JULY 25, 2003

<**MODERATOR**> INDIANA YOU HAVE THE FIRST QUESTION FOR OUR GUEST TONIGHT:)

<indiana> i'm worried about dumping will i never be able to eat sugar again??? or will that go away after a period of tiime?????

<Dr. Simpson> Sometimes yes, sometimes no. Only 40 per cent do get dumping....

<Dr. Simpson> and some get it severe enough that they cannot eat any carbs....

<Dr. Simpson> for some it improves with time- but for a few it will not...

<indiana> how do u know if you dump >?

<Dr. Simpson> you dump

<indiana> ok

<Dr. Simpson> you can be light headed, diarrheal, cramping-- this could also be lactose intol.

<indiana> ok

<Dr. Simpson> so it is something to work out. You don't need those carbs the first year anyway -- so avoid them...

<Dr. Simpson> and enjoy the ride.

<indiana> ok ty

<**MODERATOR**> CATHY 59.5 YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON:)

<Cathie -59.5 4mpo> Why do I plateau every two week. I only loose on the week of my period and the week after why is that?

<Dr. Simpson> There are a lot of reasons to plateau, and a lot of reasons that you lose with your period...

<Dr. Simpson> So -- increase walking, decrease carbs...

<Dr. Simpson> drink more water and...

<Dr. Simpson> have more periods.

<Cathie -59.5 4mpo> I do water aerobics is that good for exercise

<**MODERATOR**> TW IN CO YOU HAVE THE NEXT QUESTION PLEASE:)

<TW IN CO> Besides to lose weight, why would gastric bypass surgery be performed? Is it used for other problems besides obesity? Thanks!!

<Dr. Simpson> The surgery is done -- although in a moderated form for patients who have severe gastric outlet problems from ulcers...

<Dr. Simpson> yes, water aerobics are good. So, that is with a much larger pouch -- but that is the typical reason the RNY-GB is done...

<Dr. Simpson> the DS was originally designed for bile reflux. SO there are reasons to do the surgery besides weight loss, but...

<Dr. Simpson> the most common reason is for global warming.

<**MODERATOR**> JINGER YOU HAVE THE NEXT QUESTION PLEASE:)

<Jinger> It will be 6 months before I get an appt. with a doc. I have a history of pulmonary embolism (dopplers lower ext neg and all CT results neg); on coumadin. Does that eliminate me as a candidate for bariatric surgery?

<Dr. Simpson> If we decrease the weight of the world, then we will have no problem with having the tides come it...

<Dr. Simpson> Jinger-- no that does not eliminate you as a candidate for surgery -- there are a lot of things we can do, it does put you at a higher risk...

<Dr. Simpson> they may wish to consider a Greenfield filter, which can catch the larger clots-- and they will watch you closely---

<Dr. Simpson> if they have a glass eye they will put it on your night stand to keep an eye out for you....

<Jinger> thank you

<Dr. Simpson> but you can have the surgery. Good luck.

<Jinger> lol

<**MODERATOR**> DIANE YOU HAVE THE NEXT QUESTION PLEASE:)

<Diane> What is the cost

<Dr. Simpson> A few days in the hospital $20,0000. Surgeons fee $3000 - 12,000. Having your boyfriends buddy check you out -- priceless.

<Madison :)> hahaha

<Diane> great answer, thanks

<Jinger> LOL...a comedic surgeon amonst us....

<**MODERATOR**> MILES 2 GO YOU HAVE THE NEXT QUESTION

<miles to go> do diabetics heal time interfere with process, gall bladder gone,some scarring now stretched

<Tina> Dear Doctor: I am 4 weeks post op. Yesterday I really tested my limits on food and overdid it. I thought I heard a loud poping sound 2 different times. Is it likely that I busted open my staples?Would you hear a loud popping sound if you busted open the stapeles?

<**MODERATOR**> OKAY, DR. SIMPSON CAN ANSWER BOTH QUESTIONS, I WILL SLOW DOWN*grin

<Dr. Simpson> Well, diabetics don't heal slower, although we watch them carefully. In terms of hearing pops -- well, I think...

<Dr. Simpson> that you are probably fine -- but I would measure twice, eat once. If you measure once and eat you might measure once, eat too much, and vomit.

<Dr. Simpson> and no, you would not hear a loud pop. That is the gun going off -- duck.

<miles to go> can diabetics have lap surgery

<Tina> thank you Dr.

<Dr. Simpson> yes diabetics can have lap surgery\

<Dr. Simpson> they cannot have sugar

<Dr. Simpson> they can have surgery

<Dr. Simpson> they can have insulin too

<**MODERATOR**> KELLI YOU HAVE THE NEXT QUESTION:)

<Kelli> I am Juvenile Diabetic, how will this effect me when I have the RNY procedure, I worry about low blood sugar.

<Dr. Simpson> You do have to monitor your blood glucose carefully following surgery....

<Dr. Simpson> because you will be eating less you will need less insulin, so it is something to watch for carefully,...

<Kelli> yes, but I woory about taking in sugar

<Dr. Simpson> and you might want to involve your PCP with this (family doctor, or endocrinologist) to see if they/../

<Kelli> you know the dumping??? LOL

<Dr. Simpson> have some modifications for your insulin. IN terms, of sugar and dumping- nothing to worry about now-- don't take sugar, don't dump-- you can...

<Dr. Simpson> if you need to have some sugar because of the insulin-- have it in the OJ, and it probably will not be a problem...

<Dr. Simpson> you could also consider another operation, the lap band, or the DS which will avoid dumping.

<Dr. Simpson> good luck.

<Kelli> oh ok ... thank you

<**MODERATOR**> LYN 27 YOU HAVE THE NEXT QUESTION:)

<<Lyn 27 days post>> Hi Dr. S., I would like to know when will I get my appetite back. I'm 27 days post RNY and can only eat small amount and then I don't feel so great. Also, I haven't had a period in 3 years due to Depo Provera - then 7 days after surgery boom, my period came. Will I have a period all the time now?

<Dr. Simpson> Six months---- or sooner, you may be getting the appetite back, so don't worry about it, you don't need it. In terms of your periods-- well, sounds like you got it, and it may be there a while -- talk to your gynecologist-- or any ecologist for that matter.

<Dr. Simpson> a period which becomes a comma isn't great.

<<Lyn 27 days post>> Thank you :-)

<<Lyn 27 days post>> lol

<Dr. Simpson> and I just ate my sugar free fudgesickle for my PMS

<**MODERATOR**> SHIRLEY J YOU HAVE THE NEXT QUESTION:)

<Shirley J.> If you have lost 100 pounds and need to stop losing what is the safest?

<Dr. Simpson> Well -- your body typically takes care of that all on its own, and it is rarely something to worry about...

<Dr. Simpson> your pouch will increase, your appetite will return, and you will be able to absorb things better...

<Dr. Simpson> typically people ask -- what can they do to rejump start the process.

<Dr. Simpson> so, if you want to stop losing -- eat and drink at the same time-- eat more protein, walk more, and so forth.

<**MODERATOR**> TAMMY TN YOU HAVE THE NEXT QUESTION:)

<Tammy TN> My doctor told me that if he by-passed more than 150cm, that it would have the same results as the DS. Is that true and if so why would that be?

<Dr. Simpson> DS is a bypass of about 400 cm of small bowel, and it is also the preservation and use of the pylorus, which is NOT the same as a RNY..

<Dr. Simpson> so it is not true, and if you want the DS, then don't settle for less.

<Tammy TN> ok ty

<**MODERATOR**> LINDA VA YOU HAVE THE NEXT QUESTION PLEASE:)

<Linda-VA> Is open rny harder for people over 50 than younger people

<Dr. Simpson> well, I think that people over 50 years old do well with either surgery, and I wouldn't worry about that at all...

<Linda-VA> ok ty

<Dr. Simpson> surgery is tough, on anyone-- with some it is tougher on younger men...

<Dr. Simpson> they are kind of wimps-- unlike us old folks.

<Linda-VA> ok

<**MODERATOR**> CHRISTINA D. YOU HAVE THE NEXT QUESTION:)

<christina D.> Hi Dr. Simpson.......I have heard of talked to a few women that have had WLS and either during or right after surgery they get their period. Why is this, what causes it and how common is it...?? Thanks in advance

<Dr. Simpson> When you start to lose fat, you also have a change in the estrogen balance in your body, and you start to lose a low...

<Dr. Simpson> level of estrogen, so you have your period -- and the period can last for a while, which is why we have you see...

<Dr. Simpson> those baby delivery type people, who are familiar with those parts....

<Dr. Simpson> so, it is something that happens, it isn't a bad thing, unless you have too much blood loss, in which case....

<Dr. Simpson> you might need a bit of good old Italian Red.

<christina D.> umm how common? 1 out of a 100?

<Dr. Simpson> Don't know the figure-- I would just guess.

<christina D.> ok ty

<**MODERATOR**> JACKIE YOU HAVE THE NEXT QUESTION:)

<jackie> I am in the process of qualifying for the surgery, my family is very concerned, I am concerned about the recuperating . Just how hard is it? I hear you will be vomiting all the time, I have chronic diarrhea now my doctor seems to think this will help my stomach problems. I have had colitis I have fibromylygia and hypertension he also thinks this will help with these problems. What do you think?process

<Dr. Simpson> Well, I think that there are some problems which obesity surgery can help, and that is obesity...

<Dr. Simpson> many of my patients who have other ancillary problems find that they do feel better once they are off the sugar,....

<Dr. Simpson> and some patients find that they have an overall sense of well being-- but most of the other issues which are not related to weight loss, but can be...

<Dr. Simpson> exacerbated by obesity, do seem to improve. Good luck.

<**MODERATOR**> PAM YOU HAVE THE NEXT QUESTION PLEASE:)

<Pam> how do you know which surgery to do on a patient? is it just patient preference?

<Dr. Simpson> No, Pam it is the surgeon's preference. We do a certain surgery, or do a couple of surgeries, and we have a preference...

<Dr. Simpson> it is not like there is a manual which says for this type do this-- all the surgeries work, so find a surgeon that you like...

<Dr. Simpson> and a support system that you like...

<Dr. Simpson> and then go from there. Jason -- don't do that anymore.

<Dr. Simpson> man, the staff is interrupting me now.

<Pam> thanks

<**MODERATOR**> ALICIA YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON PLEASE

<aliciask> Dr. S, I am 4 months post op with a DS, my question is on iron. I was told I am a little low and need to supplement and everything I have tried makes me feel ill, what do you suggest for your patients? By the way I am feeling GREAT!

<Alicia> What are some things that are done to reduce the risk of DVT/PE?

<Dr. Simpson> I see we have two questions from alicias, and I will answer them both...

<Dr. Simpson> I think the iron pills which are by prescription are the best, like the Nephro forte or such....

<Dr. Simpson> there are a lot of formulations, but the best is red meat....

<Dr. Simpson> finally - to reduce PE you can do one thing-- WALK

<aliciask> thanks! I love red meat :0

<**MODERATOR**> JACK NC YOU HAVE THE NEXT QUESTION PLEASE:)LOL

<Jack-NC> I had an incision infection while in surgery, is this the doctors fault or the hospitals? Also I am 9 weeks post-op. It seems as though I can it all the stew tomatoes I want without feeling full. Has my pouch stretched or is it because tomatoes are a lot of fluid?

<Dr. Simpson> Infections most commonly happen from the bacteria on the patient's own skin, and is not anyone's fault....

<Dr. Simpson> in terms of tomatoes -- don't know why -- they might slide through the pouch easy and so you are getting a lot of carbohydrates with them, so instead, try some other stuff....

<Jack-NC> That is interesting. Thanks Doc

<**MODERATOR**> DIANE IN AL YOU HAVE THE NEXT QUESTION:)

<Diane in AL> Dr. Simpson, what advise would you give a patient with fibromyalgia? Do you think it will relieve the symptoms?

<Dr. Simpson> I do weight loss surgery for patients who are morbidly obese, not for fibromyalgia. For fibromyalgia, there are other treatments, not WLS....

<Dr. Simpson> but if you have FM and obesity, then WLS is indicated, but not for the FM

<Dr. Simpson> AM -- perhaps, because they have better talk radio.

<Diane in AL> Thank You

<Dr. Simpson> yw

<**MODERATOR**> NOREEN YOU HAVE THE NEXT QUESTION:)

<Noreen> My mother is considering a gastric bypass but she has high blood pressure, sleep apnea, problems with her legs and she is 61 years old. In your opinion, is she a good candidate? Or is it too much of a risk?

<Dr. Simpson> No, she is not too much of a risk, she is a candidate for surgery if she meets the weight requirements....

<Dr. Simpson> and, she has co morbidities which mean that if her BMI is 35 or greater she would be a candidate...

<Dr. Simpson> I have nothing against doing this on patients your mother's age-- although I would like to have the heart checked to make certain...

<Noreen> thank you

<Dr. Simpson> that it is in shape for surgery. I would also tell your mom that you love her, just because you haven't done that today.

<Dr. Simpson> and she wants to know if you ate your vegetables.

<Noreen> thanks Doc

<**MODERATOR**> GEN1 YOU HAVE THE NEXT QUESTION:)

<Dr. Simpson> Gen I and Gen II

<Gen1> Is pregnancy possible after losing weight after having an Open RNY? Does pregnancy affect the new stomach size?

<Dr. Simpson> Pregnancy does not bother the stomach size at all....

<Dr. Simpson> unless of course you decide to eat a lot during pregnancy, it is quite possible to become...

<Dr. Simpson> pregnant after surgery, although we would like you to wait a couple of years after surgery to do so...

<Dr. Simpson> in fact I recommend that patients wait 17 years to resume sexual activity.

<terrinokie> lol

<Gen1> oh you are mean

<Cathie -59.5 4mpo> lol I cant do that im sorry

<**MODERATOR**> LUCY YOU HAVE THE NEXT QUESTION:)

<Lucy - pre> What is the best method of birth control post op, oral contraceptive, the patch or depo-provera? My Dr. does not know the answer to this.

<Lucy - pre> open rny

<Dr. Simpson> in terms of the absorption of the pill--- and how long the bypass was....

<Dr. Simpson> probably the patch for at least a couple of years after surgery -- just don't take it off

<Dr. Simpson> and it won't work if you give it to the guy....

<Dr. Simpson> I hate depo -- leaches calcium

<Lucy - pre> I thought you couldn't use the patch if you were >30lb over

<**MODERATOR**> MILES TO GO YOU HAVE THE NEXT QUESTION:)

<miles to go> best dr at u of pa hospital? where are u-whats wait time for appt i like your style

<Dr. Simpson> Best doctor is the one you will pick to do your surgery. ....

<Dr. Simpson> My wait time-- well, patients sometimes wait an hour to see me.

<Pam> lol

<miles to go> some questions need direct answers i'm fighting for my life

<**MODERATOR**> HEATHER S. YOU HAVE THE NEXT QUESTION PLEASE:)

<Heather S> I had a fistula at 5 weeks out , connecting the two stomachs. My surgeon removed it but was unable to completly sew up where it was attached to the pouch because the tissue was like "wet tissue paper. I am on TPN and almost four weeks out. How long do you think it may take to heal on it's own? What caused it? It was not on the staple line but near the top of the pouch.

<Dr. Simpson> there are a number of things which can cause that type of disruption, and I am glad you are here and doing fair....

<Dr. Simpson> In terms of having the pouch heal, it may take two to four weeks, and sometimes longer, and TPN is a very good thing to have.....

<Heather S> how long does it take to heal something like this?

<Dr. Simpson> I assume you have a drain there, which is monitoring things. Sometimes they have to go back in and reoperate...

<Heather S> no drain..

<Dr. Simpson> after a few months to close it up with suture, as the inflammation around the tissue wont let it heal.

<Dr. Simpson> So, the only way to tell, is by the tests they do. It is hard being patient-- but keep it up, you are doing OK so far.

<Heather S> thanks

<Dr. Simpson> You are welcome, and good luck.

<Dr. Simpson> Hi Rose

<**MODERATOR**> JINGER YOU HAVE THE NEXT QUESTION

<Jinger> The wait for a surgical consultation is ludicrous sometimes...3 yrs at one surgical group Seems there is the potential for unscrupulous doctors entering the bariatric surgery. Your suggestions on choosing a doctor.

<Dr. Simpson> Well, I don't know that there are unscrupulous doctors, but obesity is a growing problem (pun intended)....

<Jinger> ha ha

<Dr. Simpson> the best way to chose a doctor is word of mouth, and your take on how you like that doctor...

<Dr. Simpson> and their support system, this is one case where the aftercare is probably more important than the surgery...

<Dr. Simpson> find a good support group, with people you like, and a program you like...

<Dr. Simpson> and a surgeon who has a sense of humor you can stand....

<Dr. Simpson> or no humor, if that is what you want.

<Madison :)> lol

<Jinger> would you be my doctor? lol

<**MODERATOR**> WJ LAKE YOU HAVE THE NEXT QUESTION:)

<wj lake> I'm Pre-op, my Pys. Eval. is in two weeks. I would like to know what the surgeons are looking for and why you're required to take one? Nice sense of humor, btw.

<Dr. Simpson> The psych eval has a number of things that we look for: first, we want to make certain that the patient really knows what they are getting in for....

<Dr. Simpson> second, we want to know if there is any underlying mental disorder which needs medication....

<Dr. Simpson> and finally, if there is then it needs to be treated. Don't tell them about the voices.

<wj lake> what about simple depression because of the wieght itself?

<Dr. Simpson> Depression is never simple, and is something which needs to be treated----....

<Dr. Simpson> weight is not a reason for depression. Just something which adds to it, depression needs medical attention.

<**MODERATOR**> GRANNY YOU HAVE THE NEXT QUESTION:)

<Granny> Hello Dr. Simpson. I am post-menopausal and discontinued hrt about a year ago. Will, or could, the weight loss cause any further imbalance? Also (yep, 2 questions) what are your feelings regarding use of a PIC line for patients who are really, reeeeally hard sticks? BTW, I am 58 (if that is germaine)no 17 year wait for me!.

<Dr. Simpson> Granny -- well, 58 is a fine age. Pic lines are great for hard sticks, as are central lines....

<Dr. Simpson> I don't like hormone replacement, and advise my patients get off of the hormones.....

<Granny> which one hurts the least..LOL

<Dr. Simpson> and otherwise-- for you 17 days.

<Granny> very good..hubby willbe pleased

<Granny> ty Dr

<**MODERATOR**> DETTA PALMATIER YOU HAVE THE NEXT QUESTION PLEASE:)

<DEtta Palmatier> I have chronic pain from a very bad back. I am concerned about pain control post op as I currently am on alot of meds...Duragsic patch 75 mg and Lortab for break thru pain. Will the Surgeon be able to keep me comfortable in the first few days post op

<Dr. Simpson> We can keep you comfortable, however, the pain medicine for your back and the pain medicine for your incision shouldn't be confused...

<DEtta Palmatier> but they are all narcotics?

<Dr. Simpson> that is, once you are over the Incisional pain -- and you should only need pain meds for a week or so...

<Dr. Simpson> no, no evidence of any problem, and we have been doing this surgery since the 70's -- not me of course...

<Dr. Simpson> in the 70's I was listening to the BeeGees and dancin

<**MODERATOR**> JEWEL YOU HAVE THE NEXT QUESTION PLEASE:)

<jewel> Hello Dr.I am pre op but Ive seen pics on this site that people look too thin,how do u stop losing once you are average weight? /

<Dr. Simpson> Well, your body kinda takes care of that all by itself, and we sort of design the surgery so it will take off about 65 per cent of your excess body weight....

<Dr. Simpson> if you take off more, that is you, not the surgery, not the surgeon....

<Diane> you admit to the BeeGees? lol

<Dr. Simpson> it is sheer willpower. Most folks who reach goal will tell you those last 30 lbs are the toughest. Good luck.

<Dr. Simpson> Love the Bee Gees

<jewel> I see thanks Doc and I love your SOH

<**MODERATOR**> EILEEN YOU HAVE THE NEXT QUESTION:)

<Eileen> My bmi is 41 I have no co morbitities except low back pain but my family hx has HTN,NIDDM and CAD I am currantly waiting for my intial appoint with the surgeon and wondering if he'll even consider me l

<Dr. Simpson> He will consider you.

<Dr. Simpson> You fit the criteria -- forget your family--

<Dr. Simpson> if you don't want to forget your family -- you can have some of mine.

<Eileen> on my family hx alone?

<Dr. Simpson> family history isn't important in this surgery.

<**MODERATOR**> LINDA VA YOU HAVE THE NEXT QUESTION:)

<Linda-VA> If a person is diabetic, high blood pressure, had strokes, seizures and a heart attack and weighs approx 378 pounds. Would you consider doing this type of surgery

<Dr. Simpson> well, there is always a first. Sometimes, however, the ravages of obesity have already done the damage to the heart and everything else...

<Dr. Simpson> and doing surgery would not prolong life, but could decrease it-- so that is someone that we would have to have...

<Dr. Simpson> a long talk, and an extensive work up of the heart and so forth before we would go for it.

<Dr. Simpson> Some of us don't have hearts, so it isn't a problem.

<Linda-VA> thank you, this is my husband who is only 55

<Dr. Simpson> well, he needs to have a good work up to see how much damage is done, and to determine if he would do well with the surgery or not.

<**MODERATOR**> JOHNN YOU HAVE THE NEXT QUESTION PLEASE:)

<JohnN 2 days preop> I live 500 miles from my surgeon and their support groups. There are no surgeons in our area. I know serveral other people who have WLS and I have been asking them if they would like to get togther for our own support group. How impt is Surgeon or Psyc involvement or just layman/women running support groups?

<Dr. Simpson> Most support groups are run by lay people, and they do just fine. It would be great if you can get them to come sometime to speak, and it would be helpful to you...

<Dr. Simpson> so, it would be good, there are a lot of resources you could use -- not to mention when my book comes out, and you will want a hundred copies of that.

<JohnN 2 days preop> LOL

<**MODERATOR**> CASSY YOU HAVE THE NEXT QUESTION PLEASE:)

<cassy> Hi doc, I was wondering, I had a ct scan done the other day cuz I was having stomach probs, and now they might want to do exploratory surgery just to make sure what is wrong, so my question is: Is CT SCANS always accurate if everything seems to be normal? thankyou!

<Dr. Simpson> CT scans are not always accurate, and you should see a GI doctor if you have stomach problems and let them work you up and see what is going on. And then you should buy my book.

<cassy> ty

<**MODERATOR**> MELISSA YOU HAVE THE NEXT QUESTION PLEASE:)

<Melissa> have you noticed those who get their gall bladders out after their bypasses have trouble eating afterwards? I just had my gall bladder out and am not able to eat anywhere near what I was before...I cannot even eat salads--which were my staple before!!! ( I am 6 mos. postop and down 100.5lbs, 35lbs to goal, and 1 week out from gall bladder surgery)

<Dr. Simpson> Well, gallbladders are not needed for digestion, they are a storage unit for bile....

<Dr. Simpson> and in terms of having trouble-- some people do have a bit of loose stools after their gallbladder is removed...

<Dr. Simpson> but that gets better with time, and if it does not then we have some nice medicine for that -- which tastes not so great...

<Melissa> thanks

<Dr. Simpson> it is probably not the salad you cannot eat, but the oil in the salad...

<Melissa> i eat plain salads

<Dr. Simpson> it will get better. If it doesn't then I was wrong.

<Melissa> no oil

<christina D.> lol

<Melissa> thanks though

<**MODERATOR**> JOANNE YOU HAVE THE NEXT QUESTION PLEASE:)

<Joanne> Doc, do you do band surgery as well. What is the Midband?? is it better than the lap band?? Thanks,

<jewel> lol a man that can admit hes wrong!!

<Dr. Simpson> Midband is not a surgery which is done in the US so it isn't something that you need to worry about.

<Dr. Simpson> I didn't admit I was wrong-- although I take blame for everything, it is all my fault, and I am sorry.

<Joanne> Arent there some trials going on with the midband now in the US

<Dr. Simpson> There are some trials with it-- but it is not approved.

<**MODERATOR**> JENNIE C. YOU HAVE THE NEXT QUESTION:)

<Jennie C> Dr. I had a hard time getting my Gall Bladder diagnosed as being perferatted, i gained alot of weight from it, also i have adema, sleep apnea, moderate high blood pressure,and a bleeding ulcer... i would like to lose at least 160lb (i 'm 270, 5'2")but my family doesn't like the idea of me having the surgery, would you feel i would be a good canidate, also i love your sense of humor

<Dr. Simpson> well you are a good candidate from the surgery. So, I think that you should consider an appointment with your...

<Dr. Simpson> friendly neighborhood Bariatric surgeon and discuss having your insides rearranged so that you can...

<Dr. Simpson> buy more clothes. Because in this economy, we need more shoppers.

<Dr. Simpson> I am just doing my part, one patient at a time.

<Jennie C> thank you very much i will bring my husband

<**MODERATOR**> WJ LAKE YOU HAVE THE NEXT QUESTION:)

<wj lake> I've read that if Post-ops throw up too much (meaning more than what their new tummy actually has that it's actually coming from their intestines. This is something I don't think I want to experience. Any suggestions?/

<Dr. Simpson> Yes-- measure twice, eat once, don't vomit. Know the size of thy pouch and do not over fill it (Simpson commandment number one).

<**MODERATOR**> MILES TO GO YOU HAVE THE NEXT QUESTION PLEASE:)

<miles to go> if u have non dependent diabetes,high blood press/high chlorest non diagnosed sleep apnea and 300 lbs on 5'8 frame how long should u wait for dr appt

<Dr. Simpson> As soon as they answer the phone and you say -- hey, give me an appointment....

<Dr. Simpson> so I think that you need to get one, I think you will do well with one-- in the mean time--

<Dr. Simpson> walk.

<**MODERATOR**> GEN 1 YOU HAVE THE LAST QUESTION FOR OUR GUEST TONIGHT:)

<Gen1> Earlier there was mention of birth control...I am using an IUD with great success (obviously since I remain child free) with an OPEN RNY do you see any reason to have it removed before surgery?

<Dr. Simpson> Sure-- it is one less thing to have to worry about-- and it can be put back in (or a fresh one) later.

<christina D.> lol!!!

<Dr. Simpson> Thank you everyone for a nice Friday afternoon. I won't be here next week, so please enjoy the time off from my sense of humor

<**MODERATOR**> THANK YOU SO MUCH DR. SIMPSON! WE ENJOYED YOUR CHAT SO MUCH!

<**MODERATOR**> THANK YOU TO OUR MEMBERS TOO!

<<Lyn 27 days post>> thank you

<Dr. Simpson> walk

<Eileen> thanks doc

<Heather(Boston)> thank you!!

<Dr. Simpson> water

<**MODERATOR**> HAVE A GREAT NIGHT EVERYONE!

<Pam> thanks!!!