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.

Welcome to our live chat!

Jennifer: I have a tendency to buy some foods that are unhealthy for me. How do I steer clear of the aisles where the potato chips and the coke products in the store? Also, how do I steer clear of buying fast food for my lunches?

Dr. Carrasquilla: Jennifer, Plan very carefully before you go to the store. Make a short list and stick to it. Remember, it is your life and your body.

Tina: I am 5 months post-op. I can't seem to get a good answer or handle on how much protein vs. carbs I should be taking in. What vitamins do you suggest?

Dr. Carrasquilla: Tina, We usually use 80% protein diet and the rest can be divided between carbs and fat. The vitamins that we are currently using are Building Blocks which is a company sold throughout the company especially for bariatric patients.

Sharon: Post surgery I have heard that in some cases, there is a vitamin deficiency that makes the patient feel sick, even though they are taking all vitamins recommended by their physician. Is this a side effect?

Dr. Carrasquilla: Sharon, If you take the proper amount of vitamins, you should not have a deficiency, however, not all the vitamins commercially available have the same concentration. The ones we are using now have higher concentration of vitamins. Some patients are vitamin deficient before surgery.

Suzanne: I had surgery on 23 Nov 05 and have been on sick leave since that time. I go back to work on 19 Dec. I love my work, but suddenly I am feeling depressed that I have to go back. In fact on 19 Dec we have our Christmas party and I know I will not be able to eat much of anything. Food was such a large part of my life - I almost feel that maybe I made a mistake - I know - too late now. Are these feelings normal?

Dr. Carrasquilla: Suzanne, You did not make a mistake. These are feelings sometimes experienced by patients in the beginning, but these feelings will pass. If this continues, you should be seen by a trained psychologist. As time passes and you begin to lose weight these feelings will change.

Becky: By taking in the amount of protein needed each day, will this help in avoiding any cravings for carbs?

Dr. Carrasquilla: Becky, Proteins will make you feel fuller, avoid carbs as much as possible because carbs give you craving for more carbs.

Princess: What are the benefits of surgery appose to loosing the weight on your own. I work really hard on losing and the weight just does not seem to come off.

Dr. Carrasquilla: Princess, This is the problem, if a patient has 100 lbs. or more to lose, 98% of patients fail to lose this amount of weight with conventional treatment. That is why we recommend surgery in patients who are morbidly obese.

Kathryn: I am 3 weeks out of gastric bypass and am not able to find a protein drink that is tolerable. Is there any type of pill form that will help with protein intake?

Dr. Carrasquilla: Kathryn, There are many different protein shakes which you can try with different flavors. Usually, in our program at three weeks you are in a regular roux-en-y diet. If you learn to shop in the supermarket and read labels, you will be surprised at the large amount of foods available which contain high protein and are also low in carbs and sugar.

Lulu: Do you know where I can find a list of medications ok to take after having gastric bypass?

Dr. Carrasquilla: Lulu, I advise that you discuss this with your surgeon as he will be the most appropriate one to guide you.

Linda: Are there any studies showing an increased risk of any types of cancer after having gastric bypass?

Dr. Carrasquilla: Linda, None that I am aware.

Lulu: The problem is that the surgeon who performed my surgery is no longer practicing bariatric surgery, I can not consult him any longer. This brings me back to my original question is there a generic guideline of medications I can or can not take?

Dr. Carrasquilla: Lulu, You need a surgeon with experience in bariatrics who should be following you. However, the most common medications which should be avoided are aspirin and aspirin products.

Sharon: Between the gastric bypass and the Duodenal bypass what would you say is the better of the two procedures? May I ask which procedure you would recommend?

Dr. Carrasquilla: Sharon, between the two I recommend the Roux-En-Y Gastric Bypass.

Kathryn: Me again. Water hurts my stomach when it first hits it, is this normal? Food doesn't hurt like that

Dr. Carrasquilla: Kathryn, Perhaps you are drinking water which is too cold or you are drinking too fast or too large amount. Learn to sip slowly.

Linda: for gastric bypass, how many weeks is typical recovery before you can go back to limited work day?

Dr. Carrasquilla: Linda, If done lap most of our patients return to work in one to two weeks. However, there is to be no heaving lifting for 6 weeks. If open, a minimum of two weeks will be necessary.

Kathryn: Why is it that you can never have carbonated beverages again?

Dr. Carrasquilla: Kathryn, In our program we do not have carbonated beverages for the first 2 months. After, that you can introduce carbonated beverages back into your diet, but very slowly.

Esperanza-: Dr. Carrasquilla I have a problem, trying to lose weight. I have been gaining weight, and I also have a fatty liver. My weight is 225 and I am 5'3. I really don't know what to do anymore. I have united health care, PPO. what can I do?

Dr. Carrasquilla: Esperanza, You have a BMI of 40 and therefore will qualify for bariatric surgery Check with a bariatric surgeon in your area.

Nick-: What do I have to look out for after surgery with a BMI of 55 and what things can I do to prepare myself in the next month to month and a half.

Dr. Carrasquilla: Nick, In our program, we have an education class in which we teach the patients all the details involved. We answer all their specific questions at this time. The BMI of 55 should not be relevant. We usually start our patients on 80% protein diet 2-3 weeks before surgery.

Ann-: I have had RNY surgery. My dietician hasn't told me how many calories to eat. I am 10 weeks out. She even says it's okay to eat white bread and potatoes. Is this right for us?

Dr. Carrasquilla: Ann, No, this is not correct, you should return to your surgeon and ask for adequate dietary advice. We do not recommend potato and bread.

Amy-: I had my Gastric Bypass surgery seven years ago. In the beginning I lost 65 lbs. I stopped losing and gave up again. I was able to eat anything I wanted. I am now 216 lbs. and want to get it off. I have has a scope and they say my stomach is still as small as an egg and there should not be a reason I am overweight. I have started eating smaller meals and running on the treadmill everyday 30 min. I started this last week and have lost 3 lbs. Do you have any advice to get me back on track? Please help...

Dr. Carrasquilla: Amy, You are going in the right direction. However, if the pouch is still small, it is possible that the opening of the pouch has become enlarged and more food is being tolerated. The doctor who did the endoscopy will be able to tell you the size of the opening and then you should discuss with your bariatric surgeon.

Becky: What about coffee and any other beverages containing caffeine will they have to be avoided?

Dr. Carrasquilla: Becky, No, you don't have to avoid them.

Sharon: Where would I find information on the Roux-En-Y procedure being that I have not heard of this before now?

Dr. Carrasquilla: Sharon, The internet is a great source of information; also, if you check in your area, you may find a seminar given by the bariatric surgeon which is open to the public.

Kathryn: My urine output is not near what it was before my surgery, is this normal?

Dr. Carrasquilla: Kathryn, No, be careful about your liquid intake, We advise our patients to drink about 50 oz. of liquid daily.

Linda: should I worry about not getting enough fiber in the diet after gastric bypass?

Dr. Carrasquilla: Linda, No, usually this is not a problem. As time goes on, you will be increasing the amount of fiber in your diet.

Carole-: Will you be doing a study of the gastric pacemaker or anyone will be doing this study or if anyone is doing this surgery?

Dr. Carrasquilla: Carol, Yes, we are one of the 20 centers throughout the U.S. who are conducting the study of the gastric pacemakers. This is currently still in clinical trails.

Moderator: Would you like to say anything, Dr. Carrasquilla, before we conclude tonight Live Chat?

Dr. Carrasquilla: We would like to thank all the participants for all their interesting questions. If you would like to view our website it is www.obesitylap.com

Moderator: This concludes our chat for today. Thank you all for coming into our Last Live Chat of the Year. We are so very pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. 2005 has been a wonderful learning experience and we hope it has been for all of you as well. We thank you for being a part of it. Thank you again Dr. Carrasquilla for your informative and insightful answers. We would like to wish everyone a wonderful HOLIDAY SEASON and we will see you when we resume our chats on January 15th, 2006. Good night and thank you once again.

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 and received his surgical residency training at San Diego Naval Hospital. He has served as a staff surgeon at Naval Hospitals in the Philippines, and Bremerton, Washington, and on the surgical teaching staff at San Diego, Naval Hospital. He is a board-certified surgeon, a Fellow of the American College of Surgeons, and a member of the American Society for Bariatric Surgery, the San Diego Society of General Surgeons, the San Diego County Medical Society, and the California Medical Association. He is the past president of the American Society of Bariatric Surgery.

Dr. Wittgrove pioneered the laparoscopic approach of gastric bypass surgery, performing the first laparoscopic gastric bypass as primary surgeon in the world, in 1993. He and his program have performed over five-thousand bariatric procedures.

Welcome to our live chat!

Moderator: Good Evening everyone and thank you for coming. We are ready to begin.

janet: I had bypass surgery 2-years ago and at the present time I have no health insurance do I need to follow up on the bypass every year? I do take b12 shots which they told me to do.

Dr.Wittgrove: Janet: You should follow up every year. Taking the proper vitamins and following the program recommendations are very important.

jtsbm4: Hi, I was wanting to know if you can tell me about the effects on the kidneys long term from consuming so much protein? thanks

Dr.Wittgrove: jtsbm4: There is no known side effects from that type of intake of protein. Remember the highest amount of protein that is recommended is in the immediate post-operative period.

LuLu: Lots of questions, first is there a website that shows a list of medications that are ok and not ok to take (i.e. Vicodin)

Dr.Wittgrove: Lulu: I don't know of that type of website. Your specific medication list should be reviewed by your surgeon.

LuLu: Second question was the truth or not regarding veggies? Are they too hard for our bodies to now digest?

Dr.Wittgrove: LuLu: No, you can digest them. You may have difficulty tolerating veggies first. Overcooking them is recommended early on. Remember always protein first.

janet: I take my b-12 shot once a month

Dr.Wittgrove: Janet: Usually a B12 shot once a month is fine.

janet: will this bypass last my whole life ?or will I have to get it redone when I get older

Dr.Wittgrove: Janet: The bypass is designed to be life long. Follow-up with your program is very important and following the rules needs to be life long as well.

Katherine-: I am 59 yrs old and I am a breast cancer survivor. Do you think I am too old for surgery and how can I get help to pay for this? I have insurance but it will not cover all of the cost. I am 263 lb and have been overweight all my life

Dr.Wittgrove: Katherine: 59 is not too old. Insurance payment varies from company to company. Most programs can assist in some sort of financing as well. Congratulations on being a survivor.

James: how long would you recommend a liquid after surgery?

Dr.Wittgrove: James: Different programs vary on their recommendations for advancement of diet following surgery. Our recommendation for the liquid diet post-operatively is about a week.

Kim: Doctor, I am five years out. One day I can eat something and I am fine. The next day it makes me very ill. Can you give me any insight to this issue?

Dr.Wittgrove: Kim: Sometimes it seems to go that way. The restriction involved tends to cause periodic intolerances for some individuals. If this is a chronic problem now fives years out you should certainly follow up with your surgeon to be sure this is "normal" for you.

James: What is your recommendation: distal gastric bypass or douegnal switch? What are the pros and cons of each?

Dr.Wittgrove: James: Personally, our program doesn't recommend either malabsorbtive operation. Our data tends to show that gastric bypass done by our technique had as good a result as a BPD without mal-nutrition

James: Would you recommend the gastric bypass, or the lapband for someone that is 44 yrs. old / male / 5'10" weighing 450lbs?

Dr.Wittgrove: James: Personally, our program has had much better results with a gastric bypass than the band. There probably is a group of patients who will do well with a band, but I am not sure it's been worked out exactly who those patients are.

jtsbm4: Iread somewhere that there were new findings of pancreatic tumors after the bypass, do you know anything on this and if so what is the risk and % that someone would develop them? thanks

Dr.Wittgrove: jtsbm4: There have been case reports only. It seems as though this is quite rare.

janet: dear doctor I really think I have a problem with food when I grew up my mother had a eating disorder, and now I eat chocolate until I make myself sick everyday.It's like a drug for me.

Dr.Wittgrove: Janet: I am not sure of the question, but certainly some eating disorders are best evaluated and treated by other health professionals. A therapist may be a reasonable option for your "addiction".

LuLu: My surgeon "retired" 2 days after my surgery. I have no doctor who knows about my condition specifically. However, my last question is the "Internal Hernia"....what type of doctor should I see regarding this?

Dr.Wittgrove: LuLu: Internal hernias need to be addressed by a surgeon. In most instances a bariatric surgeon would be preferred.

sharon: I weigh 350 lbs., I have been receiving a lot of good information and a lot of bad information about the gastric bypass surgery. What are the most severe side effects post-op?

Dr.Wittgrove: Sharon: Certainly you can check out our website www.lapbypass.com. We have tried to be objective about the risks and results as we have used our program's data. Another good place is through the ASBS website www.asbs.org.

Jackie: I had my surgery about 1 year ago but have only lost 60 pounds to date. Pretty much been the same since Sept 1st. Is this normal for some people? I have had massive amts of blood work & bone density done & all is perfect. Should I be concerned? Thank you.

Dr.Wittgrove: Jackie: The amount of weight lost is difficult to reply about without knowing your starting weight. With that in mind, everyone loses at a different rate and certainly different operations done by different surgeons have different results.

Lori-: I would like to lose more weight. I lost 70 than put back 10 now for one year I just sit at that weight need new jump start HELP

Dr.Wittgrove: Lori: You should certainly follow-up with your program as there are ways to optimize your success. Certainly, there can be anatomic problems which would cause your operation to be less successful and those might need to be explored.

Kim-: A friend of mine had a gastric bypass done on November 7, 2005. She has been following the diet they gave her but everything seems to be making her sick. Is there something that she can use to make her feel better after eating? To date nothing has helped.

Dr.Wittgrove: Kim: Individuals react differently to operations on their stomach. Some people do have more nausea for the first several weeks after the operation. It is important for her to follow-up with her surgeon to be sure it's "normal" for her and not something such as a hernia or an obstruction.

LuLu: Are there certain medications that you are aware of that cause ulcers to our little tummies?

Dr.Wittgrove: LuLu: There are several things that we know have more irritation capability to the new stomach. Anti-inflammatories and smoking are two of the worst. Some anti-depressant medications seem to be more irritating for some individuals as well.

jtsbm4: After one has the bypass, it seems that if there are any type of complications 6 months or so out that the patient is told to see a general doctor, how do you go about finding someone who would know about GB and be able to treat you correctly? Seems that every Dr. I speak to knows very little and that scares me.

Dr.Wittgrove: jtsbm4: It is true that not every primary physician knows a lot about the care of the gastric bypass patient. When there is a doubt about your care regarding the bypass that care should be coordinated through your surgeon's office.

Kim: Doctor, recently I have noticed that I seem to be suffering from muscular aches (mostly in my arms at this time) and unusual weakness. Could it be due to a deficit in my protein intake?

Dr.Wittgrove: Kim: Certainly, that is one possible reason. But there are several other possibilities. Some involve supplementation (vitamins) and therefore it is important for you to have rather urgent follow-up.

kardell: I am 5 years post -op (lap RNY) this month. I regularly take my vitamins and b-12 however , I am concerned what the future holds for me as far as health issues. What have the studies shown for people such as myself??

Dr.Wittgrove: kardell: Most studies tend to show people who are five years out are healthier than they were pre-op. For example, many people are no longer hypertensive, diabetic, etc..
.
Kim: Is it unusual for drinks that are cold or hot to cause actual pain. Most of my fluid intake consists of liquids at room temp.

Dr.Wittgrove: Kim: Especially early on, cold and hot can be irritating especially cold. Often patients choose room temperature liquids.

James: What makes your gastric bypass technique different than the distal gastric bypass?

Dr.Wittgrove: James: We do a proximal gastric bypass which has much less chance for malabsorbtion because less intestines is bypassed. And therefore, there is more intestine as a "common channel" for absorbtion.

Joanne-: Why am I still so tired a lot 14 weeks after my surgery?

Dr.Wittgrove: Joanne: There could be several reasons for your symptoms. Several reasons are inadequate water intake, inadequate protein intake, inadequate vitamin intake including multi-vitamin, iron, B12, and certain medications. Follow-up with your surgeon is certainly advised.

sherri_: I just had my first consultation today for my surgery. Why do I have to go through so many tests I am really not looking forward to that

Dr.Wittgrove: Sherri: Different programs have different requirements, but in general the're designed to best insure your safety.

LuLu: I can't stop losing weight...I was 230, 2 years next month, I now weigh 116. When is it too much too lose? Should I be concerned?

Dr.Wittgrove: LuLu: This is a hard question to answer because I don't know your full medical history nor the type of operation you had. This could be perfectly fine or it may represent malnutrition. Follow-up is very important to ensure it is not the latter.

kay: I was wondering what the requirements are for someone to be approved for gastric bypass surgery. I am 54 years old, been a diabetic for the last 14 years, have had no visible results from any diet except "Atkins" and because my cholesterol was so high was told by my Dr. I could no longer do that diet. I lost 42 lbs and felt good and my diabetes was under good control. I since have gained all that and more back. I am at my wits end I really need help. Thank you Kay

Dr.Wittgrove: Kay: Certainly, from a medical history standpoint you appear to be a candidate for bariatric surgery since diabetes is a prime indicator. The other qualifying factor is BMI which is calculated from your height and weight. If your BMI is over 35, again not knowing all of your history, you would appear to be a candidate.

Lori: My medicaid will not cover my operation because they said I'm not a diabetic

Lori: I wrote to you before and told you about the WVA medicaid I need help getting this operation done there is no one to help me

Dr.Wittgrove: Lori: Coverage for the operation is indeed difficult for some individuals. We find that some insurance companies refuse to pay for it and some public assistance fails to pay as well. There are advocacy groups that are working on this access problem. Individually it may appear to be an insurmountable problem.

ljp1118: hello, I am fairly young (25) and in the process of finishing up all the pre-surgery things (psych etc). However I have wondered, having surgery now, what does this mean for my body 10-20-40-50 years down the road?

Dr.Wittgrove: ljp1118: A lot depends on you and the choices you make and your follow-up. In general most people are healthier years down the line because they don't have the diseases more commonly associated with morbid obesity.

Moderator: Dr. Wittgrove...Would you like to say anything before concluding tonight's chat?

Dr.Wittgrove: Thank you very much for the questions. Certainly, we would refer anyone who is interested to our website www.lapbypass.com for additional answers. If you are in the San Diego area and need a consultation that can be done directly through our office. Good night!!

Moderator: This concludes our chat for today. Thank you all for coming into today's chat room. We are so very 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 Dr. Wittgrove for your informative and insightful answers. Please join our next chat with Dr. Carlos Carrasquilla, December 15, 2005. Good night and thank you once again.

Dr Kim received his degree in chemistry with distinction from the University of North Carolina at Chapel Hill, where he was a John Motley Morehead Scholar. He graduated with honors from medical school at the University of North Carolina School of medicine, and completed his surgical internship and residency at the University of North Carolina Hospitals.

He has experience in performing the duodenal switch procedure, the gastric bypass, and adjustable gastric band laparoscopically. Currently he performs the laparoscopic Roux-en-Y gastric bypass and the adjustable gastric band at Celebration Health in Orlando, Florida, where he is the medical director of bariatric surgery. He serves as a teaching consultant for Ethicon endosurgery and is on the editorial board of WLS surgery magazine.

Welcome to our live chat!

Kim: Hello Doctor. Thank you for offering this opportunity to those of who have entered the chat. I had a distal (the doctor planned to do a distal) RNY on Nov 6, 2000. How can I tell, without having a scoping done, if my stomach has stretched?

Dr. Kim: You can have a barium swallow done, but this is not 100% accurate. The best study is actually to have an endoscopy.

Paula-: I had the GB 14 months ago and overall I'm doing fine. Still having a little trouble with certain foods but nothing to bad. My question is since I lost all the weight I have all the excess skin that I have not been able to tone like it should. What doctor would I need to go to and does insurance usually cover the cost of the skin removal. I lost the weight so fast I couldn't keep up with it with exercise. I have 2 disc that are messed up in my lower back so I am limited to some exercises. Any suggestion are greatly appreciated and very welcomed.

Dr. Kim: I agree that trying to tone your body is a good thing - keep that up! Unfortunately, there is very little you can do about excess skin besides plastic surgery. Even more unfortunate is the fact that it is almost impossible to get insurance to cover this procedure. There are a few conditions that may deem certain plastic surgery procedures "medically necessary"....cellulitis associated with excessive pannus, sometimes portions of the surgery may be covered if there is a hernia that is repaired at the same time.

carita-: I am suffering with morbid obesity. Is the Gallbladder affected by being an obese person? Alot of obese people have said they had to have their gallbladder removed during the Gastric By-Pass surgery.

Dr. Kim: Yes. Obese individuals are not only at higher risk of developing gallstones and related problems, but they are also at higher risk of developing gallbladder cancer. Additionally, rapid weight loss, particularly rapid weight loss associated with malabsorption significantly increases the incidence of gallstone formation. Because of this, the gallbladder is sometimes removed as part of the GB surgery.

tina-: Is it normal for your scalp to itch. I'm a month out from surgery and it's driving me crazy.

Dr. Kim: This could be related to certain nutritional deficiencies or dehydration. This is not a typical complaint. What is a more typical complaint is thinning of the hair.

DinaB: I am almost 4 years post op....I have lost 153lbs to date. I have 2 questions....first I used to have the worlds healthiest teeth....no cavities, strong and beautiful, since the surgery I have had 2 root canals and 2 chipped teeth. why is that? My second question, which I'm sure has to do with my first one is that I have started getting VER sore joints...knees elbows, shoulders and I notice it is worse after working out or giving massages (I'm a massage therapist). I am not taking my vitamins like I should be and I know that both of these things are due to that. Can you please help me. What kind of supplements should I be taking....ie how much calcium, magnesium, multivitamins, b-12....etc.

Dr. Kim: I would agree with your assessment of your situation. I suspect that you have had significant loss in your bone density. You have to remember that your body is carrying around 153 lbs less than it used to. If you are not giving your body enough calcium, your body robs the calcium from the bones because it has to bear a whole lot less weight. With GB surgery, not only are you taking in less food in general, but certain nutrients, particularly calcium, iron, B12, folate are very poorly absorbed because the proximal small intestine is bypassed. It is therefore critical to take appropriate amounts of multivitamins for the rest of your life. Calcium should be 1500 to 1800 mg daily in three divided doses

sherri: I had an ultrasound done of my gallbladder a few years back and they said that i had a rock garden in there but it doesn't bother me do you think they will still take it out during my surgery

Dr. Kim: Congratulations, by the way, on the weight loss. Remember that you are just getting started though. You want to make sure that you are at a healthy weight and are still healthy 30-40 years from now. And you will only accomplish this by being as diligent about taking your vitamins, exercising, getting enough fluids and paying attention to what you are eating - just as you were the first month after surgery, for the rest of your life.

Dr. Kim: DinaB, sorry the answer got cut off. It should be calcium 1500-1800 mg in 3 divided doses, and of the citrated form. Iron 15 mg of elemental iron for men and post-menopausal women and 30 mg for pre-menopausal women. B12 is very poorly absorbed in a pill form that is swallowed. It should be either taken by injection or sublingually or as an oral spray. I strongly recommend 1000 mcg by injection monthly.

Dr. Kim: It depends on the surgeon. For asymptomatic gallstones, some surgeons routinely take it out and others do not during GB surgery. The downsides of taking it out are basically the risk of injury to the common bile duct, bleeding, bile leak from the procedure. The downside to leaving it in is obviously the development of symptoms from the gallstones. The one caveat is that if one of the stones passes into the common duct, the gastric bypass procedure prohibits the ability to retrieve that stone with endoscopy because the pouch is no longer connected to the duodenum.

renee: I'm 5 weeks post op and I'm having a real hard time getting my fluid intake....any suggestions?

Dr. Kim: Renee, the first thing I would do is just stick to fluids. If you are given similar instructions you were probably instructed not to drink with your meals and to wait a certain period after meals before drinking (I tell my patients to wait one hour). If you are trying to eat three meals a day, you lose over three hours of not being able to drink. I usually tell my patients to stick with fluids and protein shakes until they are comfortably getting in adequate amounts of fluids before routinely doing solids for meals. The other things that are helpful are to always carry around something to drink, get in the habit of sipping all day long, keep track of how much you are drinking.

Shirley: Hi Doctor...Is it possible that a hernia resulting from an open RNY could have any effect on the success of my weight loss? That is to say, can it affect my sensation of "fullness", etc?

Dr. Kim: Hi Shirley. Not likely. A hernia however, could cause pain and it could also potentially cause a blockage if a loop of bowel becomes trapped in the hernia. It sounds like from your question that you are wondering if a hernia could diminish your sense of fullness....this is not likely.

sonia: have you heard of any patients having major complications from the surgery after about 5-10years etc, i have been reading a lot about this surgery, but a lot of doctor's don't know themselves, do you know?

Dr. Kim: Sonia, even 5-10 years after surgery it is possible to develop an ulcer, that could potentially even lead to bleeding, especially with ingestion of NSAIDs, a narrowing could develop between the pouch and the small intestine (anastomatic stricture) and a blockage can occur from scar tissue. Probably, however, the most common problem that might occur that far out from surgery is weight re-gain. It is imperative to understand that surgery is just a tool and that it takes permanent lifestyle and eating behavioral changes to maintain the weight loss.

Nisy: What's the usual recovery for RNY (open)?

Dr. Kim: Nisy, 99-plus % of my cases are done laparoscopically, but the patients who have open RNY surgery have similar recovery....2-3 day hospital stay and 2-3 week return to work. I typically recommend that patients ask for 6 weeks off work because it is much easier to return to work sooner than expected than to ask for more time off.

Kim: Doctor, do you feel that it is necessary for long-term post ops to use protein supplements on a daily basis?

Dr. Kim: Kim, it depends on how much protein you are able to get from your diet and how active you are and what kind of exercise you are engaged in. You should, from time to time, calculate how much protein you consume in a day. Most people tend to eat similar foods on a daily basis, so this is usually an accurate reflection of daily protein intake. If you are falling short of your protein needs, then it is not a bad idea to supplement your protein intake with shakes. If you are relatively early postop (first 12 months) you should aim for about 1.5 grams of protein per kg of ideal body weight for your frame. Farther out, you should aim for about 1 gram per kg of ideal body weight.

jay: is the DS procedure anything like the "Distal" gastric bypass if so how, which is better and which one has a better outcome.

Dr. Kim: They are somewhat similar in that both cause significant malabsorption. Major differences are the gastric pouch in the DS is significantly larger, therefore the DS patient is able to eat more. The pylorus is preserved in the DS procedure, therefore there is no dumping with the DS procedure, and anastomotic ulcers are less common in the DS procedure. A portion of the duodenum is preserved in the foodstream with the DS procedure and therefore absorption by the duodenum is partially maintained. It obviously sounds like I am biased towards the DS, and I am. To answer which is better and which has a better outcome would take explaining myself in much more detail than this forum allows.

Linda_21249: How many calories per day should a person who is 2 1/2 years post op be eating.. 5ft 2 female

Dr. Kim: Linda, it depends on how active you are and how much you weigh and what your frame is. Having said that, I would not worry so much about the exact number of calories, but concentrate instead on making good food choices and maintaining healthy portions as well as exercising. Studies definitely show that very low calorie diets (800 or less) are ineffective in the long run for weight loss. I would try to stay somewhere in between 1000 to 1400 cal per day.

millie: I am interested in having the lap band procedure. My physician would like to do the duodenal switch which I don't want what are your thoughts on this.

Dr. Kim: Millie, I have no information to be able to recommend one versus the other. There are many patient factors that would influence which surgery I would recommend. However, ultimately my role as a surgeon is to educate you so that you can make the decision. It is important that you feel comfortable that you are making an educated decision. These two surgeries represent the opposite ends of the spectrum in weight loss surgery.

maxine: I had the surgery in March of this year and so far so good. I only have a little question. My scar on my stomach sometimes itches really badly, and I just want to know if this is common?

Dr. Kim: Hi Maxine. Yes, this is pretty common. You can try various topical ointments, including a cortisone cream, but I suspect time will take care of the problem.

DinaB: Thank you! Is it ok to take a time released multivitamin?

Dr. Kim: DinaB, probably not a good idea because the transit through the small bowel is faster after GB surgery. The small bowel is essentially responsible for absorbing all of the nutrients.
Moderator: Dr. Kim is there anything you would like to say before we conclude this session?

Dr. Kim: I appreciate the opportunity to answer your questions. Remember that your surgery is just a tool and it takes lifelong attention to details to stay healthy and at a healthy weight. Congratulations on everyone's successes.

Moderator: This concludes our chat for today. Thank you all for coming into today's chat room. We are so very 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 Dr. Kim for your informative and insightful answers. Please join our next chat with Dr. Carlos Carrasquilla November 15, 2005. Good night and thank you once again.

Shyam L. Dahiya, M.D. is one of the most experienced and most acknowledged practitioner of laparoscopic gastric by pass surgery in Southern California. He is a founding partner in laparoscopic Bariatric Specialists, a medical group based in Los Angeles that specializes in assisting patient who suffer the effects of morbid obesity.

Having performed more than 600 bariatric weight loss surgeries, Dr.Dahiya was also among the first surgeon in Southern California to perform laparoscopic gall bladder surgery. He has more than 26 years of experience in general and oncological surgery and has received advanced post-graduate training in laparoscopic surgery.

Welcome to our live chat!

karen: How will I take my doctor prescribed medications after the surgery? I take 7 medications each day...how will they be absorbed into my system to get the maximum benefit I need from each pill?

dr.dahiya> As far as the absorbtion is concerned that is going to be normal. As to how you take the medication will depend on how long ago you had your procedure. If you had be recently operated than you will have to take the medication either in liquid form or crush them if you can.

angie: I have heard that the surgery helps those with diabetes....is this for both type I and 2 or just type two.

dr.dahiya> This bypass surgery only helps diabetes type 2. It is not known to help type 1.

Karen: Hi My name is Karen. I had gastric by-pass surgery in April of 2000. I lost 100 pounds and have gained back 45. I don't get sick anymore when I eat sugar or fat. Is that normal?

dr.dahiya> For one, not everyone gets sick with sugar (whats called dumping.) Also as time goes by, the body can get used to tolerating sugar.

kelly: after gastric bypass...will i still live a normal ..life ...i mean as far as going out w/ friends and golfing ..or am i going to be tired and in a lot of pain.....i know it will take some time....

dr.dahiya> Everything would be normal, the only difference will be the amount of food that you can consume. Alcohol consumption is also affected and should be avoided altogether.

sharon: I am seeing Dr. McColgan and I weigh 340 lbs. My second appt. is on Wednesday the 19th October for a large abdominal hernia and I have staight Medical. Is it possible to get the lap band through medical?

Karen: Thank you. I'm just scared to go back to my doctor and now and feel like I'm back to square one.

dr.dahiya> That is a matter that you will have to discuss with your surgeon.

tina: My daughter who is very obese also has a chemical addiction problem, will this present special problems in having the surgery.

dr.dahiya> Yes it does matter. The dependancy issue has to be settled before the bypass.

eddie: Why do some surgeries take longer than others...........I am 64 years old ............so I have special problems because of my age....my BMI is over 50.

dr.dahiya> Could you clarify the "length of surgery" issue eddie.
lilgypsykare: I take several medications everyday and wonder about the absorption problems... Absorbtion in short limb bypass is not affected. The only elements that are affected in terms of absorbtion are vitamin B12, iron, and calcium.

jtsbmiller4: hi, i was suppose to have the surgery and i backed out at the last min. i was wanting to know with all the protein that one will eat after the surgery how will that effect the kidneys

dr.dahiya> The Atkins diet has shown that proteins do not damage the kidneys. Therefore, there should not be any issue of kidney damage in your case.

Susan: how is it decided which you will have, the medial or distal surgery

dr.dahiya> I only do proximal gastric bypass surgery.

jtsbmiller4: i was told by a friend that she read that there have been new findings of pancreatic tumors after the surgery, do you have any information on that?

dr.dahiya> There has not been any report as to any malignant pancreatic tumor, but there are some reports of pancreas producing high doses of insulin after the surgery. The cause of this is not known as to why.

sharon: I am a severe scar tissue grower. I was told that the lap band procedure would be the better of the two types of surgery for weight loss. What are the chances of scar tissue growing inside the intestines after the original gastric bypass surgery?

dr.dahiya> The scar tissue issue cannot be answered, but band and bypass surgery both perform well so choose either procedure.

Godsangel: I would like to know if medicare ever pays for this surgery if you are in bad health and need it?

dr.dahiya> The insurance issues have to be addressed with the doctors office or you inquiring directly yourself from medicare.

jtsbmiller4: what happens to someone if the pancreas is producing to much insulin? is this something that should cause someone not to have the surgery?

dr.dahiya> If you have high levels of insulin prior to surgery, then you should have an endocrine consultation. If the high levels of insulin are after surgery, then further tests and studies have to be done to determine appropriate treatment.

andrea: I have diabetes does that cause major problems with this surgery? With the increase in insulin output by the pancreas...?

dr.dahiya> The diabetes and high level of insulin years after surgery are different problems and have to be addressed separately.

lilgypsykare: One of my biggest fears (the warnings I have read about), believe it or not, is the loss of hair ....what can I do as a patient to try my best to keep that from happening?

dr.dahiya> I have not found anything that prevents the hair loss, but all your hair will return after eight to twelve months so not to worry.
Godsangel: how much over weight do you have to be for you qualify for surgery?

andrea: Thank you. And, thanks for your participation.

dr.dahiya> The general terms used are 100 lbs over your ideal weight, but for difinitive criteria you have to determine your Body Mass Index (BMI) which is determined by your height and weight.

jtsbmiller4: how is the calcium absorbed if the part of the intestines that absorbs calcium is bypasses? is there major findings that people are getting osteoprosis earlier and more severe who have had the surgery?

dr.dahiya> The lack of calcium absorbtion is only relative and is more than enough compencated by taking daily calciums of 1800-2000 milligrams.

lilgypsykare: Can I start a good vitamin routine now to help my hair become stronger? Or is it just a hit or miss with certain people?

dr.dahiya> If that is going to make you feel comfortable go ahead.

Godsangel: does the surgery help dieabetes type2 and back pain?

dr.dahiya> Yes to both. Diabetes aproximately 70% cure rate. The back pain will depend on how bad your back is prior to the procedure. The procedure can only relieve the back pain caused by excess weight.

Godsangel: is it true you can not take any kind of medications for a year after surgery?

dr.dahiya> In general, that is not true.

me_coker: what do you do once you have had the surgery but are still struggling to get to where you want to be/

dr.dahiya> Follow up with your doctor and attending support groups are very important. There are times (BMI higher than 60) that you may not reach your normal goal, but that is still better than pre-op condition.

Larry: Is it necessary to attend support groups. I am a very private person and feel extremely uncomfortable in speaking to a group about my personal situation.

dr.dahiya> I encourage all of my patients to attend support group because I feel it is very important.

jtsbmiller4: do you know if there are findings that people are getting osteoprosis earlier and more severe after the surgery?

dr.dahiya> I have not read any data that supports this statement.

Godsangel: is there a certain cut off age?

dr.dahiya> Age 64 and higher have to be individually considered. There are many practices where they do not do this procedure after age 64.

jennifer: At the age of 4yrs. I have had problems with Microscopic Hemturia. An IVP was performed on me along with other test, No reason was found for the Hematuria.I tend to keep urinary tract infections so my urethra tube was stretched.My urologist took a catherized urine specmin.It showed no microscopic hematuria.But when i give a specmin in a cup it shows 3+ blood. My concern is could microscopic hematuria present more risks for me during or after my gastric bypass surgery? Since this has been a long going problem.

dr.dahiya> Without knowing what the cause of hematuria is the question cannot be answered. You should consult a nefrologist/eurologist for there opinion prior to the procedure.

Karen: No one ever told me about any support groups. I sure wished they would have. I wonder if it's too late for me to go to one since it's been almost 6 years.

dr.dahiya> It is never to late to search for support groups in your neighborhood.

lilgypsykare: how early after surgery can a patient start walking for exercise, if they have already started a rountine about 1 month prior to surgery?

dr.dahiya> In my practice we encourage walking or any other excercise as soon as the patient is comfortable from the pain point of view.

paula: Is it more difficult for someone who has had the surgery to loose weight after having a baby?

dr.dahiya> No.

Suzanne: How soon after the surgery can I eat "normal food" rather than eating liquids. I really have a problem with that concept of liquids only. won"t I be very hungry?

dr.dahiya> It varies with practice and you should consult your doctor.

Godsangel: what kind of health problems would stop you from having the surgery?

dr.dahiya> That question is to broad and can be answered at the time of your consulation only.

Tara: I have been in therapy for 3 years and the therapist tells me that for some reason I enjoy being heavy, but I really do not. I want the surgery but I am concerned that maybe I won't be a good post-surgical patient -- do you have any suggestions on how to prepare myself for this ordeal?

dr.dahiya> If you have a difference of opinion with your therapist, you should seek another opinion.

sharon: Is there any data on post operative severe wieght loss where people have become to thin?

dr.dahiya> No, I am not aware of any such findings.

jtsbmiller4: i see that these are very general questions that are being answered, do you know of any good books or web sites that would help me understand what type of effects there may be long term after surgery on the internal organs or the body? i just dont want to trade problems for prolems so i am seeking more in depth information?

dr.dahiya> www.asbs.com is a good site to go to for references.
Karen: If your pouch gets stretched is there any way it will go back down

sharon: Thank you for your time, it was very informitive.

dr.dahiya> Probably not and a follow up with your doctor is highly advised to see if there is any further treatment that you will qualify for.

jennifer: Why do some insurance companies cover the surgery and others do not?

dr.dahiya> That is an individual matter with the insurance companies.

dr.dahiya> I appreciate everyone's time and questions. For any further questions please go to www.doctorbariatric.com

moderator> This concludes our chat for today. Thank you all for coming into today’s chat room. We are so very 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 Dr. Dahiya for your informative and insightful answers. Please join our next chat with Dr. Keith Kim November 1st, 2005. Good night and thank you once again.

Dr. Snyder has a passionate interest in helping those who suffer from morbid and severe obesity and it co-morbidities-- attendant medical and social problems. He has a great deal of experience in bariatric surgery, both LapBand and Laparoscopic Gastric Bypass, having done about 1000 primary bariatric surgical procedures. He believes the the critical features of a successful baratric program are a broad and integrated education program and a wide support network. In these realms, he has created an education lecture series for all his patients and also supports seven active support groups in Colorado (and is in the process of creating an on-line support network). In addition to his vast experience and expertise, Dr. Snyder's informal nature and his honest and available communication are what has built his program into the regional leader that it is.

TRANSCRIPT

Welcome to our live chat!

janetsago: Dear sir, I had surgery 3-years ago and lost 75 pounds I have kept off 60 pounds everything seem to be fine with me I still take b12 shots once a month. Do I need to go to the doctor for a recheck to make sure everything is fine?

Dr. Snyder: It is always a good idea to se your surgeon yearly- Also, you need yearly assessment of your folate and B-12 levels.

janetsago: I had surgery in Illinois and now I live in Florida and a doctor here wants $900 just to look at me. I used my life savings to get this surgery.

Dr. Snyder: I think that this is too much for a consult-- you should shop around. At most, a level III consult should be about $240. And, if you have any insurance then they should cover the consult. Many bariatric surgeons will also work remotely with the local primary MDs.

Michelle: Good evening Dr. Snyder. Thank you for taking our questions. I was wondering if I can go through the recovery period by myself. I live alone and don't have anyone who can stay with me.

Dr. Snyder: It depends on how functional you are-- I have many patients who live alone and do the pre-op preparation work and are able to fix their own meals and hydrate adequately alone-- I do not encourage much time off post-op. If there is a complication, the needs may change.

rochelle-: my insurance will only pay for the lap band or the sleeve. I weigh 299 and have polyps in my stomach, which are not cancerous. I've gained my weight to do multiple accidents so my mobility at present time is limited but my primary physician said look into the surgery since losing weight would be the best thing. My question being what do we know about the sleeve and approx. how much can one lose with the sleeve surgery. I also have food allergies.

Dr. Snyder: I have never heard of an insurance not covering a bypass! I am not sure what a sleeve is--- is it a duodenal switch? The weight loss with the switch is about the same as with the bypass. I am not sure why it is advantageous in your insurance's eyes?

joanne: I had my gb done 5 weeks ago. I had the roux-y surgery done. I am having trouble with my incision healing. It is still red in certain parts, even though I have some antibiotic cream to put on it. It seems wearing the binder all day irritates it, so I left the binder off today. Is this normal to have this happen? I'm due to see my surgeon for follow up visit next wk. thanks.

Dr. Snyder: It is normal to have some limited redness with healing-- especially if you had a binder on. I worry about progressive redness with any ill symptoms-- fevers, chills, and drainage. The surgeon should check it out!

Michelle: I always try to drink 64 ounces of water daily, but I was wondering how can you drink that much after gastric bypass with the small pouch?

Dr. Snyder: I require my patients to drink at least 60 to 80 ounces per day-- the only limits are functional-- how much you personally can drink-- it is a bad idea to overload the pouch routinely.

valerie-: I had my gastric by-pass done 5 weeks ago. I had the roux-y surgery done. I am having trouble with my incision healing, it is still red in certain parts, even though I have some antibiotic cream to put on it. It seems wearing the binder all day irritates it, so I left the binder off today. Is this normal to have this happen? I'm due to see my surgeon for my follow up visit next week. Thanks.

Dr. Snyder: I think you should see the surgeon and discuss with him/her. If you are ill-- fevers, chills, etc., it may be emergent-- often it is only a local irritation. Putting stuff on it is usually pretty useless. Just soap and water is fine.

barbara-: can people with no health insurance get help with this? I have tried for years and no help. Can you help me?

Dr. Snyder: It is always an option to do it self-financed. It is expensive, but I have never had a patient say it was not worth it. It depends on how much you can work or organize to finance it addition your personal financial situation-- or find a job where this is a benefit.

mireille-: I live in Canada Quebec and I was wondering if you could help me to find a doctor who could help me to have some information about the gastric Bypass thank you

Dr. Snyder: I do not personally know of anyone in Canada-- go to the site ASBS.org. It is a good starting point. And, see who your primary MD recommends.

Valerie: I was wondering what the cost of having this surgery done is. I have been suffering from morbid obesity all of my life and I am ready to try something that isn't going to fail like all of the diets that I have tried.

Dr. Snyder: The cost is variable-- more important than cost is the question of making sure you go to a mature program with an experienced surgeon and team-- personally, I have done over 1000 primary bariatric surgical procedures-- and I treat patients from all over the country. The cost is about 24K for bypass and 13K for banding.

susanW-: How can I get my health insurance to pay?

Dr. Snyder: The first question is-- is it a covered benefit? If so or maybe, then have the surgeon's office do the pre-approval. If concerns-- have an attorney get involved-- a good search is with Walter Lindstrom, who has a lot of experience in this.

denise-: I am 2 1/2 months post-op and have lost 31 pounds. from what I've heard, most people lose an average of 50-60 pounds by now. Is this something I should worry about? I work out daily in the gym and bike at night. I don't do sugar but I do eat whenever I'm hungry, just not big amounts.

Dr. Snyder: Great question-- it is not important how many actual pounds you lose. The big talkers on the net and in support groups are just that-- big talkers. How much do you have to lose? Are you getting healthier? Do you feel better-- some people have 100's of lbs to lose and others just about 80 or so-- it depends on your starting BMI, not the weight.

katarina-: What effect does having gastric bypass surgery have on a fatty liver?

Dr. Snyder: It usually improves the condition-- as you can imagine, most of my patients have this condition- although it is not always diagnosed

tabatha-: I have a 14 year old son the weighs about 250 lbs. Is there something he can do to loss the weight or is there a doctor that will do the roux-en-y or the lap band on a 14 year old. I have to do something because he won't even go out of the house because he thinks people will laugh at him.

Dr. Snyder: This is a very difficult situation-- I occasionally do adolescents starting at 16-- and there are adolescent programs. I think he needs to have a medically supervised weight loss program first-- there are many... For more details, you can contact me personally. Tell him to hang in there-- it is hard to go through this. He may also need a therapist-- it is a family problem

jtsbmiller-: Hi, I am thinking of having the surgery but wanted to know if there have been any studies on long term effects on the kidneys and the liver and pancreas?

Dr. Snyder: I know of no long terms studies showing ill effects on either organ-- but I do know of many showing the negative effects of morbid obesity on these areas!

Michelle: What can be done to prevent dumping syndrome?

Dr. Snyder: Avoid, minimize processed carbs-- I tell people to avoid the white stuff-- rice, bread, pasta, potatoes, popcorn

Kennedy: What is the lap band procedure and how long would I be out of work?

Dr. Snyder: The lap band is the procedure where we place a restrictive band around the upper stomach that allow us to make you full with a small meal-- the outlet that allows you to be full longer is tightened with special fills. It is very effective when used appropriately. Out of work is usually 4-7 days.

Michelle: I have polycystic ovary disease. Could I expect an improvement in my condition with gastric bypass?

Dr. Snyder: It is very sensitive to weight. PCOS symptoms are usually improved, if not cured by weight loss. As are fertility problems due to weight and PCOS

nan-: Had RNY 4 years ago this week. Doing fine but I do see weight creeping on. I am a red wine only drinker and would like your input on wine consumption.

Dr. Snyder: Weight creeping on is usually that you are not following the "rules"-- we can go over these if you like. But, most people know the way that they are "cheating" -keep a diet and activity and hydration log-- I bet you will be surprised. Wine is OK in infrequent moderation-- it is a high carb food.

janetsago: I have kept most of my weight off after 3-years. Do I still have to worry about my stomach returning to big again? This is my worse fear in life

Dr. Snyder: It does not need to be a huge fear. Keep eating the right foods-- I believe at least 70% protein, at least 5 meals per day. But, the critical thing is to watch meal size--NEVER eat more than 6-8 ounces per meal. And, you do not have to be full at every meal-- just "not actively hungry" is usually enough.

caroline-: I need to know if it is possible to fast after surgery? I am about 8 mos. out. Ramadan is coming up and I want to be able to fast. No food no water from just before sunrise to sunset.

Dr. Snyder: Fasting is okay-- as long as you are feeling well. In Ramadan, can you drink water? But, you may have to add extra supplements in during your evening meal times after sun down.

april: my mother is 68 years old and is obese 304 lbs. She has had quadruple bypass surgery and I'm worried she can't do the surgery.

Dr. Snyder: It is up to the surgeon to properly screen and prepare the patients for surgery-- I often use cardiologists to pre-screen and prepare people. And, I have operated on many people post bypass surgery of their heart.

sheila: My husband has insurance but it isn't a covered I and can't get any help from anyone. How can I get him help before he dies? I love my husband with all my heart and can't stand to see him suffer anymore. He weighs 650 and has no life. Every day he asks me if I think today this will be the day it will all be over. He is tired, he can't do anything for himself, he depends on me for every thing, he can't tie his shoes, go to the rest room by his self or wipe after going to the rest room, take a bath or shower by himself. No one understands why I can't go any where if he isn't with me. I love my husband, and will do whatever it takes to help him live another day to be with him.

Dr. Snyder: This is a miserable issue and I am sorry that you are having such troubles. It is criminal that the coverage of bariatric surgery is not a legal requirement-- if it were cancer it would be, but people have little respect for the obese. Terrible, I say. But, the best option is to get insurance that covers a family member's bariatric surgery or to work on self financing-- and try to keep his health up the best you can.

corina-: What do I have to do before I qualify for the surgery? Does really bad back pain count?

Dr. Snyder: The requirements are: BMI of 35 with associated comorbidities-- such as back pain, lipid problems, urinary stress incontinence, depression, heartburn amongst others -- or a BMI of 40 plus with or without comorbidities

julie: my husband says he loves me the way I am - but I am miserable and feel like a failure because I can't lose weight. I am worried he will not like me if I am doing this. He already thinks I obsess about this WAY too much. Do you have experiences with this?

Dr. Snyder: It is a very personal issue with your spouse if you can/should undergo bypass surgery. It is correct for him to "love you the way you are" but he probably also worries about your health and happiness as an obese individual. Take him to a local surgeon's individual support group or informational seminar-- there are thousands of people willing to share their story-- and this may help him. What are your goals in life, can you do them as you are? That is what matters-- in my practice we have significant other support too!

kathy-: I'm in the process of bypass surgery and they postponed my date because I have only quit smoking for a month. Has anyone had complications from smoking and getting the surgery done in the past?

Dr. Snyder: I do not operate on smokers for 3 reasons;
(1) It is an addiction and bariatric surgery is about getting control.
(2) It is bad for you-- and you knew that
(3) It messes up the surgery and increases your risk of leak, lung problems, and infections more that you realize.
You can do it-- quit

Michelle: I have a vomiting "phobia" since I'm a teenager. Even if I'm really sick, I can't vomit; my throat closes up. Is this going to be a problem if I have gastric bypass?

Dr. Snyder: Maybe-- I certainly do not think that you are required to vomit after bypass surgery! But, it is not an infrequent occurrence as you learn to use the tool. But, the vomiting is usually a very small amount and you feel better right away afterwards. I have patients who have never vomited

Michelle: I have hypertension and GERD. Could these conditions go away with gastric bypass?

Dr. Snyder: In my personal series, the resolution or notable improvement in both of these conditions is in the 80-90% range!! And, usually the results are immediate. I love that part of my job-- helping people cure their medical problems and eliminating medicines

Kennedy: Do Blue Cross Blue Shield NJ PLUS insurance plan cover lap band procedures?

Dr. Snyder: I have no idea-- it is best to call your benefits person or the number on your card and ask them. Or, have the surgeon you are considering check it out.

janetsago: after so long does it leak?

Dr. Snyder: I presume you are asking about the bypass-- leaks beyond about 10 days (unless on steroids or injury-- are quite rare.

robby: my wife is 320 lbs and is convinced she can lose the weight herself. She's spent a lot of money on diets and gyms, but keeps getting heavier. I don't want to be insensitive, but I really want her to get the surgery and I've talked to her physician, who agrees and has told her. What is your advice?

Dr. Snyder: It is about the relationship between the two of you-- the likelihood of her losing weight and keeping it off for 5 years is less than 5%. Not good odds. So, I would approach her with love and understanding-- "I am really worried about you and think you are going to become ill and infirm. Nothing has worked-- why will this effort with dieting be better. If you are "on her team and her advocate" then you are being helpful

Michelle: If I get pain meds after surgery, will I become addicted? I was once addicted to Xanax and I'm afraid to get addicted to any drug.

Dr. Snyder: There are also ways to limit the use of narcotics- e. g. Toradol use-- let your MD know.

tina: I am curious if you have an after-surgery support group - do most surgeons? Is it expensive, or free with the surgery?

Dr. Snyder: I have 8!!! And am going to have an on-line one soon. Clearly, I am not going to be the typist on that-- with my limited typing skills. It think it is awful not to provide this free!! for your patients. That is my opinion and supported patients seem to do better.

ryan: I have suffered with heart issues for my entire life......is GBP too risky for me?

Dr. Snyder: Ryan- You need to have a full cardiac screening pre-op to answer this question. It depends on if you heart disease is too advanced or unstable-- let your surgeon know your concerns-- I do cardiac patients (appropriately screened and stable) often!

Ryan: Specifically, high blood pressure my entire life and CV disease since being a young adult.......I am now 54 and over 300 pounds and fear having surgery

Dr. Snyder: Fear is healthy-- as they say. It means that you take it seriously and that you want to be as safe as possible. Keep up that level of concern and make sure that you are properly risk assessed. Then, your MD should be able to tell you the real level of risk you are-- I often tell people that NOT doing surgery is more risky

Ryan: Thank you Dr. Snyder.............being trapped between fear and weight is a horrible place to be!

April: Is that true, the odds of keeping it off are only 5%! What are the steps one should take to beat those odds?

Dr. Snyder: If you are Morbidly obese, the likelihood of keeping off your weight for 5 years plus is actually less than 5%. This is based on NIH studies-I did not make it up. The best thing to do is to not have obese genetics!! And, to not get morbidly obese. I know of few people who can control these variables. That is why bariatric surgery is so successful and wonderful

Moderator: Dr. Snyder, any last words before we sign off?

Dr. Snyder: I thank you for the opportunity of letting me share-- feel free to ask me any questions at any time-- my web site is: www.denverbariatrics.com. Check it out, it is great-- if I do say so myself. Good luck and great health to all.

Moderator: We are so very pleased to host this unique opportunity to bring out wonderful LITE AND HOPE Registered Surgeons to the "World" as a resource for your questions. Thank you again Dr. Snyder for your informative and insightful answers. Please join our next chat with Dr. Shyam Dahiya, October 17, 2005. Good night and thank you once again.

Dr. Clark is a general surgeon who graduated from Davidson College and The Bowman Gray School of Medicine in North Carolina. He completed his surgical residency at Akron General Medical Center in Akron, Ohio while also earning a Masters of Science degree from The University of Akron. He and his family have lived in the Hampton Roads area of Virginia since 1994.

Dr. Clark has performed more than 1,300 gastric bypass procedures over the past 6 years. The average weight loss for his patients is 79% of excess body weight or an average of 129 pounds. When asked why he specializes in weight loss surgery, Dr. Clark says “Over the years, I’ve found that the most grateful patients were the ones whom I helped to lead a healthy life through weight-loss surgery. This surgery can change lives forever. That is the most satisfying thing to me and gives true meaning to what I am doing.”

Dr. Clark is certified by the American Board of Surgery and is a Fellow of the American College of Surgeons. He is a member of the American Medical Association, Medical Society of Virginia, American Society for Bariatric Surgery and the International Federation for the Surgery of Obesity.

TRANSCRIPT

Welcome to our live chat!

Tinker1970: Hi! How long does it take to completely heal after surgery?

Dr.Clark: Tinker: It depends upon what type of surgery you have done and whether the surgery is performed laparoscopically or open. Typically with a laparoscopic procedure you may return to full activity within two to three weeks. With an open procedure it may take four to six weeks.

Susan: How does gb surgery of today compare to the surgery 10 years ago.

Dr.Clark: Susan: The surgery is basically performed very similarly as 10 years ago. However, with new technological advances, the surgery can be performed more efficiently in the operating room which subsequently helps avoid complications.

Bev: Dr. Clark- how long after surgery does it take for your energy levels to return?

Dr.Clark: Bev: This is variable. Many patients find their energy level returns very quickly (within a few weeks) and others may find that it takes up to a couple of months. Adding supplemental B-Complex often assists with return of energy levels.

Michelle: Good evening Dr. Clark. Thank you for taking our questions. I am 41 years old and weigh 265 pounds and have polycystic ovary disease for which I take Ortho Tri-Cyclen. If I have gastric bypass and lose a lot of weight, will my PCO improve? Would I possibly be able to stop taking the Ortho Tri-Cyclen?

Dr.Clark: Michelle: You are most welcome. Often significant weight loss will greatly improve polycystic ovarian disease. Potentially, you may be able to discontinue the medication. During the first year after surgery, some form of birth control is necessary to prevent pregnancy while you are losing weight.

melody: How long does it take to heal?(providing no complications)

Dr.Clark: Melody: It depends upon the type of procedure performed. Typically with a A laparoscopic procedure the healing takes two to three weeks. With an open procedure it takes approximately four to six weeks.

Susan: Are there any sexual limitations after gb surgery other than a time frame of when you can resume sex?

Dr.Clark: Susan: As soon as you are comfortable you may resume sexual activity. If there is any discomfort, then hold off until you are comfortable.

Michelle: I have HTN and take Toprol. If I lose a lot of weight, might I be able to get off the Toprol?

melody: Thank you!!!

Dr.Clark: Michelle: Approximately 70% of all hypertensive patients will see their blood pressure improve. Approximately 1/2 of these patients will be able to discontinue all of their anti-hypertensive medications.

Bev: Dr. Clark, I am scheduled for surgery with you in Jan. Would thid be an open surgery as mentioned in Tinker's question to you?

Dr.Clark: Bev: Thank you for your question. The combined vertical banded gastroplasty/gastric bypass procedure I perform is done through an open approach. The incision is approximately 4 inches in length.

melody: What is a stricture?

Dr.Clark: Melody: A stricture is a narrowing of the gastro-jejunostomy anastomosis (the connection between the small gastric pouch and the small intestine). It is generally fairly easily treated with upper endoscopy and having the narrowed area dilated. The risk of developing a stricture is approximately 10-20% with a laparoscopic procedure and is <1% in the procedure which I perform.

tammy: what is the best thing to do for a 14 year old boy that over weigh

Dr.Clark: Tammy: Childhood obesity is a very significant problem in the United States. The initial treatment should be a complete medical evaluation stressing increasing activity and good eating habits. At this time, surgery is only contemplated in the most severe cases.

Susan: Does that mean there are no limitations to sex after gb surgery

Dr.Clark: Susan: Once you are healed - yes :)
tammy: dr clark would you say that if someone is in good heath but way over weigh what would be the best surger

Dr.Clark: Tammy: There are a number of surgical options available. Each one potentially may be right. It requires a discussion with your surgeon to determine what option is most appropriate for any individual. Each surgery typically has its own set of risks and benefits. Most surgeons have certain procedures that they specialize in. Make sure you research the program available to make sure it is a comprehensive program (including education, psychological support, dietary support and a thorough follow-up program including a support group).
Marydale: I just found out I'm pregnant, and I had gastric bypass over three years ago. Anything I should know or watch out for during my pregnancy? Also, I've already gained back 40 of my 130 lb weight loss before I got pregnant. I'm worried about weight gain.

tammy: thanks you very much Dr Clark for taking the time to talking to us

Dr.Clark: Marydale: Congratulations! Make sure that your OB/GYN physician is aware of your previous surgery. Obviously you must continue to take a complete multi-vitamin. Most pre-natal vitamins will work quite well. My experience is that patients do extremely well with their pregnancies and do quite well losing their weight after delivery. Good luck!!

Michelle: What is the best way to prevent dumping from occurring?

Dr.Clark: Michelle: The best way to prevent dumping is to avoid high sugar and high fat foods. Dumping is the result of hyperosmolar foods (high sugar and high fat) entering the small intestine quicker than normally. This typically causes symptoms of cramping, diarrhea, sweating, light-headedness and nausea.

tammy-: what i want to know is if you cant drink the high protein drinks what can you do ? when i tryed the they did not want to stay down

Dr.Clark: Tammy: This is not an uncommon complaint. Many protein drinks are not very palatable. You may want to discuss with your programs dietician other sources of protein such as soy granules/powders, soy nuts. Often the best protein sources come from regular food (beans, dairy products, cheeses, and some meats). If you are in the first few weeks post-op, you may need to avoid solid foods. Also discuss this with your surgeon.

gwen-: Gastric by pass surgery affects you for the rest of your life, with this I was told I would never be able to enjoy the holidays with my family ever again as food would be of no interest to me. What I think they mean is I would never be able to enjoy the food with them. Isn't it true that I will be able to eat just very small amounts? I have had a lot of negative people telling me the horror stories of the surgery. What they don't understand is the horror story I am living with out this help through the surgery. Any suggestions or advice

Dr.Clark: Gwen: Holidays and family time do not need to revolve around eating. The social rewards of spending time with people you love can more than make up for your limited intake of certain foods. You should be able to enjoy most foods in small amounts (avoid foods high in sugar and fats). You need to surround yourself with positive people who will support you no matter what your decision - surgery is a personal decision you make for yourself and your overall health.

deborahdnlsn: I am 3 months post op and I have had no real problems with food yet. I know that carbs are not good but what types of carbs can I eat that will not make me crave more carbs?

Dr.Clark: Deborah: Complex carbohydrates are a better choice than simple sugars. Make sure that you take in enough protein with your meals/snacks. This will typically curb your carbohydrate cravings.

christina: I have SLE and have been morbidly obese most of my life. I've tried everything. My question is..is gastric bypass surgery safe for someone with SLE...are there healing problems?

Dr.Clark: Christina: My experience with patients with SLE has been quite good. You need to make sure that you are followed very closely by your medical physician to ensure that all of your medical problems are well controlled prior to surgery.

susan_g: Type here: I had lapband and it did not work out......can I now have Bypass or is it too late for me

Dr.Clark: Susan: Generally an adjustable gastric band can be converted to a gastric bypass. It somewhat depends upon the reasons why it failed. You should discuss this with your surgeon.

gayle: I'm 52 years old haven't been able to walk for 3 years I am a diabetic I have neuropathy and I am about 400 pounds Is there any hope for me I haven't been out of my apartment for 3 years now. I don't have a wheelchair I need to get help Is there any hope for me I don't want to go by EMS My doctor has dropped me. Is there any hope can I have an operation in my condition

Dr.Clark: Gayle: Obviously you need to control your weight but you would need a complete medical evaluation prior to being considered a candidate for any surgery. Transportation will be necessary for this evaluation to occur. The EMS may be your best option.

Marydale: Has anyone written any books/publications regarding pregnancy after gastric bypass?

Dr.Clark: Marydale: I am not aware of any books specifically concerning pregnancy after gastric bypass. You may be able to complete an online book search or check with the American Society for Bariatric Surgery (www.asbs.org).

deborahdnlsn: I am having a hard time getting in all of my water so what I have been drinking is Crystal Lite and Coffee with non fat dariy creamer and Splenda. Is that ok or do I need to cut out the coffee?

Dr.Clark: Deborah: Although water is best, adding low-caloric products such as Crystal Light and flavored water (non carbonated) are fine. Caffeine can potentially worsen blood pressure and increase your appetite. Also, it is a mild diuretic. You will need to discuss whether or not you can continue coffee with your surgeon (it may depend upon your other medical problems).

moderator: We will take one more question.

Bev: It's me again- I am approx. 115 lbs overweight, with a large "overhanging" stomach- some of which is due to previous surgeries + weight gain. Does this skin have "memory" to return to proper tightening or are the odds likely for plastic surgery? Many thanks for being available tonight!

Dr.Clark: Bev: My pleasure. Whether the excess skin "shrinks or hangs" is dependent upon many variables such as genetics, age, smoking history, and diabetic history. Toning exercises can certainly help but may not prevent skin from hanging. In such situations, plastic surgery is a very reasonable option - yet a personal decision.

moderator: You can go to Dr. Clark's web-site at www.WeightLossSurgeryCenter.com

moderator: This concludes our chat for today. Thank you all for coming into today's chat room. We are so very 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 Dr. Clark for your informative and insightful answers. Please join our next chat with Dr. Michael A. Snyder, October 1, 2005. Good night and thank you once again.

John Pennings, M.D., FACS graduated from the University of Minnesota School of Medicine and completed his surgical residency and advanced laparoscopic surgery fellowship at the Oregon Health and Science University under the guidance of Dr. Lee Swanstom. Dr. Pennings founded Surgical Bariatrics Northwest in 2001, with a strong emphasis on a multidisiplinary approach to treating the bariatric patient, and offers bi-montly, professionally-directed support groups for his patients. His practice is focused mainly on laparoscopic Roux-en-y gastric bypass, but also offers LAP-BAND for interested patients.

TRANSCRIPT

Welcome to our chat!

Barbara: I have had surgery to repair a hernia in my belly button, I had a hysterectomy (bikini line) and close to a year after had scar tissue on my colon resulting in a perforated colon which they removed about 4-6 inches of my colon. I'm doing great now. My question is "Would I still be a good candidate for Laparoscopic Roux-en-y gastric bypass?" Thank You

Dr. Pennings: Barbara, having colon surgery will not effect the outcomes of gastric bypass. There may be adhesions that could make the technical aspects of surgery difficult, and may require conversion to an open procedure. However, we have done several patients with prior surgery of this nature without difficulty.

Shirley: Hi Dr. Pennings...Would it be possible to have a laproscopic revision if the original surgery was an "open RNY"?

Dr. Pennings: Shirley, Yes it would be possible, but there is a 20% or greater possibility of requiring another open procedure.

Cyndy: I recently had a gastric bypass, and wonder like with my weight of pre-op 357, that took place on Dec. 29, 2004, would it be reasonable to say that losing 80-85lbs is good or should I have lost more weight. I did not do a lot of formal exercise, and this semester I plan to go to a physical wellness class at school. With this and commitment do you think its possible to lose more or is there a point when you are at a standstill or in slow motion.

Dr. Pennings: Cyndy, Weight loss after gastric bypass is variable and depends on activity patterns and overall caloric intake. Typically, we expect patients to lose 8-10lbs per month in their first 12-15 months after surgery. It sounds like you are close to that estimation, but if are interested in boosting your weight loss, we would recommend you increase your physical activity with an emphasis on weight training, and make sure that your diet is protein rich. Some patients plateau, but will experience additional weight loss once activity and diet are adjusted appropriately.

Michelle: Hello Dr. Pennings... I weigh 263. Do I have to lose weight before lap. gastric bypass?

Dr. Pennings: Michelle, in our program we prepare our patients for surgery with a brief calorie restricted formulated diet, regardless of BMI. The length of this program is influenced by BMI and other health factors.

Vanda: Do you have to wait exactly 5 minutes in between bites? Or how long should I wait?

Dr. Pennings: Vanda, It is our recommendation that patients take adequate time between bites, although we don't set a specific time limit.

Shirley: In what circumstances would you consider a revision to be appropriate?

Dr. Pennings: Shirley, Revisions would be appropriate when there is a clear anatomic abnormality associated with a prior surgery, in conjunction with a failed weight loss effort.

Sharonjourney: I am a heavy scar tissue grower and I've had 8 surgeries because of it, what are the chances of growing scar tissue in the intestines after having the gastric bypass surgery? I was told that the band would be a smarter decision because of the risks.

Dr. Pennings: Sharon, Scar tissue grows around the intestines in response to the healing from prior surgery. Since you have had 8 surgeries, it is likely that you have an excessive amount of scar tissue in the intestinal area. A laparoscopic adjustable band placement would be technically and easier and less risky in your case, but this does not necessarily make it the right surgery for you. Other factors would have to be evaluated.

Michelle: Is two weeks off from work enough time for lap RNY and recovery time?

Dr. Pennings: Michelle, Many of our patients go back to work one week after surgery. However, we do not recommend that our patients return to work for 3-6 weeks so that they can slow down and become acquainted with their new tool. After all, you have chosen this operation to slow down and change your life long-term. Why not start today?

BarbaraA: I am scheduled for surgery and my biggest concern is hair loss. Is their anything I can do to prevent this from happening?

Dr. Pennings: Barbara, There is nothing that can completely prevent hair loss after gastric bypass surgery, although adequate vitamin and protein consumption are helpful in slowing the process. Hair loss is more significant in patients who have very rapid, early weight loss, and is less of a problem when patients can balance their nutrition and make the weight loss process a more gradual one.

Sherry: What known side effects are recorded for someone 3 years or more after the surgery?

Dr. Pennings: Sherry, The more common side effects have to do with micronutrient malabsorption such as mild iron deficiency anemia, or calcium loss. Additional technical problems that can occur after any abdominal surgery include such things as adhesions, causing bowel obstruction. The overall occurrence of late intestinal obstructions after laparoscopic gastric bypass is less than 3%.

BarbaraA: I have a friend who is dealing with nausea weeks after the surgery. Could this be caused by not eating enough? Other causes?

Dr. Pennings: Barbara, Nausea is complex and is influenced by multiple factors. This is an unexpected circumstance, and she should be thoroughly evaluated by her physician.

Sharonjourney: since I have so many medical problems associated with obesity, I was told by my doctor today to keep appealing the insurance because its medi-cal and that it should eventually go through, have you ever had a medi-cal case go through?

Dr. Pennings: Sharon, Being located in Idaho, we have not had any experience with Medi-Cal.

Michelle: How much and what would I eat when I come home from the hospital? What can I do to prevent dumping?

Dr. Pennings: Michelle, in our program, there is a well-organized diet progression leading through 5 stages. The first stage immediately after surgery is a formulated liquid diet. To prevent dumping, we recommend a carbohydrate/sugar-restricted diet.

Libby Evans: Is there any way to get medical assistance to pay for the surgery?

Dr. Pennings: Libby, I am not sure what insurance you are referring to, but each state has their own set of criteria that a patient has to meet before qualifying for surgery. Check with your local state aid office to find out the specifics relative to your state.

New_Jen: I feel that I have a basic understanding of sugar alcohols but how do they affect our diet post op and is there really such a thing as "net carb" or is it just a made up marketing ploy?

Dr. Pennings: Jen, Sugar alcohols are not calorically inert. We recommend avoiding a high intake of these substances now, and in the aftermath of surgery.

Libby_Evans: Do you recommend the surgery for someone who has had liver surgery?

Dr. Pennings: Libby, It would depend on the type of liver surgery you have had. If, for example, you have had a liver transplant and are on immunosuppressive medication, you would be at a much higher risk for severe complications following surgery.

Libby_Evans: I have and they said it is considered an elective surgery and they will not cover it.

Dr. Pennings: Libby, I am sorry to hear that your state won't approve gastric bypass surgery. Perhaps you can appeal through your local government representative to help make some policy changes.

Maxine: Hi I was wondering what the "dumping syndrome" is and what it feels like?

Dr. Pennings: Maxine, Dumping syndrome is caused by having undigested food substances, principally carbohydrates, enter the intestine before they are broken down into small enough particles to be absorbed. Symptoms are variable but include intense nausea, cramping, diarrhea, heart palpitations, and profuse sweating.

Janice: Dr. Pennings, do you recommend patients wear medic alert bracelets post-op indicating we've have the surgery and instructions for medical personnel to not use NG tube blindly (as other patients have suggested)?

Dr. Pennings: Janice, Yes. Patients should either wear ID bracelets or carry a medical alert card in their wallet.

Michelle: Can I go through the recovery alone? I'm not married and don't have a boyfriend or anyone to "take care of me".

Dr. Pennings: Michelle, You can do anything! Recovery is easier when you have a support group that understands what you are going through. Any reputable program should have an active support group that can help you through this time.

BarbaraA: Can Advil or Tylenol be taken ( for headaches )after surgery?

Dr. Pennings: Barbara, Tylenol is safe after surgery, but Advil is in a class of drugs that can cause gastric pouch erosions and perforations and is not recommended.

Shirley: I'm sorry, but I must leave. Thank you so much Dr. Pennings, for answering my questions!

Maxine: Thank You for answering my question about Dumping Syndrome but I would like to know if the symptoms can include very severe pains in the stomach and rib area?

Dr. Pennings: Maxine, This is possible as a consequence of cramping. If this type of pain is frequent or constant, it is unlikely to be related to dumping syndrome, and an additional cause should be sought out. See your physician if the problem persists.

Janice: If pills go through the new pouch quickly, why does this class of drugs (Advil) cause erosions?

Dr. Pennings: Janice, Pouches don't always empty in the same way, and you cannot be certain that the pills will quickly exit the pouch. More importantly, this class of drugs chemically affects the ability for the pouch lining to secrete its normal protective barrier.

Michelle: Should vitamins be chewable after surgery?

Dr. Pennings: Michelle, Yes, they should be chewable. It is very important that the vitamins you choose have adequate levels of iron, calcium, and B vitamins. B12 is a very important vitamin that is found only in certain vitamins designed for use in bariatric patients. Make sure your vitamins contain the recommended levels of these. A chewable vitamin is more reliably absorbed following gastric bypass surgery.

Mel: I was wondering, if you suffer from a very slow thyroid problem and you're taking synthroid, if that affects you or does not allow you to lose the weight when you get the surgery?

Dr. Pennings: Hypothyroidism by itself is seldom a significant impediment to weight loss following gastric bypass surgery.

Mel: So how come hypotheroidism affects you so much and stops you from losing weight pre-surgery then? I figured it would do the same after?

Dr. Pennings: It has some influence but it is overwhelmed by the power of the gastric bypass operation. It is important however to monitor thyroid levels and change medication dosage according to measured levels. This will ensure that metabolic functions are normalized.

Libby_Evans: Since I have had part of my liver surgically removed would I be at higher risk for complications?

Dr. Pennings: Libby, Providing your liver is now functioning adequately, the only additional risk would be related to the technical difficulties of performing surgery in an area where there is scarring from your previous operation.

Michelle: Will having gastric bypass and losing weight positively affect my polycystic ovary disease? Will my periods regulate? Will the body hair decrease?

Dr. Pennings: Michelle, PCOS is a specific disease process, which responds remarkably to dramatic weight loss. It has been our experience that patients with this condition do achieve the benefits you described.

Kali: Can drinking carbonated beverages cause problems in a person's stomach who has had bariatric surgery? If so, please specify. I had surgery about 3years and 6 months ago and I do drink soda sometimes. I sometime feel slight pain and discomfort in my stomach after I have had soda.

Dr. Pennings: Kali, We do not recommend carbonated beverages for any of our post gastric bypass patients. Listen to your body...if it hurts, don't do it.

Patricia: How do we choose what type of GB to have??? So many and its all confusing.

Dr. Pennings: Patricia, I agree that there is some confusion when it comes to types of gastric bypass. The "gold standard" operation is a proximal gastric bypass, consisting of a small gastric pouch that is completely separated from the old stomach and an intestinal bypass limb length of 120cm or less. Have your surgeon explain what operation they are intending to do. If they do not describe an operation such as above, ask more questions. Surgery choice is a very personal decision. The most important feature, in my opinion, is to have your operation done by someone who is reputable and in whom you have confidence.

Dr. Pennings: Our web address is www.surgicalbariatrics.com and contact information is Surgical Bariatrics Northwest 208 262-0945

Moderator: This concludes our chat for today. Thank you all for coming into today's chat room. We are so very 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 Dr. Pennings for your informative and insightful answers. Please check our web site www.liteandhope.com for our next chat. Good night and thank you once again.

Dr. Barry Fisher has been practicing bariatric surgery since 1989. He practices in Las Vegas and now performs laparoscopic gastric bypass and Lap Banding exclusively. He has published extensively and has demonstrated some of the best results in his patients with the lowest rate of complications in the USA. He has lectured extensively in the US and in other countries. He is a consultant to several companies associated with bariatric surgery, and is know by his patients for his knack to be caring and giving great hugs.

Dr. Fisher's contributions to bariatric surgery have included new instruments, technical improvements in surgery, and advancement in knowledge about behavioral improvements leading to improved long term weight loss.

TRANSCRIPT

Welcome to our chat with Lite and Hope registered surgeon Dr. Barry Fisher of Las Vegas

sahara: After you have lost your desired amount of weight, how do you keep from losing too much and how do you maintain the weight you want? By this I mean, how does your maintenance diet differ from the losing diet if that makes sense?

Dr.Fisher: In our program, the weight loss diet is the maintenance diet. There should be no difference. Our concept is a permanent change in diet, NOT going on a DIET to lose weight. The failure of dieting is that it ends! We do not want it to be that way in our program.

barbie: I have had a roux-n-y gastric bypass. I have had severe low sugar, drops into the30's. I also have just had a parathyroid surgery 3 and 1/2 glands removed, ended up in the hospital for 20 days, they finally let me go home with my picc line and I do 4grams of iv calcium a day plus 6000mg oral calcium daily. My question to you, is would a reversal of the gastric bypass be warranted, to help my situation? I need desperately to have this opinion. Thank you for your time.

Dr.Fisher: Barbie, this is a difficult issue. We have had several patients with low blood sugar, but none have had their parathyroid glands removed. Some doctors treat this by severe restriction of carbohydrates; the others have their patients take some fruit when they get lightheaded. I have never seen this to be a permanent condition, as it goes a way in most people.

Alma: Do you prefer gastric bypass or lap-band? Which is better?

Dr.Fisher: Alma asked which I prefer, the Band or the bypass? The fact is I do them both because I like them both. I give the patient the decision after explaining that they are two different operations, with two different processes, but both depend on the patient making that diet change permanently, that I spoke about a moment ago.

pj: In addition to my obesity problem, I have large fibroids. Would you recommend combining the surgeries or doing them independently?

Dr.Fisher: PJ, if you are going to have gastric bypass laparoscopically, there is no benefit to doing these together. If you are having an open operation, it means having the incision go from the top to the bottom of your belly to do both together safely. I have done the latter twice with a gynecologist. If you are doing this using laparoscopy, do it separately.

donna: I am scheduled to have gastric bypass surgery in Jan. 06, I am completing my 6 months of waiting now. I am starting to get scared. I am 5'3" and weigh 266. I have tried every diet under the sun and just can't lose what I must in order to live a long life. I’m really worried about my recovery time. I chose Laproscopic. I just need encouragement, I keep having second thoughts and wondering what else I could do, but I know nothing.

Dr.Fisher: Your best bet is to join one of the OSSDG support groups on yahoo. You can even join ours at www.bandandbypass.com. Then you can post your fears and concerns and get oodles of feedback from those in the know, those who have gone through the same fears.

elizabeth: My concerns are severe pain on the left side close to the rib cage, underneath. I have had this pain for the last year off and on and my surgeon wasn't sure what it could be. After being in severe pain for the last week and half I finally went in to see him. I told him the pain was unbearable and needed to be checked. He believes that I could have adhesions or obstructure. I will be scheduled within a week for the EGD and wanted to know if you have had patients with the similar pain. On a normal day the pain level is between 6-7, and on days it hits hard, it is over a 10. Please give me some guidance.

Dr.Fisher: This pain, this long is not common and should be evaluated. If EGD and CT scan are normal, then I would probably suggest a diagnostic laproscopy to rule out a problem. Half the time these laparoscopies show normal findings, but sometimes they are helpful and they are not very risky.

sharon: I've been fighting with my insurance company and they're giving me a bad time. Does your office assist in getting me qualified for insurance. I live in Reno.

Dr.Fisher: Sharon, I share your frustration with insurance. We know what they want, and if you have the documentation, we can get the approval. However, if the documentation they are looking for is not present, then we cannot.

Dr.Fisher: Sharon, In addition, if you have an exclusion in your policy, then there is no way that you will get approved. If there is no exclusion except for this surgery being deemed experimental, then you should expect a denial, and a good lawyer can help you with the appeal and YOU WILL WIN: Do not give up if it is not specifically excluded.

susan: Do you know of any doctors that do the surgery pro bono?

Dr.Fisher: No I do not know of any in our area. There is too much effort, and too much cost involved, and too many people who need it.

mark: I see you do both Gastric Bypass and lap banding, which is better? And does it really matter?

Dr.Fisher: Mark, I answered that question earlier It was asked off line by Anne. Scroll up and you will see the answer.

linda: what effect will the surgery have on my sex life? I'm very obese but still have a great sex life. Will having the surgery slow me down?

Dr.Fisher: Linda, this is a very good question, and the honest answer is that there is no way to predict. I have seen many in whom the sex life is enhanced and gets much better. I have also heard from some women that they have lost their sex drive almost completely. This is poorly understood, as ours was one of the first publications that talked about this loss of drive. There is a belief that if the marriage is stond and built on dependency (a psychological term), then it will get better.

sahara: My surgeon told me that as soon as my surgery was over, I would no longer need to take my blood pressure medications nor my diabetes medication? Is that correct?

Dr.Fisher: Sahara, 90% of type II diabetics can expect to go off their medication in about four months after RNY, 70 % of High blood pressure patients will be improved, about half of them going off meds completely, the other half getting better control on less medication. That is what is published, and we find the same in our practice.

Elena: I am 5 months out from surgery...and I am already hungry...I work hard to make the right choices. Is this not a diet?

Dr.Fisher: I do not know what your surgeon has taught you. Our program teaches a high protein, low carb low fat approach, and natural foods without being processed. Staying away from caffeine and carbs avoids much of the appetite stimulation and allows you to stay less hungry for longer. A lot depends upon what you are eating and how you have been taught. Please visit our web site at www.bandandbypass.com and click on "diet" or behavior changes to see our simple to remember, and hard to accomplish, program.

Debbie: Hi - I am a 51 year old lady who has diabetes since I was 35. I am on concentrate insulin, of course oral med's and Lantus as well. I also have high blood pressure - reflux - sleep apnea - gastro paresis - and a condition dealing with diastolic pressure in my heart. I am also being tested for Cushing’s Syndrome. I weigh 324 pounds. Would I be crazy to think I can have gastric bypass surgery?

Dr.Fisher: You have too many problems for me to predict whether you are a candidate. The gastorparesis and heart problems may stand in your way. It will be up to your doctor to decide. Remember, nothing ventured, nothing gained. You cannot know the answer until you start the process.

julie59: With Gastric Bypass surgery, is it possible to lose weight and then put all the weight back on? What are the percentages of failures?

Dr.Fisher: Julie, I wish it were not possible to do this. But it is. The only problem with this wonderful surgery is that its effects lessen with time. If you have not changed your habits when it was easy, and you do not return to prior habits that got you fat, then you will not regain. I believe about 20% of patients in my practice have regained the better part of what they lost.

Austin: Dr. Fisher - what are the most important things a patient can do for them selves to prepare for the surgery?

Dr.Fisher: First, start to keep a journal of your feelings and thoughts. When the hunger returns in three to five years after the surgery, this will help you to remember how frustrated you were with your weight, and why you decided on surgery.

Dr.Fisher: Austin, one more thing. Do as much research and have a realistic understanding of your role as well as the role of the surgery, and be sure you re ready to commit to a permanent change in your diet.

Sharon756: I've had 7 surgeries for scar tissue, would that make the lap-band safer, so the scar tissue doesn’t grow inside the intestines?

Dr.Fisher: Sharon, It is hard to tell whether the band or the bypass would be better for you. The band will be easier for the surgeon. Scar tissue grows around the intestine, not inside them.

Faith: I would like to know why you keep the part of stomach in that is no longer in use? What happens to it just sitting their empty and does it collect a lot of bacteria? Thanks.

Dr.Fisher: No the stomach does not get overgrown with bacteria. The reasons it is left behind are, first that it increases the risks of surgery to remove it, second, that there are no options remaining should you have a problem downstream if the balance of your stomach has been removed for no reason.

Jana_G: In all of my research on RNY surgery, I have found lactose intolerance to be a major occurrence after surgery. Can you explain why this is? Can it be helped through the use of Lactaid or other products?

Dr.Fisher: Lactose intolerance can happen but I do not see it as a tremendous problem. We find lactose in milk and in cheeses. (And in other products like ice cream). You can survive well without these, Lactose intolerance is not predictable after surgery and I have only seen it in about 15% of my patients to the point that they talk about it.

Susan: I'm 5'8" 390 and can't get insurance or find any help to get this surgery. My doctor told me I'll probably be dead if 5 yrs if I don't have the surgery. I've written to many places for help including my congressman, where do you turn when you hit the dead end wall?

Dr.Fisher: I wish I had a good answer. There are some people who can find the means and get a loan for this. They are available. The Inamed Company has been helpful with financing through banks for Lap Band surgery, and there are other companies that have helped with financing for gastric bypass. Your doctor should be aware of this. I wish health care was free, but there are too many people who expect to get their salaries for patient care today, and would not be there if there were no compensation.

Sharon756: I was told there’s a 3% chance that you have to have the procedure redone because of scar tissue growth causing blockage inside the intestine. Is this correct?

Dr.Fisher: No Sharon. The chance of reoperation for all causes is only about 5-6%. Your concept of scar tissue leading to blockage inside the intestine is foreign to me. There is a chance that the junction between the new stomach pouch and the intestine can get smaller due to scarring soon after the operation, this happens in about 4-5% of people and does not need a formal operation, just and endoscopy, being treated through the mouth. I hope this answers your question.

ladybugger: My question would be that I am in pretty good health other than osteoarthritis in one knee, but a lot of joint pain, 298lbs 5 feet 6 inches, and am seriously considering surgery. Would I be a good candidate? I have my first appt with a Dr. for referral to have this done on September 1st and very anxious to get started. Thank you.

Dr.Fisher: You meet national guidelines for surgery; whether you are a good candidate remains for the surgeon to determine after he/she meets you and gets to know you. If you are ready to make a change in your entire approach to food, and maybe to the way you live your life, and you are strongly motivated, you might be a good candidate for our program. That is what we look for.

ebony: How long do you have to stay in the hospital when u have surgery.

Dr.Fisher: Most of our patients stay in the hospital for one day after gastric bypass surgery, laparoascopically, and several hours after Lap Band surgery. Other surgeons do it differently.

Shannon: Dr. Fisher, I have done some research on the Gastric Bypass Surgery and what all it entails and I would like to know if the gastric Bypass is covered through Regence Life & Health Insurance Co.

Dr.Fisher: I cannot speak for Regence. That is one branch of Blue Cross and each does it their way. You will have to call the administrator to check on benefits. When you do ask whether they pay for Lap RNY CPT 43644. They should be able to give you that answer over the phone.

julie59: With the surgery, is it still possible to be hungry?

Dr.Fisher: Yes it is. One of the weaknesses of gastric bypass is the return of hunger. One of the advantages of the Lap Band is the long-term suppression of hunger. However, if you change your diet to one that avoids dietary appetite stimulation, then you stand a better chance than if you stick with coffee and cookies.

Jana_G: I have heard that you are not supposed to eat bread or coconut after surgery. I understand the bread can gum together and cause blockages in the stomach opening (plus the carbs), but I was wondering what it is about the coconut that is a problem. Just too ro