JULY 11, 2003

<MODERATOR> ATTENTION, WE ARE BEGINNING THE CHAT NOW

<MODERATOR> WELCOME DR. SIMPSON

<Dr. Simpson> Thank you, it is good to be back, it has been a few weeks

<MODERATOR> JOANN YOU HAVE THE FIRST QUESTION FOR TONIGHT:)

<Joann> What kind of wl results can I expect to achieve in a 6 month period with the lap-band procedure?

<Dr. Simpson> There are a few variables, remember any weight loss procedure...

<Dr. Simpson> is dependent partially on the patient==which would be you....

<Dr. Simpson> generally, after the lap band, no fills are put in it for several weeks, so it can heal into place, so a lot of the times a patents will not lose weight right away....

<Dr. Simpson> then it is slowly filled over the next few weeks, and adjustments are made. So, you can expect to lose...

<Dr. Simpson> about thirty per cent excess body weight in six months-- on the conservative side ---

<Dr. Simpson> if you stick to a protein, water, walk regimen you could lose more. Good luck.

<MODERATOR> LORI YOU HAVE THE NEXT QUESTION PLEASE:)

<Lori> Can someone over 400 pounds have the LAP done? What is to be considered? and thanks for being here Dr Simpson :)

<Dr. Simpson> Every surgeon has different requirements for laparoscopy, and if you are to have....

<Dr. Simpson> it done through the scope, then you have to find out what their requirements are....

<Dr. Simpson> one of my good friends, and an excellent laparoscopist, Dr. Andrei, does not lap anyone over a BMI of 50....

<Dr. Simpson> some others do not have that prohibition. Some surgeons will put you on a strict diet before surgery...

<Dr. Simpson> so everyone has a different requirement, and some is based on the body habits 00 how much weight you have in your abdomen...

<Lori> ok, thank you

<Dr. Simpson> as opposed to in your backside. So, check with the surgeon, they are all different. Good luck.

<MODERATOR> SNUGGLES YOU HAVE THE NEXT QUESTION:)

<snuggles in mesa> DR.SIMPSON DO YOU EXCEPT AHCCCS INSURANCE , IF SO WHICH PLANS.....

<Dr. Simpson> I do accept ahcccs plans (which is Arizona's version of Medicaid) and I have no idea which ones....

<Dr. Simpson> all of those plans have some severe restrictions and takes a while to become approved....

<Dr. Simpson> some take much longer than others.

<MODERATOR> GERRY YOU HAVE THE NEXT QUESTION

<gerry/80lbs/3months> is it true that if u keep throwing up(mostly phlem you can get esophogus cancer? and is this normal for three months out and 286/206

<gerry/80lbs/3months> haha

<Dr. Simpson> Throwing up is not entirely normal, although for some folks they have more problems with this than others....

<gerry/80lbs/3months> ok thanks it is not every day

<Dr. Simpson> and no, there is no evidence of esophageal cancer and throwing up are related.....

<gerry/80lbs/3months> ok someone had said that in the chat room

<Dr. Simpson> if you have some problems go over what you are eating with your surgeon, and then make certain that you are not...

<gerry/80lbs/3months> and ive been a nervous wreck evewr since

<gerry/80lbs/3months> ok thank you! :)

<Dr. Simpson> overfilling your stomach, and so forth. There is a lot of stuff said in chatrooms which is bunk...

<Dr. Simpson> and I should know since I say some of it.

<gerry/80lbs/3months> ok i am just a worry wort

<Dr. Simpson> Warts can be dealt with.

<gerry/80lbs/3months> haha

<MODERATOR> MOLLYL YOU HAVE THE NEXT QUESTION PLEASE:)LOL

<MollyI> Hi Dr. Simpson...what are the gradual steps of diet after surgery(RNY)....what should I have ready at home afterwards??

<Dr. Simpson> Every surgeon has a different post op diet program. Most have you on full liquids for a couple of weeks then to a puree diet for four weeks.

<Dr. Simpson> Essentials for the home use are a blender, some good protein drinks, tuna fish, egg whites, and low fat cottage cheese...

<MollyI> k...and a get ready list??

<MollyI> oops sorry

<Dr. Simpson> get rid of the candy, the ice cream, and the high calorie items....

<MollyI> do you recommend any specific protien drinks?

<Dr. Simpson> there are some great new products with cottage cheese and fruit which are good. And there are some other things like sustacal dm pudding...

<Dr. Simpson> no, I don't like protein drinks, I like red meat - beef, elk, possum (fresh on my ford's grill)...

<MollyI> lol

<MollyI> okay thank for your time :)

<Dr. Simpson> isopure is one that is readily available. None of them taste too great, but they will do in a pinch.

<MollyI> any way to make taste better?

<Dr. Simpson> Nope -- no way. You find people who love certain drinks, but there are also people out there who eat dogs.

<MollyI> lol okay lol

<MODERATOR> JOEL KEENE YOU HAVE THE NEXT QUESTION PLEASE:)

<Joel Keene> Hello dr... I am 448 BMI 57.5. Is getting down in weight safer for surgery?... Better chance of less problems with less weight on your body?

<Dr. Simpson> Well, it is always better to have less weight than more weight, so if you can lose weight within a reasonable diet, that would be a good thing...

<Dr. Simpson> eating well, and not often, and having a high protein, low carbohydrate diet, will help you with healing after surgery, and you might as well start...

<Joel Keene> what about diet pill to get under 50BMI

<Dr. Simpson> taking some vitamins, because you will need them. Forget diet pills.

<Joel Keene> ok ty

<MODERATOR> LORI-MD YOU HAVE THE NEXT QUESTION:)

<Lori-MD> I've had lap surgery for cholecystectomy. Is it possible there will be a complication with adhesions during WLS?

<Dr. Simpson> If you have had surgery there are always going to be adhesions with them, the question is how many adhesions and the only way...

<Dr. Simpson> to know that is to look with a scope. So, don't worry, surgeons are use to adhesions -- we don't like them, but we are use to them. ...

<Lori-MD> Okay, thank you Dr. Simpson

<Dr. Simpson> in terms of complications-- well, if we find an adhesion we will rid you of it. The complicating thing is if we miss lunch. Good luck.

<MODERATOR> KIMWARD YOU HAVE THE NEXT QUESTION PLEASE:)

<kimward> How much do we malabsorb when we eat food after having LAP/RNY. I had 75cm bypassed. Does malabsorption effect the amount of calories and carbs we consume? What percentage are we really absorbing?

<Dr. Simpson> 75 cm is a minuscule amount of bypassed gut. In the DS we bypass about 400 cm of bowel. With the proximal bypass it is small...

<Dr. Simpson> but small is OK. So, you should do fine...

<kimward> wow.....w

<MODERATOR> COOL AUNT YOU HAVE THE NEXT QUESTION:)

<cool aunt> thank you for your time. HOW DOES THIS SURGERY WORK FOR PATITENTS WITH IRRB OR SPASTIC COLON PROBLEMS, MONTHLY MENSTRAL CYCLE/

<Dr. Simpson> you will lose weight with the restrictive component-- meaning you will lose weight more from eating less than other stuff.

<Dr. Simpson> It does nothing irritable bowel or spastic colon, although some of my patients think they do better....

<cool aunt> i will am concern because i have a spastic colon

<Dr. Simpson> in terms of the cycle, well, that is going to be there till the ovaries give out or are removed.....

<Dr. Simpson> although as you lose weight you could have a heavy bit of periods for a while, and that is rather common....

<cool aunt> i thought so, but i am so irregular.

<Dr. Simpson> well, you may go from having a period to a comma.

<cool aunt> Thank you for time and answer.

<MODERATOR> GINA YOU HAVE THE NEXT QUESTION:)

<GINA> i would lik e to know why I am so tired after surgery and how much protien is enough, and i am concerned about constipation

<Dr. Simpson> in terms of being tired, that is normal for the first few weeks after surgery-- even up to 12 weeks, but there could be other reasons that you are tired.....

<GINA> yeah but is there something i can eat other than colace to insure movement

<Dr. Simpson> in terms of how much protein is enough, we like to have you increase protein to be somewhere between 40 and 100 grams depending upon the operation and a few other details....

<GINA> per day?

<Dr. Simpson> for DS we like them having more, for RNY proximals, we like them having a little less. Yes, per day, grams per day.

<MODERATOR> TOWEL YOU HAVE THE NEXT QUESTION PLEASE:)

<towel> I am having a Greenfield filter installed, will it be a permanent thing or will it be removed at some point?

<Dr. Simpson> Greenfield filter is a permanent thing. It cannot be removed, it will be there and 5000 years from now when they open up your grave they will find it.

<twyla> ok thanks for your time

<Dr. Simpson> They will probably think you were very rich to have such a thing.

<MODERATOR> TONI YOU HAVE THE NEXT QUESTION

<Toni-> I had an open RYN 5 1/2 months ago...i've lost 77pds, but i've hit a plateau..HELP! I'm eating my protein..and drinking water..and exercising...

<Dr. Simpson> Well, plateaus do happen, and a plateau is several weeks without weight loss --- and often times you can see how you are doing by checking your body fat to see if you are losing the body fat...

<Dr. Simpson> as opposed to not doing anything. So, body fat analysis might help with where you are right now. Otherwise, always...

<Dr. Simpson> increase your walking, decrease your carbohydrate intake, and drink more water.

<Dr. Simpson> or-- protein, water, walk.

<MODERATOR> ARMY-WIFE_MISHIE YOU HAVE THE NEXT QUESTION:)

<army_wife_mishie> I was told the B12 nasal spray is a gel, how does it work? If it is going to go down my throat unlike a mist, is a shot more tolerable?

<Dr. Simpson> Everyone has different things which they like, and can tolerate.. Some like the spray, some like the stuff that goes under the tongue...

<Dr. Simpson> some like the shots, they all are effective. The only thing that isn't effective is the B12 in a pill form, which is sort of silly to try....

<Dr. Simpson> so, pick one that you like, and go for it.

<army_wife_mishie> But is it a gel like sensation down throat??

<Dr. Simpson> Don't know -- never tried it. Try it - you might like it.

<MODERATOR> ANDREA YOU HAVE THE NEXT QUESTION PLEASE:)

<Andrea> I am about ten weeks post op and have been having lower to mid back ache and pain down both my legs. The DR today drew blood work to see if something is out of wack Until I get the results is there anything I can do besdies medication? Also as my face thins out the wrinkles come along with the dryness suggestions for this also? Thanks so much!

<Dr. Simpson> No suggestions for wrinkles, enjoy them because they are character signs.....

<Andrea> LOL

<Dr. Simpson> in terms of the pain, difficult to know what you can do, I think some mild stretching would be good under the care of a physical therapist, and to increase exercise....

<Andrea> They ache from the knees down

<Dr. Simpson> dryness-- there are a lot of creams and potions for that. I think my mother-in-law has something in her cauldron which she uses....

<Andrea> Maybe I will try that a witches brew! Thanks

<Dr. Simpson> cause she must be a thousand years old, but that is another story.

<MODERATOR> SNUGGLES YOU HAVE THE NEXT QUESTION:)

<snuggles in mesa> CAN YOU HAVE WLS IF YOU HAVE HEBATITIS B?

<Dr. Simpson> Hepatitis is not a contraindication to surgery at all. However, if you have not been treated, and have active hepatitis, then it needs to be treated.

<Dr. Simpson> Same with hepatitis C.

<snuggles in mesa> thank you for you time

<MODERATOR> JOANN YOU HAVE THE NEXT QUESTION:)

<Joann> I am a "healthy" 306lb 5'6" female BMI of 50...but still pretty active....fulltime med/surg RN....when would you suggest lap RNY vs Lap Band, if ever?

<Dr. Simpson> Joann that is the key question which only you can answer....

<Joann> Medically is there ever a reason to have one over the other

<Dr. Simpson> it boils down to something simple: if you are healthy do you have the surgery, and the answer is that obesity is a risk factor for a lot of things.....

<Dr. Simpson> and the NIH consensus panel deemed that a bmi of over 40 is reason enough, but you have to make your individual decisions....

<Joann> I am having the surgery.....is ther ever a reason to have RNY vs Lap band

<Dr. Simpson> regarding the procedure, you have to make that decision also. Although I primarily do the DS, and would probably do that for your case, you have to go with what the surgeons in your area do....

<Dr. Simpson> but yes, sometimes just being overweight is reason enough, and sometimes people feel as if they are healthy and don't want to have the surgery-- and that is a reasonable decision also.

<Dr. Simpson> Better to be healthy and overweight than sick and skinny -- although better to be skinny and healthy.

<Joann> I agree....Thank you

<Dr. Simpson> where is my ice cream?

<MODERATOR> SANDIE YOU HAVE THE NEXT QUESTOIN:)

<Sandie> What are the anestesia risks for a person with 72 BMI wanting the open RNY?

<Dr. Simpson> The main risk of anesthesia with someone with a BMI over 60 is the ability to secure the airway...

<Dr. Simpson> when we do the operation the anesthesiologist puts a breathing tube down your throat, and if they cannot visualize the airway ...

<Dr. Simpson> this can be a significant problem. So, it is always worth it to lose some weight and get the BMI down to a more reasonable level before surgery.

<Sandie> What is a reasonable level?

<Dr. Simpson> BMI in the 50's.

<MODERATOR> LINDA-33 YOU HAVE THE NEXT QUESTION PLEASE;)

<Linda-33 days post> Hello, how long does one have to wait after surgery to become pregnant?

<Linda-33 days post> thank you

<Dr. Simpson> although we do think that you should not have sex for at least 17 years after surgery....

<Dr. Simpson> that should take care of those pesky problems with birth control...

<Linda-33 days post> lol

<Dr. Simpson> Somehow I don't think any of my patients comply with that one.

<Dr. Simpson> Two years is what we recommend.

<MODERATOR> PETE YOU HAVE THE NEXT QUESTION PLEASE:)

<Pete> I am 4 mos post op and having trouble keeping solid food down. scheduled for a scope on monday. what can i expect ?

<Dr. Simpson> You will swallow a very big tube.......

<Dr. Simpson> you will like it.....

<Dr. Simpson> don't worry about it.

<Pete> thanks

<Dr. Simpson> They might have to dilate a portion of your stoma, so that solid food can go down easier...

<Dr. Simpson> and that is a fairly simple thing....

<Dr. Simpson> so having the scope is routine, and you might be dilated, it isn't painful, and you might have a bit of as ore throat/...

<Dr. Simpson> you may need to be dilated a few times...

<Dr. Simpson> good luck.

<MODERATOR> MOLLYL YOU HAVE THE NEXT QUESTION:)

<MollyI> WHAT'S THE DIFFERENCE IN THE NUMBER OF BYPASSED CM? WHAT DETERMINES HOW MUCH YOU BYPASS?AND REGUARDING BODY FAT % LOST ...DO THE BODYFAT SCALES REALLY WORK? and if I tell my hubby 17 years for sex.....he will say NO SURGERY!! lol

<Dr. Simpson> Every surgeon is different in the amount we bypass. For DS surgeons it is fairly standard, we bypass about 60 per cent of the small bowel....

<MollyI> what's DS?

<Dr. Simpson> for RNY surgeons, they flip coins in the operating room, although some have standards they use. Duodenal Switch...

<Dr. Simpson> see www.drsimpson.com for an explanation when you are done with the chat....

<MollyI> k

<Dr. Simpson> body fat scales do work, and they are useful-- I recommend the impedance type, and in fact we are getting some for the office later...

<Dr. Simpson> Some surgeons bypass more when patients BMI is > 50, but there is no science to it.

<MollyI> thanks doc you are great...wish you were closer to TX :)

<MollyI> thank you

<MODERATOR> TERRY YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON PLEASE:)

<terry> i have a 14 yr old dtr 270lbs. i want to find a surgeon in the nv area to do lap banding. moms a nurse we understand the pros and cons

<Dr. Simpson> I don't know NV-- unless it is Nevada, Dr. Barry Fisher is there, and he is a great surgeon, so try him...

<Dr. Simpson> In terms of the great state of Texas, Dr. Rabkin goes there for group meetings you can find him at

<Dr. Simpson> www.pacificsurgery.com

<terry> everyone i talk to wants her to grow more....he wants her to grow more..

<terry> 300?

<Dr. Simpson> Well, adolescent obesity is something that often needs to be taken care of with surgery, just as with adults....

<Dr. Simpson> there are some great behavior modification things which can be done if they are available, but often surgery is the only good answer....

<Dr. Simpson> see Dr. Fisher, he should do well for you.

<terry> thanks

<MODERATOR> LORI-MD YOU HAVE THE NEXT QUESTION:)

<Lori-MD> As one of the *ahem* older WLS candidates, I worry about what altering my digestive system will do as I go through the aging process. I will be having RNY and wonder how my digestive system interacts with the rest of my body. What should I watch for or do we even know? Thanks!

<Dr. Simpson> You will find that your body will feel younger, act younger, and you will get in trouble chasing younger men....

<Dr. Simpson> you should not have a problem at all with the RNY as you become older, and in fact, you will enjoy having a tool....

<Kathy_has_a_date> I am 53, that answer sounds good to me

<Dr. Simpson> which will enable you to continue to lose weight, diet, and so forth. Good luck.

<Lori-MD> Okay, I'll start checking out www.gigilo.com

<MODERATOR> AL YOU HAVE THE NEXT QUESTION:)

<AL> What do legs falling asleep after surgery mean I am two weeks post op and the last couple of days my legs have gone into a real achy sleep.

<Dr. Simpson> Hard to know what the leg syndrome is -- there are a lot of things which can cause that-- my suggestion is simple: walk.

<Dr. Simpson> walk, some more, and when you are done walking, turn around and walk again. The more you walk, the better you will feel...

<Dr. Simpson> if they fall asleep you are in one place too long.

<AL> okay thanks

<MODERATOR> CDKCATALINE YOU HAVE THE NEXT QUESTION:)

<cdkcataline> i am wanting the lap rny ..but have been told if you have a lot of scar tissue that it has to be open? i hada hysterectomy last year and the dr said he had never seen such a butcher job from pryor surgery and he said it was the most difficult hysterectomy he ever did due to the scar tissue..and 17 years with out sex is not even an option to consider an option!!!!.

<Dr. Simpson> See -- already non compliant. Everyone scars differently, so it is something that your surgeon will have to figure out when they put the scope in you to determine....

<Dr. Simpson> if they can do this surgery safely through a laparoscope.....

<Dr. Simpson> in terms of the other -- well, what can I say, OK, for you how about 16 years

<cdkcataline> lol nope!!

<cdkcataline> and thansk for you time

<MODERATOR> MIMIATLANTA YOU HAVE THE NEXT QUESTION:)

<MIMIATLANTA> Hi doctor thank you for your time..I have PCOS and I have all the simtoms. I am worry That the way that I am eating will affect me. I will not be able to have the surgery. Also I am trying to be good with my food but I keep eating non stop.

<Dr. Simpson> after surgery you will eat less, and you should not graze, it is simple as that....

<Dr. Simpson> having PCOS does not bother the surgeon, we don't care what your ovaries are doing down there....

<Dr. Simpson> but it will actually decrease a lot of the symptoms of PCOS, so go for it.

<MIMIATLANTA> mean I should not worry so much about the food no2w

<Dr. Simpson> Always good to worry about it now.

<Dr. Simpson> but it won't bother us.

<MIMIATLANTA> Thank you so much Now I can sleep better and maybe I wont' it that much

<MODERATOR> STACIE YOU HAVE THE NEXT QUESTION PLEASE:)

<Stacie> how soon after a lap RNY will I feel like going out? I have a sit down event 5 days post op..just a few evening hours. You think I will be ok to go to it? (Someone else will be driving me)

<Dr. Simpson> Well, everyone recovers differently, my suggestion is to let them know you might not be able to attend, and ...

<Dr. Simpson> hopefully you can.

<Stacie> thank you

<MODERATOR> CAROLINE YOU HAVE THE NEXT QUESTION:)

<Caroline 10wks -56#> I had Lap RNY on 5/2/03 w/ starting BMI of 61. Is 150cm intestine bypassed enough to lose/maintain over a 240 lb loss? Should I have had the DS? Also, every time I get my period, my weight loss stops for 1 to 1 1/2 wks. Is this normal and any way I can prevent this? As one last question, how much Iron and B-12 does one require? My dr. has me on Trinsicon but it is causing terrible constipation. Should I decrease iron or take laxatives?

<Dr. Simpson> If you need iron, you need iron, and iron does cause constipation. The surgery you had is enough ....

<Dr. Simpson> to lose your weight and maintain, if you use the tool properly.....

<Dr. Simpson> it is entirely normal for women to have a plateau during their cycles....

<Caroline 10wks -56#> any way to prevent it?

<Dr. Simpson> and B12 and iron are given depending on how low you are and a few other things, it is hit and miss.....

<Dr. Simpson> there is no way to prevent it except to really increase activity during that time-- lots of walking.

<Dr. Simpson> good luck..

<Caroline 10wks -56#> thank you

<MODERATOR> CHARLOTTE CORY YOU HAVE THE NEXT QUESTION:)

<Charlette Corey> I'm considering the RNY procedure, but I need to know if the gall bladder surgery I have several years ago would have an affect on me having the procedure? Also, can the same incisions be used? Thanks

<Dr. Simpson> The same incisions won't be used, and it will not bother the surgeon at all that you had your ...

<Dr. Simpson> gallbladder out. It will be a bit more work for us, but hey -- we are use to that. Good luck.

<Charlette Corey> Thank you

<MODERATOR> MEATBALL YOU HAVE THE NEXT QUESTION:)

<Meatball6/19> I have a problem drinking water. cold, or any temp. I get a little tummy ache after sipping it. but crystal light i don't have a problem with. 3 weeks post op

<Dr. Simpson> Well, then drink the Crystal lite -- and you should be fine. Need water-- water good, love water.

<Dr. Simpson> So-- your stomach will be able to tolerate water more as time goes on.

<Meatball6/19> ty

<MODERATOR> DOREEN YOU HAVE THE NEXT QUESTION:)

<doreen 92lbs 9 mo> could it be possiable that at 9 months someone could be done losing? i have a bmi of 26 and havnt lost in a month

<Dr. Simpson> It is always possible, so I think that if you want to kickstart your weight loss, start walking even more, cut out more carbs and you will see the difference. So, when you are done here go for a walk, 15 minutes and one mile.

<doreen 92lbs 9 mo> thanks but i prefer the eliptical

<MODERATOR> DEB MANUS YOU HAVE THE NEXT QUESTION PLEASE:)

<deb manus> im 1 yr post op lost 111 lbs and 65 in. total.is that good? also,still vomit phlem once is awhile.why?

<Dr. Simpson> well, I think that is a great result, and you should be proud of yourself -- what other plan have you been able to do that....

<Dr. Simpson> phlegm is something that happens once in a while, it is probably becoming less with time, it is not too big a deal.

<deb manus> ok thank you very much and yes i am proud

<MODERATOR> SNUGGLES YOU HAVE THE NEXT QUESTION PLEASE:)

<snuggles in mesa> what if your dr. suggest one form of surgery but you perfer another....and is it tru that if you have had surgery in the past it is most likely that you will have to have the open rny

<Dr. Simpson> Well every surgeon is different, and for some of us previous surgery does not stop us from lap, and for some of us we do open only....

<Dr. Simpson> it is quite different. Some surgeons only do one operation, some do a variety-- it is all between you and the surgeon, and maybe your priest.

<snuggles in mesa> lol

<MODERATOR> JANET IN DALLAS YOU HAVE THE NEXT QUESTION:

<Janet in Dallas> Dr....I have applied for insurance approval...now I'm thinking I might like to consider a DS which isn't offered here in my state...my ins will pay out of state, but will I normally need to get re-approved if I change surgeons after the insurance approval ? And how difficult is it to go out of state (for getting after surgery care) is DS done lap ? Thank you and you have a fantastic personality, by the way :)

<Dr. Simpson> Janet -- turns out Dr. Rabkin is traveling to Texas -- and has a support group down there, just yesterday he did a fellow Texan....

<Janet in Dallas> how long will he be here ?

<Dr. Simpson> he is at www.pacificsurgery.com. Yes, you will need reapproval, or a change, if you do change surgeon

<Dr. Simpson> good luck.

<Janet in Dallas> where would I get info .....ok thank you

<MODERATOR> B YOU HAVE THE NEXT QUESTION:)

<B> Thanks ----I have several ?'s because I've just started researching and wishing seriously...I am in KY, 42,5'5', 250. Which procedure is best for me and how do I get insurance to agree...Can I get an additional insurance for awhile and then drop it after the procedure? What insurances are the best at paying?. What is the differnce in Lap RNY and gastro-bypass?

<Dr. Simpson> lap RNY and gastric bypass are essentially the same, although gastric bypass can be a more generic term for all procedures.....

<Dr. Simpson> in terms of which is the best, that is dependent upon your insurance carrier, and which surgeon they have on their panel...

<Dr. Simpson> so, talk to them, and they will help you make the decision. In terms of insurance, every state is different, and has different policies....

<B> my insurance at work will not pay but was considering getting an additional just for this purpose. the team in Louisville would be where I would go..

<Dr. Simpson> the insurance company that you have may cover it. So, check to see which one might cover it as an additional policy, or you might have to pay cash for the procedure.

<B> thanks

<MODERATOR> LESLIE YOU HAVE THE NEXT QUESTION:)

<Leslie> I am three and a half months post op and feel that I can eat way too much. My husband had the surgery a month after me and cannot eat as much as I can. I try not to eat too much but I feel like I have to rely on will power already. Was something done wrong? My surgeon was just starting out doing RNY's. I was the 4th patient he operated solo on.

<Dr. Simpson> It is common after the third month to feel as if you can eat more, and some days you can eat more----

<Dr. Simpson> generally, people find that they can eat a bit more, and you should continue to monitor the portions which you eat, and eyeball, the surgery is not something that can be put on auto pilot.

<MODERATOR> LEAHD1 YOU HAVE THE NEXT QUESTION:)

<Leahd1> Please explain the criteria that are used to determine proximal Vs distal RNY

<Dr. Simpson> Criteria for proximal and distal are individual for surgeons, they are not universal in the surgical community.

<MODERATOR> TAMI YOU HAVE THE NEXT QUESTION PLEASE:)

<tami> hello .. am have n a lot of trouble getting all my protein in, have heard some people talk about a tasteless protein powder they cook with, do you know what it might be? also i have not really been in the mood to eat lately, possibly because it is hot but wander if i drank protein shakes instead of a meal is that a good idea or not

<Dr. Simpson> You have to get the protein in, and it doesn't matter how you do it. SO get it in, it is important...

<Dr. Simpson> if you like shakes, fine-- although deli meat, tuna fish, cottage cheese, and fish and egg whites (no yolk) are great sources of protein....

<Dr. Simpson> so work on those for a while.

<Dr. Simpson> I have not found a tasteless protein powder.

<tami> thank you

<MODERATOR> LORI-MD YOU HAVE THE NEXT QUESTION:)

<Lori-MD> What is the advantage/disadvantage of an epidural over PCA? If I don't tolerate morphine well, should I consider an epidural? Is an anesthesologist with a pony tail likely to know his drugs and hook me up pretty well? :~)

<Dr. Simpson> Every anesthesiologist has what they like to do, Some are better with epidurals than others, some like them a lot....

<Dr. Simpson> I prefer lamaz-- no morphine, no epidural, just a silver bullet for the patient.

<Lori-MD> yeah right...ain't gonna happen...didn't work with child birth

<Dr. Simpson> OK -- PCA is actually pretty good-- and there are a few different drugs.

<MODERATOR> BS YOU HAVE THE NEXT QUESTION:)

<BS> Had RNY on 4/22 and lost 44 lbs, how many carbs should I be getting or keeping it down to? And how important is it to keep the carbs at a certain level? I thank you and appreciate your sense of humor!

<Dr. Simpson> 40 to 60 grams of carbs per day is a good number.

<Dr. Simpson> the reason is that carbs can inhibit weight gain, so it is good to keep them down until you reach your goal.

<MODERATOR> CONNIE YOU HAVE THE LAST QUESTION FOR TONIGHT:)

<Connie11dayspostop> I had RNY Lap, I'm diabetic (taking no meds for diabetes yet) and I'm anemic. The doc sent me home w/gel caps that I have to squeeze out and take down. Any other options? They taste horrible. I also have had very little energy to walk.

<Dr. Simpson> gel caps for what?

<Connie11dayspostop> iron

<Dr. Simpson> Oh-- not too many things-- there is some liquid iron, but that stuff is nasty ....

<Dr. Simpson> you might need IV iron.

<MODERATOR> THANK YOU SO MUCH DR. SIMPSON FOR BEING HERE WITH US! IT IS ALWAYS SUCH A PLEASURE!

<Dr. Simpson> wow look at the questions.

<Kathy_has_a_date> Thank you for your time Dr. simpson.

<MODERATOR> THANK YOU TO OUR MEMBERS TOO!

<Karie pre-op> thank you

<MODERATOR> YOU GUYS ARE FANTASTIC!

<army_wife_mishie> Thank you Dr Simpson!!!

<Lori-MD> Thanks, doc. Reconsider the year thing

<MODERATOR> HAVE A GREAT WEEKEND AND WE WILL SEE YOU ALL NEXT FRIDAY NIGHT!

<Dr. Simpson> OK-- I have to run folks, sorry I cannot answer them all --

<Dr. Simpson> OK-- you can have sex when you are comfortable with it-- but remember birth control -- please

<ebl> thanks

<Dr. Simpson> night all

<Karie pre-op> good night

<Linda-33 days post> nite

<Kathy-24> goodnight