| April 14, 2005 Chat
with Dr. Cirangle at ObesityHelp.com
<Moderator>
Welcome to tonight's chat with Dr. Cirangle . Chat starts at 8:15pm PST/11:15pm
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 start.
<Dr. Cirangle> Hi everyone! Ready!
<Becky> How
long can you expect to have bad breath and body odor?
<Dr. Cirangle > Some of the patients get these symptoms, but not most.
As you lose more weight, this should improve.
<Lap Bander>
I had Lap Band surgey 1/13/05 was losing very well. I have had 2 fills
in the last 8 weeks and I still do not feel the fullness felling. I am
almost ready to give up I have actually gained 2 pounds since the last
fill 3 weeks ago. Is it just I do not have enough fill yet or is this
not going to help me. I do get the feeling of food getting stuck sometimes
but that is all.
<Dr. Cirangle> Lap Bander, if you feel hungry soon after a solid protein
meal in small quantities and feel less restricted than before, you probably
need a fill. If you are eating carbohydrates and not exercising with higher
calories, you need to change your habits to lose weight. Patients often
need more fills as they lose weight since the area around the upper stomach
also loses fat.
<iRWIN> Can
you discuss if there is any pain or discomfort associated with the insertion
or removal of the Foley catheter used during wls for a male patient? Thank
you..
<Dr. Cirangle> iRWIN, most catheters are put in after you are already
asleep after general anesthesia. Removing the catheter doesn't involve
much pain. If you need to have it put back in, it is uncomfortable but
not unbearable.
<Louise> What
is the normal stoma size, when it is too small? eg 8-11mm
<Dr. Cirangle> Louise, if the endoscopics is able to pass an endoscope
through your stoma in an RGB, it is ok. 10-12 CM is usually ok.
<iRWIN> Some
pre-ops say they are on pre-surgery diets. Should I be on one? I'm 6'
2", 296lbs, BMI of 38.5 w/ sleep apnea. WLS scheduled for 4/26/05.
Thank you.
<Dr. Cirangle> iRWIN, it is best to lose 10-20 lbs prior to weight
loss surgery to minimize the chance of complications and conversion to
open. It can be associated with better outcome after surgery due to your
commitment prior to surgery behaviorally. The "it's my last meal"
syndrome is extremely frowned upon and does no one, especially the patient,
any good.
<Lesa> Can I
lose as much weight with a Lap Band as I could with the RNY?
<Dr. Cirangle> Lesa, it is possible but LapBand weight loss probably
takes longer and needs more discipline than an RNY patient. A Hershey's
kiss fits perfectly in a LapBand pouch. :)
<tammy> How
many calories should someone stay around a year out? Is each person going
to be different based on their weight?
<Dr. Cirangle> tammy, it depends on the progress of your weight loss.
If you still need to lose weight, you need to have a calorie intake of
800/day or less. If you are trying to maintain 1000-1200 is probably better
and a bit more if you are losing too much. If you get to your goal at
9 months, you need take this strategy also.
<pat nicely: what
should the diet be like for a 3 month post op patient and how many calories
should you consuming per day?
<Dr. Cirangle> pat nicely: Aloha! Hope you got the Actigall prescription.
You should be on a 2-4 oz diet, <800 cal a day, <40 grams carbs,
<30 grams fat, and >60-70 grams protein for Gastric Bypass, LapBand,
DS, VG. Sometimes more protein in the DS because of the malabsorption
and if you are male.
<NicholeinMO>
HI, I'm 24 with a BMI of 36. I am a diabetic and might have to go from
pills to insulin. My cholesterol is 300. Obesity runs in my family and
my sister just had the surgery. As a surgeon, would you want to do the
surgery on someone in my position?
<Dr. Cirangle> NicholeinMO: Absolutely, with your BMI 35-40 with diabetes,
cholesterol, you are a good candidate for surgery according to NIH guidelines
set in 1991 as long as you are not disabled, psychologically cleared,
etc.
<les> What is
your position on carbonation after 9 months?
<> les: I tell my patients not to drink carbonated beverages.
It can stretch your stomach.
<tony> When
do you remove your jp drain? Before your patient's leave the hospital
or after? I heard that some surgeons leave it in. Why is this?
<> tony: I do not place drains routinely. It depends on
the situation in which it is placed and the particular problem it was
placed for.
<amber> how
much does one lose in the first year?
<Dr. Cirangle> amber: It varies depending on starting BMI, the type
of procedure chosen, and compliance with the lifestyle changes required.
In our experience, patients can lose 120 lbs or more with the duodenal
switch, Roux-en-Y gastric bypass and Vertical Gastrectomy. Lap Band patients
lose weight slower.
<eric> what
is most important to watch after surgery calories or fats?
<Dr. Cirangle> eric: carbs, fats and calories. The easiest way to think
about being successful after weight loss surgery is to change the order
in which you eat your meal: protein first to maintain >70 grams of
protein a day, which can help minimize carb/fat/calorie intake. Doing
the reverse with defeat successful weight loss.
<Missy> Hello,
and thank you for taking my question! I am currently 15 weeks post -op
and am down 82 lbs as of today. My starting weight was 287. I was wondering
if you could tell me in your professional opinion if this is good progress
that I am making?
<Dr. Cirangle> Missy: Can you tell me how tall you are?
<Moderator>
No answer back.
<Dr. Cirangle> Well, regardless, that's pretty good weight loss but
I need to calculate her excess body weight given if she is 6 feet tall
versus 4 foot 11.
<giner> what
is the difference between a distal and proximal RNY?
<Dr. Cirangle> Giner: The proximal RNY has less bypassed intestine
than the distal RNY.
<heather> Why
do insurance companies and doctors require the psycheatric evaluations?
<Dr. Cirangle> heather: There is a documented incidence of suicide
after weight loss surgery in unstable, undiagnosed depressed patients.
I've have seen many people who are on some kind of antidepressant. Also,
there must be some evaluation of the "sound mind" status for
the person to have realistic expectations about the changes and results
after weight loss surgery.
<Kim> how long
after surgery before you can swim, with Open?
<Dr. Cirangle > Kim: Well, if you staples are out, it make be another
2-3 months depending on how you are healing.
<Jeff> how long
before you can have sex?
<Dr. Cirangle> Jeff, with laparoscopic surgery, about 2-3 weeks is
a reasonable time. If you incisions hurt, as with any strenuous activity,
you should slow down. With open surgery, you should wait longer.
<mary> why do
some doctors not do patients over BMI 60? do you?
<Dr. Cirangle> mary: patients with a BMI over 60 are considered very
high risk and thus less experienced surgeons may not have the technical
skills are are concerned about the care of those patients more than we
are. Yes, we actually are specialists in taking care of high risk patients.
I believe my heaviest patient is 550 lbs and he lost 234 lbs in 1 year
with out a single complication!
<beth> my question
is about blood clots. What can I do before surgery to help prevent blood
clots.
<Dr. Cirangle> beth: increase your activity, stop birth control pills
1 month prior to surgery, undergo laparoscopic surgery which allows for
quicker recovery, return to activity, walk the evening after surgery,
etc.
<jerry> what
is the DS?
<Dr. Cirangle> The DS is also called the BPD-DS, or the biliopancreatic
diversion with duodenal switch, or just duodenal switch. It involves making
a narrow tube out of your stomach an bypassing all but the last 1 yard
of your small intestine to induce malabsorption of fat calories to assist
in weight loss, especially in superobese patients.
<Peach Tree>
what makes a surgeon a good one? what should I look out for?
<Dr. Cirangle> Peach Tree: Experience, Knowledge and explanation of
all the risks and benefits of surgery, a comprehensive preoperative preparation
and postoperative diet/lifestyle program described in written form, support
groups, responsiveness to calls/questions from patients and doctors alike.
Remember, the American Society of Bariatric Surgery and many papers have
described that there is a learning curve to become an excellent surgeon
and this is 150 cases. All of us (Dr. Jossart, Cirangle, and myself )
at Laparoscopic Associates of San Francisco far exceed that, perform 4
different procedures, with all the latest techniques, and underwent specialized
training not only to perform the operation but to take care of the patients
afterwards. http://www.lapsf.com/
and you can see what we do.
<Parrish> For
someone waiting to have surgery, what are some things I can do now to
help improve the outcome once I have it? I have a three month (at least)
waiting period...
<Dr. Cirangle> Lose as much weight as possible, significantly increase
your activity level, read as much and ask as much about nutrition and
vitamins and everything. Get into it. People often spend much more time
deciding on which car to buy than to pick their surgeon or the type of
procedure that they are going to have. We will even put our patients on
an Optifast diet to maximize weight loss for successful laparoscopic surgery
outcome.
<cat> i am 6
days post op and i want to know if i can have sex yet? I have pcos and
have tryed 13 years to get pregnant, should i really be worried about
getting pregnant now?
<Dr. Cirangle> cat: congrats! as I said it's 2-3 weeks. It is a serious
mistake to assume that you will continue to be infertile. Start a reliable
birth control method. I had a patient who never menstruated, started 2
months magically after her surgery and was pregnant by 6 months after
surgery. That is very dangerous for the developing fetus and is severely
discouraged. Your body is going through significant changes and you even
have a chance of getting malnourished with vitamin deficiencies. What
do you think would happen to a developing fetus with folate, vitamin deficiency
if you are vomiting from a stricture or having severe diarrhea? Be safe.
<mainemissy28>
how do we get our weightloss started again after it stops from a medical
reason.. ? i had cancer of the thyroid , i was hypothyroid wich made my
motablism not working.. and i need a way to jump start my wls again..
<Dr. Cirangle> mm28: just start off as if you just had surgery: eat
protein (fish, chicken, meat, lean pork) first in your meal, exercise
5-7X a week, drink plenty of liquids, keep you calorie intake below 800/day,
see your surgeon, go to support group meetings, take your vitamins, calcium,
B12 if you had an RGB and ADEK vitamins if you had a DS, etc etc.
<lori> How long
should one wait to get a tummy tuck?
<Dr. Cirangle> lori, you want to wait until your weight stabilizes
and your comprehensive nutritional, metabolic panel of blood tests are
normal.
<Kelley F> About
what percentage of calories do we lose because of malabsorbtion with a
RNY?
<Dr. Cirangle> Kelley F: it depends on if it's proximal or distal but
most of the weight loss with a proximal RNY is from the small amount of
food you ingest (restriction) and not any significant malabsorption of
calories.
<carrie> I reciently
had versed for a vascular procedure, since Monday my lap band has been
very tight, wondering if the versed had anything to do with this?
<Dr. Cirangle> carrie, probably not.
<luke> Why do
many post-op gastric bypass patients experience problems with their gall
bladder?
<Dr. Cirangle> luke: actually I would say that the opposite is true.
If you take Actigall 300 mg twice a day for 6-12 months, your risk of
gallstone formation is dropped from 33% to 2%.
<todd> i'm 7
weeks out and not doing as well with foods i ate 3 weeks out in fact i
feel nausiated daily now
<Dr. Cirangle> todd: which procedure did you have and did you tell
your surgeon? what did he or she say? what are you eating or drinking
nowadays? are you having any abdominal pain?
<Moderator>
no reply yet...
<Dr. Cirangle> Anyway, if you had a RNY, you may need an endoscopy
for a stricture soon.
<Tim> What does
you BMI have to be to qualify with most insurances for the surgery? Or,
is there a weight chart that says if you are 100 pounds over weight?
<Dr. Cirangle> Tim: BMI > 40 or 35-40 with medical problems. You
can go to my website http://www.lapsf.com/
to calculate your BMI.
<Roberta> HOW
COME I THROW UP FOOD THATS SUPPOSE TO BE GOOD FOR ME BUT CAN EAT AN ICE
CREAM CONE NO PROBLEM
<Dr. Cirangle> Roberta: Here is what I tell patients: Take ice-cream,
pasta, mash potatoes, lettuce, etc and put it in a bowl of warm water.
What happens to that stuff? They just dissolve and can go down any narrow
pipe. If you take a piece of chicken and do the same, it will sit there
for a year. You need to chew your food well. Talk to your surgeon. Make
sure you don't have a stricture. If fish is OK you are probably OK but
communication of these symptoms is important, and an experienced surgeon
should be able to give some answers.
<Moderator>
last question goes to.....
<kathy> i have
had this surgery done in 1998 and now i have a leak and have to do it
again so my guestion is could this leak be harmful if it is not fix.
<Dr. Cirangle> kathy: I don't understand how you can have a "leak"
seven years later. If you have a fistula, you probably have not lost or
have regain a lot of weight. It depends on what you mean. Please ask your
surgeon or see one for evaluation with x-rays.
<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
<Moderator>
Another Great Chat tonight!! Dr. Cirangle, Thank you for coming tonight and
helping out the Members with all their Questions. Have a good night.
<Dr. Cirangle> Thanks Everyone! Good Night! I will be on my website
now http://www.lapsf.com/
to start our weekly support chat for anyone to join.
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