February 18, 2005

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

<Lori A.S.> My doctor has requested that i go on a liquid diet before surgery. What types of liquids do you think would be best.

<Dr. Simpson> Liquid diet before surgery is sometimes thought to help. Reduce the size of the liver -- but it has to be a high protein liquid diet. So, try some isopure protein shakes, skim milk and avoid high carb drinks. Good luck.

<I just wanna know> I was informed yesterday that my protein and iron levels are too low for sugery. By me going to get B-12 shots now and increasing my protein, allow for surgery. I have been anemic since age 16 and have been on iron pills since by a physician..Thx

<Dr. Simpson> It seems like you need to have a work up of the anemia that you have to determine its source. If you have anemia from B12 then you need those shots. If it is not from B12 then those shots would be a waste. If you need iron, then you should take it but know that some times surgery will make that anemia worse by bypassing the duodenum. The RNY will bypass one of the major sites of iron absorption. So if you have not had a work up of your anemia by a hematologist then I would suggest that you get that in order to make certain that after surgery you do well. Good luck.

<Pip> I have a BMI of 55 and have decided to have the BPD/DS. Would you recommend that this be done in two stages with such a high BMI? Does this decrease the risks?

<Dr. Simpson> It all depends on your anatomy and other risk factors that you might have. Some surgeons do it in two stages as a matter of routine. Although I do not think that a BMI of 55 is that high, some people have all their weight in a part of their abdomen that makes the bypass part difficult to do, so they get the stomach part of the surgery first and there are a number who get the stomach part done, that do not need the rest of the surgery. So, the surgeon will make those decisions based on their experience and what they find in the operating room. Sometimes we simply cannot do both parts at that time.

<carolyn> Hello and good evening. If you lose the most weight right after surgery, but like me surgery 01/11/05 weight 285 and 5'6 and have to date only lost 20/25 lbs does this mean that I cant expect to lose more than this in the future at one time?

<Dr. Simpson> You have a tool -- that is all that surgery provides for you and while sometimes you lose a lot early on, that is primarily the effect of the increased metabolism brought about from the surgery. Weight loss will slow because the body does one simple thing: it is very efficient at measuring calories. So, your weight loss will depend on the calories that you burn, and the calories that you consume - no magic here. If your body burns more immediately after surgery, that is somewhat normal. So, start walking and make some good choices for your meals. To calculate your basal metabolic rate you can find that in my book. Good luck.

<kristi> hi i really wanted a good discription of the lap procedures not sure what the difference is between rny and laps etc...thank you

<Dr. Simpson> Ah -- someone who needs a copy of the first book, which has all of the basic surgeries. Outlines with diagrams, and even a "how to" section for the home surgeon. That book is available from the obesityhelp.com bookstore, Amazon.com, and from my website www.obesitydr.com --- but it does have a good set of diagrams -- ask Nikki or Crow.

<Nikki> Wonderful diagrams!

<CROW MOD -450#> Yes, very good.

<John> Hi. I'm having surgery Monday morning in Hackensack, NJ. I have sleep apnea and use a breathing machine to sleep at night. I'm worried that during the surgery and recovery I won't have a breathing machine hooked up to me and will stop breathing without it. Am I foolish to worry about this or will the staff make sure I have a hook-up. Should I bring my own? Thanks...John

<Dr. Simpson> You should bring your machine with you and you shouldn't worry about anesthesia, they will take good care of you. I happen to like New Jersey -- one of my favorite states -- good luck with your surgery. You will do fine. What you need to do is to walk a lot after surgery, and get off the narcotics as fast as you can. Good luck.

<Ima PreOp> I'll be going in for open RNY and to have my hernia fixed. I just started a job so I want to be able to go right back to work. What's the least amount of time I should plan on taking off?

<Dr. Simpson> Three weeks -- and sometimes you have to take more --- it will be at least six months before you should lift anything more than 14 lbs.

<Dana> I want a tummy tuck some day i am still 300 lbs at 3.5 years post op.....I have a big belly still, no lose skin, am i able to have a TT, I always thought you needed to have all lose skin

<Dr. Simpson> Well, it would seem that you should probably work to lose more weight, because you have more to lose and I think that you should consider working with your tool to lose more weight. We have a good workbook for that "Getting to Goal and Staying There: Lessons Learned From Successful Patients." Good luck. See your plastic surgeon.

<hopeful> I'm a little over 3 months out...how many calories, carbs, sugars etc a day should I be aiming for?

<Dr. Simpson> Well, that is a great question, but the answer is simple: Avoid processed foods, make good choices in terms of carbs. I think that you need to learn which are the good the bad and the ugly. On my website www.drsimpson.com you will find a list of that called the glycemic index and in terms of calories -- that depends on what weight you want to lose. It is always good to calculate your basal metabolic rate, and to know how many calories it takes to maintain your current weight and where you want to get to, which is why we wrote the workbook, that helps you with those calculations. You want to not be deprived -- watch your portions and weigh yourself weekly. If you increase your weight then what you are doing isn't working. And start an exercise program -- like walking. Good luck.

<nichole> How does lap RNY effect a fatty liver and NASH of the liver. Can the surgery harm a fatty liver?

<Dr. Simpson> Weight loss is the best thing that can happen to fatty liver, because by weight loss you can reverse the fatty liver. Fatty liver tends to come from eating too many carbohydrates. By cutting down on processed foods and with weight loss, you should be able to reverse that -- which is what you want to do -- and when you have had surgery you will want to avoid those highly processed foods, high glycemic index carbohydrates, and concentrate on proteins -- good quality proteins. Good luck.

<Sue> How long is the recovery period for laproscopic G/B? (approximate out of work time)

<Dr. Simpson> Two to three weeks is what we would expect to be out of work; longer if you work for the government.

<teresa> My surgeons group has had a very difficult time getting me adjusted. Just last week they thought that I had a leak. After 4cc barium still flows through easily. Is this a sign that something is wrong? Should it have just triclked through? What should they be looking for under the fluro?

<Dr. Simpson> It could be that you have a leak in the balloon or the tube, or it could be that the band has slipped. So you need to have that evaluated.

<carolyn> I am 8 weeks out-having problems digesting meats--eggs, cottage cheese--sick of shakes- what can I eat?

<Dr. Simpson> We have a saying - swim, fly, walk -- The first month the easiest things to digest are things in the sea, like fish or shrimp. The second month, it becomes easier to digest poultry products, and after that it is easier to digest meats -- like steak or like elk. I am sick of shakes, also. Avoid well-done meats.

<Nichole> I would like to know about the death rate from Lap RNY. I was told it is 1-2%, does that count the people that pass away months after the surgery from complications?

<Dr. Simpson> Death rate from surgery is from the first 30 days after the surgery is done. So if someone dies in the first thirty days it is considered a surgical death. After that, it is something else. The rate varies between one in fifty to one in two hundred fifty, and depends on how many surgeries the surgeon does -- and so forth.

<Mary> What types of classic behavior do you see that make GBS patients regain their weight

<Dr. Simpson> Good question. To regain weight this is what we see: Increasing alcohol consumption, lack of exercise, poor food choices, fast food, a lack of portion control, and a failure to weigh themselves -- which is denial.

<joan> I had my gall bladder out in the early 80's resulting in a large scar. Is this a complication of RNY lap surgery?

<Dr. Simpson> NO, that is not a complication of the surgery at all and they should be able to do lap surgery with that.

<Sue> Should I expect to go home with a drainage bag and how long will it be in place?

<Dr. Simpson> No.

<deb b> I just had Lap RNY two days ago, why is it difficult to burp? When I try, very little comes up and my stomach cramps

<Dr. Simpson> Well, it is difficult to burp because your stomach is the size of an egg and there is not that much in there. Cramps are normal after surgery but if you have some concerns about the pain you should call and see your surgeon. Good luck, and welcome to the other side.

<Sue> I have heard that many gastric bypass patients have problems with gas...is this always the case and is there any way to prevent that?

<Dr. Simpson> Gas occurs from two sources: Swallowed air, which you cannot prevent, and undigested food that gets to the colon where the bacteria will start to chomp on it. And certain foods make gas worse -- like beans (shocking), but this is not a problem with everyone. It is primarily a problem with a longer bypass and we have a lot of things to help that.

<myrt> I have been under a LOT of stress lately. My stomach has been enlarging. Would that be from excess cortisol possibly?

<Dr. Simpson> No, excess cortisol is not a problem with weight gain, unless you have a tumor, and the people who said it did are now serving jail time. Your stomach enlarges because you eat when you have stress -- that isn't an overactive adrenal gland (that makes cortisol), that is an overactive mouth gland. Find better ways to deal with the stress instead of eating, and that will keep you from stretching your pouch. Good luck.

<Kelly> Is it true that carbonation stretches the pouch?

<Dr. Simpson> Carbonation does not stretch the pouch as long as you can burp or pass gas the other way. But what carbonation does is that food in the pouch will be forced out of the pouch by carbonation and you will then feel hungry. So carbonation can lead to feeling hungry sooner than you should. I have operated on hundreds, if not thousands of patients and many of them drink lots and lots of carbonated beverages -- sometimes they come to my office with cups that are the size of my aquarium and when I see their stomach, they are all pretty much the normal size. So, that is a myth but carbonated beverages should be avoided because of what they can do to your sense of satiety. Good luck.

<charmayne> i need to know which procedure is proven safer open/laproscopy?

<Dr. Simpson> The safest procedure is the laparoscopic adjustable band, by far, in terms of safety -- it isn't the surgery as much as the surgeon doing them. You can have a great surgeon doing either procedure and have a problem, but if you have a good surgeon who is comfortable with the procedure then that is the best thing you can ask for. So I would suggest that you get a surgeon who has done a few of these and with whom you are comfortable and let them do what they do the most of.

<Rhonda DD> I am 6 mos post op. I can now eat a lot more than I was before. How many calories should I be getting in daily?

<Dr. Simpson> You can get in a lot of calories daily, and how many you get in depends on you more than anything and I think that you can make good choices with good food and go from there. How much you gain or lose will depend on how many calories you get in. So make good choices with good food - avoid snacks and grazing.

<Jeff> How soon after surgery can we have sex?

<Dr. Simpson> I don't even know you. As soon as you are comfortable and the other person is willing.

<Cris> How long does mal absorption last after surgery?

<Dr. Simpson> Depends on a lot of things -- but two to five years and there should be less malabsorption if not all of it. However, you should be able to know that you need to have your levels of fat soluble vitamins checked, Vitamins A D E and K. Good luck.

<deb b> What would be the sign of a leak a few days after surgery, what should we look for at home?

<Dr. Simpson> You would be quite sick and feeling poorly. You could have severe stomach pain, or you could not. It all depends.

<Wanda>- What is the maximum age limit for this surgery?

<Dr. Simpson> It depends on the surgeon and the insurance and the surgery and the patient, because sometimes a young person may be a prohibitive risk. So every surgeon has their criteria.

<Kimberly> What is the average operating time for lap procedure?

<Dr. Simpson> Every surgeon is different, and every operation is different. Check with your surgeon, who should give you a good idea -- I promise, you will be asleep for those.

<Janice> I have not been taking my vitamins regularly, but my blood work came back good. What is up with that?

<Dr. Simpson> If your blood work comes back good, then that means you are probably getting enough nutrition from what you eat. However there are many types of blood work, and some do not detect as well as others. Your best protection is in your hands. Vitamin deficiencies are easy to prevent but very hard to treat. If you want to take that chance, it is all on your shoulders. So take your vitamins instead of waiting for and looking for a problem.

<Terra> I have a question about hormone levels in women. Not sure you can help with this or not. My dr. told me I have high testosterone level for a female, but that this surgery might be a way to lower that. Is that true. What is normal level of testosterone for women?

<Dr. Simpson> Well, labs have different normal and abnormal levels depending on the lab but with obesity, there is some higher testosterone, which can decrease with weight loss. So losing weight is a good thing.

<Angela> What is the most common complication for you as an individual surgeon?

<Dr. Simpson> I miss lunch when doing surgery -- that is my individual complication. Other complications include coming home late, and making rounds. Seriously - wound infections are probably the most common -- but still rare; and others include things like fevers in the first day or two because of lack of walking by the patient.

<Ronnie> Going for surgery in three weeks. Surgeon wants me on liquids only 1 one week before surgery. Do you know why they require this?

<Dr. Simpson> To decrease the size of the liver --- which makes it easier to do surgery and it will kick start your weight loss.

<kristi> i am 5 feet tall and 207 lbs my bmi is 40.7 am i a candidate for any weight loss surgery? oh i am 33 and female...ty

<Dr. Simpson> You are definitely a candidate for weight loss surgery, so make an appointment with a weight loss surgeon and start to learn about the procedures --- of course the best source of those is our first book: Weight Loss Surgery: A Lighter Look at A Heavy Subject- a 400 page book filled with the types of surgery, qualifications, how to take care of yourself after surgery, and all of that stuff.

<raspberrycreame> also i have quit smoking and was wondering why it takes so long for the nicotine test results to come back i am now 7 weeks smoke free

<Dr. Simpson> Don't know why the tests take so long, but sometimes they just do. But it is great that you quit smoking. Now it is time to start walking.

<Natalie> I had rny 3 yrs ago. I need a revision, so I am seeing another surgeon next month. What can I expect with a revision. Pouch revised or limb too?

<Dr. Simpson> If you need a revision, then you need to know why. There are a lot of reasons for a revision, and in a upcoming article in obesityhelp magazine I go through these. So get a subscription, and that article will be coming out soon. Good luck.

<may> what are the some of the cons to this surgery

<Dr. Simpson> The cons of the surgery -- besides the operative risks -- the need to really eat well after surgery (unlike before when you really, really need to) and looking so good your wife or husband will be jealous because either Brad Pitt or Jennifer Aniston will be asking you out. The cons are that this is a tool for weight loss - it is not the means to an end, but a tool to get you there. If you do not use the tool, it will not be a help to you. You still have to make good choices, but if you don't it won't do you any good. You need to exercise, and it will be easier after you lose some weight; and you will need to take vitamins, which you should probably do anyway. So it means you have to be responsible and accountable for the surgery to work well.

<Jen> I ordered your book and workbook, but what is the calendar/lanner?

<Dr. Simpson> That is a food diary divided into multiple sections --- it is for four months, so that you can see what you are eating, the effect of exercise, and see what your favorite foods are. That is what my patients use when they come to see me. It is easy to fit in a pocket, purse, or brief case. I use it myself, and it is quite helpful.

<Cris> I'm trying to decide which type of WLS is best for me. I have a BMI of 51 and tend to graze and crave carbohydrates. Do you have any suggestions?

<Dr. Simpson> There is no surgery that will overcome grazing -- you will have to learn to eat three meals a day. And in terms of carbohydrates, that is ok, because we need carbs, but you ought to learn to avoid processed foods, and highly processed foods. Instead focus on fruits and vegetables. Any type of WLS will work for you, but they all are tools which you have to work with. While there is some great stuff the first couple of years, you do need to use that period to make lifestyle changes. If you do not, then it will not be a good long term solution. However, even people who had weight loss years before find that they can get back on track, which is why we wrote our workbook for patients - Getting to Goal and Staying There: Lessons Learned From Successful Patients.

<michelle> I am a yr post and will be getting a tummy tuck soon should I increase vits and exercise to prepare myself for the upcoming surgery?

<Dr. Simpson> Vitamins are what you need, but not in excess. Exercise is always good -- go for it. Get those six pack abs.

<GREG 3 WEEKS POST> I have lost 48lbs. in 3 weeks. Is that too much and could that possibly happen every month my weight has went from 565 to 517 and Im a male and 27yrs. old.

<Dr. Simpson> That is not too much weight at all to lose for the weight you started at. So keep it up, and start walking more. Good luck.

<Moderator> Last question goes to...

<Rita> I already had my gall bladder out, many years ago and I have a long vertical scar. Will I still be a candidate for Laparoscopic surgery?

<Dr. Simpson> Yes.

<Moderator> Thank you very much, Dr. Simpson. We enjoy your chats every week. We all thank you and have a great weekend. Dr. Terry Simpson, Arizona Bariatric Center. Website: http://www.drsimpson.com/. Phone: 602-234-8995. Fax: 602-230-8344.

<Dr. Simpson> Thank you. Good night.

<Moderator> Night, everyone. Thanks for coming.