| March 02, 2005
Chat with Dr. Cirangle at ObesityHelp.com
<Moderator>
Welcome to tonight's chat with Dr. Cirangle . Chat starts at 8pm PST/11pm
EST. Please type out your questions and hit enter will see them and
present them to Dr. Cirangle at the time of chat in the order we receive
them. Thank you! <Moderator> Welcome Dr. Cirangle Please let us
know when your ready to begin
<Dr. Cirangle> Hello everyone! Ready.
<winsmom>
how long does one need to be smoke free before getting the surgery?
<Dr. Cirangle> 4-6 weeks
<CC>
I am still Pre Op waiting on insurance approval. Would it be ok to
start the liquid diet now even though I have not had the surgery yet?
<Dr. Cirangle> Yes, it is very reasonable to attempt to lose weight
prior to surgery by doing a diet but if it's a liquid fast, it may
need to be monitored by either your surgeon or primary care
physician.
<Kimberly>
Hello Dr. Cirangle I am looking to have the lap band but have been reading
more about rny and thinking this is the surgery for me. How does a
surgeon determine which surgery is best for a patient or does he let
them patient decide?
<Dr. Cirangle> Kimberly, it's a combination of explaining the
different procedures, doing the research you need to decide which is
best for you and deciding together with your surgeon what is
appropriate. For instance, if your BMI is 55, you perhaps should
realize that it is less likely to lose the weight that you expect
with the LapBand versus the RouxenY Gastric Bypass or Duodenal Switch
or even the Vertical Gastrectomy for that matter.
<Shawna>
Currently 8.5 mths out of RNY and have lost 145 lbs. Starting weight
was 390 and current wt 245. I never had blood pressure issues until
after surgery. My blood pressure was always normal but everytime I go
to the doctor it's high. I had the nurse at work take it today and it
was 144 over 90. This from someone who before surgery consistently
ran 120 over 70 or so. My surgeon said to make sure we keep an eye on
it....is this normal for this issue to only arise after I have lost
145 lbs.
<Dr. Cirangle> Congratulations on your weight loss. It is unusual for
patients who have had normal blood pressure to have higher blood
pressures after surgery. Are you sure you are using the same type of
blood pressure cuff as you did prior to surgery. Inappropriately
sized blood pressure cuffs can give falsely higher readings such as
regular or smaller cuffs. You need to get measured with a large cuff
and see what it is. Also if it is high, you may need to see your PCP
or cardiologist to double check it several times to see if it's a
fluke or not.
<Alana>
I would really like to have surgery but am terrified of the risks.
What can you tell me about the surgery that will ease my fears?
<Dr. Cirangle> Alana, each patient goes through what you are feeling
although to different degrees. Remember why you are doing surgery. If
it's for cosmetic reasons then you should think it over. If it's for
true medical reasons, remember high blood pressure gives you strokes,
heart attacks, diabetes causes blindness, kidney failure, poor wound
healing, chronic leg wounds, insulin shots, amputations; sleep apnea
causes death by hypoxia while you sleep and causes heart problems,
gives you higher risk of blood clots causing heart attacks,
degenerative joint disease cripples you. All these things also should
terrify you and leads to early death. Remember, the key thing about
surgery is trust in a GOOD surgeon. If you don't have that, find
someone whom you will trust to a significant degree. If they are
good, since complications do happen, they will know how to treat you.
If they have very little experience, know how to do only one type of
operation, doesn't have a comprehensive program with good support and
follow-up, those risks you worry about will be more likely to occur
and be a problem.
<juju>
can you still have reconstructive surgery if you still weigh over
200lbs, I have lost 140lbs already and it seems my weight loss has
slowed down tremendously so I wanted to know if I should continue
with plastic surgeon
<Dr. Cirangle> Juju, I tell my patients that it's probably best to
weight until they reach their goal weight since if you lose another
50 pounds after you do plastic surgery (I presume that's what you
mean by reconstructive surgery-tummy tuck, LBL, abdominoplasty etc),
you may still have more loose skin that you would regret waiting.
<Will>
I am 6 mos post op from having a lapband placed. I have not had a
fill yet. I am finding that my appetite is growing. My current
surgeon does not believe that I should have a fill this soon. Is this
common to not have a fill at 6 mos out?
<Dr. Cirangle> Will, if you are losing 8-10 pounds a month with your
current diet and exercise and vitamin program and you are comfortable
with it, you do not need a fill. However, if you are not losing
weight, feeling less restricted, hungry, eating more often despite
good meals and exercise and doing all the right things, you probably
need a fill. I've had patients go a whole year without a fill and
lose 100 or more pounds with my program.
<Rene>
Should we ever be concerned about our bodies rejecting any portion of
the lapband or staples that are associated with the rny?
<Dr. Cirangle> Rene, anything can happen but it is very unlikely for
either of those things to occur. The LapBand is silicone and the
staples are titanium.
<angela
coplen> why are you told not to eat and drink together?
<Dr. Cirangle> There is no room in your stomach to do both. You would
vomit and or stretch your stomach pouch or cause a LapBand
slippage/gastric prolapse.
<Monique>
Dr. what happens to the old part of the stomach once is it cut off
from the new pouch? Does it atrophy or become diseased in anyway?
<Dr. Cirangle> Monique, the upper small stomach is separated from the
lower stomach but all the blood supply to all parts of the stomach
are still left in place so it just sits there empty. Disease is a
different issue. You can never see the bypassed stomach. Many of my
patients need studies of the entire stomach prior to surgery to make
sure there is nothing hidden from view. You can get ulcers in the
bypassed stomach that would not be easily seen any longer after the
RNY without surgery.
<pb>
what happens in the long run if you do not take all your proteins and
vitamins
<Dr. Cirangle> You will get very ill and possibly suffer from severe
malnutrition, suffer heart failure and potentially die.
<Sherrie>
I have a Lap Band and just had my first fill yesterday of 2.8, I do
not feel much restriction, does it take a few days to kick in or
should I feel it right away
<Dr. Cirangle> Sherrie, if the fill is enough, you usually can notice
it right away. It depends on your Band size, your stomach thickness,
etc.
<Pam>
I have been told that the majority of patients (RNY) become
cold-natured after the surgery. I am extremely hot-natured, so this
would be desirable to me! Is this true and , if so, what causes it?
<Dr. Cirangle> Pam, I don't know what you are referring to. All of my
patients are energetic, social and exercising. Sounds hot to me.
<Moderator>
last question goes too....
<Mrs.
Honey> hey doc.. got a quick question for ya. I am 15 months post
op and, is it safe for me now if i became pregnant, any harm to me or
the baby from having wls? thanks for your time.
<Dr. Cirangle> Mrs. Honey, did you see People Magazine. Carnie Wilson
wasn't gaining weight without a reason after her Gastric Bypass. She
is pregnant! Once your weight is stable, your labs checked for any
malnutrition issues, and your doctor ok's it, you can be pregnant. I
usually tell patients after 18-24 months after surgery.
<Moderator>
Thank you Dr. Cirangle excellent chat tonight, Thank you all for
coming have a good night.
<Dr. Cirangle> I enjoyed the chat everyone. Good night.
<Moderator>
Dr. Cirangle of Laparoscopic Associates of San Francisco Website:
http://www.lapsf.com/
Phone: 415-561-1310 Fax: 415-561-1713 E-mail: WeightLoss@lapsf.com
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