July 23, 2004

<Moderator> Welcome to tonight's chat with Dr. Simpson. Chat starts at 4pm EST/7pm EST. Please type out your questions and hit enter will see them and present them to Dr Simpson at the time of chat in the order we receive them. Thank you!

<Dr. Simpson> OK, I think I am ready to get this party started.

<kimdawn> i have been able to eat large amounts of food ever since my surgery and can can swallow without chewing alot.. i have only lost 110 in two years, am i eligible for a revision or correction?

<Dr. Simpson> Just because you can eat a lot doesn't mean that you need a revision surgery. Revisions are difficult surgeries and the only reason we do them is if there is a mechanical reason to revise the surgery -- for example, an enlarged stoma or a stomach if the problem is behavioral -- that is, you are eating too much -- then there is no revision which will correct the behavior, for that we need brain revision. So, have it evaluated by a professional and go from there.

<Carrie> I'm hoping to spend a year in Africa next year (missionary work). How concerned should I be about my diet after WLS surgery? Should I postpone it?

<Dr. Simpson> That is entirely up to you -- but honestly, people in Africa eat also and there is nothing special about what they eat that you cannot eat. One of my favorite African dishes is their soup called Ugali --- kind of fun to say.

<MichelleTx> 1)how do u tell if u have a hernia and what testing is involved and 2) how soon can u start plastic consults i am out 9 months and down 115 surgeons goal is 175 mine is 250-60 i am like 35 away from mine

<Dr. Simpson> Wow down 115 surgeons-- you must have the Al qeda branch of surgeons. Generally we want the weight to stabilize for six months before referral to a plastic surgeon. A hernia is discovered by clinical exam from a surgeon so -- stop going through those

<Kat> How do you feel about the Lap Band Gastric Surgery?

<Dr. Simpson> I feel it is soft-- like silicone. I like the lap band surgery, and think that it will ultimately replace the other surgeries in this country because of its record of safety.

<stcynghty1> hello DR i am almost 14 months post op not sure if i am transected what would the signs be if you have a staple line disruption?

<Dr. Simpson> If you are transected and you have a disruption then you would probably be dead. So unless you are calling from heaven -- you are probably not transected and disrupted but being in Arizona I think I can say that I am calling from hell. Even the animals here have horns and it is so hot that the fire hydrants are asking the dogs for relief. If you are not transected then the only way to tell is an upper GI test -- that is the simple way. Good luck.

<db> Is there any ill affects from having too high level of B-6?

<Dr. Simpson> Anything can become toxic-- even water--- and the same with B6. However, the B vitamins are peed out fairly quickly -- but don't tempt fate. No need to pee out vitamins-- might as well leave them in the jar.

<Elizabeth in Y,C> DR Simpson, Can you give the odds or pecentage of people who have this surgeryhow many eventually will put the weight back on and in what amout of time will they do it in?

<Dr. Simpson> The odds are different for the different surgeries and those odds evolve with time-- but the numbers range from ten per cent on up to 25 per cent will regain their weight. The things that cause weight regain for one surgery will cause it for all surgeries.

<sheila forcier> I'm 15 days post op and im feeling like i never want to eat because of the protien drinks how should i handel this?

<Dr. Simpson> Stop the protein drinks and start the food.

<stcynghty1> i'm doing atkins right now to try and loose my last 18 pounds going through bad sugar withdrawal right now what can i do to get through this?

<Dr. Simpson> Grind up a heifer and put it in some strawberries. Eat sugar. Atkins is not a bad diet plan, but it is ultimately a plan that you will not stick with. The main thing to learn from Atkins is that you can cut out a lot of junk food, and you will discover that you will live. There is nothing wrong with pasta ---- so, you will eventually get through it, but I am not as big a fan of Atkins now that he is

<db> are slightly elevated liver functions something to be concerned about? How does prevacid affect the liver function?

<Maureen> Can adhesions from previous surgeries deter a lap RNY?

<Dr. Simpson> Not really -- adhesions are not a problem, and they are easily taken care of with a laparoscope-- unless they are mean adhesions. No way to know ahead of time, just have to put a scope in and take a look.

<Lina> how soon after the laparoscopic roux-en-y does one actually start to lose weight?

<Dr. Simpson> That day. The more calories you use, the more weight you lose. Simple formula -- nothing magic

<glori> DR simpson I am five foot 9 I have lost from 245 to 139 what is a good goal weight for me?

<Dr. Simpson> A good goal is to get to a BMI of 22 sounds like you are there

<Cindy B.> How does RNY surgery affect our immune system?

<Dr. Simpson> Well, any surgery effects the immune system, that simply is something that happens. RNY specifically has no known problems or adverse events than any other.

<New Kid Marie> How is the best way to eat a month prior to surgery, the week before

<Dr. Simpson> A diet that is a simple well balanced diet, like a 1500 cal per day type of diet, and begin walking and then walk some more and some more and some more, and more, and more. When you are done walking -- walk again.

<Tawana> My question is how hard is it to get you insurance to allow you to have the surgery?

<Dr. Simpson> Buy the policy and get the surgery. Some policies do not allow you to get WLS, those you would avoid. Others are very easy to get such a surgery, buy those.

<Tawan> can you have kids after the surgery?

<Dr. Simpson> I cannot because it is anatomically a challenge for me to have kids. Although I have done a lot of surgeries and have tried my hardest (pun intended) but no matter what I cannot have children except for Crow, and if you think he wasn't a pain in the.... anyway-- yes, you can become pregnant after surgery if you have the right parts.

<te co> what is a stricture?

<Dr. Simpson> A stricture is an area of the bowel or the stomach that has narrowed down to the point where it needs to be stretched, much like I need to be stretched out now by a nice young masseuse and gastroenterologists stretch areas of stricture to allow the normal passage of food. This happens to up to ten percent of patients with the RNY.

<:-)Larry> what would you recommend for a person whose surgeon has no real post-op food program?

<Dr. Simpson> No, not at all. The surgery is just the beginning of this journey, it is not the end. You need aftercare, and a lot of support and you need to talk to people who have been through it before, with your doctor and know what to expect and how to help you as opposed to an internet group, all of whom have their own way of doing things. Of course, the best aftercare program is in my book but hey I need caffeine.

<donnie61559> ive lost 22lbs so far 5 more to go before consult im having lap rny how much pain will be in after surgery and does a catheter hurt?

<Dr. Simpson> Your surgery will not hurt me a bit. The surgery is not too bad, and you will do fine. The catheter does not hurt unless someone decides to lead you around the nurses station by it and if they do it is because you are not walking and you should be.

<treva> what is the difference between proximal and distal rny (short vs long)

<Dr. Simpson> That is a bit hard to describe without drawings, which are in my book. In per cent terms a proximal is up to fifteen per cent or up to about 100 cm for insurance purposes. A distal is usually up to 60 per cent. Buy the book.

<Deb M.> Hi. Dr. Simpson. I am 7 months post-op (RNY) and recently had surgery to put a plate in my arm to repair a fracture. Within a week, I had developed a thrombosed hemorroid. I have been told to add citrucel to my diet, is this ok? (The Hemorroid was removed yesterday.) Thanks, Deb

<Dr. Simpson> From one end to the other. Citrucel is great -- use it, and drink a lot of water and when I last heard of a hemorrhoid removed it was an ex husband.

<Terri in FL> Is it normal for weight loss to slow around the 4th month. I've gone from 5 lbs a week to 2-3??

<Dr. Simpson> If you don't walk, it is normal, and if you are walking you need to take 10,000 steps a day. He says as he chews a macaroon. Eat less, move more.

<Pre-op Jill> I take Wellbutrin XL and have gotten lots of conflicting info on whether or not it can be absorbed post op or if I should be put on a different form of Wellbutrin. What do you recommend?

<Dr. Simpson> I recommend that you get the non extended formula, or the NOT time released formula and take that.

<Tiggy> I know with bypass operations, the first 6 months are the golden window for weight loss (or something like that). Is there a similar peak time frame for patients with the lap band?

<Dr. Simpson> The lap band patients continue to lose weight for up to three years, and maybe longer. DS the golden period is 18 months and RNY is 6 months to 12 months. Pass the cookies.

<treva> I AM ON AMBIEN FOR SLEEP WILL I GET RIGHT AFTER SURGERY

<Dr. Simpson> Ambien is for short term sleep problems it is NOT for chronic problems. I never prescribe sleeping pills, and never will. The most you should be on such an addictive drug is a month unless under strict supervision of your doctor.

<Crysti> i was wondering same thing my liver enzymes have been elevated slightly for years due to lupus and fatty deposits

<Dr. Simpson> Mostly the fat, and you need to get rid of the fat in your liver unless you want to have other problems, and weight loss is a great way to do it. So, go and lose and sin no more.

<Valere -110 3yr post> For those that are long term post op - how would you recommend them to continue losing if not at goal?

<Dr. Simpson> Diet and exercise, the old standby. Weight loss surgery is not something that makes it so that you never have to diet again, it makes the diets easier because your stomach is smaller. So you need to learn about nutrition, and you need to begin to get into an exercise program and you need to walk, and walk, and walk some more.

<Crysti> If hep a b and c have been ruled out and ultrasound showed normal liver and gall bladder should it be ok?

<Dr. Simpson> Fatty liver disease is nothing to fool around with, so it is something that you should take seriously enough and you should be going through the whole program and lose weight, exercise, and have a liver biopsy, and get with a gastroenterologist who specializes in liver disease. With fava beans and a fine Chianti

<Tiggy> Is it dangerous to be in ketosis?

<Dr. Simpson> No it is not dangerous-- it might be kind of dumb, but unless it is keto acidosis, it is not a problem.

<Crysti> Does RNY cause major problems if you have an auto immune disorder like lupus?

<Dr. Simpson> There is no evidence that the RNY causes any major problems with any of the arthritis diseases. In fact, once you get off of sugar, you will probably feel better.

<Tawana> how soon after lap. surgery can you go back to work

<Dr. Simpson> It depends -- my nurse had the lap band on Tuesday and was back to work on Monday. For the lap RNY two to three weeks, same with the lap DS. I wondered why she wasn't back to work on Thursday -- hard to find good help.

<Dawn NJ> DR told me to stop smoking prior to surgery.. I have tried hard.. surgery is on Wed im still smoking about 5 cigarettes a day down from 30.. will I be ok?

<Dr. Simpson> If you are not following your doctors advice now, then you should be. Smokers have a higher incidence of all sorts of problems. Stop smoking, stop stop stop. Call him up and postpone your surgery. Stop smoking-- change your life. Breathe.

<brittany mc alister> are you answering questions about the Lap Band,as well as RNY???

<Dr. Simpson> All questions, all comers-- we are open for business -- and anything you don't find here. You will find in my book.

<kathleen g> Dr. Simpson: I am back from having my second AVN hip replaced. Compared to open RNY, it was a piece of cake. Anyhow, can you believe I had to work my way through the entire nutrition dept at the hospital to get a diet heavy in protein. No one seemed to understand the needs of post-WLS patients. After about four people, and three days, they finally got it right. Thanks.

<Dr. Simpson> Nothing like a hospital that doesn't understand patients, which is why you should always find a surgeon who is with a hospital that has everything and can see you when you are there for almost anything.

<cindy bailey> I'm 4'11" and had a stomach stappling in 86....My bmi is 76.5 would you do a revision on me ?

<Dr. Simpson> Sounds like you need to grow a few inches. Yes, you would need to have a revision, but first you need to find out why you are at that BMI. I would suggest you get a healthwear band from www.healthwear.com and enter the steps there. That is what I require of my patients.

<New Kid Marie> How soon after surgery can I go swimming?

<Dr. Simpson> Three weeks ---- IF your surgeon says it is ok

<kathleen g> Dr. S: Like Larry, my doc has no program post WLS. None. He is mainly a research scientist who tests theories for the NIH. I do go to our local support meetings, but find many of the folks there talk about how to cheat around the surgery. This is not good. Thanks.

<Dr. Simpson> It is not good, you need a real doctor. A real support group that supports, not one that tells you how to get around stuff . Come to my group. Might be a ways, but hey worth the flight.

<Lori> How do I get rid of my sagging skin in between my legs and upper arms? I feel more embarrassed to wear shorts then 150 pounds ago. Thanks for your help in advance..Lori R.

<Dr. Simpson> With a knife and a capable hands of a plastic surgeon.

<Rosa> I want to find out info for my sister who is looking to have gastric bypass surgery. I hear there is a danger regarding leakage post op and can be fatal. Is this true? What are the other dangers?

<Dr. Simpson> There are a whole list of risks, which are for some surgeries and not others. For a complete list, as well as an excellent resource -- guess where you should look????? OK-- modestly -- my book. www.obesitydr.com. There are a number of dangers with surgery and you should be aware of them, more importantly your sister should because if you are not, or she is not, then it is going blind into the operating room, which is not good. I often wondered why we have the operating rooms numbered with Braille-- is that for the blind surgeons?

<Jana> My doctor prescribed Prevacid, but I don't have any acid reflux or heartburn, why do I need to take Prevacid?

<Dr. Simpson> Because you want the acid level in your stomach to be low following surgery so that it will heal better.

<MIKEinAnaheim> After Gastric Bypass, is stomach acid production changed? I thought Food regulated the amount of stomach acid?

<Dr. Simpson> Any stress in the body, such as surgery, causes an elevation in the level of gastric acid. So when we operate on the stomach we like to reduce the amount of acid that is present in order to allow the stomach to heal more and remember, after surgery for weight loss you may not have food in your stomach,and may have vomiting, and all sorts of problems. So while food is one factor in stomach acid production, there is a whole host of others including hormones, such as gastrin, and vagal innervation -- which is why smokers have more acid, because of their coughing and also why smokers have more ulcers than non smokers. So after any stress, such as surgery, you will find an increase in the gastric acid above the normal output.

<treva> I HEAR PEOPLE SAY YOU CAN'T DRINK FROM A STRAW AFTER SURGERY IS THIS TRUE

<Dr. Simpson> I try to drink from a straw but I keep dripping on myself. Some surgeons do not like you drinking from a straw because it increases the gas in the stomach but as long as you can burp I don't have a problem with it. I like the beer hats with the straws, myself, and I don't even drink beer.

<laurie> What percent of diabetics no longer need medication after RNY (from your experience)

<Dr. Simpson> Well, with weight loss you find that there is a decreased requirement for insulin from the body. Sometimes that translates into fewer pills, less shots, or even off the medication all together. However, skinny people get diabetes, and you will always have that tendency if you have had it before. So, eat right -- work hard, walk a lot, and remember your mother on mom's day and your husband on father's day and on the anniversary of your surgery send your surgeon a thank you card for saving your life.

<Jana> My knees really hurt me and I know I need to walk more than I am...any suggestions??

<Dr. Simpson> See a rheumatologist about your knees, and find out what and why -- otherwise, water aerobics are something that you can do and will not be hard on your knees. Otherwise if you have rough knees some walking can be harder on your knees than the white house floor with Monica.

<Sonia> How long does the lap-band procedure take?

<Dr. Simpson> Every person and every surgeon is different -- it can take hours, it can take 90 minutes -- depends on a lot of factors that are not in your control. Some have more difficult anatomy than others -- or sometimes it is easier than anticipated. I promise you will sleep through it and the surgeon will work hard.

<Just Me> Hi, I am 8 days post-op, How much fluid should I be draining daily (is 1/2 cup too much, I would like to drain more) I would like a second opinion please :O)

<Dr. Simpson> Drain? You have a drain? I don't understand the question. If it is how much should you drink then at least two quarts of water a day -- make it good water, not the evil stuff from Phoenix tap water.

<Rocky> How many calories should be consumed 3 weeks post-op?

<Dr. Simpson> Well, I think that depends on the surgery that you have had, and if you really want to count calories you can but I think the best way to do it is to go by volume. You will eat less than you and your family and friends will imagine, so don't listen to them when they say you should eat more ---honest you will do just fine if you. Eat small amounts and stick with the program, otherwise, you will stretch out your pouch. So,measure twice, and eat once, and never stretch the pouch.

<cindy> I am pre-op and see a lot of MB posts from post-ops 1-2 years out, saying they no longer have will power.Shouldn't after care start getting stretched out longer to help?

<Dr. Simpson> Surgery is not fixing your brain, surgery is fixing your gut. Willpower is not something that we put into your head after surgery -- that is why you need a good support group and you can learn to make better and different choices, and a good support group will help you through it. So, you will not change your underlying eating disorder, but you can learn to feel good about yourself, and you can take advantage of the surgery to help you along with the program. Me, I suggest you get a good support group, learn some new recipes, and new portions, and exercise like a madman -- or mad woman. Have to be careful here.

<MIKEinAnaheim> After Surgery, and when nearing Goal Weight, I want to work out heavier, build muscle..Is the Muscle Building limited or affected by the Lower intake of Food?

<Dr. Simpson> Muscle building is not limited by the intake of food, and good luck with that, it is a worthy and a good goal to have, you can always check your fat free mass with some scales, like the ones offered by Tanita where you can see how much fat v. muscle you have. Then you can check your labs to make certain that you are getting in enough nutrients and protein. Honest, you will get enough in to build body mass and to do well.

<Debm> Debm i have a stomach bacteria h pylori i was perscribed prevpac the day after i took it i woke up with a migraine real puffy face and shakes could that be an allergic reaction to what i took?

<Dr. Simpson> It always could be, and that is something that you should check, because the prev (pack does contain antibiotics and some antibiotics) cause allergies to flare up in some people. There are other drugs to treat the h pylori, so I would ask for a different variety.

<Sandy@GOAL> Do you do hernia repairs?

<Dr. Simpson> I do hernia repairs, yes.

<cindy: some people say they can have carbonated beverages post op because the beverage goes right down anyway, therefore it can't stretch the pouch. Is this true?

<Dr. Simpson> There is no evidence that pop will stretch a pouch, especially if you burp, nevertheless, it is wise to avoid carbonated beverages for the first six months at least, and you will probably find you do not need them at all.

<nikkidee> Is there anything that I could take to help with the bloating?

<Dr. Simpson> It all depends on what the bloating is from. There are a lot of reasons that people bloat like roadkill and it is important to find out why that you are having the bloats, and then we can tell you what you will need to take, if anything.

<Christine> How far out from surgery can you no longer have to worry about complications,i.e. strictures and leaks?

<Dr. Simpson> When you draw your last breath and go down to your eternal fire. Leaks are not a problem after a few weeks, strictures are most common the first year and adhesions can always crop up and be a problem. And if you are worried about your eternal soul then I suggest you say AMEN and get out and walk and eat plenty of protein and drink plenty of water.

<lilly> Dr. Simpson how soon after surgery should you think about having the excess skin removed?

<Dr. Simpson> When you have reached a plateau for six months and are not losing any more weight. Unless it is causing you significant problems. Like when you walk you think someone is applauding you, and it is your pannus. Or you have a lot of infections under the skin. Or if you lost your pet doggie and he comes out from your pannus then it might be time to see a plastic surgeon.

<Moderator> Last question goes too...

<Char> What is the typical post op diet for the the first month

<Dr. Simpson> It entirely depends on the surgeon, the surgery that you have, and a few other things. Typically the first month the protein that you tolerate the best is seafood and some soy products work well also.

<Dr. Simpson> Thanks all. See you next week. Good luck to you all. You are all my heroes. I want to dedicate this chat to Louisa, a patient of mine. Thanks.

<Moderator> Thank you Dr. Simpson, Thank you members for joining us this evening. To learn more about Dr. Simpson, please visit his website. http://www.drsimpson.com/, or call 602-234-8998 (Fax: 602-230-8344) to schedule a consult. You can get his book at www.obesitydr.com.