Moderator: Good evening and welcome. We will be starting in approx. 15-20 minutes. Please feel free to submit your questions now and they will be numbered and given to Carnie in the number received. Thank you.

kourtney-: Carnie- you are so inspirational!! And you look awesome. I just need some tips to get back on track. I also am 7 years post op and just delivered my first baby, a daughter in January. I only gained 35 pounds during the pregnancy, immediately lost 15, but now I have gained 30#!!! I need some desperate help. I feel and look miserable. I need to feel and look good for my daughter. Please help!

Delana: I am scheduled for an Open RNY on December 11th. We are a military family and live far from family and friends, so my husband will be the one to help me with our children, the household, my care, etc. (Kids are 8 and 1) My question is, How long will it be before I am able to lift my toddler, who weighs approximately 27 pounds, and how long should my husband request off to help me and the children? Thank you.

Carnie: Sorry it took this long! Welcome everyone.....Delana.... congrats to you! You are not having Lap, so the recovery time will be longer. You'll need at least 4-6 weeks recovery time, before you can return to work. This is really a question for your surgeon. Most patients that have open Gastric Bypasses shouldn't lift anything over 25 pounds for at least a month. I really don't have the exact answer for you. Dr. Wittgrove will answer all medical questions for this chat if submitted through Lite and Hope.

Carnie: I have had several abdominal surgeries and it's probably a good idea that you give yourself two-four weeks before lifting anything. Be very careful not to rip your incision. All patients recover differently. Stay in close touch with your surgeon and play it by ear. I wish you all the best and good luck to you!!!!!!!!!!!!

Lorena: I am an ER nurse/paramedic that had gastric bypass 4 months ago and the possibility of regaining weight is frightening to me. I am wondering if post gastric bypass patients lose weight much easier than non-gastric bypass patients if they cut out the bad food and participate in moderate exercise?

Carnie: Good for you for having the surgery!! At four months post op, you should be losing weight consistently. This is not a time for worrying about gaining. If you are following all the rules: Eating your protein first, drinking 64oz. of water every day, exercising at least 3-five times a week, no snacking and taking all your vitamins.... you will be continuing to lose your weight for another year or so. Keep positive with you attitude and don't think about negative things. This is a time for you to be excited, grateful and compliant. You can do it!! Stay in touch with other patients and have fun with the process. it's a miracle!!!! Much love to you.

J.: Is it true that you must stop all sugar intake of any kind including sugar substitute before surgery?

Carnie: Hi there. I have never heard of that before. There might be different instructions for someone who is diabetic or pre-diabetic or has liver problems. I think the best thing to do before surgery (like three days before) is to eat your MO FO heart out!! Just eat whatever you feel like. Take nice walks and start visualizing about your new lifestyle and body. You need to be mentally prepared for this. There will be many changes: Dietary, emotional, physical. They all go hand in hand. You'll be a better patient if you are more prepared. I remember having a doughnut a couple of days before surgery and an apple pie from McDonalds!!! LOL.

jmlopez: what is the recovery time?

Maria_Fenner: Carnie you truly are an inspiration to all women... skinny or obese

Carnie: Well, it depends on whether you had it LAP or OPEN. Typical recovery for LAP is two -four weeks. Open 4-6 weeks.
justin: hi carnie this is Justin the 777 lb man from Ohio Just wanted to say hello and thank you for your support I have lost 260 lbs now am doing well hope you are doing the same

Carnie: WOW OH MY GOSH. I am so happy for you!!!!!! I remember crying on the phone with your friends. You are such an inspiration for everyone. If you can do it ANYONE can. Keep it up. Excercise every single day. You'll need to work harder than a lot of people because your weight loss period will be longer (because you have more to lose than most). BUT----- you can DO IT!

Carnie: I am great by the way. My daughter Lola is wonderful and thriving!!!!

kimnatale: How sick and sore did you feel after awakening from the surgery?

Carnie: Well.... let's just get real here. I felt like shit. It's surgery!! I was groggy, cranky, uncomfortable and relieved all at the same time. You have to tell yourself that you won't feel good for a few days and then each day you feel better and better. You'll be losing weight so fast it'll blow your mind and that alone puts you in a better mood. You'll be sore for a good few weeks and you'll just get through it. POSITIVE attitude helps with everything.

tleach52: I had a RNY 4 months ago and now starting to experience hair thinning. What can I do to slow down it and how long will it last?

Carnie: It's totally normal to experience this a few months post op. Protein intake is crucial and vitamin supplements are critical. You can get supplements right here on Lite and Hope by Metagenics. I take Metagenics and LOVE LOVE LOVE them. You will regrow hair. Don't worry. It’s normal. Surgery can do it as well... the body goes into a natural shock after ANY surgery.

tweetie50: WHAT IS THE HARDEST PART OF THE WHOLE EXPERIENCE ?

Carnie: The HARDEST part? Well, that's a question that could take me a long time to answer. There are positives and challenges. It's very easy to get caught up in what everyone else thinks. I try to ignore people's opinions about the surgery. It’s lifesaving for many people and we should never be ashamed. If anything.... we're brave and setting a good example to take our health into our own hands. Losing a lot of weight quickly is a big change. Adjusting to my new body has been the hardest part. Believing that I deserve to feel good and look good can sometimes be confusing to me.... foreign to me. I know that sounds messed up, but it's the truth. The emotional part is has been the most challenging and ongoing. I try to accept the emotions as they come to me. Some days are harder than others. I try and think about what has been the BEST thing about this. That would be having my health back and not having to worry about how the hell I was going to lose 150 pounds when I couldn't even lose 5.

kourt_iowa: HI Carnie you are so inspirational and you look awesome! I need some tips on getting back on track. I also had my surgery 7 years ago, 6/99. I also just delivered my first child, a daughter in January. Problems is I gained only 35# during my pregnancy, lost 15# right away and now gained back 30#. I look and feel miserable. I need some desperate help.

jmlopez: JUSTIN! THAT IS GREAT!

Carnie: thank you!! it's definitely harder as the years go on. The way to get back on track is to cut back on carb portions. Your daily water needs to be at least 64 oz. You need to increase your exercise to five times a week and SWEAT. Doing these three things will ABSOLUTELY get you going!!!

BETTY_DONOVAN: Dearest Carnie, I love you for being so supportive of all of us. Keep up the good work. I am 17 months post GBS (laproscopic Roux en-Y). I lost weight really fast for 10 months, 75 % of my goal! I have been on a plateau for 7 months and I want off!!! How can I get restarted (I am still pushing protein and eating very organic)? I am disabled by Myasthenia Gravis and have lost fat and put on muscle (which is good) but I really need to lose that last 30 pounds. Give me a boost off the plateau please!

Carnie: Thank you so much. I understand plateaus. They suck. If you have a disability and can't exercise you will have a bigger challenge. That means that you need to decrease your calorie intake. Maybe do some resistance training to build more muscle and burn fat all day long. Drink a ton of water and DO NOT SNACK. Good luck!!

Renee_Walton: How much more have you lost since the Celebrity Fit Show and Oprah?

Carnie: I have lost none. I had a very stressful October and my husband was on tour for a month. I ate a little out of anxiety and now I have started back on track again. This will always be a battle for me. I try and do what I tell you people to do. We're all in the same boat together.

nanners: Carnie please continue to "Lay it all out there" because you are making a difference in peoples lives. Thank you so much! Is there anything we can do for you?

Carnie: Oh thank you!! I love to put it out there..... I can't help myself. Let's just keep spreading the word about morbid obesity and how we are understanding the impact it's having on people's lives. We can help people around us and send our love out to each other. I sound like a Hallmark card!!!!! but it's all true. :)

susan_weston: I am in my 3rd year after my surgery. Will I continue to lose weight? Since my surgery before I weighed 281 now I weigh 140.

Carnie: GREAT FOR YOU!! WOW. Wonderful. The body naturally slows down with the weight loss. If you are one of the few people that has trouble gaining weight (AAARRRGGGGG!!! :) ), then increase your calories. Workout and build your lean muscle mass. If you continue to lose and get too thin..... Consult your doctor.

Moderator: Unfortunately we have run out time and Carnie got through as many questions as she could. Carnie would now like to give everyone some final words.

Carnie: Thank you all for participating!! I hope I have been helpful to you. I know there are many of you who did not have questions answered, but Dr. Wittgrove will cover some and of course, there is so much information floating around websites like this one (LITE AND HOPE).

Carnie: Regarding insurance.... I know how awful it can be. You all need to hang in there. If you wait for too long... change companies, change jobs, do whatever you can to make it happen. Pray... be optimistic. I wish I could help every single one of you. I just can't. In the meantime.... eat more portion-controlled meals. Exercise all that you can. Drink a ton of water (Iknow I sound like a broken record.... but it works.) I wish all of you a very happy Thanksgiving and Holidays. I love you and appreciate you. Bye for now!!!!!!

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

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

Dr. Mathias Fobi, a nationally recognized bariatric surgeon, who has changed the shape of Hollywood heavyweights such as Roseanne Barr and American Idol’s Randy Jackson, has treated more than 10,000 obesity patients since 1981. Dr. Fobi received his Pharmacy degree from the University of Michigan and received his medical degree from University of Cincinnati. Dr. Fobi’s training included General Surgical Residency at the King Drew Medical Center in Los Angeles, and a fellowship in General Surgery with the American College of Surgeons. Currently Dr. Fobi serves as the President of the American Society for Bariatric Surgery Foundation and is the Medical Director of the Bariatric Program at St Mary Medical Center in Long Beach, CA and Center of Excellence Tri-City Regional Medical Center in Hawaiian Gardens, CA

Moderator: Welcome to our live chat

DEB: I am 2yrs post op , I am still having terrible trouble with my diet, I have gained & continue to gain weight. Carbs are my enemy & I don't know what to do about it. Please can some help me?

Dr. Fobi: DEB You need to be seen by the nutrionist at your surgeon's clinic for nutritional counseling.

tami-: I weigh 380, what exercises can and should I do to prepare for surgery. I have walked a mile just today, and I have begun a CURVES protein shake as my ONLY meal will I still lose?

Dr. Fobi: tami- Any effort to lose weight before surgery will decrease your surgical risks. The effort may result in no weight loss but definitely no weight gain

DEB: DR. Fobi, Hi! My daughter encouraged me with this surgery but as a nurse now sees a lot of bowel obstructions. She is worried. One woman has come in for 7 years with each year having a bowel obstruction. What is she doing wrong? What causes this? What can be done to prevent it? I personally know 8 people having GBS and have not had this. Is it prevalent?

Dr. Fobi: Bowel obstruction can occur after any abdominal operation. The incidence of bowel obstruction after Gastric bypass is up to 3%.

joanne: Thank you for taking my question. I am 4 1/2 months out and have lost 60lbs. It is getting really slow now. Should I expect to lose another 40 lbs. in the next 6 months? Also, what could I do in the long term for constipation and impaction? I get very sick and feel like I'm going to pass out!!

Dr. Fobi: Joanne , you are going through a plateau and expect to loose some more weight until 15-18 month after the operation. The constipation will be relieved by eating more fiber containing foods. In the mean time a glass of prune juice will not hurt.

cindy: Dr. Fobi, is it possible to "stretch" the pouch?

Dr. Fobi: Cindy- Yes. Repeated over stuffing the pouch and vomiting will result in pouch dilatation or stretching

Vicki_Queen: Dr. Fobi what do you enjoy most about what you do and what made you go into this arena of surgery for the obese?

Dr. Fobi: Vicki-I get a lot of satisfaction from the outcome from obesity. It changes people, give them a life, self esteem and increased activity.

Marie: Hi Dr Fobi. I am 15 months post-op LAP RNY. Can you stop losing weight if you are not exercising?

Dr. Fobi: Marie- Definitely. Surgery is a tool. Those who use it like Carnie Wilson did with a lot of exercise have the best weight loss outcome.

Kenzie: Is it possible to have your tubes tied when you have WLS done or does it depend on the surgeon?

Dr. Fobi: Kenzie- Yes you can have your tubes tied at the time of your WLS. Just ask you surgeon.

Dawn: Good evening Dr. Fobi, I am 5 months out and have not lost any weight for approx a month. Can you give me some advice as to what will kick it in gear again? I only have 11 lbs to go to get to goal weight. ::smile

Dr. Fobi: Dawn- You have done very well. You are at a plateau. Expect to lose some more weight in the next six months. Keep up with your exercise routine.

Dawn: Thank you Dr. Fobi. ::cool

MissM: Where is your hospital located?

Dr. Fobi: MssM- I work out of three hospitals. TCRMC in Hawaiian Gardens, St Mary in Long Beach and Cedars Sinai in Los Angeles,

MissM: How many laproscopic lab bands have you completed?

Dr. Fobi: MissM - I have not done any Lap-Bands

Mignon: Dr. Fobi, will I gain weight if I don't take my vitamins?

Dr. Fobi: mignon- No. Vitamins are to correct any deficiencies you may have from the surgery.

joanne: I can take a small bite of meat, chew it a long time, and I still get sick and vomit. What is happening? Is this little bit stretching my pouch?

Dr. Fobi: Joane-Meats are difficult to eat after most restrictive operations. The trick is on how the meat is prepared more than how much you chew. Yes repeated vomiting will stretch the pouch.

Kenzie: Is getting your tubes tied common during WLS?

Dr. Fobi: Kenzie- Yes . If the patient requests it 30 days before surgery and signs the sterilization consent.

MissM: What is the chance of infection with this kind of surgery?

Dr. Fobi: MissM- If done laparoscopically the chances of infection are from a leak which is about 6%. If done open, the wound Infection rate is up to 10%. The leak rate is up to three percent.

melissa: When is a good time to start exercising after surgery?

Dr. Fobi: Melissa- You should start working in the room the day of the surgery. At home after discharge you should walk a block a day and increase by a block daily until you get to ten blocks a day. After that you can increase the vigorousness of the exercise gradually dependent on whether you had a laparoscopic or open surgery. I suggest that you discuss this with your surgeon before and after surgery

carol: Dr. Fobi, I am a type II Insulin-Dependent Diabetic with a BMI of 35. I have consulted with three lap band surgeons who have turned me down because I am not 100 pounds overweight. Would you consider gastric bypass on me?

Dr. Fobi: Carol- Yes

Becky: Hi, I am 3 1/2 years out from surgery, why is it that sometimes I am amazed how much I can eat and then other times just a couple bites is all I can eat?????????

Dr. Fobi: Becky- The amount you eat after the Gastric bypass operation depends on how you choose your food, how you prepare the food, how well you chew and your mood. The more relaxed you are before the meal and the more time you allow for the meal the more you can consume. Do not drink and eat at the same time. Drink between meals.

Dawn: Dr. Fobi what is your opinion on eating bread? Is it ok or should I stay away from it? Also if I eat any kind of beef I get sick. Is that because it is so hard to digest and hard on your digestive system?

Dr. Fobi: Dawn- Bread is not a problem if you toast the bread, which makes chewing it easy. Meats are difficult. To eat meats it is good to mince the meat to hamburger meat so it is like coleslaw.

mia_pepper: I am 6 weeks out after gastric bypass and am having difficulty in getting enough protein. Protein shakes make me sick. Do you have any ideas?

Dr. Fobi: Mia-Pepper- Stay on pureed foods until you are taking enough before trying regular meals.Try eating popcorn and you will find you can eat a lot. This will give you the confidence that the surgery is intact and you do not have a narrow passage. You will eventually be able to eat anything.

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

shakia: I had my surgery in April I was 235lbs and now I'm 180lbs. I feel like I'm at a stand still in my weight. What should I do?

Dr. Fobi: Shakia= You are doing great. You are at a plateau. Give yourself two moths and you will lose some more weight.

Becky: good job Shakia

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

Donna: Hello, Dr. Fobi. Thank you for all you have done for the weight challenged! I will be having the open procedure with Fobi pouch in December. Do I understand my surgeon correctly, with the Fobi pouch, is there less stretching of the new stomach, or is it the opening to the stomach that will not grow larger?

Dr. Fobi: Donna- The main characteristic of the Fobi-Pouch is that the outlet is standardized and non stretchable for the life of the operation. This results in more weight loss and better weight loss maintenance in more patients.

robin-: I had gastric bypass 2 1/2 years ago and will be 3 in February. I am gaining weight back and I never get sick. I eat off and on all day just nibbling, I drink sweet tea but when meals come I still can't eat but very little at a time. I think my surgery did not work I went from 326 to 214 now back to 242 lbs and I am scared. I quit taking all my B12 and Flinstones over 6 months ago. Have not been to surgeon in a long time. Any Help?

Dr. Fobi: robin- Your experience is not unusual. You are grazing and that will defeat your operation. You need nutritional counseling so you can eat only three meals a day with no caloric intake between meals. I recommend that you go see your surgeon before you gain any more weight.

Monica: I am 7 weeks out after having gastric bypass. I am experiencing a lot of painful constipation. How can I help this problem?

Dr. Fobi: Monica- Drink a lot of water. A glass of prune juice a day will also help.

Becky: I weighed 293 before surgery, 165 now, BEST thing I have ever done for my health

carol: Is the bariatric surgery you perform reversible? Is it safe to perform on a Diabetic, what with the slower healing rate, etc. My last Aic 3 months ago was 6.6. Thank you.

Dr. Fobi: Carol- Yes the surgery is reversible in that you can reconnect the stomach and the small bowel so you can eat as much as you did before. The gastric bypass is the best treatment for type 11 diabetes at this time. 90% of my diabetics leave the hospital with normal blood sugars on no medications. I have not noticed any difference in healing in my diabetic patients after the Lap Gastric bypass.

Dawn: Dr. Fobi I just want to thank you for your time and for answering all of our questions!!!!:::rolleyes

Moderator: Dr. Fobi, Is there any last words before we conclude tonight’s Live Chat?

Dr. Fobi: Surgery is the only significant effective modality to control weight. However, surgery is a tool that the patient must use with the assistance of the multidisciplinary staff the bariatric surgeon has put together. Regular follow up with the surgeon is a must. Attendance at support groups has been shown to minimize weight regain. Having obesity surgery should be considered a lifetime commitment by any patient undergoing any of the bariatric operations. For more information go to fobipouch.com and many of your questions will be answered in the section of frequently asked questions.

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

Moderator: Please note that you can go to our message boards and speak to each other anytime. The link is: http://liteandhope.com/forums

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

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.

Moderator: Welcome to our live chat

sandra-: Is it normal to Plataeu when yougo from liquids to puree then to soft? I have been the same weight for a little over a week is this normal?

Dr.Dahiya: Hi Sandra, Some of this will depend on how long ago your operation was, what sort of operation you had, but plateaus are a normal occurrence. Please check with your doctor if there's any concern.

andy: I am 21/2 years post roux y surgery. I am suffering from hunger pangs. I cannot eat the quantity prior to the surgery nor do I want to. However it seems that the food I eat goes straight through my system and within an hour I am hungry again. I have gained approximately 50 lbs of the 140 lost. What can I do to reverse this disturbing problem?

Dr.Dahiya: Hi Andy, I’m sorry that you're having a difficult time. Hunger has to do with how you eat and what you eat. Proteins are the best to suppress the appetite, and you should be eating proteins first. If you are still having a problem, you should return to your doctor for reevaluation.

Mary-: I had the open RNY 7/18/03,I’ve lost 117lbs total, and I’ve kept it off! What foods should I try to stay away from if I had hernia, gallbadder surgery & a ulcer?? Thank you.

Dr.Dahiya: Hi Mary. I’m glad you're doing well and keeping your weight off. It's best to stick with your diet, exercise, and vitamins.

Betsy: I am pre-op but was wondering on average do women begin normal menses after surgery (GB-RNY)?

Dr.Dahiya: Betsy, You should return to your normal cycle after recovery.

DMAMAJ: Hello! First of all I would like to thank you for your time to address my question. I have already had R-N-Y Gastric bypass surgery back in 2001. My pre-op weight was 400lbs & my post-op weight was 232. Within the last couple years I have gone back up top 275. I am really afraid that I will balloon back up to my old weight. I called the surgeon because I wanted to speak with him. I wanted to see if he could give me some pointers on things to do differently so that I could lower the weight, but unfortunately he could not see me because I do not have any insurance anymore. My question to you Doctor is: What do YOU think that I could do to lose some of this weight again? I know that the surgery s

Betsy: I have heard of a mini-gastric-bypass...what are your thoughts?

Dr.Dahiya: Betsy, I personally do not perform that operation. I don't believe that it works in the long run.

Kristie: I am having my surgical consultation tomorrow. I am hoping to have the surgery done laprascopically and was wondering how the recovery time compares to an open surgery and how long until I am likely to be able to return to work (I am an office worker). Thank you.

Dr.Dahiya: Kristie, your recovery for laparoscopic surgery is faster than for open surgery. I would suggest you ask your surgeon his laparascopic conversions to open.

HeathrLee1: Hello, I am one month post-op and am struggling like I never thought possible. I cannot get the 50 - 60 grams of protein down each day. Do you have any suggestions on how to accomplish this? The powders out there market are very nauseating to me, and I’m afraid if I don't get in the required amount, I won't lose the weight.

Dr.Dahiya: Hi Heather. The appetite loss of up to a month or two is normal. Appetite always comes back. You shouldn't be too concerned about the exact amount of proteins at this time.

missy: heather how much did you lose so far?

HeathrLee1: Missy - I lost 24 lbs. so far.

William_G.: DR. for those of us who live in Oregon, who have OHP Insurance, that will not pay for this Surgery, what can we do? Is there anyone that will help us?

Dr.Dahiya: William, if you could go to the "Lite and Hope" website, there is a company called Care Credit that may be able to help you.

Moderator: Yes...Please click on www.liteandhope.com and click on the CareCredit button on the home page. Thank you.

deb: After I have the bypass surgery, how long will I be out of work?

Dr.Dahiya: Hi Deb. This depends on what kind of surgery (laparascopic or open) and what is your job description. Physical labor type of work may require a longer recovery. Most surgeries that I perform are laparascopic, and my patients are back to their normal routine in two weeks.

Kelley: I’m coming up on 3 yrs post-op and have lost a little over 100 lbs. about 1/2 way to goal. After what I thought was just a frustrating plateau, I’ve slowly been gaining weight over the last few months. I’m desperately trying to get a grip on my weight loss again...any suggestions ?? Help...

Dr.Dahiya: Kelley, it would help to go back to your support group meeting and back to your doctor for reevaluation.

Patty_Ingram: When do you recommend a tummy tuck after weight loss, like how long after reaching goal, and how do you get insurance to cover it?

Dr.Dahiya: Hello Patty. A tummy tuck should ideally be performed when you reach your ideal weight goal. If you have a medical problem associated with the extra skin, then your insurance may partially cover the procedure.

graciemin: I have recently had gastric bypass surgery - two weeks ago. I am feeling great. I am concerned with my protein intake-I feel as I am struggling to get enough protein. I have started a recommended protein drink. I am sure in time, as the diet changes it will become easier, however right now that is my main concern

Dr.Dahiya: Hello Gracie - the protein shakes and powders will depend on what your surgeon recommends as a supplement post-surgery.

Patty_Ingram: what are your thoughts on the lapband

Dr.Dahiya: Hello again Patty. Lapband is a good procedure, but weight loss is slower than a bypass. Satisfaction after eating a meal is not experienced by some patients.

missy: Hello I am Melissa and I had the RNY lap Surgery on July 19th and I am wondering if I'm losing the weight at a normal rate, I lost 40 lbs so far and I was thinking that it isn't going as quick as I expected

Dr.Dahiya: Melissa - the general rule of thumb is that you lose ten percent of your excess weight per month. That being said, every person is going to lose at his or her own rate.

Lorraine: Dr. I'm not sure if you received my question. I was wondering if you think its safe to have the gastric bypass after having the lap-band removed 2 years ago?

Dr.Dahiya: Hi Lorraine... barring any health problem and if you are gaining weight, a bypass would be a good possible option.

kathryn: I had my surgery in November of 2005 and my hair has stopped coming out when will it start growing in again?

Dr.Dahiya: Kathryn - hair loss should stop approximately one year after the operation. It's not supposed to be a permanent hair loss.

ruth: What are some good exercises that I can do with hip problems that will help me loose more weight?

Dr.Dahiya: Hi Ruth...elliptical machines are good for non-impact exercise. Another option is to exercise in a pool - this is also non-weight bearing.

debbie-: what is laser skin tightening?

Dr.Dahiya: Debbie - a company named Syneron has two kinds of machines which work for cellulite, skin tightening. It should be worth exploring.

Moderator: debbie, please click onto www.syneron.com for more information about this non-Invasive procedure. Thank you.

darla-: Is Red & White Blood Count of 3.8 a concern after surgery and what should be done?

Dr.Dahiya: Hi Darla. Red & white blood counts are different, I am not sure which one you are referring to.

Lorraine: Yes Dr. I gained all the weight back and more after having my band removed because of complications. I am now waiting for approval from my insurance. I guess I'm just concerned about the scar tissue I have after the last surgeries. I'm not quite 4'11" and I weigh 219.

Dr.Dahiya: Hello Lorraine - it's best to see a doctor who's experienced in conversions. More than likely he will be able to help with scar tissue.

Moderator: We will take one more question before we conclude. Thank you.

Dr.Dahiya: Hello...I have tried different vitamin preparations but have not found them to helpful. It is because your body is going through severe dieting, be patient - your hair will come back.

Kristie: I was wondering when a filter is recommend prior to surgery? Is there a certain BMI, Age or amount of overweight recommendation? Thank you

Dr.Dahiya: Hi Kristie - I assume you are talking about a filter in the vein to prevent the blood clot migration. This is something your doctor has to decide if needed. Generally, there's no need for it.

Moderator: Dr. Dahiya, Is there anything you would like to add before we conclude tonights LIVE CHAT?

Dr.Dahiya: Thank you for having me participate in this discussion. For any further needs or questions, please visit our website: www.doctorbariatric.com

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

Moderator: Please note that you can go to our message boards and speak to each other anytime. The link is: http://liteandhope.com/forums

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

Vince Afsahi, M.D., a board certified dermatologist, is a native of Orange County, California. Dr. Afsahi graduated from U.S.C. medical school with honors before completing training in dermatology and dermatologic surgery at U.S.C. Dr. Afsahi specializes in skin cancer detection and surgery, and the latest cosmetic procedures including laser surgery, facial rejuvenation, BOTOX treatments for wrinkles and hyperhidrosis, Restylane injections, leg vein treatments, facial peels, collagen injections, and total skin care with medical grade treatment regimens. Dr. Afsahi is a pioneer in laser treatments including the use of cutting edge technology for skin tightening and body contouring. Dr. Afsahi is a clinical instructor of dermatology at the University of Southern California School of Medicine.

Moderator: Welcome to our live chat

Pam-: Sir; I have most of my life had big legs and thighs, even after loosing 116 lbs my legs are still large, loose skin ,had the varicose veins closed hoping it would take down swelling in the lower leg but no help, circulation is fine, and the upper thigh looks like a sarpie dog's skin just hanging is there an answer, like my body but would like to wear skirts without children asking me what’s wrong with my legs! Or a bathing suit. Thank you

Dr.Afsahi: Pam- given that you have had varicose veins, this usually means there is a circulatory problem. This can be evaluated by ultrasound and other tests to make sure that your circulation in the larger leg vessels are fine. If they are normal, loose skin in the thighs can be evaluated and possibly improved with the velasmooth device.

nicki-: Will my medical Insurance pay for it?

Dr.Afsahi: nicki- insurance will not pay for the velasmooth as it is considered a cosmetic treatment. The treatment costs anywhere from $200 to 250 per area each session, and usually needs 12-16 sessions. These are rough price estimates

JB: AD-After the treatments, did you experience any burning on your face........I was told that headaches are common after laser treatments...did you have them?

Anthony_Davis: JB- I had no headaches at all; it was a very simple procedure. All I felt were small pinches like a rubber band. There was no pain afterward. Dr. Afsahi really knows what he's doing

sylvia: I am extremely fair skinned.....after my surgery my skin around my neck area looks horrible......my g p told me that because I was so fair, laser treatments would not work......is this true?

Dr.Afsahi: sylvia- laser treatments can be customized to all skin types. We treat our patients individually and address their needs. Fair skin patients can have excellent results for skin tightening on the neck area, jowls and eye area

AD_fan: AD- I saw you on THE INSIDER last week......your face looked like you were 35 years old........what exact treatment did you have.....I am a huge Trojan fan and still remember those great runs in 1974.........go AD and you look like you are ready for the movies.....I saw your surgery on line and it looked very scary....are you now 100% recovered?

Anthony_Davis: Dr. Afsahi performed the Refirme ST laser treatment on me, we have had 5 treatments, and I couldn't be happier. On the insider, I was actually 10 lbs. heavier. I am 100% recovered, and you will possibly see me on TV and movies I’m working on.

cindy: I have lost 143 pounds but not at goal, but I have what I would call a turkey neck would I have to have a full face lift or is there something else that I could do?

Dr.Afsahi: Cindy- New laser treatments allow patients who are not candidates or who do not wish surgery to improve the "turkey neck" you describe. I would seek consultation for non surgical laser procedures if you wish no surgery and very little down time. You may have excellent results. If your case is severe than surgical lifting may be the other alternative

veronica: If I have treatments on my face and legs, how long will each treatment take.....am I correct in assuming that insurance will not cover this if you have excess skin after gastric bypass surgery?

Dr.Afsahi: Veronica- leg treatments take roughly 30 minutes, and usually 12-14 sessions. Facial treatments usually take 25-35 minutes and you usually need 5 sessions. Insurance does not routinely cover this treatment. Some physicians offer packages that combine multiple treatments and discounted rates

janet: How much do laser treatment cost? Can my weight loss surgeon do them?

Dr.Afsahi: Janet -Laser treatments for the face cost between $450 and 700 per treatment, and usually we treat the patient with 5 sessions. A physician trained with laser can perform this treatment, ask your physician if there is someone that is experienced in this aspect of care

TrojanMan: AD.........tell the truth, did the laser hurt?? Did you have any reaction to the heat?

Anthony_Davis: no it did not hurt and I had no reaction. My Dr. says I look really good. And if I can take hits on the field, then of course I can take the heat. But thanks for asking. –AD

irma-: I have had surgery to remove a lot of excess skin after losing over 175 pounds after gastric bypass surgery. The problem I now have is that I have scars from the surgery. Will the laser treatments eliminate these scars and if so, how many treatments will I need?

Dr.Afsahi: irma- scars are very difficult to treat, and even with lasers the results are variable. The ideal treatment may involve topical medications, injections, and laser treatment. Consider showing your dermatologist.

Gail: I saw something about certain lasers not being FDA approved, are the ones you are using on Anthony approved and totally safe?

Dr.Afsahi: The lasers are FDA approved. All procedures have risks, benefits, and alternatives. Rarely, crusting, redness, pigmentation or other issues can result. Your physician can go over the options for you, and keep you informed.

Pam-: Suzanne-Aside from having surgery to remove excess skin or using the lasers, are there any exercises I can do to "tighten up" especially around my midsection and the bottom of my arms between my shoulders and elbows.

Dr.Afsahi: Pam- surgery, diet, and exercise in conjunction with cosmetic procedures can help. It’s important to take a global approach when trying to be healthy. We have patients who incorporate Pilates, yoga, and weight training as part of their routine

barbara: I had surgery over 8 years ago, lost a great deal of weight, over 125 pounds and then after 4 years started to gain back over 60 pounds.......of course, my skin is extremely loose.......I am starting to loose again and I was wondering when I should start any treatment for excess skin....should I wait until I get down or start now.....I don't want to have to do this twice.

Dr.Afsahi: Treatments can be started after your physician has evaluated you. You will probably have the best results if your weight is stable or are on a gradual weight loss program. Many of our patients have had success incorporating the velasmooth for the body and the refirme st laser for the face.

Tracy-: What are the dangers from these treatments................I know there are always side effects from almost every kind of treatment; the idea of a hot laser on my face or body really scares me.

Dr.Afsahi: Tracy- risks include crusts, redness, burns, and scarring. All procedures carry risks, and its important that you be informed. Fortunately, severe complications are rare.

Paul: Do the results vary between men and women..........AD is not a typical guy with his huge muscular frame. I am no big-time athlete and I have a great deal of sagging skin around my face and jaws..........how many treatments will it take to get the same kind of results that AD got?

Dr.Afsahi: Paul- the results depend on genetic issues, current diet and exercise, and compliance with the routine. Men and women can improve dramatically with the treatments. Treatments for the neck and face usually take roughly 5 sessions, but every individual is unique

Moderator: Dr. Afsahi, is there anything you would like to add before we concludes tonight’s chat?

Dr.Afsahi: Thank you all for participating. Best wishes for a happy and healthy future. If there is any other information that you would like you may visit my website at www.dermphysician.com

Moderator: Anthony Davis, are there any comments you would like to say before we conclude?

Anthony_Davis: Dear people in general and football fans alike, I would just like to say that my treatments with Dr. Vince Afsahi have been wonderful. Tune into me in the near future through my journal and I will let you know how they are coming along. And go to Syneron.com for more information on my skin treatments and laser treatments. With Syneron's technology and Dr. Afsahi's treatments, I am lookin' good and they have me ready for all those movies and magazines. I hope to talk to you all soon. The best-AD
Moderator: This concludes our chat for today. Thank you all for coming into today’s chat room. We are pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Dr. Afsahi and Anthony Davis for your informative and insightful answers. Good night and thank you once again.

Moderator: Please note that you can go to our message boards and speak to each other anytime. The link is: http://liteandhope.com/forums

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

Dr. 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.

Moderator: Welcome to our live chat

mandi: I had surgery 6/5 and have lost 39 pounds to date.. my question is that I should already be eating soft meats, and tuna and chicken and I can’t seem to keep any of these things down, only cream soups, or farina creams like that and hard toast... if I eat meats or veggies I cant keep it down, it won’t go past my chest area the food just stays there and I have to throw up... any suggestions ?

Dr. Fisher: mandi, It is likely that the junction between your new stomach pouch and the intestine has shrunken. This can be remedied by a simple endoscopes. I would discuss this possibility with your surgeon.

susan-: hello, I am wondering if after I loose my weight and find my stomach still hanging, will my insurance cover the cost for a panniculectomy or tummy tuck the same they are covering for my surgery? thanks so much

Dr. Fisher: This varies with the company and your policy. However, save the money that you are no longer spending on foods, and you will have a healthy start towards the "Nip and the Tuck". That is what we suggest in our practice, since we do both bypass and band and also tummy tucks.

betsy-: I have had complication I had a bowel obstruction and now phominia and pancritis is that dangerous?

Dr. Fisher: Any complication can be dangerous or not. It varies with the patient. Pneumonia is usually not very serious, and pancreatitis can be if it happens more than once. Otherwise, it may only become an unpleasant memory

Delores-: had surgery in 1996 lost 157 lbs. now have gained back 60 lbs what can I do can I now have the band surgery I am 182 thanks you

Dr. Fisher: First you have to figure out how you gained the weight back. The important thing to know about every bariatric surgery is that you can gain the weight back if you return to eating...too often....too much...and making bad food choices. Mark Twain once said that the definition of "insanity" is doing the same thing over and over and expecting that the result will be different THIS TIME. You can have a Band after a bypass, but without making a commitment to a permanent change in your way of eating, and your menu, you will always regain some of the weight.

vonda-: How can you stop the cravings for sweets? I'm one year out.

Dr. Fisher: This is the most difficult question to answer. There is no simple solution. You may need professional assistance if you know that sweets are a bad choice, and you eat them anyway. Cravings come and go. Fight it if you remember how it feels to be heavy and you do not want that burden.

Marcie: I'm 2.5 years post-op and have a big appetite. How do I know if I've stretched my pouch out?

Dr. Fisher: The easiest way to know is by having a barium swallow x-ray test. I have been doing this annually to check and to advise my patients about their "tool".

elly_verge: I had the bypass in March 2006. In May I had my stomach stretched with a balloon because I could only eat liquids. I do not get a full feeling when I eat healthy. I can eat fruit, then dinner, then popcorn and feel like I didn't eat at all. When I eat a small amount of fatty foods then I get a sick feeling of fullness. Why is this? My doctor says she doesn't know why.

Dr. Fisher: Elly-verge: The idea is NOT to eat to get full. It is to eat a measured meal, still being able to eat more, but making the conscious decision NOT TO EAT any more. If you get hungry between meals, then drink a lot of water to eliminate our bodies’ confusion of thirst for hunger.

kirsten_ball: I have lost 130 lbs. 3 years out. I have recently had iron injections for severe anemia. My stomach is a cup now and I am hungry all the time. I have recently gained 10 lbs and scared to death to gain it back. Can the surgery be redone to make stomach small again. I am hungry all the time and the recent GI series I had shows the food goes right through me with no absorption. Please help

Dr. Fisher: First, the surgery can be redone to make the stomach smaller, but that might not be as important or helpful as cutting carbs out of your diet, or reducing them to a minimum. Carbs cause your body to release internal insulin, which stimulates you to eat more. This may prove very helpful, this change in diet if you are eating too many carbs.

Melinda: Have you had many patients with a lap band that went bad--moved, causing many nausea, vomiting, and no weight loss? Is the Ruin-Y harder on those patients--me?

Dr. Fisher: Melinda: I do not understand "went bad". If you mean had a slip, then I would say, that such a result with the Band may predict overeating the bypass and less long term weight loss. Most patients who depend on the surgery to make them lose weight without understanding that they have to do their part in reducing foods intake by limiting portion size, eating slowly, eating less frequently, and making good choices, will do poorly with either operation. The operation is only a "tool" that has to be used correctly by the patient or the results will not be good. The Band takes a compliant patient and a doctor who understands the best way to do adjustments. I know this is not what you wanted to hear

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

Millied: Hello Dr. Fisher...Do you recommend a gastric bypass revision?

Dr. Fisher: Millied: I have done many revisions, but the first thing I do is check to see whether the tool is in good shape. I do not do revisions of a prior bypass very often unless there has developed a technical problem with it. Some surgeons believe in conversion to a more radical procedure, but a recent paper has shown that there is no long term detectable difference in weight loss between bypass, band, distal bypass, and banded bypass procedures.

Maggie_N: Hi Dr. Fisher, Thank You for speaking with me. My question is I went out with a few friends Sunday evening and during the course of the night I had 3 rum and diet cola's (5Hrs) anyway I got really ill and I started sweating heavily and felt like I was going to faint. This has happened to me twice before. Is this some form of dumping? I have never had dumping that I know of. My gastric bypass was done in March of 05. All is well with me and I have lost 137 lbs so far. Please take a moment to answer me. Thanking you in advance.

Dr. Fisher: This may have been a form of dumping or just the rapid absorption of the alcohol. I always say that you will get high very fast if you drink, so be careful and more moderate in the amount.

lorena: I am already taken 2 fiber tablets and colace daily but am still having great problems with constipation...what else can I do?

Dr. Fisher: lorena, I have no easy solution. My guess is that you had similar problems before surgery and they are back. The RNY does not cause this to happen. An occasional laxative like Milk of Magnesia may help.

Melinda: I made the mistake of having a lap band put in. It migrated and caused a Hiatal Hernia, now I'm attempting to get OK'd for the bypass. Will the band removal make my recovery more difficult?

Dr. Fisher: Melinda, I have become convinced that the Band does not cause slippage or hernias. These seem to occur in patients who have frequent emesis, poor weight loss, and stretched pouches. It is very important to eat slowly and avoid pouch packing. It is these latter events that lead to the Band problems, in my opinion. The hiatal hernia was probably there before the Band, but you never had symptoms because the food would pass easily. With the Band present, food gets held up and starts to pack into the esophagus causing hiatal hernia symptoms. This will not happen with a bypass as the entire pouch and the connection with the intestine is muscle and can stretch to avoid this occurrence. To answer the rest of your question, removing the band will not affect your recovery after RNY.

angela: can a hernia or polyps in the stomach postpone surgery?

Dr. Fisher: angela, it depends on the surgeon and the type of hernia. It also depends on whether you have one polyp or many.

sharen-: my daughter had duodenal switch done 2 years ago and now has terrible acne. She had beautiful skin before the surgery. Three of her friends also had the surgery and also have acne in some form. What is she lacking? What is the problem? A dermatologist is not helping? This seems to be a gastric bypass problem in many patients. Help!!!!

Dr. Fisher: Sharon, I know little bout the duodenal switch problems. However I have not seen acne being a problem in gastric bypass patients. How old was your daughter when she had the surgery? Could it be a result of her age?

angela: Dr. Fisher, will my open lap surgery fix my constipation problem?

Dr. Fisher: I do not know what your open lap surgery means??? If you mean RNY gastric bypass, it will do nothing good or bad for your constipation.

angela: Is a 10 day diet mandatory for open surgery? I mean that I am not eligible for lap surgery. I have to be cut open. I’m sorry.

Dr. Fisher: Angela, Preoperative diets are the preference of the surgeon. There is no doubt that weight loss before surgery shrinks the liver size, which tends to be big in our patients. The smaller the liver, the easier and safer the surgery for you and for the doctor

Dawn: Dr., I have had to go in 4 times now since my surgery in May to have my stomach stretched and I have numbness in my legs since the surgery. I also cannot climb stairs very well. How long will this go on? Any suggestions??

Dr. Fisher: Dawn, It is rare that stomach stretching needs to be done that often, but it happens. As far as the numbness, have your doctor check your vitamin B1 level SOON. You may be thiamine deficient.

kirsten_ball: will the new supplement on carnies site nutritional shake help me? I am doing iron injections by IV and will this supplement get me back down?

Dr. Fisher: Kirsten, Try it and see!

Shanna: Hello doctor, I want to have the surgery, but I am on Medicare. What can I do? Would you consider performing the surgery on me? I need help.

Dr. Fisher: Shanna, Medicare has taken the position that they want to see the surgery performed at the best sites that have been approved by the certifying agency. They also pay less than it costs us to provide that kind of care. The result is that if we operated on all the Medicare patients, we could not pay our rent and salaries in our office. We still operate on Medicare patients on a limited basis to do what we can to help.

Moderator: To find out about financing for private pay patients, please go to www.liteandhope.com and click on the financing button or if you prefer, here is the link. http://liteandhope.com/bariatricsurgery_financing1.html

winwin: I am just over two months out from having GB. I have plateaued several times, once for 14 days. Should this be a concern? I feel like I am eating between 500-800 calories a day and yet, the scale does not move! My energy level is extremely low.

Dr. Fisher: Do not fret. When you first start to lose weight it is not uncommon to have plateaus. Be patient.

chris: I am on a bowling team that starts in September I just had surgery on the 14th am I going to be able to start right away?

Dr. Fisher: Chris, If you had open surgery, then the answer is a definite NO. If your surgery is laparoscopic, discuss this with your treating doctor, and DO WHAT HE/SHE suggests.

elly_verge: I heard about an operation that only thing operated on is the intestine. It is shortened and when eating 100 calories only about 20 calories are absorbed. What are your thoughts about this?

Dr. Fisher: Elly: Since I do not know what you are talking about, I can only guess. The intestinal bypass was abandoned many years ago as the least safe bariatric procedure. If you look above you will see that I mentioned a paper which suggests very little difference in long term outcomes from the safer procedures that we are doing at present.

Donna: Hi Dr. Fisher. Laproscopic vs. open surgery; what decides whether I am better suited for one over the other?

Dr. Fisher: Donna: The skill of the surgeon and the surgeons comfort level. When I started to do Laparoscopic I was very selective. At this stage of my practice, I feel comfortable starting every case laparoscopically. Each of our three surgeons feels the same. The only thing that might convince me to start open would be a massive abdominal wall hernia due to prior surgery, in a very large patient. Even then, I might start with the laparoscope. Even so, there is the rare patient that has had so much surgery and adhesions, it may not be possible or may even be too risky to attempt to complete either laparoscopic or open surgery.

Marcie: Do many bariatric surgeons know about the barium swallow test?

Dr. Fisher: Yes

Moderator: Dr. Fisher, is there anything you would like to add before we conclude tonight’s chat? Perhaps you would like to post your web site.

Dr. Fisher: Thank you for the questions and your time. I hope that I have been helpful. Remember, there is no magic to bariatric surgery; it is a tool that gives you the opportunity to control the weight through the choices you make with every bite. To learn more about our thoughts and our postoperative approach to diet and behavior control, visit our web site at www.bandandbypass.com. Thanks

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

Moderator: Please note that you can go to our message boards and speak to each other anytime. The link is: http://liteandhope.com/forums

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

Dr. Eaton is the Medical Director of Southern Oregon Bariatric Center, located in Medford, Oregon. He is a strong proponent of bariatric surgery as he has seen many patients greatly benefit from the procedure. Dr. Eaton received his medical degree from the University of New Mexico School of Medicine in Albuquerque, NM. He attended the University of Texas Southwestern Medical School in Dallas, TX for his surgical residency and he completed a vascular surgery fellowship at University of Tennessee's Graduate School of Medicine in Knoxville, TN. Dr. Eaton is certified by the American Board of Surgery, with added qualifications in vascular surgery. He is a member of the American College of Surgeons, Alpha Omega Alpha Honor Medical Society, the Oregon Medical Association, and the American Medical Association. Originally from New Mexico, Dr Eaton and his wife, Shelly, moved to the Rogue Valley in the late 1990s. Both college athletes, they enjoy the wealthof outdoor activities available in Southern Oregon. In his spare time, Dr. Eaton enjoys working out at the gym and playing his guitar. He also plays the drums in all-physician rock band.

Moderator: Welcome to our live chat

Leslie-: how do u know if this surgery is rite for you. I have been over weight for almost my whole life, and think im about almost 100+ over weight. I’ve heard I'm not large enough to have it done, but to myself I am.

Dr.Eaton: Hi Leslie, this is a very good question. The answer, however, will be different for each individual. Clinically, we look at a person's Body Mass Index (BMI), which is a ratio of height to weight. To know if you are clinically a surgery candidate, your BMI must either be over 40 or between 35 and 40 with at least 2 co-morbidities. These “co-morbidities” are diseases such as hypertension, diabetes, sleep apnea, high cholesterol, asthma, etc. Individually, if you know you have tried every possible option available relative to diet, exercise and behavior modification, even possibly counseling and you are clinically a candidate, then surgery may well be an option. Appearances are deceiving.

gisele-: The doctor that I am thinking of using for my gastric bypass said in his seminar that one of the causes of death after the surgery was blood clots. They can happen up to a month after surgery. How common do you find this and is it something that you have encountered?

Dr.Eaton: Gisele, yes. We haven't had it yet but the incidence of a major blood clot is going to be the same for any major abdominal surgery and it is true it can happen even a month after surgery; but you have to remember this can happen with any major surgery.

Sharon: Hello Dr., if a person had the roux-en-y and could not handle it due to any severe health reasons, could it be reversed on an emergency?

Dr.Eaton: Hi Sharon, yes it could be reversed. but that is extremely rare that it would need to be reversed for health reasons. Usually health problems improve with weight loss. To my knowledge the only reversals have been for other reasons.

josiehatfield: Hi all not a question just want you all to know how much better I feel since I have had the surgery. I've only lost 71 lb but I feel much better and still trying to lose more

AnnieBannie: I had no issues with high blood pressure, but was sent home with atenolol. Why is this? Thanks!

Dr.Eaton: Hello AnnieBannie, this is an important question but one that only your doctor can answer for you personally.

Rebecca: Would the fact that I recently had a CRT-D implanted make any difference to being able to have bypass surgery?

Dr.Eaton: Rebecca, thank you for your patience. If the cardiologist approves surgery, we can do bariatric surgery with the CRT-D. This is not a contraindication for gastric bypass surgery.

arlene-: I have recently had a kidney stone so large they had to laser it to remove it. The urologist said having kidney stones after gastric bypass surgery is common. Could you comment on this?

Dr.Eaton: Arlene, if a patient sticks to the water, vitamins and diet as directed there is a very low risk of kidney stones.

josiehatfield: Doctor Eaton do you think I have stretched my stomach since I haven’t lost but 71 lbs since last July?

Dr.Eaton: Josiehatfield, assuming your surgery was July 2005 rather than merely last month, there is the possibility that you could have stretched it, but more discussion would be needed. Your best bet would be to contact your surgeon for further assistance and guidance.

Daphne: why do some doctors use drains and others don't?

Dr.Eaton: Daphne, this is according to surgeon's preference. Some feel that it helps, but some do not. There is no good "data" stating that one way over the other is good or bad.

Ash: Are there any particular insurance companies that cover wls more than others?

Dr.Eaton: HI Ash, most insurance companies offer the benefit to employers. It is merely a matter of the employer selecting to offer this option to their employees. Usually it makes a policy more expensive for the employer.

stevensaba: will I have any trouble with drinking coffee in the future

Dr.Eaton: Stevensaba, theoretically, coffee can cause ulcers, but it is not a contraindication after surgery. We allow it in moderation from 2 months post op.

Sandra: What do you think of endoscopic stoma repair?

Dr.Eaton: Sandra, it would depend on what is being repaired. We are not aware of any way to make a stoma smaller, endoscopically - at least a way that is FDA approved. But dilitation of a stenotic stoma is okay and is known and common.

diane-: What is the best way to avoid hair loss post gastric bypass surgery? God Bless you for all you do for us.

Dr.Eaton: Diane, there is really no way to avoid hair loss. It is fairly minimal. Taking your vitamins and eating your protein will assist though.

Jacqueline-: I am having a lot of back pain mostly the left upper and lower. I had gastric bypass in 9-2003 and I have been having this pain since April 06, the doctors who did the surgery did all kinds of test every thing is normal, he then went in and found I had a internal hernia. He repaired that in May 06 and the pain went away for two weeks and has again come back. He retested MRI, cat and still haven't found anything. I have now found out that I am about 8 weeks pregnant and I don't know how I am going to carry this baby with this type of pain. I have thought about having an abortion but I don't know if I can put my self through that. I have been to every doctor that you can think of Gastro, Orthopedic.

Dr.Eaton: Jacqueline, the first thing would be to return to the surgeon who repaired the hernia to see what the chance of recurrence before considering risking the baby's life. You could also have a barium swallow but really the best thing would be to return to your surgeon to discuss your options.

angie-: I had a RYN Gastric Bypass in 2004. I have a Brain Tumor and it is causing me a lot of problems. My starting weight was 345 and I got down to 220. I was going to the Gym everyday and exercising. The Shunt I had placed in my lower Spine came loose. I was bed ridden for 5 months. I was unable to exercise or walk outside the house. I could not tolerate Sunlight. I was taking a lot of pain medication to control the pain. The point is I now weigh 284 pounds. I had x-rays done and they say I still have a small pouch and everything is the same. What made me gain all that weight? And I can eat what ever I want. My Doctor never told me how to eat after surgery. How can I loose the weight?

Daphne: Jacqueline...Please don't have an abortion. You can make it through the pregnancy

Dr.Eaton: Angie, generally people gain weight when they don't stick to their post bariatric diet and exercise protocol. Being bed ridden for so long and not following the bariatric diet can explain the weight gain. At this point, you would do well to see a bariatric dietician or your surgeon for instructions on learning how to eat foods that will nourish and aide in weight loss. Also, if you activity is still limited, there are videos and DVD's available to do exercise in a chair.

Lorena-: My sister has had several complications after this surgery gastric bypass, is there any special diet that will eliminate the hernias, bowel obstruction, etc.??

Dr.Eaton: Lorena, bowel obstructions are unavoidable. Depending on the type of hernia the risk can be decreased with post op protocols such as no heavy lifting greater than 10# for 4-6 weeks, no strenuous exercise. Drinking her water and sticking to the diet protocol as instructed by the surgeon is the preferred route.

janice-: I had my gastric Bypass 8 months ago and I have lost 150 lbs due to not being able to eat solid foods for 7 months. The doctor finally put me on last week some nausea medicine that helps out cancer victims and for the past 4 days I have been able to keep down solid foods Thank God. The problem is my LIVER is now giving out on me and the doctor is not sure how to fix this. Have you any idea what could be done to get my LIVER functioning again and get the SWELLING in my legs and feet to go down. They said that I am swelling due to my liver malfunctioning.

Dr.Eaton: Janice, if the medication is causing the liver problem, then even though you may feel nausea, it might be wise to stop the medication. Elevation of your legs could help with swelling, and possibly other medication to assist with that as well.

pamela-: I'm 6months post-op and have lost 50lbs which I think is very slow can you please advise me of what is wrong

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

Dr.Eaton: Hi Pamela, statistics show a national average of 40% excess body weight loss at 3 months, 60% at 6 months and 75-80% at 1 year post op. 50 pounds is a great start. If you are concerned that it is not fast enough, then the best thing to do aside from consulting your doctor is to look at your daily routine. Are you drinking enough water? Are you eating protein first and at least 50% of the meal? Are you exercising? As you can see from the statistics, you lose 40% in the first 3 months and the next 40% over the following 9 months so it is reasonable to see the pace slow down after a while. Also, you may notice a period of losing inches without pounds and then visa versa. Everyone is different.

Sharon: Is the Duodenal a good surgery for someone who has had 13 abdominal surgeries?

Dr.Eaton: Hello Sharon, the suitability of one type of bariatric surgery over another is not dependent on whether a person has had prior abdominal surgery. The Duodenal Switch is a primarily malabsorptive procedure and usually reserved for the "super-obese". In most cases, the Gastric Bypass is considered the gold standard as it is both malabsorptive and restrictive and may have less risk of postoperative nutritional deficiencies than the Duodenal Switch.

Moderator: Dr. Eaton is there anything you would like to add before we conclude today’s chat?

Dr.Eaton: I would like to thank everyone for taking time out of their evening to participate in this chat. It is always great to share our experiences and our concerns and questions. We have a great team at Southern Oregon Bariatric Center and would welcome those interested to check out our website or pay us a visit at www.sobariatrics.com. Thank you very much for inviting me to participate in this chat.

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

Moderator: CARECREDIT, a division of GE CONSUMER FINANCING offers a very affordable financing opportunity for qualified borrowers to pay for bariatric surgery including surgeons fee, hospital costs, etc. Most of our LITE AND HOPE Registered Surgeons offer this financing option for private pay patients that do not have adequate insurance coverage. Here are the highlights of this opportunity.

1. The interest rate charged to patient/borrower is a very reasonable 9.9%. 2. Repayment options allow up to 5 years to repay the amount borrowed. 3. The application process is very simple and can be done in your surgeons office. 4. Once an applicant has been accepted, the borrower will have established a line of credit for additional financing for medically related issue.

LITE AND HOPE is very excited about CARECREDIT as we have reviewed many lenders and feel that this is the best plan for patients. You will note that Carnie talks about this financing option in the new updated version of our INFOMERCIAL that airs each week across the country.

Please contact your bariatric surgeon and ask about this CARECREDIT financing plan. If your surgeon does not offer this plan, have him contact us at LITE AND HOPE at 1 877 548 3446 or info@liteandhop.com and ask for Mickey or Vodge.

To go to Financing with CareCredit now. Please click http://liteandhope.com/bariatricsurgery_financing1.html or just go to www.liteandhope.com and click on the button on the right that says Financing

Please join our next chat on September 5th, 2006. Good night and thank you once again.

Dr. Koning was born in the Netherlands and emigrated to the United States in 1971 to New York City where he completed his surgical residency. In 1978 relocated to Central Oregon,and began as a surgeon at Central Oregon District Hospital in Redmond. He is also the founding doctor of Advanced Specialty Care. He is trained as a general surgeon, and specializes in minimally invasive surgery, including hiatus hernia repair, cancer screening and bariatric surgery.

moderator: Welcome to our live chat

cheryl-: Four doctors have recommended that I have gastric bypass surgery before I have my three hernias repaired. My question is- What if one of the hernias strangulates before I can find a doctor who will give me the gastric bypass surgery free since I have no medical insurance? I also have had to have 5 stents placed into my heart and probably will need more. My life is in jeopardy. What or where can I go for help?

Dr. Koning: Cheryl, if a hernia gives you problems, such as incarceration, you need to have that addressed immediately by going to the nearest hospital. To find a doctor who will do your bypass for free may be very difficult. Some hospitals have a charity policy through which that might be possible

latoya: What foods and medications should a gastric bypass patient avoid?

Dr. Koning: Latoya, they should avoid high calorie and calorie-dense foods. Remember that the procedure is a tool that restricts your food intake but that your biggest enemy is concentrated high calories. The best foods are high in protein and low in fat. You should, of course, chew your food very carefully. Regarding medications, especially in the beginning medications need to be crushed and/or very small. Remember that the opening between the new stomach and the small intestine is only about half an inch.

janet: Hello I have had bypass 2 years ago and was doing very well, but now I am gaining my weight back. Why?

Dr. Koning: Janet, the common causes for weight gain after gastric bypass are eating the wrong foods and lack of exercise. After about two years, your body is accustomed to the new stomach and you now need to focus on the right diet habits to maintain your weight. It is not uncommon for people to gain a few pounds, 10 or so, at this point but if the weight gain continues, it is usually because of the two issues above.

wendy-: Where can I find info about older (50+) females that have had surgery?

Dr. Koning: Wendy, any bariatric surgeon will have lots of patients like you. 85% of bariatric patients are female and many are over 50. Good programs have information sessions and support groups where you can ask questions of patients and get the information that you are seeking.

darla-: I had severe abdominal pain and my liver enzymes were elevated. My gallbladder was out several years ago. I had my gastric bypass in 2004. Any suggestions on this pain and elevated liver enzymes? Thanks

Dr. Koning: Darla, this is a very significant question. Abdominal pain, especially if severe, is a big red flag for every bariatric surgeon. Your gallbladder is already gone and is one of the most logical places to look. Because after a gastric bypass, a piece of the bowel is bypassed, there is no air in that segment of bowel; therefore it will not show up on routine x-rays. The changed anatomy makes it possible for bowel to get kinked and become obstructed. We call this an internal hernia. Because the bypassed segment then becomes obstructed, the bile and juices from the pancreas and stomach cannot pass downstream and back up. This causes the liver function tests to become abnormal. Sometimes an accurate diag

annette-: I am 5'7" tall and weigh about 250lbs is this considered obese? I have had terrible back problems since I have put this weight on. Please let me know before I check into having the surgery.

Dr. Koning: Annette, the measure of obesity that is most commonly used is called the body mass index (BMI). Ideal body weight is a BMI of 22. If the BMI is over 30, one is called obese. If the BMI is over 35, we talk about severe obesity. A BMI of 40 or over is morbidly obese. Your BMI is 39 and you are approximately 100 pounds overweight. On both criteria, the National Institutes of Health recommends that bariatric surgery is the best way to deal with your weight problem. I would be surprised if you do not have a number of medical problems such as high blood pressure, diabetes, elevated cholesterol, or obstructive sleep apnea. Your back pain is clearly related to your weight.

jennymay: I have just started this April, to be approved for Gastric Surgery, it is approved and my Surgery date is Aug.29th. Is it normal to have second thoughts? I am 400lbs, 49 and I don't want to be 50 years old and fat. I want it, but I guess I am afraid.

Dr. Koning: Jennymay, obviously it is normal to have second thoughts. Most people come to bariatric surgery after several years of considering all options. Most people have failed many other treatments and, because of this, find it hard to believe that this option actually will work. Also, the expense and risk of having surgery makes people worry about having made the right choice. In fact, making the decision to have surgery is the hardest part of the process. I always tell my patients, "If you're not nervous now, you'd not be human". You need to remember that most operations go without problems and that "normal" is for you to have surgery and be home in a few days.

sharon: I have had 13 abdominal surgeries, in your opinion would I still have a possible chance of having one of the bypass surgeries?

Dr. Koning: Sharon, just because you had 13 operations, I would not disqualify you. Sometimes people have very little scarring from surgery; other times there are lots. The kinds of operations are important. A lot of people have had gallbladder surgery and hysterectomy and they are not a problem. History of surgery on the stomach or on the colon may be more difficult. You may require some more testing but ultimately it depends on the findings at surgery. Fortunately, most people, even if they have a lot of adhesions in the abdomen, are relatively free of adhesions in the left upper abdomen, which is where the bypass operation happens. Finding an experienced surgeon would be very important in your case. Even after people have had many operations, we typically will start with the laparoscope and in many cases are able to finish the operation this way despite adhesions but it may be necessary to do an open procedure.

Catana: After having a gastric bypass, how often should you have your blood work done?

Dr. Koning: Catana, we do blood work as necessary within the first month or so after surgery to check for changes related to the surgery and the hospital stay, such as white blood count, hemoglobin, and electrolytes. During that period, people may have issues with infection or with dehydration or simply lack of calorie intake all of which may require lab testing. After three months, we do a complete blood workup to check for nutritional parameters and we repeat that at six months. If your weight loss is on target and your protein intake is okay and you are taking your vitamins, all of these tests should be normal. We then test after one year and annually thereafter.

janet: I am very tired and have no energy. Do I need to stay on b-12 shot?

Dr. Koning: Janet, fatigue and lack of energy can be due to a lot of different things. You may be anemic because you have not enough iron intake. Vitamin B12 can help with that, but you also need folic acid. It can be because of your thyroid being underactive and this certainly should be checked. You did not say how long ago you had your operation but early after surgery on a liquid diet, it is possible you are not getting enough calories. Electrolyte abnormalities also can give you fatigue. Check with your bariatric surgeon to have this problem sorted out.

moderator: Please remember that if you are contemplating having Gastric Bypass Surgery or have had Gastric Bypass Surgery, you will be eligible for life Insurance through PRUDENTIAL. For details and information, please click www.liteandhope.com and then click on the LIFE INSURANCE BANNER BUTTON. Also, please make sure you have joined as a member of LITE AND HOPE at www.liteandhope.com. We will keep you informed of any upcoming news or events.

Daphne: Are most insurance companies now covering the surgery?

Dr. Koning: Daphne, this is an exciting question. Insurance coverage is determined by your individual insurance contract. You need to read your contract carefully to see if your policy covers bariatric surgery. I am happy to report that Medicare officially covers bariatric surgery (bypass, Lap-Band and duodenal switch) but they have restrictions on where surgery can be done. Because Medicare covers it, most insurance companies will follow. However, this may take several years. We are very encouraged by the public awareness and recognition of the fact that morbid obesity is now considered a disease and this will undoubtedly lead to wider coverage soon.

Kirby: Please explain why all patients are asked to lose weight pre-surgery.

Dr. Koning: Kirby, this is an excellent question. There are several reasons for this but my preferred answer is that it improves the safety of the operation. All calories entering your body are stored in the liver and, therefore, this is one of the things that make the liver big and heavy and immobile. Especially when you do laparoscopic surgery, the liver is in the way. The liver is also brittle and bleeds easily. When you lose weight before surgery, a lot of that weight comes out of the liver and this makes the liver soft and pliable and easy to work with, thus enhancing the safety of the operation. Other reasons to lose weight are to get a measure of the patient's dedication to this project - everybody can

Robin: Hi Dr. Koning, I'm 3 weeks post op and feel as though I can eat quite a bit. I'll have scrambled eggs for breakfast, a protein drink for lunch and very small dinner of protein and vegetables. Am I eating too much?

Dr. Koning: Robin, if you have had a bypass, three weeks after surgery your pouch is still only about the size of your thumb and eating more volume than the tiniest Tupperware container or about a shot glass fills up your esophagus more than your stomach. A protein drink will go through relatively quickly. If you follow these measurements, I estimate that your calorie intake will be in the right amount. We would like you to have somewhere between 700 and 800 calories per day. If you have had a Lap-Band, you may be able to eat a little bit more but you will be looking at having your band adjusted in another three weeks. As long as you are losing weight, you are probably all right.

Jenifer: What is your opinion on drinking fluids when you eat?

Dr. Koning: Jenifer, don't. Liquids just wash down your food and derail your program. We recommend that you do not drink a half hour before and at least a half hour after you eat. Keeping your pouch full is an important part of feeling full and it helps you lose your weight. It is very important to develop good healthy eating habits now. If you don't do it now, you will have problems later when the bypass matures.

margaret: I had gastric bypass surgery in 2000. I weighed 335 pounds .since then I have exercised and have got down to 210. However I find that I am hungry and can't break or maintain 200 or below. Is regain a problem I should be at about 150 I an 5'9 inches tall.

Dr. Koning: Margaret, a quick calculation shows that you have lost about 75% of your excess weight and this is an excellent result and in the realm of what you can expect. Further weight loss will require extra effort, in particular exercise. We find that losing more than 75% of excess weight requires what I call industrial strength exercise, meaning working out about an hour a day. You may also want to look at your diet and focus it on more protein and some vegetables. It is important to have bioimpedance measurements to look at your fat vs. lean body mass loss and your dietitian can help you with that.

Joanne: I am nearly 9 weeks post-op and have lost 43 lbs. My BMI was 41.5 when I had the surgery. I know I should only eat when I'm hungry, but I'm rarely ever hungry. Should I force myself to eat? I am worried about getting in enough calories. Otherwise I feel very healthy and have a lot of energy.

Dr. Koning: Joanne, one of the beautiful things about a gastric bypass is that people lose their appetite for about six months. This has to do with, among other things, a hormone named ghrelin which stimulates appetite, is produced by the stomach but since the stomach is bypassed, is very low in gastric bypass patients. Because of this, it is important to consider your diet a medical program and make sure that you get 50-100 grams of protein and adequate liquids on any day. This will keep you from starving and using up your own muscle protein. If you have concerns about this, go see your dietitian and have her measure your fat/protein loss ratio, which should be 4:1.

moderator: Dr. Koning, Is there anything you would like to add before we conclude today's chat?

Dr. Koning: Thank you all for your questions. If you would like to contact us, see our web site at advancedspecialtycare.com or call our bariatric coordinator, Kathyrn, at 541-322-1765

moderator: This concludes our chat for today. Thank you all for coming into today’s chat room. We are pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Dr. Koning for your informative and insightful answers. Good night and thank you once again.
Please join our next chat on August 15th, 2006. Good night and thank you once again.

Dr. Archer graduated from the University of Tennessee Medical Center in 1991, completed general surgery training at the University of Cincinnati in 1998 and completed a fellowship in minimally invasive surgery and bariatrics at Emory University in 2000. He stayed on the surgery faculty at Emory after graduation. In 2001 he moved to Central Oregon and joined Advanced Specialty Care.

Along with Marinus Koning, he is the founder of Advanced Bariatrics and is involved in all aspects of treating morbid obesity. He is the director of the St. Charles Bariatric Surgery Program. He is the founder of the Bariatric Conference of the Cascades—a multi-specialty regional medical meeting focusing on the treatment of obesity.

Dr. Archer is on the clinical adjunct faculty of Oregon Health Sciences University department of surgery and is regularly involved in teaching for the university and in teaching at national conferences.

He enjoys traveling with his wife, Ann, fly fishing and mountain biking.

moderator: Welcome to our live chat

Bethany :I was wondering if you maybe knew of any surgeons in Louisiana would be willing to help my mother get the gastric bypass surgery. She is morbidly obese and the doctor said that she had about a year to live unless she had this surgery. We don't have medical insurance and we can't afford to pay for the surgery outright. If there is any way possible that you could help me in finding this information, it would be GREATLY appreciated.

Dr. Archer: Go to liteandhope.com's MD Directory to check for a surgeon in your area and make some calls. I do not know of a surgeon in Louisiana —I live in Oregon. Good luck!

Tammy: How soon after laparoscopic gastric bypass can I be up & driving again?

Dr. Archer:You cannot drive while you are still on narcotic pain medication-- usually a week to 10 days, but everyone is different

Lynda:Hi I am 3 yrs post op don’t want tummy tuck yet and need to loose 40 more lbs; been stuck on 202 for 2 yrs after many a complication was ironed out; I feel great but what is the problem/ I am finally on thyroid med this week and off diabetic meds too! I do take anti dep trying to wean off them; could that be why? My start weight was at around 310 2/03; thanks I am also 48

Dr. Archer:It is important to remember that losing weight leads to the goal of a healthy lifestyle with fewer meds and fewer health risks. In that sense you are a success! Here is a suggestion: remember that muscle burns calories better than fat. No one minds growing muscle and it is actually a healthy thing. So, I would recommend that you embark on a muscle building plan: weight lifting if you are able (under the supervision of a trainer), do more cardio. Also, you may want to go back to habits like weighing or measuring your food—1/2 cup per meal. As you lose lots of weight, you need even fewer calories to maintain your metabolism, so you will have to eat less as you get smaller in order to lose weight.

Latoya:What foods and medications should a gastric bypass patient avoid?

Dr. Archer:Early on avoid pills unless they can be crushed. There are no meds that you cannot take, but the dosages may have to be adjusted after surgery. Discuss this with your surgeon

Wendy:Where can I find info about older (50+) females that have had surgery?

Dr. Archer:Most bariatric surgeons have support groups. Try getting to know some of the patients in your local support group.

Eva:My surgery is coming up next month. I'd like to know what is expected of the person who will be with me. Will she spend the night in the hospital or can she go home? Do I need someone with me when I return?

Dr. Archer:Depends on the hospital policy whether the support person can be with you in the room overnight or not. You should have someone at home with you for a few days.

Jenna:Can Advil or Tylenol be taken for headaches after surgery?

Dr. Archer:Tylenol is preferred.

Miri:I had the surgery exactly 2 months and 1 day ago and I was wondering how do you continue to lose more weight even though your adding more food to your diet.

Dr. Archer:You will still be eating less than before surgery. Your stomach is one ounce in size, or so. Pay attention to the feeling of being full. At first it really helps to measure every thing you eat or drink. That way you will get a sense of how much food it takes to feel full. Also, eat slowly so that your brain has time to know the pouch is full.

Sharon :I have had friends that have had roux-en-y and others that have had duodenal switch, the ones with the duodenal switch seem to be happier and are more tolerant with vitamins. Is the duodenal switch recommened for any reasons?

Dr. Archer:Duodenal switch is a good operation with excellent results. There are fewer problems with eating regular amounts of food—the body simply does not absorb the food. In some ways, the bypass is a great teaching tool for eating smaller volumes of food. The switch is not the same kind of teacher. Discuss what operation your surgeon is most comfortable with—that will dictate what is safest for you.

Maria Eugenia:Is it true that the stomach of an obese person is the same size as a normal person?

Dr. Archer:Yes

Gina:I have Hypertension and I take a medication for it. After the GB surgery will I no longer have to take pills for my hypertension?

Dr. Archer:In my practice there is an 80% chance that your high blood pressure will return to normal within the first year. That means 20% of patients still have to take blood pressure meds. If a patient regains weight after surgery, they may re-develop hypertension.

Maria Eugenia:DO YOU BELIEVE IN GASTRIC SLEEVE ??Why

Dr. Archer:Gastric sleeve is being studied. I am reserving judgment until more data is available. The idea is that sleeves are useful to act as a bridge until a safer weight is attained and then converting the operation to a bypass or duodenal switch. It makes some sense to me, however your insurance company might disagree. It is mostly used for patients with BMI’s well over 60.

Becky:I had gastric by-pass 3 years ago, and I recently went for my annual check-up which went well, however, I have re-gained lbs. Should I assume that I have stretched my stomach back to the original size? I still exercise on a daily basis and try hard to watch my caloric intake and portion size. My Doctor said that had I not been doing so, I would have gained back the lbs. that I've lost. Will I lose while I strive to do what is necessary to lose this added weight? Thank you!

Dr. Archer:The pouch does stretch. I stress to my patients that bariatric surgery is not a cure—it is an opportunity, an intervention that allows the patient to relearn how to live with food. Some weight gain usually occurs as the pouch grows a bit. Increasing muscle mass is the best way to get back on track. Sounds like you are doing that. If you can, get a trainer and try doing some weight lifting to increase the muscle mass.

Robin:Hi Dr. Archer, I am 6 days post op from a proximal gastric bypass. I have terrible nausea and diarrhea episodes about 4-6 times a day. Is this normal and what is it from? Yes, I have contacted my Dr. They called in a scrip for the nausea today.

Dr. Archer:It is not unusual this soon after surgery to have the nausea. Narcotics used for pain make some patients nauseated. Your bypassed stomach may be a little distended and that can lead to nausea. The diarrhea also occurs sometimes. If it continues your doctor will likely test it to make sure there is not an infection.

Tracey: Hi, I have lots of medical problems and I don’t know if I can have this surgery but I need it what should I do?

Dr. Archer: You are doing the first step, which is educating yourself. Contact the coordinator of a local bariatric surgeon and she/he will give you more information and you can decide if this is for you. I do a lecture every month here in Bend , OR that is free to the public that helps with the education process. Your local bariatric surgeon may have one of those. Check it out.

Daphne: Is it standard practice to do a scope on a patient before having the RNY done?

Dr. Archer:I always do. It is the last chance to see the portion of the stomach that will be bypassed.

Teresa: What percentage of people die from this operation? I know it’s a horrible question but I do wonder about this?

Dr. Archer:Most experienced bariatric surgeons report that deaths occur, but rarely, largely because of their good training and the extensive work up prior to surgery. It is a good idea to ask your surgeon how many patients have died under their care. It is a tough question, but you deserve to know. In my practice, we have had one death in 300 patients, which is a little less than the national average. Be aware that it is possible to die from bariatric surgery—your question is a good one.

Crystal :I have CML Leukemia and I am A diabetic also on a insulin pump. Could I still have the weight loss surgery?

Dr. Archer:There are too many unknowns in your story for me to answer, because of the CML, not the pump. Start by meeting with a bariatric surgeon and he/she will contact your oncologist and primary care MD to discuss your case.

Angela: I would like to know on an average, how much weight usually comes off during the first 3 months after surgery?

Dr. Archer: Results vary, but I generally tell patients to expect about 8-12 pounds/month during the first year after gastric bypass, and about 5 pounds/month after lap Band.

Mike: I had surgery 6 days ago if I can tolerate pudding is it ok to eat it. Is it normal to be this hungry 6 days after

Dr. Archer: Check this one out with your surgeon.

Millie Doyle: I had a gastric bypass in 1999 and have put on over 50 lbs...Do you recommend redoing it? I am still 100 over weight

Dr. Archer:Possibly, but first you should determine whether the problem is technical—pouch too big for instance, or one of the intestinal limbs might be too short—or maybe your behavioral patterns need an intervention. Check this out with a bariatric surgeon who is qualified and willing to do reoperative cases. It is important in this instance to get someone with lots and lots of experience.

moderator: This concludes our chat for today. Thank you all for coming into today’s chat room. We are pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Dr. Archer for your informative and insightful answers. Please join our next chat on August 1st, 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

 

moderator: Welcome to our live chat

Barbara_Murray: Hi Dr. Wittgrove. I haven't seen you in quite a while, you performed my surgery on August 31, 2004 and I will be forever grateful. My name is Barbara Murray and I met you for the first time in Las Vegas. We have moved back to our hometown in Ohio. I just wanted to take this opportunity to thank you for changing my life. I was a very sick woman. Severe diabetes, severe high blood pressure, gastro intestinal reflux disorder and debilitating back pain. You turned that all around for me. I didn't have a chance to tell you all this because we needed to move back here because of illness in my husband's family. So this is my chance now. Thank you. My surgery was twenty-one months ago

Dr. Wittgrove: Hi Barbara, very nice hearing that you are doing well, even if you have moved away we still would like to keep follow-up so call the office and we can do it even by phone. Nice hearing from you.

Tom-: I am 5 weeks post op, will this bad breath ever go away?

Dr. Wittgrove: Hi Tom, the answer to this depends on what type of operation you have had. In general there is ketosis, which can cause bad breath, and does go away over time.

michelle: Ii had my surgery 2 months ago but it seem like when I eat I get hungry fast. Is that normal? I have already lost 58 pounds.

Dr. Wittgrove: Hi Michelle, some of the answers depend on what type of operation was done. With gastric bypasses if people eat protein generally hunger is turned off for longer period of time. Carbs tend to promote snacking.

Brenda_H.: I am scheduled to have surgery on 7/6/06. I recently went to the doctor and found out I have either a varicose vein or phlebitis in a superficial vein. Do you think this will stop my surgery? My surgery is rny lap

Dr. Wittgrove: Hi Brenda, without an examination it is hard to say for sure but in general varicose veins do not cause bariatric surgery to be canceled. Certainly you should check with your surgeon.

Jack: Doctor, What is the difference between an Lap Band and a Roux-en-Y bypass? What is your preferred approach and why?

Dr. Wittgrove: Hi Jack, the difference is a long discussion rather than a short chat answer in general the bypass gives the patient satiety rather than simply feeling full. Band patients don't seem to feel the same feed back of satiety. Most studies show the results of the bypass to be better than the results of the band, I only do bypasses at this time.

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

Elle: Hi Dr. Wittgrove. Have you experienced any problems with women who had gastric bypass and then wanted to get pregnant after a year’s time?

Dr. Wittgrove: Hi Elle, no for the most part if a women waits 12-18 months after her bypass and is healthy and wants to become pregnant she can do so with out many of the risks she would of had when she was morbidly obese. She should be followed by both her surgeon and her OB.

gabbylinda: I am having my surgery 6-19-06. Anxious but a little nervous. Is this something that we all just go through?

Dr. Wittgrove: Both feelings are normal. You should be excited for the reasons you want to have the operation and nervous because there are potential complications (and the operation is on you...). Good luck!

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

Kat: Can I drink too much at one time, 1 month out of surgery?

Dr. Wittgrove: Hi Kat, At one month it is fairly common for even water to be difficult, at times. Go at your own pace but water intake is very important so keep up the effort.

Linda: I am scheduled for gastric bypass on 7/25. Do you think it is of any benefit to have a vena cava put in place before the surgery, even if you don't have any high risk factors for blood clots?

Dr. Wittgrove: Linda, Vaval filters are used for very specific indications. They should not be used "just because" as they can have complications as well.

jOANNE: Dr. Wittgrove, thanks for taking my question. I am 2 weeks post-op from lap roux-en-y. I have lost 16 lbs., but for the last three days, have only lost a pound. What's going on? I am on a purely liquid diet.

Dr. Wittgrove: jOANNE , You do not have the same # of pounds lost every week. The body needs to catch up. You go down in weight step-wise and not as a constant slope. Just stay the course and follow the rules of the program.

moderator: Please note that you can go to our message boards and speak to each other anytime. The link is: http://liteandhope.com/forums

mcee.: Hello doc i am 3 months post surgery at this time. How many calories do you suggest for a gbp patient also i have lost 100lbs since surgery is that to much to fast?

Dr. Wittgrove: Hi Mcee: The # of calories is not as important as the fact that you are following the rules of getting the grams of protein, water, exercise ..... If you are following the rules and are following up with your surgeon, 100 pounds sounds great.

Terri: I had lap rny on 2-24-2004 my ongoing battle is the horrible gas!! I've tried beano, gasex and devrom. Nothing seems to help. Any advice?!?!!

Dr. Wittgrove: Hi Terri, Most of the time a proximal RNY patient does not have this difficulty (from the operation). Some people do anyway. The gas we pass is influenced by the things we eat and so you should cut back to very basic diet and then add back foods to try to get to the bottom of it.

Terri: What do you consider a basic diet??

Dr. Wittgrove: Hi Terri, A basic diet changes from one month to month five to month nine or 12. After all the healing, basically my patients eat 2 or 3 meals a day that are 1/2 protein.

Elle: Dr. Wittgrove, do most of your bypass patients need plastic surgery?

Dr. Wittgrove: Hi Elle, need is an interesting word. Want maybe better sometime. Need has to do with function. Many people are so happy to be healthy that the skin issues are not that bad. Others want it removed or should have it removed to improve function. It is very personal and very varied.

Brenda_H.: I've been reading a lot about r.n.y lap and open bypass. Do both of them require a drainage tube and are they removed when you leave the hospital? Also, Is it always necessary to take fragmin injections post-op?

Dr. Wittgrove: Hi Brenda, Drain tubes are up to the individual surgeon. I generally take the drains out at day two. I use Fragmin (or Heparin) to deal with the potential clotting issue.

Kat: I'm 4 weeks post up and my doc. keeps everyone on soft/puree for the 1st 10 weeks. I have been keeping track of my food. I have been eating between 6and 7 hundred cal. a day, about 70gms. protein. Sometimes my carbs go as high as 60. Is that too many?

Dr. Wittgrove: Hi Kat, It depends on the type of carbs and what ever else it being consumed at that time. In general I have my patients eat only when they are hungry, eat their protein first and then have a balance of other "meal foods". Follow your surgeon's program.

Pamela-: Once you decide to have surgery & your insurance to approves it, how long does it take to actually be scheduled for the surgery? I know you see a nutritionist, dietician & psychologist, but how many visits must you have before you have the surgery? By the messages I've read it seems the patient sets the date? Are we talking weeks or months? I'm getting anxious! Thank you

Dr. Wittgrove: Hi Pam, It depends on the program. Most of all those consultations are done in our program before the approval and we can move right to scheduling once there is an OK. I don’t like to put the patient off too long at that time as I think it gets to be human nature to want to get on with your life NOW!

lynn-: I had GBS 2 yrs ago. I only lost 70# out of 120 needed to complete my loss. I take several heart meds for "sick sinus syndrome". Could this be why I'm not losing any more? Also, my surgeon recommended no fruit for two years and only 2 meals a day w/ 7 bites per meal. I quickly left that behind, but not the fruit. My concern is how healthy is this regime? My labs are all ok. Does my "tool" still work after 2 years?

Dr. Wittgrove: Hi Lynn: Hopefully your tool is still in place. You have complicating issues that may affect your weight loss. Certainly I would have you follow your surgeon's rules, as he knows you best. As I said before, I have my patients eat a balanced meal but heavy on protein and eat the protein first.

Deanna: I had my lap RNY on May 17 of this year and have had absolutely no complications whatsoever. No post surgery pain or food intolerances. Although I am very happy with my weight loss of 45 pounds so far, I am curious whether this is normal.

Dr. Wittgrove: Hi Deanna: Most patients do not have complications. 45 pounds of weight loss sounds great in that time frame but I don't know where you started.

Helen: hello...........I am 2 ½ months out from surgery, I know you can eat too much and make your stomach larger...... how do you know if your doing that ? Is there a sign we should be looking for?

Dr. Wittgrove: Hi Helen, Gastric bypass patients generally know when they have eaten too much. From a surgical standpoint, it is important to make the pouches very small so it is very difficult to dilate up the pouch over time. Listen to your body and do not eat if you are not hungry! Stop when you are satisfied and not when you are "full".

missy: How is the surgery a permanent weight loss method

Dr. Wittgrove: Hi Missy, There is no guarantee that the weight will stay off forever. There are rules to follow just as normal weighted people need to follow rules. It is not a cure but rather a tool.

mcee.: Hello again. Do I need to take in more than 60grams of protein in order to absorb at least 60 grams of protein?

Dr. Wittgrove: Hi Mcee, Depends on your operation. In general gastric bypass patients absorb most things normally. Most patients need 60 to 70 grams or so of protein especially just post op.

moderator: Dr. Wittgrove, Is there anything you would like to add before we conclude this evenings Live Chat?

Dr. Wittgrove: Feel free to check out our website at www.Lapbypass.com for further information. Thank you

moderator: This concludes our chat for today. Thank you all for coming into today’s chat room. We are pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Dr. Wittgrove for your informative and insightful answers. Please join our next chat on July 17, 2006. Good night and thank you once again.