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Chat with Dr. Cirangle, September 9th, 2004

<*Moderator*> We want to welcome you all to this evenings surgeon chat. Dr. Cirangle will be arriving soon, so please get your questions submitted. To submit a question, simply type it out and hit enter and it will be answered in the order in which it was received.

I am 5'6 and about 455 lbs. I am looking at having the RNY, but lap. Am I too large for this to be performed this way?

Kelly. I think that with your weight at 455 it is very risky to have an RNY performed laparoscopically and possible even open. You have a higher chance of being converted to open, longer operation, etc.

Hi Dr. I am 6 mos post op from rny and I am still not getting my fluid intake in like I should. I try to drink throughout the day, but I get so full Any suggestions?

Criselda, if you are having this much difficulty, you may have a stenosis or stricture from your RNY. How was it performed? How fast are you drinking? How is your food and protein intake?

performed lap, drinking fairly fast and food and protein is about the same as the fluid low. I have lost 98 lbs and I started out at 245

You should be able to drink about a shot glass every 5-10 minutes early on and this gets better. How much food do you eat at each meal? Do you drink during meals? How much protein are you taking in (in grams)?

2-4 bites of my protein which is what I eat the most of. Small bites and it takes me about 15-20 mins to eat. I don't drink during my meals, only 45 mins after and before. Protein is mainly coming from protein shakes and the little amt of food I can get in and I am doing at least 60grams a day.

How many ounces of liquids are you drinking each day? What color is your urine?

about 35-50 oz a day, light yellow almost clear at times.

Criselda, overall I would say that you are doing reasonably well with your protein intake but you should be transitioning by now to solid food and probably exceed 70grams a day with solid food. You don't sound dehydrated per se, but in general, most patient drink more than 64oz liquids in a day (protein drinks count). Does it hurt when you drink or do you find that you have acid reflux/heartburn, especially in the mornings? How fast do you drink?

Does not hurt to drink until I get full then I can't drink anymore or eat anything until that pain goes away. I drink at least 8 oz in an hour sometimes 30 mins.

What happens after you eat 2-3 bites of fish? Can you eat that much at a meal?

Yes, but only 2-3 bites. Then I get full. Pain in the middle of my chest.

Has this improved? Did you ever have a stricture or need endoscopy after surgery?

Criselda: No stricture at anytime and no endo. It has stayed like this since surgery.

What does your surgeon say?

Not much. He says it will get better with time.

I would tend to agree with him. You may just have a very small pouch. It doesn't sound like a stricture or ulcer, but it is possible. Hang in there and keep up the fluids/supplements/protein.

Thank you!!!

Hello, I have been hearing that some surgeons will not perform WLS if the patient is missing any teeth, not even one back tooth is permissable. How common is this?

I'm not aware of this. If you are able to chew your food well, then you probably will be ok. Thanks.

Hello, Dr. I have Fibromyalgia and am comtemplatihng this surgery. Is there any documentation that demonstrates that WLS will cure my condition?

I do not believe so, although many patients have pain from a variety of reasons (arthritis, degenerative joint disease, etc) and losing 100+ pounds usually does not worsen discomfort and oftentimes improves someone's issues with pain but not always. There are many patients for instance, who say that their orthopedic surgeon will not perform a total knee replacement until after weight loss surgery, if the patient qualifies.

I had my right kidney removed in the year 2000 due to cancer. It was totally contained and I required no addition treatment. My question is how will this effect me in being a canidate for the weight loss surgery.

I do not believe there is an absolute contraindication against weight loss surgery in your case. However, you need to either find a specialized advanced laparoscopic surgeon or possible accept open surgery since you have had major surgery (unless your scar is on your back).

i HAVE A QUESTION ABOUT THE LAPBAND IS IT BETTER OR WORSE THEN THE OTHER OPTIONS

Mariea, that is a complex question with a complex answer usually suited for the time of consultation with your surgeon. What do you mean by better? or worse?

is one surgery perfered over others sue to weight or health issues

Mariea, to answer your question: Yes, each patient has individual needs and different surgeries are suited for different patients and that is why I perform 4 operations laparoscopically myself.

can i just say hi to Dr. Cirangle? im camille from illinois :)

Hi Camille! Hope all is well! Thanks! I will tell Dr. Jossart that you joined in today. See you at 9pm.

WHAT DO THINK ABOUT TAKING AN 8 DAY TRIP TO cHINA 6WEEKS AFTER LAPROSCOPIC SURGERY

Deirdre, I think that is probably ok depending on the type of surgery and what resources you have on your trip: You may be traveling on a bus for 8 days eating at roadside stalls (not good) or staying in the big cities where there is medical care and clean restaurants and 3-4 star hotels with air conditioning, drinking water, and medical help. It is about risk and how much risk you want to take. We have patients who have come from Samoa and return in a few days without any problems.

What are the most common risks associated with this surgery?

Which type of surgery?

lap rny

The laparoscopic Roux en Y gastric bypass procedure has risks similar to other general surgery procedures including: bleeding, infection, leakage at connections, pneumonia, blood clots that go to your lungs, bowel obstruction, internal hernias, ulcers, strictures, etc. I have a list of over 60 that I can think of and we talk about them with our patients before surgery so that they are fully informed. Luckily all these things are actually uncommon, and we have seen very few of these things. However, we list them all so that patients can ask about them since they probably have happened to someone at sometime somewhere in the world.

What tests do you require before surgery

It is not a short list. What do you have in mind?

rouxeny

Some patients have more medical problems than others and need more tests and some have fewer.

Is a person with GERD more likely to develop ulcers after roux-n-y

Not necessarily, a person with H.Pylori bacteria probably is.

I am seven months out from my RNY. I've lost 95 pounds, and 20 pounds till goal. My weight loss seems to have stopped at this point, and I was wondering if you have any suggestions on how to jump start the weight loss again.

Eat mainly protein meals (not from protein drinks) 3 times day, drinking plenty of liquids in between, less than 800 cal a day, less than 40grams carbohydrates 30grams fats a day, taking you vitamins twice a day, with vitamin B12, calcium and exercising 5-7 days a week.

HELLO I AM 15 MONTHS POST OP NOW AND I WAS WONDERING IS IT NORMAL FOR A SURGEON TO MAKE THE SIZE OF THE POUCH 30-40 CC'S?

Yes, or less.

Are there usually any long term problems from staples in the body?

Not usually.

Do you ever think insurance will pay for the Lap Band?

Certain insurance companies do pay for the Lap Band.

i'm 6 mo post op (open vbg) i have trouble getting enough food in each day because I'm just not all that hungry. any suggestions?

Congratulations! Surgery worked! However, I do not perform the VBG so I cannot recommend anything. Please ask your surgeon.

How early should you quit smoking before having surgery? Assuming you KNOW you will wait until the last possible second?

Now. You are more likely to have respiratory difficulty with surgery which is dangerous, have infections, get ulcers etc...

What are some good exercises for people far enough post-op to do?

Treadmill, Curves, some Yoga (don't hurt yourself), Aerobics, Running, Swimming, Scuba Dive, Tennis, Volleyball, Walking, Running, Fencing, Basketball, Baseball, Bicycling, Spinning, Softball, Running, Swimming.

<*Moderator*> And, the last question of the evening, goes to:

what is the difference between open rny and the duodenal switch?

The RNY is a mainly restrictive procedures, making you stomach the size of your little finger with a connection to the intestine to empty the food with possible dumping syndrome. The DS involves narrowing the stomach to about 5 ounces and disconnecting the intestine just beyond the stomach and connecting that part to the last 10 feet of your small intestine to cause malabsorption.

<*Moderator*> We want to thank you all for joining us this evening. Thank you Dr. Cirangle, for joining us this evening. Awesome chat!

Thanks everyone for a good session! I'm off to my own chat with my patients.

Your welcome! Look forward to future chats. Good Nite! Thanks for staying up late for all you East of the Rockies.

<*Moderator*> To learn more about Dr. Cirangle and the procedures he performs, please visiti http://www.hawaiiweightloss.com or http://www.lapsf.com/ to schedule a consult, please call 808-561-5511

Contact us via email or phone or register for an appointment.

Read more about morbid obesity surgery, bariatric surgery, or gastric bypass surgery, or LapBand®.