Dr.Sasse: Great question.  This is a challenging area for all of us.  First of all, congratualtions on what you have achieved!  You have undoubtedly immensely improved your health and well-being with the weight loss you have accomplished.  I wish there were an easy answer to your question of how to lose next 100.  While this field is evolving all the time, my current thought is that people can have the best success when all the best tools and techniques are brought to bear.  Medically-supervised weight loss programs, prescription weight loss medications, counseling, behavior modification therapy, fitness training, motivational coaching, dietary counseling, and even revision surgical techniques may all play a role.  The most important step is one you have already taken: you have identified your goal and written it down.  Now phrase it in the active voice, in a way that says you will do it.  "I will lose 100 more pounds."  Some behavior psychologists recommend you practice saying, "I have lost another 100 pounds, and I feel terrific." every day to reinforce the feeling you want to achieve.  We work with these kinds of goals in our center, and more such comprehensive centers are emerging around the country.  I would say that you may need some good professionals to help you achieve your goal, evaluate the possible effectiveness of all of the above techniques, but that you can do it.  Don't let anyone tell you otherwise.  Good luck!

Moderator: CJ, your question is up next.  Thank you.

Moderator: If you have just joined our chat, please submit your question now.  We have 15 minutes left in this chat.  Thank you.

lovdabluz64-: I had lap rny 1-29-05.  I lost 96 lbs the first year and nothing since.  I never  reached my goal.  In the last year I have gained 20 lbs.  I am getting weekly iron infusions, my ferritin level was 2.  I took my vitamins religiously, the doc said I am having an absorption problem.  When I get my blood straight will my weight loss begin again? They also did bloodwork last week to check for insulin resistance, any thoughts on this?
Dr.Sasse: Thank you for your question.  Firstly, great job losing 96 lbs!  The weight loss is good, but you would like to lose more, and this is possible, but never easy.  When weight re-gain occurs in the years following weight loss surgery, most of the time the best answer on how to lose more weight lies in the tough challenges of eating better, consuming less carbohydrates, changing ingrained behaviors, increasing exercise and muscle activity, and hard work.  Sometimes we are finding people who have lost the sense of restriction they once had, and we consider offering a surgical or endoscopic intervention in an effort to restore the sense of restriction and fullness that the person felt in the first year after their gastric bypass.  We usually start with an upper GI Xray study and a re-evaluation by our team to identify the best solutions. There are better and better medically-supervised weight loss programs available that can offer more tools including formulated diets, prepared meals, counseling, prescription drugs, coaching, support groups, and more.  To see an example, visit www.iMetabolic.com, and consider looking for something similar in your area.  With respect to the iron deficiency, you are not alone.  Iron deficiency is the most common nutritional abnormality seen after gastric bypass and is usually corrected with oral iron supplements, but can sometimes require iron infusions.  It is unlikely that your weight loss will resume if the blood issues resolve; instead the weight loss will require the kinds of hard work and professional help I describe.  Your commitment to it is the number one factor however, and you can reach your goals.  So don't give up.  Insulin resistance is common in anyone who is overweight and sometimes related to genes and polycystic ovary disease.  It usually improves markedly with weight loss.  It sounds like your doctors are working on the right things.  Best of luck to you.

cj: How safe is the surgery for someone over 60?
Dr.Sasse: Good question.  Generally the surgery is quite safe in the hands of an experienced bariatric surgeon, even well over the age of 60.  The risks do increase with age and, more importantly, with increased medical conditions.  Usually, the older we are, the more health problems there are lurking under the surface, so it is natural to expect the risks to increase with age.  Studies have identified high BMI as probably the most important risk factor, followed by age and male gender, for gastric bypass surgery. The best approach is to see an experienced bariatric surgeon in consultation who performs a range of bariatric procedures and ask him or her this question with respect to you specifically, after he/she has a chance to review your health and examine you.  In some cases a less invasive option, like the lap band may be considered; in some cases the risks are only minimally increased with age.  Overall, I would say that age is just one factor among many, and not the most important factor, determining the safety of bariatric surgery. You can profoundly lower your risks preoperatively by losing weight with a medically-supervised program, even for eight weeks. Good luck in achieving your weight loss goals. I hope this answer helps.

Moderator: Cjaguas2003 this is a moderated chat which means that you can not speak out of turn.  The doctor is already answering your question.  Please be patient.  Thank you.

cj: I understand some patients do not absorb the vitamons they are taking and have to go into the hospital for iv'. What percentage does this happen to?
Dr.Sasse: In our experience this kind of event has been a very low percentage, likely less than 1%.  Vitamin deficiencies can occur after gastric bypass surgery, so it is important to take the vitamins recomended by your surgeon and program, and be tested for the long term.  We have a program of long term annual testing of a large number of vitamins, and we do discover deficiencies.  But it is quite rare to require hospitalization.  I would add that it is increasingly recognized that overweight people planning to undergo bariatric surgery appear to have a fair amount of vitamin deficiencies even before surgery, so a few centers have begun testing for these preoperatively. The understanding of the importance of these vitamins is always changing and improving, so it is important to continue contact with the bariatric center over the long term. Several studies have shown that people live longer, healthier, higher quality lives after undergoing weight loss surgery than similarly overweight people who choose not to have surgery.  So these vitamin problems must be addressed and understood and kept in context of the overall risks and benfits of weight loss surgery. Good luck!

cjaguas2003: Why is it that everything makes me feel sick to my stomach when I eat, and it doesn't matter what it is cause everything does it
Dr.Sasse: Well, I am sorry to learn you are having troubles like that.  I am guessing that you have already had a weight loss operation and are looking for some generic advice about eating trouble afterwards.  I would say that it is uncommon to have such a tough time as you describe, but there are cases where people experience symptoms like yours, especially in the early days and weeks after weight loss surgery.  If the symptoms persist then it is definitely a reason to ask your doctor for help.  There are some conditions such as gastritits or ulcers that can cause symptoms like yours; alternatively sometimes a gallbladder problem, a stenosis or blockage may cause such symptoms.  The important thing is to communicate them clearly to your doctors and investigate the causes.  I hope you can find the answers and resolve the trouble soon.  Good luck.

Moderator: Dr. Sasse, is there anything else you would like to add before we conclude tonights Live Chat?

Dr.Sasse: Thank you very much for the opportunity to participate.  These were excellent questions, and it is an excellent forum.

Kent Sasse, M.D., MPH, FACS, FACRS
Medical Director, Western Bariatric Institute
Medical Director,  International Metabolic Institute
www.iMetabolic.com

Author of The Sasse Guide to Outpatient Weight Loss Surgery
visit www.SasseGuide.com

Moderator: This concludes our chat for today.  Thank you all for coming into today's chat room.  We are pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Surgeons to the WORLD as a resource for your questions.  Thank you again Dr. Sasse for your informative and insightful answers.  Good night and thank you once again.

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moderator: Hello and welcome to tonights Live Chat. We will begin shortly. Please ask your questions now since we take them in the order that they are received. Thank You.

moderator: Please note that our Surgeon hosting tonights Live Chat is Plastic and Reconstructive Surgeon Dr. Susan Downey.

Yvette-: What are the risks in having excess skin surgery? I had a very bad experience with my lapband procedure and am concerned about risk

moderator: from Dr. Downey....I am not sure what your bad experience was, but one thing important to remember is that patients that loose alot of wait actually have a lower risk when they undergo anesthesia then patients that are still heavy.

Andrea-: If you have excess skin on both you legs, arms and around your chin, can you have it all removed in one surgery? Is that dangerous? How long would be the recovery time?

Dr.Downey: Andrea - Often several procedures can be done at the same time . The decision on what can be done at the same time and how much depends on several factors - most notably the patients health and also how much skin and fat is to be removed.If the patient wants several procedures, i try to plan with the patient what can be done in about six hours. This is an amount of surgery that someone healthy can tolerate with minimal risk . if a patient is to have that much done I do recommend that they spend at least one night in an aftercare facility where they can be monitored.

Sheila-: I had my gastric bypass 8 months ago, have lost 95 pounds and have a GREAT deal of excess skin....I really hate it and am very embarrassed by the way I look....especially my arms. I still would like to loose another 42 pounds but am very unhappy with my arms.........I really do not want to wait.
Dr.Downey: ShielIa - Even though you want to loose additional weight you may want to consider doing surgey on your arms now. For some patients who have carried a lot of weight in their arms reaching their ideal wieght goal does not change their arms- you might need to undergo a staged procedure starting with liposuction and then doing the arm lift (Brachioplasty) six weeks to three months later. I would suggest that you consult with a plastic surgeon familiar with weight loss patients at this time. generally one year after a bariatric procedure - and about a 100 lb weight loss - is the ideal time to go for a consult with a plastic surgeon.

Susan-: I have excess skin on my
arms...............I was 305 am now 222. Is it time for surgery?
How much does it cost and how long will I be out? Must I go to the hospital?

Dr.Downey: Susan - It sounds like you are at the right time for a plastic surgery consult. Arm lifts unfortunately are rarely covered by insurance and the cost does vary according to region of the country. The surgery can ( in otherwise healthy individuals) be done as an outpatient. I would not expect that you would have to stay in the hospital but depending on how far from the surgeon you live and who will be able to help care for you , you might want to consider an aftercare facility for one night.

Francis-: I am contemplating both gastric bypass and lap band. Which procedure creates the most significant problems in terms of excess skin?
Dr.Downey: Francis - The amount of excess skin after weight loss is most dependent on the amount of weight lost and your own genetics ( much as some women have very little excess skin after preganancy and others have a lot, the same is true after weight loss). Exercise does seem to help the excess skin retract - so if you are not exercising start! It will help your weight loss and may help your skin retract. it will also help you recover faster if you do decide to undergo plastic surgery to remove excess skin.

Moderator: IM Thomas please ask your question again. Thank you.

John-: Does insurance cover the cost of excess skin procedures after weight loss surgery?
Dr.Downey: John - Unfortunately it has gotten more and more difficult to get insurance coverage for removal of excess skin after weight loss. If the patient meets ceratin criteria the abdomen may in some cases be covered. I have seen these criteriato be having a pannus (skin and fat) hanging down to mid thigh, having a rash which has not responded to prescrition medications and low back pain not improving with exercise or physical therapy. Howvever these are general criteria and you should check with your insurance company to see what their criteria are.

RICHELLE: Richelle Iam very upset with the hanging skin. After loosing 150lbs I had such a ugly body that I brecame so upset I gained 40lbs. I need help.
Dr.Downey: Richelle - You should be congratulated for having made yourself so much more healthy. There are surgeries that can help with the excess skin. I know it is difficult and expensive but I would try to find a plastic surgeon who knows about treating patients after weight loss and together you can make a plan to go forward. Your bariatric surgeon will probably be able to recommend someone in your area.

Chris-: I live in Kansas. How can I find a plastic surgeon that specializes in post bariatric skin removal procedures?
Dr.Downey: Chris - I would start with your Bariatric surgeon. he /she probably knows which plastic surgeons in your area have a special interest in post weight loss patients. Other patients , in your support groups etc are ofter good referrrals as well.

Moderator: imthomas I do not see your question. I just see you asking if we see your question. Please ask your question again. Thank you.

George-: I am now over 400 pounds and will be having gastric bypass surgery on April 1, 2008. I know I will have a great deal of excess skin after loosing so much weight-----my goal is 200 pounds. What do you think I will need in terms of excess skin removal. Please be as specific as possible.......will I need more than one surgery?
Dr.Downey: George - Most people who do loose over 200 lbs do have a lot of excess skin and fat. The first area that most people want to have addressed is their abdomen. This can be treated by either an abdominoplasty ( tummy tuck) or if the excess skin and fat goes all the way around, a lower body lift. If the lower body lift is done then this usually is the only procedure done. If the choice is an abdominoplasty then it may be combined with another procedure such as arm lift or breast lift. For many men an area of great concern is the chest. The male chest after weight loss may have a lot of hanging skin and some underlying fat. For men with just a litlle bit of loose skin and fat ultrasonic liposuction may be all that is needed. For men with a lot of skin it may be necessary to excise or cut away the skin as well. It is hard for me to specifically tell you what you will want or need but in general it does take more than one surgery : the 1st : abdomen or lower body lift 2nd ; Chest and /or thighs and for some the face and neck.

Bonnie-: I have now lost 125 pounds after gastric bypass. I want to have a breast lift and excess skin removal..I want to do all of this in one procedure. My general practice doctor says this is not a good idea, but I do not want to do this twice. What would you recommend?
Dr.Downey: Bonnie - the decision on whow much can be done in one stage depends on which surgeries are to be done and the health of the patient. In general six -eight hours is the maximun that I would try to plan in some one who is in good health. Make sure you are taking your vitamins as recommended by your Bariatric surgeon and eating your protein first to maximize your health. If someone has a low protein or low hemoglobin ( blood count ) surgery may not be ablke to be done at all until these problems are fixed. If you are in good health it is often able to combine procedures but again the six - eight hour limit is important.

Moderator: We will take one more question for Dr. Downey and then we will conclude this Live Chat.

RICHELLE: From Richelle I am so depressed at the way my legs look. They are like the Michialan tire man all Roll after roll etc.. After taking off allthat weight I should be able to show them off. Instead I have to make sure they are covered at all times. Lifes not fair. Plastic surgery is alot of money when you have to pay and your ins. company says its cosmetic. I have gained back 40lbs and angery with my self I know it is my own fault for the weight gain. But if there was a way people could get help with the cost of plastic surgery I think people would not gain back there weight. Its embaresssing. I cry sometimes.
Dr.Downey: Richelle - You have had some major life changes. I would think that it might help to talk to a professional to help you deal with all of these changes. I am sure your Bariatirc surgeon can recommend someone who is familiar with the procedure that you have had done. As far a s plastic surgery - if you live near a university with a residency program you may be able to get a lot of the surgery done at a much lower cost. I would recommend you check that option out.

Moderator: This concludes tonights Live Chat with Dr. Downey. Before we conclude, Dr. Downey is there anything you would like to say?

Dr.Downey: It was a pleasure talking to you tonight ., On my website DrDowney.com I have posted answers to many of the common questions patients have after weight loss and you can also send me an email thru that site if we did not get to your question tonight. Have a pleasant evening. Susan Downey

Moderator: Thank you for everyone who joined tonights Live Chat. A special thank you to Dr. Downey for hosting tonights Live Chat. Good night.

ladysplenda43: Are there any tests that can be done? Any other reason some
do not lose weight. I cannot get another doctor that will even look at her
because they did not do the surgery. Her doctor said it is she and not the
band. I have the same band I cannot believe she has not lost weight. It was
very easy for me.

dr.wittgrove: I do not like it when doctors say that it is the patient and
not the band failed. The band clearly takes different work to make it
successful. To say that the patient is at fault is going back to the old
concept that this is not a disease.  In fact, this is a disease and not
every therputic manipulation works.  The patient may need other therapy and
it is NOT the patient’s fault.  Just like the same drug can work differently
on two people.

ozlady1000: Hello all..

ozlady1000: good evening. I had RNY in Feb of last year. Now after a good WL
of 96 lbs, I have hit a very long & stubborn plateau. I am so discouraged.
What can I do to get back on track again; and is it normal for this to
happen?

dr.wittgrove: ozlady1000-Plateaus are very common. The main thing is to stay
the course and follow the directions of the program. Most programs are
equipped to deal with this problem. Support groups are also very helpful in
addressing this issue

ozlady1000: thank you. I was just searching for answers to see that perhaps
I am not alone.

2hot2u: hey beachmom

marciag1: I had a vbg in 1988.  It did not work.  What options are there for
me?  I have tricare.  It will not pay for a lap band.

dr.wittgrove: marciag1 VBG's failed in a high percentage of patients.  It is
reasonable to look to a revision. Revision operations are often quite
complex and it is important to select a skilled and experience surgeon. I
cannot comment on your insurance situation, as I just do not know.  Thank
you.

hart2hart: hi everyone, I am new to this, so I am just observing.

michelle: After 7 months, how do you beat the plateau?

dr.wittgrove: michelle Stick to your program and sometimes it is easy as
changing up the exercise routine.  Stay on the course and good luck!

Jennerdad3: Hello all

Jennerdad3: Its has been 5 years since my surgery I am afraid that I am
getting out of hand and may stretch the stomach. I have always felt that my
dr didn't spend much time working on the issue of why we put the weight on
originally.

dr.wittgrove: jennerdad3-to evaluate people who need either a revision or
simply to get back on tract is sometimes and it takes a lot of experience.
I would recommend seeking a consultation with a very experienced bariartic
surgeon. Your operation may be in tact; you may simply need some other tools
to combat your problems.

michelle: do you think that you can stretch a rny?


dr.wittgrove: michelle-The short answer is yes. But it really is a deeper
question and you must look at eating behaviors and how the operation was
done technically. If someone is struggling many years after the bypass, an
evaluation of the bypass is appropriate.

moderator: Max_yero.  We have started the chat and all is working on our
side.  I am sorry we cannot assist you with the difficulty you are facing
with your computer.  If you can read this, then I would suggest signing out
and back in again.  Thank You.

2hot2u: Dr.Wittgrove, as far as insurance goes, some of the companies offer
medical discounts on the surgery, is that a good route to go?

dr.wittgrove: 2hot2u-Sorry, I do not understand your question. Please expand
and we will try to get you in.

kmdladyluck: If insurance doesn't cover, how much is the surgery?

dr.wittgrove: kmdladyluck-The price depends on the individual programs for Gastric
Bypass.  The average for GBP is between 20-25K. The banding procedure may be
less depending on the program

angelic: Hi Dr. Wittgrove, I am 6 months post op RNY. Have noticed I get
hungry even after I have eaten. Am presently consuming 80 - 90 grams of
protein daily, and 64 - 72 oz. fluid.  Why am I hungry?

dr.wittgrove: angleic-About 85% of people feel an overwhelming loss of
hunger. About 15% still feel that sensation. At times, it is because of
their own psychology and sometimes it is from the way the operation was
done.  An evaluation is appropriate in these kinds of cases.

moderator: Jennerdad3.  Your question was already answered.  If you signed
off or stepped away from your computer, then you might have to scroll up or
down to view.  If that doesn't work, then you have to see your question in
our achived section that will be posted with in 48 hours.  Thank You.

Rogério_Abramo: Good evening. Are there any basic differences between males and
females about vitamin deficiencies after gastric bypass? Must they follow
the same program?

dr.wittgrove: Rogerio-Vitamin deficiencies are about the same for men and
females after GBP.  With menstruating females, the iron requirement is always
different.

moderator: Ladies and gentlemen.  This is a moderated chat.  This means that
your questions come to me in the order they are received.  If we did not do
it this way, then people would be speaking out of turn or not raising their
hand so to speak.  Please just ask your question and submit.  If we have
time, your question will be answered.  Thank you.

beachmom57: Thank you Dr.Wittgrove for all of this information.  There have
been some good questions answered.

Rogério_Abramo: Is it possible after gastric bypass follow a calorie
restriction with optimal nutrition (CRON) diet safely? It had a RNY in
july/2006. I’ve been on CRON since nov/2007. I don’t need do lose anymore
weight, but I eat about 1.200 cal/day, because a I feel better eating
little and think is more healthful. But I’m afraid of not been able to get
good nutrition, since I had a RNY.

dr.wittgrove: Rogerio-As long as you have a balance in your diet and are
taking your vitamin and mineral supplements, you should be doing fine.  Be
sure to follow up with your program so they can do the proper testing to
better insure that.

marciag1: I  had a vbg in 1988.  I have gained all the weight back and some.
Can a gastric bypass be performed?  Will insurance pay for it?

dr.wittgrove: marciag1-Yes, but this is a revision operation and therefore
there is more risk from complications.  Be sure to go to someone who is
experienced in revision operations.

max_yero: what is a vbg?? Anyone

dr.wittgrove: Max_yero-It means VIRTICAL BANDED GASTROPBASTY------this was
popular in the mid to late 80's but is not performed much anymore.  It has
some very significant technical problems and therefore the overall results
were not very good.  It is rarely performed today.

ozlady1000:  thank you for having these chats and your honest answers..

max_yero: thank you,good luck to all of us.

moderator: This concludes our Live Chat for this evening.  Dr. Wittgrove, is
there any last words you have?

dr.wittgrove: Thank you.  Your questions tonight were excellent. If you would
like more information about bariatric surgery please always visit
www.liteandhope.com  and our site www.lapbypass.com.  A belated Happy New Year
greeting to all of you. Thanks, Alan Wittgrove, MD.

moderator: This concludes our chat for this evening.  Thank you all for
coming into today's chat room.  We are pleased to host this unique
opportunity to bring our wonderful LITE AND HOPE Surgeons to the WORLD as a
resource for your questions.  Thank you again Dr. Wittgrove for your
informative and insightful answers.  Good night and thank you once again and
good night.

Moderator: Welcome to our live chat

Ilene : I had lap band surgery last year and have lost 95 pounds (I am still losing). My "flap" is really ugly. Can I have this removed while I am still losing weight or do I have to wait until I reach my target weight.... another 35 pounds.

Dr. Downey: : Ilene - The answer depends on several things - if you are still losing weight rapidly you should wait until the weight loss has slowed down or stopped. If your weight loss has significantly slowed or even stalled this may be a good time to go ahead and have the "flap" removed. Sometimes this will start the patient losing weight again.

Dr. Downey: : Connie - Insurance companies have come up with criteria to cover procedures that they consider reconstructive. Of course every insurance company is different but in general removing the excess skin and fat off the
abdomen is considered reconstructive if the flap hangs down to mid thigh, there is a rash that the primary care doctor cannot control and the weight of the flap is causing or aggravating back pain. Overall unfortunately insurance companies have become stricter over the last decade.

Dr. Downey:: Linda B- Usually I recommend that patients start discussing plastic surgery about a year after their bariatric surgery. By that time you will have lost a substantial amount of your excess weight and your body will have adjusted to the bariatric surgery. At that time you can discuss with your plastic surgeon what procedures you are considering and together you can make a plan for the future. There will be many things to discuss -and to plan!

samantha: Are there any special risks for patients that have diabetes? I have Type 1 so that I still have diabetes after having had gastric bypass. Does taking shots of insulin create any complications for me?

Dr. Downey:: Samantha- Diabetics do have increased risks for healing and infection with any surgical procedure including plastic surgery. However if your diabetes is under good control and your plastic surgeon works with your diabetes doctor you should be able to undergo the plastic surgery uneventfully.

Kim: Hi, Dr. Downey. Prior to surgery I weighed 331 lbs and I have lost 160 pounds in less than 8 months and needless to say, I have flabby skin on my upper arms and thighs. I have 40 pounds to go to reach my goal weight and it's been just 13 months since surgery. I have been told that surgery can be avoided by doing several things i.e. exercise (free weights) and eating liver. Do you happen to know if either of these is true or help in the least?

Dr. Downey:: Kim - I have not heard of this benefit of eating liver but I do know that it appears that the skin of patients who exercise does seem to retract more or better ( I do not have scientific evidence for this however!). In addition patients who exercise seem to do better (recover faster) than patients who do not exercise.

Jude: I am one year out after having Lap RNY. I've lost 110 pounds so far. Does the speed of loss have an effect on whether or not plastic surgery will be needed or is more related to age?

Dr. Downey:: Jude - The most important thing in determining how much skin will be left in a particular area is how much weight is lost from that area. For example some patients carried all their weight in their abdomen and had
always thin legs - these patients even after a 200 lb weight loss will not need a thighplasty Other patients carry their weight all over and of course have a different outcome. Skin will retract some on its own but after a
massive weight loss not all will retract - exercise will help. Age does not seem to make that much difference.

QUEENOFQUIET: I don’t have a belly button anymore since my tummy tuck. What can be done to get it back and how complicated is the procedure. Also, what is the cost?

Dr. Downey:: Queenofquiet - Do you have a midline scar or no scar down the midline? This will make some difference in what can be done. In either case there are procedures designed to reconstruct the belly button. The complication level will depend on several factors such as the other scarring on you abdomen. I do not know the cost off hand but it might be something you could see if your insurance company would consider reconstructive.

Barry: I am 29 months Post Surgery, I've lost 300 pounds and have had the first of 4 plastic surgery procedures. My insurance advisedme to let the loose skin almost turn dangerous before they would pay for any procedures. I honestly don’t want to risk my health to get them to pay for it. Is there any way to get around this?

Dr. Downey:: Barry - In my experience it has gotten very difficult to get insurance companies to pay for a lot of the plastic surgery procedures after massive weight loss. One recommendation would be to combine cosmetic plastic surgery procedures with other reconstructive or "necessary" procedures - these might include a hernia repair, varicose vein stripping (if covered by insurance) etc. This means you will be sharing the cost of the Operating Room and the Anesthesiologist with the insurance company, which will be less expensive for you.

nanners: I am 18 months out and have started looking into plastic surgery... My heaviest weight was 360 pounds and I lost 45 on my own and 146 from surgery... total of 191 pounds to date!!! Needless to say my skin looks awful... I've gone to a consultation but the quote given to me for everything I need done is like two years wages for me.... I knowinsurance companies don't cover this part of it... especially Kaiser, which I have... But are there other places I can go to get help? Are there any special programs?

Dr. Downey:: Nanners - This is a very difficult situation. First I would prioritize which procedures matter the most to you. You don’t need to get everything done at once much nice as that would be. Then talk to your Kaiser plastic surgeons - some Kaisers are now doing some post massive weight loss plastic surgery and I believe this would be less expensive for you than in the private world. Another consideration would b e to look for a University Plastic Surgery program - there you may find a way to have the plastic surgery done by the plastic surgery resident (supervised by the attending doctors) at a much-discounted cost.

konadiver: How can I find a doctor in my area that specializes in plastic surgery for bariatric patients?

Dr. Downey:: konadiver - I would first talk to your bariatric surgeon. He/she might have a good referral for you. I have also found that a lot of patients have found me thru chat rooms or other support groups - so ask your fellow patients.

Barry: Dr. Downey, have you heard or know of situations where plastic surgery costs were offset, by donating excess skin to a "burn unit"?

Dr. Downey:: Barry - Certainly it is a wonderful thing to donate your excess skin to help someone else. However there is no circumstance where the patient gets paid for the donation. This would actually be against the law - a law that was established to ensure the safety of our blood bank supply during the beginnings of the AIDS crisis.- to further answer your question - the MTF Foundation works closely with plastic surgeons doing post massive weight loss procedures and accepts donations of skin.

Sarah_Sarviss: I have surgery coming up next Tuesday, at what point should I start checking to see if any reconstructive surgery is covered by my insurance company - does everyone get sagging skin - or do some people 'ping' back in to place?

Dr. Downey:: sarah_sarviss - If your surgery is that close you need to talk to you insurance company and your doctors office right away about insurance issues. If your doctor thinks that some of the surgery might be covered then the process of approval needs to get started as it can take several weeks. It is almost impossible to ask for approval after the
surgery has been completed. Some people do have better resilience to their skin - this is mostly due to genetics although exercise does seem to help!

Kim: Dr. Downey, if a patient is in relatively good health, is it possible for them to have multiple procedures done at the same time i.e. upper arms, thighs, breasts or do these have to be done individually?

Dr. Downey:: Kim - It is indeed possible to do several procedures at the same time. Most plastic surgeons try to limit their time in the operating room to between 6 to 8 hours and will try to plan stages to fit within that time frame. When I first meet with a patient I try to establish their priorities as to which procedures matter the most to them and then together we come up with a plan for each stage. As to the timing in between the stages - I use the rule that the patient has to be back to their baseline standard of health before the next stage - this might be as early as 3 months but depending on many factors the whole process can take a lot longer. An example of a staging for a patient considering all the body would be (1) Lower Body Lift (2) Breast and Arms (3) Thighs (4) Face - but there are many combinations that can be done and of course not everyone want s or needs all procedures.

SHAWNA: I have lost 187lbs at Alvarado thanks to Carnies book. Surgery was in 2002. In 2005 I had a little girl but I gained 75lbs. I have lost all but 20lbs. how do you know if it is just loose skin in the tummy or if it is fat. If it is fat can it be removed in a tummy tuck or do I need to loose all the weight first?

Dr. Downey:: Shawna - After a pregnancy many things change, as you well know. There is both loose skin and fat in the abdominal area. I would make an appointment to see a plastic surgeon who can tell you whether you will get the result now or need to loose more weight - since your weight was put on due to a pregnancy you may now be carrying some weight in different distribution which may be amenable to liposuction in addition to the tummy tuck.

suzi: I have already had an extended abdominoplasty, but still have excess skin under my breasts. Is it possible to have that removed at the same time as having a breast reduction?

Dr. Downey:: Suzi - Yes it is possible to remove the excess skin under the breast as well as what extends from the sides of the breast at the same time as other breast surgery. In the past few years there have been some very exciting developments in plastic surgery regarding the treatment of the breast after massive weight loss and sometimes that skin and fat can even be used to augment the breasts instead of using an implant. Also I now incorporate the excess skin and fat lateral (to the side) of the breast and remove it at the same time when I remove the excess skin and fat of the arms (brachioplasty)

suzi: I am 2-1/2 years out from my RNY, and my insurance did cover my extended abdominoplasty. The doctor had to write a letter stating that it was a medical necessity as I was getting rashes and infections from the skin hanging down. I did have to pay up front, but my insurance has reimbursed me for the majority of the expense.

missy: I’m Missy I had Gastric Bypass July 19th 2006 and I have lots of hanging skin but when would be a good time to start looking into Plastic surgery, I have been on a plateau for months and Now I am up a few pounds from 288 to 180 now about 185.

Dr. Downey:: Missy - It sounds like you are at a good time to start looking into plastic surgery. In general I like to see patients about a year after their bariatric surgery to discuss what procedures they would like to consider. In preparation for you plastic surgery make sure that you are taking whatever supplements and vitamins your bariatric surgeon has
recommended, make sure your labs (especially protein and blood counts) are in good shape and start exercising if you are not already as this preparation will make the whole next stage go a bit easier!

Kimberly: After reaching my goal weight I have excessive cellulite in my
calves to the point I hate for anyone to see my legs. Is there any type of
plastic surgery to improve the look of my calves?

Dr. Downey:: Kimberly - We have made many advances in plastic surgery after massive weight loss but we still have a lot to learn. The calves are an area that is still difficult to treat. It might be possible that liposuction or actual excision (but of course this would mean a scar), or a combination of both procedures might give you the result you want but you
need to talk to your plastic surgeon about the options.

happygirl101: I read about a woman who had a thighplasty (is that the correct term for having the loose skin on your thighs remove???) and now she has lots of pain and can't run, when before even with all of her loose skin she was an avid runner. She wrote that she wished she had not had it done. Can you speculate what went wrong with her surgery and is it common to have complications such as this with thigh surgery? My thighs are heavy and I am sure I will be considering it...I am only 9 weeks post op lap RNY...

Dr. Downey:: happygirl101- I cannot speculate what happened to that woman - it certainly sounds like an extreme case. That said thighplasties (the removal of excess skin and fat from the thighs) have one of the highest rate of complications of all plastic surgery procedures after massive weight loss. As you approach your goal weight if you are considering a thighplasty you should discuss with your plastic surgeon the risks and benefits and determine in your individual case if the procedure will be right for you.

moderator: Dr. Downey is there anything you would like to add before we conclude tonight’s live chat?

Dr. Downey:: For any patient who has lost a significant amount ofweight there are many questions. It is important to get as informed as possible, ask questions before the plastic surgery and most important prepare yourself for the surgery by getting yourself in the best shape possible before undergoing the plastic surgery. I have answered some of the most common questions about plastic surgery after massive weight loss on my website www.DrDowney.com. Thanks it has been fun chatting with you tonight. Susan Downey MD

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events. Thank you again Dr. Downey for your informative and insightful answers. Good night and thank you once again.

Moderator: Welcome to our live chat

stella-: I live in Portland. I have an HMO and can't seem to get the doctor to think I need the surgery. I'm 4'11" 229lbs. He says my BMI is not high enough. How do I convince him?

Dr. Korman: You seem to be an appropriate candidate for surgery with respect to your BMI

sylvia: I have heard that if you have gastric bypass, it will cure type 2 diabetes. Is this also true with lap band surgery?

Dr. Korman: The lap band can resolve TYPE 2 but the percentage with LAP BAND resolving this is slightly lower

Jane-: is it possible to have weight loss surgery as an outpatient?

Dr. Korman: Jane-One can have Lap Band surgery as an outpatient, but now with Gastric Bypass but most GBP patients do stay over night

sharon-: It will be 2 years on 7/22 since my surgery. I lost over 100 pounds, but have gained about 40 pounds. I am really upset with myself. I do watch what I eat. But still seem to be gaining weight. What am I doing wrong?

Dr. Korman: Sharon-This is a function of the multi-disciplinary approach to post care.......exercise, nutrition and psychological support. Consult those professional in your program.

shakia: Hello doctor. I had gastric bypass about 16 months ago when I went in I was 235 now I’m 165 is that good or bad? I think I should've lost more.

Dr. Korman: Shakia-It would seem that you have done very well. Average weight loss is about 70 % of excess weight, and you seem to have done that..........congratulations.

Joy4765: I had lap band in Feb. of 2006 and rapidly lost 65 lbs. I lost my momentum and have stayed the same for 1 year. I haven't lost anymore for a year- had some fluid removed a month ago, because x-rays showed too small a hole and band was too close to junction. I'm to wait 6 weeks and come back - I guess they're waiting to see if the band slides down into place. If not, is this repairable or does that mean another surgery?

Dr. Korman: Joy-My understanding of your question is that the X ray revealed a slippage of the band. Removing the fluid is the correct first step. If the slippage does not resolve this way it is correctable by a repeat procedure to reposition the band.

Natalie: I am really struggling with my weight. I had RNY in 2004, I weighed 300lbs. My lowest was 205 and now I have regained 35 lbs. and climbing. My appetite is out of control and I don't know what to do. How do I get back on track. Should I consider a revision? HELP!

Dr. Korman: Natalie- First step to revisit the weight loss team at your program. Revisions are occasionally done, but this should not be your primary focus. The therapist on the team along with the nutritionist on the team should be consulted to deal with the issue of your appetite "being out of control".

bee: I am 4' 11 and weigh 345 lbs. What should my weight be if I have the gastric bypass? I mean what do you think is reasonable?

Dr. Korman: bee-Your ideal weight should be in the 120 pound range. You would seem to be an excellent candidate for weight loss surgery. The average result from Gastric Bypass would be 150 pounds. Good luck.

lynnema: I have developed a hernia post op. My insurance wouldn't cover the surgery and won't cover the hernia surgery because it is a side effect. I am trying to wait until 2008 to see if my coverage will change. How dangerous is it to wait? Can the hernia get bigger over time?

Dr. Korman: lynnema-I would think you should appeal the decision of your insurance company not to cover. You should not wait. The hernia may get larger and this may be dangerous.

Moderator: Please remember that if you are contemplating having Gastric Bypass Surgery or have had Gastric Bypass Surgery, you will be eligible for life Insurance through PRUDENTIAL. For details and information, please click www.liteandhope.com and then click on the LIFE INSURANCE BANNER BUTTON.

bee: Hi doctor, is it possible to go from 345 being almost 5ft to normal weight after gastric surgery??

Dr. Korman: bee-It is possible to loose 100% of excess weight though the average is a loss of 70% of excess weight. To perform better than average, you need to be very strict with our nutrition and exercise program

shakia: would it be possible for me to be on birth control without gaining any weight?

Dr. Korman: Shakia- You should check with your OBGYN on this as there are various oral contraceptives

Pamela-: I had surgery 7/12/07 and have lost 34 lbs so far but for the last 7 days I have not lost 1 lb. I am wondering if I am doing something wrong. Will I ever lose any more weight??

Dr. Korman: Pamela - Don't stress. There are often plateaus in losing weight...just be patient.

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.

Gracie: My mom recently had a gastric bypass, it will be 2 years in January. My mom also has lupus and arthritis. She has insomnia and almost eats nothing. She is also on a lot of different pain pills, ambien, and some other medications. Her medications seem to hit her faster and harder. After taking a pain pill she seems more affected than one should be. I am wondering if this is due to her small stomach or her lack of nutrition. She seems to be getting worse and my family is at a loss because her doctors tell us she is doing fine.

Dr. Korman: Gracie-With multiple medical issues, it is important to involve both the surgeon and the primary care physician on making a judgment on what is the best course of treatment. I suggest that you fully engage all of her medical professionals in making an assessment of the situation.

samantha-: Hello Dr. Korman, I heard that there is a new procedure that will tighten the pouch for patients who previously had gastric bypass surgery. If there is, how can I get more info to go about having that surgery? I had gastric bypass surgery on 3/04 and now find myself eating a lot more and have trouble keeping my weight off. Thanks for your time. Samantha.

Dr. Korman: samantha- It is true that there are new techniques and options for treating various post op issues. In fact, I am exploring some of these techniques in my practice. Of course, the most important issues are to assess if there is anything in your behavior (diet, exercise) that needs improvement and then to assess if the pouch anatomy is possible as well.

bee: Thank you doctor , but in your years of service have you seen anyone actually go down to their ideal weight? Losing 150 is GREAT! but if I can co down to normal weight after this surgery will be even GREATER!! So do you think it is something that can actually happen or am I just thinking too far ??

Dr. Korman: There are many patients that have achieved the ideal weight loss. It is like getting an A+ on a test. Hard to do but doable. You are NOT thinking too far ahead. There is no reason why you cannot outperform the average.

bee: After losing so much weight, how soon do you think someone should wait to have skin tightening?

Dr. Korman: Generally around 18 months after surgery.

Moderator: BARIATRIC MEALS…customized meals for all post bariatric patients prepared fresh and delivered to your front door. Go to www.liteandhope.com and click on the banner button on the top left side of the home page.

clm: It has been two years since my surgery. I am gaining my weight back. What do I do? HELP!

Dr. Korman: revisit your team at your program. They can guide you through the process. What you are experiensing is not unique. That is what the team is trained to address.

andrea: I am one year out and down 165 lbs. What is the best calcium to take?

Dr. Korman: The formulating should be a calcium citrate as opposed to carbonate approx 1200 mg per day.

Moderator: Dr. Korman, Is there anything you would like to say before we conclude tonight’s Live Chat?

Dr. Korman: It is common for patients post op year out to struggle. That is the reason we have a multi disciplinary team to address these issues. If you have any specific questions for me, go to my website www.labariatriccenter.com. Thank you

Moderator: This concludes our chat for today. Thank you all for coming into today’s chat room. We are pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions.

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events. Thank you again Dr. Korman for your informative and insightful answers. Good night and thank you once again.

Moderator: Welcome to our live chat

sandra-: Iam 65 and am having lap band surgery at the end of July. I know that I am older, but I want the rest of my life to be happier and healthier. I have not heard of older patients from anyone. I hope to lose over 100 pounds, is this possible in a year with a lap band? Do you do patients as old as I am?

Dr. Dahiya: yes, I have done several lap band patients of your age and if you stick with the plan and follow the regimen post lap band surgery I’m positive that you will meet your weight loss goal.

sylvia-: Dr Dahiya-I have heard that if you have gastric bypass, it will cure type 2 diabetes is this also true with lap band surgery?

Dr. Dahiya: Sylvia, yes, there's a good chance that it will go out completely or partially.

Judy: At your six month post op for RNY how much weight loss should be our target and how do we figure that out? thanks

Dr. Dahiya: hello, Judy! There's no set target but there's only an approximation of whatever excess weight you have at that time you lose per month of 10% of excess weight.

lea-: I had the Ruen Y Laproscopic By-pass surgery in August 2004 at 302 pounds, I only lost 75% of the weight, 110 pounds and have been stuck for the past 2 years at 200 pounds. I recently found a way of life called Kimkin, of pure protein, low fat no carbs, with emphasis on multivitamins and walking 30 minutes a day, and I have finally started to see the needle on the scale start moving southward again. It is sort of like Atkins but low fat. What is your opinion on this diet?

Dr. Dahiya: Lea, I personally do any medically supervised diet, however, protein based diets are known to cause weight loss. It seems like it's working for you. Without knowing more details about your bypass, it is going to be hard to give you specific so maybe you have to revisit your doctor and seek an opinion on him any revision or any other possibilities that may help you.

Judy: Does not getting enough protein slow our weight loss progress; and does it cause hair loss?

Dr. Dahiya: Judy, hair loss is a function of dieting which is forced by a procedure in the bypass patients and this hair loss usually last about 12 months or so. The reduced amount of protein or the amount of protein itself is not responsible for weight loss, your weight loss/gain is related to the intake of calories.

Lynne: I am six weeks out of surgery and have lost 28 lbs. The Vitamin B1, thiamine, comes in a capsule and has to be opened and put into food or drink. It is really nasty tasting. At this point can I just swallow the capsule?

Dr. Dahiya: Lynne, congratulations on your surgery, you seem to be doing well, but specific answer to capsule or otherwise should come to your physician since everyone has slightly different protocol to manage post operative issues.

chanda_o: Were you a gastric bypass patient?

Dr. Dahiya: Chanda, no I have not had any operation nor , medically, do I need it, but thanks for asking.

tina: I had the surgery 3 years ago & I have the worst case of gas! I can’t be around anybody its so embarrassing!!!

Dr. Dahiya: Tina, what specific operation did you have?

shakia-: I had my surgery done on April 17, 2006 I was 235 and now July 9, 2007 I’m 165 and I want to get to 150 but I’m not losing anymore weight what can I do to lose more weight?

Dr. Dahiya: Shakia, I hope you are doing the follow up with your doctor you are not still that far out of the bypass. Without knowing your BMI at the present time or any other specific, the procedure already appears successful. I hope and wish you will still lose 15 lbs but continue follow up with your doctor.

Judy: Does our body get used to the same exercises, and stop recognizing them for help in weight loss?

Dr. Dahiya: Judy, not to any extent that I am aware of, the only factor might be that depending on the amount of exercise you will develop some muscle mass and theoretically, it is possible that it may account to slightly less weight loss.

chanda_o: My surgery date is 9/5, is there anything in particular I should be doing to prepare?

Dr. Dahiya: Chanda, Good luck on your surgery and while you are waiting, try to lose as much weight as possible that would be good for your surgery as well as your recovery from the operation.

Lynne: I have been walking 30 minutes a day, but after 6 weeks I am noticing a lot of flab. What other type of exercise do you recommend and is the Curves program strenuous enough?

Dr. Dahiya: Lynne, good job for doing regular exercise, the flab maybe is the result of your weight loss and you can add exercises as they go along and as they come natural to you, also consult your doctor please.

babybecoat1: I am 2 weeks and 4 days post op and my incision I had rny still hurts feels like a paper cut is this normal?

Dr. Dahiya: babycoat1, your operation was not too long ago and it maybe a normal pain unless that you have any signs of redness, infection or fever, etc. in which case you should consult your doctor.

reneetierre: I had the gastric bypass 16 years ago & I have poor iron absorption, staple disruptions, weight gain. I would like to know if it's complicated to have the surgery for the stapling.

Dr. Dahiya: reneetierre, it looks like multiple questions are being asked. Iron absorption is always reduced after gastric bypass that is why you are supposed to be taking extra iron after a gastric bypass. Your weight gain maybe that you are failing the procedure and maybe a candidate for revision ( I don't know how much you have gained). I do not exactly know what you mean with staples disruptions and therefore, it is so hard to answer.

bmbutler: I am a 40 year old female beginning the gastric bypass journey. I weigh 228 with a BMI around 37. Co-morbidities. are knee and back pain (arthritis in knees), urinary stress incontinence, high cholesterol. I know every insurance company is different. Would I be a good candidate for GBP?

Dr. Dahiya: bmbutler, if your cholesterol problem is well established and you require treatment for it then medically, you are a candidate for weight loss surgery, I would not know as to what your insurance specifics.

kristi-: I just found out that I have gastric paresis and I was just approved for my Roux en Y. Would this surgery actually help with this condition or am I putting myself at greater risk by going ahead with the surgery? My understanding from my research is that sometimes the treatments for the gastric parasis is to totally remove the stomach so I thought maybe Bariatric surgery would actually help this condition as well as help with my obesity?

Dr. Dahiya: kristi, I have not had any patient with gastro paresis so I can't give you an answer from my practical experience. Theoretically, it should improve your situation. The other part of your medical history I don't know is if you are diabetic or not, if you are diabetic then gastro paresis related to diabetes would certainly improve.

Moderator: Please remember that if you are contemplating having Gastric Bypass Surgery or have had Gastric Bypass Surgery, you will be eligible for life Insurance through PRUDENTIAL. For details and information, please click www.liteandhope.com and then click on the LIFE INSURANCE BANNER BUTTON.

Christine-: I have lost about seventy pounds and would like to know how to really jump start my loss again. Should I just do protein shakes for a while?

Dr. Dahiya: Christine, I certainly do not have any specifics as to your surgery, what type and when you might have had it, I usually do not prescribe any protein shakes.

bmbutler: I have the medical policy from Empire Blue Cross. It does not specifically request a 5 year weight history. Is it better to submit it or leave it out? The reason I ask is back in 2002 my weight was at 215.

Dr. Dahiya: bmbutler, usually it is a good policy to send all your documents.

bmbutler: Thanks. Will do.

babybecoat1: I’m sorry but I was cut out of this when my question came up and I did not get your response

Moderator: Babybecoat1, the doctor already answered your question and you will not be able to scroll back if you got cut off. You will be able to come back to www.liteandhope.com and go to "Ask the Surgeon" Live Chat button and see your archived question and Dr. Dahiya's answer. Thank you.

Theresa: Do you know of any doctor who takes Medicaid for the gastric bypass surgery?

Dr. Dahiya: Theresa, for patients being referred to me with medical, I normally refer them to UCLA.

Julie: Joining in late---Can you recommend something to slow down hair loss? RYN 3/13/07

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.

Dr. Dahiya: Julie, in my experience there's no medication that makes any difference, it should stop by approximately 12 months after your operation.

Karen: Hi Dr. Dahiya, I had GBS one year ago and have lost 130 lbs. I'm a 32 year old, 5'3" female. I currently weigh 250 lbs. Will I still continue to lose weight and will I ever be within a normal BMI with constant healthy eating and exercise? I'm beginning to feel nervous.

Dr. Dahiya: Karen, the BMI higher than 60 sometimes do not reach their ideal BMI. If you continue your diet and exercise per your doctor's instructions you still should lose some more weight but it is a possibility that it may not reach at the normal BMI range.

Moderator: BARIATRIC MEALS…customized meals for all post bariatric patients prepared fresh and delivered to your front door. Go to www.liteandhope.com and click on the banner button on the top left side of the home page.

doug-: my hands and feet are constantly numb since my surgery, is this common?

Dr. Dahiya: Doug, that's a very specific complaint and your physician should know best, so I advice that you address it in your next visit.

Julie: What is your opinion on biotin?

Dr. Dahiya: Julie, it is supposed to help reduce hair loss. Since I have never use it or prescribe to my patient, I wouldn't have any opinion on it.

Julie: Is there a problem with staying at a low daily caloric amount? About 800-900 a day.

Dr. Dahiya: Julie, can we have any more details on your procedure or anything related to it.

brenda-: I am in the process of scheduling my lap band surgery. I was wondering how long before you can swim in a pool, lake or ocean after having laporoscopic surgery?

Dr. Dahiya: Brenda, this is a doctor's specific question but generally it should be a slow process where you should do one thing at a time and slowly. It should also depend on your progress after surgery and presence or absence of complications.

pamela-: 10 days after my y n roux bypass I bled out from where my new stomach and intestine was joined how common was that and do I need to be concerned it will happen again I am at day 18

Dr. Dahiya: Pamela, I’m so sorry to hear that had happened to you, but this are some complications that can occur from multiple reasons after the operation.

Moderator: Dr. Dahiya, is there anything you would like to add before we conclude tonight’s LIVE CHAT?

Dr.Dahiya: Thank you for the opportunity, I hope I have been of some help to the patients and I wish them all luck. For further questions, you could log on to www.doctorbariatric.com. Goodnight!

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events. Thank you again Dr. Dahiya for your informative and insightful answers. Good night and thank you once again.

Moderator: Welcome to our live chat

lynana-: I was just wondering... I am almost 14 months out... How soon can I start thinking about plastic surgery... I am definitely going to need it... My starting weight was 360... I lost 45 pounds before surgery and 137 since for a total of 182 pounds... It is really going be needed...

Dr. Houston: We generally recommend waiting until you have reached your weight loss goal and the weight has stabilized for 3 months.

Nancy_Johnson: How many surgeries have you done?

Dr. Houston: 500 gastric bypasses and 150 lap-bands and approx 30 revisions

brenda-: I am in the process of scheduling my lapband surgery. I was wondering how long before you can swim in a pool, lake or ocean after having laporoscopic surgery?

Dr. Houston: Usually about a week as long as all the incisions have healed.

jennifer-: I was wondering if Juice Plus could replace any of the many meds that a patient has to take before and after surgery? I have a potential JP+ customer who wants to take JP+ but only if it replaces some of the meds that she currently takes. She said that she has a hard enough time getting all that she has to take down so she's hoping that JP+ will replace a few. Thanks!

Dr. Houston: I would check with the dietitian at your program and see of she would allow it.

Kim: I am seven and a half years out. I feel tired and weak a large portion of the time. I have a lot of swelling in recent weeks. I have an appointment with a bariatric surgeon but it is a month away. Anything I can do to improve the way I feel and reduce swelling?

Dr. Houston: It sounds like you are protein malnourished and would recommend consuming > 80 grams of protein a day. I would also recommend getting into the office sooner.

Jenna-: I am 4 years post WLS. I am currently anemic but also have a gastric ulcer and iron pills cause me a lot of pain. How can I get my iron needs met without gastric pain?

Dr. Houston: The ulcer needs aggressive treatment with Carafate and a proton pump inhibitor. Until the ulcer heals nothing will feel good going down. If you smoke the ulcer will most likely not heal.

Kim: Is it typical for a post-op to experience watery bm's each time he/she visits the loo?

Dr. Houston: Only if you've had a malabsorptive procedure like the duodenal switch. Otherwise, the bypass and band are generally constipating if you stick to a protein diet.

kellie: I work with 3yr olds (10 to 1 teacher). How long would I need off from work (I also work in the office half the day?

Dr. Houston: Approximately 3 weeks with the lap approach.

mary: I have heard about people after gastric bypass whose anastamosis has enlarged and they are able to eat way too much and not feel full after meals. Subsequently they gain weight back. Is this common? And can it be fixed?

Dr. Houston: After a gastric bypass, the restriction may fade some over time and won't feel as restrictive as it was right after surgery. We teach people to live by portion control and not fullness. The surgery is excellent at hungry control and if you make the right choices it should work for you long term.

lea: I had gastric ruen y- gastric by-pass 3 years ago this August. I lost 100 pounds in the first year, but have not lost or gained a pound since. I am 5'5.5" tall, 42 years old, and 204 pounds, size 16. My first goal was the hundred pounds and my second goal was the last 50. I have been trying everything from working out to the only protein diet with of course tons of vitamins and supplements, but nothing seems to be working. I can't lose any more weight... any suggestions?

Dr. Houston: Go back to the basics and keep a food diary. I bet you are consuming more calories than you realize. I also recommend walking every day. I don't have a patient in my practice who walks every day and hasn’t lost every pound.

kathleen: How significant is your lifestyle i.e. going out to eat, holidays etc. changed after the surgery change. I am 100 percent committed to do whatever it takes. I am just looking to what it will look like down the road. I want to be successful.

Dr. Houston: I tell my patients that once the weight is gone you will pretty much be able to function normally in social settings. The only difference is that instead of eating bad 95% of the time, you will have to make the right food choices 95% of the time.

tania: Does Gastric bypass ever result in liver damage?

Dr. Houston: I guess there can be damage at the time of surgery and that is why we ask all patients to loose some weight before surgery to shrink the liver size. After surgery, the weight loss only helps the liver.

esther: I had gastric bypass the same year Carnie did (99). Has the FDA approved the lap band for people who have had gastric bypass? Is it possible? Very serious about this because I would do it if I qualify.

Dr. Houston: It isn’t approved for that indication but surgeons are offering it. The key to long-term weight loss is behavior modification not more restriction.

cathe: In stage 2 having trouble getting anything down, the smell makes me nausea, no vomiting, can drink tea, broth, can't drink cold due to an ulcer on the thing that hangs in the back of my throat. In tears, please help me

Dr. Houston: I would recommend you calling your surgeon’s office for assistance in the morning b/c you are going to get protein malnourished quickly.

allen: Can anything be done after bypass surgery if I am getting fat again.

Dr. Houston: You really have to get back to basics and keep a food diary. I suspect you have steered away from the tennets of weight loss surgery.....protein, protein, protein, water, and walking.

sherri: I am 130 lbs over my ideal weight. How much weight can I expect to lose with a gastric bypass or with the lap band?

Dr. Houston: All of it if you really work at it!

lea: Is it possible the surgeon didn't make the pouch small enough, or go down far enough on my intestine for me to lose all the weight I should have? I only lost 75% of the weight I should have and I have followed the surgeons, nutritionist, and psychotherapist and personal trainer's directions to a "T". And I can't seem to lose the last 50 pounds three years out.

Dr. Houston: 75% weight loss is excellent and any further surgery may have serious risks. I would keep up what you are doing to maintain you weight loss. I may be beating this up but you will be surprised about your calorie consumption of you keep a food diary. It doesn’t take too many foods to get in 1000 cal which is most peoples limit.

marie: When can I exercise after my surgery?

Dr. Houston: I let my patients start whenever they feel like it, but all surgeons are different. Please check with him/her first.

Dee: I am in my 50's, is that too old to consider a gastric bypass?

Dr. Houston: We have operated on people in their late 60's with great success, so the answer is no.

Nancy_Johnson: How much weight do I have to lose before having the surgery?

Dr. Houston: Nancy, I don’t put a number on it. I just ask patients to loose as much as they can by a high protein/low carb diet.

sherri: I am currently leaning toward a gastric bypass. I have been told two weeks before the surgery you go on a liquid diet. What kind of liquid diet is it and how much do you drink?

Dr. Houston: Sherry, most pre-op liquid diets are at least 64 oz per day and 60 grams of protein.

Kim: I am looking at having a revision. First surgery was a rny. What is my best option for successful loss of the remaining weight? (I was near 600 lbs at the time of surgery and have lost 300+ lbs).

Dr. Houston: Kim, we have offered a distal bypass to select patients in your situation and they have done well so far. It isn’t a hard surgery but it does create malabsorption and all the potential risk with that type of surgery. You are to be congratulated on your fantastic weight loss!!

Jaymielynn: What are the long term effects of the lap-band and does it have to be replaced years down the road?

Moderator: Please remember that if you are contemplating having Gastric Bypass Surgery or have had Gastric Bypass Surgery, you will be eligible for life Insurance through PRUDENTIAL. For details and information, please click www.liteandhope.com and then click on the LIFE INSURANCE BANNER BUTTON.

Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.
BARIATRIC MEALS…customized meals for all post bariatric patients prepared fresh and delivered to your front door. Go to www.liteandhope.com and click on the banner button on the top left side of the home page

Dr. Houston: The long-term effects are permanent weight loss. The only band that have to be removed are those that slip or erode- approx. 3-5%.

marie: Will I have to see a Physical therapist after surgery to help with any strengthening that might need to be addressed after surgery?

Dr. Houston: An exercise physiologist is more appropriate and should be a part of any comprehensive program.

Judy_: Yes Congrats Kim!!!!!!!!

Judy_: How many grams of protein post op RNY should we have a day?

Dr. Houston: Judy, we recommend 60 grams of protein on average per day.

Judy_: Some doctors and nutritionists say 50-60 some say 75-100 why the huge difference??

Dr. Houston: If you eat more protein there is less room for carbs I guess? Some may recommend more b/c most people will get in less than the recommended?

marie: Can you have caffeine, coffee, splenda etc. after surgery?

Dr. Houston: We don’t recommend any of the above. Caffeine is dehydrating and causes highs and lows throughout the day that can be mistaken for hungry. Splenda acts just like sugar and actually has 4 cal per serving! It causes cravings just like sugar.

Moderator: Dr. Houston is there anything you would like to add before we conclude tonight’s Live Chat?

Dr. Houston: Thanks for everybody's interest and good luck with your weight loss journey!!

 

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.

Dr. Carlos Carrasquilla

A South Florida resident for more than 30 years, Carlos Carrasquilla, M.D., F.A.C.S. is secretary of the medical staff and Director of Bariatric Surgery at Florida Medical Center, having previously served as Chief of Surgery and Chief of Staff. He is also Director of the Florida Center for Surgical Weight Control, P.A.

Dr. Carrasquilla is a recognized expert and surgical pioneer in the field of Bariatric Surgery who specializes in the laparoscopic gastric bypass and in the laparoscopic adjustable gastric band (lap-band) surgical techniques.

Moderator: Welcome to our live chat

Pam-: I've gained 62 lbs since my surgery in 2000. What can I do? What about a revision? Is that possible?

Dr. Carrasquilla: Pam, Yes a revision is possible, but you should return to your surgeon's support group for advice. He can review your diet and possible psychological problems.

alisha-: I just had the bypass surgery and was told that I am supposed to eat 4oz meals 3 times a day. Years of dieting have always told me small meals thoughout the day, and I seem to get so hungry. Would it be wrong if I had 2oz meals 6 times a day?

Dr. Carrasquilla: Alisha, you can eat 6 small meals, you should be eating 80% protein at this time for six months.

roxanne-: I am 34 years old and weigh 310. My question is that I don’t have high blood pressure , diabetes or cholesterol but what I do have is really bad varicose veins my right leg is the worst the doctor has a term for it thum... somthing I keep forgetting the name and my leg is getting worse day by day do you think my insurance will cover it? And yes, I’ve tried every diet none to man

Dr. Carrasquilla: Each insurance policy is different; you have to check with them. It should cover the procedure.

nahna-: Is it possible my operation wasn’t done properly? It did not work for me 3yrs out, lost 98 gained back 35. Pouch was never shrunk. What can I do now? surgery is out. Thank you

Dr. Carrasquilla: Surgery is a tool to help you lose weight. You did lose 98 lbs. that is good. You should return to your surgeon so he can re-evaluate your situation.

Patricia: hello everyone...I had a question...I am over one hundred pounds my desired weight, but there are three builds to consider...other than BMI, how do I know what my "true" desired weight should be as I a m 5'4"

Moderator: Patricia, Please tell us what you weigh.

Dr. Carrasquilla: Patricia, I'm sorry but I don't understand your question. Please rephrase your question and we will come back to you.

Kenya60609: I am on a diet on my own losing weight but I caught the flu and gained all the weight back plus 10 more. I am very scared and now I hurt my knee so I can’t exercise like I use to. I was considering a gastric bypass but then I lost my job and on top of all that so I don’t have insurance so what can I do? I am in Chicago Il and I am desperate.!!!!! Please help me!!!!!

Dr. Carrasquilla: Kenya, got to the liteandhope.com web site. They will guide you on financial assistance.

JJ-: I have a BMI of 45, I am 52 years old with high blood pressure and type 2 diabetes. I also have MS, can I still have gastric bypass surgery?

Dr. Carrasquilla: JJ, with a BMI of 45, you qualify for a gastric bypass.

hands1015: I had gastric bypass surgery March 1st of this year. I have had difficulty, had my run of tests; everything is okay knock on wood, but I struggle with food. I wasn't able to hold food down for 18 days and wanted to know is this common among patients in the beginning stages? I also exercise daily and have hit a plateau; will I start to lose weight again?

Dr. Carrasquilla: Hands 1015, several problems could cause the difficulty with keeping food down. If you are still having problems, you must see your surgeon for this. Plateaus often happen on a temporary basis.

Moderator: BARIATRIC MEALS…customized meals for all post bariatric patients prepared fresh and delivered to your front door. Go to www.liteandhope.com and click on the banner button on the top left side of the home page.

Patricia: I am looking at insurance charts that state a certain height and weight and three builds, small medium and large frame. How do you know if the BMI is correct as I have read that some athletes would be considered obese using the BMI system. I am thinking I am a large build as I cannot place my hand around my wrist....

Dr. Carrasquilla: Patricia, Clinical judgement of the bariatric surgeon is very important to decide if you are an atheletic person or an obese person. You should be personally evaluated.

andrea: I had my surgery Oct 2007. My starting weight was 273 now I'm at 230 .Why is my weight coming off so slowly? I have been at 30 for 3 month now. Also when I had my surgery I had a clamp put in is that so the stomach won’t grow back to it's original size???

Dr. Carrasquilla: Andrea, Depending upon the type of surgery you had, your weight will come off slower or faster. For example, gastric banding will lose the weight much slower than with the gastric bypass.

Moderator: Please remember that if you are contemplating having Gastric Bypass Surgery or have had Gastric Bypass Surgery, you will be eligible for life Insurance through PRUDENTIAL. For details and information, please click www.liteandhope.com and then click on the LIFE INSURANCE BANNER BUTTON

HRR: Does the gastric bypass effect the amount of coumadin a person needs, in other words, is the dose usually higher after surgery than usual?

Dr. Carrasquilla: HRR, the dose of coumadin should not be affected by the surgery.

Joanne: I am 56 years old, 5'2", 146 lbs., down 88 from a high of 234. I would like to lose 12 more lbs. It's almost a year now. How many calories should I be eating? Thank you.

Dr. Carrasquilla: Joanne, I think you are doing well. Try to up your exercise and keep carbs to a minimum.

hands1015: Is it common to plateau so early after surgery?

Dr. Carrasquilla: I suggest you keep a month diary for your food intake and have it evaluated by your doctor or dietician. It is early to plateau. You may not be aware of the calories you are taking in.

Moderator: Please remember that if you are contemplating having Gastric Bypass Surgery or have had Gastric Bypass Surgery, you will be eligible for life Insurance through PRUDENTIAL. For details and information, please click www.liteandhope.com and then click on the LIFE INSURANCE BANNER BUTTON.

Ronda: Hi Dr. I had LapBand 5 years ago, and have a problem since the beginning with terrible reflux each time I get a fill. Now I’m going to have the Band removed and have bypass. What are the chances of still having problems with reflux?

Dr. Carrasquilla: Rhonda, I think you are doing the correct thing in having it removed. The reflux will depend on the conditions of your stomach.

jency-: I see that this website is advertising special home delivered meals from ZONE CHEFS for post bariatric patients. Have you recommended these to your patients and have they been happy with them?

Dr. Carrasquilla: Jency, This is a new program for us. We are very excited about it and look forward to getting more information. We will be announcing this new service at our next support meeting.

jamie: Is it possible to have gastric bypass surgery after having an unsuccessful lap band procedure? My lap band has not worked and I really am confused on what I should now do. My BMI is 46 and I am 42 years old.

Dr. Carrasquilla: Jamie, We do perform gastric bypass surgery on previous lap band patients. This is possible on most patients.

Moderator: Paralee. If you have just signed on, you will not see prior questions. You will have to go to www.liteandhope.com and click on the ASK THE SURGEON button and look up the archived chat. It will be posted with in 48 hours. Thank You.

konadiver: I have had type 1 diabeties for 25 years, I am currently 280 lbs and I have just sent in my application. Have you had success with patients with type 1?

Dr. Carrasquilla: Konadiver, most of the time Type II diabetes is correctable and Type I diabetes may improve.

Moderator: Please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.

Paralee: Hi Dr., I had DS 5 years ago (Dr. Kim in Mississippi) and have done well, however, have recently gained 15 lbs. I thought with the DS I was home free

Dr. Carrasquilla: Paralee, Surgery for obesity is a tool not a cure to assist you in behavior modification. Just having surgery does not make you "home free". It puts you behind the wheel of the car, but you still have to do the driving.

andrea: I had the gastric bypass where they cut almost at the top of the stomach and again at the clamp so that the stomach won’t grow back to it's original size??? And for almost 3 months now I haven't lost weight

Dr. Carrasquilla: Andrea, the fact that yours stomach is smaller lets you eat less food, but not necessarily less calories, you have to be careful what you eat and drink. You should be re-evaluated by your surgeon and dietician to see way you are having this problem.

Moderator: Dr. Carrasquilla, Is there anything you would like to add before we conclude tonight’s Live Chat?
Dr. Carrasquilla: If it looks like you need some guidance and if you have a support group, please attend, if you don't, try to create one. We are in the Ft. Lauderdale area and if you are in the vicinity, please feel free to attend our support group.

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.

Carnie Wilson

Carnie's own bypass procedure in 1999 was the first to be shown live on the internet, and she became an inspiration to many who were considering the surgery. Today, years later, Carnie Wilson is 125 lbs. lighter and is a new mom.

Moderator: Welcome to our live chat

lori-: I have not had the weight loss that others have had and I am far from my goal, I am 3 years post-op. Is there a way to jump start my weight loss without having a revision ? I am exercising as much as I physically can

Carnie: Hi everyone!!.... Let me start with the question from Lori...

Carnie: SO.. Lori, at three years post op, you will be definitely eating more and may have even reverted back to some older habits ... like snacking on carbs, not drinking enough water and not eating your protein first at meals. You need to see how much you are eating at meals and do NOT drink liquids with your food. This pushes the food out of your pouch and then you will not only stretch your connection (which keeps the food in your pouch and feeling full), but you will eat more at mealtime.. more calories!!!!

sheila-Canada: Hi Lori, I had my WLS May 5 2005 and I've only lost 70 pounds and I feel the same thanks for asking this question. I am also type I diabetic on insulin...

cam-: How do I lose weight again. I lost 105lbs after doing the surgery 2001 from 255lbs. Now I am 200 again, I really need help and feel so lost. Please HELP ME

Carnie: CAM-don't get discouraged. First of all, you are better off then before. I sort of addressed this in Lori's question, but weight gain is really becoming an issue for many post op patients. There are four basic rules to follow to lose all of your weight and keep it off: 1. protein first at meals 2. Exercise at least three times a week for 30 minutes (at a good pace!) 3. No snacking and if you do, only solid protein 4. At least 64 oz. of water every single day. Sweetened waters like crystal lite and Propel, iced tea and coffee do NOT count. No sodas in place of water either.

Carnie: Part two for Cam: Alcohol is a biggie.... pure sugar and also leads to snacking. Bad for our livers, too. The alcohol goes STRAIGHT to our bloodstreams and livers. NO more than 3 drinks per week. Take an honest look at your patterns over the last three years and I can guarantee you that you have fallen off the wagon in terms of compliance. Don't beat yourself up for this. Just start with the water (we pee out our fat) and cut down on snacking and you'll instantly lose. PROMISE. Write your food down, too.

Cira_Saget: When does someone start developing transfer addictions? Is it usually when you are more than a year out or before? I am 6 weeks post op.

Carnie: Cira_Sagat- time will only tell. I can tell you this. You need to know who you are going into this surgery and changing your life as a GB patient. If you have an addictive personality to begin with , it is crucial for you to monitor your behavior and stay in support groups so you are honest at all times. Share your feelings with people and even get therapy to deal with your issues before and after surgery. Your history does not erase. You are creating a new life for your health, but this is going to be a challenge for you mentally. Things will be different. You wont be able to binge. Food will take on a new meaning. Your body will radically change. Big changes can create some anxiety and new feelings that you are not used to. People will treat you differently. You will have new confidence. You might even have feelings of guilt or feel awkward. It's totally normal. But to really answer your question about cross addictions.... if you start doing anything else too much..... drinking, smoking , shipping, sex whatever it is.... just be aware of it and if it becomes a problem: GET HELP. I did. I started to drink too much and that opened up a painful part of this journey for me.

Carletta: I sometimes get a vasovagal response and at times I pass out or nearly pass out as something passes through my pouch. I am 6 yrs post-op. Can you explain this response so I understand what happens, physiologically. Thank you.

Carnie: Carletta_ I haven't heard of people passing out when they are eating. Dumping syndrome can make you super tired and you might even take a little nap.... but you might be taking too big of bites and not chewing enough, then getting some anxiety about the food passing through. This is a question for your surgeon and you should handle this immediately. Good luck!

joanne: Carnie, I am almost 11 months out with 10 more lbs. to lose. I seem to be at a stand still. Can I still expect to lose more weight and if so, until when? Thanks.

Carnie: joanne- Congrats on your weight loss. You have hit a plateau. Normal!! The way to get over a plateau is to exercise harder (sweat more, do more cardio) and drink a TON of water. 30 ounces of water a day is only enough for your kidneys to even function but you will see an amazing result in weight loss if you increase that water to 64 oz. or more. IT WORKS. you have done really well. Keep it up.

sheila-Canada: carnie do you mean animal protein or non animal - what does solid protein snacks consist of?

Carnie: Sheila: Good question. Food can get so boring and repetitive. As GB patients, there is some element of fear when we eat food. Certain foods make us feel a certain way depending on how far out of surgery we are. Solid, bulk protein such as chicken, turkey, steak, fish, eggs, tofu, and soy are wonderful ways of getting really good protein. The advantage of eating solid protein is that you are full, satisfied and it doesn't mess with your sugar levels like carbs do. You will be hungry a lot faster after eating a carb versus a protein. Fiber is very important too. Read labels.

Cira_Saget: Thank you so much for your advice. I don't believe I have an addictive personality but since I am addicted to food I wonder if I will go through that. I am in counseling and I go to monthly support groups. You are an inspiration thank you!

Carnie: Beef jerky and string cheese, or a little all natural peanut butter is a good alternate snack.

sharon: Hi Carnie! So glad I finally made a chat with you. I have so many health problems that I was told I would never make it through this type of surgery. Do you think that second and third opinions are smart?

Carnie: Sharon: Health problems come with obesity and morbid obesity. The purpose of having WLS is to eliminate the co-morbidities associated with the disease. It’s not to "get skinny". It saves lives. However, like any surgery, there are risks. Each individual is a separate case. It all depends on your health at the time of surgery. Most patients have problems with hypertension, breathing, diabetes, circulation, gall bladder and much more having surgery. All of these problems go away after surgery. But there is certain criteria for having the surgery in the first place. I do wish you the best of luck! Keep searching and praying.

sharon: Thank you very much Carnie and Moderator!! You guys are great people!

Moderator: BARIATRIC MEALS…customized meals for all post bariatric patients prepared fresh and delivered to your front door. Go to www.liteandhope.com and click on the banner button on the top left side of the home page.

Pat615: Sorry I'm late, I had my surgery 5 years ago and was just diagnosed anemic, doc says my body is not absorbing iron but my 12 is fine, haven't had an injection for over a year, why does this happen? I'm so tired all the time, taking double doses of Flintstones vitamins that's what the doc prescribed. Thank you

Carnie: Pat: Good question and I am sorry about your iron. Most people who become anemic did not take iron , skipped lots of iron for periods of time and/or took the WRONG kind of iron. Iron from Ferris Fumerate is the kind you need. When we lose our iron stores its very hard to get them back. But it's possible. Each patient (no matter how old you are) needs routine blood work once a year (after you are one year or more post op) and your doctor should be checking all your iron stores. FULL iron panel testing. Also, test your vitamin D, A and your B12. Calcium should be from Citrate, not Carbonate, and it should be taken separately from your iron.

Carnie: Being tired is a symptom of being anemic. Always check your levels and never assume you are getting enough if you do feel symptoms. Shortness of breath is another (if you are at a healthy weight).

Moderator: That was the last question....Carnie would like to add some comments before we conclude tonight’s chat.

Moderator: If you would like to see a broadcast of Carnie's Infomercial, "Lite and Hope", please visit www.liteandhope.com and click on BROADCAST SCHEDULE. Please note that you will not see it up today due to the LIVE CHAT page up at our home page. Thank you.

joanne: Carnie, you, too, have done amazingly on your weight loss and keeping it off! I really enjoyed you on Celebrity Fit Club. You were a true leader! I also like watching your infomercial, but never know when it's going to be on. I live in Orange County, California; do you know when it will be on again in my area? Thanks.

Carnie: Just an update for you all... it's great to be here and I love you all. My daughter turned two... she's a dream and is probably going to be a singer!!! She's fabulous. Motherhood takes up a lot of my time (and sleep). I am recording a Christmas album and writing a book about addiction!!! I am doing voice overs on TV for all the Tide and Johnson and Johnson Baby commercials. An Internet cooking show for me is also in the works. I am struggling with 30 pounds that I have gained back. I go up and down the same 10 for a while now. I have to practice what I preach and what has worked for me in the past. Be well everyone and thanks for joining. Remember that this is such a gift. Be grateful and positive!!!

Moderator: If you would like to see a schedule of Carnie's infomercial, please go to www.liteandhope.com and click on the link that says BROADCAST SCHEDULE. Please note that you will not see it up there today due to the Live Chat page. Thank you.

Moderator: This concludes our chat for today. Thank you all for coming into today’s chat room. We are pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Carnie Wilson for your informative and insightful answers. Good night and thank you once again.

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.

Moderator: Welcome to our live chat

michelle-: I had my gastric by pass done 11 months ago. I was 326 before surgery now I am 210 I have been stuck in 210 for the past month does that mean that I am not going to loose any more weight?

Dr. Marema: Michelle, it does not mean that you aren't going to lose any more weight. The last pounds are always the hardest to lose. Are you compliant with your exercise, diet, and supplements as well as avoiding drinking while you eat? Maintaining your metabolism through exercise is crucial to success.

Andrea: What veggis are good to eat?? I love to eat cauliflower and green beans with garlic salt and pepper is that ok? I hade my surgery 3rs ago and have a baby 7 month old

Dr. Marema: Andrea, typically the vegetables that are deepest in color are the best for you. Keep in mind that you want to lean towards lower glycemic (sugar) vegetables and avoid the higher ones like corn, peas, and potatoes. Green beans, cauliflower, spinach, kale, broccoli, collard greens, and lettuces are great choices.

Kourtney-: I was wondering what your experience has been with post ops developing reactive hypoglycemia after a RNY? My BS will drop anywhere from 20-50 after a meal, and it doesn't matter what it is. I have had episodes after eating a plan salad. Precose isn't helping. And I have gained back 60# since developing this. Do you think some type of revision would correct this? I have seen an endocrinologist, they don't know much about the surgery.

Dr. Marema: Kortney, your weight gain concerns me. Are you eating a meal in response to the blood sugar, thereby increasing your meal frequency? If so, this habit should stop. It is important to avoid high glycemic foods such as starches and simple sugars. Make sure that protein is the main component of your meal. There are rare conditions of the pancreas that can lead to hypoglycemia. It is important to speak to your bariatric surgeon about this for workup.

Andrea: Are rice cakes ok to eat? How many a day is it ok to have?

Dr. Marema: Andrea, I would not recommend rice cakes as a part of your diet. They are high in carbohydrates and low in nutritional value.

byoung: You mention supplements---but how do I know what to take? Everyone has a different opinion.

Dr. Marema: byoung, there is no question when you ask the experts in bariatrics that supplements that are formulated FOR bariatric patients are the best. Simply taking a vitamin won't work if it is not bio-available or absorbed by your body. With the newest studies showing links to low vitamin intake and weight gain, I am even more of an advocate. I have used Building Blocks vitamins exclusively with my patients for many years, and these I feel are the best. There are devastating consequences of not being diligent with taking the right vitamins and supplements.

Melting_Mama: I had GBP/RNY three years ago this week. I'm having very severe hypoglycemic reactions (haven't been DX'ed) and neurological symptoms such as "gloved-hand" numbness and "floating head." Does this sound like nestidoblastosis or Wernickes'? Where do you suggest I head now? (I've already seen a neurologist who has suggested "atypical migraines." I need more answers. I'm a danger on the road.)

Dr. Marema: Meltingmama, First I would urge you to get on bariatric vitamins immediately. There are vitamin deficiencies such as the B vitamins that can cause neurological symptoms as you are describing. Secondly, nestidoblastosis is a possibility. I would suggest an endocrinologist or bariatric surgeon for this workup.

Kristen Daniel: What is your opinion of the sleeve gastrectomy vs. the Lap-Band, in terms of long-term weight loss and maintenance? What percentage of excess body weight can I expect to lose?

Dr. Marema: Kristen Daniel, My opinion of the sleeve gastrectomy is that it appears to offer weight loss approximating 2/3rds to 3/4 excess weight loss at one year. The downside to this procedure is that we don't know what to expect with weight loss long term because it hasn't been studied long enough. When compared to the lap band, in our early data, it appears that the sleeve gastrectomy appears to have more predictable weight loss in the first year. We are hoping it will hold, but this is unknown.

Michele: Good evening, Dr. Marema. I live in the Orlando area and am currently working on gathering all the documentation for your Celebration office for insurance approval for bariatric surgery (I have completed the 6-mo. dr. monitoring requirement). I have a BMI of 50-52 and moderate sleep apnea, joint and back pain, and GERD. Otherwise, no diabetes, cardiac or blood pressure problems. Would you be able to determine which procedure might be the best surgical procedure for me to consider?

Dr. Marema: Michele, because sleeve gastrectomy is not yet covered by insurance, we are talking about the band vs. the bypass. When making this choice, we have to consider your personal preferences for resolution of diseases and risk tolerance, as well as lifestyle changes. It has always been shown that the gastric bypass induces more weight loss than the band. It does however have slightly higher risks.

Andrea: I am sorry, I'm the one that eats lettuce like crazy with lemon juice. I forgot to tell you that I drink sometimes 5 to 7 bottles of water of 0.9 fl oz a day but I don't go to the bathroom that much or lose weight. Why is this?

Dr. Marema: Andrea, Actually, 56 oz of water per day is only half of what I recommend to my patients. During weight loss, the body is in a state of dehydration, which is why you don’t urinate that, much. Drink more. While lettuce with lemon juice isn't bad, it is a food, much like the rice cakes that you can eat a lot in volume and get little nutrition from. Focus on protein and I bet you will lose again.

Andrea: my surgery was 3yrs ago from 395 down to 235 that size 36 down to 12 was very good for me, but I have a 7 month old baby and gained 50lbs. I can't have meat, fish or chicken. I can only have veggis or salads, but I was thinking of going back with protein drinks to make up for the foods I can't have. i'm done with my prenadol vitamins and I was thinking to take one a day women vit. what do you suggest?

Dr. Marema: Andrea, please read my previous post regarding the necessity for bariatric vitamins. As for your nutritional concerns, you must find a way to eat protein. Make sure the meat is very moist and cut into small bites. If this doesn’t help, you should see your surgeon. There may be an anatomical cause. Protein shakes are good, but you also need to be able to eat meat.

byoung: I never heard of Building blocks, where can I buy them? My surgeon told me that I would be OK with 2 children’s chewables, but I have found that my energy level is not what I had hoped even after losing my weight.

Dr. Marema: byoung- www.bbvitamins.com. While I am aware of surgeons recommending children’s chewables to their patients, I do not agree with this. After all, they are for children, not bariatric surgery patients.

jean-: I was born with TYPE 1 diabetes. I know that gastric surgery can reverse type 2 diabetes........will having the surgery help me with my condition?

Dr. Marema: Jean, It is unlikely that a gastric bypass will reverse type 1 diabetes completely. I have seen dramatic improvements in blood sugar control as well as medication needs with type 1 patients having a bypass.

shirley-: How do we go about getting insurance to pay for the lapband surgery? I work for a health dept. for the state of Ga. and they want you to be healthy but they do not want to help you to become healthy. Thank you, Shirley S.

Dr. Marema: Shirley, your point is well taken. There are attorneys who specialize in this. www.obesitylaw.com is one. We will be happy to facilitate this for you if you call our St Augustine office at Flagler Hospital.

Michele: Thank you, Dr. Marema. Knowing myself as I do, my guess would be that the most restrictive will work better for me. I think I need the revulsion factor to help me stay away from foods that I crave or enjoy which are bad for me. Also, I don't want the opportunity to regain to be as easy. I had always thought, not having a physician's advice as yet, that the RNY would be best for me. Am I thinking straight about this thus far?

Dr. Marema: Michele, it certainly seems like you understand the differences between the 2 operations. Having had the bypass myself, I really do feel that it is a great tool

Moderator: BARIATRIC MEALS…customized meals for all post bariatric patients prepared fresh and delivered to your front door. Go to www.liteandhope.com and click on the banner button on the top left side of the home page.

Andrea: I’m low in iron last time it was 6.5 what iron intake you recommend?

Dr. Marema: Andrea, low iron could explain some of your food cravings. I recommend chelated iron- 60 mg. Again, building blocks is the brand I use.

Moderator: Please remember that if you are contemplating having Gastric Bypass Surgery or have had Gastric Bypass Surgery, you will be eligible for life Insurance through PRUDENTIAL. For details and information, please click www.liteandhope.com and then click on the LIFE INSURANCE BANNER BUTTON.

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.

trudi-: I weigh 297 lbs. how much weight can I hope to lose after 6 months? Or a year? I won't be able to exercise until I get some the weight off

Dr. Marema: trudi, in general, bypass will cause weight loss of 50-60 % excess at 6 months. For band it is more like 25-30%. Sleeve weight loss is similar to bypass. At 1 year the % excess goes to about 70-80% for bypass and 40-50% for band. I encourage you to try to do some exercise even if it is sports cords, pool walking, or walking. you must maintain your muscle.

Moderator: Dr. Marema, Is there anything you would like to add before we conclude tonight’s LIVE CHAT?

Dr. Marema: Thank you everyone for your participation. It was a pleasure to exchange information with you tonight. If you have any other questions that I can answer, you can contact us directly at www.usbariatric.com

Moderator: Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.

Dr. Alan C. Wittgrove was born and raised in Missouri. He graduated from the St. Louis College of Pharmacy in 1972. He then attended the University of Missouri School of Medicine, graduating as a Doctor of Medicine. He served his internship