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<**MODERATOR**> MISS SCARLETT YOU HAVE THE FIRST QUESTION
FOR OUR GUEST TONIGHT:)
<Miss Scarlett> Hi! Thanks so much for joining us again! I'm having
my first glass of Montrachet in 15 weeks - how appropriate that you would
be here! My surgeon doesn't specify how much protein I need to take in
each day. Can you help? And why does an increase in protein seem to help
WLS'ers lose?
<Dr. Simpson> First of all, you need to send
me the Montrachet
<Dr. Simpson> you should not be drinking that--
I like the 1998, but whatever you have, send it to me.
<Miss Scarlett> Ooooh, sorry.....no can do. =)
<Dr. Simpson> The reason that an increase
in protein works is that instead of eating the carbohydrates, you have
the protein
<Dr. Simpson> and if you have a long limb,
or a DS....
<Dr. Simpson> you need the extra protein in
order to absorb enough protein....
<Dr. Simpson> so-- if you have a routine RNY
then we suggest 40 grams of protein a day...
<Dr. Simpson> for DS anywhere from 70 on up,
depending on whether you are macho or not.
<Miss Scarlett> ok. How
much can we absorb at one time?
<Dr. Simpson> still, send me the montrachet--
<Dr. Simpson> well, it isn't how much you
can absorb, it is that you might have a limited amount...
<Dr. Simpson> which you can absorb, and through
a limited amount of small bowel, therefore,....
<Miss Scarlett> Sorry, I don't understand.
<Miss Scarlett> Oh....
<Dr. Simpson> well-- if you have a duodenal
switch, you only have about 100 cm of small bowel to absorb protein...
Dr. Simpson> so, you need to have a lot of protein
on the surface of that small bowel, so it can absorb an adequate amount...
<Miss Scarlett> OK
<Dr. Simpson> the normal small bowel is about
600 cm long, so you can have a lot less protein and not get deficient...
<Miss Scarlett> so if I get 45 in my morning shake, I'm OK for
the day?
<Dr. Simpson> but having a shorter amount
of small bowel to absorb it, means that you will need to...
<Dr. Simpson> eat more protein. well -- I
don't like protein in shakes as much as I do in food. I think food is
a better source
<Miss Scarlett> OK
<Dr. Simpson> of protein, it is more "bioavailable"
it tastes better, and it costs less...
<Dr. Simpson> and it gets you use to counting
protein and carbohydrates in food.
<Dr. Simpson> which is a good thing to become
aware of. So you know what you eat, and why you might plateau.
<Dr. Simpson> good luck.
<Miss Scarlett> TY!!
<**MODERATOR**> STEPHIAZ YOU HAVE THE NEXT QUESTION:)
<StephiAZ~16wks/-80> Hi Doc. My hair loss has started to come on
strong. Any suggestions? :-) By the way just hit 80 down today.
<Dr. Simpson> I thought I saw your hair in
my office the other day -= so it isn't lost....
<StephiAZ~16wks/-80> LOL You are so funny...
<Dr. Simpson> hair loss comes from a follicular
change at the time of surgery...
<Dr. Simpson> that is, your hair follicles
stop producing hair for a bit in response to stress....
<Dr. Simpson> now, you can exacerbate hair
loss if you don't take enough protein, or have a nutritional deficiency...
<Dr. Simpson> but, essentially the follicles
kick back in and in a month your hair will come back fuller and thicker
than before...
StephiAZ~16wks/-80> That will be nice
<Dr. Simpson> don't perm it during this time,
and don't color it=== so we will find your true hair color...
<StephiAZ~16wks/-80> OMG NOOOOOOO Just kidding
<Dr. Simpson> the other thing that works well
is super glue
<Dr. Simpson> it will keep the hair on. Or,
other things work-- remember the movie "Something about Mary.
<StephiAZ~16wks/-80> Ah yes the gel sceen
<Dr. Simpson> anyway-- there are a lot of
products which people swear by, which they say uses it. But they don't
work.
<**MODERATOR**> SUN2SHINE YOU HAVE THE NEXT QUESTION:)LOL
<Sun2Shine-100> DR SIMPSON, I GET MUSCLE SPASMS IN MY STOMACH,
IS THERE A REASON, OR IS IT BECAUSE OF LOOSE SKIN BECAUSE OF LOSING 100
LBS?
<Dr. Simpson> Muscle spasm- generally are
from a lack of use of the muscle, not from the skin loss....
<Dr. Simpson> so, it is best to stretch them
out a bit, unlike how they were stretched before, where your insides stretched
them...
<Dr. Simpson> although some of my patients
think that I am due to deliver any day now....
<Sun2Shine-100> I also had hernia repair, any connection?
<Dr. Simpson> they will spasm less if they
are used. So begin some light abdominal workouts. Hernia repairs...
<Dr. Simpson> can cause some spasms, because
they tighten things up tighter than an Jersey wallet.
<Dr. Simpson> good luck.
<Sun2Shine-100> thank you
<**MODERATOR**> JODI YOU HAVE THE NEXT QUESTION:)
<Jodi> I am scheduled for open RNY on 12/17. I was told I have
to give myself injections to thin my blood, 1 per day for 10 days. Is
there another form of meds I can take in place of injections?
<Dr. Simpson> Not really -- Jodi, the main
cause of death is from pulmonary embolus,...
<Jodi> Thanks....
<Dr. Simpson> which is a blood clot which
starts in the leg or pelvis and travels to the lungs....
<Jodi> but walking helps with that right
<Dr. Simpson> we have oral blood thinners,
but the problem that they have is they last for about 48 hours or more...
<Dr. Simpson> so the injections are a good
thing. Walking is the best. Walk, and walk some more.
<Dr. Simpson> then walk even more-- .
<Jodi> thanks...
<Jodi> Thanks for your help!
<Dr. Simpson> you are welcome-- and keep walking.
<**MODERATOR**> DEBBINOHIO YOU HAVE THE NEXT QUESTION:)
<DebbiNohio 1 month P> hi, I am one month po and my surgeon is
worried that I don't feel full at all on anything, and I have not lost
any weight in the last two weeks, does this sound like a staple line disruption
to you? He has ordered an upper gi test next week.
<Dr. Simpson> Well, Debbie== that is something
we always worry about....
<Dr. Simpson> and an upper GI test is something
which is easy to do....
<Dr. Simpson> so, I think it is a wise thing
to order. So, good luck.
<DebbiNohio 1 month P> could it be something else?
<Dr. Simpson> Sure, it could be that your
feeling of satiety, or feeling full....
<Dr. Simpson> doesn't happen right away, and
you need to wait a few minutes to feel that...
<DebbiNohio 1 month P> so eat slowly?
<Dr. Simpson> or it could be that you need
to start the supermodel diet, where you eat something then go to the bathroom
and purge yourself
<Dr. Simpson> just kidding....
<DebbiNohio 1 month P> oh great, lol
<Dr. Simpson> YES-- eat slowly, enjoy your
food...
<Dr. Simpson> enjoy your company...
<DebbiNohio 1 month P> OK, I won't try to worry too much, glad
he is testing me
<Dr. Simpson> walk after eating. And stay
away from people who want to feed you carbohydrates...
<Dr. Simpson> those people are evil. Be glad
he wants to test you. Always send your surgeon Christmas presents...
<Dr. Simpson> it is a good thing to do. Good
luck.
<**MODERATOR**> LUCY YOU HAVE THE NEXT QUESTION:)
<Lucy> I used to have really great skin due to taking fish oil
supplements...with an rny...will they be absorbed?
<Dr. Simpson> Depends on where you put the
fish oil......
<Lucy> I will go buy the docs office a present tomorrow
<Dr. Simpson> yes, the fish oil will be absorbed
if you take them orally, especially if you have had a proximal bypass....
<Dr. Simpson> if you had a distal one, you
might need to double the dose for a year or so...
<Lucy> OK great..I will stay wrinkle free
<Dr. Simpson> so, if you take fish oil do
you have scaley skin?
Dr. Simpson> all these questions.
<Lucy> thank you
<Dr. Simpson> oh, I need to pm the moderator
for those. Sorry === being from Alaska,
we love fish oil, we use it a lot, along with seal oil...
<Lucy> I am off to rollerblade
<**MODERATOR**> GINA TX YOU HAVE THE NEXT QUESTION:)
<Gina (Tx -116#)> How common are post op abdominal hernias and
do they usually require repair before you get to goal wt?My PCP said today
the bowel is involved and wants to send me for a surgical referral. I'd
rather wait until TT time
<Dr. Simpson> to make some good ice cream.
<Dr. Simpson> Gina, abdominal hernias occur
in about 15 per cent of the patients. So it is fairly common no matter
how your procedure was done....
<Gina (TX -116#)> It didn't come out until about 6 weeks ago
<Dr. Simpson> if you have bowel stuck in the
hernia it can create a problem. Last Friday night I was in the hospital
operating...
<Dr. Simpson> on a fellow who had an acute
hernia with bowel stuck in it, and the bowel ruptured...
<Dr. Simpson> so that is how I spent my Thanksgiving
weekend. So, get it repaired, you don't want to wait too much on those...
<Dr. Simpson> although I like doing bowel
surgery, patients would rather not have it.
<Dr. Simpson> good luck;
<Dr. Simpson> walk
<Dr. Simpson> walk more
<Gina (TX -116#)> Yuck--ok--ok--I'll go for the referral--TY--always
enjoy talking to you
<**MODERATOR**> CATHY YOU HAVE THE NEXT QUESTION:)
<Dr. Simpson> fish oil, protein, water, and
walk.
<Dr. Simpson> I still want whoever had the
Montrachet to send me some.
<**MODERATOR**> LOUISE YOU HAVE THE NEXT QUESTION:)
<Louise> Dr. I had bad burning pain at the top of my incision,
no fever, no redness, no swelling , 6 weeks post-op open RNY do you have
a clue of what this pain could be?
<Dr. Simpson> It could be from a number of
things. It could be a minor disruption in the incision deep inside, and
...
<Dr. Simpson> may become a hernia, it could
be some nerve which was cut on the way through the skin which is now healing....
<Dr. Simpson> it could be that you were ironing
clothes the other day, and you burned yourself...
<Louise> thank you Dr.
<Dr. Simpson> keep an eye on it== and if you
get a bulge, see your surgeon. Probably just healing nerve tissue.
<Dr. Simpson> good luck
<Louise> follow up with him on tuesday thank you
<**MODERATOR**> BRIAN IN OHIO
YOU HAVE THE NEXT QUESTION:)
<Brian In Ohio> yes
<Dr. Simpson> Brian-- do you have a question?
<Brian In Ohio> Yes
<Dr. Simpson> you can ask, this is your chance,
where I can impart wisdom...
<Dr. Simpson> if you can get it through all
the other stuff I impart...
<Dr. Simpson> to which my closest friends
say I should use more Devrom.
<Brian In Ohio> Will this surgery cure my apnea
<Dr. Simpson> ah-- well, it certainly will
improve sleep apnea, and in many cases it will improve the apnea....
<Dr. Simpson> it will also improve apathy,
but that is another problem....
<Dr. Simpson> so, it is considered by many,
a cure for sleep apnea, although some skinny people get apnea also. Good
luck.
<Brian In Ohio> dowill I have to take my machine to the hospital?
<Dr. Simpson> Take your machine to the hospital,
or at least your settings for them. Now about your pace problem....
<**MODERATOR**> PEGELLA YOU HAVE THE NEXT QUESTION:)
<Pegella> I am still 2 months pre-op (RNY) and I want to pace myself.
My BMI is almost 50; I have recently lost 23 pounds but plateaued in the
last month or so. My concern is about pacing myself. I don't want to be
so fed up with dieting by the time my surgery comes that all I want to
do is eat! (My pattern is to diet for a few months, lose 20-30 pounds,
then begain.) Advice?
<Dr. Simpson> the diet roller coaster is something
which you will never be off of. There is no cure for that four letter
word....
<Dr. Simpson> including bariatric surgery.
What surgery will do is give you a tool to make dieting a lot easier....
<Dr. Simpson> and in the short run you will
lose a lot of weight....
<Dr. Simpson> but you will have to learn to
eat smaller portions, because your stomach will be smaller....
<Dr. Simpson> and you will have to learn about
what foods are best for you to eat....
<Dr. Simpson> but you will always fight obesity,
but you will have a fighting chance. Good question -- continue to work
yourself.
<Dr. Simpson> and best of all--- have fun.
<Pegella> I'll certainly try. Thanks, doc!
<**MODERATOR**> CAROL YOU HAVE THE NEXT QUESTION:)
<Carol> My surgeon has recommended that I take a Protein supplement
for the first 6 mos. I have tried many and can not seem to tolerate any
of them. I would like to know your recommendation for foods that a three
week post op could handle to get the recommended protein? I had open RNY
PS you are quite a cut-up aren't you? lol
<Dr. Simpson> I cut up for a living....
<Dr. Simpson> I hate protein supplements as
a rule, of course, I don't like the taste of sawdust....
<Dr. Simpson> for the first three weeks here
are some proteins: low fat cottage cheese, egg whites (egg beaters)....
<Dr. Simpson> tuna fish, shrimp, soy protein
products like Bocca burgers or morning star products...
<Dr. Simpson> cheese, and yogurt. Also peanut
butter is a good snack, as well as some deli meats...
<Dr. Simpson> get a good book which has protein
counters in it so you can measure what you are eating and see the content
of them...
<Dr. Simpson> good luck. When my cookbook
comes out, we will have lots of recipes for you to try...
<Carol> Thanks Doc
<Dr. Simpson> in fact one of my editors is
looking up protein content this weekend for the recipes...
<Dr. Simpson> if I can ever get her to work,
but you know, hard to find good employees .
<**MODERATOR**> CRYSTAL YOU HAVE THE NEXT QUESTION:)
<Crystal> I am 2 years
post op and am wondering about long term lab needs to monitor potential
problems from malabsorption...... several longer term friends (3-5 yrs
post) who achieved goal and are very compliant in diet and vitamin regimens
are showing up with low calcium, iron, and protein levels anyway .....
I am also compliant and careful about diet, vitamins, exercise and water
but now it has me concerned....... Any suggestions?
<Dr. Simpson> There are a number of vitamins
which you should be checking in laboratory tests....
<Crystal> Dr. S...
maybe you dont pay her enough
<Dr. Simpson> you should check levels of the
fat soluble vitamins, which are ADEK---
<Crystal> oh sorry
thanks for answering
<Dr. Simpson> K is for blood clotting, and
if you find you bruise easy, by interrupting surgeons, you might need
more of that, and it can be checked with ...
<Dr. Simpson> a protein level. You can check
levels of vitamin A and D easily....
<Dr. Simpson> in addition you should have
levels of homocysteine drawn, to check folate levels, and finally you
should have...
<Dr. Simpson> calcium checked, B12 levels
checked, and a simple blood count. Protein content is a major problem,
<Crystal> what is homocysteine?
<Dr. Simpson> and if you are getting enough
protein and calcium then you will do well.
<Dr. Simpson> That is a marker of folate level
in the blood, it is also a marker for some forms of vascular disease...
<Dr. Simpson> so, it is a vitamin that you
will want to take if you want to live long to give your favorite surgeon
a hard time...
<Dr. Simpson> and, for the record-- I do pay
my editor well-- treated very well, I think-- although maybe I better
check and make sure...
<Dr. Simpson> good question, thanks. So, you
keeping the weight off after two years?
<Crystal> Yes
Dr. S... thanks and maybe you are OK
<**MODERATOR**> MELISSA NY YOU HAVE THE NEXT QUESTION:)
<MelissaNY> Hi, I would like to know why some people need revisions
and how do I know if I need one? I am 16 mos post and can eat quite a
bit and have gained several pounds and I am quite concerned! thanks!
<Dr. Simpson> A revision is needed if there
is a problem with the surgery, such that it doesn't do, or cannot do what
we want it to do....
<Dr. Simpson> for example, if you have a RNY
and the upper pouch is leaking into the lower pouch, so that you get full
easily....
<Dr. Simpson> or if you have a stricture such
that you have been dilated a lot and cannot eat enough to keep you going...
<Dr. Simpson> if you can eat a lot, you may
have stretched your pouch, and the best way to check that is to...
<Dr. Simpson> have an upper GI ordered and
see how large it is. Most people have a pouch which increases to about
ten ounces, which will not inhibit weight loss....
<MelissaNY> OK thank you very much Dr.!!!
<Dr. Simpson> if you have stretched your pouch,
and there is no real problem with the surgery, then you probably don't
qualify for a revision....
<Dr. Simpson>
so, most notice an increase in food after a while, and that is normal....
<MelissaNY> DR. S. Then how can I continue to lose
<Dr. Simpson> what you want to do, however,
I'd watch your intake, decrease carbohydrates to less than 40 grams per
day....
<MelissaNY> I want to lose another 30
<Dr. Simpson> do not eat and drink at the
same time and above all....
<Dr. Simpson> WALK
<MelissaNY> yikes..walk the evil word...
<Dr. Simpson> 45 minutes per day--- fast,
not a saunter, like the Arizona drivers do....
<MelissaNY> lol thanks!
<Dr. Simpson> especially those who pull in
front of me....
<Dr. Simpson> walking is a holy experience.
<Dr. Simpson> so walk, and walk some more.
<MelissaNY> Thanks!
<MelissaNY> take care
<Dr. Simpson> Or, since you are in NY-- go
out and shovel a bunch of snow.
<Dr. Simpson> When you get to Atlantic city
you can stop.
<MelissaNY> YES I DID THAT lol
<**MODERATOR**> DEE FROM IOWA YOU HAVE THE NEXT QUESTION:)
<MelissaNY> thanks
<Dr. Simpson> Hi Dee Ho
<Dee from Iowa> Hello Dr. Simpson...from the great state of Iowa.......I
am 6mos post-op as of 12/11.....I have only lost about 70 lbs so far...the
problem is ...i fear that I have stretch out my pouch...is there a way
to tell? Also...right where the incision is....that part of my tummy seems
bloated all the time.....and the other part of the tummy makes noises
all the time...I feel like Im a mess....am I just losing my mind.....what
is leftof it anyway?
<Dr. Simpson> Well, Dee, I love the great
state of Iowa, spent a couple of years there, and that is a good weight
loss for six months.....
<Dr. Simpson> all the noises are common, although
you could be losing your mind also....
<Dee from Iowa> hahahaa..
<Dr. Simpson> fear of stretching is common
among people, and don't worry about that, just eat slowly and do not over
eat....
<Dee from Iowa> I just seem to be able to eat alot one time...and
not so much the next..
<Dr. Simpson> I suggest you go to Des Moines
and try out for the Drake Relays.
<Dee from Iowa> i dont think so..LOL
<Dr. Simpson> watch your portions, don't eat
and drink at the same time, limit carbohydrates to 40 grams per day, and
WALK. Good luck.
<Dr. Simpson> good luck, Dee.
<Dee from Iowa> thanks Dr...you are really a trememdous help.
<**MODERATOR**> SARAHB YOU HAVE THE NEXT QUESTION:)
<SarahB.> I had surgery in July of 2000. I have always since then
been able to eat anything. I never feel fullness. My surgeon in Richmond,
VA has only done a upper GI at one year postop and says everything is
fine. I have only lost problely like 40 pds since surgery. This was a
revision from a vbg done in 1985. I have talked and cried to my surgeon.
something has to be wrong. He now wants to do a more distal bypass bypass
even more intestines than the six ft he originally did. He tells me this
surgery does not work for everyone and this is what he would like to do
for me. He has of course told me the vital need for vitamin intake with
this extended distal surgery. I am extremely perplexed and discouraged
and frustrated that I have gone thru all this and can eat anything with
out feeling fullness like I should. Do you have any suggestions?
<Dr. Simpson> protein fills the pouch. The
other thing you want to know is how large the opening is between the pouch
and your intestine, if it is too wide, then things will fall through the
pouch into the intestine...
<Dr. Simpson> people who don't have stomachs
don't loose too much weight because everything goes through and they absorb
it all....
<SarahB.> okay, it seems to me that as soon as I eat something
I can really feel it going right to my intestines. Soon thereafter I get
lots of gas and diarhea
<Dr. Simpson> you might need the opening revised.
Or you might want a more distal. I do a lot of DS, and we bypass about
60 per cent of the intestine...
<Dr. Simpson> so, those are a few things you
need to know, and then we can go from there. Good luck.
<SarahB.> This is what my surgeon wants to do now.
<SarahB.> the need for vitamin intake is extremely vital./
<Dr. Simpson> DS is a good option for revision---
so that wouldn't be a bad thing. Vitamins are vital.
<SarahB.> thanks so much.
<**MODERATOR**> SAVANNAMN YOU HAVE THE NEXT QUESTION PLEASE:)
<Savanna MN> Dr Simpson...My Doc instructed me to stop all herbal
remedies (echinacea, ginseng, royal jelly, etc, etc) at least a month
before surgery (scheduled for Dec 30)...1.) Do you have any insight why
he would suggest this?? and 2.) When can I start them again?
<Dr. Simpson> Yes, because many of the herbal
remedies contain things which can cause excess bleeding during surgery...
<Dr. Simpson> or have other effects. We do
not know what is in all the herbs, and so it is difficult to know the
effect...
<Dr. Simpson> so, restart them, if you feel
you need to, about six weeks after surgery, when your diet is beginning
to be normalized...
<Dr. Simpson> I like green tea, so send me
some of that.
<Savanna MN> I do too..=)
<**MODERATOR**> LOUISE YOU HAVE THE NEXT QUESTION:)
<Louise> 6 weeks post-op, open RNY, 40 pounds lost, 59 years old,
am I on target, from 280 to 240 and worried to death of failing with this
one procedure
<Dr. Simpson> Louise that is the most common
fear that post op patients have. Because you are so use to the diet and
gain cycle....
<Dr. Simpson> you think that you will fail
this. And some people do. But, look at your scar, and as you go through
...
<Dr. Simpson> this, remember, you can fail
this, but you have a great tool, that you never had before...
<Dr. Simpson> so you can lose a lot of weight
quickly, and you should really work hard to get to goal as fast as you
can...
<Dr. Simpson> and not eat pecan pie (like
one of my favorite patients)....
<Dr. Simpson> then it will be easy to add
foods and see how they change your weight...
<Dr. Simpson> now you have a great tool, so
in a few years you need to lose a few pounds, well it is easy to do. Good
luck.
<**MODERATOR**> KAREN IN AL YOU HAVE THE NEXT QUESTION:)
Karen in AL> What percentage of malabsorption is there w/the RNY w/2-3
feet bypassed? Also, my surgeon does not credit me w/all the weight I've
lost, since he says my starting weight of 340 was a lot of fluid.Is that
right?
<Dr. Simpson> Karen you take all the credit
you want. It is all you. We will give you that credit.
<Karen in AL> Thank you, I will!!
<Dr. Simpson> with 2-3 feet bypassed there
is not much malabsorption. IN fact, probably less than ten per cent.
<Dr. Simpson> so, it wasn't fluid loss, it
was fat, and you did it, you did the surgery, you have to eat small amounts,
and you are walking---- great job.
<**MODERATOR**> JENNIFER 5 WEEKS YOU HAVE THE NEXT QUESTION
<Jennifer 5wks post> What are the indications of a stricture? I
sometimes get an awful pain in my chest and it feels like a heart attack
and at this point in time, I should start adding more regular foods but
the chest pain makes this difficult. Thank you for your professional advice
and Happy Holidays...
<Dr. Simpson> Well, strictures can happen
at different places, so the primary indication isn't pain, that might
be from reflux....
<Dr. Simpson> the primary indication of a
stricture is nausea and vomiting, although having a lot of...
<Jennifer 5wks post> it seems to hit just after two to three bites
<Jennifer 5wks post> vomiting just relieves the uncomfortability
<Dr. Simpson> reflux could be from that. You
should consider taking something like Nexium, protonex, or aciphex and
seeing how that works for you...
<Jennifer 5wks post> thank you! Go Hurricanes :)
<Dr. Simpson> and, you might have a primary
problem with your esophagus. SO, I would also suggest you see a gastroenterologist,
you might need to have a scope.
<Dr. Simpson> Good luck.
<**MODERATOR**> MARIA YOU HAVE THE NEXT QUESTION:)
<Maria> what sre your thoughts of Lap. DS surgery? and How big
can a stomach stretch without exploding? and with the DS do they really
need to remove the stomach in your only 100 lbs. over weight?
<Dr. Simpson> I like lap DS surgery. A stomach
can stretch a bit and it will explode, so don't challenge it too much.
Yes, they do need to remove the stomach in the ds surgery.... and 100
pounds over weight is enough to have the DS, and to have that portion
of your stomach removed. It will grow back.
<Maria> Thanks Doctor
<**MODERATOR**> AUDRA 145 YOU HAVE THE NEXT QUESTION:)
<Audra-145> Dr S. ...hi there....I am in the process of working
on getting PS covered....any suggestions or comments on what to do to
try and get insurance to cover (other than rashes, letters from MD, etc)...anything
out of the ordinary that you may suggest doing to increase the chances???
<Dr. Simpson> Audra, first thing to do is
check the insurance policy and make certain that you don t have an exclusion...
<Audra-145> just medical necessity being the key
<Dr. Simpson> to weight loss surgery. Then
find out what their requirements are. Some, like Aetna, require that you
have a six month doctor supervised...
<Dr. Simpson> diet and such before they will
consider you for surgery. Now, this isn't really necessary, but it is
their way of spending less...
<Audra-145> wait wait wait..this is for PS..not gastric bypass
<Dr. Simpson> on bariatric surgery for their
patients--- remember, they are bottom line this quarter period....
<Audra-145> I was asking about getting PS covered...I already had
RnY and have lost 145
<Dr. Simpson> oh, plastic surgery, well, if
you have no exclusions to plastic surgery in your policy....
<Dr. Simpson> then you need to document that
you have had problems with the excess skin, like rashes and the like...
<Dr. Simpson> so, if you get a rash, see your
doctor and get it in the record....
<Dr. Simpson> good luck.
<Audra-145> okay, thanks
<Dr. Simpson> good weight loss, by the way,
audra
<Audra-145> thank you so much!
<**MODERATOR**> JENNYHANNAH YOU HAVE THE NEXT QUESTION:)
<jennyhannah> Hi Dr. Simpson - I'm 29, from Atlanta, GA - scheduled
for gastric bypass in Feb. Can you tell me a little bit about what to
expect with excess skin? Do most have to have plastic surgery after weight
loss? Also - I'm concerned about losing my bosoms! My doctor estimated
I would lose around 100lbs. Oh and I'm having the sugery done via laproscopy.
Also - one last thing - will I feel satiated with only being able to eat
such a small amount?
<Dr. Simpson> You will feel satisfied with
a small amount....
<jennyhannah> like really fully?
<jennyhannah> full?
<Dr. Simpson> in terms of excess skin loss,
it is variable, you are young, so if you work out a bit then you will....
<Dr. Simpson> lose it easier than if you do
not. If you do not work out, and use your muscles, you will have more
excess skin...
<Dr. Simpson> it takes about six weeks before
you can really start to work out with weights.....
<Dr. Simpson> and don't worry about your breasts,
they will be fine-- you won't lose them, they might shift down a bit,
but that can be fixed if you think you really need that...
<jennyhannah> lol ok...good.
<Dr. Simpson> yes, you will feel really full,
and it will play games with your head that you feel full on so little
food, but you will
<Dr. Simpson> survive. Honest. Good luck.
<jennyhannah> ok. thank
you. :-)
<Dr. Simpson> Skinny doesn't mean thin-- it
means lots of skin---. Think about it.
<**MODERATOR**> LYNDA YOU HAVE THE NEXT QUESTION:)
<Lynda> MY STARTING WEIGHT WAS 338 7 MONTHS LATER I HAVE LOST 90
POUNDS. WILL I GET BELOW 200 POUNDS?DOING ALL THE RIGHT THINGS?MY SURGEON
TELLS ME THAT I SHOULD NOT HOPE TO GO BELOW 200. I AM NOT HAPPY WITH THAT
AT ALL WHAT IS YOUR
<Dr. Simpson> Lynda I think that you can get
to a BMI of 19 or 20 with no problem whatsoever....
<Dr. Simpson> you should be able to get down
to that weight, and you should not only hope to but you...
<Dr. Simpson> should expect to.The more you
walk, the more protein you eat, the more you drink water when not eating,
<Dr. Simpson> the faster and better you will
lose weight. So, go for it all. and you will do just fine.
<**MODERATOR**> KAREN IN AL YOU HAVE THE LAST QUESTION FOR
TONIGHT:)
<Karen in AL> What is your recommendation for drinking before and
after meals after RNY?
<Dr. Simpson> Well, Karen, I think that you
should not drink for 30 minutes before you eat and probably 90 minutes
after you eat for the RNY.
<Dr. Simpson> Thank you all. Good questions
tonight...
<**MODERATOR**> THANK YOU SO MUCH TO DR. TERRY SIMPSON FOR
JOINING US AGAIN FOR THIS CHAT!
<Pegella> Thanks, Doc!
<Savanna MN> THANK YOU DOC!~ =)
<Dee from Iowa> thanks Doc..
<**MODERATOR**> THANK YOU TO OUR MEMBERS AS WELL!
<Pat in PA> Thanks Doctor Simpson
<**MODERATOR**> HAVE A GREAT WEEKEND!
<Dr. Simpson> walk
<Dr. Simpson> water
<Dr. Simpson> protein
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