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<**MODERATOR**> KANDI YOU HAVE THE FIRST QUESTION
<kandi> Hi Dr. Simpson - I'm having lap RNY in Nov - are there
any benefits for lap RNY over open RNY or ds - I would like to know I’m
making the right choice in wls.
<Dr. Simpson> Kandi, there are all sorts
of arguments about those things, lap vs. open, vs. DS, the best thing
is to find a surgeon who you trust, and who you like....this is a surgical
decision. Some people are lucky enough to have a choice...in terms of
surgeon, and in terms of procedure, but many are not....However, I think
that all the surgeries currently done have good points and bad points,
what you want...is to have a surgeon you like, who has a good reputation,
and one who has a good support group system in place. Good luck.
<**MODERATOR**> KIM YOU HAVE THE NEXT QUESTION:)
<Kim> I have diabetes....and I’m concerned that I'll have the same
problems with diet after surgery that I do now. Also.....is hair loss
as inevitable as it seems to be with fasts?
<Dr. Simpson> Well the first thing to understand
is that surgery is a tool, it is not a be all and end all.... with surgery
you have a mechanism which evens out the genetic odds. You still have
to have the control over your environment, or your diet...those who think
that you can have the surgery, eat what you want, and lose weight are
those who do not reach a goal of a BMI of 22 or so... well, what I mean
by that is there are those of us who have a tendency to gain weight with
smaller amounts of food...we tend to gain weight easier than our thin
relatives who can eat ice cream daily and not...there is a complex physiologic
change, however, if you eat high carbohydrates and such, you will not
lose as much as you would like to....so, in addition to the surgery, you
have to change your lifestyle as well, and that is often the tougher part....
<Kim> do you anticipate being off of insulin I'm 3 shots a day
currently at 290#
<Dr. Simpson> many people are able to get
off of insulin, but some do not, some require less, certainly if you have....diabetes
as type 2, the odds are that you can decrease your requirements as you
decrease your weight...however, that is not universal, remember, even
skinny people get diabetes, just because you become skinny does not mean...
you are off shots. So, weight loss surgery is a tool to help you lose
weight, it is not an end in itself.... check with your primary care doctor.
Clearly, people who have obesity have insulin resistance, which is somewhat
decreased when lose the fat tissues. Good luck.
<**MODERATOR**> RACHAEL YOU HAVE THE NEXT QUESTION:)
<Rachel> Does endometriosis effect your ability to qualify for,
or to have gastric bypass surgery?
<Dr. Simpson> No, Rachel, it does not. You
can still have the surgery, without problems.
<Rachel> Thank you
<**MODERATOR**> PATPA YOU HAVE THE NEXT QUESTION:)
<PatPa> What is your opinion on a weight or age limit for surgery?
<Dr. Simpson> Well in terms of age that is
an individual thing which is determined by the surgeon, and how comfortable
he feels with patients.... for example, some of us do not operate on patients
under the age of 18, and some of us do not operate....on patients over
the age of 70. In terms of weight, most of us follow the NIH guidelines
of ....BMI of 40 with no co morbidities, or 35 with comorbidities. Some
have different age limits, and some insurance companies have different
requirements. Check with your surgeon. Good luck
<**MODERATOR**> LINVILLE YOU HAVE THE NEXT QUESTION
<linville> HI, I'm 2 yrs post-op, and I have read that we have
an increased risk of getting stomach cancer, is this true, and what are
the stats for this..what is the time frame for the possibilities?
<Dr. Simpson> Linville, that is not true,
it is another ugly rumor started by some people who have nothing better
to do than to scare pre ops into not doing the surgery.... There is no
evidence of any increased cancer associated with weight loss surgery.
Now that doesn't mean...that we won't find that getting skinny doesn't
have an increased risk. I think that most....find that there is an increased
risk of lead poisoning....which happens when your spouse finds that many
people are checking you out than they did before....but being beautiful
is never easy for most of us. The long-term effects are mostly in terms
of nutritional supplements...vitamins, calcium, iron, and those are things
which you should be checking out with either your surgeon...or having
followed by your primary care physician. Good luck.
<**MODERATOR**> TERRI-MICHIGAN YOU HAVE THE NEXT QUESTION:)
<Terri-Michigan> I am post-op 8 months, and my doctor told me slow
down on losing the weight. I have increased my intake but still losing
an lot, right now as of last Friday was 130 pounds and I am getting concern,
I take my vitamins, also get an b12 shot every month and also on coumdin
for the rest of my life for history of DVT and two PE's...Should I be
concern too? Plus my body is getting very saggy even though I am exercising
<Dr. Simpson> Terri, that is a good weight
loss. Although I have heard different people say their doctors are concerned
about their weight loss.... I have never seen a good reason to be concerned
about it. Losing fat is not a problem; your body can do it easily, and
should be allowed to do it.... Whether you need a b12 shot every month
should be a matter of whether you need it, not just taking it, we can
measure b12 levels and see if it is a problem.... I think that if you
get to your goal in nine months after surgery, that is good, otherwise,
keep working at it… In terms of body being saggy, better saggy than a
bag filled with fat. Plastics is a good way to get rid of sags, but keep
exercising. Good luck. Go Lions.
<**MODERATOR**> KANDI YOU HAVE THE NEXT QUESTION:)
<kandi> what % of your patients have a problem w/ excess skin?
I’m 26 and 120 lbs overwt - I'm heaviest in the lower body - do you think
ill have a problem.
<Dr. Simpson> Kandi, excess skin is something
that a number of people have, but it is something that we cannot tell...if
you will have it pre op. There are some things you can do to make certain
you will have saggy skin.... if you don't exercise, if you smoke, and
if you expose your skin to the sun, you can be assured that it will sag....
otherwise, you can help yourself by not doing those things.... so good
luck.
<kandi> I've started a walking program of 20 min/ day and I’m preop
- is there anything else I can doI also don’t smoke or tan
<Dr. Simpson> increase walking to 45 minutes
per day, and some other things might help too....
<kandi> ok - will do - I really don’t want any additional surgeries
<Dr. Simpson> find a good physical trainer,
and they will help you exercise all your groups. Good luck.
<**MODERATOR**> KIM YOU HAVE THE NEXT QUESTION
<Kim> Does Laparoscopic Gall Bladder surgery make it less likely
that WLS can be done the same way?....because of previous surgery?
<Dr. Simpson> No, Kim it does not....in fact,
there is much less adhesions formed from laparoscopic surgery than with
open surgery....so, having it does not mean you cannot have it again.
Good luck.
<**MODERATOR**> BRYCESMOM130 YOU HAVE THE NEXT QUESTION:)
<brycesmom130> hello...I am 4 weeks out and have had diarrhea now
for the past 3 days, even when I drink water. Should I be worried? What
can i do?
<Dr. Simpson> Well, you should first call
your doctor, and when you tell him/her that you have diarrhea here is
what they will want to know.... how many stools a day are you having,
what consistency, and if you have camped out, eaten in strange places...
or the like. So, diarrhea is a relative thing, people with cholera have
liters of fluid loss per day...some people think if their bowel movement
isn't like a moose dropping they have diarrhea, so, it is, like Einstein
said, relative...so, call your doctor, and keep up with fluids. Good luck.
<**MODERATOR**> MARY YOU HAVE THE NEXT QUESTION:)
<MARY> DR. MY WEIGHT TODAY IS 300 , WHAT IS THE CHANCE OF LOSING
HALF THE WEIGHT BY ONE YEAR DO YOU THINK I CAN LOSE IT FASTER THEN THAT
<Dr. Simpson> Weight loss is individual with
people, and it is partway up to then.... that is, if you eat the right
things, and exercise, you can get to goal quickly, within a year or so...
although you can get to goal in two years also, it really is somewhat
up to you more than otherwise.... So, I think that you should plan on
avoiding the following foods until goal: rice, potatoes, bread, and pasta....
as well as other high carbohydrate foods, like ice cream, and eat a protein
based diet, then... once you get through that, you should do quite well.
Good luck.
<**MODERATOR**> CJK YOU HAVE THE NEXT QUESTION:)
<CJK 10/16/01 267/147> I've been having pain on my right side since
shortly after surg one year ago. (No GB) Just had an upper gi and the
radiologist said that my intestine (coming off of the pouch) is "twisted
in a loop". What does this mean, how'd it get that way, and how will
it get "fixed"?
<Dr. Simpson> Well, what the radiologist
says, and what you have may be two different things.... if you do not
have a lot of vomiting, then I would doubt the twists are a problem....
pain can be from a number of things, including retractor pain, or chest
pain from other sources.... so having intestine twisted, in and of itself,
generally does not cause pain.... instead, it tends to cause problems
with vomiting, because things cannot get through easily...
<**MODERATOR**> POOKSTER YOU HAVE THE NEXT QUESTOIN:)
<pookster> Evening doc!! How do you deal /cope with head hunger???
<Dr. Simpson> Pookster first you have to
twist, then I will answer the question. Come on out of that chair, one
quick twirl...off with your head.... oh, well, if you think you are hungry,
and your body says you are full then you have a problem. Because if you
do that, then you will defeat what you have. You have to learn to listen
to your body, and not...worry because you think you should eat. Trust
me you don't need to eat. You need to twist, but not to eat.... you need
to walk. There are several mechanisms...the first is to have THREE meals
a day, not five.... Snacks of high protein, and keep track of what you
put in your mouth...water is a great tool to use, and the diet.... should
be meaty, something that will stick to your ribs, instead of flab in the
breeze when you twist.... it is something which you will have to lean,
it is a hard thing to break.... journals are good, if you are compulsive,
which some are.... but, I think you need to have a regimented program
of eating...and when you are hungry, remember that nothing tastes as good
as slender feels.....
<**MODERATOR**> SUSANNE S YOU HAVE THE NEXT QUESTION:)
<Susanne S> I have a concern about staple line failure - long term.
I know that having this surgery IS right for me, but do I need to have
the fear in the back of my mind that my staple line may fail?
<Dr. Simpson> Well, the staples are something
which are not the sole source of keeping things closed.... your stomach
heals over the staple line, and once that happens you are going to be
pretty strong.... most staple line failures happen for two reasons: the
first is a technical error, which is, the staple gun is a mechanical device,
and as such.... it will have a certain failure rate, which just happens.
The second reason.... is that if you over stretch your pouch in the first
six weeks, you can cause the staple to bust, and that is not a great thing....
so, I think that you should not worry about that, ....watch your portions,
and go from there. Good luck. You will get very sick if you leak... and
leaks happen in the first while after surgery, so portion control is the
key. Good luck.
<**MODERATOR**> FRANKIE-CA YOU HAVE THE NEXT QUESTION:)
<Frankie-CA> Thank you Ms. Moderator and Dr. Simpson. I had multiple
pulmonary embolisms in May 2001. I will be seeing my surgeon 11-7 for
consult. Is there a way he can prevent any blood clots during and after
my surg? How about a vena cava filter? Can the filter be place the same
time as my DS surg?
<Dr. Simpson> That is a series of good questions.
You can have a filter placed before surgery, which would be the time to
do it....if that is what is needed.... we cannot totally prevent blood
clots during and after surgery, we can do a lot of things to prevent them....there
are several things which you should find out....first, if you have a hypercoagulable
state, that is a tendency to clot, and there are a number of factors which
....can be tested for, and that would be useful information to know....we
surgeons do a lot of things to prevent clots, including giving blood thinners
during surgery....using compression pumps on the legs (and it is hard
to get a purse to match those pumps)... but YOU can do the most, by walking
and walking, and walking, a lot. Including the day of surgery...good luck.
<Frankie-CA> I am on blood thinners now 8-mg a day
<Dr. Simpson> Walk, Walk some more. Talk
to your surgeon. But for you --- walk.
<**MODERATOR**> SHEILA IN FL YOU HAVE THE NEXT QUESTION:)
<Sheila-in-FL> DO YOU EMPATHIZE W/ ALL YOUR PATIENTS WHETHER THEY
NEED TO LOSE 100# OR 300+#, AND DO YOU FEEL THIS IS A GIFT YOU HAVE TO
DO WLS FOR PEOPLE TO GIVE THEM A BETTER LIFE?
<Dr. Simpson> It isn't a gift at all, Sheila,
it is what I do. I love seeing patients lose weight.....in terms of empathy,
well, hard to say-- you would have to ask them.....but 100 or 300, it
is still a surgical problem that we can fix, and I love fixing it, so
it is my pleasure....
<Sheila-in-FL> That's what I wanted to hear.....I'm scheduled for
surgery 11/25....so excited. I've enjoyed your answers tonight.
<Dr. Simpson> and when my patients bring
me goat cheese ice cream, like one did the other day..... well, that makes
me feel better. Of course, I need to lose a few pounds myself.
<**MODERATOR**> AILI MA YOU HAVE THE NEXT QUESTION:)
<Aili MA pre-op> AFTER THE PRE-OP ULTRASOUND AND F/U CT SCAN AND
MRI, I'VE BEEN TOLD A MASS ON MY LIVER "MAY" BE A HEMANGIOMA;
SHOULD I BE CONCERNED?
<Dr. Simpson> Hemangioma is, in general,
a benign condition of the liver....and something that we see with some
regularity.... don't let anyone put a needle in it or it will bleed like
a stuck pig( although I have never stuck a pig)...good luck, it won't
inhibit you from getting surgery.
<**MODERATOR**> JOMAMA YOU HAVE THE NEXT QUESTION:)
<Jomama> What is the exact difference between distal, medial and
proximal (also DS) as far as length (specifically in cm) of bypass? What
circumstances dictate specific type of surgery? Is there a benefit of
one type over another? I am doing the twist STILL around the computer--soon
won't need the surgery;) I have about 125# to lose.
<Dr. Simpson> Ah someone wants specifics,
well here goes my favorite question....most people who get to goal after
weight loss surgery have a proximal bypass.... proximal means that about
10 to 15 per cent of the small bowel is bypassed. With DS we do a distal
bypass which is about 60 per cent of the bowel....but that is a part of
the DS. There is NO data to support that proximal or distal is better
in terms of weight loss...and there is some increased malabsorption with
distal, so some insurance companies are not paying for it...we do have
a belief that those individuals with BMI over 60 might benefit from a
distal bypass,...but that is a religion, and not based in facts. Medial
bypass is something in-between, and has no real place in the literature.
Good luck.
<Dr. Simpson> you should do well with proximal
bypass.
<**MODERATOR**> MISSY FROM NY YOU HAVE THE NEXT QUESTION:)
<missy from NY> I had open RNY 4 weeks ago and may have tore the
underlying stomach muscles from sneezing. Is this common and what measures
are taken to heal or fix this. I go see my surgeon on Monday.
<Dr. Simpson> If you have a hernia, then
it will need to be repaired. If it is muscle only, then you need to rest
them...and take some medicine to relieve the pain. Hernias are common
after weight loss surgery....lap or open,. Sounds like a hernia. See your
surgeon, you may need another surgery, good luck.
<**MODERATOR**> SARAH YOU HAVE THE LAST QUESTION:)
<Sarah> What stops your body from loosing to much weight? Does
your stomach always stay smaller? Is food always bypassed in the intestine?
What is the percentage of unwanted weight that will be lost? (AND I LOVE
YOUR SENSE OF HUMOR)
<Dr. Simpson> Hi Sarah. Well thank you. It
is as twisted as can get.....you stop losing because the pouch will stretch
and accommodate more, and you will accommodate it with more. If you have
intestine which is bypassed it will not see food, for that segment....and
the per cent of unwanted weight is up to you more than the surgery....it
is rare we see people go from morbid obesity to being too thin,....often
people worry about that long before they are to that stage...but if you
get to a BMI of 19, well....then you need to consider that you might have
lost enough and introduce new things to your diet...we can always put
weight on, taking it off is always the issue... Good luck
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