December 3 , 2004

<Moderator> Welcome to tonight's chat with Dr Terry Simpson. Chat starts at 4pm PST / 7pm EST. Please type in your questions and hit enter. I will see them and show them to Dr Simpson in the order I receive them at the time of chat. Thank you!

<Shannon> I have a 2 yr old son who is 23.5 lbs. I am having Open Gastric Bypass surgery on 12/27/04. How long until I will be able to pick him up and return to my normal physical activity?

<Dr. Simpson> Well you will be picking him up a long time from now....for usual surgery we say six weeks before picking up something more than ten pounds...But with weight loss surgery, we even consider longer, as you go through a period of malnutrition, so you do not heal as well as you should. Some surgeons wait six months and some a year. You will be able to walk, and do many other things-- but the last thing you want is a hernia because they are not fun for patients. And just when you think you are feeling good, and pickup or do something you shouldn't you get a tear in the fascia (or gristle) and develop a hernia. SO be careful, and good luck

<Robin> I had rny 4 mos ago and am at about a 95% excess weight loss now. Will this slow down soon?

<Dr. Simpson> Will the weight loss slow-- of course it will. It will slow down because your requirements for a smaller weight will do that, and your capacity to eat will be increasing. But hopefully you will do the things that successful patients do...nicely outlined in the new book -- which is the following: make good healthy food choices, take your vitamins, eat three meals a day, and exercise. Good luck. Walk.

<Dr. Simpson> Hang on. Ok. sorry, that was my publisher-- we just published a second book called "Getting to Goal and Staying There: Lessons Learned From Successful Patients".

<Moderator> Super!

<Bambi> Is DS generally better for acid reflux and hiatal hernia than other surgeries?

<Dr. Simpson> Hiatal hernias, as a cause of reflux are a separate problem from reflux being caused by being overweight. In terms of which surgery is best for reflux, it would be an anti-reflux surgery, which may be done at the time of ANY given surgery. I recently placed a lap band on a patient with reflux, which cured it-- we also fixed the hiatal hernia...all of them will work. Go with a surgeon you like, and the surgery they do. Good luck

<carolyn> Hello Dr I was wondering if the pouch immediately after surgery is capable of holding large pills especially the ones that cant be crushed or cut in half?

<Dr. Simpson> It can hold large pills-- that isn't the problem. The problem is will those pills go through the pouch into the rest of the body.
All pills can be formulated to be crushed except time released, which should be changed to a non time-released formula, which will be better for you after this surgery. Good luck.

<Susan> when does one stop losing weight?

<Dr. Simpson> As soon as the calories in equal the calories burned. That is up to the patient. Simple, true, and stark. You can get to goal
to a BMI between twenty and 25 -- but you will need to do some of the work...and wait for my next book -- or get our workbook.

<Jake> I am throwing up almost everytime i eat. Not everytime..but most of the time. I am eating with a baby spoon and VERY conscience of my bites. Coudl this be a stricture? And if not, what else could it be?

<Dr. Simpson> Vomiting is NOT normal-- not not not not not not not not not. I am tied up in nots. It could be a stricture-- you need to see a GI doctor and get that evaluated - ASAP. Until then-- liquids only-- get your nutrition that way. DO NOT VOMIT. Vomit is bad. Trust me. I had vomiting -- yuk. Besides, it is bad for you.

<David> Is it true that the less weight that you need to lose, the less chance of dying?

<Dr. Simpson> No, it is not true. The more weight you have on, the closer you are to death.

<Lisa> I'm 5'6 250 lbs with no co-morbities. I'm having surgery in jan, what are the chances that i will have complications?

<Dr. Simpson> Well, for an individual, that is tricky. Healthy, normal, young people can have complications in the best of hands and when we are talking about one person, statistics break down. But there are things you can do to help yourself between now and then...First- start a walking program-- if you have clearance by your doctor...Second, start eating well-- good quality food, not junk...Third, start taking some vitamins NOW -- to get in as a good a nutritional shape as you can...Finally, if you are smoking-- STOP-- don't smoke-- unless it is after sex. Get in good shape, then after surgery walk walk and walk and walk.....Walk so much that the nurses complain you are wearing a hole in the tile. Walking and walking is the best thing you can do. You will heal faster, breathe better, and you will like life. Good luck

<Terry> Is there any age limit to having surgery?

<Dr. Simpson> Yes. I don't operate on fat babies

<carolyn> Hello Is there any way to prevent pulmonary enbolisms during or after surgery? and why do they form?

<Dr. Simpson> 16 to 70 is common for many. Walk, walk, walk, walk, walk, walk, walk. The doctors will do the rest. We have things we do, but what you can do is walk. They form because of inactivity...they form during surgery...they form when you cannot walk enough. So walk and walk some more, no matter how much it hurts, because if you are dead you can rest then.

<jeana> Dr. what are your thoughts on lapbanding after RNY and stretched pouch?

<Dr. Simpson> Great idea-- but first I want the patient to demonstrate that they have learned something...that is, sometimes people think they can do whatever they want and the surgery will take care of it...They cannot. I like putting lap bands on old surgeries.

<wendy> Kristin asked this question on the Cal MB today: How does alcohol affect the body after WLS?

<Dr. Simpson> Kristin also asked that question on my message board. First of all, alcohol is a source of calories that is completely absorbed with ALL weight loss surgeries-- we cannot prevent that absorption. Second, alcohol has the same effect on the body of a weight loss patient as with a normal, except sometimes you absorb more. So-- limit alcohol to an occasional drink, not a nightly event.

<Doris Griffith,In.> Dear Dr. Simpson I'm going to have surgery on Dec. 17 I take many medication 21 every morning. How in the world will I ever get all these down every morning even if I can crush them?

<Dr. Simpson> Well, first check with your doctor and your pharmacist to get better or different medicines. And some medicines you will not have to take after surgery. Some medicines can be changed to where they can be crushed, or given in liquid form.You need to check with your surgeon and regarding the type of surgery they are doing and what they can do with the pills you take. Good luck.

<Soon2BeTinySantaElf> I am pre-op and not on birth control. I want to have the depo shot. Should I wait until after surgery, or can I get it now? I don't have a date yet, just sent in for ins approval.

<Dr. Simpson> Well, I am not a gynecologist--- and they know a lot more about birth control than I do....I know what causes babies-- at least I have an idea...and I think that after surgery, you need some form of birth control because we do not want pregnancy in the first two years. So-- either stop having sex, or get some good birth control. I tell my patients to not have sex for 17 years after surgery. Wonder why they don't comply?

<Lana> As a post op, should we eat low carb, or low fat?

<Dr. Simpson> Good question. Low carb is silly as a diet (see my book). Low fat isn't bad- but....you need to eat a balanced diet, not some weird idea put across by a now dead cardioogist. Balance. Avoid processed foods, avoid white flour, white sugar, and starches. Eat a healthy blend of good food-- it is better for you, and you will find some very good choices. McDonald's, alcohol, fast food are not good choices. Balance-- my next book-- which I am writing now-- addresses these things in some detail. But alas, you probably wanted the answer now.

<Florence> what types of surgery do you preform? And where are you located?

<Dr. Simpson> I am in Arizona, and do not take out of state patients---have been doing surgery since 1991-- have done a lot of RNY, duodenal switch, and lap band. These days I am doing a lot of lap band.

<DebbieDo> Hello Dr Simpson! Do you think it is necessary to undergo the intense psychiatric evaluation prior to the surgery?

<Dr. Simpson> Interesting question, and the answer is complex: When the guidelines were put in place in 1991 they did not intend for a simple single psych evaluation of a patient. Remember, it is psychiatry not parapsychology...no one, in spite of a lot of studies, has been able to tell who would do well or do poorly with the surgery. But what a psychiatrist or psychologist can do is be a bridge for when you are post op and as things change. You will have a relationship with someone who has seen you before and after and can treat you and help you deal with whatever changes come, whether those be simple head battles in your life, or depression, or trying to replace food as a method to cope in your world. While I have seen a lot of psych evaluations-- never have I seen one that predicts how someone will do that is accurate. So look at the evaluation as a process--- a part or adjuvant treatment in the weight loss journey.

<Kevin> I've heard of a few people who said that after their surgery their inrestines got 'jumbled up' and they had to go back in under Emergency situation to fix that problem. What exactly is that and about when can it occur after the surgery?

<Dr. Simpson> Some patients develop bowel obstruction, which can occur after any abdominal surgery. Anytime someone has had any type of surgery they develop scar tissue, and scar tissue in the abdomen is called "adhesions." Those adhesions can cause problems, like blockages in the intestine, which need to be taken care of surgically.

<Linda B> Hello. I got approved for Gastric Bypass today. But my BMI is 35.7. I really wanted lapband because it can be adjusted. How dangerous is gastric bypass?

<Dr. Simpson> As with any surgery, there are risks, and rewards. You have to balance them. If you wanted one surgery, then go for it...
it is your body, not the insurance company-- if that means saving pennies, then do that. You have one good shot at this-- get it done how you want it done-- like burger king-- have it your way.

<wendy> Hello, Dr. Simpson. I love your book and can't wait for your new one! Question> A person suffering from documented and diagnosed benign PVCs - is this surgery safe for them?

<Dr. Simpson> First, they need to be evaluated by a cardiologist, who will determine how safe they are and help the anesthesiologist with any questions if there are problems with the heart during surgery. But, yes, it is perfectly safe if your heart keeps beating. It is when the heart stops that we have problems---a lot less blood loss, though, so - go for surgery.

<Kevin> Can your book be found in Barnes and Noble?

<Dr. Simpson> Don't know if it is there yet-- it is at amazon.com-- but the best place is my website...www.obesitydr.com as they have both the original book, and the new workbook, which is not out in popular press yet. You get the latest and greatest. By the way -- our pre production run of those books sold out quickly, which is why I talked to the publisher about a new run, before our first edition comes out---
so, go to www.obesitydr.com. We anticipate it in major bookstores in a year. We are going through the "pre production" phase, where they do market testing and all that. Me, I just write em.

<michelann> what are the death statistics currently? still 1 in 200?

<Dr. Simpson> For RNY, VBG, and DS the rate is between one in fifty and one in two hundred -- for the lap band the rate is between one in two thousand to one in ten thousand.

<Judy-140@11months> I have lost 140 pounds in 11 months...still have about 75 to go...working out like crazy...getting protein and water in...coming off very slowly...any suggestions?

<Dr. Simpson> Good weight loss, and sometimes as you replace fat with muscle, weight loss slows. Here are a few simple things: Count calories-- they all count, I don't care if they come from fat, protein, carbohdyrates, or alcohol....Next, find some way to get a measurement of your body fat -- some physicians have the body analyzers in their office...See what your portions are...Finally-- determine your basal metabolic rate, and if you can comfortably eat below that you will continue to lose weight. Be patient-- comes off slower in the end. Set your goal, and go for it.

<Shannon> What is the main cause of patients getting blood clots?

<Dr. Simpson> There are a number of reasons, but the main thing a patient can do is walk-- there is no shortcut here. Doctors will give you all the great stuff to thin your blood, and other devices for your legs-- but blood clots happen during surgery and in the immediate post operative period. The more you walk, the less likely it is that you will have a problem with them.

<jamie> what is it about walking besides burning calories?

<Dr. Simpson> What about walking????? What about walking?????? Should I ask again? Simple: If you walk you increase blood flow, decrease the chance of clots, your guts work better, you get off the narcotics faster, and in terms of longer post op the successful patients all have a form of exercise above and beyond whatever they do for a job. Walking is easy, quick, you can measure it, you don't need some special machine...and I get a hundred bucks for every mile you do.

<Becky> Hi Dr. I am 3 1/2 years out from an open RNY, I alternate between walking 3 miles briskly and running 4 miles. I am just about at goal and I feel great. My question is...will I always have to supplement my protien? I will admit I am not a very good meat eater at all.

<Dr. Simpson> You need to get in your protein, you need it you need it you need it. So check out what you are eating, and see the protein table in my first book or in my workbook...or sign up for my free newsletter, it should be in there somewhere. You have to know what you are eating-- you have to have an idea of what you are eating and how much protein you are getting in. Great weight loss, great attitude, I think you will make it to goal, and I am proud of you. But those shakes are about as fun to drink as liquid sawdust. Now I have some wonderful people I have met who are post op and love shakes and attribute their good health to them, and I have even put patients on protein supplemental shakes. But you can get all the protein you want through diet--- and we have made it easy in our workbook, and in my first book-- all the work is done, recipes, menu plans, and so forth. But-- not trying to sell more than a million copies. You need to know what you are putting into your body-- it is your mouth-- measure it, find out what it contains and determine if you need more protein or not. I need some protein tonight...I am thinking about finding some nice roadkill.

<Debra Nipper> My ? is about the possibility of having surgery if you have had the Lap Nissen Fundoplication done. I had it done for gerd and also had a hernia repaired.

<Dr. Simpson> You can have the surgery-- it will take a talented bariatric surgeon-- but it should not be a problem at all. Good luck.

<LIZZIE> WHEN WILL I BE ABLE TO EXERCISE AFTER MY SURGERY?

<Dr. Simpson> You can start walking from the recovery room-- walk to your room, don't let them push you in that gurney-- in fact, push the gurney. Don't take the elevator, push the gurney up the stairs-- well, maybe not that radical. You can walk, run right away -- swim in a few weeks, and check with your surgeon about weights. Walking will do you just fine. Great question-- good luck.

<carolyn> what causes a patient to wake up with a tube down their throat?

<Dr. Simpson> Alarm went off too early. They all wake up with a tube in their throat-- whether they remember it is a function of the agents that the anesthesiologists gives the patient.

<garyo> can you drink water when eating?? or is it detrimental?

<Dr. Simpson> If you drink water when you eat, you can force food down the pouch, and that can cause you to feel hungry sooner. If you have a duodenal switch, this is not a problem or an issue, other than you cannot eat as much. But you need to drink- you should eat about 20 minutes three times a day-- that leaves 23 hours to drink water, unless of course, you wait an hour after you eat, which leaves 20 hours, then six hours to sleep, that leaves 14 hours---seems you can get enough water in in 14 hours-- unless of course you are a fish, but that is another story.

<susan> i am 18 months post op and still get a pain in my chest, where the pouch is, at times when beginning to eat. Why is that?

<Dr. Simpson> Sometimes the pouch gets a bit mad at us-- sometimes it needs to have a bit of warm water in it first to make it ready... sometimes it needs some antiacid medication...sometimes it just needs love.

<Doris Griffith,In.> Dr. will your books be offered in the store of Obesity Help

<Dr. Simpson> Yes, they are-- they have the first book, they don't have the second book yet-- only special guests get that one. They will get the second one in a bit, once they order some.

<Damaris> Is it possible that bariatric surgery will "cure" my benign intracranial hypertension?

<Dr. Simpson> Well, that is a great question. There are some forms of BIH that are fixed with weight loss, and the only way to know is to lose the weight-- and see. Many patients have done quite well with pseudotumore cerebrii after surgery...So, get the surgery, lose the weight-- then get a haircut.

<Linda B> WHY do some insurance companies not pay for Lapband they consider it experimental but will pay for RNY.

<Dr. Simpson> Because they are mean. They are in it for making money, not for your health. Make no mistake about it.

<Linda B> Have your patients had more success with RNY or Lapband

<Dr. Simpson> They have had success with all of them. So worry not about that.

<Jill> I am out 9 months and have lost 130 pounds. I started at 410 and want to get to 150. Is that achieveable? I used to be a athlete years ago. And can any exercise hurt your pouch?

<Dr. Simpson> It can be done. Exercise will not hurt your pouch-- exercise will make your pouch happy -- it will do the happy pouch dance, and you will feel good in your new thin body.

<susan> Some suggest cancer rates increase after wt loss surgery. Any truth to that?

<Dr. Simpson> Never saw that before, never heard that before. Sounds like an urban myth. There is an increased lead poisoning after weight loss surgery--- from the gun of jealous lovers.

<Donna Nehring> I am 2 weeks post gastric by pass and have been doing fine and this morning I started seeping from my incision, is this normal

<Dr. Simpson> No, not at all. Your surgeon would want to know about that.

<V.J.> Why is it that some docs require extensive pre-op testing before RNY & others don't? Should I avoid a surgeon that doesn't require lots of pre-op tests?

<Dr. Simpson> Pre op tests are not insurance, nor do they say anything about the surgeon. Some do select tests, some do not...Some test everything, some test as is needed--- so go to a surgeon who you like, get along with, and has a good reputation.

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

<Lisa> How important is a sleep study proir to surgery?

<Dr. Simpson> If you have sleep apnea, or undiagnosed sleep apnea -- it is critical.

<Dr. Simpson> Thank you everyone for a wonderful way to spend a Friday afternoon.

<Moderator> Thank you Dr Simpson and members. For more information on Dr Simpson and his practice please go to www.drsimpson.com or call 602-234-8995. Have a great weekend. Members, join us next week for another Simpson Chat.

<Dr. Simpson> Check out the websites: www.drsimpson.com and www.obesitydr.com. Thank you and good night.