August 13, 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!

<Janet> I am set to have my physical on Aug. 31. Can you tell me what all you doc's look for?

<Dr. Simpson> Well as with any physician, we do physical examinations of our patients to see if there are any obvious problems that would cause us to want some more work or other tests. For example, we will check heart and lungs and see if there is anything we need to do further work up with.

<Linda Lou> I was wondering if It is ok for me to start soft foods on my own if I dont see the doctor untill the sixth week after surgery?

<Dr. Simpson> We usually allow soft foods after the second week, so you probably are going to be ok with that. We have a progression of diet in our book and your surgeon probably has some progression that they want you to follow. The answer is to go slow, small, and easy. Do not go too fast as you will find some things will upset you even though you are a few weeks out. Good luck

<Umzaina> Hi Dr. Simpson, do you do lap-band

<Dr. Simpson> Yes I do the lap band. I also do the jitterbug and the waltz but yes, the lap band is one of the operations we offer our patients.

<Shell> Do You have to take someone to the hospital with you in order to have the surgery and how would anxiety affect the surgery if at all

<Dr. Simpson> Well not everyone has someone that they bring to the hospital with them and sometimes having friends and family is a good thing, but other times those things can be more of a problem than not. So you have to determine that for yourself anxiety is normal for any surgery. We all get a bit anxious when having surgery, but it will be done with soon, and you will be on the other side if you have an anxiety disorder you should make certain it is under control and you are medicated before going to surgery.

<Joanna> hi. I am looking for information. would love to have surgery....but which one?

<Dr. Simpson> Ah -- Joanna, probably the best source of information is my book -- which is available at www.obesitydr.com. It has a complete list of all operations, what to expect pre op with insurance companies, and the risks involved as well as what to expect in the hospital, what to bring to the hospital, what sort of things to have done before surgery, then has a comprehensive section about the post operative care of all procedures, including recipes and menu plans and some information for your primary care doctor as to how to take care of you following surgery so where to start -- the book. Good luck.

<Linda Lou> Am I in for any trouble if I have a appetite at six weeks out?

<Dr. Simpson> Appetites are mental more than physical, and they come back. When you don't have an appetite nine months out then there is a problem. Now you have to learn what to eat, how much to eat, and when to eat. Do not skip meals, eat a limited amount, measure twice, eat once, vomit never.

<Debbi R> I just came from my 6 month check up today. My Dr says I'm 11 pounds from Surgical Goal. What are the chances of loosing the remaining 37 pound to reach my ideal goal of 130. I forgot to ask him when I was there. Thank You.

<Dr. Simpson> Great job! You can lose that weight and now suffer what the rest of us suffer. Those last few pounds that we have to lose in order to get to a personal goal. Yes, you can get there, and you have the tool to do it. You have a smaller stomach, and you can eat better, and with the weight gone it will be easier to exercise --- so start that.

<bobby martin> how much water should we drink after surgery?

<Dr. Simpson> Two liters per day just for basic living, and more if you have diarrhea or vomiting, or if you are out in the sun, or doing a lot more things -- which we hope you will start.

<Shell> I have heard the percentages complications patients have what is the percentage of patients that would have no complications?

<Dr. Simpson> Well the percent of those who have no complications simply subtract the complications from 100 and you have the number. Most patients have no complications following surgery, but it comes down to about 80 per cent have no complications --- and about 15 per cent have some minor complications, including wound infection, vomiting, dehydration and the last five percent have severe complications -- that is a complication which causes them to spend at least one extra day in the hospital and that can be as minor as not advancing the liquids as fast or something more major.

<sandra burns> are we to have to take supplements the rest of our lives after surgery? and if we dont will we get sick?

<Dr. Simpson> Yes, you will need to take supplements for the rest of your life following surgery, and if you do not take them you can have some severe difficulty so vitamins are important, nothing to fool around with, so take your vitamins.

<joann> i have a qwestion ..im out 2 years now with a rny and some days my appetites a killer then some days im not hungry is that normal?

<Dr. Simpson> That is entirely normal. Someday you will find that you can eat more than others, and some times during the day you will feel a bit more full than others, all of that is normal, and those are all things that you should be aware of.

<Lisa> Good afternoon Dr. Simpson I would like to know how long is the recover time for a patient that has open rny done. How soon can you drive after and resume normal activities?

<Dr. Simpson> Open RNY is probably a hospitalization of four days or so, and three weeks before you should go back to work. You can drive after two or three weeks if your reaction time is back to normal and you are off all narcotics. No sex for 17 years.

<tonya> do you do surgery laproscopic or open? and what types do you do. thank you

<Dr. Simpson> I do both laparoscopic and open. Open is for revision surgery, and laparoscopic is for most others, although if the BMI is high sometimes we do those open.

<Linda Lou> Do you think my surgeon would give me a script for pain pills so I can walk and exercise without being in pain untill some of this weight comes off and I feel more comfortable working out without being in pain.

<Dr. Simpson> Surgeons give pain pills in order for patients to have relieve from post operative pain if you are having pain while working out then I think you should see a physical therapist in order to determine what the source of pain is or consider a different type of work out such as water aerobics, or something like that. I don't think that pain pills in order to exercise and walk is a good thing.

<Mike> What are the current improvements in WLS that cuts down the risks?

<Dr. Simpson> The lap band has the least risk of all weight loss surgeries and is a dramatic reduction in risk form other surgeries. However all surgeries have risk, even the lap band, and all surgeries have their Achilles heel ---- but we have a few more tools and techniques which have come in lately that we are all evaluating such as fibrin sealant, reinforcements of the staple lines, and other such things. Some of the stapling devices are a great improvement in the way we do the operations.

<lydia> i need to know if protein shakes are ok to drink in place of meat cause i cant keep meat down well and i need protein?

<Dr. Simpson> Well there are a lot of things to get protein from besides shakes or meat and I would think about learning about those things before you resort to a shake such as, I think seafood is easier to digest than red meat some soy products, like Bocca burgers are well tolerated, cheese, cottage cheese, and skim milk are all good sources of protein so there are a number of things that you can use for protein, but if you need a shake to modulate the amount of protein that you need then by all means use it.

<seth> what happens to the skin after you lose all your weight does it go back or can it be toned up?

<Dr. Simpson> Some skin will go back and be toned up and some skin will not ---- everyone is different and there are a lot of things that go into that in order to determine whether you might need plastic surgery or not.

<roberta> i got you book and i loved it so much thank you for writing it and its very informational on just about anything i wanted to know any books coming soon?

<Dr. Simpson> We have a number of books in the works. We have a book just about the lap band which has the latest information in it about the lap band. We have a book coming out for long-term post operative patients, which you saw a bit of in the last book. We have a book coming out just for physicians who take care of weight loss patients and maybe a novel or two will be coming also.

<Misty> I am 5 months out and i have been feeling great til these past 2 weeks, I am dizzy all the time and can barley stay awake at anytime also staying sick to my stomach rather I eat or not and always feel like i have a lump in my throat. I am takeing my vitamins and lots of protein intake nothing out of the normal i have lost 89 pounds got 40 to go. what do you think is happening? is this normal

<Dr. Simpson> Doesn't sound normal at all, it sounds as if you are on a bit of dehydration and need to increase your water, or you could be pregnant, which is always a joy but you need to see your physician and have a physical and some lab work in order to get this taken care of.

<Janet> Do females with PCOS lose slower than others with the RNY?

<Dr. Simpson> No -- they lose just as fast or sometimes just as slow as others. Weight loss is a simple formula, that is, weight loss is something that the less calories you take in and the more that you work, the faster you will lose weight. Want to increase your metabolism, take a walk.

<Shell> my consultation is in oct i have gotten my physical and met with a nitritionist and a pulmonologist how many times will I need to see my surgeon before havin the surgery?

<Dr. Simpson> Every surgeon is different. Typically I will see patients twice before they have surgery some like to see them longer than that, some only one time -- but I like seem them initially then about a week before surgery although often I will see them in the office and they will be thinking about a couple of operations for weight loss and I will have them come back a week or two later in order for us to look at things.

<Mary5> I am 18 weeks post-op. Am hungry all the time, can tolerate all the wrong foods without dumping. How can I stop eating the wrong foods?

<Dr. Simpson> Well that is what we call willpower ---- and that is something we do not put in you during surgery. What you have to do is to take care of that yourself, by finding new foods to eat. I would suggest you get a whole new diet, with new foods and new tastes and get rid of the stuff that isn't doing you any good for example, instead of keeping a bowl of candy in the house --- keep some fruit bowls instead.

<cat> can you explain reactive hypoglycemia and how would a Doctor test for it? fasting Insulin level?

<Dr. Simpson> That is not something that we worry about in weight loss surgery, while many patients say that they have hypoglycemia, when we actually test for it they don't have it -- and it is simply they become anxious when they don't eat, so they eat more and eventually they become my patient. There is one disease which causes that, which is a tumor that produces insulin and that is very rare -- although there are a lot of books out there that say it does happen, but in fact, it does not.

<tammy> can we have surger ever after bypass surgery? or will you dump always?

<Dr. Simpson> After RNY 60 per cent of people dump and 40 per cent of people do not dump. Dumping is not related to weight loss, it is not a good thing. But I would attempt to avoid sugar or at least those uncomplicated sugars instead go for fruits and vegetables.

<Joanna> where do you do your surgery?

<Dr. Simpson> In the operating room or the kitchen table if it is available but the dogs always beg for scraps. Phoenix, Arizona.

<miss murry> are we able to get pregnant after surgery i heard you do?

<Dr. Simpson> I have never been pregnant and I have done a lot of surgeries. Patients can become pregnant after surgery, and we like them to wait at least two years after having surgery to become pregnant. However, many people seem to be super fertile and super interested in the opposite sex and do not take appropriate measures to avoid pregnancy but we really would feel better if you waited a couple of years.

<mary ross> How long does it take an open-rny patient to recover from surgery?

<Dr. Simpson> Three weeks to back to work, two weeks to drive, 17 years to sex.

<JennT> Dr. - I am very concerned about managing hair loss. My surgery is scheduled in a week, and I already have thin hair (along with PCOS and Hypothyroid). What recommendations do you have for me to manage any further hair loss?

<Dr. Simpson> Well hair loss happens to thirty per cent of the patients, not 100 percent and it is related to surgical stress, and not related to a lot of other things, however there are some things that make hair loss worse -- such as if you are not taking enough protein, zinc, biotin or if you lie to your surgeon also perms, hair coloring, and the like -- especially three months to four months after surgery -- which is the optimal time for hair loss. To avoid hair loss I suggest you shave your scalp bald, and keep it that way until six months post op then let it grow back or if you don't like that keep superglue on your scalp.

<Linda Lou> Is sugar the only thing that makes you dump/ because I haven't experienced the dumping thing since I stay away from sweets.

<Dr. Simpson> Simple carbohydrates can also lead to dumping -- breads, cookies, and the like but dumping is not a good thing, so avoid it.

<laura> how much protein should we get in in a day and should that be meats or both with shakes?

<Dr. Simpson> The amount of protein that you need is related to how tall you are and how long the common channel is that your surgeon left you with. Without knowing that it is difficult other to say that it will be somewhere between 50 grams and 110 grams of protein a day. We like patients to get that in food instead of in shakes, but sometimes they cannot take in enough protein, especially if they have a distal bypass or if they have had a duodenal switch operation. And in that case they will need to have more protein and probably shakes. I shake whenever I don't get my daily milkshake.

<RAC> Would you cancel the surgery on a 60 yr. old male with blood/oxy. level of 85?

<Dr. Simpson> Cancel -- maybe if I just discovered it before surgery that, in and of itself, is not a contraindication to surgery, but it does need to be worked up. In order to find out why the level is 85 instead of 90 or 100 but the age is not the factor, it is just that we have indication of some other disease process going on and we have t get that figured out.

<Danielle P.> what is the best vitamin to take to help control hair loss?

<Dr. Simpson> Hair loss is not related to vitamins, it is entirely unrelated to vitamins, contrary to what some people think. There is a whole chapter about hair loss in my book, but it occurs with surgical stress, not vitamin deficiency.

<rita> when performing the surgery, do the Drs make the size of the pouch by the size of the patient

<Dr. Simpson> Pouch size is standard, and everyone has a slightly different standard. Our standard pouch size is about one ounce, some have less than that, and some have more.

<pumba> If someone is wanting to do a surgery, yet is scared to death, and weighs 440 lbs, and needs it done, would you recommend it to them?

<Dr. Simpson> Well unless they were over 8 feet tall, yes I think that they would need surgery and we would recommend that they undergo weight loss surgery after an appropriate attempt is made to lose weight under medical supervision.

<Linda Lou> I am so worried I have streched my new stomach since my surgury july 12th 04 because I started softer foods before I was told, what do you think?

<Dr. Simpson> I think you will be just fine, solid foods are not something that will cause pouch stretch, they might cause some vomiting if you eat them too early, but they should not stretch the pouch unless you over fill the pouch with the solid foods.

<glendasue> I am 3 weeks out and most days I only eat 2 or 3 bites and also am having difficulty with fluids. They tell me it will get better

<Dr. Simpson> Two or three bites is just fine, that is what we expect, and that is what we desire. I think you need to get some more liquids on board so you feel better also, as time goes on you will feel better. The first 12 weeks suck.

<mary ross> I'm in need of dental work ..extraction of my upper teeth .Should I have it done before or after surgery?Ithink i may-be having surgery next month.

<Dr. Simpson> Get the dental work done now, and get those teeth replaced. I come from the villages of Alaska where we judge a woman by her teeth. We know that the toothbrush was invented in our village because if it was invented in the city it would have been called a teethbrush. We would call a woman with ten teeth a ten -- but none of us could count that high.

<MH> Good evening...How active can you be with a lap band? I'm extremely active in sports, especially football. Is this a hazard?

<Dr. Simpson> Sports and football are hazards, but I do not think they are a problem with the lap band. In fact we like active patients, we like active patients a lot. Football, however can be dangerous, lost a knee to football.

<Patty> Is there any reason that lap rny would be stopped after the surgery is started?

<Dr. Simpson> There are always reasons to stop surgery, but they rarely happen - if we find something unusual, or if you have strange anatomy but that is rare, nothing to worry about.

<Misty> Not sure if i can get a two for one deal here, but thank you for your answer, but no luck in the baby dept...so i cant be prego...but i do have another question..I love my doctor but she knows nothing about WLS surgery, is there some place i can get some info for her to read on what neds we can have and danger signs.. thanks Misty

<Dr. Simpson> Ah Misty --- now there is a lead in. Yes, there is a great book which was written for patient and doctor alike. The book is --- my book which you can find on www.obesitydr.com which has a section just for doctors. In a few months we will have a whole book just for the doctors but still working on that.

<Hal> If the band does start to slip, do you feel it Can the band pop open? How do you know if you have over stretched the pouch above the band?

<Dr. Simpson> The band should not pop open and the only way to see if things are over stretched is to see an x ray to determine if the pouch is large or do a cottage cheese test. Band slippage can occur, and will need to be placed back with surgery but DO NOT over eat, and you should be fine.

<Sphinxyldy> Have you had any patients with SLE (lupus) and if so, how did they tolerate surgery?

<Dr. Simpson> I have had patients with lupus, fibromyalgia, and halatosis. They all tolerate the surgery well

<Hal> How close is the band to your heart?

<Dr. Simpson> Well I am not in love with the band, but I have a close place for it. The band is on the other side of the diaphragm from your heart so you have a big muscular thing, the diaphragm, so about an inch.

<Judy> I have been weighing (no pun intended) the risks/advantages between doing the lap rny versus the lap band...do lap band patients lose as well as the rny's?

<Dr. Simpson> There have been some new studies which show that the lap band will continue to lose weight up to three years after surgery where the RNY stops after about 18 months to two years. You can lose as much weight with either surgery, although the early data did not show that. The first bit of data which came in about the lap band was not too good but we discovered that it wasn't the data as much as how things were done now the later data coming in shows that the lap band is far better than the early statistics indicated. Still, however, a lot of people use those old statistics.

<trena> how long do you keep your patients on pureed foods postop

<Dr. Simpson> It depends on the surgery for lap band we keep them on it about a week or so, for the duodenal switch we get them off to regular food by the time they leave the hospital.

<Amelia> Dr. Simpson, I am 4 years post surgery. I had lost 75 pounds and have been steadily gaining about 10 pounds a year. This means I need to loose 50 pounds again. I think I have busted my staples. What do you do to repair the staples if I have done this?

<dianne> why does it matter.....food or shakes....isn't protein.."protein"?

<Dr. Simpson> And some might come in expecting the wit and wisdom protein is protein, however, there are a lot of things that are different. Protein is a combination of amino acids, and some protein shakes do not contain all of the essential amino acids, or the essential ones. Second, some protein shakes are not as "bioavailable" that is, while you drink it you do not always absorb all the protein in the shake. Food is readily bioavailable, and most contain the appropriate amino acids and it uses your gut, which is a good thing so, if you need the supplements, that is fine -- but if not, then I think food works better.

<Moderator> The final question for the evening is:

<kat> What is any reason is there a post op patient would be burping.

<Dr. Simpson> Gas - you swallow air when you eat food and if you change your eating habits, as many do after surgery and swallow more air then you can burp. So swallow less air, chew your food and enjoy it. Eat less, enjoy more. Nothing tastes as good as slender feels.

<Dr. Simpson> Good night everyone get the book: www.obesitydr.com

<Moderator> Thank you very much Dr. Simpson , We enjoy your chats every week. We all thank you and have a great weekend.

<Moderator> Thank you all 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.