April 15, 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!

<Moderator> Welcome, Dr. Simpson. Just let me know when you are ready to begin and we will get started.

<Dr Simpson> Ready to go.

<Bonnie> I've been diagnosed with Cushings Disease. My RNY was in 1999; have regained almost 100 of the 140 lost. How do I find out about stoma enlargement or pouch problems?

<Dr Simpson> Ah well, Cushings disease probably means that you got a heck of an appetite -- and so now you have to figure out a few things: first how many calories you burn daily - or your BMR -- you can determine that based on some formulas-- and then you need an upper GI to see if the pouch is large-- or you could do the cottage cheese test. If the stoma is enlarged, the only way to find that is by endoscopy, or if you are hungry soon after you eat a steak, or some meat type of meal. We have the bmr formular in our "Goal" book, so that is a good place for it. We will have it on our website once we make some changes to it in a bit.

<Lindap 05/05/05 open> I have a question I was postponed back in August 04 for a medical problem Since August I had been down with severe astnam problems Pnuemonia had to be put on strong strenghts of steroids Can one lose weight while on steroids Insurance has denied my surgery cause I haven't lost any weight in last 8 months. I am a trach patient Will I have to be on a ventilator right after surgery

<Dr Simpson> You can lose weight on steroids ...and I am sorry your insurance denied you the operation because of lack of weight loss, but keep working with the insurance company...and it will eventually get there. Good luck.

<Bonnie> Dr Simpson, thanks for the great article on Revisions. A local bariatric surgeon would like to have an on-line discussion using the article, what permission is needed?

<Dr Simpson> None. Use away. Glad you liked the article.

<flash> i am considering WLS. Do you think it would help with chronic achilles tenditis

<Dr Simpson> Certainly. Weight loss will decrease the stress on the tendon and that will no doubt help. Good luck. Limp on.

<Autumn(-110)> I am 11 months post op and have only lost about 20 pounds in the last 6 months. I have 75 more to go and am frustrated!! I have signed up with the NutriSystem plan to try to get my eating on track as much as possible. Any feelings on NS?

<Dr. Simpson> Every surgeon has a different protocol for prre operative diets...some use them to shrink the size of the liver, some of us do not...I like it when patients make a hearty attempt to lose weight before surgery because it shows..a committment to the process, and that makes me feel better...however, the best committment is surgery, and following through with ...the steps outlined in our workbook.

<irwin> Some pre-ops say they are on pre-surgery diets. Should I be on one? I'm 6' 2", 296lbs, BMI of 38.5 w/ sleep apnea. WLS scheduled for 4/26/05. Thank you.

<meemee> I am considering wt loss surgery, am approx 100 lbs overweight, some people are saying lapband is not working unless there is alot of weight to lose, any feedback?

<Dr. Simpson> The lap band works just as well as other weight loss operations...it may not be as fast at first, but it certainly....has shown, in multiple studies, that it does just as well in the long-run...there is a lot of misinformation about the lap-band, because the early studies with the lap band...were done so poorly, and the surgeons who did them were simply not that good...but now, they have shown it works quite well. Go for it.

<irwin> Is there any pain associated with the insertion or removal of the Foley catheter in males? Thanks

<Dr. Simpson> Some discomfort. But, for a very personal story about re-insertion of the foley catheter...you can find it in my first book "Weight Loss Surgery: A Lighter look at a heavy subject.." where I talk about the various tubes...it is easy coming out.

<charlotte> have you done a RNY on any patients with parkinsons

<Dr. Simpson> No

<beachlover girl> What percentage of patients develop blood clots during or just after surgery?

<Dr. Simpson> That is hard to know, and we can only say that a number of them do. The best thing that patients can do is to walk, walk, walk, walk, walk, walk and keep walking.

<sara> how long after surgery do I have to worry about complations? When can I stop worry about complations?

<Dr. Simpson> Walk like you have the winning lotto number. You can stop worrying about complications following your cremation.

<janice armstrong> i am 10 days post-op and still have dull ache on my left side in the vicinity of my new pouch. is this normal and how long will it last? i had a open rny.

<Dr. Simpson> It is normal, and it will last for a week or two-- but if you are worried have it checked out. I have a dull ache in my knee from my surgery in 87....aches and pains are common. New ones are things we worry about.

<beachlover girl> Are there any precautions that can be taken to prevent blood clots during surgery?

<Dr. Simpson> Walk.

<Sally> I am having laparoscopic surgery on May 11, will i lose weight while i am in the hospital?

<Dr. Simpson> No, you will gain weight.

<gina> What is the better surgery lapband or RNY?

<Dr. Simpson> The surgery that your surgeon does.

<martha> How many calories should you eat 1 year post-op?

<Dr. Simpson> That depends. There is a wide variety that you can eat, and the point is to make good choices and to know the calories in them. For example, in our workbook we have a recipe for salmon with a couple hundred calories that is better than A JR. Whooper with 400 calories. So it is making good choices.

<beachlover girl> What is the average pouch size created (in ounce capacity)?

<Dr. Simpson> One ounce when it is made.

<Bonnie> Besides the cottage cheese test, is there any other way to estimate the volume a pouch can hold?

<Dr. Simpson> That is a simple and easy one...sometimes instead of cottage cheese we use tuna fish...or instead of tuna fish we use haddock...or sometimes we use beef from England that died with seizures --mad cows.

<jim> how long before we can lift weights after surgery?

<Dr. Simpson> Better yet, start lifting them now, start a walking program and continue the walking program after surgery and think about lifting weights when your surgeon says it is ok -- like six months.

<beachlover girl> How long does the average roux n y procedure take in the operating room?

<Dr. Simpson> Depends on the surgeon, the patient's anatomy, and a whole lot of other things. The main thing is that you will be asleep, so it takes as long as it takes---don't plan on doing much else that day.

<kevin> I have some sexual problems now, and wondered that if losing weight might help them "get up"?

<Dr. Simpson> Well, if you lose weight you might find it.

<BigDog Brad> when do most people experience their first plateau after surgery?

<Dr. Simpson> Some never do because they keep walking, and get to their desired weight...some get there very quickly and have to adjust the food choices they make...so best to get that all taken care of.

<Mary> What percentage of WLS patients have reconstructive surgery after weight loss?

<Dr. Simpson> Not a clue.

<odetrice taylor> can you have a bariatric surgeon if you already had 4 c-sections

<Dr. Simpson> You can have a bariatric surgeon at anytime....we are quite cute, cuddly, and we require a lot of maintainence...but if your question is can you have a weight loss operation after four c sections-- of course you can. You can even have it done laparoscopically. And be certain to bring your favorite bariatric surgeon a nice basket of fruit....cause we are what we eat, and some of us are fruits and some are nuts.

<Sara> how much slower do patients with the band lose weight compared to ryn?

<Dr. Simpson> IS it a race? Remember, when we put the band in is not when weight loss starts...it starts with an RNY, but not with the operation for the band..weight loss with the band comes seriously after a couple of adjustments...so the other operations have a "head start," but again, weight loss is NOT a race...you choose the procedure based on what you feel is best for you...not what you think will get you there sooner---cause what really works for weight loss is....(ooops, almost gave away the secret).

<LisaR> what is Cushing's disease?

<Dr. Simpson> A disease of the adrenal glands-- nothing to do with this stuff.

<Cheryl G.> Hi Dr. Simpson! I'm a 5ft 7in, female with a large build. My goal is to weigh around 160lbs. However, the BMI for this weight states that I would still be overweight! How accurate are BMI charts? Do you use them in your practice as an indicator of a healthy weight for an individual?

<Dr. Simpson> They are not so bad, and we do use them for setting goals. But we also use body analyzers, so that we have a goal of getting rid of excess fat...and once someone has a desired level of fat, and muscle, we are happy...so other things can be used...I have never met a big boned person, although many tell me they are...most people I meet have small bones with a lot of meat. So, getting to your goal should be something you choose based on what works for you...that is, if you are ripped, full of muscles, your weight will be more than if you have nothing on your skinny frame...then it is less.

<Autumn(-110)> I am on Nasonex. I know it has a small amount of steroids in it. Could it affect my weight loss?

<Dr. Simpson> No. But ice cream after the nasonex can...trust me, I have been working at ridding the world of ice cream to help you out. The marginal effect of steroids can be overcome from exercise.

<Dorothy> Dr. Simpson-What is the difference between the Fobi pouch and RNY

<Dr. Simpson> The Fobi pouch has a band around it, the standard RNY does not.

<odetrice taylor> i had 4 csections can i still have a bariatric surgery i weight 265 at 5'6

<Dr. Simpson> Yes.

<angel> hi doctor when do you notice most patients start to have bounce back weigth or start to regain some ? and when does the malubsorbtion usualy stop?

<Dr. Simpson> Malabsorption stops after a couple of years....patients don't "bounce" if they make good choices...start exercise, and do the things that are in our workbook "Getting to Goal and Staying There: Lessons learned from successful patients."...then you won't bounce.

<chipper> i'm 17 months out and have not any weight loss in 4 months am i'm done?

<Dr. Simpson> No, you are not done...you can continue to use your tool for your life, and you can ...which is why we wrote the workbook.

<angel> doctor how much ft do you usualy bypass on a person i was 10 ft what is that considered medial?

<Dr. Simpson> Everyone does it differently -- and so do I....well, we really don't do it differently, in fact we have some standards which we use..and there are some great diagrams, and our philosophy about this in..."Weight loss surgery: A Lighter look at a heavy subject."

<charlotte> do you see any long term problems with parkinsons patients have the surgery

<Dr. Simpson> No.

<Autumn(-110)> Is it true that surgeons make the pouch sizes different according to their preference?

<Dr. Simpson> No. A man of few words, because I am so quiet and shy.

<jenny> I had the ru en y gastric bypass on january 27 2004 and i want to know what is the maximum amt of calories i should be eating?

<Dr. Simpson> Jenny, that is a complicated question, and is not an accurate question...here is the deal, you have to make good choices-- as I said...good food, not food with fat, not food with high glycemic indexes...simply good food, and regular portions (for a RNY).

<Jenny X> I'm having trouble finding info on how IBS will mesh with this surgery. I would like to have a BPD, but am concerned that if I already have diareha the condition could get a lot worse.

<Dr. Simpson> You will get diarrhea, or loose stools, particularly if you eat a lot of fatty food or junk food.

<angel> how many carbs a day should we be eating at 2 yrs out ?

<Dr. Simpson> Again, the answer is making good choices--- eat all the carbs if they come in green or yellow vegetables...and avoid them if they have starch like white bread, white pasta, white rice and highly processed foods.

<katie> how many of your patients have to have skin removed and any idea of the cost?

<Dr. Simpson> If you go to the bad section of town it is removed for free....They don't sew it up so well, though. Cost varies with plastic surgeons.

<Sue> can we drink diet soda after a lap-band

<Dr. Simpson> The carbonation will force food out of the pouch and into the lower stomach. So you can, but you will be hungry sooner.

<Sally> what is the cottage chesse test

<Dr. Simpson> A test to determine the size of the pouch, which is described on my website.

<BigDog Brad> Dr. Simpson, I'm 4 months today, post-op with a Lap RNY, on average when do most patients start to experience plateaus or a slowing of weight loss after surgery?

<Dr. Simpson> On the average people go through plateaus...after a couple of months, at which time they will need to...increase their exercise.

<brenda> i have 3 heriated discs in my back and have had cronic back pain for about 20 years will this be considered along with my bmi

<Dr. Simpson> Yes

<LisaR> I have Osteoarthritis in my knees. Walking is very painful. I am hoping that once I have lost enough weight I will be able to walk pain-free again. Do you have any advice as to exercises in the meantime

<Dr. Simpson> Water aerobics...getting in the water works well. You can walk pain free with artificial joints.

<vikki> dr simpson, what would ytou think of a surgeon who not only does lapband and bypass but also other laprascopic surgeries

<Dr. Simpson> A well rounded surgeon -- instead of someone who only does ONE thing.

<betty c> What if I have anemia? Am I still a candidate for weight loss surgery?

<Dr. Simpson> Yes.

<julie> I was banded in January and am ready for and needing my second fill. However, I was stated on Prednisone for a skin condition. Is that a reason that my surgeon may not want to give me another fill?

<Dr. Simpson> None whatsoever. Go get a fill.

<cheryl> If you are 3 years out like I am can i jump start the process with liquid protein and lose weight like I did before?

<Dr. Simpson> You lose weight simply by eating less and moving more...making healthy choices, and going forward with a good exercise program.

<odetrice> how long is recovery time

<Dr. Simpson> Depends on how much you had to drink...oh, wrong forum. Depends on the operation...Lap band is quick, open surgery is longer.

<gails21> Is either of these operations covered by Medicare?

<Dr. Simpson> Medicare has different coverage in different states. Your bariatric surgeon should know.

<Autumn(-110)> What is the BMI to no longer be condidered overweight?

<Dr. Simpson> Overweight is 25, obese begins at 30...kind of like life begins at 30 or 40, or I am thinking 50.

<cheryl> how urgent is it to have a hernia repaired when it is not bothing you or causing any pain?

<Dr. Simpson> Depends-- kind of like what I wear. Talk about it with the surgeon....they will give you some good advice...and if they don't, come to my office.

<odetrice> my goal is 145 am at 265 which will get me there the fastest

<Dr. Simpson> Fastest with any of the weight loss operations. And combine with vigorous exercise, and healthy food choices.

<caroldunn> what is a hernia

<Dr. Simpson> A hole in the fascia or gristle, where things protrude out. Occurs in 22 per cent of weight loss operations.

<LisaR> Have you ever considered a career in comedy?

<Dr. Simpson> Me? Comedy? I am dead serious...well, sometimes I am just dead. But there we go with the limp jokes again.

<odetrice> how much does it usual cost

<Dr. Simpson> Anywhere from 14k to 30k, depending on whether you want a room with a view or not.

<caroldunn> i had gastric bypass 2yrs ago have problems with stomach so they check it i have a heria and my stomach is open open near the inten and my stomach is this my fault

<Dr. Simpson> Not at all, sorry that it happened. Needs to be fixed-- good luck.

<beachlover girl> To what volume can a 1 oz. sized pouch expand?

<Dr. Simpson> Quite a lot, but we anticipate 8 to 10 ounces.

<Irwin> how soon after ryn wls is it safe to fly and leave the states?

<Dr. Simpson> You have to lose a lot of weight before you can fly, but with the bat wings, and wing-legs, and osteoporosis to thin the bones, it can happen. Otherwise, a couple of weeks.

<Bonnie> I thought an RNY would always cause malabsorption issues. Does it lessen as time goes past the first year or so?

<Dr. Simpson> You malabsorb a number of things, some of them can become major issues...such as calcium, iron, vitamins A,D, and K----and will always be an issue...and yet you will be able to absorb fats better.

< Autumn(-110)> What tests are important before getting prenant after weight loss surgery? Any advice on pregnancy after?

<Dr. Simpson> Having a uterus, and something to contribute to the uterus...advice on pregnancy -- well, wait two years.

<Crystal_needshelp> Hello I was banded in Oct 04 and I was told today that it may have slipped or possible erosion. I do not have any pain and I have no restrictions please help

<Dr. Simpson> You need to see the surgeon, and see if it has slipped....it needs to be fixed, and it can be fixed.

<Autumn(-110)> What about Nasonex on my ice cream? What if it is low carb ice cream? Just kidding! I dont eat ice cream. I like your sense of humor. LORD BLESS YOU!

<Dr. Simpson> The Lord did bless me. He has given me a wonderful profession to help a lot of people...and alot of folks who I can see a difference, so I was and am blessed.

<Rudee> Why do some people end up with some complications and others don't? Is there a way to tell who will not have complications and who will?

<Dr. Simpson> And a lot of those patients still come by and say hi. There is no way to tell who can have complications...None. Not one way.

<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. Thank you very much, Dr. Simpson. We enjoy your chats every week. We all thank you and have a great weekend.

<Dr. Simpson> Thank you all.