June 4, 2004

<**Moderator**> Hello and thank you for coming to tonight's chat with Dr. Simpson. Please enter your questions and they will be posted and answered in the order received. Thanks again for joining us.

<LisaWeesa> Dr. Simpson...... what is the difference between proximal and distal RNY? And why would a Dr. have to cut out more smaller intestine in some patients?

<Dr. Simpson> You never cut intestine in patients. You bypass some, but you do not cut it out. The difference between the proximal and distal is the bypass part. A proximal bypass is about 10 to 15 percent of the bypass a distal is defined in one of two ways -- first is from insurance purposes is 100 cm or more of bypassed intestine for surgery -- we consider distal more than 50 percent of course, there are a lot of good pictures of this and an explanation of all of this in my book which is -- of course, a fine work of literature and available to those with such interesting questions at www.obesitydr.com.

<Beverly> How do I select a surgeon?

<Dr. Simpson> To select a surgeon is easy!! If you have an insurance plan, then they have a number of surgeons who are on retainer with them, that is who are contracted with them, to do the surgery for them. Then you chose between those. If you are paying cash, then the world is open to you, in terms of this you first start with www.obesityhelp.com which will have a list of surgeons, as well as credentials, and you can view that by state. If you want a specific surgery, such as a duodenal switch, or a lap band, you might investigate those websites www.duodenalswitch.com or www.inamed.com otherwise, start with obesityhelp.com and go from there.

<danielle> I am interested in lap band surgery can you tell me what the long term success has been with this surgery

<Dr. Simpson> The lap band becomes more successful every year that it is on a person. In fact, in the latest data, the lap band has out performed the RNY at three years for weight loss. Data ranges from 61 percent of excess body weight loss at one year to other numbers. But the lap band is doing better in the long run than RNY, and that trend is expected to continue.

<Cathie> why am I still having indigestion and pain after I eat,I have to take Protonix

<Dr. Simpson> Well indigestion is something that happens for a variety of reasons, not always related to surgery, and related to other things, which we cannot go into here. But, weight loss surgery will not alleviate all forms of indigestion, you should have it checked out to make certain your symptoms are not from something else: such as your gallbladder -- if you still have one, or your heart -- if that wasn't taken out either.

<Kim> I am 3 weeks P/O and still have an incredible amount of pain on my left side. Is there anything I can do to help this improve?

<Dr. Simpson> There are a number of things that can cause residual pain, and many of them simply become better with time. However there are a few things which need to be examined by your surgeon and ruled out, such as a pulmonary embolism, or heart (again, if you are a mother-in-law you may not have a heart) attack. Otherwise, it is probably rib pain which will improve slowly over time. Good luck. If you are a man, the rib was removed by God to create a woman -- oh, that's another chat room. The Genesis Chat room.

<Melanie> When choosing a surgeon, what should I look at first, # of surgeries he has done or # of deaths he has had?

<Dr. Simpson> To help it improve we must first diagnose it. You should chose a surgeon based on his reputation, not based on any numbers, death rate is something which can happen to any surgeon, with any patient, at any time, and you can have a run of them, or you can have hundreds of patients without having a death but, I would suggest that numbers of cases do not mean that the surgeon is better, because like a golf swing, they can practice the wrong things. So, see if you like the surgeon, if they are known to have a good reputation, and if they are someone you want to be with if things do go wrong. Finally, make certain there is an aftercare program, because with weight loss surgery it is aftercare that is the most important.

<Vanessa> Beer, post-op? What's your thoughts on this?

<Dr. Simpson> I wait until I am done with all of my surgeries for the day before I drink a beer. Beer is something that may be a source of unneeded calories, and must be measured carefully, it is something which is fine after a few months, however, it goes down easily and has a lot of things that you don't need in it. Therefore, I usually tell patients that alcohol should be used very moderately and if they have a lot of fine wine they should give it to me, so that I can remove the temptation from them. Consider beer a source of caloric waste of space-- it will go through and not make you full, and after surgery you can drink a lot. It is a great source to put on the weight you have lost.

<lrg> Do you do lap band surgery?

<Dr. Simpson> I do lap band surgery, and I like lap band surgery a lot. Lap band is the least invasive of all weight loss surgeries. You don't lose the weight as fast, but it does come off and like the tortoise and hare-- it seems to win out in the end. The risks of lap band surgery are real, however, like any surgery --- but in comparison to the other procedures -- it is much safer. Of course, anytime someone has a complication from surgery it isn't a good thing but of all the modern procedures, I think that lap band will become the standard in the United States in a few years. Much like it has in Europe and Australia, of course you can read about all the surgeries in my book. 390 pages of pure joy.

<kathleen g> Dr. Simpson: Hi. I'm 14 weeks post open RNY. At week 11, I awoke one morning and my old stomach was growling. I thought this was not supposed to happen. ??? Thanks.

<Dr. Simpson> Well your stomach can growl -- in fact, Kathleen. We expect that it will growl and don't worry about it, just tell everyone that it is a good thing: it will growl, and you will not.

<Sherr> What is the preop diet for your patients for Lap Band surgery?

<Dr. Simpson> No pre op diet for the lap band surgery at all. Just eat normally.

<Liza> I suffer from leg cramps and swelling in my legs. Does this mean I am likely to have blood clots there as well?

<Dr. Simpson> No Liza that is not what that means at all. However, it is easy to check that out with a Doppler ultrasound. However, many people have cramps and swelling ---- some like it.

<mama mama> although I have an appt. with my surgeon this week, I was wondering if I am supposed to empty my bowels (like a colonoscopy) prior to surgery as well as the 48 hour fast?

<Dr. Simpson> Every surgeon has their own routine-- some of us like to have the bowels cleaned out, some do not but you will be more comfortable after surgery. If you have them cleaned out and ready to rock and roll.

<MiniMe> In the 6 mos since my surgery, I have lost about 86 lbs. starting weight was 286. I really do not want to lose more than another 60 lbs. If I start to go lower than I want, how can I stop the weight loss or at least stabilize it?

<Dr. Simpson> I don't think that this will be a problem, in fact I think that you are in fantasy land if you think that the sixty pounds will run off you faster than what happened for the first bit of weight. Our surgeries are designed to lose 65 per cent of excess body weight, and if you lose more than that it is because of rigorous diet and exercise-- and we know that you can modify what you eat to gain weight -- somehow, I think that is quite possible. So, don't worry, in a few months the question will be how to get off the plateau. In the meantime enjoy the weight loss -- begin with some new eating habits, and start an exercise program-- WALK, then walk some more, when you are done walking-- walk even more.

<Melinda> I am having surgery in about 3 mos. I was told today that I have to have a psych evaluation. Can you tell me why they require that?

<Dr. Simpson> There are a number of reasons that we ask for a psych evaluation, and yet in spite of it there is very little which such an evaluation will reveal that will deter us from doing surgery. I have done surgery on patients with major psychiatric disorders and they have done quite well and have done surgery on patients who were completely under the care of a psychologist or psychiatrist, who were cleared, and they didn't do well, or did not comply but it does allow us another look at a patient from another professional. There are some practical applications of this also --- such as, if you have depression, we will want it treated for at least one month prior to having surgery and to keep on the medication after surgery and a lot of things change in a person when they lose weight and having a professional help you through this process is a good idea. Good luck.

<Maxi> is any fat removed during procedure?

<Dr. Simpson> No fat is removed during the procedure -- it is not liposuction at all, and in fact, it is done to help you change the way you eat. You will lose the fat on your own as you lose the weight.

<Sandy Lizard Tucson> how fast is RNY surgeries growing per year

<Dr. Simpson> The number of surgeries is growing every year, and it is difficult to say. For example, a few years ago about 20000 weight loss surgeries were done, and last year 120,000 were done. We think that next year maybe 200000 will be done and we will keep doing them until everyone in America looks like Twiggy -- or like me.

<~Connie Sue~> My doc says I had distal, but how would I KNOW FOR sure???

<Dr. Simpson> Well, if they said it -- they were there. The only other way is to open you back up and look or we could cut you open and count the rings-- or is that your age?

<Jessika> Hi Dr. I have been to all your chats and have missed you not being here the last few weeks. Thanks for being here this week. My question is, can a surgeon decline to perform the type of procedure on you? I want a distal rny and my surgeon says he will only do a proximal on me. I don't feel that I will lose enough weight with the prox. I am 355 pds and 5'3 tall. I have read that most surgeons do a distal if your bmi is over 55....

<Dr. Simpson> We all have different standards, however, it is something that we know. T he majority of people who lose weight will lose it with a proximal bypass. I t is the restriction, not the malabsorption which is the major reason for long term weight loss. So yes a surgeon is the only one who will decide what surgery is done not the patient, and they will tell you what they plan on doing ahead of time and the only restriction that you can do is to tell them NOT to do something. However the surgeon is the one with the experience and is in the abdomen, and you have to trust what they want, it is not like a car where you can order up a lube and oil change.

<Patty> If a person is having lap rny and an ulcer is discovered does it turn to open?

<Dr. Simpson> Not necessarily, if you have an ulcer there are other things that can be done but you do not need to have the open stuff.

<Rayme> What is the number one leading cause of death from this surgery? What can we as a patient do to prevent it?

<Dr. Simpson> The leading cause of death from surgery is a pulmonary embolus-- which is a blood clot. Formed in the leg or pelvis which travels to the lung and chokes you. The best thing you can do is to WALK after surgery. So, walk, walk, walk, and walk some more, that is the best thing you can do - you will recover faster.

<Laurie> My aunt had surgery about 3 yrs ago. I am now considering having it. I am 23 and borderline diabetic, they are treating me with glucopage. I weight 240 and am 5'1. I know I qualify, but ins says it is not medically necessary. What documentation do I need to do, to prove that it is medically necessary?

<Dr. Simpson> The insurance company determines that not a doctor, which is unfortunate but they have some standards, and your surgeon will present your stuff to the insurance company and it will have to be appealed and appeal... and appeal, all of this is nicely outlined in my book.

<karen> hi. I am about 6 1/2 months out from my surgery. I have lost 91 lbs. is that considered good weight loss.?

<Dr. Simpson> That is a great weight loss, and you should be proud of yourself, so should everyone in this room Stand up and clap, clap clap clap. Now if you get that clap you might need some penicillin but great weight loss.

<ChristieNBama> Do you ever do a lap RNY that doesn't require a drain tube and what would allow that patient to have no tube?

<Dr. Simpson> Every physician has a different means of doing the surgery and if they think, you need a tube or a drain, then you do and it may seem nice, so -- do that.

<Stacie S> Where did you get your sense of humor?

<Dr. Simpson> From my dad -- he gave it to me after his heart attack, which surprised all of us because we didn't know that he had a heart.

<Michele> I am pre-op, do you think the long-term success rate it better than other options?

<Dr. Simpson> Long term success of surgery is better than all other options--- so go for it.

<Helene> I'm having lap RNY the end of July, but thinking I may have a hernia, would this be able to be repaired laprascopically at the same time?

<Dr. Simpson> They probably can do both at the same time, but that is something for the surgeon to determine and they may not be able to if it is too large to be corrected with a patch. However, there is a type of patch which results in less infection, a type of mesh made from pig collagen.

<Patty> After surgery springing a leak could be fatal. What are the symptoms that one might have a leak?

<Dr. Simpson> It is pretty obvious when you have a leak, you get very sick. Of course all of this is in my book, which can be purchased at www.obesitydr.com, another shameless plug.

<ghost> if you get lap surgery done do you find the skin bounces back better than quick weight loss surgery?

<Dr. Simpson> We work on you until a quarter can bounce off your skin. Oh, that is making beds in the Navy. It does not matter what type of surgery or the approach to surgery, what matters is your genetic predisposition as well as you doing some exercises to help get the skin taught.

<glendasue> is their a bmi at which most surgeons must perform the rny as open

<Dr. Simpson> Yes -- once the bmi is too high it is almost impossible to do a laparoscopic surgery, every person is a bit different, but some cannot be done. So, some individuals can be done but must lose weight to have it done through a scope.

<jojo> Do you still feel like eating compulsively after the surgery?

<Dr. Simpson> Yes, we do correct the gut, but we do not correct the brain. Eating disorders are eating disorders, and they are not something that we can correct when we correct the gut what happens is that we help you feel full faster but you will still want to eat and believe it or not. Thin mints don't make you thin.

<Shirley 12wks-55> Is 55lbs a good loss for 12 wks out

<Dr. Simpson> Yes it is a good weight loss for 12 weeks -- just keep it up, now is the time to start a vigorous walking program, three miles a day, and fast, and make good selections for food and learn about nutrition. Your weight loss will improve as you increase your activity. So go for it.

<Sandy Lizard Tucson> how young is too young for WLS surgery?

<Dr. Simpson> Too young for WLS -- most of us do not do patients under the age of 13. I don't do anyone less than 15 years of age but we all have different standards.

<kay> What is the reason for having a bone density test of forearm before surgery?

<Dr. Simpson> It is always good to see what your bone density is because then we can follow it and make certain that you are getting enough calcium.

<Patty> Is a medical alert bracelet needed after WLS?

<Dr. Simpson> Not at all, although a lot of people seem to like them, I think if you are going to wear a bracelet, get a nice diamond one from Tiffany's and forget the medical alert ones.

<Suzi Q> Is there any type of lotion or oil (or combination) that will help with skin problems?

<Dr. Simpson> It depends on the skin problem that you have and some skin problems are related to other issues, so that is something for the skin doctors like a dermatologist to examine and determine, not me. However, for major skin problems I suggest that you take your vitamins, and take a nice hot bath once a day followed by a massage and then once you are done with that -- call the pool boy over to get you a drink oops-- again, wrong chat room.

<kay> after surgery Ive heard it can shorten your life 10 to 15 years is this true?

<Dr. Simpson> There is no basis for that whatsoever. If you die from surgery your life will be shortened, if you don't then you will live longer because of not having the obesity. Obesity will shorten your life.

<Nancy> I am scheduled to have lap RNY the middle of this month. I would like to know what is the difference between lap and open, besides the incisions?

<Dr. Simpson> The incisions, there is a lot of difference in them but not what is done to the guts. So, that is a good thing to look up in a nice reference book about surgery.

<Dr. Simpson> Nikki -- do you know any good books?

<**Moderator**> Well, I hear that YOUR book is excellent! Lots of information!!

<Dr. Simpson> well, there is that one, yes. And where would someone get a copy of that?

<**Moderator**> You can purchase a copy of Dr. Simpson's book at http://www.obesitydr.com

<Dr. Simpson> all proceeds from the book go to the foundation to buy me a new golf club it is also available at the obesityhelp.com bookstore and later this summer or early fall in Amazon.com and Barnes and Noble.

<**Moderator**> Ok, the last question of the evening goes to......

<Dave> I have to decide in the next 8 weeks to have lapocopic or open RNY, I know there is no difference in procedure, but what about time under the general? Is it not true that the shorter the better?

<Dr. Simpson> The shorter is not always better --- and don't think that it is with modern. Anesthesia we like short surgeries, but, we want careful and what happens in the operating room can affect you for years, the advantage that laparoscopic surgery has is that you have faster recovery, and you have less scar tissue inside the abdomen so overall it is better for you to have it, you also have fewer hernias and you don't want a hernia.

<**Moderator**>Thank you all for joining us this evening. To learn more about Dr. Simpson, please visit his website. http://www.drsimpson.com/, or call 602-234-8998 to schedule a consult. You can get his book at www.obesitydr.com.

<Dr. Simpson> I am sorry that I missed the last few weeks, it has been busy traveling around the country. Thank you all for allowing me to spend time with you on a Friday. I hope to see some of you, if not all of you next week. Good night.