June 11, 2004

<**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.

<Deanna> What kinds of complications can I expect after surgery? I don't want to think that I am the only person who has ever experienced a particular problem.

<Dr. Simpson> There is a large list of problems that you can have. The first being that you will become thin and everyone will envy you so you will lose friends, you will have to find a new lover and then you will have to have other things: the typical complications are ---- wound infections, stomal ulcerations, adhesions, blockages, diarrhea, constipation... halitosis, and a few other things --- heart problems, lung problems, kidney problems --- problems with your clothes, because you have to always buy new ones and lead poisoning -- because a jealous lover will shoot you. Of course, a beautiful chapter about the risks of this surgery is provided in www.obesitydr.com. Thanks.

<Karen Smith> How long after surgery can you stop worrying about complications. Do I have the flu or is it something with my new pouch. Do you prescribe pepcid or prevacid after surgery. I had open rny.

<Dr. Simpson> Hello Karen, I think you can stop worrying about some complications a couple of weeks later but things like adhesions will be a potential problem for your entire life, and long term things like needing vitamins, minerals -- like iron, may be there and yes, I like medicine to decrease acid in the pouch and pouchitis is a common problem after surgery. So, go forth and multiply.

<kathleen g> Dr. Simpson: I have been told that the action of mucous backing up ones throat into the mouth is called "frothing" and an indication that not enough protein is being consumed. In your opinion, is this correct? Thanks.

<Dr. Simpson> No frothing occurs when you get rabies so check your tags and make certain that your shots are up to date --- oh there I go, wrong room -- is this the doggie room???? Frothing happens when you overeat the pouch -- and you produce an abundant amount of saliva and it gets better with time, and a bit of protein never hurts. Here kitty kitty.

<marcia> I have the lap band and have lost 32 lbs in 7 weeks...I love my band. My question is how do you know if you are at your "sweet spot"??

<Dr. Simpson> When the drive goes straight and long down the fairway, with a mild draw. Oh, that's the sweet spot in golf. When you find you no longer feel a restriction, and that you are beginning to be able to eat a whole lot more, and not feel full like you did before. Then you need a fill. You are sweet when you no longer need fills, and are maintaining on your own with only a little help from the good doctor to give you encouragement and comment about your tan.

<kathleen g> Dr. Simpson: Have you decided in which order you will publish your next two books? Will you be doing a coast-to-coast book tour? Thanks.

<Dr. Simpson> I am meeting my publicity agent for cocktails once this chat is finished. And the next book is for the long term post op. I am writing a fiction tale also, not to mention a book about boards of directors. Alas, a writers work is never done and the tour -- yup, it is coming, in fact I hope to be with obesityhelp.com as we both go through the country meeting all of you nice people and hearing your experiences, and having a laugh or seventeen.

<Amy~Butterfly> What would you suggest if you had a pill get stuck?

<Dr. Simpson> Crush the pill next time. It will dissolve eventually and flush it with lots of water. Don't try to vomit it out vomiting is not a good thing-- except for Hollywood stars, crush the pill -- put a bit of Splenda on it, and take it with some water. Good luck

<LindaNY> Have you ever had patients who have had Gastric bypass surgery and have developed fluid around the incision several months after the surgery? Thanks for your time.

<Dr. Simpson> I have had patients who develop all sorts of strange things, and getting that fluid -- also known as a seroma, has occurred but strange things happen to patients, and I am never surprised to see what can happen and does enjoying their life.

<kritter> I've tried thru 2 appeals to get approval. I was told by my G. P. Doctor that he will not try again. It's not worth his time. He doesn't get paid to write letters. Am I being selfish for being upset with him?

<Dr. Simpson> No, his office doesn't get paid to write appeal letters, but there are people you can hire who do, such as obesitylaw.com where they do this for a living. Some physician offices charge for appeal letters, some do not, but most do and should. It takes a great deal of time and effort from the staff to do that. So, check with www.obesitylaw.com.

<Amy~Butterfly> Why is every surgeon's postop menu different? Some have liquids longer than other, what is the healing time for your pouch?

<Dr. Simpson> It is all different because they have not read the definitive authority about weight loss surgery: which is -- Ok--the authority for the book can be found at www.obesitydr.com. The pouch will heal after a few weeks, although the stomach will become upset from time to time. Many do not have uniformity, but they should, and can.

<anne> WHY DO WE DUMP ON SUGAR AND SUGAR ALCOHOLS

<Dr. Simpson> Dumping is caused by the sugar breaking down in the intestine-- and sugar alcohols do this also-- and they breakdown to form many products. These breakdown products have to be diluted, so the body sends in fluid to the intestine. When that excess fluid comes in people feel clammy and a bit light headed, cause the fluid comes from the blood stream, then once the fluid is there, you start to move-- and I mean move, so many people will have diarrhea --- and that complex-- or parts of it, is called "dumping"

<Bev> Dr. Simpson can you tell me if not having a fistula repaired is a danger?

<Dr. Simpson> Surgery is always a danger --- and so that has to be weighed (pardon the pun) against the potential benefit of having the surgery done. It depends on where the fistula is located, and what symptoms it is causing. Sometimes we have to repair them to save a life, which is our primary purpose is to save lives, we love to save lives. God save the doctor.

<Amy~Butterfly> What form of birth control do you recommend for patients postop, is there a concern for malabsorbing the pill?

<Dr. Simpson> No sex for 17 years. The pill may not be absorbed in an adequate amount, so we recommend mechanical forms of birth control-- such as condoms and spermacide, as well as IUD devices. And check with the local gynecologist (are they really ecologists) for more information. Or you could just have the male counterpart neutered.

<mike> How long does the hair falling out stage last? And why does this happen?

<Dr. Simpson> Hair today, gone tomorrow. It happens when you lie to your surgeon, they plant little seeds in the head. When you lie, a few hairs will fall out. Ok-- it lasts for about three to four months and then it comes back richer and fuller than before, no matter what you do, or what you put on it. Do not put on a lot of perms, or that other stuff--- some of my female patients have more toxic chemicals in their hair than was in Love Canal.

<Wendinj> what is your program like?

<Dr. Simpson> HBO, The Sopranos -- if you eat the wrong thing you get whacked. We have great compliance. We have a strong pre operative and post operative program, where we work with nutrition, as well as a number of other issues and support groups, of course. The program also has a physical therapy component to it stretching, and the like.

<Barb> I had a stomach stapling in the late 80's. Lost alot of weight but put alot back on after kids. I am currently still 100 lbs overweight and would like to lose this weight since i am now 44 and its getting harder to lose weight. Can and will my insurance do this again?

<Dr. Simpson> I don't know what your insurance has, or what it will do, but revisions for surgery are something that many insurance companies will cover without a problem, although not all companies will do this. However, I would recommend that you go to a bariatric surgeon who likes doing revisions and does them with some regularity.

<Miz Cass> I am 6 weeks post op and every time I eat I vomit, but was told I have no stricture what else could be the problem?

<Dr. Simpson> You are probably eating too much, or eating the wrong things, or not chewing your food too well. We have a simple saying in weight loss surgery: measure twice, eat once, vomit never. So measure what you eat, plus some foods simply do not settle well for a while, and you may need to change a few things of course, you need to keep up with vitamins and fluids during this time. Good luck

<wendy> hello. I am only 7 days out of surgery today. Silly question, but, everyone has said that they were not hungry at all, and did not want to even think about food. I am hungry and think about food constantly. I am on my 2nd day of protein shakes. please tell me this will go away

<Dr. Simpson> The protein shakes will go away --- you just need to eat more food. Food hunger is something that is different for everyone, and some are hungry. I suspect as you start to take more solid food you will be able to have less hunger pains than you do at this moment. I had the shakes from gin not protein.

<Anita<21dayspostop>> I am 21 days post op for lap rny. I have graduated to full liquid diet but everything I either eat or drink makes me feel like i have heartburn. I sip slowly do not use a straw. HELP!!!!!!!!!!!!

<Dr. Simpson> You may sip slowly, but still sip a lot and things could be there for a while so, I think that you should consider taking a medicine to decrease acid in your stomach, like Pepcid or some other such thing. Gin and tonic

<Miz Cass> How can I tell the differnce between head hunger and actual hunger I am 6 weeks post op and I have a lot of cravings

<Dr. Simpson> Cravings are from the brain, not the gut. We can fix the gut but we cannot fix the brain, so you will have those for a while, and that is normal and expected, and do not worry about those for too long, because they will get better in a few years: if you don't weaken.

<Jill> I am almost 4 months post op and i have lost 50 pounds. Am i in the normal range for loosing weight? I have bad knees so exercise is almost impssible but i am doing some. My protein is in the range and I drink but i know not enough. What can i do to help speed up the weight loss?

<Dr. Simpson> Find a swimming pool and begin water aerobics, and there is no excuse to not do that. Weight loss will be made better with bike riding, and almost anything in terms of activity, do not snack, or plan your snacks to be certain items. Finally, if you want to increase weight loss I suggest that you move more, eat less.

<skso47> How do I know if I have surgery that I'll will be able to control my sweet tooth

<Dr. Simpson> You won't. The desire for sweets is something in your brain, not in your gut. So you will always have it-- the question is to begin to moderate the sweet tooth, to learn to have and enjoy less with it, instead of a bowl of ice cream you should, enjoy a spoonful of ice-cream, instead of a box of thin mints, just one.

<Ursula> I get sharp pains that come only occassionally in my lower stomach and sometime through my rectal area is this normal. Almost like cramps?

<Dr. Simpson> That pain is not normal, and can be one of a hundred things, although in you I would bet it is not your prostate. It could be a urinary tract infection, it could be diveritculitis, it could be some other stuff so have it worked up and checked into.

<LorettaMI-3mo post> Dr S...I am three months post...how much protein should I really be taking in..how much in drinks v/s food?

<Dr. Simpson> It is nice to get all of your protein from food, and if you can that is preferred over a drink however, would say that you need a fair bit of protein, I have a table around here somewhere but, it depends on the surgery, and a few other factors, go to my book and see it in there, you will like it. It is in the appendix.

<Ginger> How safe is the lap band surgery , and is it effective as the other surgeries

<Dr. Simpson> The lap band surgery is the safest of all weight loss surgeries.. And over the course of several years it has been shown to be as effective, if not more effective than the other surgical procedures that are available.

<Miz Cass> what can I use to keep my hair from coming out?

<Dr. Simpson> Super glue. Eat right, drink right, and be nice to your surgeon.

<LorettaMI-3mo post> Is drinking Propel ok...people in the chatroom told me not to drink it today??

<Dr. Simpson> Well the people in the chatroom should not drink Propel, but since you are in this chatroom you can.

<LorettaMI-3mo post> Is it true we do not absorb the full calories of things...how does that work?

<Dr. Simpson> Food passes through the intestine,and as it passes through the intestine, it becomes absorbed. However, the amount that it is absorbed is regulated by things like how far the bolus is from the point of digestion. Some simple sugars you absorb very well, complex carbs you won't, and protein and fats are less well absorbed.

<GERNIC1016> WHAT ARE ADHESIONS?

<Dr. Simpson> Things that make paper stick to other paper, Oh that is adhesives. Adhesions is another word for scar tissue which is occurs after any surgery in the abdomen. They can be bad, because they can bind intestines and cause them to kink off, leading to a bowel obstruction. Adhesions are formed early on after surgery and over time they become smaller. However, they are always there and can cause problems, so we keep an eye out for them.

<Miz Cass> should all medications be in liquid form or is taking pills okay? what would you suggest?

<Dr. Simpson> Depends on the size of the pill and if it can be crushed or not, and if it can be then you can crush the pill and put it in things like apple sauce.

<Jill> My liver is very high about 1,500 my pcp said it would go down in a while. It was high some before surgery i was on lipitor cholestoral medicine could that affect my levels? Is it dangerous to me?

<Dr. Simpson> Livers are not things that you want to fool around with. So weight loss surgery is something that will help you get the liver enzymes back into shape. And as you lose weight you will need to have less Lipitor. So it will be a good thing for you.

<karNJ> Will taking over the counter meds ( Tylenol, Alka Seltzer, Tums etc) and carbonated drinks ( specifically club soda) ever be part of my life again months down the line? Not that I use OTC's a lot, but how do you treat the occasional headache?

<Dr. Simpson> I take a hammer and hit the toe, then the head doesn't bother me as much. But those things are all fine and you can take them. In terms of carbonated drinks --- well, lightly carbonated is ok.

<Doris> How soon after a Roux-en-y can a person be considered for a revision?

<Dr. Simpson> Well, I don't think that you should get a RNY then a revision. I think that you should work with what you have and make it work for you and if there is a problem with the surgery then you need to revise a mechanical problem but if the surgery is fine and you are not losing weight then you need to work on finding what you are eating and how much you are moving. You cannot manage what you cannot measure. Hence I would tell patients needing a revision that they need to get a band from www.healthwear.com

<wendy> Is it normal to feel somewhat down afterwards? I don't feel bad, just not good.

<Dr. Simpson> I feel down myself today--- so we can commiserate together and I will toast you when I have my gin. It is normal to have a little post surgical depression for several reasons. First, it takes a lot out of you, more than you can imagine. Second, the changes in the weight can lead to depression through some complicated mechanism involving lots of hormones and nerve tissue in the brain, and so it is normal, sometimes we recommend that you simply get on some medication. The psychiatrist that you saw before surgery will be helpful now.

<Terri in FL - 47 1/2> Dr. Simpson, I have been continually losing approx. 5 lbs per week for the last 10 weeks, should I expect that to slow down. Lap RNY 3/31

<Dr. Simpson> Weight loss always slows down over time. But if you want to keep it going then you need to move more so I say walk walk walk walk walk walk walk walk walk walk.

<Tina PO 8 weeks> Dr. Simpson, why is it I feel so dam sexy after only losing 35 lbs!!!! I am so beautiful I didnt even know it!!

<Dr. Simpson> Because you are sexy, and now you feel good about yourself, so enjoy it. .I'm too sexy for my shirt-- which is a bowling shirt, but hey -- its the song and the shirt.

<GERNIC1016> CAN WE CHEW GUM AFTER WLS?

<Dr. Simpson> Some say yes, some say no -- I say -- why chew ? Smoke the gum instead.

<Diana Heck> I have never come in contact or heard from anyone who has had a gastric bypass 5 or more years ago. Does any one know how this will affect us long term? Thanks

<Dr. Simpson> I know a lot of people and have a lot of patients who are out that far and long term you do just fine.

<wendy> WW--I am on Zoloft, and cannot STAND it crushed. Can I just swallow it, if I had RNY 1 week ago?

<Dr. Simpson> Probably -- if it gets stuck then you will need to get it out of there and crush it. So, sometimes we have to take a spoonful of splenda to make the medicine go down. Should be a song

<Kathy> What are the advantages to having the lap band as opposed to the Lap Gastric Bypass

<Dr. Simpson> The lap band is less invasive, it is easier on a person, you recover quicker and over the first few years you will eventually catch up with the RNY and pass them.

<Avalon> How does your body know when to stop losing weight?

<Dr. Simpson> When your calories input equal the output. Your body is a perfect calorimeter, and it will keep perfect timing for you so, it will find a way, and then you will be asking me how to lose more weigh and I will tell you to walk more and to eat less.

<Leigh Ann> WHEN SHOULD A PERSON KNOW TO START LOOKING IN TO PS?

<Dr. Simpson> After you have maintained your weight for four months, and feel as if you will need to get rid of the whatever. Pannus envy.

<RagDoll> I had colon surgery last week. What would be a safe period to wait before having WLS? Thanks

<Dr. Simpson> You can have it for about six weeks after at the earliest, usually three to six months.

<melindalopez@aol.com> what is the risk of this surgery?? death rate of rny?

<Dr. Simpson> Death rate of RNY is anywhere from one in fifty to one in two hundred.

<SunnyDisposition> My "byproducts" since surgery have been very light in color. Does this have anything to do with absorption, and if so, how?

<Dr. Simpson> Well, it probably can be from a number of things-- too numerous for this discussion, and something that is a bit gross if you are absorbing your bile then you will probably have that etc.

<Cha> Dr im 6 mo out and a few weeks ago I started getting a cough and thick saliva in my mouth sometimes I gag and heave..nothing comes up but the what feels like phlegm with no color..what is this and what can I do for it?

<Dr. Simpson> The hell if I know. Drink more water so it isn't too thick. Bubbles from eating too much.

<karNJ> Have you lost patients to WLS, if so, how many and are there commonalities with respect to WLS morbidities?

<Dr. Simpson> Yes, I have. Pulmonary embolism is the most common cause world wide, and is something that can occur.

<Tambra Blackmon> I had this surgery January 21, 2004. I had about 100 to 110 lbs to lose. I have only lost 46 lbs so far. I sometimes go weeks without losing. I eat my protein and take my vitamins. I don't fill up on sweet liquids..Is the rest of my weight going to come on off? I am so scared it is not.

<Dr. Simpson> I think that you should continue to walk more and keep walking, and keep walking and get a band from www.healthwear.com so you can see what you are taking in and what you are putting out.

<Nancy> I am set to have surgery this coming Monday, June 14. What would you suggest to be the best things to eat the day before?

<Dr. Simpson> Something light and not lots of fiber --- and as little as possible, and liquids mostly -- not milkshakes. Of course it is all in the book.

<marsha> if you have ibs but not had an attack for along time can you still have bypass surgery. I was told may not be able to because of this

<Dr. Simpson> IBS is not a contraindication to bypass surgery.

<**Moderator**> Last question for Dr Simpson...

<Teresa Snyder> Is it true that after having a Lap Band, any type of soda will stretch it out? Can you have - Diet Soda per week?

<Dr. Simpson> No. No soda for a few weeks. Don't get started on soda. Don't need it, don't want it. But it won't stretch things if you can burp like this braaaaaaaaaaaaaap. Pardon me. Do not ask about the other end.

<**Moderator**> 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. Get the book. All your questions will be answered. It will tell you about life, love, and a boy with his dog. www.obesitydr.com

<**Moderator**> Arizona Bariatric Center Website: http://www.drsimpson.com/. Phone: 602-234-8995. Fax: 602-230-8344.