October 31, 2003

<**MODERATOR**> OUR GUEST HAS ARRIVED

<Dr. Simpson> The guest who brings his own towels to wash his hands. The guest who scrubs for ten minutes before operating

<**MODERATOR**> WE WILL NOW BEGIN. KATHLEEN G YOU HAVE THE FIRST QUESTION FOR TONIGHT:)

<kathleen g> Dr. Simpson: As we all know, your new book will be out next month (tomorrow?). Will it include some of your famous WLS recipes? My surgery is coming up soon and I can't wait to get back my ghoulish figure. Also, what is the determining criterea for the type of WLS surgery any given surgeon routinely does? Is it training based or a personal preferance? Thanks a bunch.

<Dr. Simpson> Hi Mom-- plugging my book again, eh?

<kathleen g> yep

<Dr. Simpson> Sorry-- Kathleen isn't my mom

<Dr. Simpson> I just received some of the final proofs today, and will print out the pdf file tomorrow and go through them. Once I have approved, or changed things then the book will be printed-- and I will approve of that in about a week, then about four weeks to print. Then it will be here-- featured on obesityhelp.com in the store, for your purchase-- Although I will have a few copies at the office for signature for friends, like our moderator, and others, and will send those out. Now-- as the other boring topic: what we do for weight loss surgery is dependent upon training.. Some of us have preferences, for example: I like DS and lap band, and still do an occasional RNY. Some do just RNY -- some do VBG-- most of us have what we like to do, and we do it rather well. so, what we do is personal preference -- and most surgeons should do it well-- what you don't want to do is to have a surgeon who likes doing one thing and you talk them into something else.... Thanks - - great question.

<kathleen g> Does the final outcome differ?

<Dr. Simpson> Yes-- it is dependent on the patient-- not the operation. You can defeat any of the operations with high carb foods. No one operation is superior in terms of being defeated. If you want to defeat the operation I suggest you eat lots of potatoes, bread, fast food, fried foods. Ice cream, cookies, candy, cake - If you want the surgery to work - protein first, veggies next, and a rare dessert and make dessert special. Like me

<kathleen g> OOOH

<Dr. Simpson> That is, special like I am-- I don't want to be dessert--- I have a few patients who are cannibals and I don't want to give them ideas.

<kathleen g> Thanks

<**MODERATOR**> ERICA YOU HAVE THE NEXT QUESTION PLEASE:):)

<erica> Hello, I'm trying to find a way to have gastric bypass, and was wondering what the possible cost is

<Dr. Simpson> The cost is about 13,500 for lap band at our hospital, and about 17 k for duodenal switch -- some are more, some are less

<Dr. Simpson> The cost of bypass is surgeon and hospital dependent, so save your pennies. Good luck.

<erica> thank you

<**MODERATOR**> POOTSCRATCH YOU HAVE THE NEXT QUESTION PLEASE:)

<pootscratch> How common in wls is it to leave drains in to be removed after the surgery? This is a big fear for me

<Dr. Simpson> Drains may or may not be common, depends on the surgeon, not a bad thing and they are easy to remove, like linguine

<**MODERATOR**> PAM W YOU HAVE THE NEXT QUESTION:)

<Pam W> how often have you had to REMOVE a band that you just put in two days prior? I had my band put in Tues and he had to remove it yesterday.

<Dr. Simpson> Not often, why was it removed?

<Pam W> swelling

<Dr. Simpson> Swelling happens

<Pam W> extreme swelling

<Dr. Simpson> Well sometimes that does happen -- but it is ok.

<Pam W> he said it would have gotten infected if he'd left it in

<Dr. Simpson> Well, then it is a good thing to remove something. It can be put back in later.

<Pam W> he's going to do that for me......but he thinks it's his fault

<Pam W> i don't blame my doc at all

<Dr. Simpson> That is good surgeon. We always blame ourselves.

<Dr. Simpson> We don't always tell you, but we do

<Dr. Simpson> So, send him a nice card and thank him for taking care of you, I am sure he feels bad and he would appreciate it that you understand, surgeons are people too.

<Pam W> i will!!! sure they are!

<Dr. Simpson> Great - you will become his favorite patient.

<Pam W> thank you Dr Simpson

<**MODERATOR**> BRANDE SMITH YOU HAVE THE NEXT QUESTION:)

<Brande Smith> What pre-op test should i expect to have and how much pain after surgery? I was just approved yesterday, no date yet.

<Dr. Simpson> Well Brande-- the pain after surgery is individual. Most of my patients have very little pain following open repairs, and less with laparoscopic. However, there are a few who if they have a hangnail need morphine, so everyone is different...

<Dr. Simpson> If I had the surgery I guarantee you I would be in extreme pain...and need to have my brow wiped by an angel, or a pretty nurse - every second, but enough about me...

<Brande Smith> that is what i am affraid of thanks

<Dr. Simpson> The pain really isn't that bad. The pre op tests are also individual, but.. are you afraid of the nurses? Because Madison and Stacy would take good care of you. So, pain is easy, pre op tests are easy-- post op taking care of you, walking-- that is what you need to do to be a success.

<Dr. Simpson> So, walk, water, and protein.

<Brande Smith> great thanks

<**MODERATOR**> MARILYN-61 YOU HAVE THE NEXT QUESTION:)

<Marilyn<61 - 4mthsPO> I am 4 mths post op from open RNY. Had a terrible case of C-Dif and have not returned to work yet. Just came off Vanco last week. I have lost alot of hair already-started after one month post op. (C Dif developed immediately after surgery) and had a lot of false negatives so not treated right away and it reoccurred. This is my second round of Vanco. My question is does this have anything to do with hair loss and when will the hair loss stop? Also I feel like my appetite is starting to return already. Is 4 mths post normal for that? Thank you. I LOVE YOUR HUMOR.

<Dr. Simpson> Hair today, gone tomorrow...

<Marilyn<61 - 4mthsPO> Cute

<Dr. Simpson> For hair loss I highly recommend you take superglue to your head. Hair loss happens and is something that you can expect from stress--- and it can be exacerbated by low levels of protein and zinc, so keep up your vitamins...

<Marilyn<61 - 4mthsPO> I'm doing that

<Dr. Simpson> and rub your head daily with droppings from a Gila Monster....

<Dr. Simpson> Oh, sorry -- Arizona humor

<Marilyn<61 - 4mthsPO> At least you're making me laugh.

<Dr. Simpson> It will return in four months, and you will have richer and fuller hair, and the Gila monster will be happy to be set free

<**MODERATOR**> PIPS/DS YOU HAVE THE NEXT QUESTION:)

<pips/DS> hello, with small ventral hernia, what is the best for repair, i have heard of some talk of a mesh, so question is, to mesh or not to mesh?

<Dr. Simpson> Well don't mesh with me son

<Dr. Simpson> Mesh is fine-- it is a good thing, it can be done through the laparoscope, and it is a great reinforcement.

<**MODERATOR**> LEE YOU HAVE THE NEXT QUESTION:)

<Dr. Simpson> Lee is a quiet shy type. Come one lee, ask

<Lee> sorry I am 5 mths post op and am pregnant how dangerous is this

<Dr. Simpson> In terms of pregnancy, that does happen, and you need to have a good ob on your case. You need to watch the folate level carefully, and other levels. You might need to double up on vitamins. Pregnancy is an individual issue and a choice...It is something that you have to decide if you want....sometimes five months is early, and that might be something you wish to consider...

<Lee> but how dangerous is it

<Dr. Simpson> well, it can be a problem, because if you don't have the nutrition that the child needs could have some serious problems, like spina bifida, so, if you need to -- have a lot of tests, and watch the nutrition-- it is critical.

<Lee> I have two young girls that I already have and would not want to risk myself they have no one but me

<Dr. Simpson> That is a very personal decision lee-- and whatever you decide is ok

<Lee> have you heard Dr's have patients consider abortions

<Lee> I do realize that the ultimate decision is mine but how do Dr.s feel about this

<Dr. Simpson> We are fine with it. Some are not, but we are fine. This is your choice, and it is a choice. There are those who say this is not, but most of us realize, it is a choice.

<Lee> thank you Dr. symposia

<**MODERATOR**> AJ YOU HAVE THE NEXT QUESTION:)

<AJ> which WLS is best for 60 and over females?

<Dr. Simpson> Lap band for 60 and over.

<AJ> What is the length of recover for the lap band? How soon can I return to work?

<Dr. Simpson> Lap band is fast. Probably return to work in a week.

<AJ> Thanks for the help.

<**MODERATOR**> SWEET AMY YOU HAVE THE NEXT QUESTION FOR DOCTOR SIMPSON PLEASE:)

<sweet_amy> i was wondering how much complications can cost if there are any, since i am self pay. And in lap band don't you tend to lose less weight? Thank u

<Dr. Simpson> Complications are a statistic, and if you have them, then it is bad. But you have to know that the lap band has the lowest incidence of serious complications of all the weight loss surgeries. But all the surgeries are safe, effective, and work rather well. So, make a good choice, find a surgeon you like, and go for it.

<sweet_amy> but you lose less with lap band?

<Dr. Simpson> You can lose with any of the surgeries, and less is not true...

<Dr. Simpson> You can lose less with DS, you can lose less with RNY, it is up to you more than the surgery... and there is no surgery which will allow you to eat what you want and lose weight-- doesn't work that way

<**MODERATOR**> ROBIN GA YOU HAVE THE NEXT QUESTION FOR OUR GUEST PLEASE:)

<Robin_GA> I am expecting my 1st consult in a couple of weeks what should I expect? I have already had to get psch. consult, gallbladder scan, blood work, and nutional consult before appointment with the surgeron what should I expect from this?

<Dr. Simpson> What can you expect from the surgeon? Well, the surgeon is the right hand of God, so you should bow and humble yourself. You need to get to know the person who will be operating on you, you need to decide if this individual is someone you can trust with your life. How many times he has done the surgery doesn't matter, it is your gut feeling about the surgeon....

<Robin_GA> I was wondering what you go over in your first visit

<Dr. Simpson> In your first visit you ask questions, you ask what he thinks of the surgery, and how he deals with patients ..You ask about aftercare, because aftercare is far more important than anything. and you get a guess of him and he of you - It is a commitment, and you have to feel comfortable with this individual..

<Dr. Simpson> He will ask about your health, and you will ask about him.

<Robin_GA> Ok Great I have researched this for about 5 months and I feel very good about my surgeon

<Dr. Simpson> Good -- that is great, but you have to meet them-- if he doesn't do it for you, or you don't like him/her then you need to move on...

<Dr. Simpson> Like Blind Date.

<Robin_GA> Great thanks and thank you for your time tonight

<**MODERATOR**> JESSIE YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON:)

<Jessie> Just starting - how does one go about picking a surgeon, even a surgery??? I read about adjustable lap band and like the idea of less invasive surgery---but is that a good enough reason to seek out that particular type of wls? how/where do I start? (I'm in Ohio if it helps or if you know of a good surgeon here!) :-)

<Dr. Simpson> Inamed, which makes the lap band, has a registry of surgeons who are approved to do their procedure. So if you want the lap band you should go to their site www.inamed.com and see. Then you have a surgeon that you can look up and see if you feel comfortable with them. If you don't there are other surgeons and other places...

<Jessie> so just pick one and try it on for size huh??

<Dr. Simpson> So, pick your surgeon, not your nose

<Jessie> great advice Dr. S.

<**MODERATOR**> JLGIRL YOU HAVE THE NEXT QUESTION:)

<jlrgirl> Can corrective surgery, such as repairing a fallen bladder, be done at the same time as lap band surgery?

<Dr. Simpson> No, Not at all. Shouldn't expect it to be

<jlrgirl> Why not?

<Dr. Simpson> Get the weight off, then work on the bladder. Two separate areas. It will be better to take care of the one later

<jlrgirl> Thanks

<**MODERATOR**> KATHLEEN G YOU HAVE THE NEXT QUESTION PLEASE:)

<kathleen g> Dr. Simpson: Why do some WLS surgeons request some of their patients lose weight prior to surgery and others not? Is it a metabolic jump-start thing, behavior modification or something else? Thank you.

<Dr. Simpson> Some of us think it shows compliance...some think it helps reduce the size of the live...some need weight loss to make the laparoscopic instruments work better...and some think it is a good thing to do. Often, doesn't work as well as doing the surgery and watching the weight come off.

<kathleen g> Thank you.

<**MODERATOR**> SKYLAR YOU HAVE THE NEXT QUESTION FOR OUR GUEST PLEASE:)

<skylar> I am slightly under #100 pounds and doomed through genes to be overweight. Am I a good candidate

<Dr. Simpson> Skylar, you are doomed, you will need surgery and you will do great

<skylar> How do I convince a surgeon even though I am under #100 pounds over?

<Dr. Simpson> Check your BMI

<Dr. Simpson> What is that?

<Dr. Simpson> That is more important than the weight

<skylar> Thank you

<**MODERATOR**> BRANDE SMITH YOU HAVE THE NET QUESTION LEASE:)

<Brande Smith> Dr. Simpson, where is practice? I have a desk job, very little up & down. What is the estimated time off after open and lap? I went back to work 4 days after a hysterectomy. Would you think that the pain and recovery time is more or less?

<Dr. Simpson> Brande-- I practice in Arizona. The time off is about three weeks, no matter what...

<Dr. Simpson> Give yourself a chance to heal....

<Dr. Simpson> Recovery time is a bit more...

<Brande Smith> thanks good night

<**MODERATOR**> THERESAW YOU HAVE THE NEXT QUESTION PLEASE:)

<theresaw> i'm having the rny lap. I understood it to be the type of surgery where you would not gain a large amount of weight back ...because of the malabsorbtion and smaller stomach. is this true?

<Dr. Simpson> Well, theresaw--- good question. You can gain weight with a small pouch, but it is more difficult.The weight gain is more of what you eat, than what you don't eat and more of what you do than what type of surgery we offer. While some want to say this surgery is better - the bottom line is that once you have any of the major weight loss surgeries, if you eat a lot of junk, you will gain back the weight... But the great thing is this: You will feel full with less.

<theresaw> i thought junk was next to impossible to eat after surg

<Dr. Simpson> Only sixty percent dump, so many do not, and dumping is not related to weight loss

<theresaw> it's no quick fix, still have to work at it, but a good tool anyway!

<theresaw> i'm ready

<theresaw> thank you

<Dr. Simpson> The tool is better than what you have now . Surgery is a great tool, but you have to work it. Just like I get worked by my office staff.

<**MODERATOR**> JOAN B YOU HAVE THE NEXT QUESTION PLEASE:)

<JOAN B> I've noticed that a lot of folks have problems with stenosis and stricture. Why is that?

<Dr. Simpson> Some are just tight.Some have scarring, and about 11 percent of RNY patients have a stomal stenosis, which may need to be dilated by endoscopy and some even will have to have multiple attempts at it. It is just the way they heal.

<JOAN B> So nothing necessarily one can do to prevent it...

<JOAN B> Is it likely due to things they eat or how fast?

<Dr. Simpson> Nope

<Dr. Simpson> Wish there was

<Dr. Simpson> Good luck

<JOAN B> thanks!

<**MODERATOR**> DEBRA YOU HAVE THE NEXT QUESTION FOR DR. SIMPSON:)

<Debra> how about female and 51, which is the best surgery.Ive talked to surgeons who do the RNY AND THE STILASTIC BAND.WHAT IS YOUR FEELING ON THIS

<Dr. Simpson> My feeling is that the surgeon who you trust, who you like... that is the surgeon you should use, and they will do a good job, and that surgery will be best for you

<Dr. Simpson> So, you have to be comfortable with the surgeon. Simple as that.

<**MODERATOR**> AMY YOU HAVE THE NEXT QUESTION PLEASE:)

<amy> are certain surgeries best for certain weights? such as I'm at 380, what would be best for me, 5 ft., 3 inches..my bmi is 47.5

<Dr. Simpson> The best surgery is the one your surgeon does.

<Dr. Simpson> I suggest you gain about six inches in height, however.

<amy> lol, i wish, thank u doc

<**MODERATOR**> GRACE FAYETTEVILLE YOU HAVE THE NEXT QUESTION:)

<Grace Fayetteville> I had surgery on Monday (Lap RNY). I have not been hungry. Should I do the clear liquids anyway?

<Dr. Simpson> You should follow your surgeon's protocol. Lack of hunger is fine. You can live on liquids and vitamins for six months, so don't worry about the loss of appetite.

<Grace Fayetteville> Thank you.

<**MODERATOR**> LMICHELLE YOU HAVE THE NEXT QUESTION PLEASE:)

<lmichele> I had lap rny on Sept. 9, have lost 42 lbs, but have this overwhelming feeling that I am failing. I don't know why. I haven't done ANY of the "wrong" things. Just feel this way. Does this feeling pass with time? Thank you.

<Dr. Simpson> Failing is a normal thing, It is because so often you failed diets, but you didn't the diets failed you. So don't worry, you have a great weight loss and that is a wonderful thing... 42 lbs since Sept is wonderful, and I am clapping for you clap clap clap .

<lmichele> thanks, but this is normal then?

<Dr. Simpson> Anyway, fear of failure is common, so I want you to not worry, just keep working, start walking, and drink water.

<Dr. Simpson> Protein, water, walk

<Dr. Simpson> Protein, water, walk

<lmichele> thanks!

<Dr. Simpson> You are more than welcome . Ok, now to everyone, Hey - put that down I said no candy.

<**MODERATOR**> KATHLEEN G YOU HAVE THE NEXT QUESTION PLEASE:)

<kathleen g> Dr. Simpson: Is it possible to slip into an anorexic mind-set after post-surgical losing has abated? Thank you.

<Dr. Simpson> DO you want to slip into an anorexic mind set?

<kathleen g> no

<Dr. Simpson> Anything is possible, but it is unlikely.

<kathleen g> Thank you.

<Dr. Simpson> So, I would suggest you just keep working the program --low carbs, protein, walk a lot, exercise, and have some fun with your new shopping

<kathleen g> Thanks

<Dr. Simpson> Avoid a lot of alcohol, donuts, pasta, bread, candy, and so forth

<Dr. Simpson> Eat well, and plan your meals

<Dr. Simpson> Chew your food

<Dr. Simpson> Floss your teeth

<Dr. Simpson> Walk my dog

<kathleen g> And read your book

<Dr. Simpson> I don't care if you read the book, just buy a bunch of copies and send it to a lot of people

<**MODERATOR**> AMY YOU HAVE THE NEXT QUESTION

<amy> what are good snacks between meals that are heathy? some in chat said they get bored with same things all the time?

<Dr. Simpson> There is a whole range of snacks to choose from: start with cheese, and there are a bunch of these cheeses. There are protein bars-- although most taste horrid, and there are other things, Take some salami, nuke it for a while, and they make chips. There are soy chips in some supermarkets. Some fruits make good snacks, the key is to plan snacks, and to plan meals and not to skip meals. The key is to not think of peanut M and M's just peanuts

<amy> smile ty Dr. S

<**MODERATOR**> DEBRA YOU HAVE THE NEXT QUESTION PLEASE:)

<Debra> Is there a way to keep from getting so much excess skin after your weight loss.

<Dr. Simpson> Exercise, exercise, exercise. Many individuals think that if they just lose weight that will be enough. But exercise will help a lot. Some times you need the knife to get rid of excess skin. But the more you work out, the less excess you will have. Or you could look like a prune

<Debra> thanks

<**MODERATOR**> CHUCK YOU HAVE THE NEXT QUESTION:)

<Chuck> thanks. I would appreciate your opinion about the pros and cons of RNY vs. BPD/DS.

<Chuck> I am super obese

<Dr. Simpson> Well, I am not super surgeon ----

<Chuck> 435 pounds at 5'8"

<Chuck> Bmi of 66

<Dr. Simpson> but the DS works well for patients who have a BMI over 50. It provides a lot of benefits that the RNY does not-- for example, a distal bypass, however you can lose weight with any of the surgeries which are offered, but the DS is a great surgery for your category.

<Chuck> are you concerned about malabsorption with the DS?

<Dr. Simpson> No, you can malabsorb a little and not have a problem, you do need to be religious about taking vitamins and calcium after DS, just like after RNY. Hey-- with a BMI of 66 malabsorption shouldn't be the issue. The issue should be getting that under control

<Chuck> what about loose stools and foul gas with the DS?

<Chuck> is that really a big problem?

<Dr. Simpson> Well, none of my patients seem to want to trade whatever those bathroom issues are with obesity...

<Chuck> thank you Dr.

<Dr. Simpson> The malodor can be managed with Devrom and avoidance of certain foods. The loose stools are a function of non absorbed fat, so work on a lower fat content to foods.

<Chuck> understand

<**MODERATOR**> WITCHES BREW YOU HAVE THE LAST QUESTION FOR DR. SIMPSON TONIGHT PLEASE:)

<witches brew> Dr., do you have any ideas on why my skin seems to be "tearing"? My wls was in June '03 and lately it seems to be very thin, and Im getting these little cuts on my hands etc...some in chat are experiencing the same thing, any thoughts on this? Appreciate your time, thanks!!

<Dr. Simpson> Well, hard to say, but I would suggest that you have some lab work done to see your vitamin levels and a few other things....

<witches brew> okay

<Dr. Simpson> Sometimes it is that, sometimes it is just your body getting use to less of you....

<Dr. Simpson> You can download the tests from my website .

<Dr. Simpson> Good luck

<Dr. Simpson> Happy Halloween everyone

<witches brew> Thanks!!

<Dr. Simpson> Don't eat the candy

<**MODERATOR**> DR. SIMPSON, IT HAS BEEN A PLEASURE HAVING YOU HERE TONIGHT AS USUAL! THANK YOU SO MUCH FOR JOINING US! AND HAPPY HALLOWEEN TO YOU ALL!

<**MODERATOR**> THANK YOU TO ALL OUR WONDERFUL MEMBERS TOO!

<Dr. Simpson> Good night all

<**MODERATOR**> GOODNIGHT EVERYONE!

<Dr. Simpson> www.drsimpson.com

<Dr. Simpson> www.doctorsimpson.com