| August
29, 2003
<**MODERATOR**>
SARA MN, YOU HAVE THE FIRST QUESTION FOR DR. SIMPSON
<Sara-MN 6/6/03
-72> I started at 433 lbs, surgery on June 6th 2003, is 72 pounds on
track, or should it be more by now?? Thanks in advance...
<Dr.
Simpson> Oh -- well, in terms of Sara -- on track, hmmm
<Dr.
Simpson> Ok, I think that you are doing just fine and that is a great
weight loss...
<Sara-MN 6/6/03
-72> thanks
<Dr.
Simpson> Is there any other program you have been on where you have
lost 72 pounds in . a few months?
<Sara-MN 6/6/03
-72> no, but it seems like ppl have lost more than me in 3 months
<Dr.
Simpson> It always seems like others lose more than you do, so don't
worry about that. Just keep going, and doing what we do: water, walk,
protein.
<Dr.
Simpson> Good luck
<Sara-MN 6/6/03
-72> thanks!
<**MODERATOR**>
DAVIDW/SO CAL YOU HAVE THE NEXT QUESTION PLEASE..........
<DavidW/SoCal/10dPost>
Multipart question: A) Does the new pouch created in proximal rny function
like a normal stomach? B) Does the new pouch hold and let out food in
the same manner? C) Is the new opening to the small intestine the same
as a normal stomach? D) How does this affect hunger/appitite?
<Dr.
Simpson> The new pouch does not function like a stomach Second, the pouch does not hold food like a stomach -- instead
it is more like an hourglass, and drips food in slowly according to the viscosity of the food and size of the food. It will make
you feel full longer when you have solid food in the pouch,
<Dr.
Simpson> such as protein, vegetables (not fiber types) and so forth.
<Dr.
Simpson> So, three meals a day -- no more than five hours between meals--
plan to have good quality snacks. Good luck. Great questions.
<Dr.
Simpson> The stoma is not like a pylorus, nor does it function like
one.
<**MODERATOR**>
TREA 3 DAYS, YOU HAVE THE NEXT QUESTION
<TREA 3DAYS CONSULT>
i am having a sleep study in oct, my initial is tuesday, how long after
study can i have surgery if they say i have sleep apnea
<Dr.
Simpson> The next day. Even if you have sleep apnea, it will not interfere
with your surgery. The sooner you lose weight, the faster you get over
the apnea, and the less you sound like a freight train when you sleep.
Good luck.
<TREA 3DAYS CONSULT>
so i dont need oxygen to heal my lungs?
<Dr.
Simpson> Nope -- only for your brain.
<Dr.
Simpson> This is your brain on oxygen !!!!!!!!!!!!!!!!!!!!!!
<TREA 3DAYS CONSULT>
lol ok
<**MODERATOR**>
POLLY, YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON..............
<Polly> Dr.
S, Are there any challenges after rny surgery as one ages?
<Dr.
Simpson> Yes, the challenges are that you will have more energy than
your friends who didn't have the surgery and you will have to go to their
wakes.
<Dr.
Simpson> There are no long term problems which have been identified
with the modern bariatric surgeries which are performed.
<Polly> Actually,
my husband wondered if anything is coomplicated due to surgery?
<Dr.
Simpson> No, I think you will find you have more energy, and do quite
well after surgery. Good luck.
<**MODERATOR**>
TERRY, YOU HAVE THE NEXT QUESTION PLEASE..................
<Dr.
Simpson> Great name
<Terry> I had
surgery Monday. came home Thursday. is a 3 hr nap too long? i do sit up
for about 2 hrs at a time.
<Dr.
Simpson> Well that nap would be too much for me, my boss would fire
me. But,
I think that when you first come back from surgery you can expect that
sleep cycles will be a bit off and abnormal, and don't worry about it.
It takes time, sleep, protein, and lots of walking to get over the surgery
that we do to you.
So-- get up from the nap, and take a walk. Good luck, and welcome to the
other side.
<Terry> ty
<**MODERATOR**>
SAMANTHA, YOU HAVE THE NEXT QUESTION PLEASE....................
<samantha> i
was denied for failure to comply with lifestyle changes needed to maintain
a healthy weight what does this mean?
<Dr.
Simpson> I have no idea what that means, and the insurance company
who denied that to you should be obligated to explain it to you. There is no evidence and no test that we know of that will
determine if someone will have success after surgery or not So, you will need to ask whoever said such a silly thing to
explain that to you. Good luck.
<**MODERATOR**>
SHELLYPOE, YOU HAVE THE NEXT QUESTION PLEASE....................
<shellypoe>
im 9 weeks post op, whats the minimum amount of protein i need im 5'6
200 lbs now -52lbs
<Dr.
Simpson> shellypoe, what surgery?
<Dr.
Simpson> In terms of protein it matters in terms of the surgery, if
you had a proximal surgery then you will only need about 30 to 40 grams
per day...
<shellypoe>
open rny
<shellypoe>
prox
<Dr.
Simpson> If you had a distal surgery than 60 grams per day or more.
So, that would be what you need in order to do that. Good.
<Dr.
Simpson> You don't need that much, but always have protein first, and
go from there. Good luck.
<**MODERATOR**>
MICHELLE IN FL, YOU HAVE THE NEXT QUESTION, PLEASE........
<michelleinfl>
I've been taking a supplement that burns fat and speeds up metabolism
and have lost about five of my last ten pounds that have been hard to
get off. Is this ok? It's Ephedra-free and I feel great!
<Dr.
Simpson> Well, who knows what the stuff is really made of and what
it really is doing to you-- there is no magic pill....
<michelleinfl>
I had open RNY and lost 100 lbs. by the way
<Dr.
Simpson> There is no solution which will work for all of weight loss.
RNY does work a lot better than a pill The only pill that really works is the one made of 100 per
cent beef-- take one a day.
<michelleinfl>
thanks :0
<**MODERATOR**>
BKS, YOU HAVE THE NEXT QUESTION PLEASE................
<bks> Hi Doc,
I am now 7 mths post op from having lap RNy and lately everytime I bend
over or sit down I have been having this weird sensation in my legs like
the muscles or something is tearing, but I don't have much pain though,
what do tyou think this could possibly be it just started about a week
ago and really bothers me I don't want it to be the start of anything
serious? Thanks!
<Dr.
Simpson> I have no idea what that means. I wonder if you have a hernia
developing in your abdominal wall? So, I think if you are worried see
your surgeon and have your belly examined.
<bks> okay I
will
<**MODERATOR**>
EVELYN HALL, YOU HAVE THE NEXT QUESTION, PLEASE........................
<Evelyn Hall>
My question is " is the nausea having just below the gag reflex normal?
Also, I have extreme fatigue. It is an effort to walk from one room to
the other.
<Dr.
Simpson> Well, start by telling me when was your surgery.. Nausea can
happen if you overfill your pouch, and are consuming too much, so that
can occur quite easily.
The second thing is that fatigue is normal after surgery, or if you have
an anemia (sound familiar) such as iron deficient or B12 deficient anemia
So, I think you need to have some blood work done and check that out,
and go from there.
<**MODERATOR**>
JACKIE, YOU HAVE THE NEXT QUESTION PLEASE........................
<Jackie> I have
surgery scheduled for 22 Sept. do you think I will be up to a vacation
the 1st of Nov this has been planned a long time hate to back out now.
ty
<Dr.
Simpson> You will probably be a bit tired for the vacation, but I think
you will be up for it. So continue to plan it and look at it as a time to recoup, and enjoy some time when you are finally feeling
well. Usually the first six weeks are the toughest, then the next six
weeks are better.
<Jackie> thank
you
<**MODERATOR**>
JSC4TIDE, YOU HAVE THE NEXT QUESTION.....................
<jsc4tide> What
do they do with your stomach after the RNY? Do they leave it in place?
<Dr.
Simpson> They leave it right there, in place, and set --- so it will
be there if you need it. Don't worry, it won't go away. In the DS we remove the stomach.
<jsc4tide> OK..thanks!
<**MODERATOR**>
MSTHANGY, YOU HAVE THE NEXT QUESTION PLEASE.......................
<msthangy> can
you consume things that have sugar alcohols ...like sugar free yogart??
Why would it be okay to consume gatorade with so much sugar?? I thought
sugar was a no no.
<Dr.
Simpson> Sugar is a no no-- and you don't need it. There are always
circumstances where it is ok, but those are rare and specific, and
just because we want you to do something for a bit, does not mean it is
license to do it forever. So, in terms of alcohol-- well, I like tequila,
send it my way, I will have it for you
<**MODERATOR**>
PHYLIIS GLOVER, YOU HAVE THE NEXT QUESTION PLEASE.................
<Phyllis Glover>
I am a diabetic that is on an insulin pump...will my open RNY be any diffrent
then any other open RNY.. also are there any studies or stats. out about
people who are on insulin pumps and been able to go off them and perhaps
go back onto orals.I will be a first for my dr. and the first that he
knows of in minnesota having the surgery done with the pump.
<Dr.
Simpson> Many patients who have insulin are able to reduce or get off
the insulin after weight loss It is one of the more gratifying things
about this surgery, although there are other gratifying things, like watching
your clothes bill come back. So, you will no doubt use less insulin, you
may even be able to get off of it, although it also depends on the nature
of the diabetes. If you have type I, you will probably need insulin, but
less of it. Good luck.
<Phyllis Glover>
Ty
<**MODERATOR**>
KATHY, YOU HAVE THE NEXT QUESTION, PLEASE.....................
<Kathy> I have
lost 100 pounds in 8 months is that too fast?
<Dr.
Simpson> The only way that you lose weight too fast is if you have
a horrible illness -- otherwise -- no.
<Kathy> how
much protein should I have?
<Dr.
Simpson> Protein is a matter of the type of surgery which you have
had...
<Kathy> lap
rny
<Dr.
Simpson> If you have had a distal bypass then we recommend 60 to 80
grams per day, some more, if you have had proximal bypass then 30 to 40 grams per day should do
it. People are tired after surgery...
<Kathy> sometimes
I feel tired
<Dr.
Simpson> That is normal and natural If you don't feel tired then I want whatever they gave you.
<Kathy> okay
thanks
<**MODERATOR**>
DEBRA PHOENIX, YOU HAVE THE NEXT QUESTION PLEASE.................
<DEBRA>PHOENIX>
I HAD GASTRIC STAPLING IN 1989 IT WAS UNSUCCESSFUL THE STAPLES DID NOT
GO THROUGH THE FUNDUS AS PLANNED. NOW IM HOPING FOR THE RNY WILL THIS
BE DONE OPEN OR LAP AND WILL THE OLD STAPLES BE REMOVED
<Dr.
Simpson> Revisions are done open, not lap -- and the staples will probably
not have to be removed. they will be worked around -- so, we don't have to get that
old staple remover out of your desk...
<DEBRA>PHOENIX>
OK THANKS DOC THAT WHAT I THOUGHT WELL THATS GOOD TO KNOW MIGHT BE A LITTLE
RUSTY
<Dr.
Simpson> We could send you to Seattle and let the staples rust.
<DEBRA>PHOENIX>
NO THANKS
<**MODERATOR**>
LUNA, YOU HAVE THE NEXT QUESTION PLEASE................
<LUNA> I am
36 years of age, female, 297 BMI 50.1 What should my goal be for loss
at 6 months and then at one year, and 2 years? How soon before my body
will start feeling the results of the loss. Example, lowered blood pressure,
more energy ect.?? Thanks!!
<Dr.
Simpson> Well, Luna, I think your goal should be to get to a BMI of
24 in one year-- although it could take longer, it is a goal. In terms of feeling loss, usually it takes 12 weeks before
you say that you are really happy you did it and feel a difference. You will still be a female, but you will be older than 36
in a year.
<**MODERATOR**>
FAWN LORI, YOU HAVE THE NEXT QUESTION PLEASE..............
<Fawn Lori>
I am nervous. I will be having my consult in Oct. (went for orientation).
I need to work my surgery around my vacation time (I teach year round).
I'm not worried about his schedule, but concerned he'll see that as a
lack of committment. Can you give me your take on that?
<Dr.
Simpson> We like teachers, and we understand their work schedule, and
we don't think that your life and schedule has to work around ours, nor does ours around yours. So, I think an understanding surgeon
would have no problem trying to work you into a schedule . and not try to fit yours in his. Just my opinion-=- but then
again, - I am a saint.
<Fawn Lori>
LOL- you sound it :)
<Fawn Lori>
tequilla and all
<Fawn Lori>
ty
<msthangy> lol
<**MODERATOR**>
THEATRE, YOU HAVE THE NEXT QUESTION PLEASE......................
<Theatre(NH) -124>
Hello Dr. S- can you please tell me who my recovery will be from my hernia
repair and TT I am having in a couple of weeks? Thank YOU!
<Dr.
Simpson> Theatre, nice to see you, or chat with you again-- well, you
will recover. Usually the first few days are a drag, and you will be bent
over a bit- which will make you look like me -- being 72 years old and
all, we expect that ...
<Theatre(NH) -124>
Hello good to see you also, how long. I teach, and have to let my boss
know
<Dr.
Simpson> Take a few weeks off, and go from there. Generally two to
three weeks is what we expect. Good luck, and I am glad you are getting
that repaired.
<Theatre(NH) -124>
thanks
<**MODERATOR**>
DAVID/SOCAL, YOU HAVE THE NEXT QUESTION PLEASE.......................
<DavidW/SoCal/10dPost>
Thanks for giving us some of your time doctor, where do we send our tequila?
:-) I'm 10 days post op, I'm not taking in enough protien and worry that
I won't be able to (I HATE protein shakes/powders), how real is the danger
of vital tissue loss? What are the warning signs?
<Dr.
Simpson> Well if you don't like protein shakes and stuff (and who could
blame you) then you might consider cannibalism....
<DavidW/SoCal/10dPost>
rofl
<Dr.
Simpson> Getting in protein is important, but it is a goal, and if
you don't get in enough you might feel light headed, you might have some swelling of your legs, and you might get
nauseated a bit. Sometimes you have to take in supplements, even if you don't
want to, just to get by. Otherwise, keep going, protein first, drink lots of water,
and walk.
<DavidW/SoCal/10dPost>
Thanks
<**MODERATOR**>
REEN, YOU HAVE THE NEXT QUESTION PLEASE................
<Reen> My rny
was almost 1 1/2 yrs ago. It didnt work for me. Lost 27 lbs first month.....took
6 more months to lose the next 28 [only lost 7 lbs the second month....after
that it was even less, if any per month until the loss just stopped. And
I have stayed the same ever since. BMI is almost 40...it is 39.something
now. I have been doing everything right all along.....water, protein,
exercise, small meals, no grazing, etc. I still have back pain, I am still
on 3 meds for high bp, and for high cholesterol and also on 50mg zoloft
daily. I take my vits, etc religiously. I am 50 yr old and want to be
healthy! What are my options? Thank you so much! Oh yes, I recently had
an upper GI and another visit to my dietician.
<Dr.
Simpson> Well there are usually reasons that the surgery will fail
and they fall into one of two categories: The first is what you dispelled, which is what the patient
does, any surgery can be overcome by any patient, for any reason. that is, drink milkshakes, and you can gain weight after surgery....
<Reen> I understand
this is a tool
<Dr.
Simpson> The second is a technical reason why a surgery can fail, for
example, you can have a large pouch, you can have a large stoma, or you
can have al a leak from the upper stomach to the lower stomach. So, if you have no technical problems, then we have to take
a close look at what you are doing If there are technical problems, then you need a revision,
and that would probably be what I would recommend.
<**MODERATOR**>
SHERYLYN, YOU HAVE THE NEXT QUESTION PLEASE.................
<Sherylynn>
Hello Dr. Simpson. I am scheduled for WLS Sept 16th. I quit smoking a
month ago. I have a prescription for Albuterol, from when I smoked/coughed.
Would it help my lung capacity to use the inhaler daily until surgery?
<Dr.
Simpson> No, albuterol should be used for its indicated purpose, and
to help your lung capacity. Go take a nice walk, and keep walking-- keep
walking like a policeman after a donut.
<Sherylynn>
ty Dr.
<**MODERATOR**>
PHATLEXUS37, YOU HAVE THE NEXT QUESTION PLEASE................
<Phatlexus37>
Hello Dr. Simpson my BMI is 76.4. What can I do about that I weigh 457
what surgery is best for me
<Phatlexus37>
I have phentermine to day what are the risk and ghow much should i loose
<Dr.
Simpson> The surgery that is best for you is the one that your surgeon
will do. If you have a choice then with that BMI a distal type of procedure
would be best, like a duodenal switch. The more that you can lose before
surgery, the better it is, because you will keep that weight off, and
the loss you have will mostly come from your neck, and the airway in the
neck.
<Phatlexus37>
what is distal
<Dr.
Simpson> Distal bypass is one where more intestine is bypassed.
<Dr.
Simpson> so, look in to distal RNY, or duodenal switch.
<Phatlexus37>
open or lap
<Dr.
Simpson> Either way.
<Phatlexus37>
thanks Have a great Weekend
<**MODERATOR**>
GRETCHEN, YOU HAVE THE NEXT QUESTION PLEASE.........
<Gretchen> Hello,
my husband is having a vbg and I am concerned about the effects and possible
need for a revision what are your thoughts on vbg
<Dr.
Simpson> VBG is a great surgery and can work well. There are a lot
of surgeries that work well, and VBG is a tried and tested one If you need a revision, from a VBG, then there are ways to
do it, but again, you should be able to lose weight with it, while other
surgeries have better weight loss, that does not mean that they are
"better" so, follow the program with the VBG and he will do
quite well. Good luck.
<Gretchen> thank
you
<**MODERATOR**>
POLLY, YOU HAVE THE NEXT QUESTION PLEASE..................
<Polly> Dr.
S, does the remaining stomach atrophy after surgery? What is the difference
of distal rny, proximal (?) rny, open rny? I am scheduled for open rny.
ty I think you may have answered some part of this question. sorry.
<Dr.
Simpson> The stomach does not atrophy, it sits there and does it self.
A proximal RNY bypasses about 15 to 20 per cent of the small bowel, a
distal will bypass more than that. Open is done with a 6 inch incision, or larger, and laparoscopic
is done through a few tiny port sites...
<Polly> i am
having open
<Dr.
Simpson> They both work quite well.
<*MODERATOR>
MARILYN NYC, YOU HAVE THE NEXT QUESTION PLEASE...................
<Marilyn-NYC>
Hi Dr. Simpson! I always look forward to your chat! I had my Lap Rny on
March 22, 2003, Can I use Vioxx for menstrual cramps? If not what can
I safely take besides Tylenol?
<Dr.
Simpson> Well, I don't know, I never had menstrual cramps....
<Marilyn-NYC>
lol
<Dr.
Simpson> but that should be appropriate to use with the cramps, and
I don't think it will be a problem You can take any of the non-steroidal medicine, however, you
have to use a proton pump inhibitor medication, such as Prevacid if you
do that and then you have to do it under supervision, and approval,
and blessings from the pope.
<Marilyn-NYC>
lol thank you
<**MODERATOR**>
LISA BARDELEZ, YOY HAVE THE NEXT QUESTION PLEASE
<LISAB> Hi Dr
I have stomach ulcers and i am taking meds is it still safe to have surgery?
I'm Having open RNY in October, they are much better though
<Dr.
Simpson> Well, it is important to work up the stomach ulcers in a separate
way, and I am sure they did in terms of surgery, ulceration and the propensity for ulceration,
are things which need to be evaluated by the surgeon prior to the surgery...
<LISAB> so it's
safe to have the RNY
<Dr.
Simpson> Once that is done then it will be fine. That is not a contraindication
for the surgery, in and of itself, so it will probably be safe They might want to biopsy the ulcers at the time of surgery,
however.
<LISAB> THANK
YOU DR.S
<**MODERATOR**>
KAREN, YOU HAVE THE NEXT QUESTION, PLEASE.....
<Karen> Is this
surgery ever reversed? or Can it be?
<Dr.
Simpson> You cannot consider this surgery to be reversible, and should
go in with the attitude that it is what you are going to get and you will
make it work The lap band is the closest to reversibility, but even that
is something we put in you, and nothing is totally reversible...
<Karen> I mean
in case of emergency of some kind
<Dr.
Simpson> We can revise it, but you will always have some part of you
which isn't as the original factory installed equipment.
<Karen> ty
<**MODERATOR**>
MARGARITAGIRL, YOU HAVE THE NEXT QUESTION PLEASE..............
<margaritagirl>
i would like to know what can i do to prepare myself for the surgery.
would it be okay to start taking protein supplements now?
<Dr.
Simpson> It isn't what you eat that will prepare you-- the best thing
you can do is to start a walking and exercise program and then the next
thing you can do is to take a multiple vitamin daily. If you like supplements, fine, but you probably don't need
them now.
<margaritagirl>
thank you
<**MODERATOR**>
LEAPA, YOU HAVE THE NEXT QUESTION PLEASE...............
<Leapa> i had
an open rny 4 weeks ago, my incision got infected. I now have two holes
in my stomach that has to be packed by a visiting nurse. I am so miserable
from the drainage and the pressure caused by the drainage. How long will
it take for this to resolve... I was in so much discomfort I cried all
last nite.
<Dr.
Simpson> Incisions can become infected, and they take a long time to
close on their own....
<Leapa> anything
i can do for relief
<Dr.
Simpson> They need wound care, and your best bet is to continue with
some good nutrition, and keep working on them. Hopefully it will close soon and you will be feeling better.
<Leapa> i do
have wound care, my nurse want to do more proactive stuff but my dr refuses
<Leapa> like
vacumm the wound
<Dr.
Simpson> Sometimes the vacuum doesn't do as well as the company who
sells them would like, so traditional care works well, and is less expensive.
<Dr.
Simpson> Go with the surgeon's advice, they know a lot about the wound
care.
<Leapa> thank
you
<**MODERATOR**>
KATHY, YOU HAVE THE NEXT QUESTION PLEASE..............
<Kathy> I had
surgery jan 2 2003 and I only have 25 more pounds to go I am wondering
when could I have a tummy tuck and breast reduction done?
<Kathy> I am
only 8 months out
<Dr.
Simpson> Kathy, great loss, and congratulations-- probably wait for
a year after surgery or more and then eight has stabilized. then you can have the breast tuck and tummy reduction.
<Kathy> okay
thank you
<**MODERATOR**>
JESSICA, YOU HAVE THE NEXT QUESTION................
<Jessica> I
am 4 Months Post Op, and I don't take any meds, Or Protein. What Problems
Could Happen? Oh, and is Everyone aware that Your Spouse will lose weight
too?! My Hubby Lost 11 lbs Sense My surgery.
<Dr.
Simpson> Yes, weight loss by proxy-- I keep hoping my patients weight
loss will rub off on me....
<Jessica> lol
<Dr.
Simpson> You may not need meds, and that is ok ---
<Dr.
Simpson> Protein is essential, you don't need to eat any protein supplements...
<Jessica> no,
i used to eat alot of Beef Jerky, But
<Jessica> it
made mmy kidneys hurt tremendusly
<Dr.
Simpson> Well, you do need protein to eat, and to keep you going.
<Jessica> so
i just take a couple of bite of what everyone else is eating and i am
good to go
<Jessica> i
dont get dizzy or anything, i actually feel fine
<Jessica> except
for back pain
<*MODERATOR>
NITNTAZ, YOU HAVE THE NEXT QUESTION PLEASE................
<nitntaz-preop>
i'm confused there are so many calcium supplements outthere which is the
best and protein supplementsand does everyone have to take these and do
kidneys stones change having the surgery
<Dr.
Simpson> Calcium is a difficult, but essentially it works like this::
Calcium citrate is absorbed best in the stomach, and calcium carbonate
is absorbed less well.. The best protein is the meat that you eat, fish,
meat. Kidney stones do not effect surgery....
<nitntaz-preop>
ty
<**MODERATOR**>
KRISTY NUSH, YOU HAVE THE NEXT QUESTION PLEASE....
<Kristy Nush>
My surgeon will not give me an idea of a goal weight. He just says that
I should expect to lose 65% of my excess weight. I weight 320 lbs and
am 5'8". 23 year old female. I have decided on a personal goal weight
of 143. What do you think? I'm having the distal (150 cm bypassed) lap
rny.
<Dr.
Simpson> I think that your goal should be your goal. I think that you
should have a goal of 24 BMI
and yes, we have the wish to be 65 per cent of excess weight, that is
what we do for surgery that is not what we expect you can do, we think
that you can do anything that you want with the surgery. because it is
a good tool
<Kristy Nush>
thanks
<*MODERATOR>
DAVID, YOU HAVE THE NEXT QUESTION PLEASE...................
<David> Dr.
Simpson, I am a virgin to all of this; severe heart disease in my family
and a BMI of 31 where do I go for reliable information? What are the requirements
for surgery?
<Dr.
Simpson> Family history is not relevant to your weight loss, the NIH
criteria are the best....
<David> fighting
weight loss like a yo yo for years
<Dr.
Simpson> What they care about are the following: BMI of 35 with comorbidities,
or BMI of 40 without -- supervised diet by a physician, .. which usually
means at least 6 months of a supervised physician diet, with their chart
notes to look at it. That is what they care about, and that is the criteria.
BMI of 31 does not meet it. Good luck.
<*MODERATOR>
DEBRA>PHOENIX, YOU HAVE THE NEXT QUESTION PLEASE...................
<DEBRA>PHOENIX>
SORRY, QUESTION IM 5'7" 235LBS DO I MEET THE CRITERIA FOR SURGERY
IM THE PERSON WITH THE RUSTED STAPLES YOU SPOKE WITH EARLIER
<Dr.
Simpson> For a revision, Debra, you might meet it -- something to discuss
with a surgeon, good luck.
<**MODERATOR**>
DIETICIAN VICKY, YOU HAVE THE LAST QUESTION FOR DOCTOR SIMPSON THIS EVENING...............
<Dietitian Vicky>
Just wondering whether you have noticed any correlations between s/p WLS
clients and clinically diagnosable eating disorders further down the line..Have
you personally come across any such links within your own practice, and
as a clinician (Bari RD), what can I do to prevent my clients from lapsing
into such a condition? Certainly, I have come across many a patient whom
I worry about (even those who have emerged with a 'clean' psych consult),
in terms of emotional balance/tendencies to venture into extremes, particularly
when emotional issues that initially caused the obesity haven't been resolved,
and thus, are simply 're-channeled' in yet, another unhealthy direction...
(ie. super morbid obesity, potentials for 'taking and running with the
surgical implications' towards the other end of the spectrum) How can
I best support my clients pro-actively, and what is your perspective re:
this phenomenon? Thank you kindly.
<Dr.
Simpson> Wow -- that is a great question, and it isn't an easy answer,
but of course I will try:
<Dietitian Vicky>
thanks
<Dr.
Simpson> The great thing about weight loss surgery -- any of them,
is that after the surgery many patients feel in control for the first
time ever. They feel full and satisfied with less, and it is a little
freaky for some it is also the time when their mouths can hold more than their
stomachs can. which is a strange place in biology. The only known entity which does not work well is a syndrome
called Prader Willi syndrome, and an associated abnormality like it Otherwise, the best thing you can do is work on "retraining"
their new tool-- that is, have them come and eat with you...
<Dietitian Vicky>
right...endocrine disturbance
<Dr.
Simpson> Have them feel satisfied, and know what the feeling is, and
how long it lasts, and then. they need to slowly reinforce that.
<Dr.
Simpson> That becomes their new tool, some new sensation...
<Dietitian Vicky>
ooh! Great suggestion!
<Dietitian Vicky>
Intuitive eating approaches
<Dietitian Vicky>
Thanks!
<**MODERATOR**>
THANK YOU DR. SIMPSON, THANK YOU MEMBERS...WE WILL SEE YOU ALL HERE NEXT
FRIDAY AT 4PST....PLEASE VISIT DR. SIMPSON AT: WWW.DOCTORSIMPSON.COM
|
