June 25, 2004

<Moderator> Thanks for joining us for tonight's chat w/ Dr. Simpson. We will begin in about 20 mins. Simply enter your questions and hit enter and they will be submitted to the dr in the order received.

<Dr. Simpson> Hello all, let us get down to business and answer a few questions. Just remember, there are no stupid questions, but there are some ignorant inquisitors.

<Alletha> I had rny surgery 8 mos ago. I have literally been able to eat anything and everything for the last month. My surgeon says that my stoma is probably enlarged, what does this mean and what is the treatment for it?

<Dr. Simpson> The only way to tell if the stoma is enlarged is to look at it with some endoscopy and measure it. If the stoma is enlarged -- and the stoma is the opening between the stomach and the small bowel, then food goes through quickly and you do not have a feeling of fullness and food will digest quickly, and you can eat a lot. However, if the stoma is enlarged, you can have the gastroenterologist place some solution in the stoma, which will cause it to scar down a bit -- although not all GI docs can do this -- it can save an operation. Good luck.

<JENNY FOX> hi my surgery is 2 years old I still have 30 pounds to lose so far I have lost 370 pounds but I am at a stand still for 7 mos what can I do to get it moving again

<Dr. Simpson> That is a great weight loss--- in fact, everyone stand up and clap (clap clap clap), good job!!!!!! To get moving again is simple: you get moving --- and that means you need to increase your caloric output, which,simply said -- WALK...... walk, walk, walk, and walk, some more. In order to lose weight you have to spend more calories than you consume as you go through the weight loss post operative period your pouch or stomach will enlarge over time and you will be able to eat more and more things. So, it is important to learn to change some of the choices that you make but simple things, nothing too drastic, you have already done the drastic thing but the most important key is to increase your physical activity, and now with those 370 pounds gone, I imagine doing things is a lot easier than it was before, so-- walk. Good luck, and great job so far!

<Jennifer> I can not stand the taste of meat anymore, chicken or beef. What would be the best way for me to get my protein in, since the smell and taste of meat makes me sick? Protein drinks?

<Dr. Simpson> I guess I would stop trying to cook the cat food, or the cat, and it isn't uncommon for tastes to change, and the smell of some things to be difficult to take-- we call this phase the bionic nose. Protein comes in a lot of sources-- and no doubt soy products will not bother you in the early period. F or example, bocca burgers make a good choice, the other way is shakes, however I prefer solid food, as shakes do not stick with you as long--- and keep you feeling full. Other things to try are various forms of seafood-- fish, shrimp, and finally you will find that if you add some salsa, capers, or balsamic vinegar to things it will wake up those taste buds. Don't worry, you will be able to tolerate meat again-- until then, cheese, eggs, tuna fish, cottage cheese (or a house cheese if the cottage is too small) and there are a whole lot of places you can obtain protein. Good luck.

<mel> hi doc, I am now 17 mths post op rny and wondering why is it, I can eat more some days than others, and some times I feel hungry too soon after I have already eaten about an hour later? thanks!!! I am still losing though not as much right still some!

<Dr. Simpson> Everyone experiences being able to eat more some days than other days, and that is very common. Not to worry however, because that is normal and natural -- unlike the hair coloring in mom's hair. Feeling hungry early you have to differentiate between head hunger and real hunger, sometimes your pouch or stomach can put through food quickly, and sometimes if you gulp a lot of liquid quickly you can force food out of the pouch and into the gut and feel hungry again. When you do that, then you need to refill with something benign -- sawdust works well and is readily available at sawmills but you should plan not only our meals, but your snacks to reduce the amount of calories, and increase fiber. Good luck.

<kathleen g> Dr. Simpson: I have experienced an enormous surge of energy since surgery four months ago. Will this last? Right now I am flossing my teeth, typing, watching the news and doing butt squeezes in prep for my hip replacement in two weeks. I am so used to being a slug, this is hard to believe. Thanks.

<Dr. Simpson> The surge of energy that many patients feel post op comes because you are able to sleep through the night, many obese patients have a degree of sleep apnea-- that is, they stop breathing at night and in order for their brain to get oxygen they have to partially wake up and hence, they are tired a lot, and it contributes to further obesity as you lose weight that goes away, and patients feel this great new energy in their lives and have the urge to floss their teeth. That is great news--- keep up the good work, and good luck with the new hips.

<kathleen g> Dr. Simpson: Is there an increased instance of kidney stones/problems after WLS? Thank you.

<Dr. Simpson> There can be, the reason that people get kidney stones-- or develop kidney stones is that there is not enough calcium in the colon -- and the oxalate is then bound to sodium and transported across the colon into the blood stream. Once sodium oxalate is in the blood, sodium is traded for calcium and you have calcium oxalate which is filtered in the kidneys and can precipitate out as a stone. How to prevent it is simply to increase the amount of dietary calcium or supplemental calcium that you take strange that calcium actually prevents calcium stones, but that is how it works and it doesn't matter what form of calcium you use for this-- Tums works as well as the more expensive stuff. This is particularly a problem with distal bypass patients or patients who have had either a BPD or DS (biliopancreatic diversion, or duodenal switch). Good question.

<kathleen g> Dr. Simpson: I am having hip replacement surgery soon and was told by my bariatric surgeon that because of my bypass/short bowel, coumadin will be especially powerful and thin my blood way-way too much when taken in the normal amount. Have you found this to be true? Thank you.

<Dr. Simpson> The great thing about coumadin is that you can measure it in the blood and adjust the amount that is taken, so it is something that can be measured and followed easily. So it is not something to worry about, it is something to measure and follow. Good luck.

<Deanna A> How much harder is it for someone who is allergic to aspartame (nutrasweet) to follow the diet that needs to be followed for the weight loss?

<Dr. Simpson> It isn't a problem at all because nutrasweet is not essential to weight loss surgery, you can sweeten with many things-- including splenda and there are other things-- one does not have to be artificially sweetened or you could use my finger and stir it in a drink, because I am very sweet. Good luck.

<Peggy Jones> How important do you feel after care is to a WLS patient. Do you feel it is the PCP's reposibility or the surgeons?

<Dr. Simpson> After care is critical to the surgery and the success of the surgery, it is not the responsibility of the PCP although many are doing that, which is why many PCP need a good resource to determine what patients need and patients need a resource to find out what they need and it just so happens that we have that resource.

<Lisa> Dr. who decides what surgery to perform on the pt? I mean do you give your patients the option of a surgeries you perform or do you just determine based on weight and eating habits what is best?

<Dr. Simpson> Many physicians only do one or two surgeries. So, often times the surgery that is done is what the surgeon is comfortable doing. For many that is the RNY, and only the RNY -- which is a great surgery, some offer more. In that case it is preference for the surgeon, sometimes it is what the insurance company will cover and sometimes a patient has a strong idea about what they want and have to listen to the surgeon talk to them about other options which might be more appropriate for the patient. The really smart ones research the options, the surgeons and what they offer and of course --- obesityhelp.com is a great resource for this as is the book.

<Andrea G(ND)> how soon after surgery do you need to restart protein supplements??

<Dr. Simpson> You may not need protein supplements at all. Some do, if they are not taking in enough protein, and the only way to know what you are taking in is to measure what you are eating, and see how much you are taking in -- you cannot manage what you cannot measure. So, figure out what you are taking in first, and discuss it with your doctor or nutritionist, and see if you need something more. Good luck.

<shishie> Are there any problems with strenuous exercise after getting a bypass? For example, taking in enough fluids during a marathon.

<Dr. Simpson> I think protein shakes taste no where near as good as real milk shakes. Anyone who does a marathon is nuts in my book but that is a personal opinion, and just because someone thinks they want to run 26 miles probably won't get them committed, you can get in enough water after the surgery to do such silly sports as that or sky diving without a parachute. The only thing is you have to wait a while until the incision is fully healed---- which might be months-- in order to avoid getting a hernia. Good luck. Forget the marathon-- just walk.

<Mare> While researching this surgery, I found that most people are able to get off medication for diabetes. Is this true?

<Dr. Simpson> If you lose weight you will have less requirements for insulin, and less requirements for many medicines for diabetes. Not everyone-- but many will reduce and some will get off the medicine completely. However, some diabetics (type I) will always need insulin. Good luck.

<Dr. Simpson> By the way, for those who want to check out the book --- which is listed above, you can also go to my website. www.obesitydr.com and read a bit about the book, it is a comprehensive guide to all types of weight loss surgery, what to expect before and during and after surgery and it does have a bit of humor-- although there is a lot of serious stuff (notice I used the word stuff here) in the book.

<Beth> My mother in law is about 5'4 and weighs about 240 lbs. She has diabetes and CHF. Would she be able to have surgery or does the CHF knock her out of the running?

<Dr. Simpson> The CHF may or may not. That is something to discuss with her cardiologist and the surgeon, sometimes weight loss will improve cardiac function (imagine not pumping against that extra hundred pounds) and is not contraindicated, sometimes a less invasive choice, like the lap-band would be useful for her. Good luck.

<Randy> I am also looking into having surgery. What are some of the risks associated with the lapband?

<Dr. Simpson> The lap band has specific risks of: erosion of the band into the stomach, or prolapse of the stomach around the band. However, over all the lap band is safer than any other weight loss surgery, and can be done quickly and easily by most lap band surgeons. The risks specific to the lap band have to do with it being a device, and like all devices it can fold, spindle, or mutilate, it can become infected. Still, it is safer than RNY or DS for weight loss.

<stcynghty1> hello I had surgery on June 4 2003 and I weighed myself today and found that I have gained 5 pounds. I am worried that maybe I hurt the pouch some how or stretched it or something or if it's because I stopped exercising and am making bad food choices please help?

<Dr. Simpson> Well, I don't think making a bad food choice or stopping exercise will cause the pouch to stretch. However, those are things you will need to deal with, because the pouch is a tool it is not a solution to weight loss, and you will be thinking and fighting food choices for your entire life. So use the tool, learn about food, and for the love of Pete -- get out and walk more.

<honskee> dr having surgery aug 15 very anxious is this normal

<Dr. Simpson> Nope, no one is very anxious about surgery -- everyone feels comfortable with someone putting a knife to the belly and someone else strapping a mask on and putting you to sleep wondering if they will ever wake up again, knowing that they will wake up and things will be different. No, anxiety isn't normal at all.

<Kari> Dr. Simpson, PLEASE tell me about the whole "pouch stretching" thing...I see so many people say "soda will stretch it, too much food will stretch it, a full moon will stretch it...PLEASE clear this up for me!! I'm going back on the message board with your wisdom and try to stop the insanity!! thanks

<Dr. Simpson> I doubt soda will stretch a pouch unless you cannot or will not burp. A full moon will stretch it -- no stretching actually comes from constant and persistent stuffing the pouch with more food than it was designed to hold. The message boards are filled with insanity -- and say hi to my insane friends there, and tell them to buy my book, which has truth and wisdom, and forget about trying to listen to old wives tales from old husbands.

<honskee> dr having open is this still common

<Dr. Simpson> Open surgery is common, and is still done in a lot of places, and not to worry about that. Open works well as laparoscopic, and is still the most common surgery performed. Lap is nice, and so is open.

<Andrea G(ND)> what is the difference between RNY and the fobi pouch surgeries???

<Dr. Simpson> Fobi is a modified version of the RNY procedure and has a cute extra step or two involved in it, nothing that has any proof that it works any better than the standard RNY, unless you ask Fobi or one of his followers --- disciples. Nice pictures of this are on the website here and in the book.

<Andrea G(ND)> are there restrictions on how much fruit you can have after surgery???

<Dr. Simpson> I am certain after a RNY it would be impossible to eat a watermelon whole, fruit problems come from the pulp, or fiber in the fruit, which can, with the RNY, develop a bezoar. Which is like a hair ball. So, that is why some surgeons ask that their patients DO NOT eat fruit with fiber, which would never be a problem with me, since I don't eat fiber, this is also touted as the reason some surgeons prefer the duodenal switch because the fiber is not a problem with this operation.

<Yvonne> I am preop and would like to know how much hair I can expect to loose after surgery.

<Dr. Simpson> Depends on a lot of things, not always the surgery, and not always the type of shampoo you decide to put on your head, some of my patients put so much junk on their hair it reminds me of a New jersey Toxic chemical dump, of course people from NJ tell me that isn't so, there is nothing in Jersey as toxic as these folks hair. Hair loss has to do with stress at the time of surgery and follicular regeneration. Hence, you will have hair loss about three months after surgery and several months later it will come back richer and fuller than before. So, only 30 per cent experience hair loss. The rest use super glue.

<Jeff> How often should labs be drawn for a rny patient? I had rny over 6 mos ago and my surgeon has not ordered them. Should I be concerned?

<Dr. Simpson> I don't know if you should be concerned or not, many patients do not need labs drawn, but we do need to monitor them. We have various recommendations depending on the type of surgery, and so forth but at six months, you should have a good labs like a CBC and a BMP or CMP.

<Carol McLeod> Is there things I can do BEFORE the surgery to prepare me better for the transition?

<Dr. Simpson> Walk, take vitamins and that is probably about it, walk some more.

<Yvonne> After surgery, do they give you any meds. to help you from being sick? I think of the stitches, throwing up, and the pain...and worry

<Dr. Simpson> They have a lot of things which can be done for post operative surgery and we do them, and we like doing them, so don't worry -- we will watch out for you, honest.

<Karee> What percent of rny patients have to have revisions and reversals??

<Dr. Simpson> Hard to say what percent-- not too many about five per cent.

<Crissy> I am 5 months post op and just found out I am 2 mos pregnant. What should I do?

<Dr. Simpson> Enjoy the kids, you need to be in contact with a good perinatologist and the surgeon. You need to have blood levels checked all the time of certain vitamins and minerals, especially folate.

<Moderator> Sorry that's all the time we have this evening. Thank you Dr. Simpson for another informative chat. For more info you can contact him at 602-234-8995 or http://www.drsimpson.com. Dont forget Dr. Simpson's book available at the obesityhelp.com store. Have a great evening.