October 1 , 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 will see them and present them to Dr Simpson at the time of chat in the order we receive them. Thank you!

<Robin B> I am 8 weeks post-op with the lapband. I am down 31.5lbs with another 70 to go. What percentage of extra weight do you typically see your band patients lose within the first year?

<Dr. Simpson> That is up to the patient. You can lose 100 per cent of your excess body weight with a lap band.

<LA> My BMI is 37 I am interested in a lap band what is the BMI requirement for that procedure

<Dr. Simpson> The BMI is the same for all bariatric procedures: 35 with co morbidities which include things such as diabetes, hypertension, sleep apnea, cardiac disease, joint disease related to obesity. Otherwise a BMI of 40. Of course all of this information is nicely contained in a great book by yours truly -- which is available at www.obesitydr.com.

<Jill> Hi, I had my RNY 2/23/04 and I have lost 130 pounds. My liver levels have fluctuated up and down, and I have been to a Liver doctor who did some test and said that everything was ok and it was a fatty liver. My question is how long does it fluctuate before it gets to be a normal level? Thank you

<Dr. Simpson> There are several things that can modulate the liver. One of them is that you can make it worse if you, do not take in adequate protein, the other is if you add a lot of simple carbohydrates to that mix but weight loss is something that will improve the liver. Although without having a liver biopsy it is difficult to determine where your liver is in the process.

<mskitty61> Hi! My BMI is 47 & am just starting research on the Lap-Band Surgery...I'm having trouble find a surgeon located near me. Any recommendations?

<Dr. Simpson> Check the website from www.inamed.com. They have a list of the surgeons who they have trained to put in the lap band.

<Kris> Hello! I had surgery June 14 and have lost 85# already. My question is I am having trouble with water. I can drink flavored water but plain water just comes back up. Why? I have heard of others having this problem also.

<Dr. Simpson> Sometimes water is tough. Some like it warm, some like it hot, although that was not a reference to ya know. Anyway, I think that you should keep drinking fluids in however you have to have them flavored. Often the terrible taste that comes with not getting enough water is made better by more water and second, you need to get in enough protein. We have three things we like --- protein, water, walk. Simple Simpson formula for success after weight loss surgery.

<Dances With Trashbag> ok doc.. here is my question.... I have a new honey in my life now and love the attention. The depo wore off months ago, I know I need something else in place since I am only 10 months postie. Here is the problem.. My period which used to be regular is M.I.A right now.. in fact 6 weeks missing.. I did a pregnancy test and had a false positive, did more tests and neg for sure.. why would it stop like that? I have all the signs of being pregnant,.. is my body having a false

<Dr. Simpson> You need to see your gynecologist and determine if you are pregnant or not. It is something that you will need to do, and they will have some birth control methods for you. I think that you should just stop having sex for the next 17 years.

<tam*VA*> Dr. Terry .. thanks for being here for us. My question is this, I had surgery 10 months ago (11/12) and have lost 106pds. I am able to eat pretty well and am scared I will stop losing. I have another 112 pds to go. I have been exercising at home, but to step things up some, I joined "IT FIGURES" an intense 30-min workout for women, much like Curves. I am doing this 5 days a week and elliptical trainer and biking. Is it true our losing span is only up to 18 months ?? Will I just stop losing before I am done ??

<Dr. Simpson> Well, the plateau is a simple thing. You have to remember that after surgery there is a honey moon period but like with all honeymoons that does not mean the fun stops. You will always be personally responsible for the food choices that you make and choice, rather than diet, will modulate what you will eat. Second, you have to determine an idea of what you will eat and how many calories are there. Finally, while Curves is a great idea -- although I don't like their political stances on things, you need a bit more than that. I recommend getting a pedometer and walking a lot. A great device which will help you with both the food and the exercise, and will tell you how many calories that you are using at a time is the band from www.healthwear.com.

<Jill> My tailbone is really hurting alot after my 130 pounds of weight loss, why is it hurting? What can I do and how long does this pain last? Yes my tushie is smaller and reshapeing but WOW ~ Thanks

<Dr. Simpson> No more cushion --- happens to all my patients The pain in the behind is a reminder that you don't have enough cushion. It is also a reminder to get off that backside and walk.

<Robin B> Dr. Simpson, let me first say I LOVED reading your book. I read it in about 2 days, couldn't put it down. Do you recommend band patients eat all of their protein or is it ok to do long term protein supplements?

<Dr. Simpson> Long term protein supplements are good if you need them, but hopefully your food choices will make it so that you will be able to not have to have the supplements; besides, lets face it -- most supplements have the appeal of eating sawdust and if you can take in enough protein, which isn't too much -- but just take the protein of the meal first, you will not need to have the supplements. I am glad you liked the book and hope that it serves you well.

<April> Dr.Simpson, Do you have to take vitamins the rest of your life post surgery?

<Dr. Simpson> Yes you do. There is no question of ifs, ands, or buts about it. When the stomach is smaller you want to get those vitamins in. Very simple, very needed and it is a lot easier to prevent a vitamin deficiency than to treat one. Let me give you an example -- you do not have enough vitamin BV you can develop irreversible nerve problems. Why be a skinny person with a tic? Take your vitamins.

<Julianne Loconsole> Dr. Simpson, how important is it to take daily vitamins after open RNY? I haven't been taking any, have already lost 50 lbs in just 2 months, but feel extreemly weak and achy most of the time.

<Dr. Simpson> IT IS VERY VERY IMPORTANT. Go to www.obesitydr.com and at the bottom you will find a place where you can order from Bariatric Advantage, which will allow you to have your refills sent to your house. If you DO NOT TAKE vitamins you will be very sick, very sorry, and wish that you were -- well, it isn't good. Please take them. I like bariatric advantage because they deliver to your door, and they cost the price of a coke from McDonald's

<rlovejoy> i am 8 days out, open. My q is why do i feel hungry all the time?

<Dr. Simpson> Well, that does happen. There are appetites and there is satiety, and if your stomach is not seeing food it will be hungry. That is normal.

<Kit> Hello. My surgeon promotes a vegan diet. What do you think about this? He is against all animal protein.

<Dr. Simpson> I promise you won't starve. It is not always good for us to have our personal beliefs in the mix. There is nothing wrong with animal protein, although some do not like that animals are raised and killed so we can eat them. Some don't like cannibals and having human protein for dinner either. However, protein is essential to getting well and to making a good recovery, and it doesn't matter if it is from a animal or vegetable. Although I personally do not like to think of those poor baby carrots taken from their mothers.

<micki> Hey Dr. Simpson, I am interested in having lap band, my insurance does not pay, do you recommend any clinics or hospitals in Mexico that is a reliable facility. They seem to be much cheaper than here in the us. there is no way I can afford 18,000.00. But I really need a change in life, I need to lose this weight to be healthy.

<Dr. Simpson> I do like Dr. Ortiz in Mexico -- have seen him operate. Great surgeon. His website is www.obesitycontrolcenter.com. Although many in the U.S. charge less than 18k -- but still, Dr. Ortiz is a great surgeon and I would not hesitate to recommend him.

<tam*VA*> Dr. Simpson (yeah, me again... lol) What percentage of protein, veggie, fruits, carbs should we be having at 10-12 months in our new eating habits ??

<Dr. Simpson> No one eats that way --- you want a good, balanced meal that you will be able to stick with. That is simple, and easy to follow instead of guessing a percentage and going with it. What I would recommend is this -- if you go to the back of my book there is some menu plans an recipes there that will allow you to see a normal diet. You can make out a menu plan for yourself and see if you are getting in the necessary protein. You can even calculate the vitamins, minerals and other things and take supplements as appropriate. There is not much nutritional value in ice cream --- which is why if you have it you should package it up and send it to me.

<Laurie> What got you interested in WLS?

<Dr. Simpson> During my residency we had a professor who did it, and I enjoyed the surgery and I enjoyed watching the change in patients' lives. Most of surgery, we do not see that. Take out an appendix, and while you save a life, you never see the long term of it. Its nice to watch people being able to do more with their families and friends and fun to see them change the way they dress, and so forth.

<April> My mom & husband both think that bariatric surgery is only for people who eat too much, and won't work for me because I don't eat that much, anyway. Is that true? My BMI is 50 & I've tried diet & excercise, but it's not owrking.

<Dr. Simpson> I rarely have a patient who tells me they eat too much and they all seem to do well with bariatric surgery. You have eaten enough to store some food, and our job is to help you get rid of that storage. It isn't what you eat during meals that is the problem. It is the stuff in between with weight loss surgery you won't be able to eat as much as you do now, and you will be satisfied with less and you will have three meals a day and, you will feel full and less tempted to have that handful of peanut M and M's, which will leave more for me.

<Melanie M.: What is a simple carbohydrate vs. a complex carbohydrate, and what is the difference in how they are metabolized, especially by those with a malabsorptive procedure?

<Dr. Simpson> Ah, Melanie, you know my weakness don't you? Let us start out with some real basics here. Carbohydrates are essentially sugar molecules which are strung together like pearls on a string. You like pearls I assume. Anyway, besides the sugar molecules they are also complexed with other things, like fiber. If you have some "simple" carbohydrates that means that there are just a few molecules of sugar strung together and they are broken down very quickly and cause your blood sugar to rise rapidly. Examples of these include -- sugar, candy, bread, pasta, and potatoes. However, if the molecules are long, and have other things with them -- like beans, for example, it takes the body a while to digest them, and they do not cause the rapid rise in blood sugar so they maintain your sense of fullness longer and digest slowly. Now with a malabsorptive procedure such as a duodenal switch (world's favorite) or a long-limb rny, you will absorb the simple carbohydrates very quickly but not the more complexed ones. Hence, things like bread, pasta and candy will still cause a rise in blood sugar which may not be a good thing and that rise will cause insulin to release, which will want to store that sugar as FAT... So, since the goal here is to not store fat -- unless the apocalypse is coming and I don't know about it -- we need to take in those complex carbohydrates which will last us a while and keep us satisfied. The more modern term is low glycemic index -- that is those foods which are carbohydrates that burn slowly and do not cause a rapid rise -- mostly these are vegetables and some fruits as opposed to high glycemic index carbohydrates -- such as bread. For a good list of these go to my website at www.drsimpson.com. See the list there and use that. Great question. Fingers are tired.

<shirl> I had open RNY 9 days ago...I work in a elementary school as a cook, and lift a min of 25-50# at a time, will 6 weeks be enough recovery time?

<Dr. Simpson> It will be good enough to recover but if you lift that much after six weeks you will probably get a hernia. For most surgeries we tell patients not to lift for six weeks, but for weight loss surgery it takes longer because patients after weight loss surgery malabsorb and are a bit deficient in protein and such - so we want them to not lift for six months or longer, to avoid a hernia.

<shirl> Multivitamins... when can we take the ones you swallow instead of chew?

<Dr. Simpson> Well, there are a number of them out there, and I think that you probably want to, early on, take ones that are chewable or dissolve easily.

<heather> I have a family history of serious illness including cancer,heart disease,kidney disease and diabetes. I myself have had cancer and at 29 I"ve already had my gallbladder removed I"m 115 lbs overweight how do I know if RNY is an option for me?

<Dr. Simpson> Well, it is not that surgery will prevent or overcome genetics but certainly having excess weight will cause you to have a rougher time with all of those things so I think that RNY would be a good option for you, or one of the other weight loss surgical procedures.

<Sally> So it is possible to be a vegan and have this operation?

<Dr. Simpson> Of course it is. I have a number of patients who are and I think being a vegan is great --- just don't take those baby carrots from their mothers.

<diana> Do revisions from vbg's to rny's lose weight at a slower pace?

<Dr. Simpson> Revisions are tough, and they are something that a few of us do, but no -- you can lose weight just as rapidly.

<grandma> i've developed a seroma in the first area where port was know port moved to other side and looks like same problem. How long should i wait before having port taken out all together..6/5/04 then 9/10/04 by DR ortiz

<Dr. Simpson> Well, I think that is something to discuss with Dr. Ortiz. First of all, you may not need to have it removed, and having a seroma is something that is an interesting problem. Dr. Ortiz is a great surgeon who has seen far more lap bands than anyone in North America. Good luck.

<Kathy> I am two months out with DS that I had in Brazil with Dr. Marchisini. I have had an unremarkable recovery. I still cannot eat or drink very much at a time. I know that I am not getting in the amount of protein and water that others seem to be getting in. What can I do and will I be running into trouble? I am scheduled to have my first blood work done next week.

<Dr. Simpson> Well, first of all, remember that the surgery is designed to take in less food. If you are not taking in enough water you will have some obvious problems, which doesn't sound like you are having. In the blood work make certain that you get a prealbumin drawn. For a complete set of blood work look in my website www.drsimpson.com and under the "forms" section is a complete set of what we draw on patients. Sip sip sip

<martha> I have researched bariartic surgery for 2 yrs now & know I need & want it, but live in Jackson, Ga. & find it almost impossible to attend classes held in Atlanta - any advice?

<Dr. Simpson> Well, the best source of research about weight loss surgery is my book and if you need to go to a surgeon's seminar to get into their program you will probably have to drive there. Remember that you will also have to go to that surgeon for follow up, so find someone that you don't mind traveling there for follow up and so forth. Good luck.

<tayah> Hi Doc! 2 week post op, and feeling pretty good. A little concerned about how much I eat after my morning protein shake. Does it matter that I'm not eating full meals, but concentrating on eating protein foods like cheese, ground chicken, broth etc. when I feel like eating? Also, if I were to put a tattoo of Senator Kerry on my ass right now, will the likeness be uncanny after I've lost 100 pounds? hehehe

<Dr. Simpson> Well, in terms of eating -- don't worry that you do not eat enough ---- THAT IS THE IDEA. In terms of Senator Kerry --- well, I would avoid a tattoo until you are at your weight and remember, tattoos change with time -- find any world war two vet and ask to see a tattoo and you will see what they eventually look like.

<Connie> Can you explain why I have (8-9 weeks post-op) a difficult time rapidly swallowing liquids?

<Dr. Simpson> No, do not rapidly swallow. Do not. Sip sip sip sip. Eating and drinking is not a contest, you should not chug, especially after weight loss surgery. Chugging is for college fraternity brothers, who are basically immature. Now, being a mature adult -- sip, and put that pinky out.

<marcus1weeksinceop> i have had my surgery 1 week ago and i was wondering do i have to stay on the liquid diet

<Dr. Simpson> If your surgeons say you do -- then yes, you should always follow their advice, unless you are my patients, in which case you will know exactly what to do and when cause you will have read "THE BOOK"

<April> I take ~ 8 pills twice a day for other problems. If I have bariatric surgery, will I still be able to swallow my pills?

<Dr. Simpson> Yes, you will ---- and some of them will have to change to a liquid form, and some of them will have to change from long acting to short acting.

<stcynghty1> I AM ALMOST 16 MONTHS POST OP AND I'M WAITING FOR AN APPROVAL RIGHT NOW FOR AN ENDOSCOPY. I THINK I'M TRANSECTED BUT I THINK I HAVE A FISTULA. WHAT ARE THE SIGNS OF A FISTULA?

<Dr. Simpson> Well, the signs of it are that you are hungry more than you should be and an upper GI test is something that you can order quickly and get and see if there is one...Better than an endoscopy.

<grandma> Me again about the seromas. It's a pain because both sides of incisions are draining. No bacteria just a pain in the neck. From 6/5/04 i've lost 30lbs and the band works. I think my body is rejecting it. DR Ortiz is very good. i'm just frustrated

<Dr. Simpson> Perhaps then you will need to have a drain placed in them and they will have to have an agent put in the cause of scarring of the area so that they don't develop anymore.

<Sunny~N~Fl@goal> I'm fourteen pounds below my surgeon's goal (130) at 120. I'm 5'5". Should I be concerned about losing too much?

<Dr. Simpson> As long as you are getting your nutrition in you should not be worried. However, if you are becoming protein calorie malnourished, then we worry. How far out are you? Some people drop down a bit lower and will then gain some of it back again. You are at your standard now. Good luck.

<dmpacker> What is a normal diet 6 months after gastric bypass?

<Dr. Simpson> A normal, balanced, diet-- with protein first, and good choices of food groups.

<Bermudababe> Hi Dr. Simpson, I had my surgery 5 mos.ago., I thought my gastric reflux would completely disappear. Why do I still have it?

<Dr. Simpson> There are a lot of reasons for GERD. Some of them are anatomical and not due to weight and that needs to be checked by your friendly GI doctor. You might need to be on some medicine. Remember -- skinny people get disease too ---- skinny people get heartburn, diabetes, heart disease, and all sorts of things so -- that could be the case.

<Sally> Once Ihave the surgery and start to lose weight will it help the stress incontinence i suffer from now? And what is the name of your book?

<Dr. Simpson> It will help the stress incontinence. However, you may still need a surgical procedure to help that. We will just have to wait (weight) and see. My book is listed above in the flyer, it is called "Weight Loss Surgery: A lighter look at a heavy subject" and you can order it from www.obesitydr.com. It is a complete and comprehensive book about all aspects of weight loss surgery, including pre op, post op, and how to take care of yourself.

<LA> My BMI is 37...what is the BMI requirment for the lap band?

<Dr. Simpson> Regarding BMI --- the requirements for lap band are the same as for any other surgery.

<curious> I'm having surgery on Dec. 7, is there anything i should be doing now to prepare ?

<Dr. Simpson> Although various surgeons might change them depending on the co morbidities. YES -- first -- start a walking program to get in the best shape you can for surgery. Second - start taking a good multivitamin --- we recommend bariatric advantage because of how it is used. Those you can order online from our website (it will pass you through their website) and finally ---- learn about nutrition, and eating well, and balanced meals, and protein content. Good luck.

<Kim> I will be having a Tummy Tuck and hernia repair soon. But my BP is 100/50 on a regular basis. Will being put under be more dangerous for me than someone with a higher BP?

<Dr. Simpson> No -- that is a great blood pressure you should do just fine. Good luck.

<Randi> I weigh 475 pounds do you think i can have lap?

<Dr. Simpson> Depends on the surgeon and procedure. I would have no problem doing a lap band on you and for other surgeries, it would depend on where your body weight is distributed. Good luck.

<Kitty-OH> I'm pre-approval ... on average, how many WLS patients end up in ICU or with complications? (I am 54, BMI 39.4, 258 pounds at 5'8", few co-morbidities)

<Dr. Simpson> Not too many do. About 3 per cent or less would be my guess.

<LA> I suffer from knee and feet pain which makes exercise painful is this pain considered co morbidities

<Dr. Simpson> No, but joint disease which is contributed to by obesity is. So see an orthopedic surgeon and see if that is the issue.

<Moderator> And the last question goes to...

<dmpacker> After gastric bypass is there a change in absorption of medications?

<Dr. Simpson> For a few there are and it depends on the surgery and how much small bowel is bypassed. The major ones which change are cyclosporin and hormones (like birth control pills). There are some others --- the other class to consider is things such as time release medications --- you might want to have those changed to non-time released. Hopefully it will get your off all medications.

<Sally> Thank you DR Simpson you are great.

<Dr. Simpson> You are more than welcome.

<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> Book available at www.obesitydr.com

<Dr. Simpson> Thank you