October 22 , 2004

<Moderator> Welcome to tonight's chat with Dr. Simspon. 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!

<Dr.Simpson> Ready

<louise> How common are ulcers post-op?

<Dr.Simpson> As common as they are pre op. There are different types of ulcers for different people...Some require treatment with anti acid medications, and some for bacteria which require antibiotics. There are various types...we have to figure which type we need.

<Elaine> Hi Dr. I am post op 2 1/2 years and had my labs done this morning. The hospital already called my surgeon (2 hours away) and said my hemoglobin is low (7.7) what exactly does that mean and should I be scared?

<Dr.Simpson> That means that you are low and you will need blood. There has to be a reason for it, and that is what needs to be determined.

<yvonne> Can a person weighing in at 370lbs lose 200 lbs with the lap band. assuming all exercising and eating plans are followed

<Dr.Simpson> Yes, you can -- that would not be a problem. You can lose all the weight. It is not easy, but it is certain.

<Pat Bybee> Anyone had VBG and part of their stomach go up through the band?

<Dr.Simpson> The vbg is like any foreign body and can erode through the stomach. The stomach does not usually prolapse through the band.

<Mercedes> After you reach goal, what is the key to keeping the weight off?

<Dr.Simpson> Ah, that is a great question...How to keep things off. Well, we are just putting together a workbook for patients which will help you get to goal and to stay there. The idea is that you need to learn to measure what you put in and to determine the calories that you use. For example, start a walking program and get a pedometer so you can see how many steps you are taking during the day. I was shocked the other day when I had a busy day but only had 2000 steps. My personal goal is 10,000 steps per day, which should be everyone's goal, if you do not have joint problems. Otherwise we are talking water aerobics, in which case we have different things for you to do. In terms of eating, you have to learn choices...I like calling them choices instead of diets because a diet is some set of rules that someone else puts on you...A choice is something that you make. After surgery you make choices. Surgery is the biggest choice that you make for your health -- and what you eat is a choice you make. Since your portion sizes are smaller, it allows you to learn to eat new foods. Remember, most became obese ten pounds a year for ten years---which is only 95 calories a day...so, choices. The workbook, I hope, will be available for the LA ball and we will have copies there. Good question.

<chubs> What surgery do you do?

<Dr.Simpson> Me -- well this morning I fixed two hernias and took out two gallbladders. I spent ten years doing RNY gastric bypass and had a lot of success with them...Have done a lot of duodenal switch operations, and had great success with them...And have been doing lap bands for the last year and have had success with them.

<Pat Bybee> Had VBG in 1998 & now dr. has said part of my stomach has pushed it's way up through the band. Unusual?

<Dr.Simpson> Well, it is unusual. It means that you have a hernia, and that needs to be operated on. But without seeing it, we don't know...So, that is something that will need to be operated on and fixed and that is very, very unusual. Not with a lap band, but with a vbg almost unheard of.

<Goldie> Could you please tell me if you believe and endoscopy should be scheduled before RNY surgery as one of the pre-op tests?

<Dr.Simpson> Not necessarily -- although some do it as a matter of routine...Their reason is to check for H. pylori in order to see if there is that infection which can cause ulcers. We have just obtained a "breath test" machine for the office which can test for H pylori without the endoscopy. So, we can do the same thing, with out the invasive nature of the endoscopy. Blow.

<Buddy> Hello I am 7 weeks out and I have this empty feeling in Belly all the time even after I eat. Is this normal?

<Dr.Simpson> Yes, that empty feeling is where the fat was. With a liquid diet it is normal to feel hungry all the time. But what you must do is measure you food for your pouch or stomach and determine how much it takes to make and keep you full. Some don't feel hunger for a long time, some feel it earlier than that.

<rene goal> I HAVE BEEN HAVING GAS SINCE SURGERY 1 1/2 YEARS AGO AND IT IS GETTING WORSE WHAT CAN I DO ABOUT IT I CAN NOT CONTROL IT AND IT IS EMBARRASSING

<Dr.Simpson> Most find there are certain foods which contribute more to gas than others, such as beans, simple carbohydrates, sugars, and those sorts of things. Some find that gluten-based products cause gas. Some find that they have bacterial overgrowth syndrome and they need to be on some antibiotics...There are a lot of reasons for gas. The best thing is to start checking what you eat and slowly changing one thing and going from there. For example, start with something that is high in protein and low in fat --- and have that as your sole meal for a bit...If that does not cause gas then add other things as time goes on. Devrom is a good product which helps decrease the odor in gas and is available at www.parthenoninc.com.

<Sindy> Are you going to the Ball at the LA Event? If so, what will YOU be dressed up as? ;)

<Dr.Simpson> I believe I will be either moderating or giving a talk at the LA event...I will be dressed up as a nerd surgeon, which is how I normally come...or, to quote the Addams family, I will be a psychopathic killer--- they look like everyone else.

<Teddy> I am hearing different opinions on which surgery is most effective. Why is that -- aren't there statistics to show which is best?

<Dr.Simpson> Teddy, here is the simple truth --- it is not the surgery, it is the patient. Sure, various surgeries have various success rates...However, all the surgeries are great tools for weight loss and help patients lose weight far better than what they have been doing. If you think that surgery is something that you can simply have and the weight will magically come off without having to participate in it, then you will be disappointed in whatever surgery that you opt for. The most important component in losing weight is the patient - not the surgery and not the surgeon, and your participation and acceptance of personal accountability. Surgery makes it easier to lose weight -- but you have to be active, not passive in the process. Ask my son, who has lost 450 lbs.

<MOD-CROW -450# Lost> yup yup < :-)

<Dancin D> Hi Dr. Just had my 3 mo. blood work done. My potassium level came back a 8. What causes this and what can it harm to be high? My nurse said no diuretics or bananas but I thought diuretics caused your potassium level to go down. What is the deal?? Thanks.

<Dr.Simpson> A potassium of 8 is critical, and you need to see your doctor NOW. Do not pass go, do not collect 200 bucks. If your potassium is that high you can die - your heart can stop and you will die. Go, see your doctor, now. Don't finish the chat. If it was 4.8 that is ok.

<Fashola> I am preop for the lap RNY and am vomiting at times for no apparent reasons. I do take glucophage. What could this be an indication of and do you recommend an endoscopy before surgery

<Dr.Simpson> That is how we kill prisoners by lethal injection. With potassium, it is difficult to determine why you are vomiting at different times for different reasons. Clearly you are not losing weight from it, but still
vomiting is not a good thing and needs to be worked up by a gastroenterologist, because after surgery we do not want you to vomit -- ever. Endoscopy will not reveal why you are vomiting.

<Deb> I am considering LapBand, but I want to be honest and say I do like to drink beer on the weekends when we are at camp in the summers. Would have to stop this in order to be successful?

<Dr.Simpson> There are a lot of choices that people make in life - that is one that you will have to make...
how much beer, how often - those are things you will have to decide. If beer is what made you obese, then you cannot expect that beer will not after a lap band. The definition of insanity is doing the same thing that you did before and expecting a different result. So, again -- your choice as to what you do, how much you do, but it is your choice. Good luck.

<Bert> Do wls patients have to watch their salt intake?

<Dr.Simpson> Everyone has to watch their salt intake. Some patients have disease process, unrelated to wls, which mandate watching salt intake. Me -- I like salt, and I watch it as I put it on my food.

<Fashola> Is the fobipouch and a vbg/rny about the same procedure?

<Dr.Simpson> The Fobi pouch is a RNY bypass with a ring around it. See pictures in "the book".

<sara> Hi .I am 4 days post bypass. I have had a sore throat from the intubation.Is there anything that can help me? Feeling good about the lap but this is a major pain (in the neck).

<Dr.Simpson> Drink hot tea....gargle with warm salt water...do not swallow the warm salt water -- just gargle with it. The other suggestion is to get a hammer, hit your little toe with it, and your sore throat won't bother you as much.

<felicia> For people with an inability to maintain a weight loss for any length of time, who yo-yo consistently, but have relatively low BMI (@30), with comorbitities like Syndrome X, depression, can they ever get WLS?

<Dr.Simpson> No. WLS is not a treatment for any of those diseases. WLS does not cure depression----WLS can alleviate symptoms of those disease processes. Our recommendations-- walk a lot, monitor what you take in, and keep walking.

<Mary Bailey> Do you recommend that you patients take their BP meds on the morning of surgery. Also - do you prescribe any anti-anxiety drugs to take the night before (ie Xanax or similar) to calm the jitters?

<Dr.Simpson> I never prescribe anti-anxiety drugs-- except in only ONE case in the last 13 years. And it depends on the blood pressure medication - some you should take the morning before and some you should not. Your surgeon should have that information for you.

<Morticia> Will I have to watch out for anemia after surgery?

<Dr.Simpson> You will need to have routine labs done on your blood to check for anemia and other things, like B12 levels... and you will need to have those drawn on annual intervals for the rest of your life.

<Darling> I went to a seminar and was told by the surgeon that he would not do the surgery on someone who was missing even one tooth. Is this common?

<Dr.Simpson> Where I come from, in the villages of Alaska, a woman with ten teeth is considered a "10"....
the only problem is no one can count that high --- never heard of that before.

<Mary Bailey> When do you recommend that patients begin taking vitamins - how many days/weeks post-op?

<Dr.Simpson> When they go home from the hospital.

<Brandi> Hi Dr Simpson, I am seriously thinking about going with the lap band,a year ago when I was researching it, the stats werent that good, but now they seem to be much better. Do you agree with this and if so, why do you think the stats are better?

<Dr.Simpson> The statistics for the lap band are much better. Probably when you first investigated it you heard the statistics that were published from the original trials with the lap band...And those statistics were not that good. However, the people who did the lap band were probably not that good, not the product. Now with surgeons who are dedicated to the lap band, and have a practice which is dedicated to the lap band we are seeing that patients are doing better, and in fact, the lap band - at three years out - continues to have weight loss, where other surgeries are having some weight regain. So, yes, the lap band is doing quite well and I believe those statistics.

<vicki> I'm 10 mo out, only lost 80....have I done something wrong?

<Dr.Simpson> It all depends on how much weight you need to lose. If you needed to lose 100 lbs then you are doing great...But remember, you have lost 80 pounds in ten months, and that is better than the trend you were on before. This is why we are working on developing a workbook, to go along with our regular publication -- which is "Weight Loss Surgery: A lighter look at a heavy subject" which you see in the banner ad above...And available from www.obesitydr.com. So, depends on where you start, but still a good loss...And you can continue to work on the weight loss and keep losing weight.

<AngReyes> Should gastric bypass surgery be used as a last resort?

<Dr.Simpson> Well, I think the Four Seasons is a good last resort...Have fond memories from that resort...Oh, sorry....Gastric bypass surgery -- or weight loss surgery -- isn't a last resort. It is a tool for weight loss. There is ample evidence that....and I mean ample...patients, after they get to a bmi of 35 or more...simply do not respond to diets and exercise programs. When we talk about medically supervised diets -- it is a great idea. The problem is that there is not one out there with any proven, long-term success. So weight loss surgery isn't a last resort-- although it is probably the last thing that you will need...because once you have it-- if you follow the program, you will be able to lose weight and keep it off.

<vicki> My main menu is canned chicken & egg whites. That ok???

<Dr.Simpson> Well, again -- what is ok is relative...Chicken and egg whites are good sources of protein, and high quality protein. Of course, you should have some vegetables, and perhaps other things for variety. You can gain weight on lots of chicken and lots of egg whites, but hopefully you are being faithful to measure that. We have some great menus in our book, and some great recipes in the book. So that might be of some help to you.

<felicia> Is the lap band procedure as effective in reducing appetite as the usual WLS methods?

<Dr.Simpson> That is how all weight loss surgery works: You feel full with less, because of some restriction-- and when you feel full you eat less. For example, sitting here I was hungry and saw in the office some red licorice so I have had a few of those. Probably would have been better if my office staff would have had some bananas around here...Or a side of beef.

<Laurie> I've lost 73 lbs in less than three months. If I continue to do what I am doing, will the weight loss continue at this rate?

<Dr.Simpson> Weight loss will probably not continue at the rate that you have had. It slows down, and it does so because the basal metabolic rate after surgery is raised, then it goes down after a few months. So the weight loss will go down a bit ...But keep working it.

<npurple60> I'm going through Kaiser, just getting ready to see the phyc. and take the Health Ed. class. I don't know what type of surgery they do yet. What might I need to know or questions to ask?

<Dr.Simpson> You need my book---- get it from the library or somewhere....and glad that you are going through their program-- good luck.

<Kim Filip> I have the lap band and I had my 2nd fill last Wednesday. As the week goes by I seem to get tighter and tighter. The closest thing I can down for solids is Tomato soup. Everyone tells me to wait it out, it will get looser, does that usually happen after a while? My first fill did absolutely nothing.

<Dr.Simpson> Fills are a tricky thing: When they get tight, and you cannot hold anything -- that is probably too tight. However, the amount of room that you have to have of food to sustain you is minimal. So if it is simply that you can only eat two bites -- then it is a perfect result. But if you cannot eat solids, then it might be a bit tight for now.

<jan eldridge> Waht about neuropathy? I alredy have foot drop from a previous who knows what? Noone every told me why it occurred. I take Neurontin and work full-time--do pretty well.

<Dr.Simpson> It is sometimes difficult to know why patients develop neuropathy -- and after a few months it is difficult to know if it will get better -- usually it does get better in the first few months, but it may be that this is something you will always have.

<Dolly> Hi Dr Simpson, would an ulcer slow down weight loss-at say 7 months post op?

<Dr.Simpson> No, an ulcer does not slow down weight loss and has nothing to do with weight loss. Weight loss slows down because of normal things. But if you want to speed it up again --- walk

<LisaB> I weigh 250lbs... how much weight can I expect to lose?

<Dr.Simpson> Well, you can expect to lose all of your excess weight in one year if you work at it, which means, do the menus and plan what you eat, and begin an exercise program. With the weight loss surgery the weight will melt off and you can expect to get to goal.

<Joyce> If a person is a high risk patient because of severe sleep apnea, diabetes etc... and they had spinal stenosis and limited mobility and this surgery was their only answer to live but their insurance company would not help and they lived on a very limited income would you still help them with this surgery?

<Dr.Simpson> Patients who have limited incomes might qualify for Medicare or Medicaid, which does cover weight loss surgery. Some people are able to get financing for their weight loss surgery, some get second mortgages in order to pay for it. So it is an investment that is worthwhile and pays off. So, I would find the best price I could, from whichever surgeon...And beg, borrow, and borrow again to get the money to pay for it.

<Debbi R 278/160> Occassionally, I feel like I still have eating binges. How do I get control over thoes times - they can last a week or more.

<Dr.Simpson> A binge is a binge is a binge - Simply put--- that is an abnormal fixation for food. It is time to choose something else to binge on instead of making food the center of your life, because it is clear that food is not your friend. You need to find something else to occupy that role...And to occupy that role I would suggest walking -- and go on an exercise binge.

<gracie> im 39 and am 5'0 and weigh about 435 and i cant get any assistance for surgery. Is there any program for those who dont have any insurance?

<Dr.Simpson> Not that I am aware of. I think that it would be important for you to begin a few things...
First, you need to control what you eat -- it is the one thing in your control and to go on a very low calorie diet.
Second, see if you qualify for Medicare or Medicaid. Third, I would work on finding alternate financing for the surgery. Good luck.

<morriegirl> i have trouble with the chewable vitamins...when can i switch to regular swalllowable ones?

<Dr.Simpson> Various vitamins work well for patients. I think that some of the chewables are not that good. They begin to taste like a cross between a mint and tin foil. There are a variety of vitamin products out there that are good and you can take in pill or capsule form. We like Bariatric Advantage vitamins. Good luck.

<Dawn> What are the vitamins that you have to take for RNY and i have your book and it's great looking forward to the workbook.

<Dr.Simpson> Thank you, Dawn. Glad you like the book...I am familiar with Bariatric Advantage -- and I like their product a lot. It is easy to absorb, and it contains the things we think that you need. You certainly need to have your labs checked on a periodic basis to make certain that you do not have deficiency in various other things, such as vitamin b12.

<brian/pa> How is the overall health of the patients that you did the rny on ten years ago any problems related to wls?

<Dr.Simpson> The occasional hernias, and anemia requiring iron or B12 is about the only problem. Some have regained weight and are looking for revisions. Most are quite happy, and most don't come and see me anymore...which is sad, because we always like to see our long-term post op patients.

<Laci> Hi, I was wondering if the lap band surgery was as successful as the other surgeries?

<Dr.Simpson> Laci, it is as successful, but remember: The key to success in any surgery is the patient, not the type of operation.

<Sue> I'm in process of trying for Lap Band surgery, my question is I've read where lots of pre-op's do liquid diet 1 to 2 weeks prior to surgery, is this something they are told to do and is it to help shrink stomach before band is placed?

<Dr.Simpson> Some patients are asked to be on a liquid protein diet, like Optifast, in order to decrease the size of their liver, which is an organ we have to move out of the way. And if the liver has a high fat content in it -- fatty liver... then the Optifast will help make it smaller and make our job, and hence patient recovery, easier.

<miles 4wkspostop> Am I going to be ok? Ive just come out of the hospital after a stomach infection and scared

<Dr.Simpson> Well, I am glad you are out of the hospital and welcome to this side of weight loss surgery. Sounds like you had a nasty time of it, which does happen to some patients. And while anything can happen, as you well know, the longer you do well, the better. So good luck, and remember protein, water, walk.

<Moderator> Last one goes to...

<glendasue> How long following surgery can you continue to have strictures?

<Dr.Simpson> Generally strictures occur once, and may require multiple dilations -- usually four dilations. After that, they generally are not a problem any more.

<Moderator> Dr. Terry Simpson, Arizona Bariatric Center. Website: http://www.drsimpson.com/. Phone: 602-234-8995. Fax: 602-230-8344.

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

<Dr.Simpson> Good luck and thank you all for the time. The book is available at www.obesitydr.com. Good night, all.