Dr. Marema is one of the most respected physicians in bariatric medicine. When ObesityHelp magazine released its top 100 "Surgeon Rankings...Lives Transformed Score" (July 2003), derived from information collected from over 150,000 bariatric patients, Dr. Marema was listed as #1.

As a bariatric surgeon, Dr. Marema has changed the lives of thousands of formerly obese individuals, and, as an innovator and pioneer, he has helped in the development of new medical devices and the refinement of several bariatric procedures. The bariatric program created by Dr. Marema at U.S. Bariatric and Holy Cross Hospital is considered by many to be one of the best in the world.

Not only is Dr. Marema a bariatric surgeon, he is also a successful bariatric patient.

moderator: Welcome to our live chat

marie: I had my surgery a year ago and have only lost 60 pounds. I can't seem to get anymore to shed. How long is normal to stall???

Dr. Marema: Marie, First, it depends upon how much weight you had to lose, and how well you are following your prescribed aftercare. Exercise at this point is crucial to maintain your metabolism and jump start your weight loss. You should try aerobic exercise in the morning on an empty stomach followed by fasting for an hour afterward.

naomi: How successful is the Lap band and how much can one expect to lose during their first year after getting a Lap Band?

Dr. Marema: Naomi, The lap-band generally gives weight loss of about 65% excess weight (65 lbs if you are 100 lbs overweight) in 18 months. The results are less predictable than with a gastric bypass, but it is a great option for those fearful of bypass or looking for a quick return to their life.

suzanne: Is the waiting time for me to be able to get pregnant shorter with the lap band or is it the same with the bypass surgery......is it true you have to wait for almost two years after bypass surgery to safely get pregnant? Thank you Dr Marema.

Dr. Marema: Suzanne, generally, 12-16 months is sufficient time to wait to get pregnant after a bypass if you are taking proper vitamin supplements and getting good nutrition. With a band, pregnancy is not an issue since the band could be deflated at any time to allow more food intake.

April: I had my surgery 4 years ago. I went from 226 to 120. I am now gaining weight again. In the past year I have gone up to 130. I haven't changed anything. I am starting to get sick again too, with certain foods that I eat. Should I go back to the liquid diet for a while? Any suggestions would help. I really want to get back down to my 120. Do you have any diets you recommend? Thank you, April

Dr. Marema: April, The best diet is ALWAYS lean protein followed by nutritious fruits and vegetables. Be sure to take you calcium supplement, as this has been found to effect weight loss positively. About 1500-2000 mg of calcium citrate with vitamin D is correct for bypass patients. As to your weight gain, it is common to see about a 5-10% weight regain. If it does not continue, good habits should keep it controlled. If it continues, you should see your surgeon as this could be a sign of problems with the surgery.

Maire: Dr. Marema, I am 2 weeks post-op (gastric bypass) and have lost only 14 lbs. Should I expect to lose more by now? If so, what am I doing wrong?

Dr. Marema: Maire, Adequate weight loss is measured in percent of excess weight, not by lbs. It depends on how much weight you have to lose, but generally it sounds fine.

della: Good evening to you. I got a question about very loose stool some time all day. I had gastric bypass --a few days from being nine months. I have tried a lot of things and now the doctor got me on something but it still happens. Even while sleeping and I never know until I get up to use the bathroom. It is very shameful, especially if it continues. There is also a very bad smell coming from the bowels, help me if you can, I have dropped 106 trying to make it down to 170, so as you see I got some ways to go.

Dr. Marema: Della, some weight loss operations involve malabsorption as part of the weight loss process. If you had one of these surgeries, then frequent, liquid foul smelling stools may be part of your new life. If you had a standard gastric bypass, then you should consider discussing other medications to assist you in reducing this. I am aware of a medication named devrom that you can buy online. It will only help with the odor of the stool or gas.

bizeemom: I have had two (no complications) C-sections in the last 3 years. The most recent one was in August of last year. Does this rule me out for gastric bypass surgery?

Dr. Marema: bizeemom, no, there is no reason for you not to proceed. That is if you can squeeze it between childcare duties!

sheila: Is it true that if you have the gastric bypass, your diabetes can disappear?

Dr. Marema: sheila, Absolutely! Approximately 80% of type 2 diabetes is resolved within several weeks of surgery with a gastric bypass, and about 60% is resolved with band surgery after weight loss.

naomi: In comparing the lap band to gastric bypass, what type of results (% of weight loss) will typically happen with gastric bypass?

Dr. Marema: Naomi, In our practice, we see weight loss with band surgery at about 65% at 18 months and we see weight loss at about 85% at 12 months with gastric bypass.

bizeemom: I have two VERY busy little boys. And although my mother-in-law has graciously offered to stay with me and help with the boys, I was a little concerned when I read that RNY patients weren't supposed to pick up any more than 20 pounds for quite a while. What is the typical amount of time that such activity is limited? My littlest one likes to ride in one of those baby backpacks - would that be any better? Also, how about stairs?

Dr. Marema: bizeemom, If you have a laparoscopic gastric bypass then I would not limit your lifting after 2 weeks post-op. Backpacks are fine and help distribute the weight across your shoulders instead of pulling on your belly. Stairs are fine. Be sure to discuss techniques used for quicker recovery when picking your surgeon.

MJ: Dear Dr. Marema, I will be having my gastric bypass surgery on June 21st. It will be done laproscopically (hope I spelled that correctly). I was told I might only be hospitalized to 2 days is this true?

Dr. Marema: MJ, That sounds correct. We even discharge many patients the day after surgery because they want to recover at home and they feel well enough to do so. Good luck.

della: I had the RNY-gastric, so should this be going on with it?

Dr. Marema: Della, Some surgeons perform a non standard gastric bypass with a malabsorptive component. It sounds like you need to have a conversation with your surgeon to understand better what was done. It may be very helpful, though to significantly limit the amount of fatty foods in your diet.

naomi: With the significant weight loss, there is a lot of skin left over. At what areas of the body is it dangerous to have too much loose skin? I have heard bacterial infections can happen if there is a lot of loose skin around certain parts of the body. What areas of the body are more frequent to this problem?

Dr. Marema: Naomi, It is far more dangerous to have your skin filled out with fat than it is to have loose skin with mild infection underneath. The most common place for these infections is under the belly or breasts. This is treatable with creams. This is also very common in patients prior to surgery.

bizeemom: Dr. Mareema - RE Della's question about the loose stools - I thought that gastric bypass (specifically RNY) surgeries were malabsorbtive in nature. However, the fact that the stomach acids are still being dumped into the intestine made it a "better" procedure. How common is chronic loose stool & foul gas? Does your system ever get used to its new shape? Can a postsurgical patient eat fibrous foods? Right now, my "bran & fruit" type breakfast keeps things regular. Is that an option for post surgery?

Dr. Marema: bizeemom, you are right, a gastric bypass does produce slight malabsorption. But the degree of malabsorption can vary depending on surgical technique and physician preference. A proximal bypass produces less malabsorption, thus less malodorous, loose stools. A distal gastric bypass produces more. Some patients do find it difficult to tolerate very fibrous foods like asparagus or celery. But fiber intake through supplements and other fruits and vegetables should be maintained and is encouraged. How common is malodorous stools depends on 1. The amount of intestines bypassed, and 2. the amount of fat consumed in the diet.

kathy--: I am two years out from a open gastric bypass, After losing 140 pounds I am having significant problems (weight gain included ) as I have enlarged stoma- 2.5cm . My surgeon last Dec 2005 up and retired . He had told me previously I would need to fix my stoma as excessive dumping, flushing, nausia, and the list goes on will occur. I have four children and was self pay . Besides my constant hunger I am slipping in my health as more and more foods make me sick as they are not being processed well enough in the short stay they have in my pouch. I need a surgeon and an explanation on to how they will fix this. There is no one at my office here in Seattle that can help anymore. Please respond with any information

Dr. Marema: Kathy, Your problem is not uncommon to me. I am seeing more and more patients who have a bypass that is not working for them. There are many reasons for this and you have listed one of them. I would suggest that you identify a surgeon VERY experienced in revisions as they are complicated and risky in inexperienced hands. In all likelihood, until you have a revision, you will continue to struggle. Some surgeons will perform revisions laparoscopically which has an advantage over open surgery when it can be safely performed. Stoma enlargement is managed by myself with the use of a ring on the pouch, as well as surgically reducing the stoma size. Both of these things have been shown to improve.

Maire: Dr. Marema, I rolled over in bed the other night and felt a "pull" near one of my incisions. It hurts to get up out of bed after that. Should I be concerned?

Dr. Marema: Maire, This is a question for your surgeon's office as I cannot assess you.

April_F: Hi Dr. Marema I had my surgery with you 5 months ago and am still having problems digesting most meats even after it is chewed well and I was just wondering if this is something that will get better as the months go on and do you suggest protein shakes as a supplement this far out, since I do not get my protein from meat

Dr. Marema: April, Hello! The meats I suspect you're struggling with have a lot of fibrous links. Meats that will go easy are fish, scallops, crab, and dark meat poultry that is roasted. Cooking techniques cuts of meats (filet mignon vs. skirt steak), and moisture component of the food are things to look at. I do not want you to turn to shakes for your nutrition because this does not keep you as full as meat does. Try cooking in a crock-pot, using broth to make meats tender. Hope to see you in the office soon! Remember to take the building blocks vitamins.

gina: If you don't have insurance can you make payments?

Dr. Marema: Gina, many offices work with lenders to arrange a payment plan. Remember, it can be tax deducted and you are buying a new life.

Annie: I had the laproscopic Gastric Bypass done 3 years ago. Last fall I had to have my foot operated on and was in bed and a cast for 6 months. I gained 45 pounds from inactivity. I am afraid to gain more weight. I lost 120 lbs with the initial surgery but I am at 290 weight right now. Is it possible to get a lap band to help get the rest of the weight off when you have had the bypass done?

Dr. Marema: Annie, There may be a problem with your bypass causing you to gain weight. It also may be that your metabolism has been drastically affected by the inactivity. I suggest you return to basics including a regular activity program. If you do not see results, then you may want to follow up with your surgeon. Make sure to take proper vitamins, as I feel this is an integral part of health as well as weight loss success.

kevin: Is it true that if I've have gastric bypass surgery I can get life insurance at a normal cost? I think I saw Carnie talking about this on TV.....I had my surgery 10 months ago......Do you know how much it is... what do I do?

Dr. Marema: Kevin, Life insurance has been almost impossible to obtain at good cost for people suffering from obesity until now. Prudential released a plan at good prices that you are eligible for at 1 year post-op. I think you can go to the lite and hope website and click on life insurance for details.

Kat: Why am I retaining water 10 days out from surgery? I had a lap RNY, am walking and following my puree/soft diet, watching my salt intake. Is it because my surgeon had me only on clear liquids without any protein for the first 9 days?

Dr. Marema: Kat, A liquid diet for 9 days doesn't give you adequate protein unless you were adding it into your liquids. Inadequate protein causes fluid shifts and fluid retention. Ask your surgeon for ideas to increase your protein intake, and I suspect this will resolve.

Lisa: I just joined this chat, so pardon me if this question has already been addressed. Doctor, do you accept Medicaid insurance?

Dr. Marema: Lisa, Our hospital is currently working with Medicaid on a case by case basis.

moderator: Please note that our chat is almost over. If you missed any part, it will be archived at www.liteandhope.com in the next day or two. Thank you.

missy: If you lose the weight before surgery, what is the actual weight loss for the surgery after?

Dr. Marema: Missy, Losing weight before the surgery helps you to go through the surgical process more safely.

moderator: Dr. Marema, Is there anything you would like to add before we conclude?

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

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

Dr. Marema: I'd like to thank all of the participants for their interesting questions. I'd like to invite you to visit our website at www.usbariatric.com for more online education and chat rooms. Good luck to everyone in his or her journey!

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. Marema for your informative and insightful answers. Please join our next chat on June 15, 2006. Good night and thank you once again.

Born in Stockholm, Sweden, Dr. Bengt Pehrsson received his medical degree at the University of Munich in West Germany. He was accepted to the residency program at Tulane University in New Orleans, Louisiana. He did his training primarily at what was then known as Charity Hospital in the heart of the city.

A member of the Boards of both General Surgery and Colon/Rectal Surgery, he maintains active membership in the American College of Surgeons, SAGES, the American Society of Bariatric Surgeons, American Society of Gastroenterology and Society of colon and Rectal Surgeons.

With his extensive training and experiences in general and colon/rectal surgery, he became an early advocate of Bariatric surgery, specifically with Roux-en-Y Gastric Bypass. Performing these procedures since 1991, they were initially all preformed as open surgical cases but now they are done almost exclusively laparoscopic. With his vast training and year of experience in this procedure he is the only surgeon in the San Gabriel Valley performing laparoscopic revisions of Bariatric surgery.

During the past 14 years he has traveled extensively on the West Coast speaking to groups about Bariatric surgery and obesity. An early advocate for weight loss surgeries, he is the Medical Director of the Bariatric Surgery Program at Methodist Hospital in Arcadia, California.

moderator: Welcome to our live chat

johnnie: I am 56 years old, was born with and have lived with diabetes my whole life.........my BMI is close to 40...........I really am concerned that I may not be able to withstand a surgery though I clearly need it....what would say my chances are of having a major complication because of my life long diabetes..........I feed trapped between my obesity and TYPE 1 diabetes....help!

Dr. Pehrsson: Johnnie, most of our patients have diabetes, and by itself is really an indication to have the surgery rather than a contraindication. It should not be an issue. Finally, type 1 diabetes does not respond quite as well as type 2 after the surgery, but should still be improved significantly.

donna: What is your opinion of the BPD/DS ???

Dr. Pehrsson: donna, the bpd/ds certainly has a place for patients who are super obese , but for people with a BMI of 35 to 70 , the roux y gastric bypass offers the same or better outcomes with lower risks. In addition, very few centers in the United States offer this laparoscopicallly, if they do it is often performed in 2 stages.....malnutrition can also be a problem, while the gastric bypass really doesn't have this problem

sissie: I am 67 years old and have been approved for the surgery. I have passed all the tests, and am waiting for a surgery date. I wonder which surgery to have-the sleeve or the band. May be you could give me some insight. thank you. Sissie

Dr. Pehrsson: sissie, it is hard to say for sure since we don't know more about you....what are your BMI and co-morbidities? Generally speaking, the long term results are better with the gastric bypass.....since you are unlikely to have the band removed in the future, the gastric bypass is probably a better procedure for you.

Dawn: Hi Doctor, My surgery is Wednesday and I am a basket case now. I am not afraid of the surgery or anything I just get so worked up just before surgery. What can I do to calm myself? Any ideas would be greatly appreciated.. :)

Dr. Pehrsson: Dawn, it is normal to be nervous, I would think your surgeon could prescribe a sedative for you if needed so you can get some rest....

Tap: I've also been approved for surgery at the end of this month. I'm having the lap band procedure. What are my chances of reducing my weight within a year's time. I currently suffer from high blood pressure and taking med for it. I'm 44 , weigh 274 and 5 ft 5 inches.

Dr. Pehrsson: tap, your chances are excellent ,,,you should be able to lose about 60% of your excess body weight . and hopefully reduce or eliminate your bp meds...good luck

eliana: I am 5 3 and 300 pounds. All of my family members think I should lose weight by changing my diet and exercising. I'm so tired of hearing it because I've tried. I just really am attached to food as a relaxant and de-stressor and I'm worried that because I can't do the diets, I'd spend all the money on the surgery and then just gain the weight back. Do you think it's good to have therapy first before making a decision about this?

Dr. Pehrsson: Eliana, first ....you should be able to lose your weight 85 to 90% of excess weight if you are having a gastric bypass....and 80% of the people keep the weight off for 5 years......most can refocus on other things than food after the surgery......it is really not as big a problem as you may think...in my practice I have a requirement of pre op patients going to our support group prior to having the surgery.. as well as a preop psychology clearance.....certainly if the preop psychologist thinks you should have therapy preop then it would be appropriate.

Sher: Hi Dr! I'm scheduled for Open RNY. I'd like to know the typical time off from work. My Dr. had told me that I could go back in a week, and people I talk to think that is VERY optimistic. Your recommendation?

Dr. Pehrsson: Sher, I used to do open gastric bypasses prior to the advent of the laparoscopic method, now I do exclusively lap gastric bypasses....my open bypasses usually did not go back to work for 6 weeks......with the laparoscopic method people go back to work in 3 to 14 days

sharon : is there anything you look for specifically in the pre-op check- up, that might possibly stop the surgery?

Dr. Pehrsson: sharon , the most common thing is the failure to approve by the insurance company....I work all my patients up with blood tests and EKG and occasionally require cardiac and or pulmonary clearance. Sometimes this may delay the surgery, but rarely stops the surgery..

Lori: I recently am hearing that the newest theory for weight problems can be attributed partially to a hormone that is low or missing in some people. Have you heard this and what is the hormone? How can one be tested for it?

Dr. Pehrsson: Lori, you may be referring to the hormone ghrelin...there are no routine tests for this at this time.....it may be that the gastric bypass increases the amount of ghrelin produced so you are less hungry .. at any rate there is no benefit in trying to test for this preoperatively

Kymber: Hi Dr. Just out of curiosity, why do so many doctors have different methods of vitamins and nutrition afterwards? It is very hard to coach someone who's doctor. told them Flintstones is a way of life and that they can get all their protein from food with no supplements. I know we are supposed to listen to our surgeons, and thank goodness Dr. Trotter cares more about my lifelong health than my initial surgeon before my revision. I guess my question is why are there so many different ideas of what's right, and what kinds of questions should a pre-op be asking to find out if their Dr's nutritional plans are good for life long health?

Dr. Pehrsson: Kymber, congratulations on now having Dr. Trotter, he is a great guy and surgeon......bottom line is you don't need to be on supplemental protein if you can get enough in per day.....I do like patients to be on a multivitamin , calcium , and b12 for the rest of your life....as do most bariatric surgeons, how diet is managed varies greatly....it usually is tailored the individual practice

Dee_H: I just had gastric bypass surgery last Tuesday. I've been experiencing a lot of gurgling in my intestines and gas -- is that normal? I am just taking water, broth, Atkins Advantage drinks, and sugar free Jello at the moment. Does using a straw to sip the liquids cause gas?

Dr. Pehrsson: dee_h, it is normal to have gas ,,, and i advise to not use a straw as it can increase the amount of swallowed air

lisasisallen_: What are your thoughts on lap band versus gastric bypass? My surgeon says that the gastric bypass seems to be more successful for his patients.

Dr. Pehrsson: lisasisallen, it is a trade off of weight loss versus risk....lap band typically has about a 60 % weight loss and the bypass about 75% weight loss ...the bypass requires an overnight stay with slightly higher risks and the band can be done as an outpatient....

Sher: An extension of my original question... On the Open RNY-When do you think my activities would be back to normal? BMI 39, Age 43

Dr. Pehrsson: Sher, 2 months

sharon : when it comes to malnutrition, why is the roux y gastric bypass harder on your body than the regular gastric bypass?

Dr. Pehrsson: Sharon,, there are 2 types of gastric bypasses......long and short limb......no one does the long limb type any more which was the one which is harder on your body ...now we do only short limb, we just reversed a long limb procedure last week which was done at another practice and he is doing well.....it is harder on your body because there is significant malabsorption while with the short limb there is very little.

Tap: How long would I be out of work after the lap band procedure if there are no complications? I am a teacher.

Dr. Pehrsson: Tap, 1 to 2 weeks

lisasisallen_: 35 year old female wanting to know the long term effects of the surgery on your health. Have there been any studies of nutrients not being absorbed? Are the supplements enough?

Dr. Pehrsson: lisasisallen, there is an excellent study by Dr. Pories where he followed his patients for 15 years without any nutritional problems. If you take your supplements you should be fine....multivit...calcium, and b12

moderator: Please fill free to visit our message boards to talk with each other ANY TIME. The link is: http://liteandhope.com/forums

kenya : Are there any doctors that finance the surgery or know who I can contact to finance the surgery? Are there any doctors that are willing to perform the surgery pro bono? Is there a new surgical procedure that you need to test on someone? Because at this point I'm willing to be a test dummy

Dr. Pehrsson: kenya, plastic surgeons have long allowed people to finance a surgery like you are buying a car, you can do something similar for gastric bypass.....I do not know anyone doing this pro bono...I don't do any experimental surgeries and can't think of any at this time

brenda_h.: I am 45, BMI 42, and 145 pounds overweight. Is it unrealistic to think I will lose up to 80% of my excess weight within a 14 month period after RNY gastric bypass?

Dr. Pehrsson: brenda_h, no, you should have a good chance as long as you follow the instructions of your surgeon....

brenda_h.: Are the risks of pulmonary embolus less with the lap rny bypass v. open rny?

Dr. Pehrsson: brenda_h,, pulmonary embolism is more likely after an open gastric bypass do to the inability to ambulate.....our lap bypasses walk 5 hours after surgery, and our PE rate is less than 1 %.

kathryn: Hello, why are carbonated beverages forbidden after gastric bypass surgery?

Dr. Pehrsson: Kathryn, there are not, however, initially for about 8 weeks after surgery they may be difficult to tolerate while healing, most of my male patients are able to enjoy a beer once in a while....

Lori: Is there a higher risk for complications or scar tissue problems when having the RNY laproscopic procedure done on people who have had previous laproscopic procedures. I have had my gallbladder removed, lodged kidney stone and my appendix.

Dr. Pehrsson: lori, previous laparoscopic surgery never causes a problem

moderator: Sissie, Here is your answer from Dr. Pehrsson. sissie, it is hard to say for sure since we don't know more about you....what are your BMI and co-morbidities? Generally speaking the long term results are better with the gastric bypass.....since you are unlikely to have the band removed in the future, the gastric bypass is probably a better procedure for you.

kathryn: I am 6 months out of surgery, have lost 80 pounds but now it seems that I have come to a stand still, any advice?

Dr. Pehrsson: kathryn....step ladder type weight loss is quite common.....after a loss of 80 pounds we expect you to slow down....try to focus on getting your protein in and adding significant exercise.

lisasisallen_: Do most people find that they have enormous amounts of loose skin after losing the weight so fast? I have a BMI of 44 and I am 35. I’m concerned that it will require me to have even more surgery.

Dr. Pehrsson: lisasisallen_ ,, it varies from person to person.....the younger you are and the more you exercise the less likely you will have a problem..if you have hanging skin after you are done losing your weight ...you may opt to have plastic surgery to remove extra skin

Lori: What percentage of those who have the RNY surgery experience hair loss, post-op?

Dr. Pehrsson: Lori, about 50%, however it reverses after all weight loss stops

Mary: I am 5ft 2in and weigh 210, I suffer from asthma. How would I know if I qualify?

Dr. Pehrsson: Mary, your BMI is 38.2 with one co-morbidity...so it is unlikely you will qualify, usually insurance companies will want you to have 2 significant co-morbidities if your BMI is between 35 and 39

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

Dr. Pehrsson: thank you for your questions....I wish you all good luck on your weight loss journey...please feel free to visit our website at www.cbgsa.net or www.calbariatrics.com Thanks again

moderator: This concludes our chat for today. Thank you all for coming into today’s chat room. We are so very pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Dr. Pehrsson for your informative and insightful answers. Please join our next chat on June 1, 2006. Good Night and thank you once again.

Tracy Owens, RN, BSN
Director of Program Development

Tracy is the Program Director of the Wittgrove Bariatric Center at Scripps Memorial Hospital, La Jolla, California . She has been working as a bariatric program director since 1987. Her responsibilities include oversight of the program, patient education, preoperative and postoperative education, and support – group facilitation. She has taught both national and internationally to Allied Health and surgeons on the multidisciplinary approach to patient care. Tracy is the immediate past Chair of the Allied Health Section of the ASBS, has presented at the annual ASBS meeting, and is course director of the ASBS Allied Health Essentials curriculum. She also sits on the governing board of the Centers of Excellence.

moderator: Welcome to our live chat

Brenda-: After having surgery, losing weight & keeping it off for 20 years, after being diagnosed with depression, regaining many of the lost pounds, Is there any way to get back on track and lose the weight again?

tracy_owens: Brenda, although I am not sure as to what procedure you have had, you still have a very powerful tool in weight management. First, access your current daily routine from long term data and research, we know that the following guidlines help with weight loss and maintenance. #1- 8 glasses of water a day. #2 - protein first. #3 - no snacking. #4 - exercise 30 minutes each day. #5 - Make sure you are taking your prescribed vitamins. I would also suggest you return to support group. Good luck.

marthapentland: Why does the grehlin hormone go away and then return again after some time has passed after surgery?

tracy_owens: Martha, Grehlin hormone is in the stomach but seems to be more concentrated in the distall (bottom) portion of the stomach. After bariatric procedures it is not uncommon to have little or no appetite for some period of time. There are numerous reasons for this, however; grehlin is probably not one of them. There is a decreased amount of grehlin hormone that is active after bariatric surgery especially with gastric bypass because of the defunctionalized stomach. Some appetite return is natural after any bariatric procedure at varied periods of time.

Deb: I had gastric bypass RNY in Aug of 05. I weighed 293 and am currently down to 173. How long do you recommend waiting until consulting with a plastic surgeon. I think I'm going to have to have something done with my thighs. I got Guillian Barre about 3 1/2 months after surgery and lost all of the nerves and muscles in my quads and am learning to walk again and my legs look horrible to me.

tracy_owens: Deb, Congratulations on your success! Most plastic surgeons want you to have stabilized weight loss for at least 6 months. You are not quite one year post op so most likely are still losing weight. It is best to allow your weight loss to run its natural course post operatively. In the meantime, exercising to maximize your muscle mass and adequate amount of protein will give you the best results. It may be helpful to consult with a physical therapist do to your medical history of Guillian Barre. Best of luck to you.

Margaret: What percentage of gastric bypass patients regain 20 or more pounds of their weight back? When is the honeymoon over?

tracy_owens: Margaret, Weight gain after gastric bypass or any bariatric procedure is very individual from patient to patient. Some weight gain at 2-3 years post op is not abnormal (7-10 pounds). However; if you are not following the recommended post operative guidelines of nutrition (adequate protein intake and no snacking as well as adequate water intake) and not exercising regularly you most likely will regain weight just like most individuals who have had surgery or not. The first 12 months following bariatric surgery is the "golden opportunity" to take on new healthy habits so they become a lifestyle. Remember, morbid obesity is a disease in which we have no cure for only a powerful tool - surgery.

Helen: hi ... i went today for my 1 month post op appointment .. I have lost 30 lbs.. a man was there who had the surgery about 1 week before me .. he has lost over 50 lbs... so men DO lose faster than women.. or maybe he's doing something More than I am ... I am happy with the 30lbs in 4 weeks..... I just hope it keeps coming off.. seems like in the last week or so it has slowed down a bit...........I know water is important ..so reading your answer to the above question , I think I need to drink more water

tracy_owens: Helen, First and foremost, don't compare your results with other individuals for numerous reasons. Males have more muscle mass and tend to lose more quickly. Also, we need to look at excess body weight not just overall weight. This is why we measure BMI "Body Mass Index" which takes into account an individuals height and weight. In other words, being 6' 2'' and weighing 190lbs is not overweight, but being 5' 4'' 190lbs is overweight. You may have lost the exact or more excess body weight than the gentleman you were comparing yourself to.

Dawn: Hi I am having surgery on 5/17 and was told to take my BP meds. I am confused because I have to eat or drink milk with it. Is it ok??

tracy_owens: Dawn, It is always best to keep your blood pressure and any other co-morbidity well controlled prior to surgery so you are in the best condition for a healthy recovery. Taking your medication as directed by your doctor is OK. Best of luck with your surgery. I'll be thinking about you.

RobinOC: Hi Tracy, What do soda's do to the GBS patient?

tracy_owens: Robin, Regular sodas are loaded with calories and sugar and most likely will cause you an awful dumping episode. Diet sodas commonly are loaded with caffeine which can act as a diuretic, therefore; making it harder to be compliant with your necessary water intake. There have been numerous studies that lead us to believe that the chemical makeup in diet sodas actually stimulate appetite.

connie: Are there any other alternatives or suggestions you could recommend for someone who has been turned down by insurance reasons for the Gastric Bypass Surgery? I am 298lbs and 5'9. I am considered morbidly obese but have no known health problems. The only thing that troubles me is a regular exercise routine, I have a rare arthritic condition that makes it difficult to exercise regularly.

tracy_owens: Connie, Your body mass index is 44 which qualifies you for bariatric surgery based on BMI alone. It would be best to know why your insurance denied you. Reviewing your insurance policy in the employers manual will educate you as to if bariatric surgery is a covered benefit and what options you have for appeal. You can always contact your company’s benefits office to gain more insight as to what your options are after denial. Good luck.

RobinOC: Is Guillian Barre a side effect of surgery?

tracy_owens: Robin, Most likely Guillian Barre is not a side affect of bariatric surgery.

Marthapentland: Why does our sensitivity to sugar go away? Why does the ghrlen hormone go "dormant" right after surgery?

tracy_owens: Martha, Peoples decrease insensitivity varies from individual to individual. It seems to be that the more you "test the waters" with sugar the more likely you are to become desensitized. Remember, sugar stimulates appetite and works against the bariatric surgical tool. Ghrelin hormone sensitivity most likely varies from procedure to procedure.

sighbrella: Hi Tracy, I want and need GBS and am required to be followed by a dietician for 6 months. WHY? Thanks!

tracy_owens: Sighbrella, I do not believe that a mandated diet benefits the patient. Most people who suffer from morbid obesity have been on diets for years. We know from research that MO suffers do not respond successfully to diets. I believe that this is an unfortunate requirement. The best thing to do is get on a medical supervised diet as quickly as you can as you prepare for surgery. Don't lose hope.

sheila: I am having a hard time finding a surgeon anywhere near my area. If I do find one eventually through lite and hope, how do I know they are "reputable". I am so terrified to have this surgery done, but really feel that it is the best thing for me. I am in Ontario, Canada by the way and the closest to me would be Michigan I guess...

tracy_owens: Sheila, I understand and respect your anxiety regarding bariatric surgery. However; there is greater risk in remaining morbidly obese than there is in undergoing bariatric surgery in a well-trained, experienced multi-disciplinary team. It is best to chose a surgeon that is very experienced, who has a multi-disciplinary team in place as well as good data and outcomes. Lite and Hope is a great way to look for a surgeon because they have a process of accessing their referral of surgeons to insure that they are experienced. I believe that they don't list surgeons outside the country so if you put in zip codes from Ohio (45342) and Illinois (60061) you will find surgeons who meet experienced criteria.

connie: I was turned down from the surgery due to the insurance policy (they do not approve nor pay for this type of surgery - it is a private insurance company). Now that I am limited in my options, I would like to know if there are any other alternatives/suggestions in losing my extra weight considering my circumstances?

tracy_owens: Connie, I am sorry to hear you have been turned down for bariatric surgery. It may be beneficial to speak to the director of benefits since it is a private insurance company they can make exceptions. If that fails, it is always best to try to lose weight. The best way is to find a doctor who offers a multi-disciplinary approach that includes nutrition, exercise and support group. Diets are commonly not successful long term for patients who suffer from morbid obesity. You may have the option to change insurance during open enrollment or to pay cash. Best of luck.

Loretta: How long should one expect to be off of work after lapro. bypass surgery?

tracy_owens: Loretta, Ultimately it is up to your surgeon and you as to when you return to work. Generally, most patients who are in a low to moderate activity job can return to work within 2-3 weeks. This is dependent on numerous conditions from how overweight you are, your age, and individual recovery. When you get home from the hospital, it is best to walk and build your stamina daily. Sometimes, you will only know after surgery when you feel ready to return.

Denver: I want to have the surgery, but only have medicare as insurance, Is there help for me in getting this surgery?

tracy_owens: Denver, Good news, Medicare does cover bariatric surgery including gastric bypass, lapband and DS. They do however insist that medicare patients have surgery at bariatric programs that have been designated as a Center Of Excellence by the SRC or ACS. You can call these accrediting agencies for a list of COE programs or look at their website..surgicalreview.org

moderator: Tracy is there any last words you would like to say.

tracy_owens: Thank you for all who have logged on for this chat. Please feel free to look at our website for general information about morbid obesity and bariatric surgery at www.lapbypass.com Or you may also go to ASBS.org for more information from our surgical society. To your health with love, Tracy.

moderator: This concludes our chat for today. Thank you all for coming into today’s chat room. We are so very pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Tracy Owens for your informative and insightful answers. Please join our next chat with Dr. Bengt F. Pehrsson, May 15, 2006. Good Night and thank you once again.

moderator: Please note that we did not have time to answer all of your questions. This is only an hour chat. Please sign on again on MAY 15 with your same questions that did not get answered and we hope to answer them at that time. Again, Thank you all for participating in today's chat.

Dr. Titus D. Duncan is a 1978 graduate of the University of Oklahoma School of Medicine. He completed his residency at Georgia Baptist Medical Center. Dr. Duncan has practiced general surgery since 1983 and is affiliated with Atlanta Medical Center, Emory Crawford Long Hospital and Piedmont Hospital. He is a board certified surgeon and Fellow of the American College of Surgeons, He is the Director of Minimally Invasive & Bariatric Surgery at Atlanta Medical Center and Morehouse School of Medicine.
Dr, Duncan is the founder of Peachtree Surgical &. Bariatrics Associates, P.C. located in downtown Atlanta. He is a Health News Reporter and expert Fox WAGA Channel 5 “Good Day Atlanta”

moderator: Welcome to our live chat

anna: I am from Mexico. Everyone in my family, especially the women are all very large. I think that because we all love our traditional food, we all have this problem. If I have the surgery (I am over 125 pounds overweight and just 17 years old) will I ever be able to eat our traditional foods again.......this would be a very big problem for me because my mother is very proud of her cooking ability and would be hurt if I did not eat the foods that she lovingly prepares. HELP!!

Dr. Duncan: you will be able to eat some of your traditional foods(depending on what they are) but simply in much smaller amounts. Some foods may cause problems such as sweets and spicy foods

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

Dr. Duncan: Kelli: No this operation doesn't cure type 1 diabetes. I have had some patients where it has improved their condition.

judyjude: I was wondering how do you know if you are obese

Dr. Duncan: Obesity is an excess of body fat. We use the BMI tool as an indicator. If your bmi is > 30, you are considered to be obese

helen: I had my surgery April 3rd... went back 8 days later to have staples taken out & a check --up .. I had lost 16lbs............... OK today is 6 days later & I haven’t lost any more weight... is that normal or could I be doing something wrong ?

Dr. Duncan: Helen this is completely normal. Most of the weight you've lost so far is water weight. You will now begin to lose fat as you continue your post-op course. Congratulations!

Sheila_in_Canada: I am having a hard time finding a surgeon in Canada - I am so scared if this is the right thing for me - do I eat normally after awhile. I wanted to know about malnutrition, how do I avoid losing hair, becoming dehydrated etc.

Dr. Duncan: Sheila you will be able to eat normally just much much smaller amounts, and that's the key. there are some things that just doesn't agree with a small pouch, ie carbonated beverages, sweets, some spicy foods etc. Just use this as a tool to help you to learn healthy eating habits and you'll be fine. . Try to take in an increase number of your calories as protein. This will slow your hair loss. Malnutrition is very unlikely, however, it's extremely important to take your vitamins for the rest of your life. To avoid dehydration, simply carry a "sippey" bottle of water with you everywhere you go and simply sip water all throughout the day, even when you're not thirsty.

trudy: how much do I need to expect to pay for this

Dr. Duncan: Trudy, that varies depending on your geographic location and the type of procedure. Here in Georgia if you're paying out of pocket for the bypass, you can expect to pay total cost of $18-20,000.00. The lap band is a little cheaper at around $15 - $16,000

joanne: I got my surgery approval today and am so excited for my future, but also nervous. I am currently on a cpap machine. Will this in any way affect my staples?

Dr. Duncan: No this usually doesn't make a difference. Some surgeons are a little afraid that the increased pressure from the cpap may increase the chance of a leak. But so far that has not been demonstrated in our literature. If you need the cpap post-op by all means use it.

Yvonne_-: I suffer from acute depression. I have been told that often times post surgical patients suffer from depression from the surgery.....the last thing I need is more depression...what should I do?

Dr. Duncan: Yvonne, going through such a major surgery can be tough for anybody, so this is not unusual. If you have a buddy in your support group, that always helps. You might want to ask your psychologist for his suggestions of a few things you should do to keep you from becoming depressed. But what has seemed to work for most of my patients is simply keeping their minds focused on losing the weight, doing everything exactly as they've been directed and beginning their exercise program. do all of that an you won't have time to be depressed

karolkris: I just completed my upper GI ultrasound pre testing and was told by that doctor that I have a small hietal hernia but showed little sign of GERD ....does this condition pose any problems with going forward with my election of LAP RNY?

Dr. Duncan: Karolkris, this is not a problem at all. If the surgeon feels that the hernia is large enough, he/she will repair it at the time of surgery.

Dawn: Hi Dr. Duncan, was just wondering if you could suggest some good protein drinks

Dr. Duncan: Dawn, as you might expect there are 100's out there. I personally use a product called myoplex low carb. Sylvester Stallone has a new product out that has high protein and very few carbs. What's cool is that he even has a great tasting high protein pudding. I even use it myself. The point is to make sure to get in high protein and attempt to keep the carbs to a minimum.

debbie: My doctor told me that if I went with the lap band, I'd have to have it adjusted before every airplane flight. But I can't find any more information about this. Is it true?

Dr. Duncan: Debbie, that's a new one on me. I have many patients who fly to have their bands adjusted by me and they've not had problems. I'm sure the issue is the pressurization phenomenon. But in today's planes that's usually not a problem at all. Your ears may still "pop" a little, but I'm sure the band will do just fine.

bonnieB: I have been heavy my entire life, 44 years. I have had NO health problems even though I weigh over 275 pounds and my height is 4 foot 11. Could it be that the surgery is just not necessary for me as I do not have any health problems? I do not desire to have a social life as my work as a librarian gives me all that I want out of life. My parents keep bugging me to have the surgery but I just don't think it is necessary for me........my parents will be participating in the chat tonight and I want to once and for all get them off my back, assuming you agree with my feelings.

Dr. Duncan: BonnieB, I agree. This surgery is an elective operation and only for those people who are in the mindset that it will help them improve the overall quality of their lives. Although you have no health problems, the question is how is your "quality of life." If you feel that it's fine, then the surgery may not be for you. However, with that said, as we age, things tend to change. And things that were once never a problem, all of a sudden become an issue. Diabetes for instance... many patients don't have it now, but as their pancreas tires, it becomes a problem in the future and maybe even at a time when they may be at increased risk for the surgery

nurseDebb: 3 months after having surgery I came down with severe Guillian Barre like symptoms. Have you had any patients have trouble with neurological issues after surgery?

Dr. Duncan: nurseDebb: yes I absolutely have. I've not personally seen it within the period of time you mentioned, but many of my patients who simply stop taking their vitamins will get problems with nutrient deficiencies. A common one is thiamine and B 12 deficiency, both of which can present with neurological symptoms. If this occurs, have all of your levels checked to make sure you are getting the proper amounts of phytonutrients your body needs.

JOANNE: I was wondering if it is good to stay away from bread, as it tends to "gum up" and get stuck. What other carbs should we avoided.

Dr. Duncan: JOANNE: yes I think it's prudent that you stay away from these type of carbohydrates. As you mention, they get stuck and if it's not whole wheat bread, then it tends to raise your insulin levels (not good). Unfortunately, many of the pastas are things that I would suggest you avoid, i.e. spaghetti, macaroni and cheese, etc Those things go down easier but will make your quest for long term fat loss harder

angelofhope: I'm wondering if you yourself or know of any other Doctor's that may do for charity cases.For people who just can not afford the gastric bypass surgery?

Dr. Duncan: Hello angelofhope; we actually perform charity cases. To be perfectly honest, our hospital only allows us to do only a few per year. Each case is looked at with regard to need, previous attempts at weight loss and commitment to the program. Several doctors around the country also offer similar programs; it takes some research, but they're out there

Sheila_in_Canada: If I can't find a surgeon in my area - which I can't, how do I know if they are reputable from the internet - should I only go by Lite and Hope? Michigan would be my next closest area...I have found surgeons from Lite and Hope for Michigan, how do I know they're "good" Sorry, I'm so ready but also freaked out!!! I have a million questions!!!

moderator: http://liteandhope.com/criteria.html

Dr. Duncan: Sheila ; please see the above link that details the criteria that LiteandHope mandates from their participating physicians

moderator: Trudy, your same question was already answered by Dr. Duncan. If you missed it, you will be able to go to www.liteandhope.com in the next couple of days and see an archived version of this live chat. Thank you.
.
Christy: I am having my surgery in a couple of months. I am 5'2" and weigh 233. How much weight can I expect to lose the first month and then subsequent months?

Dr. Duncan: Christy; the amount of weight you lose totally depends on several factors. But usually the 1st month after surgery you can probably expect to lose anywhere from 15 - 25 lbs. Unfortunately, not all of that lost weight is fat. But once you begin your post-op regimen including exercise and small frequent high protein meals, you can probably continue to see "fat loss" of up to 10 - 20lbs per month for the first 6 months

judyjude: i am 5'6 and weighs 240 is that obese or what

Dr. Duncan: judyjude; go to peachtreebariatrics.com that's my website and click on the bmi calculator. Put those same numbers in and see what it says. If the bmi is greater than 30, that's considered obese. Greater than 40, that's what we consider morbidly obese

sandee481: Dr. Duncan, I will be having Lap Band Surgery but I have a problem with chronic pain which I take presc. meds. for, the problem is the meds. Are extremely weight gaining but I've tried so many others and this is the only one that helps my pain. I'm afraid that once I have the surgery, will I still be able to lose weight while on these meds and not able to exercise, at least not at this time?

Dr. Duncan: Sandee481, it’s extremely difficult to lose weight and perform some form of exercise. Let me retract for a minute. You will lose weight, but without exercise a lot of the weight loss will be muscle mass. That's extremely bad. Once you lose muscle, your metabolism slows; the fat loss slows then stops. There are many forms of exercise that you can perform in your situation. My favorite is water aerobics. It provides resistance and aerobic activity. If there's a will.... there definitely is a way!

Jeannie: What foods other than protein shakes and liquids can be taken in the first month after surgery, baby protein foods or what?

Dr. Duncan: Jeannie; you can probably take in most high protein foods that have very little solid content. We try to make sure that we're not stressing the anastomosis too soon, and therefore keep you on liquids and high protein soft foods within the 1st 4 - 6 weeks following surgery. Yes, baby protein food is just fine. But again, try not to take in too many heavy solid protein foods during this "healing time".

roni: I'm going through the pre surgery process for g-by-pass but have run into a snafu by a recent biopsy for a possible lentigo maligna in the vaginal area. Once this is taken care of, how soon after can I safely schedule my surgery. I have other medical problems but basically feel good and heal well.

Dr. Duncan: roni: Once this problem is under complete control as per all of your consultants, I don't see any contraindication to the surgery. Make sure that your oncologist knows that you're about to undergo this type of surgery for his or her input. I think you should be fine.

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

Dr. Duncan: This surgery has done wonders for so many people that have suffered from the disease of "morbid obesity." We've been able to give so many people a quality of life that they've been deprived for so long. There are risks to this surgery and it should be considered very very carefully before proceeding. But, I strongly feel that the lives we changed have verified that this disease can be conquered. Good luck, but more importantly, "good health" to you all.....thanks

moderator: This concludes our chat for today. Thank you for coming into today’s chat room. We are so very pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Dr. Duncan for your informative and insightful answers. Please join our next chat on May 1, 2006. Good night and thank you once again

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

Welcome to our live chat!

moderator: Hello and Welcome. Feel free to ask your question now and we will keep them in the order that they are received. Thank You.

Carnie: Hello everyone! Welcome to this chat

missy: How does the Gastric Bypass make you lose weight?

Carnie: Missy, the gastric bypass is a procedure that limits the amount of food you can eat and with a combination of the right foods, water and exercise, you will lose a lot of weight!

toni_marie-: Carnie, you are my inspiration. I have followed you from day one. I am 4 months post-op. I am 4'10'', and I weighed 205 on the day of my GPS. I now weigh 140, and have been at that weight for the past three weeks. Is it normal to reach this stage of not losing any more weight? I am 60 years old and work a full time and a part time job. I eat my protein, and take all my meds/vitamins daily. I can't seem to go any lower. What am I doing wrong?

Carnie: toni_marie...first of all congrats on your surgery!

Carnie: everyone, please be patient with me, I am at home typing myself for this chat and it might take a minute or two for answers.... Toni_marie, congrats to you.... you might want to increase your water and exercise. usually plateaus are a result of lack of water and exercise. It’s totally normal, it will pass. DRINK WATER. Do this for one week and see if you come down a couple of pounds!

missy: Hello I would like to know what to expect for my first consultation. I am having surgery on the 5th of April

Carnie: missy... your first consultation will probably be a ton of medical questions and weighing you.... getting your BMI (body mass index) and important medical history. You will get a feeling for your surgeon and his/her staff program and how they run. it's kinda scary, but FUN! make it positive and ask a lot of questions, even if you think they are stupid... they're NOT.

valerie-: My surgery was Oct 4, 2005. I still cannot eat eggs they make me very sick to my stomach, is this normal?

Carnie: valerie.... after having GB surgery, you take the risk of having certain foods not agreeing with you anymore. This usually is higher fatty foods and sugars (when you eat too much at one time). but , sometimes you might eat something in the first two years that doesn't work or makes you feel dumpy and then the next year you CAN eat that food. it's strange... things change over time. Tolerance and reactions to foods.

Sheila: How did the surgery affect your nutrition - did you need to take supplements so not to become malnourished and lose hair?

Carnie: After weight loss surgery... all of them..... there are different kinds... you need to take vitamins to ensure you are getting enough. Your body does not absorb all the nutrients from food so it is crucial to make this a part of your every day routine. Hair loss comes from Anesthesia lack of protein.... it might happen 3 months after surgery and then take 3-6 months to grow it back. Take hair vitamins and eat LOTS of protein FROM the START. This helps.

Sheryl_: I had a gastric bypass on February 20th. THe only real side effect I have is a very dry mouth. Pharmacist says might be the calcium. Also, how long is the scar sensitive. I had an open procedure.

Carnie: Sheryl... good for you! Well, dry mouth is common for a while. You need to be sipping water ALL DAY LONG. This helps with that. Don’t chew gum because it encourages snacking (believe it or not!)... make sure you do take the right vitamins. I took (from the start) a multi, calcium (from calcium CITRATE... NOT CARBONATE), iron and B-12 sublingual (under the tongue)... dry mouth will go away. Not everyone has it , either.

Desiree: I know it is common to hit a plateau, but how long does it last and what can I do go get around it?

Carnie: Desiree.... you are going to hear me say this a lot. It's funny, it seems like a lot of my answers will be DRINK MORE WATER. LOL. Here's the truth, folks. Listen carefully..... we PEE out our fat. We don't sweat or poop it out. It comes out in our urine. SO...... we need to drink at LEAST 64 or MORE ounces of water every single day. Pain in the you know what, but it helps and it works. A plateau can last a week. In your first year out of surgery, you will hit 3 or four of them. That is your cue to take a look at what you are doing. FOUR RULES people: Protein first at meals, 64 oz. or more water every day, no snacking and if you have to PROTEIN ONLY, regular exercise (like at least 3 days a week... mo

Noahs_mom: How does a patient judge whether or not she is dehydrated in the 1st few weeks after surgery?

Carnie: Noah's_mom... people who have the gastric bypass can easily become dehydrated. That is why you need to SIP water all day long. Who cares if you're peeing every half hour! Your body needs the water. Sometimes protein shakes can help with water, vitamins and protein in general.

Laura: I have a pre op appointment on 22 May, pending my insurance approval, I should be in surgery two weeks after. My hospital stay is worrying me. I will have open RNY. What advice do you have to a quick recovery while in the hospital?

Carnie: before I answer you Laura, I need to comment more about dehydration... you will feel extremely tired. You won't feel good. You might have very dry lips and a sticky mouth. You won't be peeing very much. Now to answer Laura: Good luck to you! Believe me, no one likes surgery, no one and me likes to be in a hospital. This is where you have to be patient and concentrate on healing while you are there. You'll have some discomfort for two days and then every day will get easier. Listen to your nurses.... they know what they are talking about and to make you heal faster. Just understand that your body will be going through a lot. Have family and loved ones visit you. Take a shower as soon as you are able to

Bobbi: It has been 2 years since my surgery and I lost 170lbs. I have gained weight, 20 pounds! And I'm so scared! How do I stop the gain???

Carnie: Bobbi... this is a good question. You SHOULD be scared. I bet you are reverting to some old habits. Snacking between meals. Not exercising. ALCOHOL. Not enough water. You need to first feel so proud of yourself for your weight loss. You've lost so much weight and that is incredible! DO not beat yourself up because it will lead you to make poor decisions. Are you in therapy? Do you go to regular support group meetings? You need to start being accountable for your actions, now. It's all about calories in versus calories out. Are you burning more than you are taking in. This is how we lose that weight. I know what it's like to gain 20 pounds back. It's so scary. But you can get back with it. Follow the five rules I mentioned earlier and you should start to see your weight come down again. GO to regular support groups!!!!!!!!

Payneful4: Carnie...did you ever have problems with a stricture? I have one now and it scares me a bit.

Carnie: Payneful4... sorry you have a stricture. Just to let everyone know... a stricture is scar tissue that has formed in your opening to your tummy. It makes it very difficult to eat even drink! If you have one, you MUST consult your surgeon. It’s not uncommon, and might require some minor surgery. The few people I know who have had one had it corrected and then everything became easier after. Watch out for dehydration..... very easy if you have a stricture. Good luck.... go see that surgeon! :)

LisaMarie: what is the real deal with the calcium? Is it necessary to take citrate over carbonate? Can you explain why. I understand that citrate is acid based, but if we took carbonate with a glass of oj would that be ok?

Carnie: LisaMarie,... We do not absorb calcium form carbonate. TUMS will not cut it, people. There is more of a medical answer about this than I can give you... but I don't ask questions, I just know that I am taking from citrate because I know I have to! . OJ will make you dump. Don't drink juice (even if you don't dump). It's not a good habit to get into. Vitamin C is good to take with your iron. It helps to absorb it. REMEMBER... do NOT take iron and calcium at the same time... they cancel each other out!

Desiree: Miss - congrats on having a surgery date. The first question I had for my surgeon was when do I get to go on roller coasters. They have been asked everything under the sun. Start writing down the questions as you think about something. That saved me from worrying too much.

Robin: Are there other proteins besides meats that one can eat after surgery. I don't eat meat very often.

Bobbi: good question, Robin!

Carnie: Robin... yes there are other forms of protein. EGGS< COTTAGE CHEESE, BEANS, TOFU. FISH. I ate a lot of the same foods the first year and a half after surgery because I was comfortable with them. Try new things and see what works for you and then stick with them. Try to get your meat in, though. it is really the best form of solid bulk protein!

Theresa: Around my area most of the doctors that perform gastric bypass are non-participating doctors with insurance companies. I have an out-of-network provision in my plan but when I called to find out what their usual customary payment would be they would not tell me. How do I find out what their contribution would be before I commit to surgery?

Carnie: Theresa... doctors have different ways of doing things. If a surgeon near you doesn't have what you want.... you need to keep looking for one that DOES: A Lite and Hope doctor is the best. Try to find one in your area. It’s worth traveling for. It's for your LIFE!!!! :)

moderator: Bobbi...We only have 1 hour with Carnie and we are trying to be fair to everyone. I cannot take any more questions from you. Please understand and thank you for your previous questions.

JEN: Hi, Carnie !You have been an inspiration to so many people and I want to thank you for being such an active advocate! I haven't had the surgery yet, but am in the process of getting approved. How does one know if the weight they are losing is fat or muscle? Also, when should I start taking these vitamins and supplements?

Carnie: Jen... thank you very much!!! I wish you nothing but success! One will lose muscle while losing fat... you can't help that. The number one most important thing you can do to save your muscle while losing weight (and losing weight rapidly) is EXERCISE. Cardio and weights. Great combo.... you'll see results. Get a body composition test. you can keep good track of your lean body mass that way!!!!! GO GIRL! :)

Sandi: Hi Carnie! I'm really looking forward to your new album!! What ever happened to your other solo album, For the First Time? And will we ever get an album of original material from Wilson Phillips?

Carnie: Sandi.. Thank you! I love my new album.. "A Mother's Gift.. Lullabies From The Heart"... it was so wonderful to make. I did it for my daughter Lola. She's now 11 months! :) My other CD will probably not come out. I didn't even finish it. I went straight into Wilson Phillips, then pregnancy, then this CD. I am happy to have made this music. It's not cheesy, it's beautiful. I hope you like it as much as I do! Thank you in advance for buying it! It comes out May 2nd!!

robinfromoc: Carnie, I've trailed your success since your surgery 7 years ago. It’s taken me a long time to get to this point and like you, I've finally realized that enough is enough and will be having the surgery this summer. I'm nervous that I will miss food terribly. Do you miss food terribly now or have you adjusted well to what your new system allows?

Carnie: robinfromoc... good for you! People are ready when they are ready, you know? Only you will know this. People shouldn't be forced into it. Yes, I do miss eating certain foods... but it's more like I miss pigging out sometimes..... When I want the whole damn brownie and not just a bite. it can be hard. But then I ask myself: would I rather be morbidly obese and in the physical condition I was in before surgery? NO FRICKIN" WAY. It's not worth it. Food has become less of a focus for me. Don't get me wrong... I love to eat ... I wrote a darn cookbook!! I now have some self-control, which feels much better than giving in and pigging out for the MILLIONTH time in my life. The empowering feeling I have had for the last 7 years to beat this disease is the best thing ever (besides having Lola... :))

LisaMarie: OK this is not a question, I want to thank Carnie for her support and inspiration. If there were an email to reach you I would love to have it. You are someone who I would love to have for support. You were beautiful before surgery and you are beautiful now. Congrats on the baby I am sure you are a wonderful mother. Also loved your book. I had my surgery on Halloween 2005 and I have lost 70 pounds so far. Thank you again!

Kellie_Harris: Hello Carnie, I think its great how you are so open about this & how you try to help people. A family member just had It done and he is doing great. Now myself and another family member would like to get it done but we are also having trouble finding an insurance company.

Carnie: Kellie... it has been a big challenge for me to keep the weight off from 3 years post op. I find that everyone gains back some and then struggles to get that off. Here's the deal: You are so much better off than before. I lost 155. I gained 18 back. Then I got pregnant. I gained 70 pounds with Lola. WOW. Not happy about that. Made some good AND bad decisions while I was pregnant. I learned a big lesson. I have lost 60 of those pounds this last year! It is getting easier. I am into a routine now and I have been really working out hard with my trainer. Cardio and weights. My body is looking better. I will get to my goal of 150 by August! I can do it! I weigh 180 and I am not ashamed. I weighed 3

moderator: That was our last question for the evening. Thank you all for your questions. Carnie is there anything you would like to add?

Payneful4: Hi missy!

Laura: Thank you very much Carnie....this has helped me so much in knowing what to expect after my surgery.

LisaMarie: JUST THANK YOU SO MUCH CARNIE

tntreeher_: HAS IT BEEN EASY FOR YOU TO KEEP THE WEIGHT OFF AND AT TIMES DO YOU STILL FEEL FAT

Carnie: I weighed 300 pounds! No one is perfect! I do the very best I can I watch out for emotional and stress eating. I am proud of myself and if someone says a negative thing about me and my weight loss/gain/loss WHATEVER..... well... they're just unhappy with themselves. I am blessed and i also create my own blessings ... WE ALL CAN... so, with that thought I wil say to you all that I believe that we can make huge changes in our lives without being too scared. We have to work hard at it. This surgery and everything associated with it is NOT easy. I don’t' care what anyone says. People who haven't struggled with weight have NO clue. And then there are people who do struggle and have NO CLUE... LOL. It's a

moderator: This concludes our Live Chat. Thank you for participating in tonight's chat with Carnie. Of course, many of the questions did not get answered due to the limited time available. Many of your questions may have already been answered in other chats so we invite you to go to our archived chats as a resource. We are also delighted to announce that Carnie's new CD that will be released on May 2, 2006 will be available for purchase in our LITE AND HOPE Boutique ..........please click on to our BOUTIQUE for details. Also, we are also proud to announce that we can offer to all one-year post patients that ability to apply for Life Insurance at reasonable rates. Carnie just got one of these policies issued by PRUDENTIAL.

moderator: Carnie needs to finish up with a couple more lines

Carnie:....It's all up to you as an individual. You make your own decisions. Just know that you deserve to be healthy and whatever it takes, you can get there. Believe what you see and see what you believe. Thank you for participating and I love you all. Byeeeee!!!!!!

Robin: thank you for taking the time to chat with us and for some more insight on Gastric Bypass Surgery

robinfromoc: Thanks Carnie! I'll be having it done with Dr. Wittgrove in July so maybe I'll see you in the future at one of his functions! I dream of having a baby myself someday! Thanks for always sharing your life with us. It has meant so much to so many!!!!

Payneful4: I also wanted to thank you for your documentary of the surgery and pre op procedures. It was as if you walked me through the whole process. Your commitment to helping people beat this disease deserves applause. Thank you Carnie

moderator: Please Note: To all...This is a moderated chat, which means that people cannot talk out of turn. The questions come in one at a time and we take them in that order. Some of you submit things that are not questions and we try to include them in this live chat. We apologize for any inconvenience this may have caused anyone. Thank you again for coming.

Sheryl_: the insight you have given is invaluable. I hope you do another session soon

moderator: This concludes our chat for today. Thank you all for your participation in today's Live Chat. We are so very pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Carnie for your informative and insightful answers. Also, please make sure you have joined as a member of Lite and Hope at www.liteandhope.com. We will send out emails for any upcoming news or events. Our next Live Chat will be on April 17th, 2006. Good night and thank you.

Carson-Tahoe Hospital Medical-Surgical Weight Loss Center
Carson City, NV 89703

Dr. Lee D. Trotter was born and raised in Southern California. He graduated from Brigham Young University in 1984. He then attended Western University of Health Sciences earning his medical degree, graduating in the top ten of his class. Dr. Trotter served as Medical Director of a regional trauma center, life flight system and surgical intensive care unit. He is a board-certified surgeon and a member of the American Society for Bariatric Surgery. He has earned a reputation as a nationally recognized speaker on advanced laparoscopic techniques.

Welcome to our live chat!

moderator: Hello and Welcome. Our chat will begin in approx. 30 minutes. Feel free to ask your question now and we will keep them in the order that they are received. Thank You.

dawn: when I contacted my insurance and asked them about how long it takes for approval from them they said about 5 days unless they turn it over to a doctor. Why would they do that if a doctor is requesting to do the surgery. Is that unusual??

Dr. Trotter: Dawn: This is not unusual; the Dr. the insurance company is referring to is their own physician reviewer. Your personal physician will submit their findings to the insurance company for review. 5 days is actually quite fast for an insurance company.

tifini: I would like to know if anyone accepts medi-cal or iehp insurance plans for gbs? I am about 120lbs overweight.

Dr. Trotter: Tifini: Each physician's office will accept specific payor types. You will have to call Bariatric surgeons in your area and ask if they accept your insurance.

Donna: Dear Doctor and group... I did have my gastric bypass over 3 years ago After my surgery I had a bleed out two days later and almost died Then this past July of 05 I again had a bleed out this time I was vomiting blood. Now Thanks to a doctor who does gastro work not bypass but he was the one checking to see if my bleeding had stopped ...luckily I was in the procedure longer than expected and I was somewhat awake and I did hear the doctors state that Who ever did this Gastric Bypass Really #$@#@# up... And with hearing that I tried speak and I heard the docs say oh my she is awake and then I was out again... The findings were true that my bypass surgery was screwed up and has to be repeated. Due to the bile that keeps backing up into my stomach... they did give me a pouch but did not staple off the larger part of the stomach so no I am freaked out... and don't know who to trust with my next surgery and some doctors want me to start all over again even the 8 weeks of dietician crap I just want to find a doctor I can trust who's not going to kill me and finally get my life back... I am in Cincinnati Ohio and do not know who to trust? Sorry I am on my sisters lap top and things keep getting sent and I am not used to how things keep moving on me... I will be home soon but need your help..asap I am willing to go anywhere to find a doctor who will help me my nephews come home from Iraq and my daughter leaves for

Dr. Trotter: Donna: This is a serious issue, you must contact your physician and notify them of this event. Many possibilities exist as to the cause. An ulcer would be high on the list. Do not wait until the next bleeding event to call. If you bleed again go to the ER. The Lite and Hope website has a physician list of highly recommended and skilled surgeons. You need to locate a bariatric surgeon who is comfortable with revision surgery. The type of surgery you may or may not need would be determined after a thorough evaluation. Don't get depressed over this situation; there are many well qualified surgeons who can help you.

Dee: Hi - how will I know if I am eating too much food, one year post op?

Dr. Trotter: Dee: You should never eat more than one cup of solid food at any given meal.

MissSofey: Hi I'am scheduled for 3/31 I've been taking 2 ferrous sulfate and one vitamin c I just had my iron checked and the results are my iron is good but my serum is low is there anything I can do to bring it back up and do you think my surgery will be cancelled?

Dr. Trotter: Miss Sofey, There are many iron blood tests that are required to identify potential iron deficiency problems. If your hemoglobin is normal, I see no reason to cancel your surgery. You will require iron, calcium, and multi vitamins after surgery for the rest of your life.

MissSofey: Thank You Dr. Trotter I have been taking the vitamins for about a month so far, to get in a good habit, Thank You for answering my question

nurseDebb: I had RNY gastric bypass on August 17th, 2005 and in November I got severe peripheral neuropathy with Guillian Barre like symptoms putting me in a wheelchair for 8 weeks. Have you had any of your patients have this happen before?

Dr. Trotter: NurseDebb: Thankfully not. This syndrome is not related to your gastric bypass, however, there are nerve conditions related to thiamin deficiency that can occur after gastric bypass. It is important to have regular follow ups with your physician, and have appropriate blood completed

nurseDebb: thanks Dr. trotter-my physician I was referred to at the Mayo clinic said he did a study on peripheral neuropathy after gastric bypass and 16 percent got some form of neuropathy within 6 years

debbie-: I had vbg in 2002,lost 75lbs in the first 9 - 10 months, then my oldest daughter was told that her cancer was terminal, and with my daughter's passing dec/2004, I have gained back 30lbs. I would like to have a revision to a rny but the doctors here in Canada says there is nothing wrong with my pouch so they will not do it. What can I do to start losing weight I've tried shakes and different diets again but most of my problems is I forget to eat. What can I do to jump start losing weight again??? is it possible to have the pouch made smaller again? or can a doctor down in the states do a revision??? or is it needed???

Dr. Trotter: Debbie: Revision surgery is sometimes required, however, this should be a last resort. The reasons for your weight loss failure need to be identified prior to any surgery. This evaluation should be completed by a qualified bariatric surgeon. Check the Lite and Hope website. For now, get back to the basics. Contact a nutritionist or someone familiar with bariatric patients.

celina-: Is the LAP-Band safe? and which of all the different surgeries is the most effective?... Thank you!

Dr. Trotter: Celina: Yes, the lap band is safe. However, the RNY bypass is the gold standard and is associated with higher weight loss maintained over a longer period of time. All bariatric procedures must be accompanied with dietary and lifestyle changes to be successful.

Robin_B.: I'm having a PROBLEM with vaginal odor. I'm 9 weeks post-op roux-n-y is this normal? Will chlorophyll tablets help? I shower like 3x a day

Dr. Trotter: Robin B.: This would not expect with gastric bypass surgery. Antibiotics can disrupt the normal bacteria in the vaginal area. I suggest visiting with your gynecologist.

mari: I want to start a family soon, but I'm worried that the baby will not get the nutrients it will need and will I gain a lot of weight?

Dr. Trotter: Mari: If you have already had bariatric surgery, it is very important that protein and vitamin supplements are taken. Vitamin levels should be monitored during pregnancy. Remember, NO ONE should become pregnant within the first year to one year and 1/2 after gastric bypass. Weight gain during pregnancy is normal, but should not exceed what is expected with any woman.

DAWN696: Hi, I am going for the lap band procedure. Would you say this is effective as bypass? For instance, I know it is a little more work but would you say I could still lose as much way by having the banding as opposed to the bypass?

Dr. Trotter: Dawn 696: A gastric bypass is the gold standard. The Lap Band can be an effective tool if used properly. The amount of weight loss is in large part up to you. Are you eating properly? Are you exercising? If the answer is yes, then you should do well.

nurseDebb: thanks Dr. trotter-my physician I was referred to at the Mayo clinic said he did a study on peripheral neuropathy after gastric bypass and 16 percent got some form of neuropathy within 6 years

Dr. Trotter: Nurse Debb: I am familiar with their work, this has been thiamin related. We are also identifying an increased frequency of other vitamin deficiencies. A high quality chewable or liquid multi vitamin is mandatory in all bypass patients. Flinstones vitamin are NOT acceptable. Through the Lite and Hope website you can obtain medical grade supplements from Metagenix.

nurseDebb: thanks - I will order them tomorrow

Annabelle: My name is Annabelle and I would like to know your thoughts on 10% weight loss before RNY.........Thank you Annabelle

Dr. Trotter: Annabelle: This is not an unreasonable request. The reason why is it demonstrates your ability to comply with the necessary post operative requirements. Your determination to follow instructions and also to help reduce the size of your liver, so that a laproscopic procedure is technically easier to perform which ultimately is to your benefit

Annabelle: Thank you Dr. Trotter

drunyan: Hi, I was just wondering if you could tell me what to expect once I get an approval.? My paperwork has been submitted and I have seen the Dr., done my phsyc eval and seen the nutritionist. Also do you have any idea how long it usually takes bcbs of calif to do an approval? Thank You

Dr. Trotter: Drunyan: After insurance approval your on easy street. As far as the pre-operative requirements are concerned. Your surgeons office can provide you the hospital details that you will need to know before your surgery date is scheduled. In the meantime, focus on protein intake, and exercise to lose 10 to 15 lbs before surgery. Don't become of the Last Supper Syndrome ie: multiple large meals of things you think you'll never have again.

drunyan: Thank You Dr. Trotter

helen: Why does each vitamin company seem to say that their product is the only one that works for post gbp patients?

Dr. Trotter: Helen: Money... Studies have shown that most supplement companies do not put in the container what is written on the label. You must find a reputable product. I have had difficulties in this area with my patients. I have spent years helping to develop a product specifically for bariatric patients. Metagenics is a company who focuses primarily on the patient. I have never been disappointed with their products, as they meet medical grade standards. Body composition can be performed in the office and provide guidance on your nutrition.

Dee: What should I expect when I choose to become pregnant, concerning nutrition for me and my unborn child?

Dr. Trotter: Dee: You can expect a healthy baby; in fact, studies show that obese women have a higher chance of birth defects than women who are near their ideal weight. With deliberate meal supplementation and the use of high quality vitamins you should do just fine.

Jenn: What do you know about this new ruling about Centers of Excellence? Are all surgeon's offices going to follow suit on this?

Dr. Trotter: Jenn: I believe the Centers of Excellence (COE) is a positive step in helping improve the equality of bariatric care in our country. I do believe that ultimately all surgeons will need to be become a part of the ASBS and participate in a COE. The insurance industry will make it so.

Jenn: Appreciate your answer, have a great night.

Boy_Wonder: I understand your nutrition program has been very successful. What would you recommend for someone 6 mos post-op RNY?

Dr. Trotter: Boy Wonder: At that stage, a highly absorbed protein source is important. That is why Metagenics is used in my office. Their Bariatrx Esssentials formulas as specifically designed for RNY patients. The protein in their products has been specially filtered to remove proteins that are not digested. One meal replacement per day with two other healthy meals (Protein based) should be sufficient. If you are very active, additional protein may be required. Multi vitamins, B-12, Calcium, Iron, are also required. Blood vitamin levels will guide additional requirements.

DAWN696: I have gallstones and have had them for 10 years they only act up once in a while. Will it be necessary to have my gallbladder removed prior to lap band surgery?

Dr. Trotter: Dawn 696: Yes....

DAWN696: Thank you Dr Trotter for answering our questions!

Jenna-: What kind of consistent exercise is best after the surgery to help take off the weight at a good rate? Without taking in a lot of food is exercise even advised?

Dr. Trotter: Jenna: Exercise is always advised and is necessary to be healthy and lose your weight. I would pick an exercise that you enjoy, and one that can be performed no matter what the weather is outside. It's all about developing habits....

carrieonca: How long after the surgery can you expect to be off work?

Dr. Trotter: Carrieonca: It depends on your operation. The laproscopic procedures expect 7-10 days with no strenuous physical activity for 3-4 weeks. The open procedures expect 2-4 weeks with no lifting for 4-5 weeks. The laproscopic approach (by a qualified surgeon) is associated with less complications and quicker recovery

moderator: We have approx. 5 minutes left in this chat. If your question did not get answered, please go to www.liteandhope.com and submit your question for our next chat.

nurseDebb: Is milk allowed after gastric bypass? My physicians all seem to disagree and I don't know what to do. I am taking Citracal + D three times daily for calcium supplementation but I would like to have a little bit of milk when I eat oatmeal occasionally.

Dr. Trotter: Nurse Debb: There is no contraindication to milk after bypass. Some patients will have lactose intolerance that may be exacerbated by gastric bypass. For those patients milk is a bad idea. If you do not have problems with milk you will do fine. In regards to the calcium and vitamin D supplementation, blood levels of these compounds will determine if you absorbing this type of calcium. I am glad to hear that you are not taking Tums. Calcium carbonate is not well absorbed by gastric bypass patients.

nurseDebb: thanks so much for answering my questions-we don't have many physicians with experience in this area here in Nebraska-thanks moderator for your work tonight too!

Janswlfhnd: My daughter had bypass surgery. She had to go back 5 times to have the opening stretched, is this common thing?

Dr. Trotter: Janswlfhnd: This occurs in approximately 3% of patients. With this occurring so many times an underlying cause should be determined beyond "just healing wrong." Medications, ulcers, stitches, bile, and acid are potential causes. Your daughter's surgeon should be involved in the evaluation process.

moderator: Donna, If you would like to get a message to Carnie please send it to info@liteandhope.com. All this info is on our web-site at www.liteandhope.com. Thank you.

theresa_tracy: I am 8 months out and am 139 pounds an still loosing and I am worried

Dr. Trotter: Theresa_Tracy: Your concern should motivate you to concentrate on a diet that will maintain your health and weight within acceptable parameters. There are many potential anatomic problems that may contribute to your eating difficulties. These can be identified by your surgeon. As far as nutrition goes you must take a medical grade product. Remember. NOT all protein is created equal. Just because the label says 30 grams does not mean you will absorb all of this. In fact, most supplements contain protein that a gastric bypass patient can not absorb. You think you are doing well but the protein goes right through you and not IN TO you. Body composition is an important measurement of what type of weight

moderator: Dr. Trotter, Is there anything you would like to add before we end tonight's live chat?

Dr. Trotter: I would like to thank Lite and Hope for their contribution to insuring quality care for Bariatric patients. I have come to find that bariatric surgery is like marriage. Your wedding day (surgery) is very important. However, the work in a successful marriage takes place AFTER the wedding. Your diet is extremely important for each of you to be successful. You will learn to eat properly sooner or later, learn sooner and prevent a lot of heart ache(and body ache). I have found a high quality protein supplement or meal replacement is needed in all patients for life. Remember also, that the scale does not tell the truth all the time. Weight loss should be healthy and is not determined by the scale. It is determined by you and the diligence that you give to that tool. Remember, all protein is created equal; most products contain protein that is not absorbed. Just because the label says 30 grams does not mean you absorbed 30 grams. A medical grade supplement is necessary; www.weightloss.meta-ehealth.com is a site to obtain quality products. Body composition is extremely important. If you lose 20 lbs, ask yourself 20 lbs of what? If this is muscle loss, you are not doing well. You most likely need more protein. Gastric bypass is a wonderful TOOL if used properly. You can be successful, and meet your long term goals. Good luck.. Dr. L. Trotter

moderator: This concludes our chat for today. Thank you all for your participation in today's Live Chat. We are so very pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you again Dr. Trotter for your informative and insightful answers. Also, please make sure you have joined as a member of Lite and Hope at www.liteandhope.com. We will send out emails for any upcoming news or events. Our next Live Chat will be on April 3, 2006. Good night and thank you.

Dr. Leslie McClellan is founder and director of the Mercy Bariatric Wellness Center in Vernon Hills, Illinois. She graduated from The Johns Hopkins University in Baltimore, Maryland and completed her surgical residency at the University of Chicago Hospital. She received her bariatric surgery training from the former president of the American Society of Bariatric Surgeons (ASBS). Dr. McClellan is a member of the American Society of Bariatric Surgeons and a Fellow of the American College of Surgeons.

(Dr. McClellan will by our expert commentator for the live cybercast on our site of a GBP surgery of former USC All American, College Hall of Fame football star Anthony Davis on Saturday, March 11, 2006 at 7:30 AM PST (10:30am Eastern).. Joining Dr McClellan as a co-commentator for this live cybercast will be Carnie Wilson.)

Welcome to our live chat!

ruthie : How much is the cost of the lap band surgery and this have the same result of the bariaty surgery

Dr.McClellan : ruthie, Depending upon the center the cost of the lap band surgery can cost approx. 25,000. Bariatric Surgery means all of the weight reduction surgeries that are now being performed in the United States and the lap band is one of those procedures. Out of all of the procedures that are now being performed, the lap band is the one that works the least generally.

ledee: if you don’t have insurance, because you are so obesity that how can you go from there?

Dr.McClellan: Ledee, Without insurance it's difficult to get coverage for any medical care.

marie: Another question....is it safe to take Benefiber daily after RNY? I find it's the only thing that keeps me regular.
Dr.McClellan: Marie, It really depends upon how long ago you had the RNY, but generally (especially if it's been awhile after surgery) it's should be OK, but check with your surgeon.

marie: I am 3 months post op (open rny), when is it safe to start weight training?

Dr.McClellan: Marie, You should be able to start weight training now. Usually, it's approximately 6 wks after surgery, but again, check with your surgeon.

kathycreel: I am scheduled for my first doctors appt in may wish I could get it moved up but anyway what all should I expect for my first visit

Dr.McClellan: Kathycreel, Usually the initial consultation is lengthy, including overall preoperative and postoperative care as well as expectations and hospital course.

sharon-: why is there a 2,000 program fee here in akron ohio.

Dr.McClellan: Sharon, Every program is different and I'm not familiar with Akron, Ohio's program.

susan-: I have a real problem because I want the surgery, have insurance coverage but my husband seems to be afraid that if I am thin and not heavy like we both are, I may leave him....I love him and would never leave but that is what he keeps saying and trying to talk me out of the surgery....my BMI is 41.

Dr.McClellan: Susan, That is sometimes not unusual. Your health is very important and continued reassurance and the faith you and your husband share should follow. Maybe he and you would benefit from going to the consultation (with the surgeon) together. Also, has he addressed his weight issue?

MARIA: I wanted to ask about getting revision surgery done... Is it possible to find a surgeon that will do it??? I can't find one and its so hard living in pain. The last CT scan shows 2 hernias and the doctor said that my surgery has come undone (?). It’s been since 12/98 and it feels like I have a charley horse pain in my gut after I eat. The doctor also said that it seems like food is going everywhere...getting stuck and that’s what the problem is. Then I always seem to get the same advice: find another surgeon. No one wants to operate. No one wants to go behind another surgeon. Seems like I get appointments to see new doctors, see them, get no results but I always seem to get a bill. I am frustrated and depressed.

Dr.McClellan: MARIA, Yes. Looking at the ASBS website should help you locate a surgeon in your area who does the revision surgery.

MARIA: ty :)

Tap: What is the normal weight loss percentage after having the lap band procedure?

Dr.McClellan: Tap, Approximately 25% comparing that to the laparoscopic gastric bypass which is approximately 75%.

Vickie: My friend is fixing to start the process of getting ready for the surgery. What do we need to expect on first visit?

Dr.McClellan: Vickie, Usually expect a complete and lengthy evaluation reviewing your medical history and what to expect from the surgery, and aftercare.

dawn-: what are the chances of insurance denying someone and do you know if they tell you that you have to see a doctor for 6 months or a dietician do they eventually ok the surgery? How long does it take to get approved??

Dr.McClellan: Dawn, Each insurance company has their own set of guidelines. Some do require a documented 6 month diet program, some require 12 months, and some approve immediately without a diet program, based on medical necessity.

tanya-: How does some one who cannot afford to pay for surgery possibly get any sort of payment plan?

Dr.McClellan: Tanya, Every program usually offers different payment plans. Some banks are now starting to offer different plans depending upon where you live. For example, New Jersey.

Vickie: What surgery is the best? Bypass or Lapband??

Dr.McClellan: Vickie, The bypass works the best in terms of overall weight reduction.

samantha: I am using a fake name because I know my sister is a big Carnie Wilson fan and she is also bigger than Carnie was back in 1999. The question is how does a loving sister raise this issue without hurting my sisters feelings. SHE IS SO SENSITIVE AND HAS TOLD ME THAT HER WEIGHT WAS HER BUSINESS NOT MINE..........help me!!!

Dr.McClellan: Samantha, Maybe talk about the other potential health issues, if she has them; like hypertension, GERD, diabetes, sleep apnea, back pain, etc. Address it as a real health issue.

madeline: I live in Canada, near Michigan but I have heard of you......is it legal for me to come to the US for a surgery, and if so, how long must I stay close to your hosptial before returning home....I have 3 kids and being away too long is a problem........I am now a single mom .

Dr.McClellan: Madeline, Of course you can come to the US and receive healthcare. Insurance coverage will be the issue. The hospital stay is generally short, approximately 3 days including the day of surgery, and follow up care would have to be tailored to fit your needs.

tracy-: I had the lapband procedure 3 years ago with another doctor in Chicago.....the results have been horrible....can I now have gastric bypass surgery....I am 5-3 and weigh 277.

Dr.McClellan: Tracy, Yes you can have gastric bypass surgery after having the lapband procedure.

kimbra: I have insurance but it doesn't cover gastric bypass surgery. I live in Gulfport MS. Is there any doctors that take payment plans or can see if my insurance will cover because of all my medical problems because of my obesity I am 5'5" and weigh four hundred pounds and I am slowly dying day by day.

Dr.McClellan: Kimbra, The best thing for you to do is refer to the ASBS website, find a bariatric surgeon in your area and investigate further.

kathy: are patients usually put on resperator after surgery

Dr.McClellan: Kathy, No.

diana-: I had the Gastric Bypass in October. I am terrified that I am going to gain the weight back. My question(s) are: How can you tell if you have stretch your diet and what kind of foods are the best to eat?

Dr.McClellan: Diana, Follow a healthy lifestyle/diet, including high protein, low fat, low sugar, small meals, good hydration, and exercise.....take your supplements and follow up routinely.

eva: What happens once you reach your goal weight after the surgery?

Dr.McClellan: Eva, Maintenance, lifelong maintenance.

Vickie: Once you have the surgery how much down time do you need to expect??

Dr.McClellan: Vickie, Usually you're in the hospital for approximately 3 days (including the day of surgery) and back to work in 1-2 weeks.

deb: I have heard that a problem arose with one bypass patient about needing a pacemaker now and having a low heart rate. I don't know about past heart problems but I'm sure doctors would not have done surgery with any previous heart problems. I have also heard rumors she lost a tremendous amount of weight but maybe did not follow all the rules about protein drinks, etc. Could this have been her problem?

Dr.McClellan: Deb, No, this is a very unusual case. I have never had this problem.

Robin: Dr. McClellan, I'm planning on having surgery this summer with Dr. Wittgrove. My one question that really seems to go without a direct answer is longevity post op. I'm a 31 year old female and I would hope that my lifespan...when of the right weight would be the same or have the same odds as someone just like me. Can you give some insight and feedback? Thanks!

Dr.McClellan: Robin, The reason why the NIH recommends bariatric surgery is because by treating your disease of morbid obesity and achieving a healthy weight it lengthens your life expectancy to normal values.

moderator: This will be our last question. Dr. McClellan, is there anything you would like to add or perhaps let our members know about your web-site??

moderator: Thank you Dr. McClellan. Would you like to say anything before we leave...perhaps you would like to make reference to your web-site.

moderator: For those of you that would like to see a transcript of this Live Chat and past live chats. Please go to www.liteandhope.com and click on the, "Ask the Surgeon" button on the right hand side of the home page. Then scroll down to transcript. Please note that this transcript will be posted in the next couple of days. Thank You.

Dr.McClellan: Thank you, moderator for inviting me to participate in this chat this evening. For further information please refer to my website at www.bariatricwellness.com

moderator:This concludes our chat for today. Thank you all for your participation in today’s Live Chat. We are so very pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you Dr. McClellan for your informative and insightful answers. LITE AND HOPE will be presenting a LIVE CYBERCAST and Dr. McClellan will by our expert commentator for the live cybercast on our site of a GBP surgery of former USC All American, College Hall of Fame football star Anthony Davis on Saturday, March 11, 2006 at 7:30 AM PST (10:30am Eastern).. Joining Dr McClellan as a co-commentator for this live cybercast will be Carnie Wilson. Please check our web-site www.liteandhope.com for further information on this Live Cybercast. Also, please make sure you have joined as a member of Lite and Hope at www.liteandhope.com. We will send out emails for any upcoming news or events. Our next Live Chat will be on March 15, 2006. Good night and thank you

Dr. Sasse graduated from the University of California, San Francisco with his medical degree in 1994. He is bi-lingual in English and Spanish and is a Major in the United States Air Force Reserves. He is a board certified surgeon, a Fellow of the American College of Surgeons, a member of S.A.G.E.S., A.S.B.S., the Society for Surgery of the Alimentary Tract, and the American Society of Colon and Rectal Surgeons. He is also a Clinical Instructor at the University of Nevada School of Medicine and Clinical Instructor Uniformed Health Services, MGMC.
Dr. Sasse is the Medical Director for Western Bariatric Institute in Reno, NV., where he and his team practice at three major local hospitals.

Welcome to our live chat!

nancy: I had gastric bypass surgery this past august and what I need to know is, why do I get so gassy at night for.

Dr.Sasse: Nancy, many people experience different symptoms after gastrointestinal surgery. Many of these of these symptoms are more pronounced in the early weeks and months after gastric bypass surgery. Often it is a matter of experimentation with a variety of foods and liquids to find those that produce the least stomach upset. If the symptoms persist, it is important to follow up with your surgeon to be certain there is no other cause such as gastric irritation.

cathy: Hello Dr. I had RYN(Lap) 2 1/2 years ago. And I was very successful losing 130 lbs, but over the past year I have gained 20 lbs and feel I am returning to my old eating habits and feel my "tool" doesn’t work for me like it should. And I worry all the time that the pouch has stretched back to "normal" And I'm confused about what type of diet to follow. I know I need the extra protein, but I still feel I get confused about what to be eating. And my current bariatric doctor is a little far away to see and my regular doctor only recommends this doctor. Are there any suggestions you can give me to get my diet under control the right way, because I don’t want to be a failure at this too. And Carnie Love You !!

Dr.Sasse: cathy, some people do feel that the gastric pouch has "stretched", but it very rarely does stretch significantly. It is important to follow up with your surgeon or another qualified bariatric surgeon to make sure the anatomy is as it should be. In most cases it is a matter of redoubling your efforts to minimize those "hidden carbohydrates" that appear in all of our diets, drink plenty of zero-calorie beverages, and think of "protein first" when buying or preparing meals. Making regular visits with a dietician is a good start also for you.

Dawn: After the lap band surgery, do you know what percentage of people put the weight back on?

Dr.Sasse: Dawn, the recent studies of the LapBand show that the patients in the studies continue to lose weight many years out after surgery. It is believed that a small percentage of patients, perhaps five percent or less, will regain some or all of their weight, after lapBand or RYGB surgery. It definitely takes a commitment to succeed over the long term, and no surgery alone will create long term success, but the vast majority of people do succeed adn continue to do so even in 10 yr follow up studies of the Lap Band.

jim-: would you recommend having gastric bipass over lapband

Dr.Sasse: Jim, I would recommend each person discuss that question individually with his or her surgeon. Neither operation is perfect, and each has its own set of pros and cons, risks and benefits. We at Western Bariatric Institute have gradually become convinced, after years of performing RYGB, that the LapBand also has an important role and is highly successful, as is the RYGB.

Dawn: Thank you. How often should a lap band be adjusted and what are the signs that I need to look for that it needs to be adjusted? Is there a time frame that needs to pass after the lapband procedure on a minimum before getting pregnant?

Dr.Sasse: Dawn, the frequency of adjustments depends on the pace of an individual's weight loss. The signs that one looks for are whether the person is experiencing a satisfactory level of satiety, or whether that person is feeling more hungry and seeking more to eat, and whether the person feels some sense of restriction, particularly with foods like meat and bread. The best plan is usually to follow up regularly with your bariatric program and discuss those issues, weigh in, and talk over whether it is time for an adjustment. At Western Bariatric Institute, we tend to perform an average of around 3 to four adjustments in the first year after LapBand surgery, and then much less frequently thereafter. It is best to discuss the pregnancy issue with your doctors and bariatric surgeon, and it is best to avoid pregnancy during periods of rapid, substantial weight loss.

grace-: What are the typical side effects for someone 3 years out of surgery?

Dr.Sasse: Grace, every person is different in terms of side effects and how they feel at different stages. Most people have very few side effects at three years and have adjusted to a diet that is different than they experienced preop. The studies would indicate that the vast majority of people three years out from bariatric surgery report improved health, less medical problems, and greater activity level and satisfaction with life.

Maria: I had the RNY gastric bypass done 12/98 and since then have had surgeries for at least 5 bowel obstructions and adhesions. My original surgeon no longer practices in the state I was living due to so many lawsuits filed against his practice. I am in desperate need of finding a surgeon that can correct my surgery. I am in pain all the time and it’s getting worse. Are there any surgeons out there that will do revision surgeries?? I am 36 and can't see myself getting to 40 with all the pain and problems I am having. Is there anyone out there that can help? When I go to the ER when the pain is beyond my threshold, all I get is more pain meds and suggestions to see someone about getting a revision.

Dr.Sasse: Maria, I am very sorry to learn of your difficulties. Chronic pain syndromes can be difficult problems to treat effectively. Bowel obstructions are something that can be related to scar tissue after any kind of abdominal or pelvic surgery, and in a small percentage of people, can become of severe problem. It can be difficult to find sub specialists for complex problems, and I think the best advice is to be persistent in seeking recommendations in your area from doctors you trust, and try to maintain a relationship with a good gastroenterologist and gastrointestinal surgeon.

Jan: Do you know what the percentages are of people who loose 100 + that need to have plastic surgery to remove excess skin to the abdomen area. Since most insurance companies consider that cosmetic, I'm concerned that after I loose all the weight, I'll be stuck with lots of excess skin. What are the most successful ways to avoid having to have plastic surgery?

Dr.Sasse: Jan, a significant percentage of people having successful bariatric surgery do then seek a plastic surgeon's help in the years following their bariatric surgery. At Western Bariatric Institute, I would estimate that 30% of our patients undergo some form of plastic surgery in the five years after their bariatric procedure. To maintain skin elasticity and health, it is important to avoid excess UV light exposure and use sunscreen throughout life. Most often the decision to pursue plastic surgery is a personal decision related to individual perceptions of the appearance. Usually it is a pleasant trade-off, to be rid of the 100+ lbs of weight.

angie: I had my surgery 14 weeks ago. I get extremely tired all the time. Is it supposed to be that way?

Dr.Sasse: Angie, it is not uncommon that people report being tired in the early weeks following any surgery, even minor procedures, and sometimes following bariatric surgery. It is uncommon that people report fatigue 14 weeks down the road, but it is important that you follow up with your surgical program and be certain you are drinking enough fluids, taking in enough protein, and taking your prescribed vitamins.

mary_marquez: Had bypass 5 yrs this month having chronic pancreatias "Don’t drink alcohol" Have severe attacks where I’ve been hospitalized. Impression is small bowel blockage. Taking morphine pills for acute pain and also wear patches. Seen many doctors they don’t seem to know what’s happening. Any advice on and where to go living in Aurora,Il.Thanks

mary_marquez: I have a question directly for Maria, Her chronic pain is the same I am having. Would like her to contact me at my e-mail address. This is great to be able to talk to someone that understands the pain .Please pass this along to Maria .A big hug to you for passing this along. Thanks

Dr.Sasse: Mary, there are a number of causes of pancreatitis, and usually they are best investigated by a qualified gastroenterologist. I would ask your gastroenterologist who they refer cases to if a recurring problem cannot be solved. Your bariatric surgeon may also have some input and advice about your specific case.

Courtney: Hello--when you have Open RNY do they have to crack your ribs open to do the procedure?

Dr.Sasse: Courtney, many experienced bariatric specialty centers such as ours perform a large number of bariatric operations with a minimally invasive, or laparoscopic technique. Rarely, perhaps in 1-2% of cases, is it necessary to perform open surgery. However, if an open operation is recommended or required, it is not necessary to "crack" any ribs.

moderator: Mary Marquez. An email has been sent to Maria explaining that you would like to make contact with her. Thanks again.

elaine-: Dr Sasse: Could you please outline the major advantages of Gastric Bypaas over Lapband? I have a BMI of 47 and want to make the right choice

Dr.Sasse: Elaine, it is a good questions and one that many American programs are grappling with now. At Western Bariatric Institute, our philosophy has changed as more data has emerged on the long term outcome of the LapBand, and we now see it as probably equally effective as RYGB over the long term. More studies will help us decide who will benefit most from which procedure, but at present, I would recommend you talk over that very question with your bariatric surgeon. Each procedure has pros and cons and risks and side effects, so it is important to understand as much about them one can.

Callisto: Will the supplements that we have to take be taken basically the same way as the vitamin's and if so, what supplements are required

Dr.Sasse: Callisto, programs differ with respect to the specifics of supplements and vitamins. Most experts agree that a general multivitamin and B12 supplementation are important, especially after RYGB. Additionally, we emphasize the importance of protein in the postoperative, and even, preoperative, time periods. Most people find the vitamins pretty easy to work into their regular routine.

moderator: This will be our last question of the evening.

Michelle: I am 10 days post roux en y gastric surgery. Will I ever be able to eat more than a half of egg ? I am worried about malnutrition and dehydration

Dr.Sasse: Michelle, most people are able to eat more over time, as their body adjusts to gastric bypass, but they generally do not return to eating large portions. Most people lose weight and improve their health after bariatric surgery, and they manage to take in plenty of calories, protein and vitamins. Malnutrition and dehydration are rare, but it is important to follow the guidelines of your bariatric program and drink plenty of fluids.

moderator: Thank you Dr. Sasse. Would you like to say anything before we leave...perhaps you would like to make reference to your web-site.

moderator: For those of you that would like to see a transcript of this Live Chat and past live chats. Please go to www.liteandhope.com and click on the, "Ask the Surgeon" button on the right hand side of the home page. Then scroll down to transcript. Please note that this transcript will be posted in the next couple of days. Thank You.

Dr.Sasse: Thank you very much. I enjoyed the opportunity to participate in this live chat. The questions were very insightful. For more information on bariatric surgery, or Western Bariatric Institute, including laparoscopic adjustable gastric banding (LapBand) and minimally invasive Roux-en-Y gastric bypass, please visit our website at westernbariatricinstitute.com.
Thank you

moderator: This concludes our chat for today. Thank you all for your participation in today ’ s LIVE CHAT. We are very pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you Dr. Sasse for your informative and insightful answers. LITE AND HOPE will be presenting a Live Cybercast of a Gastric bypass procedure in March of this year hosted by Carnie Wilson. Please check our web-site www.liteandhope.com for further information on this Live Cybercast. We will post something there soon. Also, please make sure you have joined as a member of Lite and Hope at www.liteandhope.com. We will send out emails for any upcoming news or events. We will send out emails for any upcoming news or events. Our next live chat will be on March 1st, 2006 at 8pm. Good night and thank you.

Steven M. Clark, M.D., FACS graduated from Harvard University with a degree in Chemistry. He completed medical school at the University of Michigan and did his surgical residency at the University of Cincinnati. He served as staff surgeon at Naval Medical Center San Diego and Camp Pendleton. He is co Medical Director of the St Francis Medical and Surgical Weight Loss Center in Indianapolis. Dr. Clark is board certified, a Fellow of the American College of Surgeons, and a member of the American Society for Bariatric Surgery, Indiana State Medical Association and the American Medical Association. He performs laparoscopic Roux-en-y gastic bypass and the LAP-BAND for his patients.

Welcome to our live chat!

moderator: Hello Everyone...Welcome...We will start in approx. 5 minutes. Feel free to submit your questions ahead of time.

Icupps:Is someone with a BMI of 66.6 with co-morbidities such as lymph edema thyroid disease ulcers a good candidate for the surgery?

Dr.Clark: Icupps, The patient you describe will be challenging. It's imperative that you find a quality center with an integrated program to maximize the chances for success. Bariatric surgery is the best chance this patient has to improve their health.

lcupps: Also I'm trying to get approved with WV Medicaid and wondering if you have any suggestions to help me get approved

Dr.Clark: Icupps, Medicaid varies from state to state. It's important that you understand what your particular state requires and that you meet all of their requirements. Your primary care doctor will need to send a letter of medical necessity as well.

cpcmom: I am almost 7 months out of my surgery and I have lost 96 pounds. What are the foods that I should avoid here on out?

Dr.Clark: cpcmom, I strongly encourage you to work with your dietician or nutritionist. In general we want you to eat good protein sources, fruits, vegetables and whole grains. You should try avoid empty calories such as soft drinks, alcohol in excess, sweets, and high fat, high sodium foods. An occasional splurge is to be expected.

Brenda_Jones: I am 55 yrs. old, and I weigh 260 lbs, at my age would I qualify for gastric bypass surgery?

Dr.Clark: Brenda, What is your height? Do you have any other medical conditions associated with obesity?

Robin: If your doctor finds it medically necessary, does that mean your insurance company will pay for it?

Dr.Clark: Robin, That's an important first step. You have to check your policy to make sure it's a covered benefit and make sure you meet all the requirements.

Robin: I am 36 y/o and my doctor asked me if I thought I would consider having the surgery. I am thinking about it, but not sure how to research all the options

Dr.Clark: Robin, The American Society for Bariatric Surgery is a tremendous resource, of course, Lite and Hope also has a wealth of information. You should be able to find a program in your area that offers an informational seminar. These are usually free of charge and cover the basics of bariatric surgery.

joyce_marsh: I'm at least 140 lbs. overweight. I have sleep apnea and hypertension. I've been thinking about laprascopic bariatric surgery. Would I be a candidate for this type of surgery?

Dr.Clark: Joyce, You meet the National Institute of Health criteria. Your surgery should be able to be performed laparascopically.

Kristie: Hello Dr. Clark. Thanks for your time. My problem is with my Dr. not wanting to refer me for the surgery even though I weigh over 300lbs. and am a short 5'2" with major back pain and hypothyroidism and also suspected sleep apnea. Why do you suspect the doctors I have talked to are so negative towards this surgery even though I obviously qualify?

Dr.Clark: Kristie, Some physicians aren't aware of how successful bariatric surgery is in resolving medical conditions associated with obesity. Others have had experience with the JI bypass and don't know that the procedures performed today have an excellent safety profile. If your doctor will not refer you despite your qualifying, you will probably have to change doctors.

lcupps: kristie, I have the same problems

cpcmom: I know that but some doctors say to avoid ice cream, some say peanuts, popcorn. I was just wondering what u told your patients to stay away from

Dr.Clark: cpcmom, All things in moderation. My pet peeve is with soft drinks and large quantities of sweets.

Brenda_Jones: I am 5'3", and I am on disability for arthritis, I have high blood pressure, and I have Medicare, and does Medicare pay for the surgery?

Dr.Clark: Brenda, Your BMI is 46 and this would qualify you for surgery. Medicare does pay for surgery if you fulfill their criteria.

Jo: Doctor, I have been talking with my clinic nutritionist about the surgery. I told her my big concern is weakness and fatigue when I get so little calories. At 1400 calories a day, I still lost 3.5-3.75 lbs a week over 3 months on a well-known weight loss program. But I quit because I did not feel well, and lacked energy for activities outside of work. I also have FMS, which also causes fatigue. So, I increase calories and feel better. BUT, I can not go that with a very small stomach.

Dr.Clark: Jo, The Lap-Band might be a better choice for you. The weight loss is slower and perhaps that would ameliorate your weakness. The overwhelming majority of my patients report increased energy during their weight loss phase.

sharon: I read your bio on the lite and hope site, can I ask you what the difference is between the regular gastric bypass and the Roux-en-y gastric bypass?

Dr.Clark: Sharon, Today, they're one and the same. Roux-en-y is a technical term that describes how the you reconstruct the flow of food. In the past there were loop gastric bypasses done.

Kimberly-: Seven years ago I had GBS and lost 150lbs. I have since gained back nearly 75lbs. What am I doing wrong? I was thought it would be impossible to gain back this much weight. It seems my metabolism is completely gone. Thank you for any help.

Dr.Clark: Kimberly, I would need a diet and exercise history to know exactly what's gone wrong. I would encourage you to find a center in your area and make an appointment to talk with the dietician, exercise, and a surgeon to see if there's an anatomic reason for your weight regain.

jacqueline: Type here how do you get a referral to a us surgeon I'm Canadian and can't get a bypass done here although I've been approved there no longer doing them in my area

moderator: Dr. Clark, Jacqueline can call 877-lite4hope (548-3446) between the hours of 10 and 5pm Pacific Time Monday -Friday and we can assist with that

Dr.Clark: Jacqueline, I believe you would need a letter from your provincial official allowing you to come to the US for surgery. I'm not that familiar with Canadian requirements to seek care outside of your health care system.

Brenda_Jones: Can you tell me what their criteria are? I have tried and tried to lose weight, I keep trying diet after diet, and I feel that the surgery is the way for me.

Dr.Clark: Brenda, First you must meet National Institutes of Health (NIH) criteria which you do. I know they require medical supervision but I'm not sure of the duration. You will need psychological testing as well. I would have your doctor refer you to a center. Lite and Hope can help you find a qualified surgeon in your area.

Brenda_Jones: Thank you Dr. Clark

Kristie: Dr. Clark, My Dr. also mentioned something about the state I am in requiring six documented attempts and failures of weight loss, i.e. via weight watchers, jenny craig, etc. That is a mighty hefty cost for me not to mention that would take years-giving each program a required 6 months trial. Have you ever heard of any other state having such "strange" requirements?

Dr.Clark: Kristie, I know that states require attempts at weight loss but I've never heard of a state requiring 6 separate attempts. 18 months is the longest I've ever heard of and there's no medical evidence to support anything over 6 months.

Jo: Would this lap band remain, or be removed after a person gets to their weight goal?

Dr.Clark: Jo, The Lap-Band should be viewed as permanent. The band can be removed if you have complications, but I wouldn't take it out once you meet your goal weight.

Jeannie: I read that zinc & biotin will help prevent hair loss. Do you think this helps and if so what is the recommended dosage and if you take a B-12 supplement is biotin needed?

Dr.Clark: Jeannie, Hair loss is very common. In our program we recommend a multivitamin/mineral supplement as well as B-12. Biotin's recommended dosage is 30 micrograms a day.

Diane: I am 5 weeks post-op. Doing really well till I have tried to eat solid proteins (chicken and fish). I get nauseated and vomit. Am I trying too early? I have lost 45 lbs and am frequently lightheaded also.

Dr.Clark: Diane, Make sure you're getting enough fluid in. Patients will often have intolerance to different foods. You may do better with beef, lamb, turkey or pork.

Robin: Hi Dr. Clark, I'm planning to have GBS this summer with Dr. Wittgrove. My question has to do with longevity. I'm 31 tomorrow. I'm scared that GBS will bring on a whole other slough of health issues that could affect my longevity. I guess what I'm wondering is if I have children, will I live to see them grow up? There's lots of scarry stuff on longevity and GBS on the internet and I just don't know what to believe.

Dr.Clark: Robin, Anxiety is natural. Bariatric surgery represents your best chance to regain your optimal state of health which includes your having a normal lifespan. There are risks associated with the surgery but multiple medical studies have convincingly shown that bariatric surgery improves the health and well being of the patients. You have an outstanding surgeon to help guide you through the process.

Katarina: I am about 4 months post surgery and am doing very well except that my hair has started to fall out by the handfuls, is this normal and is their anything I can do to stop it?

Dr.Clark: Katarina, Hair loss is one of the most common side effects. Make sure your taking the appropriate multivitamin/mineral supplements and that your protein intake is sufficient.

sharon: in all of your years of experience, have you ever had any patients who have had problems with scar tissue, because I am a heavy scar tissue grower

Dr.Clark: Sharon, Scar tissue or adhesions can occur after any surgery. If your surgery were to be performed laparoscopically, that would decrease the chance of adhesions or scar tissue.

joyce_marsh: My sister is 5'10" and is over 400lbs overweight. She's 44 years old and has hypertension, sleep apnea, a busted patella and may have problems with clotting. I know her insurance would cover her surgery. She weighs close to 600lbs. She's had some reservations in the past but I feel surgery is needed.

Dr.Clark: Joyce, Your sister meets criteria, but is she interested in the surgery?

angelgurlee: Hi Dr.Clark, I am 5 weeks out and have trouble getting fluids, vitamins and food At this point should I be more concerned with getting in the fluids and vitamins? Also have trouble getting in the protein, do shakes count towards your fluid intake?

Dr.Clark: Angelgurlee, Are you vomiting or are you having trouble with the volume of material you must take?

angelgurlee: Just a problem with the volume and there just doesn't seem to be enough hours in the day to get everything in.

Kristie: Are you familiar with an OTC med called zetacap that is supposed to be a non surgical alternative to GBS? And if so do you feel this medication is safe?

Dr.Clark: Kristie, I'm not familiar with "Zetacap" However, none of the prescription weight loss agents have the success rate of GBS.

Robin: Dr. Clark, will hair grow back after it goes through the 'shedding' period?

Dr.Clark: Robin, Fortunately yes.

Robin: Will it be the same thickness? I've got GREAT hair now and want GREAT hair later...

Dr.Clark: Robin, It should be, none of my patients that are several years out have complained about a permanent change in the texture of their hair.

sharon: Thank you Dr.Clark. It was a pleasure to have you on lite and hope.

angelgurlee: Just a problem with the volume and there just doesn't seem to be enough hours in the day to get everything in.

Dr.Clark: angelgurlee, I have heard this from a few patients. Protein and fluid intake are a must. You have to literally schedule your day around your eating. Your nutritionist can help you with this problem.

Franklin-: Is there any particular insurance company in Indiana that you recommend that covers all of the costs associated with Gastric surgery

Dr.Clark: Franklin, Almost every insurance plan will require a co pay. I know that Anthem has restricted coverage recently, but the other companies (United Health Care, Aetna, Cigna, MPlan, etc) still cover bariatric surgery.

ellie-: I am contemplating on having the lap-band procedure performed, will the cravings disappear? Or will I need to take an appetite suppressant to ward off the yearning to eat?

Dr.Clark: Ellie, The Lap-Band works by inducing satiety. After you've been appropriately adjusted to your "sweet spot", you will not require an appetite suppressant.

Cathy: Dr. I am five years post-op but have been snacking and put on 20 lbs in the past year. Have I stretched my pouch and/or anastamosis? How could I find out?

Dr.Clark: Cathy, Snacking may be the sole cause of your weight gain. An Upper GI or Endoscopy could tell you the exact size of your pouch.

moderator: We will take one more question for today's chat.

Robin: Dr. Clark, I've read that some GBS patients will have chronic diarrhea as a result of surgery. Is this true in some of your patients?

Dr.Clark: Robin, I haven't seen chronic diarrhea. The most common complaint is constipation.

moderator: Dr. Clark...Is there anything you would like to add before we conclude today's chat? Perhaps a web-site??

Dr.Clark: Thank you all for participating. You can reach our program at www.premierbariatric.com. Good luck in the future!

moderator: This concludes our chat for today. Thank you all for your participation in today's LIVE CHAT. We are so very pleased to host this unique opportunity to bring our wonderful LITE AND HOPE Registered Surgeons to the WORLD as a resource for your questions. Thank you Dr. Clark for your informative and insightful answers. LITE AND HOPE will be presenting a LIVE CYBERCAST of a Gastric Bypass procedure in March of this year hosted by Carnie Wilson.

moderator: Please check our web-site www.liteandhope.com for further information on this Live Cybercast. Also, please make sure you have joined as a member of Lite and Hope at www.liteandhope.com.

moderator: We will send out emails for any upcoming news or events. Our next live chat will be on February 15, 2006 at 8pm. Good night and thank you.

Dr. Robert E. Brolin is one of the nation's leaders in bariatric surgery. His surgical competency is known worldwide and his dedication to his patients is unsurpassed.

Dr. Brolin has 25 years experience in bariatric surgery and has performed over 2,500 bariatric operations; Roux-en-Y Gastric Bypass, Gastroplasty and nearly 200 revision operations (for complications or unsatisfactory weight loss after a previous bariatric operation).

Dr. Brolin was the President of American Society of Bariatric Surgery (ASBS) from 2000 - 2001, on the ASBS Executive Council Member for over 10 years and has been an ASBS Committee Member for over 18 years. He has 60 publication in medical journals and has lectured extensively.

Welcome to our live chat!

Tina: I’m concerned about having the surgery because I’ve heard people have died. What amount of patients have complications?

dr.brolin> The Centers of Excellence initiative sponsered by The SRC and The American Society for Bariatric Surgery has approximately a 0.35% mortality rate and less than 5% incidence of major complications. This contrasts with a 5% mortality rate nationally in medicare patients recently published (2005). The authors of that recent publication reported that mortality and complication rate is closely correlated with surgeon experience. So choose an experienced surgeon associated with a Center of Excellence.

JenJen: Dr. Brolin, Do the patients that you have dealt with in the past absolutely know that this surgery is for them by the time they get to you or are they still very scared and sceptical by surgery time...?? I want to have this surgery done emmensly but am very scared of the risks and side effects....What percentage would you say are very successful non-complication related surgeries...?? Thank-you

dr.brolin> Jen Jen, About 90%plus patients do not have major early complications after RY Gastric Bypass. More than 95% of Lap Band patients do not have early complications. 10% may have late complications during the first two years after either procedure.

JenJen: Dr. Brolin, My cousin had the roux en y procedure done at Dr. Leslie McClellan office in Illinois, I live in Wisconsin. If I would prefer to have the procedure done in my area, what questions should I be sure to ask of the clinic or Doctor's around here..?

dr.brolin> Jen Jen, Great question! I am sure there are a number of highly qualified surgeons in Southern California who are associated with Lite and Hope and/or The Centers of Excellence initiative.

Randi: I'm having my surgery on Tuesday. Any tips.....I'm scared.

dr.brolin> Randi, being a bit anxious is quite normal, in fact, most people experience this. If you are experiencing a great deal of anciety, ask your anesthesiologist or physician to prescribe a minor tranquilizer or sleeping pill for the night before.

amy: hello can you have this bypass done if you don't have insurance

dr.brolin> Amy, yes, if you can find a surgeon or clinic who is willing to work with you. I suggest looking at University associated programs which frequently take charity care.

amy: If you have had the bypass done 15 years earler can you have it done again?

dr.brolin> Amy, yes! You will need to either have complications which would require surgery or have regained enough weight such that you are currently morbidly obese with a Body Mass Index greater that 40.

JenJen: O.K. so of that 10% that may have late complications....What are we talking about...Gallbladder problems or something more severe possibly even life threatening....Also what is the longest studied case of someone who has undergone gastric bypass....and have there been any problems that have derived from that case..??

dr.brolin> JenJen, perhaps 1-2% of those late complications are potentially life threatening. There are many gastric bypass patients as well as patients who have had other types of bariatric operations that are doing well more that 20 years after their surgery.

Randi: If you are a type two diabetic after the surgery what keeps you from having hypoglycemia? This really concerns me. My blood sugars run a little high.

dr.brolin> Randi, There is no relationship between post operative hypoglycemia and pre operative type 2 diabetes. Anywhere from 5-10% of gastric bypass patients may have some symptoms (usually not severe) of hypoglycemia. I would not expect LapBand patients to develop hypoglycemia post operatively.

carolschick: what to do about an insurance company who is being very difficult and uncooperative ?

dr.brolin> Carol, as long as the option to have bariatric surgery is in your policy and you meet conventional weight and comorbidity qualifications to have bariatric surgery, I would solicit the support of your employer, primary care provider and any other medical specialist who are treating obesity related comorbidities. If this approach fails, and you meet the above qualifications, consider contacting your local newspaper, State insurance commissioner and even an attorney. they usually respond to the latter.

Randi: Is the Cleveland Clinic in Weston, Floirda considered a Center of Excellence?

dr.brolin> Randi, I am not sure but I know at least one surgeon there and have considerable respect for there bariatric surgery program.

Girard: I have MS and am also very obese.........can I still be a candidate for Gastric bypass if I have MS......I am 47 and have had MS for 24 years.

dr.brolin> Girard, yes! I have had several patients with MS and all of them had good weight loss results and some improvement in their MS. None of them had worsening of their MS.

Ilene: Is there any action patients can take to make their insurance companies pay for Gastric Bypass Surgery.........any suggestions?

dr.brolin> Ilene, you can solicit support of your primary care doctor, any other medical specialists caring for you or your employer . If this does not work and you meet qualifications for surgery, contact your local newspaper, State insurance commissioner or even an attornet. Insurance companies will frequently respond to the latter.

Jonathan: My son is only 17 but is 320 pounds and only 5 foot 9....he is suffering from both diabetes and hypertension yet I have been told that he is too young for the surgery......what would you suggest?

dr.brolin> Jonathan, in my opinion, he is not too young, provided that he has made serious attempts at weight loss using non surgical methods. My youngest patient was 14 years and nine months old when she had surgery and had a successful outcome.

Randi: Is there a lot of pain associated with having the roux en y hopefully laproscopic procedure?

dr.brolin> Randi, if it is laparoscopic, it hurts lots less than an open operation. Many of my patients go home on the second post operative day on oral pain medication.

Brent: MY question is that I went to a Bariatic seminar in my area which was good information. I just found out that my insurance does not cover the surgery. My Neurosurgeon is the one who reccomended the surgery to me before I have to Have my other Two back operation with rodes. What does a surgery like this normal cost to get it done. I haven't work in over a year with my back problems I just need a little guidance in this mater.

dr.brolin> Brent, I would ask the surgeon who ran the seminar about changing to a more friendly insurance carrier. Out of pocket costs for RY GB start at about $20,000; LapBand expenses might start at $15,000.

Nick: Dr. Brolin what determines one to qualified for Open and not for Laproscopic at 395lbs?

dr.brolin> Nick, usually weight less than 500 pounds is light enough to have lararascopic surgery. Inexperienced surgeons tend to prefer lighter weight patients for fear of having problems that result in conversion to open surgery .

Rita: I've heard that people with thyroid problems might have trouble losing weight even with the surgery. My synthroid was recently increased to .125 from .075. is it not a good idea to have the surgery for me - is it a waste.

dr.brolin> Rita, I have never known that patients taking thyroid medication fair any worse than other patients provided that their thyroid function tests are maintained near normal.

dr.brolin> We would like to thank everyone for their great questions and hope that you gained insight from ouranswers. If you need more information, please feel free to refer to our websire @ www.njbariatricspc.com.

moderator> Lite and Hope will be presenting a Live Cybercast on www.liteandhope.com of a gastric bypass procedure in March of this year hosted by Carnie Wilson. Please check our website www.liteandhope.com for further information on this live cybercast. Our next live chat will be on February 1, 2006 at 8pm.