information on the web about that subject, although there are a number of support groups... on line that are for such patients, mostly in yahoo....in fact, that is the subject of the next book of mine, which I want to call "The Road kill diet" and I might yet call it that... he best way to keep the weight off is to make certain that people measure the things hey put in... and measure what calories that they use.... a pedometer costs about twenty bucks, and if you take 10,000 steps a day you will do well.... I am a few steps away from that today, so I will take a walk in he rain once I am done here

<**MODERATOR**> Last question of the night goes to....................

<Allen@goal> Do you keep in touch with your long term patients and how are they coping emotionally? It's a different world from BMI of 78 to 25

<Dr. Simpson> I love keeping in touch with all my patients...they all have my email address, and I keep my pager with me== blackberry...everywhere I travel in the world, and I love to keep in touch with them... often they go on with life and don't keep in touch with me as much as I would like... kids, you raise them up and the only time you hear from them is when they want money or have trouble digesting something.... so, I love keeping in touch with patients, it is one of my joys in life... besides listening to my ipod and doing a Friday afternoon chat....

<Dr. Simpson> thank you everyone, you made what was a dull, miserable, rain-filled Phoenix day, a good one.

<Dr. Simpson> good night.

<**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.