May 13, 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> Good afternoon all.

<Polly> I just want to make sure that the worst of the infections if those are mostly the leaks. Are the leaks the worst type of infection you can have with this surgery and that can kill you.

<Dr. Simpson> Leaks are bad, and they can kill you, mostly, however, they do not. You can also get a hernia, and the hernia mesh could get infected. You could have a bad wound infection. You could get pneumonia, and that can kill you. You could die from a jealous lover, with an infected bullet.

<Jackie> Dr. I had surgery 10 mos ago. In the beginning I got full very quickly and even had probs keeping things down, as I felt "stuffed" About 6 mos post op, I started drinking diet coke again. My surgeon said it was fine. I am not concerned as I feel that the carbonation has stretched my pouch or stoma because I can feel the food going through. I will get full for a min or two, then I feel it pass through and I can eat more. Do you think I have stretched either of them/ What shoul

<Dr. Simpson> Carbonated beverages cause food to go through the pouch quicker and can force large pieces of food through stretching the stoma. They will not stretch the pouch. Typically, since food is forced through the stoma, it makes you feel hungry sooner, so you eat more and you gain weight. So if you want to drink diet Coke -- remember, you will end up eating more, and you didn't go through an operation for that.

<Lezlie> Hi dr. I have a question about food choices. I had rny because I love sweets. I have tried to give them up, but still crave them. I don't over indulge anymore, but my nutritionist says I should not eat anything sweet, not even reduced calorie, fat free or sugar free products (such as Jello, Pudding, Popsicles) The program I am on forbids any sweets, they say it promotes grazing. What are your thoughts?

<Dr. Simpson> Sugar, grazing, and such are not great things. You will crave anything, and that is ok but lets be honest -- skinny folk eat sweets, just not as much, skinny people eat cookies -- but one, not ten. If you can have one and satisfy an urge, great. If you cannot stop until the gallon of ice cream is gone then you need to not keep it around, and talk to a shrink about your relationship with food. If you want to lose weight you have to decide which is more important, sweets or weight loss. If you are trying to maintain it is a different deal.

<ErinKay> can you die from dumping?

<Dr. Simpson> You can feel like you will. You might clear out a room and they will feel like they will. If you are declared a superfund site because of your gas, you might want to limit dumping.

<Rita> How soon after surgery are we allowed to start exercising and doing weights again?

<Dr. Simpson> Start walking the day of surgery, ask your surgeon about weights.

<Michelle> I would like to have surgery and am in the beginning stages. I would like to know what surgery you would recommend for someone who is 5'8 and weighs 334 lbs?

<Dr. Simpson> Weight loss surgery, any kind, whatever your surgeon does and is comfortable is fine.

<Betty> My 16 yr old daughter has been telling me about this surgery. Is this a common procedure to be performed on children? Are there different guidelines for children to follow as opposed to an adult. Such as, should they be under a Psy care during their initial weight loss for coping mechanisms, etc?

<Dr. Simpson> Guidelines are the same. Involve the pediatrician. Psychiatry if the kid needs it, and I think they are all nuts or perhaps it is their parents. Anyway, if you have a teenager, you should be given free psychiatric advice and a voucher for boarding schools.

<Angela> I had surgery 5 yrs ago. I seem to have a problem now with my pouch. I can feel food going through it and I am not getting the full feeling I normally get. What could be causing this?

<Dr. Simpson> Your stoma could have enlarged and if it has you have several options, sclerotherapy, lap band placement, further surgery. Good luck.

<tanya2wk po> what is the normal diet @2wk for rny?

<Dr. Simpson> Every surgeon is different, some want you on liquids, some soft foods. S so ask your surgeon's protocol.

<Robert> hi interested in the lap band and would like to know what is the typical cost of this procedure? I have no insurance so I have to pay for it thank you

<Dr. Simpson> The lap band prices range from 15k on up, which is all inclusive but if you call today we will throw in a set of ginsu knives.

<Howard Benedict> Dr.Leste I will be meeting with the clinic personnel on June 3 how long will it ake to have the procedure done, also how long will I be in the hospital after surgery

<Dr. Simpson> Don't know the procedure you are having done, their typical times or their aftercare. If it was Dr. Simpson -- then we would say the lap band will take us, typically less than an hour. You will be in the hospital for four to six hours and go home that day. But alas, others are different.

<Barb> How much of a problem will scar tissue be if you are having the lap band. My surgeonis concerend about it.

<Dr. Simpson> Scar tissue is not a problem at all.

<Mary> Dr. I weigh 340lbs currently. What is a reasonable weight for me to get to, once I have surgery. I am 5'4.

<Dr. Simpson> 142 pounds.

<Shelley> What is the difference between the gastric bypass and the lap band surgery?

<Dr. Simpson> Lap band does not involve cutting stomach, or intestine is always done laparscopically. RNY involves rearranging of the guts. Now all of these nice pictures, diagrams and explanations are available in a 390 page book, called "Weight Loss Surgery: A lighter look at a heavy subject" by yours truly available at www.obesitydr.com.

<Mary Ann> I had surgery 5 weeks ago and ever since my sense of smell is messed up. Is this related to surgery or am I just imagining things?

<Dr. Simpson> I am tempted to say you are imagining things but you are not. This is common -- in my book I refer to this and we call it, the bionic nose -- apologies to Michael Jackson.

<Kelly> I am 5'3 and weight 412 lbs. I would like to have the ds surgery. What would my goal weight be and how much can I lose with the ds surgery?

<Dr. Simpson> 135 lbs is your goal -- and we explain how to get to goal in our workbook, "Getting to Goal and Staying there: Lessons learned from Successful Patients." Which is our workbook to guide you through, and set goals, and get to them. It does not matter which surgery you have. The principles and the lifestyle changes are the same. If you don't change your lifestyle, no matter what the surgery, in a few years you will regain.

<Melanie> I had surgery outside of the US due to no insurance. I have gotten very little info on what my post op diet should be. I am a bit concerned because I am still on soft foods now at 3 mos post op. Can you tell me what I should be eating this far out?

<Dr. Simpson> Melanie -- you need my first book and my second book (excerpts seen on www.obesitydr.com) to guide you through the post operative phase, and to set goals. You should graduate to solids. Good luck.

<sam> Hello, I started a new job and I will get med ins BCBS in August and I am thinking of bariatric surgery

<Dr. Simpson> See if they cover the operation you want or not. If not, you might have to pay out of pocket and get my book to learn about the different operations and what to expect from insurance. Good luck.

<Wendy> My husband had surgery 7 mos ago. I am not thinking about having surgery. He had the lap band, but I think the gastro surgery is best for me. I would like to know who will make the decision which surgery I have? Is it up to me or the surgeon I choose?

<Dr. Simpson> Some surgeons only do one type of surgery, and that will be part of the choice. Some surgeons do more than one type of surgery, and then you can discuss what is best. All operations end up being the same after a few years. At least that is what the latest data shows, the best guidebook for weight loss surgery is "Weight Loss Surgery: A lighter look at a heavy subject". Shameless promotion -- but seriously, I do get a buck and sixty seven cents, per book, but it is a good and informative guide.

<Carol> I am 61 yrs old and in fairly decent health. Can I qualify for this surgery even though I am over 60?

<Dr. Simpson> Yes.

<Connie Smith> Interested in the Lap Band surgery here in Indianapolis. Who are some of the best doctors?

<Dr. Simpson> You can check with the Inamed website, www.inamed.com and they will give you a list of their physicians.

<sam> is there genrally a problem getting insurance to cover the procedures?

<Dr. Simpson> Depends on the insurance company. Some of them cover the procedure without a problem, some are poops.

<Sue> I am pre-op and take no meds for anything. Will I need a medic alert bracelet after wls?

<Dr. Simpson> Unless you like that as jewelry. I don't, but some people like it.

<Renee> Hi. I am scheduled for surgery in two months. Today at my surgeon's office we talked about pain control. He said that he uses an epidural. This scares me. What are your thoughts on the epidural and would your suggest it or a pca pump?

<Dr. Simpson> I like epidurals, especially if I am in labor, which is hard - labor that is.

<Crystal> How many calories should a person who is 8 mo post op be getting in daily?

<Dr. Simpson> It depends. You need to know your BMR and calculate from that. What you will need to eat to get or maintain weight loss and you can get that from our workbook.

<Sue> What pre-op diet would you recommend to prepare for this lifestyle?

<Dr. Simpson> Learn good healthy physician, nutrition, that is, and that is the best thing because you can learn about nutrition and go from there.

<Crystal> I still have problems getting my fluids in at 8 mo, any suggestions on how to increase that?

<Dr. Simpson> Sip sip sip sip

<Tamara> Why is it that alot of the people I know that had the surgery are now regaining their weight?

<Dr. Simpson> Because they have not changed their lifestyle one bit or they graze or they drink alcohol.

<Tami> I am beginning to have problems with meats. I was wondering if it is normal for someone to be 6 months post op and just NOW start having problems getting meat down?

<Dr. Simpson> Sometimes it does that. Sometimes things do not go down as well.

<Luann Kunisch> Have you had anyone have to do more than three appeal levels before getting approved?

<Dr. Simpson> Yes I have, but not always. It is tough.

<Brandi/Tx> What are your feelings about teenagers(18 yrs) having Gastric Bypass?

<Dr. Simpson> I think that teenagers are good candidates. They are healthy, they do well after surgery and it is a good thing. So it is good.

<p> I had a lap sleeve gastrectomy 5 weeks ago. I have some pain below the largest scar . apparently nerve routes. My questions are does this mean that the nerves have been damaged? and how long should I expect to have this pain? Thanks for your anwser.

<Dr. Simpson> Two months before any nerve damage resolves and it might be something else, like the beginning of a hernia. So see your surgeon again.

<Luann Kunisch> What suggestions do you have to prepare for surgery the day prior to it?

<Dr. Simpson> Walk

<MissTeddie> Dr. Simpson, is it possible to get 3rd roux en Y?

<Dr. Simpson> I have no idea what you are talking about. You can have a RNY. You can have a revision. You can have it redone but I don't know if you can have three. Makes no sense.

<Mike Sander> How much water should I drink during any given day?

<Dr. Simpson> Two liters.

<xxl> dr..im 8 mons po and im feel tired im taking all my vit and b12.....and my hair is still falling out?

<Dr. Simpson> You need to see your physician and have some blood drawn. For a list of the blood to draw see my website. www.drsimpson.com

<cheki318> I was interested in the lap band. What makes it so different from the gastric bypass.

<Dr. Simpson> It is safer. It takes less out of a person to do it and for more information about the procedures you need to see THE BOOK.

<Pam> After you have RNY and get to your goal are you able to eat and not really worry about gaining weight back?

<Dr. Simpson> You have to change the way you look at food and how you eat it. If you don't change the lifestyle, then you will regain weight. Doing things the same way and expecting a different result is the definition of insanity.

<ErinKay> How long after RNY before it would be safe to have babies, vs the lap band

<Dr. Simpson> Two years, one year --- 17 years for having sex.

<Mike Sander> I am a 34 year old Male, 6' 4" 355 Pounds. I try to be very active. Softball, Weights, Walking, Golf, etc. Is Gastric Bypass surgury a good option for me. I have tried weight watchers, South Beach, and Atkins. I have a cousin who this worked wonders for.

<Dr. Simpson> Yes, it would do quite well for you and you should golf more and invite me.

<Tammy in Mississippi> at 37 years old. After RNY is there anyway to prevent extreme loose skin ? A certain exercise program etc. ?

<Dr. Simpson> Not really, although some say weight training but everyone is different. Some will have more loose skin, some will have less. More skin is called skinny.

<Pam> Dr. Simpson, where are u located?

<Dr. Simpson> In my office. Phoenix.

<ren> if I have a bmi of 41 but no comorbidities can i still qualify for surgery w/ bc/bs?

<Dr. Simpson> Depends - you might need to have a six-month, physician supervised diet.

<katie h> how can we get the workbook "getting to goal"?

<Dr. Simpson> www.obesitydr.com --- you are a wise person.

<rhonda> Are there cases were Gastric surgery has been performed and the patient fails to lose weight?

<Dr. Simpson> Yes

<Pam> What type of surgery do you recommend for someone with a BMI of 52?

<Dr. Simpson> Whichever your surgeon does.

<MissTeddie> Please, have you ever heard of having a second revision of rny?

<Dr. Simpson> If you need a revision, the first thing that you need to do is determine if you have a head revision or a problem that is in the operation. If you have not changed lifestyle, and are eating junk, then all the revision in the world will not help you. But sometimes there is a mechanical reason to have a revision and you can have more than one.

<Pam> I have had 2 c-sections and had a terrible time getting an epidural...when and why do they give it to us..

<Dr. Simpson> We like to torture you, which is why you become pregnant - to torture. You can have analgesia that is not epidural.

<Tina F> ok..new at this, but BMR?? whats that

<Dr. Simpson> BMR is basal metabolic rate, how many calories you burn.

<Howard Benedict> why are a number of doctors who are in my medical plan and covered for this procedure want to be paid out of network

<Dr. Simpson> That I do not know. Sometimes weight loss surgery is carved out of general surgery. Sometimes they want more cash. Ever think of giving the surgeon a tip?

<ErinKay> What happens when you get old, like those in the nursing home that don't eat, we give them health shakes, something that may cause dumping to a RNY pationt, what would they do?

<Dr. Simpson> Depends. (Get it?)

<Mary> I want my children to learn acceptance of others no matter what their size. I am worried about the message I'm sending them if I have WLS. Thank you for your advice.

<Dr. Simpson> You should accept people of different sizes, colors, religions, or even people who are from Texas. But if someone wants to improve their health by weight loss, that should be commended and should not be perjorative based on size as long as they are not in the middle seat on the airplane next to me.

<Cheryl G.> I'm 3 weeks post-op and have only been sleeping 3 to 4 hours per night! I'm soooo wired! And so extremely happy and full of energy to a fault! Can insomnia be a side effect of having wls?

<Dr. Simpson> No.

<cindy> Is it necessary to go on a low carb diet before a laproscopic RNY?

<Dr. Simpson> No.

<Pam> Why does your hair fall out when you have WLS?

<Dr. Simpson> Because people lie to their surgeon. Seriously, follicular regeneration based on stress. Your hair follicles reset themselves. Three to four months later it falls out. Three to four months later it grows back.

<Charlotte> Do you know why Medicaid will not cover Lap banding?

<Dr. Simpson> Sometimes it does. We have been successful in court at overturning them.

<Julie> I have 2 friends who have had wls. One is 4 years out and the other is 4 months out. They both drink alcohol. Is there any nice way for me to remind them of what they are doing to themselves?

<Dr. Simpson> Tell them that they will absorb those calories and if they are not taking in too many calories, then they are fine. If they are drinking too many calories they will get fat.

<Charlotte> Dr. I have really hard fat deposits in the hanging skin under my bellybotton. When loosing my weight will that fat go too, considering it is hard fat?

<Dr. Simpson> Fat disappears all over, usually in the places you don't want it to go first.

<Moderator> Last question goes to...

<Gerry 18d po/20#> Why does the appetite eventually return post WLS?

<Dr. Simpson> Appetite is appetite. It will return. It is nature, it is evolution (or creation, to be fair and balanced here), but you do not have to, nor should you ever -- STUFF yourself.

<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.

<Dr. Simpson> Thanks. Books available at www.obesitydr.com.