September 24, 2004

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

<tammy adams> what is the success rate of vbg? is vbg safe?

<Dr. Simpson> The vbg is like any procedure, it is safe, and has all the precautions of the surgeries. The safest of all surgeries is the lap band, which is probably a better operation than the vbg but the vbg is a good operation and will help lose weight.

<shelly> How long will it take for your hair to stop falling out and is there any thing I can take to help this ..Thanks so much...

<Dr. Simpson> Super glue. Hair loss usually continues for three to four months. It is exacerbated by zinc and protein deficiency but is primarily caused by the hair follicles resetting themselves at the time of surgery which is why it takes three months after surgery or four -- to see the hair loss. Hair today gone tomorrow. Hair comes back richer and fuller in many cases. Although there are always exceptions. Things to avoid during this period are perms, coloring, or other toxic things that some like to put in their hair.

<Vicky> why do some surgeons require a 2 week liquid diet and others require nothing at all

<Dr. Simpson> Some surgeons like to torture their patients more than others for the lap band it is standard to have a week of clears and a week of full liquid diet. For others we like to allow the surgery to heal before we proceed liquids are easy to go down, and you lose some weight with them. Some surgeons have a six week requirement for liquids go with what your surgeon wants you to do ---- but it allows the stomach to heal without putting too much pressure on the staple or suture lines. Good luck.

<shellytx> How far out have bariatric patients been tracked? How are patients doing 10+ yrs out?

<Dr. Simpson> There are patients even longer out while most weight loss surgery patients have been done in the last couple of years. Weight loss surgery has been done for years in this country. I have some patients who are 13 years out and doing well.

<PreopLibby> Just wondering if you book is available in bookstores?

<Dr. Simpson> Depends on the bookstore ---- but if you want a copy the easiest way is to order it is through our office at www.obesitydr.com because it is a specialized book, and not in a wide audience. Many bookstores do not wish to carry it. It is also on Amazon.com

<brandy wine> what should i do to prepare for my surgery i am 3 wks away?

<Dr. Simpson> Several things: first get on a good multi vitamin, one that digests easily. Second, begin a walking program -- get a podometer and start counting steps and see what you do in your daily activity then there is a whole range of things to get and buy for your operation ---- all of which are in "the book".

<shellytx> Im concerned about Post op pain (in recovery) what is the pain described as or like? is there any way to reduce the post op pain? (lap RNY)

<Dr. Simpson> The best way to reduce pain is to walk, the more active you are and the more that you walk, the better you will feel and the faster you will recover, the sooner you get off the narcotic agents the faster you will recover.

<johanna> Hi, I just got home from the hospital, and I'm still pretty groggy and disoriented. My surgery was eight hours long. Is it okay to take it slow for right now? Also, now that I've had the surgery, should I paint my toenails bright red or pink?>;^)

<Dr. Simpson> I think that red is a good color for you. It is ok to be groggy and disoriented. That is how I feel most mornings until I have my second cup of coffee but instead of taking it slow -- start to walk, keep up with fluids, and keep your mind occupied. Do not lay around in bed.

<TwinMomma> Dr. Simpson-- I recently read your book and was approved for surgery this week. I am not worried about the surgery itself, but have failed at so many diets, am scared I will fail again. I know the generic advice is do what your doctor says, eat protein first, drink water, exercise, etc. Any other ideas from your successes?

<Dr. Simpson> Thank you for getting the book, and I hope that you find it helpful. Surgery is not something that you can fail. Well you can if you decide to drink milkshakes all the time and in terms of the generic advice -- yes, it is simple. Measure what you eat -- twice, and learn your new portions, learn some new recipes, and above all --- walk. Then re read the book and pass it on.

<Jill> Is it normal after RNY to have fluxuating liver levels?

<Dr. Simpson> Well the liver is usually below the diaphragm and doesn't move too much. T the liver enzymes might change over time and there are reasons for that. Alkaline phosphatase might rise if you are not taking enough calcium. If you are having some protein deficiency you might have a rise of the liver enzymes but if there is such a thing, then I would suggest you make certain that first your liver is ok, ask your surgeon if you had some fatty liver --- and you might need to see a liver specialist, but I am certain you will be fine.

<Shawna Dithrtu 6-10-04> Lost 70 lbs first two months and haven't lost anything for five weeks. Eat less than 1000 calories a day and walk a mile every day. Is this normal to plateau this early. Started at 387. Currently 317

<Dr. Simpson> A plateau is not only when you are not losing weight but when you are not losing inches. Often this early on the weight will stabilize but you will still lose inches. In terms of walking --- we want 10,000 steps a day, and the only way that I can get that in is to walk three miles a day and best to do that in about a 17-minute mile. So, keep up the walking, and walk some more, and by the way, that is a great weight loss. Everyone stand up at their computers and clap.

<Moderator> CLAPS

<Jill> After loosing 130 pounds I have lots of loose and flabby skin, is that covered by insurance as a result of the surgery?

<Dr. Simpson> The flabby skin is not a result of surgery, it is a result of obesity and sometimes insurance companies will cover that, and sometimes they will not. That is something that you will have to work out with them but even if you have to pay for it yourself, you should remember that you live in your skin 24 hours a day. You pay more for a car that you spend an hour or less in a day, so don't worry, pay it and look nice for yourself.

<candy> my"friends" are now telling me that lapband make you vomit alot

<Dr. Simpson> Well, your friends are full of it. I have known a lot of patients with the lapband and have a lot of patients who I have placed it in and vomiting is NOT an issue, not not not. Just because the operation is easy some folks want to find something wrong with it.

<sherrylp> Are you required to pay what your insurance doesn't before your hospital admission?

<Dr. Simpson> Some hospitals do require that and some bariatric programs require that and that is because it is amazing that after getting this surgery some patients do not pay their deductible. So those rules are placed because people before you were not always honest with their surgeon or the hospital that took care of them.

<~Connie Sue~> DR Simpson, could you PLEASE PLEASE PLEASE just CUT that last twenty five pounds off me?? Ok, I didn't think so....so anyway...huge WL stall...Can't seem to break it...at 8 months out....any suggestions to get things moving again?

<Dr. Simpson> Yes ---- get a podometer --- or a healthwear.com band --- journal what you eat -- count the calories YOU CANNOT MANAGE WHAT YOU DO NOT MEASURE -- ten thousand steps a day. Hey, since I started that program I have lost a few pounds --- old Dr. Simpson is getting in shape.

<Dolly> hi there, I am 6 months out today, down 95#, wheelchair bound, and have 63 lbs to loose for goal, how can I jump start the loss again, I need to lose another 18 before hip replacement,

<Dr. Simpson> Wheel faster ----- again, when you can increase any exercise you increase the calories that you burn. You are at the bottom end of what you can restrict in your intake. Although we can always make better choices for the short term.

<shellytx> what are some post op things we should be concerned about (pains in certain areas?) How do we tell when we need to contact surgeon vs just surgery pains?

<Dr. Simpson> If you are ever worried then call the surgeon -- or email them (which is what my patients do) because sometimes simple pains can be evil, and sometimes hard pains can be gas. No way to tell, but the person who rearranged your guts wants to reassure you. There are two frustrating parts of being a surgeon --- when we are called for nothing --- and more frustrating than that when the patient doesn't call because they are in trouble. We want to hear from you -- we really really do. We hate it if you do not call us when you have something wrong that we can fix, even if it is gas x.

<candy> I take celebrex for my knee and it allows me to walk without much discomfort will I be able to take celebrex after the lap band?

<Dr. Simpson> Celebrex is something that I allow my patients to take, although at first I want you to take some other things with it, like Pepcid Complete ---- but some surgeons do not like to have their patients taking some of those anti inflammatory agents as they worry about this being a problem -- me, I like you to get out there and walk.

<TwinMomma> Do you recommend a certain vitamin/supplement?

<Dr. Simpson> Yup I do. First of all, it is critically important that you take your vitamins and we use to have patients take Flintstones, or something like that but for the first time in my career -- I now have endorsed a vitamin -- and am not getting paid to do it. Bariatric Advantage at www.bariatricadvantage.com they will send you the refills to the house, and the cost of getting your vitamins and micronutrients is less than McDonalds charges for a coke a day.

<Diana Cox> Under what circumstances do you recommend the DS over the RNY?

<Dr. Simpson> The DS is a great surgery -- it works well, my patients like it a lot --- and has a lot of features that make it a better choice for a lot of patients. For example: patients who have had ulcer problems should have the DS over the RNY and there are a host of others --- I think the DS is a great operation, but RNY is also very good. Some worry about malabsorption with the DS -- and that is always a consideration but I have a very close friend who had horrible malabsorption with the RNY and almost died from it. So that can happen to anyone. Anyway -- go with your surgeon's recommendations, they have a reason and don't be afraid to ask. Our job is to help you, and to inform you ---- sometimes you don't like our recommendation but there are plenty of surgeons out there.

<Laurie> Do people who have had distal have an easier time losing weight? Is it more risky regarding malnutrition?

<Dr. Simpson> The main component of weight loss with any surgery is the restrictive component not the malabsorptive component and that is true for the DS, the BPD, and others. Malnutrition can happen to anyone who has a restriction and does not eat certain things or eats poorly. Weight loss in very morbid obese individuals is increased in longer bypassed segments. However, we have seen that with the lap band -- which is purely restrictive. Can have every bit as much weight loss as the other procedures.

<shellytx> can one's gallbladder be removed at time of surgery to avoid a later surgery- even if there is no need prior to surgery?

<Dr. Simpson> Some surgeons remove the gallbladder as a matter of routine, and some do not. That is a good thing to talk about with your surgeon -- clearly if the gallbladder is found to have disease in it then it needs to come out.

<melissa> Hi Dr. Simpson.. I am considering having gastric bypass and I have severe asthma do I have a much higher risk of something going wrong during the surgery because of that?

<Dr. Simpson> I am sorry you have asthma -- and I have a touch of it myself, but no, in fact. Anesthesia is good for asthma because it relaxes the airways. So you will do well, and your surgery will help you have less reflux, which is good for you, and with all that weight you lose you will get an asthmatic attack from all the new clothes you are buying or your significant other will -- you will be smiling too much to get it.

<phooah> where, how big and how many scars does a lap procedure leave on your belly?

<Dr. Simpson> The scars are about an inch or so and there are five or six and some are a quarter of an inch. Scars are sexy.

<melissa> How do you feel about patients who are uninsured traveling outside of the U.S for their surgery?

<Dr. Simpson> There are some very good surgeons overseas -- and I know a few of them, and am friends with them. The problem that I have is two fold --- one is that if anything else goes wrong with you, overseas does not always have the facilities to take care of it -- for example, if you need to have an angioplasty for a heart attack, or a stent placed you need to research those surgeons, just as you research the surgeons in the United States and remember, just because someone says good things about them -- like patients, does not mean they are a good surgeon, just that they have a nice manner, which is a good thing too. Some physicians in the states have very low cash prices --- as we try to negotiate that on behalf of our patients, so do not hesitate to ask --- and, before we go any further, I am not soliciting for anyone here, because I don't take out of state patients, except under extraordinary circumstances as an example: our lap band price is about 14,000.

<kay> Good Evening Dr. My question is after a RNY what should be the size of your stomach?

<Dr. Simpson> After a RNY your stomach might be one half an ounce to an ounce in size and over the course of a year it will grow a bit. But don't push it.

<sherrylp> How will wls effect a hiatal hernia?

<Dr. Simpson> Sometimes at WLS surgery we will fix the hiatal hernia, or should. So that is how it will effect it.

<kay> If I got along okay with open gallbladder surgery do you think I'll do the same with open RNY?

<Dr. Simpson> Sure.

<shellytx> Im hoping to regain my fertility after surgery and weight loss.. is it safe to get pregnant after a year and are our babies at higher risk of birth defects after surgery

<Dr. Simpson> We like to have patients wait a couple of years after their surgery. However, we do think that you can be getting pregnant and we watch you carefully or the ob doctor does. The nice thing about the lap band is that we can always deflate it if you become pregnant. Then you can inflate the belly and deflate the band.

<Scott> I am 10 days Post Opt, wondering if getting a flu shot is ok?

<Dr. Simpson> Yes, far better getting the flu shot than getting the flu or in my case, one flew over the nest. Coo coo

<TwinMomma> What are your thoughts on taking birth control pills post-op?

<Dr. Simpson> I never take them, but then again, I probably wouldn't look good with breasts. Some birth control pills after some surgeries are not as well absorbed. For example, after a DS we do not think that bcp are indicated to prevent pregnancy instead we recommend that you use a mechanical form of birth control such as an iud or such.

<Cher (PA)> IS IT TRUE THAT SOMEONE THAT HAS DIABETES PRIOR TO THIS SURGERY WILL NOT HAVE IT AFTER THEY HAVE THE SURGERY AND LOSE WEIGHT

<Dr. Simpson> No, that is not true at all. As you lose weight you lose some insulin resistance, however, you still have an under producing pancreas and some patients will still require insulin, although usually less, and some will still require pills, although usually less and if you have type I diabetes you will always need insulin. But better less insulin than more.

<undecidednwi> My doctor typically performs lap RNY but will do open if necessary. How much does weight play a factor in the decision?

<Dr. Simpson> Sometimes weight plays a large factor (pun intended) because some will not do lap surgery with a bmi of over 50 and some surgeons do not mind. We lap band anyone who walks in the door, if they can fit through it.

<3wks&30lbs> 3 wks out, on soft foods, haven't been able to reach the nutritionist. how many carbs, cals and protein should i be taking in at this point. i am doing well with the basics, eggs, cheese, tuna, chicken

<Dr. Simpson> You should attempt to eat a balanced diet and not overstuff your pouch. It is ok to count calories and protein, and those all vary by body size and type of operation (here is where you need my book for that) but I think that you should consider less than 1000 calories a day, and maintain yourself with protein because if you do not take in enough protein you won't feel too well.

<undecidednwi> What are the true mortality rates for the RNY?

<Dr. Simpson> Depends -- some say one in fifty some say one in two hundred. For surgeons who do a lot of the surgeries, then one in two hundred is closer, for those who do less, it can be higher.

<lj> hi i have pain under my ribs had it before the surgery what is diverticulitis and does surgery clear it up

<Dr. Simpson> Diverticulitis is not cleared by surgery. That is an inflammation and condition of the colon. The pain under the ribs can be a number of things from a pullled muscle to pneumonia, to a small pulmonary embolus but that you had it before surgery, who knows, that is something to ask your surgeon about in terms of surgery to clear up diverticulitis -- yes, it can, but that is removing part of the colon. So you have a semi colon -- that is not weight loss surgery- although you will lose some weight.

<Laurie> I had lap RNY 2 months ago. I've lost 61 pounds and no longer have diabetes. I just want to thank people like you who help people like me. Thank you....

<Dr. Simpson> You are more than welcome, and that is a great result-- keep up the walking... keep walking-- and then enjoy life. That is what we like to see.

<Cher (PA)> Hi Dr. Simpson....I had thyroid surgery and my vocal cords got paralyzed from the surgery and now I have a breathing problem...my pulmonary doctor recommend I have this

<Dr. Simpson> Well your anesthesiologist will certainly want to know about your vocal chords and in terms of weight loss, I would highly recommend the surgery based on that one single co morbidity that you have because you need to breathe -- I mean, come on -- you need to try to wean yourself from breathing -- just doesn't work too well -- honest. You don't really have to try to wean, but I try to wean my car from gas, and I just cannot seem to get it done.

<undecidednwi> What long term studies have been done and what has been shown as the long term complications?

<Dr. Simpson> Same with breathing - so get the surgery. By long term-- we have a number o studies which are a few years out, and some even longer and there is some weight regain with RNY after three years, although continued loss with lap band but in terms of complications, we do not see a lot of them as a group of individuals. Although there are some who claim there are, we have not seen any data to say that this will be a problem. There are some good studies on the website www.asbs.org

<shelly> WHY DO PEOPLE GET A HERNIA OR MOST DO AFTER THE SURG

<Dr. Simpson> Well, after surgery you undergo a period of time when you are malnourished and when you are malnourished you do not heal as well, and when you have surgery. We cut the fascia -- or gristle, and if that cut does not heal well and you start to pick up too much too soon. Then you can get a bulge, and not all bulges are good --- and a hernia is one of those that is not so good.

<melissa> Dr Simspon.. Can I have a tubal ligation at the same time as I have my surgery?

<Dr. Simpson> That is up to the surgeon. Some of us are up on one side of the abdomen and the tubes are way down there. So often times we cannot reach down there to do it, although it is easier with a lap scope. You might see if the gynecologist could scrub in and do it at the same time. There would be no reason to NOT do that. Good luck.

<Cher (PA)> surgery in hopes that losing the weight might give me a better airway...besides losing the weight...is this possible?

<Dr. Simpson> The airway that you have is the airway that you have. Weight loss will improve your function of the diaphragm which will allow you to take deeper breaths and force more air through. So, that is a good result, and something that you would want to do.

<RichRich> Hi Doc, will the rapid post - op weight loss be bad for my gout?

<Dr. Simpson> Not necessarily, in fact, the rapid weight loss will probably make you feel better and improve the gout - toes up.

<Kari A.> OK, I've had it. I've only lost weight a total of 5 months out of 11 1/2, I've had a 5 month plateau and now am on another of 2 months. I have followed the rules like a "food nazi" and still can't seem to lose!! I've "changed it up" too many times to count and follow my surgeons & nutritionists gilines to the letter. Am I done?? I've lost 80 lbs. have 70 to go

<Dr. Simpson> You are not done. First, we need to find out what you are doing and why you cannot manage what you do not measure -- so, you might consider getting the band from www.healthwear.com which will allow you to see what you eat and how much calories that your body is using then we can work with it. You are never done with weight loss until the worms have stripped your bones in the casket.

<undecidednwi> Does one's age or size affect the risks with WLS?

<Dr. Simpson> Sure, all of those are factors-- the older you are -- the more chance for co morbidiites. The oldest patient I operated on was 68 years. The larger you are the more dangerous the surgery, and the larger you are the more dangerous to not have the surgery.

<Dolly> I am currently getting between 850 and 950 cal a day, 30 carbs, 20 fats, and 110-145 grams protein, 6 months out- and 95# lost so far, do I need to increase them?

<Dr. Simpson> What you need to increase is your walking -- not your protein, and not your calories or carbs. Sounds like an awfully strict diet, which might be hard to maintain - but I applaud you. Stand up and clap, so go out and WALK walk walk walk.

<E> Dr. Simpson, do most women that have WLS lose their breast?

<Dr. Simpson> They find them below the belly button.

<marcy7/20(-50)> my mom is 67 and struggles with lung issues. I am 2 months po and doing great. Feel terrible that she can't qualify for surgery. What is the max age you approve of

<Dr. Simpson> Well, it depends on a lot of things. First of all, many surgeons won't operate on someone that age. Medicare will not always pay for the lap band, which is the safest, so she might have to pay out of pocket if Medicare doesn't pay. So find a surgeon and see if you can get that arranged --- and no, I don't take out of state patients.

<Robin> my friend was scheduled for open rny but they found a cyst on her kidney now they wont do surgery. Why is that, what could it be?

<Dr. Simpson> Probably a benign cyst, which needs to be worked up to make certain it isn't. Anything evil like cancer. Once it is found to be benign your friend's surgery will be scheduled like the wind.

<sheri>: Hi I am new to the site. I am just looking into this surgery. My doctor wants me to try Meridia first but when I look at the side effects of the drug and the risks it seems surgery is safer and long term. i have been over weight for 15 years. My joints all hurt and feet and knees hurt daily. I am tired of the pain and isolation. I want to run and jump. Where do I go from here.

<Dr. Simpson> Go run and jump. You do not need to be on a prescription drug to fill the need for a physician supervised diet, which many insurance companies require, sometimes you can do a medically supervised diet, such as optifast but if your insurance company requires it, then they require it. If you pay for it out of pocket you probably can skip that step and I wish you the best of luck. Lose the weight, and you will run and jump but I will be happy if in a year you come back to this and tell me you are doing 10,000 steps a day. Good luck.

<melissa> Dr. Is there a big difference between someone using staples to separate your stomach or a complete separation?

<Dr. Simpson> Staples can do a complete separation just as well, and some of us prefer to transect the stomach instead of leaving it together-- we find it works better that way.

<shellytx> I have six children and the mortality rate concerns me.. is there any way to tell which patients are at higher risk of mortality- local surgeon has done 500+ and no mortality yet.

<Dr. Simpson> There is no way to know. We are about to celebrate a holiday for my religion, and at this time of year part of what we read states that God knows who will live and who will die, that he has sealed it and not meaning to get religious here, but we really do not know who will die and who will not. Most do quite well, and I am certain that you will do just fine but this is an operation, and it has risks, and that is always something to consider. Sometimes the healthiest individuals die, and sometimes the individuals who are not well do very well with surgery. I remember one of my favorite patients, his name was Mike, he was 64 years old with a bad heart, bad kidneys, and very large but very nice guy. I thought he would have a rough time -- that night, after surgery, when I rounded on him he said, "Hey doc, when can I get a little something to eat?" Mike did well for over a year and died of complications from a stroke but he died lighter, and we will always remember the twinkle in his eye.

<virginia> I have opted to have lap band surgery as opposed to RNY, what is your opinion on lapband surgery?

<Dr. Simpson> I love the lap band, think that it will ultimately replace the RNY as the most common surgery in the United States... but it is a choice, we all make choices, and the lap band is a choice with its own risks..so is the RNY-- and sometimes patients who have one surgery over the other are a little like churchgoers... thinking their operation is better than the next persons -- and in reality -- it is just a choice, a tool that you can use for weight loss. Whatever tool you pick you will do better than the tools you have tried to use in the past. Good luck.

<ChubbyKimmy> Dr. Simpson, Can gastric bypass surgery be performed with an epidural, versus being put to sleep?

<Dr. Simpson> No

<Laurie-UP-MI> Not sure if this is the right format anymore, but since I cannot message Crow I will try: Do you know what would cause a sharp shooting pain in my left shoulder after eating? Someone said it is a referred nerve from my diaphragm?

<Dr. Simpson> It means you are eating too much. Hard to say without an examination of you, so plug your shoulder into the USB port on your computer.

<Moderator> And tonight's last question goes to...

<mika> Is there a time when the body kind of 'slows down' in weight loss? Does it resume losing weight?

<Dr. Simpson> The body is very simple, and very honest as you lose weight, it takes fewer calories to maintain the weight. At some point you will reach the point where the calories you take in will match the calories that you expend on a daily basis. When you reach that equilibrium you will stop losing weight. The only way to increase that equilibrium to lose weight is to increase exercise or decrease calories so -- get out there and walk.

<Moderator> Dr. Terry Simpson, Arizona Bariatric Center. Website: http://www.drsimpson.com/. Phone: 602-234-8995. Fax: 602-230-8344. 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 for another nice Friday. Please stop by our website and sign up for our monthly newsletter. Good night all.