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<Dr. Simpson> Good evening all,
<**MODERATOR**> WELCOME DR. SIMPSON
<Dr. Simpson> greetings from Alaska, the
land of the last frontier
<Dr. Simpson> Tonight we will discuss the
wit and wisdom of bariatric surgery
<Dr. Simpson> we will talk about plateaus.....
<Dr. Simpson> we will talk about how to
make a great thing happen
<Dr. Simpson> OK, I suppose I should allow
Lissa to get things started, and then we can be off on another afternoon...
sometimes these are like Gilligan's Island.....you never know how they
will turn out for a three hour tour.
<**MODERATOR**> MARIE/10 YOU HAVE THE FIRST QUESTION FOR OUR
GUEST:)
<Marie/10 days post o> Dr. Simpson, How long are you are risk
for blood clots post-op? and how soon should you drive? Open RNY 10/8
<Dr. Simpson> Hi Marie, most blood clots
happen on the operating room table, and they are... silent, that is, there
is no symptom which can be felt or seen.... when they manifest themselves
can be several weeks out, or even longer.... So the best thing you can
do is to walk, and walk some more, and keep walking. Good luck
<**MODERATOR**> MADISON YOU HAVE THE NEXT QUESTION:)
<Madison> DR S.....what kind of exercise is the best & how
many times a day??? :) :)
<Dr. Simpson> don't want those extremities
getting swollen. Well, Madison, the best exercise is one which you can
do simply, easily, and often.... so I often like walking, because it is
easy on the joints, it is simple to do..... and if you have a joint problem
then I think that swimming would be a good exercise.... but the amount
of time to do it is four times a week for forty five minutes at a time.
<**MODERATOR**> KUKATIE YOU HAVE THE NEXT QUESTION PLEASE:)
<kukatie> I have GERD, what procedures may I not have because of
it or will the doc want to do a fundo?
<Dr. Simpson> kukatie, actually a RNY is
probably one of the best procedures for GERD, which.. for the rest of
us humans is reflux, also known as heartburn.... although some of us like
Gastro Esophageal Reflux Disease, and we are cool to call it GERD.....
but doing a fundoplication for it, and doing obesity surgery is not needed.
The RNY is a great operation for GERD. Good luck.
<**MODERATOR**> MINDY IN MIAMI YOU HAVE THE NEXT QUESTION:)
<MINDY IN MIAMI> can I use a digestive enzyme product to help breakdown
food for better absorbtion?
<Dr. Simpson> I like peanut. Of course you
are what you eat, so I am a nut..... You should not need an enzyme product
for digestion unless you have a primary disorder of nthe pancreas, in
which case there are prescriptions for that....the problem is not digesting
food, it is getting less of it to digest, and hopefully letting some of
it pass speaking of which, I think we should make a protein M and M. good
luck.
<**MODERATOR**> GLORIA YOU HAVE THE NEXT QUESTION PLEASE:)
<Gloria> what is the difference in the distal RNY and the proximal
RNY ?
<Dr. Simpson> Ah, Gloria, I knew this was
going to be a question today.... my mind reading ability is amazing this
week, I also predict that sometime in the next few days we will have a
new world series winner…seriously, a distal RNY is one where you bypass
more than 60 per cent of the intestine, or about 4 yards.... a proximal
is about 1 yard bypassed. There is NO difference in the ability to lose
weight...in fact most people who are at goal, such as Madison, have a
proximal bypass.... a distal has more malabsorption of fat, and for those
who get a lot of their calories from fat... which are usually people whose
BMI are greater than 60, this is an attractive option many insurance companies
will not pay for it, and for good reason.... you can do just fine, and
be at goal in a year, with hard work of course, with a proximal bypass.
Good luck.
<**MODERATOR**> LAURIE YOU HAVE THE NEXT QUESTION:)
<Laurie> how much does it cost for self pays? Is it a long waiting
list for self pays?
<Dr. Simpson> Ah, self pay a good question,
and I would say that every office and every surgeon, and every hospital
is different. Surgeons fees go from 3 grand to 6 grand, and the hospital
fee goes from 16 grand to 22 grand.... generally I would think going to
someplace which is close to home, even if it costs more, would be better....
because you can have your follow up care close by. As opposed to going
way far away out of state... in fact some of us, such as myself, do not
take out of state patients, because we believe the follow up care is important....
good luck.
<**MODERATOR**> JOANNE YOU HAVE THE NEXT QUESTION:)
<Joanne> I had gastric by-pass 2 weeks ago and I now have to go
for an endoscopy with dialation what causes this and why.?
<Dr. Simpson> When the surgeon makes a new
opening between the upper pouch and the small intestine. That opening
is called an "anastomosis." And this is usually made with a
circular stapler, sometimes it is made with... the surgeon sewing it by
hand. In either case there are some people who scar that area down...and
when it scars down it can make it impossible for solid foods to go down...
so, in that case, it needs to be dilated Sometimes, often it takes three
or four dilations to happen. The time that a stricture happens is about
10 per cent... so it isn't an uncommon event at all. Good luck.
<Joanne> eating anything even water is painful
<Dr. Simpson> Well, sounds like you will
need the dilation and will notice a difference almost right away.
<**MODERATOR**> BARB YOU HAVE THE NEXT QUESTION
<barb> can you talk about the diff between calcium carbonate and
citrate and which is best for RNY patients
<Dr. Simpson> The key ingredient is the calcium.
The other part, carbonate vs. citrate is not essential to what you have
the body absorbs citrates much easier than carbonates, so if you can take
calcium citrate you will absorb more calcium than you will with Tums (calcium
carbonate). Although Tums are cheaper.... it is also a good idea to have
your blood levels of these things checked once a year to make certain
that you are getting enough calcium. Good luck.
<**MODERATOR**> PAM AZ YOU HAVE THE NEXT QUESTION:)
<*Pam AZ*> Hi Dr S ... What types of pre-op tests do you normally
have your patients, LIKE ME, go thru? Blood, Ekg, ? Just wondering, generally,
what else I'm gonna need ...P.S. Temp here is 79 ;-)
<Dr. Simpson> Hi Pam -- another patient of
mine, to be. It depends on the age of the patient as to what we order
as well as the physical condition of the patient. Some people need a cardiac
stress test in addition to an EKG, or the EKG will find something which
will mandate such a test. Some people have signs and symptoms of sleep
apnea, so we require a sleep test the blood tests vary from time to time,
and again it depends on the patient.... if you are of child bearing age
you will have a pregnancy test, you will have a blood count, some patients
we order even more... so it could be quite a few tubes of blood, or not
so many. For you, we will order the works with mayo.
<**MODERATOR**> PAM IN OHIO YOU HAVE THE NEXT QUESTION:)
<pam in ohio> I am 4 wks. post op open /rny , i am always thirsty,
sick to the stomach,and yucky breath, any suggestions???
Dr. Simpson> well always thirsty happens a lot,
and we advise that you keep a water container by you and always sip.....
sick to the stomach happens to some people, usually from about three weeks
to six or eight weeks, although it is caused by a number of factors....
the most common factor is overeating the pouch, and distending it to the
point of nausea, so we often ask.... people to carefully take the amount
of food they are eating and measure the volume of it, because if you are
eating more than one ounce, one shot glass full, you will get sick and
that includes if you eat and drink on top of it. Some other causes for
nausea are if there is a stricture which develops... between the stomach
and the intestine. Not having an appetite is what we expect and what we
want.... anyone who gets this surgery can do just fine for six months
on ... water minerals and vitamins your appetite will come back, then
you will have another issue, called a plateau. Good luck. Drink, measure
what you eat, and start walking.
<pam in ohio> ty
<**MODERATOR**> GLORIA YOU HAVE THE NEXT QUESTION:)
<Gloria> I understand the distal RNY lessens the dumping syndrome
<Dr. Simpson> No, Gloria, that is not true
at all. The dumping happens when you have carbohydrates.... which hit
the small bowel, it happens to about 60 per cent of people who have the
RNY bypass.... so avoiding carbohydrates is a good and right thing to
do. Distal bypass does not avoid dumping at all... having a duodenal switch
would, they rarely dump. Good luck.
<**MODERATOR**> PAM IN TN YOU HAVE THE NEXT QUESTION FOR DR.
SIMPSON:)
<PamTN> Dr. Simpson, I have 200+ pounds to lose, are you saying
I could be at goal weight in one year with hard work?? Thanks.
<Dr. Simpson> Yes, Pam I am saying that exactly......
I have a very good and close friend, not a patient of mine, who was at
goal in a year, and lost... 185 lbs. My patients who are at goal generally
did it in about 16 to 18 months, although there are a number who did it
in a year. The faster you get to goal, the better you will feel , and
the easier it is on you.... so, avoid Bread, pasta, rice, and high carb
foods until you get to goal. Good luck.
<**MODERATOR**> KIMBERLY YOU HAVE THE NEXT QUESTION PLEASE:)
<Kimberly> I wanted to know how long you have to wait until you
can do heavy excesses like situps and aerobics what about yoga is it ok?
<Dr. Simpson> well, I think that the easiest
thing that you can do is to walk. In terms of sit ups six weeks, yoga
is fine, but not really exercise.... and aerobics are ok from the get
go. But for your specifics, check with your friendly surgeon.... we have
patients walk from the recovery room to their hospital room, and we don't
give them a bed because we want them to walk more.. Good luck.
<**MODERATOR**> TORIGIRL YOU HAVE THE NEXT QUESTION:)
<ToriGirl> how long after RNY surgery can you start experimenting
with like mashed foods..?
<Dr. Simpson> well, mashed potatoes, not
until you get to goal.... in terms of having pureed foods, that is up
to your surgeon, some of us wait until two weeks.... some wait until four
or six weeks, there are a lot of differences in the way we approach that....
of course my way is best, but that is another story.... so check with
your surgeon.. Also, some of us allow patients to chew real well, although
you have to demonstrate discipline. Good luck.
<**MODERATOR**> LIZETTE YOU HAVE THE NEXT QUESTION:)
<Lizette> duodenal switch - what can you tell me - safer than the
RNY? Your opinion? Thanks
<Dr. Simpson> Well, I like it, and in terms
of safer, there is no real answer for that question.... it is more an
individual preference. For example, with RNY you have less malabsorption,
which is in some things positive.... in terms of the surgery, duodenal
switch is a more complicated surgery which is only done by about forty
people in the United States.... but whatever YOUR surgeon does is the
safest, because you want him or her to be doing it. That is not true...
both are tools, both require a patient to work for their goal, both require
exercise.... both require life long diets so neither one is better. They
are just different tools. Like a hammer and a screwdriver... although
most know to keep me away from household tools. The words which put fear
into my heart, "some assembly required." I am OK if it involves
people-- I can take them apart and put them together...
<**MODERATOR**> KUKATIE YOU HAVE THE NEXT QUESTION:)
<kukatie> Years after post-op a set point is established, what
happens when one needs to lose weight or just maintain, won't it be harder
because our bodies have adjusted to living on fewer calories?
<Dr. Simpson> Your body doesn't adjust to
living on fewer calories, you cannot wean from food.... or sleep, although
I tried that in college on Saturdays.... you have a great tool with any
of the weight loss surgeries because you've a decreased capacity to eat...
that is restrict amount you can eat, and a mildly, or greatly, decreased
ability to absorb... although anyone can overcome the effects of surgery
by eating soft high carb foods like bread, pasta, rice, and potatoes...
so, use the tool well, and you will live a long skinny life.
<**MODERATOR**> TAFFY YOU HAVE THE NEXT QUESTION:)
<Taffy> I've been reading cabbage juice to prevent ulcers would
drinking cabbage juice be beneficial for RNY patient also to prevent ulcers
proactively?
<Dr. Simpson> It would be beneficial to keep
people away from you who might have nasty disease because you would ...
pass a lot of gas from your rectum.... no, we often ask our patients to
take daily some Pepcid or Zantac, which you can guy over the counter....
and most ulcers are caused from a bacteria called Helico bacter pylori,
which can be treated.... although you can have ulcers from aspirin and
motrin, and those types of products... so, if you like such soup, enjoy
it, but I think such things are best left in the pot at someone else's
house.
**MODERATOR**> KELLY D YOU HAVE THE NEXT QUESTION:)
<kelly d> All things being equal, would you suggest open or lap
RNY? Aren't complications less with open, but faster recovery with lap?
<Dr. Simpson> Well, I would suggest you do
what your surgeon in your area does the most of..... you recover just
as fast with either surgery, in spite of the incision.... there is a higher
leak rate reported with laparoscopic, so some of us prefer open, but....
some people do lap with less of a leak rate. So ask your surgeon. Then
if it is around the middle... you look like me, and should be very happy.
It won't deter either approach to the surgery.
<**MODERATOR**> MINDI IN MIAMI YOU HAVE THE NEXT QUESTION;
Mindy MIAMI> I have been on protein and veggies for 1 month. I am
pre-op for 10-29 Should I switch to protein shakes only one week before
surgery. My surgeon doesn't require it but others I've talked to do.If
yes how many shakes /day?
<Dr. Simpson> No, I don't think you need to do that. But I do think
that you should start taking vitamins... and eat well. I hate protein
shakes because they are tasteless... although some will disagree with
me.
<**MODERATOR**> ANTHONY YOU HAVE THE NEXT QUESTOIN >
<Anthony> In the case of extremely bad varicose veins in the legs
is this something that should be dealt with before surgery or can it wait
or does it matter
<Dr. Simpson> I think you should have the
weight loss surgery done first... then have the vv done later, and it
might even make them easier to treat and to deal with...
<**MODERATOR**> LORI W YOU HAVE THE NEXT QUESTION:)
<LoriW> have you heard of SeaSilver as a supplement (vitamin) and
would you recommend it? It tastes way too good (IMO) to be any good :)...no
one seems to have any data on it
<Dr. Simpson> I have heard of it, and I do
not know what it is, but a vitamin is a vitamin, and that is one which
some like a lot.... so, if you like it take it, if you like Flinstones
take... them. Or try Vista vitamins, they work well. Good luck.
<**MODERATOR**> DEE YOU HAVE THE NEXT QUESTION:)
<DEE weeks po> hi what can it mean if you eat and have a pain
about midsternum for about 2-3 mins and sometimes spit up a little?
<Dr. Simpson> Well, it might mean that you
have a stricture of the anastomosis, or it might mean that you.... are
eating too much and too fast.
<**MODERATOR**> LS YOU HAVE THE NEXT QUESTION:)
<LS> Dr. Simpson- you were comparing proximal and distal earlier-
wouldn't the DS considered distal- in your opinion does the DS have a
higher complication rate than the RNY? I keep hearing on this chat
that it does? Also I have been at the same weight for 3 weeks - I have
been walking a lot, getting my protein in and water- what breaks Plateau's?
<Dr. Simpson> and it does not have a higher
complication rate, although it can, depends on he surgeon to break a plateau
you need to do the following: > first, measure you neck, thighs, chest,
waste, hips, arms, and ankle and wrist... keep a diary of those because
sometimes you lose inches instead of pounds, which is ok.... next, you
need to walk not just walk, but walk fast.... 45 minutes per day four
days per week.... finally, you need to count your carbohydrates and keep
hem to less than sixty grams per day. That will break the plateau... and
will make you thin and wonderful, and maybe even happy... and it will
make me smile. Good luck.
<**MODERATOR**> CAROL YOU HAVE THE NEXT QUESTION:)
<Carol> How much at risk is a very recent ex-smoker for a pulmonary
embolism? A pack and a half a day/20 yrs.
<Dr. Simpson> Smoking is not a separate risk
factor for PE (pulmonary embolism)... also known as a blood clot from
the legs to the lungs.... especially, an ex smoker, so it won't add to
that risk, but you have a risk of having... underlying heart disease or
lung disease. To avoid a clot, the best thing you can do is to walk....
and walk, and walk some more, and when you are done walking... walk again.
Good luck; don't smoke
<**MODERATOR**> LIZETTE YOU HAVE THE NEXT QUESTION:)
<Lizette> DS - If the common channel is longer does that mean you
will lose slower?..does the length of the channel have any bearing on
how quickly one will lose weight?
<Dr. Simpson> The length of the common channel
has to do with absorption of protein, if it is too short you will not
absorb protein as well.... if it is too long it can inhibit weight loss,
although it is less likely. Good luck. Swim if you can't walk.
<**MODERATOR**> LISA NORFOLK VA YOU HAVE THE NEXT QUESTION:)
<Lisa Norfolk Va> Hello Dr ..whats the best way to take care of
a OPEN rny scar?
<Dr. Simpson> Well Lisa I say that you should.....
not use knives around it, do not let the sun expose it.... some like to
rub vitamin E capsules on it....some like to rub aloe on them.... some
like to rub them with their finger tips.... but finger tips are really
hard to get into a capsule... all scars fade with time, and will become
smaller. They are at their worst at six months... good luck.
<**MODERATOR**> SCOTT YOU HAVE THE NEXT QUESTION:)
<Scott> Does your hospital special accomodations for larger people?
Such as bigger beds ect?
<Dr. Simpson> They should, Scott, they should.
Most hospitals do, and it is the law that they accommodate bariatric patients....
not just for weight loss surgery, but for everything, so they have to
comply. Some do not do as good a job as others, however. So if they have
a bariatric program, they are probably sensitive to the needs for you.
Or for me, good luck
**MODERATOR**> PAIGE YOU HAVE THE NEXT QUESTION:)
<paige> hi doc...what is head hunger???
<Dr. Simpson> Head hunger is where you think
you need to eat but you are not hungry in your stomach.... you are full,
you feel full, but feel like you should eat something.... or you have
an "appetite" but your like your in laws, you ignore it. They
are hard to ignore.... so is head hunger. Food is a biofeedback which
is hard to break, and it does become.... mind over matter. If you over
eat you will stretch the pouch.... so don't respond in that manner, I
think the easiest way is to have something small to nibble on.
<paige> thank you... don't quit your day job! :)
<**MODERATOR**> ANTHONY YOU HAVE THE LAST QUESTION: >
<Anthony> I am halving a puffiness and tenderness around the scar
is this normal
<Dr. Simpson> Well, Anthony it could be,
or it could not be, best to check with your surgeon first.... it is normal
to have tenderness at the scar site.... and then it can be an infection,
so have your surgeon, or a nurse check it for you... good luck
<Tammy> THANK YOU DR. SIMPSON! THANK YOU MEMBERS! PLEASE VISIT
DR. SIMPSON AT: WWW.ARIZONABARIATRICCENTER.COM!
<**MODERATOR**> THANK YOU ALL FOR JOINING US HERE TONIGHT! AND
A BIG THANK YOU TO DR. SIMPSON!
<Dr. Simpson> thank you all, I am off here
in Alaska to do some work
<Dr. Simpson> bye
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