<**MODERATOR**> TRISH YOU HAVE THE FIRST QUESTION TONIGHT:)

<Trish> If u have the Lap and they say 3 days is that counting the day u have the surgery to when u can go home if all goes well? I live almost 4hrs away from my surgion and have to have someone come and get me.

<Dr. Simpson>Day three is post op day three, not counting the day of surgery

<Dr. Simpson>You will need someone to drive you home

<Dr. Simpson>although I like walking, four hours walking on the third post op day is a bit much.

<Dr. Simpson>but, I would applaud your enthusiasm

<Trish> ty

<Dr. Simpson>walking is good.

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

<Jeanie> I want to know if the Dr's do not really know what happens to bypass people 10 to 20 years down the road..? And do bypass people end up sick years down the road? Is this experamental?

<Dr. Simpson>Love walking. This is not an experimental surgery, although we call anything we do in medicine practice....

<Dr. Simpson>ten years down the road we have great data, and 20 years down the road we are still accumulating the data....

<Dr. Simpson>there is no decrease in life span, as sometimes is suggested.....

<Jeanie> Great

<Dr. Simpson>and there does not seem to be any increase in illness. However, surgery is something which is invasive, which has risks....

<Dr. Simpson>and something you should consider carefully. Give it a fair trial then hang it. Good luck.

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

<esther> i have had hernia surgey  4 times  will this  stop the

<esther> surrgoy

<Dr. Simpson>People who make hernias, make lots of them, and they keep surgeons busy for years....

<Dr. Simpson>this surgery has an incidence of hernias, as do all abdominal surgeries. ...

<Dr. Simpson>decreasing the weight in the abdomen will decrease the risk for further hernias, but not completely...

<Dr. Simpson>good luck.

<esther> thank you

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

<Vicki> I am having alot of trouble keeping my food down Dr. says my stoma is small? is my food ever reaching my stomach

<Dr. Simpson>The food is reaching your upper pouch, and since it isn't getting through very well, you vomit it...

<Dr. Simpson>so you will need to chew your food for a while, and you will probably need a gastroenterologist...

<Dr. Simpson>to go down and stretch the stoma open a bit in order for you to eat more normally. ..

<Dr. Simpson>this happens to about ten per cent of people who have the RNY gastric bypass...

<Vicki> does it hurt?

<Dr. Simpson>seems a bit annoying, but it does happen. No, it doesn't hurt, it is something that they do under a bit of anesthesia...

<Vicki> ty DR.

<Dr. Simpson>chew your food well. Good luck.

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

<angel> hello Dr. my question is, why is open kicked over larodscoptic?

<Dr. Simpson>Angel, open and laparoscopic are two approaches to the abdomen to do this surgery....

<Dr. Simpson>not all surgeries can be done through the laparoscope, and  there are a number of surgeons...

<Dr. Simpson>who feel that they have better control over things when they feel them with their hands, as opposed to see them through a scope....

<Dr. Simpson>there is a leak rate of 1.5 percent nationally with open as opposed to 3 per cent with the scope, however...

<angel> Is one picked over the other for some reason?

<Dr. Simpson>there are many surgeons who have much better numbers than that. You pick which one your surgeon does...

<angel> I was wondering, as the surgeon iam going to does open

<Dr. Simpson>and if you have the luxury of having a surgeon who does them all, then you talk with him/her about it....

<angel> ok ty..

<Dr. Simpson>so, first pick the surgeon, and then discuss the procedure. Find a nice surgeon with good teeth.

<Dr. Simpson>good luck

<angel> lol

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

<ifonly> how come i have only lost 19lbs in 3weeks doing all i am suppose to do?

<Dr. Simpson>because you did? I guess if you think that is a bad result you have to consider if you ever did that before in your life....

<Dr. Simpson>and if you lose about 20lbs every 3 weeks, then at the end of a year you will have lost.....

<Dr. Simpson>a lot

<Dr. Simpson>calculating it out, you would really have a lot. So, if you want to lose more there is one thing you can do....

<Dr. Simpson>walk, walk, and walk some more. It is not a secret, here, and the surgery itself is no magic, you simply have to...

<Dr. Simpson>watch your portions, chew well, keep protein first, if you have a RNY do not eat and drink at the same time....

<Dr. Simpson>and walk four times a week for 45 minutes at a time, and make sure you are sweating when you do it. Good luck.

<ifonly> im doing all that correct

<Dr. Simpson>By the way, if you lose 19 lbs every three weeks at the end of a year you will have lost over 300 lbs.

<Dr. Simpson>So, sometimes a little bit at a time isn't so bad. Just keep walking, and go from there.

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

<Karenintulsa> i am preop and have ulcers, how long should they take to heal, they are not from the h pylori virus, will this affect the outcome of my surgery? my surgeon wont do the surgery until they have healed

<Dr. Simpson>Well ulcers typically heal in short order, usually they heal over four to six weeks on appropriate therapy...

<Dr. Simpson>they are caused by a bacteria, not a virus, and you don't want to do surgery on someone with an ulcer because....

<Karenintulsa> so taking aciphex witll heal them?

<Dr. Simpson>you cannot get to the ulcer after the surgery. Aciphex will decrease the acid to almost nothing...

<Karenintulsa> the nurse told me some people take 6 months to heal

<Dr. Simpson>and it will allow the ulcers to heal. You will also need some antibiotics if you have helicobacter pylori.

<Karenintulsa> i didnt even know i had them

<Dr. Simpson>Six months is too much, and isn't correct. Good luck.

<Karenintulsa> thank you

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

<Debbie> I have had my date a week and an feeling depressed. Surgery is in 1 month.

<Dr. Simpson>So, it is something which can happen. Don't be depressed. It is normal to feel anxious before surgery.

<Dr. Simpson>I feel anxious before surgery all the time.

<Mykayla> yikes

<Debbie> I want ot feel happy

<Dr. Simpson>we all want to feel happy, but surgery doesn't do that for us. Surgery simply gives us a tool for weight loss. Happiness is found from another profession.

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

<Rosemary> is open RNY anymore dangerous than open gallbladder with a 18 inch incession? no problems no drain tube

<Dr. Simpson>Open RNY has more risk involved than a gallbladder because the surgery is longer, involves ....

<Dr. Simpson>putting together and taking apart a few guts, and so it is a  bit more involved. The risk of hernia and bowel obstruction and pulmonary embolus is the same...

<Rosemary> thank you

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

<Poco 9/24/02> Hi Dr.Simpson, thank you for being here......my question is, if your taking medicine to you still take the regular about..because your body doesn't absorb everything.....how does that work?

<Dr. Simpson>Poco, depends on the medicine you take and the surgery that you have. Some medicines are not well absorbed after...

<Poco 9/24/02> I had an RNY

<Dr. Simpson>distal surgeries, like DS or a distal RNY-- those medicines include anti rejection agents for transplants, some hormones...

<Dr. Simpson>in addition, calcium and some other nutrients. Which is why we take vitamins....

<Dr. Simpson>so, you have to know what the medicines are. Most, however, are very well absorbed after surgery....

<Dr. Simpson>and given that should be no problem. Good luck.

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

<Dr. Simpson>Hi Doreen.

<Doreen 11 wks po> at 11 weeks i feel i can eat to much food and i know you will say just quit eating do you think a whole sandwich is to much and does it mean in time i will be able to eat even more without getting that full feeling?

<Doreen 11 wks po> Hi

<Dr. Simpson>The sensation of satiety, or feeling full, is something which is a bit off kilter in a lot of patients...

<Dr. Simpson>often time it is a mind game, because you think you should eat more, you don't feel full, and you eat more....

<Dr. Simpson>the problem with that is you can stretch out the nice small pouch which we created for you...

<Dr. Simpson>which will lead to weight gain, or a slowdown of the weight loss....

<Dr. Simpson>so, start by eating slowly, take a given amount of food...

<Dr. Simpson>such as a bit less than a cup, and make certain that you eat it over thirty minutes, as opposed to eating it like you are a crazed wild  lion after a zebra following a famine....

<Dr. Simpson>although zebras have a lot of protein, sometimes the black and white clash with the intestines....

<Doreen 11 wks po> thanks lol

<Dr. Simpson>so, the real answer is to chew your food well, eat it slowly, use a small plate to have your food, and use smaller kitchen utensils..

<Dr. Simpson>go to an import store and get small plates. Small plates, small portions, chew well. The longer you take to eat...

<Dr. Simpson>then you will feel full, and you can enjoy your food. Use the time to talk. But don't talk with your mouth full of food....

<Dr. Simpson>that is how I get in trouble. Of course, some would say I get in trouble by just talking-- can you imagine that?

<Dr. Simpson>good luck

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

<Connie> I have a BMI of 45, have no health problems yet, would I still be considered for Gastric Bypass surgery?

<Dr. Simpson>Yes, Connie, a BMI of 40 is the standard which we set, as well as the National Institute of Health, for the bypass surgery....

<Connie> Do you have to stop taking birth control pills before surgery? And what about the hair loss thing?

<Dr. Simpson>so you would fit into that quite well, so have the surgery and fit into something else....

<Dr. Simpson>Well, I don't take birth control pills anymore, they made me have , well never mind.....

<Dr. Simpson>hair loss only happens to those who lie to their surgeons....

<Connie> What do you mean?

<Dr. Simpson>birth control pills are something I advise my patients to stop because of the increased risk of deep venous thrombosis, that is,...

<Dr. Simpson>they cause you to have thicker blood, which is even thicker than water....

<Dr. Simpson>in terms of hair loss, only thirty to forty per cent of patients have it after surgery....

<Connie> Why?

<Dr. Simpson>and again, that is because they lied to their surgeon, if they are honest we don't pull their hair during the procedure....

<Connie> hahahah

<Dr. Simpson>hair loss happens because there is a reset of the hair follicles, in some people, because of stress...

<Connie> Thank You for your answers.

<Dr. Simpson>it can be exacerbated by a lack of protein, biotin, or zinc, but most often it is a simple stress alopecia (fancy word for hair loss)....

<Dr. Simpson>so, be nice to your surgeon, send him a Christmas present, and maybe he won't pull on your hair during surgery. Good luck.

<**MODERATOR**> LYN@GOAL YOU HAVE THE NEXT QUESTION:)

<Lyn@goal-242#> hi doc, i had the body lift and because of old gb scar i had a area of dead tissue and they cut it out about 2 weeks ago, hole is approx. 3 x 5 x 1 1/2 inches, how long does that take to scar over. its been cut on twice more. keep forgetting to ask doc, thanks

<Dr. Simpson>Well it takes a while to heal some of those incisions, and it is a matter of patients....

<Dr. Simpson>and patience...

<Lyn@goal-242#> this isn't an incision its a hole

<Dr. Simpson>probably it will take about six weeks before it heals over, although after a while they should be able to take you back....

<Lyn@goal-242#> ok thanks doc

<Dr. Simpson>and then close it. Well, still about six weeks. IF your nutrition is in good shape it will take less time...

<Dr. Simpson>good luck. Hate holes where they don't belong.

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

<Jessika> have been hearing that most people who have had WLS have later had to have their gallblatters out ...can you explain why this is? by the way doc I love your sense of humor.... LOL

<Dr. Simpson>some of us, as a matter of routine, remove gallbladders, and some do not. Surgeons preference....

<Dr. Simpson>but if you don't take them about 40 to 60 per cent will end up coming out....

<Dr. Simpson>so, it is one of those things. If you like my sense of humor you clearly are not related to my wife.

<Jessika> is there anything that can be done to prevent?

<Dr. Simpson>There are some drugs which can be used to decrease the chance of having a gallbladder problem, but I simply take out the gallbladder then I don't have to worry about it.

<Dr. Simpson>ooouch-- frying pan just hit my head.

<Trish> lol

<Jessika> lol thanks doc

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

<stephanie> I am 13 months post op lap band and I keep getting physically sick from this band. I know that I am chewing good and small amounts, exercising. But the doctor cannot seem to get the fill right. I feel like a pin cushion. I have lost 70 pounds and 35 before surgery. I ended up in ER Sunday with my band so restricted I was on IV for 2 days. I am an RN. I have been thinking about having a RNY with another doctor. I keep hearing that it is better have a dud.switch. I feel like I gave it a fair chance. Any suggestions of a good Doctor in Portland, Oregon?. Do you think I should have a open or closed procedure or which one to have? I have another 80 pounds to loose I feel so much better than the 284 I started with. But just I cannot deal with this pain

<Dr. Simpson>Hi Steph. The lap band is something which does have a lot of problems with it....

<Dr. Simpson>and so having it switched over to either a RNY or a duodenal switch isn't a bad choice....

<Dr. Simpson>in terms of Portland, there are several bariatric surgeons at the University who do the duodenal switch, and you can get their names...

<stephanie> which one

<Dr. Simpson>from this site, by looking up physicians. I would encourage you to go to their support groups and talk to the other patients....

<stephanie> I have theie names

<Dr. Simpson>Portland is a great place, but not during this time of year. Good luck.

<stephanie> but what about RNY

<Dr. Simpson>RNY is also a good surgery.

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

<Karenintulsa> Dr. Simpson, i asked the question earlier about the pre op ulcers. Will i have to continue to take ulcer medicine after the surgery? will ulcers be able to develop in the portion of my stomach i am not using (i will be having an open rny) Since my ulcer is not caused by the h pylori bacteria does this mean i got them from stress or taking ibuprofen?

<Dr. Simpson>If you have ulcers which are caused by H pylori then you should be cured. They can be caused by ibuprofen, the best way to find out is to ask the gastroenterologist....

<Dr. Simpson>you will probably need to take some medicine, like Pepcid or Zantac for the rest of your life....

<Karenintulsa> even though i dont use that part of my stomach

<Dr. Simpson>because you don't want ulcers, they are not nice. Ulcers hurt, or can hurt, they can bleed and they can perforate, and you get them even in the part of the stomach that you don't like....

<Karenintulsa> will my chances be higher to get ulcers at my staple line

<Dr. Simpson>No, there are no increase in staple line ulcers.

<Dr. Simpson>RNY vs. DS is an old debate which has no right answer. The answer is finding the surgeon you like, or who is on your health plan, and going with him/her.

<Karenintulsa> thanks

<Dr. Simpson>they both work well as surgeries, and they are both accepted procedures to lose weight.

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

<Stephie~MI-64> I have been having heart pulpations, at weird times like when I button my new jeans, or (blushing) when having sex, this did not happen before could it be from lack of potassium? Also, do you keep your PT on birth control pills after surgery? is there a risk of Pregnancy?

<Dr. Simpson>After surgery I ask patients to use a mechanical birth control, since I do primarily the duodenal switch, and the birth control pills are not...

<Dr. Simpson>well absorbed. If they don't take them there is a risk of pregnancy, but I tell my patients not to have sex for 17 years after surgery....

<Stephie~MI-64> Could you write me a note to get out of it?????

<Dr. Simpson>the palpitations can be from anyone of a number of things, and if they bother you a lot I think you should see a cardiologist and get them worked up....

<Dr. Simpson>I could, Steph, but sometimes those notes get me in trouble. Good luck.

<Stephie~MI-64> dang.. thank

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

<angel> How long does it usually take to heal from rny surgery?(You are humorous..wish you lived here..lol)

<Dr. Simpson>Angel it depends on what you mean by heal. If you mean how long before returning to work, we usually say three weeks....

<Dr. Simpson>if you ask how long before you can lift more than 15 lbs, then it is six weeks...

<Dr. Simpson>if you ask how long before when you wake up you forget that you had surgery, three months....

<Dr. Simpson>if I lived there, I wouldn't be here.

<angel> I mean.. do you have to be on pain meds?

<angel> LOL very true!

<angel> You are needed in NY!

<Dr. Simpson>Pain medicines are individual. Generally after the first week you won’t need them. If you do then you will be coming off of them quickly. Keep walking.

<Dr. Simpson>I love NY

<Dr. Simpson>but this time of year I love Arizona.

<angel> (MY son lives there:)

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

<MsMonte 24daysPO> I had an open RNY with gallbladder removal 24 days ago....and I never seem to always feel blah and have trouble getting liquids in... About how long does it take to start feeling "normal".....or basically waking up feeling pretty good able to have energy?...I'm still on blended soup and yogurt and milk 3 times a day as my diet.....will it change when I add soft solids next week? Should I be taking Pepcid always too...as I am almost out of what He gave me?

<Dr. Simpson>You need a refill of the Pepcid. You will feel better the more you walk, and as you advance your diet you will feel better....

<Dr. Simpson>feeling blah is something which people have to feel after major surgery...

<Dr. Simpson>and I like to blame it on the effects of anesthesia, as opposed to the scars we give you....

<Dr. Simpson>but it takes, as I said above, about three months before you feel normal, then you wont feel normal because you will be getting skinny...

<MsMonte 24daysPO> Thank you doctor

<Dr. Simpson>so, walk and then walk some more. Walk your way to normalcy. For some it is a long way to go.

<**MODERATOR**> DOREEN YOU HAVE THE NEXT QUESTION:

<Doreen 11 wks po> hello again, how dangerous is taking an 800 mg motrin/ and if thats the only pill that you ever found that works for back trauma could one get away with an occasional dose? i am also an Rn but only do labor and delivery lol

<Dr. Simpson>Well after labor and delivery I always like a little Motrin too.....

<Doreen 11 wks po> lol

<Dr. Simpson>the problem with taking non-steroidal anti inflammatories....

<Dr. Simpson>NSAIDS. is that you cannot evaluate their effect on the distal stomach, unless you had a duodenal switch....

<Dr. Simpson>which is why patients with DS can take all of those drugs, but RNY we caution...

<Dr. Simpson>an occasional one should not hurt you, especially if you combine it with a proton pump inhibitor, PPI, such as Aciphex, Prevacid, etc.....

<Dr. Simpson>you simply have to know why it can be a problem, then weigh the risk-- pardon the pun. Good luck. Keep those babies comin....

<Doreen 11 wks po> great  thanks

<Dr. Simpson>good luck

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

<Tek> Hello Doc. I am planning RNY, after surgery walking will be difficult due to Heal problems, could I use my exercycler? How soon? (I really like my exercycler).

<Dr. Simpson>Yes you can use your whatever that is... although I suppose that...

<Dr. Simpson>it is something which, if it is used like I use them, hangs clothes up really well....

<Dr. Simpson>so, there are those who cannot walk, and must use those devices or use...

<Dr. Simpson>aquatic (water) therapy. Good luck.

<Tek> TY

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

<Trish> If ur surgeon tells u he is going to do the Lap RNY on the first consultation and hasn't said anything different how much of a chance is there of that changing on the day of surgery?

<Trish> My surgery is next month

<Dr. Simpson>Trish, those things can change depending on the nature of the patient, and the equipment, and a whole host of other things....

<Dr. Simpson>I doubt that he/she will change their mind the day of surgery. Good luck.

<Trish> ty

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

<Jeanie> If a person does not do well with this surgery RNY can it be reversed? What happens to your old stomuck

<Dr. Simpson>It is raining here in Arizona-- yuk

<Dr. Simpson>Well, you can have the surgery reversed, but it is a little like remodeling your house...

<Dr. Simpson>once you have moved things around a bit, having it reversed isn't easy, it isn't cheap, and it doesn't always go as you planned...

<Jeanie> what do u mean?

<Dr. Simpson>so you should NEVER consider the surgery is reversible, and you should consider it to be permanent...

<Dr. Simpson>every now and then we reverse a surgery, but that is rare.

<Jeanie> but if need be it can?

<Dr. Simpson>It can be altered, but not totally reversed.

<Jeanie> thank u:)

<Dr. Simpson>you can get back to where you do things the way they were meant, but it is not exactly the same.

<**MODERATOR**> NIKKI @GOAL YOU HAVE THE NEXT QUESTION PLEASE:)

<Nikki@Goal> Dr.S howdy..and I miss ya..anyways...I was in a car accident..they found some blood in pouch..they don't know why or how....any ideas??

<Dr. Simpson>Hi Niiki-- for those of you who don't know she is my daughter.....

<Nikki@Goal> Hi Dad

<Dr. Simpson>well you have had some ulcers in the past, and you might have had a bit of one there before which caused some...

<Dr. Simpson>blood in the pouch after you got roughed up in the car....

<Nikki@Goal> DAD will or should it stop on it's own?

<Dr. Simpson>I certainly hope it was your car or your mother's and not mine....

<Nikki@Goal> lol

<Dr. Simpson>you will need to have it scoped a bit later if you find out that you are having blood in your stool or ....

<Dr. Simpson>if you have black stools. Have your blood count checked. Good luck Honey, and don't tell mom.

Nikki@Goal> Dad thank you

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

<Dr. Simpson>herlene is with hislene, and temporarily unavailable.

<Herlean> I am just over 2 weeks post op - almost nothing stays down! Please help. I tried canned fruit, rinsed in water, up it came.

<Dr. Simpson>Well, I think that you have a couple of choices, but the first thing is you need to call your surgeon...

<Herlean> Only things that stay down are liquids, yogurt, cottage cheese, water.

<Dr. Simpson>you will probably need to see a gastroenterologist, unless your surgeon does endoscopy, because you might have a stenosis, or narrowing, of where they put together...

<Dr. Simpson>your stomach and small bowel. You might simply need to chew your foods better. canned fruit is a bit pulpy, and might not stay down...'

<Herlean> Do I ask the surgeon for a referral to the gastroenterologist?

<Herlean> Is this normal 2 weeks out?

<Dr. Simpson>but it sounds as if someone needs to take a look inside of you and see if there is a stricture....

<Dr. Simpson>first call your surgeon, and it may be that your primary care doctor needs to make the referral, depending on your insurance....

<Herlean> What do you do if you can't stand the taste of the protein drinks?

<Herlean> I can't eat the bars, too much sugar. I can barely stomach the protein drinks, but I don't want to suffer from a lack of protein.

<Herlean> I am not up to eating much of anything right now. I am 2 weeks post op, but I know that I need protein.

<<Dr. Simpson>then eat protein, if you don't like the taste of protein drinks then you have good taste.

<Dr. Simpson>good luck.

<Herlean> thank you

<Dr. Simpson>Tonight I will have veal, it will stay down if my gallbladder doesn't act up.

<Dr. Simpson>It's quiet, must have some shy folks out there

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

<Dr. Simpson>maybe not so shy

<Dr. Simpson>although it is Friday, and everyone is looking forward to a weekend...

<Dr. Simpson>I am on call this weekend, so I won't look forward to it , just waiting to see what Santa will bring me

<Dr. Simpson>no doubt it will be another year of coal and switches.

<Sarita> Hi Dr. Simpson...what vitamin supplements do your patients take?

<Dr. Simpson>Simply a complex multivitamin, such as Vista vitamins, or Flintstones, or prenatal types, or Geratol...

<Dr. Simpson>nothing fancy. If they have a DS then after a month I recommend they take 1800 mg of calcium...

<Dr. Simpson>we watch their labs and see what it shows up as, and we go from there.

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

<MsMonte 24daysPO> Doctor....what is happening to the other part of my stomach.....under the pouch....how does it stay working...or is it working?

<Dr. Simpson>it is working just fine. It empties into the duodenum and that is how it drains, it still works, secrets stuff and is there...

<Dr. Simpson>just waiting to be active again, but it won't be. Alas, poor stomach, you fed it well.

<MsMonte 24daysPO> Thank you doctor

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

<Amy Preop Pittsburgh> ok

<Amy Preop Pittsburgh> I have a question about Fatty liver

<Amy Preop Pittsburgh> what is it, is there a way to decrease it before you go in?

<Dr. Simpson>Fatty liver is something which will decrease over time and the best way is with weight loss surgery...

<Dr. Simpson>however, if you are waiting for the surgery, then a diet which is based primarily on protein is best, such as Atkins diet...

<Dr. Simpson>fatty liver isn't caused by too much fat in the diet, but by too many carbohydrates in the diet...

<Amy Preop Pittsburgh> cool ;)

<Dr. Simpson>many of us consider it a co morbidity of obesity, although it is not yet recognized as such by insurance companies.

<Dr. Simpson>So, have a steak.

<Amy Preop Pittsburgh> I've been on a similar diet preop and have lost 40 lbs

<Dr. Simpson>don't eat the potato or the bread or the dessert.

<Dr. Simpson>good, go for it.

<**MODERATOR**> RANDINMISSOURI YOU HAVE THE NEXT QUESTOIN:)

randyinmissouri> In Aug. I was hospitalized for severe abdominal pain that started immediately after a ate a handful of grapes. Several episodes of vomiting, a couple of days later had fever (102) and elevated Wbc. Could grapes have caused all of this

<Dr. Simpson>I doubt they caused the infection....

<Dr. Simpson>you probably had a bit of dumping from grapes, because grapes are very high in sugar, and should probably...

<Dr. Simpson>be avoided until such time as you get to your goal weight, or a BMI of 19-22.

<Dr. Simpson>So I will have some grapes tonight-- pressed and fermented.

<MsMonte 24daysPO> lol

<randyinmissouri> thanx!

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

<annie> I have had nessians fundiplication, and also have barretts esphicus, have you ever performed surgery on a person that has had this type problem?

<Dr. Simpson>Yes, I have, and it is a bit more difficult, however, there are many who would say that RNY is the best....

<annie> Thanks

<Dr. Simpson>anti reflux surgery there is. So, you should do just fine. Good luck.

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

<Jessika> I am in PHX, AZ and I love the rain... but it is really cold here now... Questions is how difficult is it to remove the gallblatter during lap RNY... also wanted to know if you have your own office here or do you come in to workwith others..do you take

<Dr. Simpson>Eight more minutes of my wisdom

<Dr. Simpson>Well Jessika, during lap RNY it isn't easy to remove the gallbladder, but it can be done. Not everyone does it. My office is in Phoenix, and I do the DS. Good luck.

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

<Herlean> I am 17 days PO. I don't want to suffer from a lack of protein, but I can't stomach the powders and most of the bars are loaded with sugar. Suggestions?

<Dr. Simpson>Well, protein intake is variable....

<Dr. Simpson>if you have had a distal RNY or if you had a DS we recommend that you have 60 to 80 grams as a goal, which we expect you....

<Dr. Simpson>will get to after a month or two, not right away. What we don't want you to do is have a lot of carbohydrates instead of protein....

<Dr. Simpson>if you have a routine RNY then we would say 30 to 40 grams of protein. We prefer...

<Dr. Simpson>patients get their protein from food, not from drinks or bars, or shakes... <Herlean> So, I shouldn't worry about it at this point? I had proximal surgery.

<Dr. Simpson>it is easier to digest. Early sources of protein which are good are eggs, egg whites, tuna, and low fat cottage cheese.

<Herlean> Thank You Dr. Simpson.

<Dr. Simpson>So, no don't worry, but it is good to be aware and keep an eye on it.

<**MODERATOR**> NIKKI@GOAL YOU HAVE THE LAST QUESTION FOR THE NIGHT:)

<Nikki@Goal> Dad, how much fat and sugar does distal rny patients absorb? and when we eat high fat and sugar and um well you know(run to the potty lol) is it because we are not absorbing it?

<Dr. Simpson>Eyes are a good source of protein too.

<Dr. Simpson>You absorb the same amount of sugar no matter what the surgery you have, and that is all of it....

<Dr. Simpson>if you go to the bathroom a lot it may be a low level of dumping, and even if you dump you will still absorb the sugar....

<Dr. Simpson>in terms of fat, we anticipate the first year you will only absorb 30 per cent of the fat, but that will increase with time...

<Dr. Simpson>but we are less concerned with fat. So, honey, have a nice steak, and if you cook mine medium I'll be over in an hour.

<Nikki@Goal> Dad you got it..see ya in an hour..lol

<**MODERATOR**> THANK YOU SO MUCH TO DR. TERRY SIMPSON FOR JOINING US TONIGHT! AND MANY THANKS TO OUR MEMBERS AS WELL!

<Dr. Simpson>Good night all and thank you for an entertaining evening.

PLEASE VISIT DR. SIMPSON AT:

WWW.ARIZONABARIATRICCENTER.COM

<Dr. Simpson>Thanks to obesityhelp for everything

<**MODERATOR**> HAVE A GREAT NIGHT!

<MsMonte 24daysPO> Thank you doctor

<Nikki@Goal> thanks Dad for your time..your the best

<**MODERATOR**> GOODNIGHT ALL