July 30, 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. We will see them and present them to Dr Simpson at the time of chat in the order we receive them. Thank you!

<brian/oh> hi my sister is 5'7 290lbs what would be her best option

<Dr. Simpson> Well if she is your sister then her best option is to let you pick the food for the parties and she should probably consider having weight loss surgery and any of the weight loss surgeries would be an option for her. There are four main ones -- the RNY which is the most commonly done in the United States. The Duodenal Switch, which is done by about forty of us. The VBG which is done less and less and the lap band which is the safest of all surgeries and probably in the long run, the most effective but those surgeries are nicely outlined in a very comprehensive and funny book. Then that would be the book to buy because it really gives a comprehensive look at everything.

<J.B.> Okay. I have a problem swallowing. When I take a pill, it's stuck in my throat for a period of time (not my imagination). How concerned should I be about this when talking about strictures?

<Dr. Simpson> Well, there are a lot of reasons that pills can get stuck, and not all of them are from a stricture, they might be from some irritation in the throat. If you have a stricture you probably won't be able to eat solids so, I would have a gastroenterologist work up your sensation and they will probably want to put a scope down your gullet and have a look. Swallow.

<LisaC> Dr. Simpson, I'm smaller than your average WLS patient and was wondering if laparoscopic surgery would be easier on me as opposed to someone larger. Or are my organs more cramped LOL :)

<Dr. Simpson> Laparoscopic surgery is probably going to work just fine for you, we like small and compact sometimes. It is always difficult to know how well we will do in side someone until we have a look once we see -- go for it.

<Debbi R 5moPO -97#> Dr. Simpson Thank You so much for your great book! I have read it 3 times. Right now, I have lost 97 #. I eat until I'm full but not stuffed and I continue to loose (a good thing). BUT... If I'm eating until I'm full now, what happens when I get to goal. How do I STOP loosing?

<Dr. Simpson> Oh trust me, that is a common question and guess what at every weight there is a certain number of calories required to maintain it. Including your lean body mass. And we have the operations made such that you will lose about 65 per cent of your excess body weight and if you lose more than that -- it is you-- not the surgery. So it will be fine and safe and I am glad you enjoyed the book.

<rhonda s> When do ulcers commonly occur and what is the cause?

<Dr. Simpson> Ulcers in weight loss patients at the stoma -- or anastomosis, between the stomach and small bowel is typically caused by... one of several things: the first is that there might have been not enough blood supply to one or the other bits of gut when they were put together, so there is an ulcer-- the other is that you might be making a lot of acid, in which case you may need to be on some acid reducing agent. Scars which occur can also ulcerate. Bottom line -- if you have an ulcer it needs to be worked up and to be checked for the bacteria which causes ulcers, H pylori -- and you will need to be placed on acid reducing agents. Good luck.

<Angela> How successful can lap band be in terms of excess body weight lost. I would like to lose nearly 200 pounds and prefer the idea of an easier surgery with less major complications, but I am worried about success of weight loss.

<Dr. Simpson> Weight loss comes not from the type of surgery that you have but from what you put into your gut while various surgeries do appear to have a greater weight loss with them. The major success is the aftercare of the patient with any surgery you can make it to goal and with any surgery you can lose not enough but surgery is such a great tool that it will be far better than any diet you have tried. However, you will, forever, think about what you eat, be on a diet -- and that means you will eat sensibly not some weird diet of cabbage soup or eating lamb chops for breakfast and no matter which surgery -- your stomach, or pouch, or whatever, will be smaller and it will take less to fill you up. So that lean cuisine which is now just an appetizer will become food for two meals. So go for the surgery you are comfortable with and remember it is going to be a good thing for you -- to quote Martha in Levenworth. Good luck.

<Dee> is the vbg a difficult procedure?

<Dr. Simpson> Well they are not difficult for me and they are simple procedures from a technical manner but as with all procedures almost anything can happen. The vbg is a good operation which works, although it is done less often now. Having been supplanted with the RNY and now the lap band.

<esmith po 3 weeks> Is there anything that you can take to help reduce extra skin?

<Dr. Simpson> A knife -- a good plastic surgeon -- and a bullet or some gas but until then low resistance isometric exercise will reduce the skin excess but not entirely.

<POST OP SUE 24 DAYS> hi there. i'm just over 3 weeks post op and i can now eat just over 2oz at each meal of food is this too much will i burst my pouch?

<Dr. Simpson> If it would burst your pouch you wouldn't be here. Different foods of different consistencies will tolerate different volumes for example: if you could you pro and an ounce of chicken. BUT DON'T measure twice, eat once -- vomit never, and NEVER risk a pouch stretch.

<kathleen g> Dr Simpson: After spending time in a hospital for surgery other than WLS, I would like to suggest you put together a program for hospital administrative staff that gives them a heads-up on nutrition and care of post WLS patients at all points along the road to recovery and maintenance. I know your book covers a lot, but, something specific to the medical community would be great. I banged my head against the wall explaining my nutritional needs. Thank you.

<Dr. Simpson> Well -- the book does have that in it. It is all there and if you get a copy for your staff they will learn about it a lot but there are a lot of myths out there about what you can and cannot eat. I suggest to my patients that I could tell the hospital what to feed them but I would rather educate them so that they can make a good choice because life is not someone telling you what you should eat -- It is your decisions. So your needs should be met by you cause outback steakhouse, the hospital, and everyone else will not know them or you as much and most hospitals allow you to order a variety of things. Get the hospital my book-- then I get the buck sixty seven royalty check.

<tera85> is this surgery safe

<Dr. Simpson> Surgery is like any surgery. Is it safe -- sure it is safe, but things can, and do happen, and things that we sometimes do not expect or things that we do not anticipate will and can happen and healthy people die, and people who we worry will not make it will sail through and people will get complications and problems but is it safe -- sure it is, but there is risk, and you should be aware of that as much as you possibly can before you jump under the knife.

<Laurie> What is your experience resolving diabetics who under go WLS? What percent totally get off their meds?

<Dr. Simpson> Well that varies with different individuals and we have some people who seem to have great luck, but remember, diabetes is not a single uniform disease that is, where I am from, we have the Pima Indians who have the highest incidence of diabetes in the world -- and with weight loss surgery we are able to see a great reduction in the medicines that they require. We can say this -- think of fat as a sponge that takes up insulin and the less of it you have, the less insulin is soaked up and the more is available for your bodies use. So weight loss will promote a decrease in the pills you need, or the insulin you take. It may get you totally off. However, if you eat high glycemic index carbohydrates you may very well need some additional help.

<kathleen g> Dr. Simpson: I would like to tell you that WLS surgery is like that proverbial ripple in a pond. Now that my family can see real progress in my recovery, three more relatives are in line to get the surgery. We are a family that is not unsmart, nor unsavvy. Just a bit overweight with a penchant for heart attacks and strokes. Thanks for the great inspiration. Keep up the good work.

<Dr. Simpson> Thank you -- and tell your family that my address is: in Phoenix --- we will do a group rate. Just kidding. Thank you -- it is something that a lot of people can use.

<tera85> im very nervous about having surgery will i be able to cope without eating alot of food

<Dr. Simpson> Be able to cope? That is something that is psychological and not something that is to do with the body and to do with the mind, but most people who have weight loss surgery do very well. In fact, they may mourn food for a bit, but feel this great sense of control which they never felt before and while they worry about it, it is something that often is not a problem. We cure the gut, but not the mind. Often the mind comes along, however. My mind was lost in space.

<Dee> whats the best way to get your protein intake daily?

<Dr. Simpson> Eat meat buffalo, elk, moose, haddock, patagonian toothfish, shrimp, lincod, wolf eel, Norwegian Sardines, lutefisk and so forth. Protein supplements may be required by some, but often they are not, and one can get in. The usual protein that they need with food-- besides, food is good. I like food. I like protein foods.

<Jacquie> With the open rny bypass and stapling,are there problems that can occur years down the road?

<Dr. Simpson> Well, I worry about down the road because if you catch a cow in your hood ornament it isn't always ready to eat. Any surgery has the potential to have adhesions which can cause bowel obstruction years later, any surgery can cause other issues within the person, but overall these are less of a risk than the risk of obesity -- while people might deny it, obesity is a health risk for virtually all cancers and other problems.

<LindaP Aug 9th> I am scheduled For Open Rny they have found a mass lower lobe of right lung going to do a Cat scan of chest Will this stop surgery

<Dr. Simpson> Well some things are more important than an elective surgery and if they find a mass then it needs to be worked up to determine what it is and if it needs some treatment -- like surgery, or some other thing and that beats the gut -- rock over scissors. Good luck with the mass, I avoid mass because I avoid churches.

<Maria maria, RNY on July 13th> If we are only to start with 2 tbsp at a meal, how are we ever to increase that because we are told that even one bite over could cause dumping or vomiting.

<Dr. Simpson> Well, that is not quite correct. One bite over will not cause dumping, dumping is caused by something that you might eat, which contains high glycemic index carbohydrates. You eat until you are satisfied and over time the size of your pouch will increase a bit and that is normal and expected but measure what you eat --- do not stress it, do not over indulge, do not chronically challenge the pouch. of course we have rules for the pouch and Simpson's pouch rules -- rule guess where you can find them? Actually, we will have an article about them in an upcoming magazine of obesityhelp.com so subscribe today.

<POST OP SUE 24 DAYS> you said earlier the lap band in the long run is the most effective what makes you say that??

<Dr. Simpson> Well there are a lot of things. First the studies show that weight loss with the lap band occurs even three years out. Second, weight loss is predominantly caused from the restriction not the malabsorption. Third, when we talk about effective we also talk about safety of the operation. There is no doubt the lap band, while it is a device and things can happen is the safest of all weight loss surgeries. On the other hand the duodenal switch, which has a record of the most weight loss has an 18 month window, where most the weight is lost. So, you can go through the statistics in any way you want suffice it to say that the old information about the lap band is and should be forever put to rest. It is the most common weight loss surgery in Europe and Australia, and when the first studies came out in the US about it we all wondered why we did so poorly with the lap band. We thought silly things like somehow those in Europe and Australia are different than we are. What we discovered -- much to the dismay of those who tested the lap band was simply that the first surgeons who did the studies were not that well versed in the lap band didn't do the operation that well, and didn't follow their patients that well. But their statistics are the one that Inamed (the manufacture) has to put in its literature. My next book, or one of my next books is just about the lap band, and its latest statistics.

<carrie> Do you forsee the ds passing up the rny in the futrure as far as popularity?

<Dr. Simpson> There are only a few of us in the nation who do the duodenal switch, and it is likely to stay that way. So I doubt that DS will overcome the RNY as there are so many surgeons doing the RNY right now, and probably will be for sometime but duodenal switch will be an effective tool for weight loss, especially in the super morbid obese.

<Maria> If the lap band is the most effective I don't understand. Once you have that removed you'd gain all the weight back, wouldn't you?

<Dr. Simpson> Well there are very few reasons to have the lap band removed. The main reasons are: erosion of the lap band, prolapse of the lap band, migration of the lap band or patients who think the lap band shouldn't be there because it freaks them out. The lap band is a permanent part of life, although we can deflate it sometimes for things like women who become pregnant -- or men if that ever happens or if you become ill and need chemotherapy and need more nutrition.

<Judy> Would you reject someone for surgery who has osteopenia? I haven't seen the surgeon yet but I am concerned since I was diagnosed with this a year ago.

<Dr. Simpson> I wouldn't reject them for that. I would reject them if they used illegal drugs, smoked cigarettes or if they didn't share their ice cream with me.

<Dee> whats a stricture

<Dr. Simpson> A stricture is when the opening between where we put the bowels together. Narrows that opening, so a stricture is a narrowing -- usually caused by scar tissue.

<LindaP Aug 9th> How soon after Op can you start full liquids

<Dr. Simpson> That depends on the surgery, the surgeon, and a whole host of factors. There is a progression of liquids to solids and I would think that usually we start full liquids on week two for a lap band on day four for a duodenal switch and RNY is a second week or so.

<kc> Where is your surgical practice, and which surgeries do you prefer to do, and in what order?

<Dr. Simpson> My surgical practice is in Arizona -- and we sit down and talk about the surgeries when the patient is fully informed about them and sometimes we change what they think -- but we always challenge what they think. So if they come in and think they want the lap band I talk about the DS but we tailor this for the individual, there is no formula all the surgeries will work for anyone of course, the smart pre op patients have read my book.

<Rob/AZ> If a stricture has not reoccured after 4-6 weeks after having the procedure done, is it a good guess that it won't reoccur?

<Dr. Simpson> Most of the time a stricture will need dilating one to four times and then that is it, it will, most often, not recur.

<sheryl h> My surgeon says no protein shakes...How do I get all my Protein in without them > Most here on OH use protein shakes. Thanks Sheryl H

<Dr. Simpson> There is plenty of protein in food and I think that if you can get the amount of protein in through food, then do that. Shakes are not needed -- although there are those who will disagree with that, and often do. In my duodenal switch patients, they require a lot of protein because of the malabsorption of protein in the gut, and they are often able to get all the protein they need by eating good old fashioned meat. Elk is good that way.

<DeeDee> I'm 13 months post-op with a staple line disruption and my surgeon has had to take a medical retirement. Since I will have to have a new surgeon what would you suggest as my best course of correction repair or revision?

<Dr. Simpson> Plus they lose more weight running after the elk. Well I would suggest you find a bariatric surgeon who is comfortable with revisions. Some are not, but some are and have a conversation with them. Find a surgeon with a few gray hairs --- or no hair who has been around a bit and seen it all before revisions can be a bit tricky.

<Melanie-TN> Dr. Simpson my surgeon has me restricted to 3 meals a day, no snacking, 600 calories max in a day. It seems that if I stick to that I dont lose as well. Can it be possible to eat too few calories?

<Dr. Simpson> Ah, I love that myth -- that you need to eat more calories to lose weight. That is a fairly tough regimen, by the way, and it is probably as complied with as well as when I tell my patients to not have sex for 17 years after surgery. If you stick to a low calorie diet you can become tired and lethargic and not exercise or get around. So you have to find a balance, where you work hard at exercise to lose the weight and then the caloric intake is immaterial.

<Shawn> I'm just coming into the chat room, so I"m sorry if this has been asked before... I've heard that some people die from the surgery... is it because they were bad off to begin with? or that they don't follow the "rules" after surgery?

<Dr. Simpson> Those who die from the surgery have done nothing wrong at all death is something that is an unfortunate consequence of surgery and sometimes people want to find blame with the person who has had the surgery, or the surgeon, or the hospital, or some doctor taking care of the patient but sometimes bad things happen, and it is very unfortunate and very tough on everyone -- certainly for the family certainly for the staff of the hospital and I can tell you -- it is very hard on the surgeon -- more than they will ever probably let on.

<Terri> I am currently 3 wks post op and I am not sure if I am eaing enough. Today I have had 6 oz of water 1 oz of egg salad and ine SF popsicle. I have just been mirated to foods two days ago. How much should I be eating and how often?

<Dr. Simpson> You should have a regimen for you that was decided upon by your surgeon and a meal plan. If not, then I suggest you call your surgeon or nutritionist and get one and if they don't have one --- it is the book and I am thinking of posting the meal plans on my website or certainly in my monthly newsletter -- which is an email newsletter and free and available to everyone and you can sign up through my website (should be posted soon) but that is a fundamental question that should have been answered for you long before this. Check with your doctor, and if you still don't know ---- get the book from www.obesitydr.com and the final question of the evening goes to:

<Terri> I would also like to know the title of your book

<Dr. Simpson> Well, it is in the banner of this talk periodically but the title is: Weight Loss Surgery: A lighter look at a heavy subject. It is available through the obesityhelp.com bookstore, or my website -- www.drsimpson.com OR amazon.com

<Moderator> Dr. Terry Simpson, Arizona Bariatric Center Website: http://www.drsimpson.com/ . Phone: 602-234-8995 Fax: 602-230-8344. Buy his book on his website, you will love it!! Thank you very much Dr. Simpson. We enjoy your chats every week. We all thank you and have a great weekend.

<Dr. Simpson> Thank you all. Good night.

<Moderator> Good nite everyone.