July 2, 2004

<Moderator> For those of you just arriving, if you would like to ask Dr. Simpson a question, please type it out and hit enter and it will be submitted to the moderator.

<Donna> Dr. S I am 3 and 1/2 weeks post and at the top of my incision which was done open, I have lots of tightness is this normal?

<Dr. Simpson> Yes-- it is normal-- you will feel tight- and tight is a good thing, better than loose.

<stcynghty1> hello doc i had surgery on june 4 2003 and have lost 142 lbs so far i gained about 7 pounds and haven't had a period in 2 months could my weight gain be caused by the water weight i'm not loosing because of no period?

<Dr. Simpson> It could be gained because of the pregnancy or perhaps not but the seven pound weight gain is probably not water weight. It is probably weight from something else so the next step is to walk, walk, walk, and then walk some more. But, I do think that the 142 lbs is a great result and I will clap for you but I have to type. Everyone in the room can clap, come on -- clap.

<chappy> I am 19 month out of surgery, when should I consider seeing a plastic surgeon

<Dr. Simpson> Well, if you need to see a plastic surgeon, then go for it. However, if you are still in weight loss then you should wait for a while until the weight stabilizes, and remember those saline filled implants will cause you to gain some weight.

<Dee> How many ounces max should I be eating at 3 weeks out (pureed stage)

<Dr. Simpson> Well, the puree food will go through very quickly and you can drink/eat a lot of that without it really putting a stretch on the pouch and if you can, then you can. But remember the pouch is something that works with solid food, not something that works so well with puree food. So, don't worry -- just make certain that you have your protein, your vitamins and that your caloric intake is not over a thousand during this stage. Good luck.

<stef1851> i just found out yesterday that I'm scheduled for surgery on 16 Jul if I pass all the tests---am having open RNY---I am most concerned with loosing my hair and the problems with excess skin-----any suggestions on what I can start doing now that would help? thanks

<Dr. Simpson> What you can start doing now is to walk a lot and in terms of hair loss, not everyone gets it, but those who do find that if they avoid hair coloring, perms, and putting other toxic waste into their head have less a problem with loss than those who put most of stuff, some people think that protein does have the problem and if you do not have protein in the mix, you will have more loss than not but, no nothing you can do at this point. Walk, and when the hair falls out-- use super glue.

<Arissa> Hello Dr. Simpson, I was wondering if there ever is a danger of losing too much weight and what to do if that happened? I am pre op

<Dr. Simpson> The only way you can lose too much weight is if you have cancer, some other disease or you have a bad infection (HIV) and some weight loss is good, there isn't too much, but there can be. Gradual loss is fine-- but that isn't a reason to slow down weight loss with Dunkin Donuts.

<DonnaL> Dr.Simpson I have just been approved for WLS. I would like to ask if I should try to lose wt before the surgery or not worry about it

<Dr. Simpson> It is always a good thing to lose weight before surgery because if you do the "last supper syndrome", you might end up with an enlarged liver and you might end up with more problems, plus the weight that you lose ahead of surgery stays off. So go for it.

<Christine> How many weeks post op should a person be, before they can start doing protein shakes/bars?

<Dr. Simpson> It depends on the surgery that you have, and you might not even need the protein supplements. If you have enough protein from your groceries, then you don't have to drink that liquid sawdust. Sometimes people do need it. Essentially when your surgeon allows you to go into full liquids you can start drinking shakes.

<DebbieC> how long after surgery should we wait to drink alcohol?

<Dr. Simpson> That is a good question, because alcohol is one of those things that doesn't do you much good and has a lot of empty calories, doesn't matter about carbs either cause the calories in alcohol is in alcohol but, it is easy to drink alcohol after most weight loss surgeries, and in fact one of the ways that people regain weight is to drink a lot. So it is something to be careful of when you can drink-- about the six week mark.

<Lila> Dr. I am looking into having the DS procedure. Can you tell me the difference between this bypass and the rny?

<Dr. Simpson> Sure I can. Oh, you want me to the RNY is an opening made between the upper part of the stomach and the small bowel. The DS it is made to the duodenum., the DS utilizes the entire stomach and has a larger reservoir. I can draw it better than tell it, and the best discussion of the similarities and differences of these two is -- honestly -- in my book. www.obesitydr.com is the website to see some of it, not that I am trying to sell a book or two but, really there is a lot of good information in the differences between them.

<JULY 19THPEGGY> HOW MANY DAYS SHOULD I EXPECT TO STAY IN THE HOSPITAL, PROVIDED THERE ARE NO COMPLICATIONS

<Dr. Simpson> Well, That is a good question: if you have a lap band you can be out of the hospital in eight hours if it is a lap RNY one to three days, DS same if lap ---- open three to five days post op, if I am your surgeon, then we get you out quickly. Some surgeons like keeping an eye on you longer -- unless it is Friday, then we all discharge you so we don't have to round on the weekend-- just kidding.

<Amy> Dr. Simpson you told me last week that if my stoma was enlarged, there is a non surgical procedure that will take care of this. My surgeon wants to do a surgical revision, should I be concerned he has not discussed this non surgical method with me?

<Dr. Simpson> There is --- a gastroenterologist can scope you and inject some sclerotherapy solution into the area to scar down the stoma and that would be done as an outpatient.

<CHRIS-LAPBAND-275=AZ> WHATS YPUT TAKE ON THE BAND

<Dr. Simpson> The band is going to take over as the major weight loss operation in the United States within a few years and because of the new data coming out showing that you can have equal results after a few years. So, it is something that is here to stay, it is the major operation for weight loss in Europe and in Australia and while it has gotten bad press, it is going to be here to stay. That is my take on the band, and I didn't like the band at one time and now--- I like the band. Rock and roll band is my favorite.

<Emily> My aunt has had rny and I am looking into having it done. I am only 16 yrs old, but feel that I need to do something now, or I will be as big as she was. Is it uncommon for a 16 yr old to get surgery? Where do I start?

<Dr. Simpson> You start with a surgeon and your pediatrician and it is something which you can do at age 16, and I like it that you are motivated and want to do something. So, good luck.

<JULY 19THPEGGY> WHAT QUESTIONS SHOULD I HAVE FOR THE DIETICIAN?

<Dr. Simpson> You should learn as much as you can about nutrition and what choices you should make for example learn about high glycemic index foods and what carbs are good and bad and why Atkins is not quite better than anything. So, learn as much as you can it is about choices, not about depravation. Although I am depraved. Not deprived.

<Kathy> Being 6 foot and 400 albs, I know that the gastric surgery is my only hope. But, what I don't know is what procedure. Which is best fo rme? I have no health problems, other than high bp.

<Dr. Simpson> I think that you should grow taller that way you won't need surgery. The best surgery that you can have is the one that your surgeon does, all surgeries work quite well and so there is none that works better than another, although all will say their surgery is the best but that is like a religion.

<Laura> I was just wondering what I can expect right after surgery and for the first couple of weeks after surgery as far as eating is concerned

<Dr. Simpson> The first couple of weeks is going to be a rough time and depending on the surgery that you have will depend on what you will be eating. For example, if you have a lap band you will be on clear liquids for a week followed by full liquids for a week, then you you have soft foods going to more solid foods, but other surgeries have different ways to go through the process. Of course, the best way to find the post op diets is to ask your surgeon, and if they don't know, there is a great book available that you can read. The main thing is this: treat your new stomach like a baby stomach and you have some things that will not go down well one day and another day they will go down quite well. There is a simple progression which works well, that is swim, fly, walk. Those things that swim work well the first month, those things that fly (some chickens do fly, and so I count those) then those things that walk. Now-- things that don't sit well are fried foods, and overcooked foods. Good luck.

<Sandra> I am almost 4 wks. post op and I've heard alot of people say they can barely eat 3/4 of a scrambled egg. I can eat about an egg and 1/2. Could they have made my pouch too big?

<Dr. Simpson> I doubt it, everyone can eat different amounts, and it is dependent on a couple of things. First of all, you should measure what you eat, instead of trying to test how much you can eat. Measure twice and eat once and vomit never -- or never stretch the pouch, just got off the phone with Eric and JC, so I can type faster as I don't have to use my fingers to illustrate points so don't worry if you can eat more one day than other--- but DO NOT PUSH IT. One egg is plenty -- for me, and I have a 50 ounce stomach. ONE EGG IS PLENTY, good luck.

<JULY 19THPEGGY> WOULD YOU RECOMMEND THE B-12 INJECTIONS OR A PILL AFTER SURGERY

<Dr. Simpson> Pills do not always work well and if you need B12-- and not everyone does--- then the sublingual form is good, which means under the tongue, but I cannot say that because as a doctor I have to use big words, a pill is a waste -- so use the under the tongue method but only IF you need B12-- and the only way to know if you need it is to have the lab tests done, once you have the lab tests done and if you DONT need it then DONT take it, B12 shots are a pain in the (nevermind).

<Dr. Simpson> Forth of July weekend, eh? hope you are all going to eat some healthy stuff and do a lot of playing.

<Lisa R> I had rny surgery 6 yrs ago. Surgeon told me that this would cure my PCOS. it has not. I am still having fertility issues as well as hormonal problems. Have I just not lost enough weight or what?

<Dr. Simpson> Well, PCOS is sometimes relieved with weight loss surgery and certainly obesity is related strongly to PCOS (which is poly cystic ovarian syndrome) for those who are trying to figure this out-- and it is a painful condition for women, very few men get it although I am having these pains down there---- anyway, like all conditions that are made worse with obesity and improved with weight loss---- not everything is CURED when you lose all the excess weight. After all, skinny people develop PCOS---- just like skinny folks get high blood pressure, heart disease and diabetes but if you still have weight to lose-- then losing it will certainly help, but may not cure.

<cali pre op 19 days> hello dr. thanks for being here with us, my question is this, I got my date today and was informed they need to remove my gallbladder as well and although i realize this is normal..what is it a glallbladder does anyway?

<Dr. Simpson> The gallbladder is a storage unit for bile, and if you lose weight the bile in the gallbladder can crystallize and make stones, which are not fun to have and the other main function for the gallbladder is to keep surgeons in shoes.

<chappy> with the open RNY how much will the pouch stretch over time?

<Dr. Simpson> Up to 8 to 12 ounces, although it does not affect weight loss remember the stomach is much larger.

<Arissa> I have just recently been diagnosed with hypothyroidism, how will this affect me as a candidate for WLS?

<Dr. Simpson> It wont affect you at all.

<JULY 19THPEGGY> SOME PEOPLE THAT ARE POST OP SAY WALK AS MUCH AS YOU CAN AS SOON AS YOU CAN? IS THIS WISE RIGHT AFTER SURGERY?

<Dr. Simpson> It is not only wise, but proper and will keep you from being a slug, and from getting bad things like a pulmonary embolism.. There is no reason not to walk after surgery and every reason to walk so get up after the recovery room, and walk, and walk. You won't harm yourself, and you will feel better when you do it and once you get home and start a walking program, you will find the weight will come off easier, you will sleep better, and you will love life a lot better. Don't forget to bring dog cookies with you in case some doggie needs a treat.

<brian> do lap rny's lose weight as well as open rny's

<Dr. Simpson> They do, and there is no difference, it is the same operation, just different ways of doing it.

<haw> I have no medical need to have the sergary. but i'm at high risk for hart and diabites. i have a bmi of 48.6. would it worth my time to look in to seeing a dr..

<Dr. Simpson> You have a medical need to have surgery -- you are morbidly obese. So, yes, it is worthwhile to see a physician to discuss the surgery because if you have a BMI over 40 then you qualify, and you will benefit from weight loss surgery.

<cali pre op 19 days> do you recommend giving up caffiene and does it have any effect on results of wls

<Dr. Simpson> Caffeine has no effect on weight loss, however it can stimulate the appetite so some surgeons do not like it--- me, I like my patients drinking coffee as they round the nurses station the day of surgery but then again, I am Norwegian, and as a Norske we think coffee is an essential nutrient.

<bks> hi doc, I was wonderign now that I am 17 mths post op, how many calories should I be eating so I ,can get these last 10# off?And also the debate continues, Can diet soda caffiene free ofcourse, really stretch out the pouch? thanks!

<Dr. Simpson> Soda cannot stretch the pouch unless you can't burp. If you want to lose those last ten pounds then start walking, and the best thing to do is to know how many calories you are burning per day or that I recommend a little device called a healthwear band which is made by Roche diagnostics, www.healthwear.com is where you will find it. So go there and read about it after the chat, which should be ending in about two more questions.

<kathleen g> Dr Simpson, when we go to bed at night at one weight, then weigh five pounds lighter the next morning, where does that five pounds go? Is it all flushed away? Just curious. Thank you.

<Dr. Simpson> Not even a clue here,could be that your soul has left you and it weighed 5 pounds instead of 28 ounces,so you might be a heavy soul. Coltrane is heavy soul although I like Barry White. But that is another discussion.

<Moderator> and the final ? goes to

<Amber> Hello, I was wondering if having sleep apnea can cause higher risk factors when going under anesthesia?

<Dr. Simpson> No, under anesthesia someone is breathing for you, and watching your every breath-- a doctor no less, so that is the safest thing for you.

<Moderator> Thanks Dr Simpson for another amazing chat we appreciate it. For more information go to www.drsimpson.com or check out his book at the ObesityHelp store.

<Dr. Simpson> Thanks for the day, have a good fourth.

<Moderator> Good night everyone.