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Chat with Dr. Jossart, December 8, 2003

I have had 5 surgeries over the years when smoking wasn't an issue. why is it now?

Smoking is an issue in morbidly obese patients since it puts you at risk for immediate lung problems after any surgery, of course, lung cancer and lung damage in the long run. Remember, obesity surgery is ELECTIVE and the risks must be minimized.

What is the difference between a distal and proximal bypass?

Snickey999, a gastric bypass involves connecting a small stomach pouch to some portion of your intestine. That portion can be further along the intestine (distal) or further up the intestine (proximal)... Distal bypass involves increasing the malabsorptive aspect of the gastric bypass surgery.

I am interested in the lap band surgery. Like many other patients I've have been on every diet under the sun. The most I have ever lost is 30 pounds. I'm currently 120 pounds overweight. My concern is that I get all gung ho on a diet anywhere from a week to maybe 3 months. I have severe cravings like an alcholic has with alcohol. The cravings hurt after a while if I don't eat chocolate to sooth. I'm afraid this surgery won't stop the cravings and I will have the most expensive attempt

Karen, as with any type of currently approved bariatric surgeries, we decrease your stomach size and the amount of food you can take at any one time/meal. Surgery does not intend to change your choices of food, including bad choices. You have to be motivated to do that yourself. After weight loss surgery, LapBand included, you will feel full after 2-3 ounce-size meals and you have to use this result/situation as a tool to lose weight. Oftentimes, my patients do change their habits and sweet things taste too sweet. It is an interesting effect. Talk to you soon.

I am 6 weeks post op and I'm concerned because I've only lost 25 lbs.

Hi Jackie... can you tell me what type of surgery you had, laparoscopic, where performed, etc.

I'm very concerned because from the posts I read, others are losing much more quickly. I had open RNY, San Antonio and this was done while removing a band I had in place from Dr. Molina in 97.

Jackie, do you know if your stomach is divided and how large they said your stomach pouch is now....?

I know it is divided, but I don't know the size of it. I have yet to feel full, but I stop myself after eating about 2 oz of food.

Hmmm.... what kind of diet are you on now, that you are at 6 weeks?

I have been on solid food since about week 3. I am off of all restrictions. Potatoes cause me to dump, and I don't eat sugar but pretty much anything else, chicken, salad, beef

Did your surgeon give you any instructions regarding what types of food you should be eating?

I'm eating 3 meals a day (protein first) with 1 oz of almonds and 1 oz of beef jerky per day.

Did he or she provide you with a diet manual? What has he or she said that you should expect from weight loss?

She said protein first and if I have any room then I can eat veggies. For snacks, only nuts, beef jerky or sugar free jello.

In the first 1-2 months, after surgery, my patients are often losing 1/2-1 pound a day. How much water/liquids are you drinking each day? What is your starting BMI, weight?

My BMI was 50 and the weight was 303 day of surgery and 310 1 week before surgery. I'm drinking about 95 oz of sugar free liquid per day.

What is your caloric intake each day? Protein intake? Fat? Carbohydrates?

I've been tracking on Fitday.com and my total calories ranges between 400 - 600 per day with about 40% protein, 30% carbs and 30% fat.

How much exercise are you doing?

10,000 to 13,000 steps per day.

OK... Here is my recommendation, which is how I instruct all my patients: After surgery, you should be consuming 70-75% of all your total calories (<800cal/day) in the form of protein, with only 20% from carbohydrates, and only 5-10% from fats... So protein intake should be >70 grams per day, <40g carbs, and <30g fats per day. You are doing well with your caloric intake. I"m not sure what 13,000 steps are, but you need to exercise 5-7 days a week 45min-1 hour a day at least, drink plenty of liquids which you are doing well and attend support group meetings, such as this one online. You are eating too many carbs and fats. You do not need all the carbs (veggies, potatoes, breads, starches) and you must minimize your fats also. Good luck!

MY BMI IS 64, CAN I STILL GET THE LAP RNY? Which hospital do you use to do your surgeries?

Dixie, with a BMI at 64, you are considered super,super-obese, with the associated high risks for complications. We would not recommend a RNY but a vertical gastrectomy. I operate at California Pacific Medical Center.

with any of the types of surg., what do you see as happening to the patient in about 10-15 years (medically) Do you know for sure?

Laurie, from the literature, patients in 10-15 years are expected to lose 60%-80% of their excess body weight, have a 70-90% chance of resolving their obesity-related disease, become more fertile and increase the likelihood of having non-obese infants, depending on the operation.

If diagnosed w/sleep apnea and Dr. didn't order C-PAP is this a problem at surgery time?

If your sleep apnea is severe, you need to be on CPAP since you are at risk for having lung problems after surgery. Also, according to sleep doctors, the swelling in your airway may also improve. If your sleep apnea is mild, then you may need it just after surgery for recovery.

Dr. Jossart, I am 3 weeks post op and taking Centrum Vitamins and an iron pill. SHould I be taking a calcium pill too?

Absolutely, MaryE, most surgeons recommend 1000-1500g calcium intake a day for the rest of your life to avoid osteoporosis, preferably calcium citrate. It is not too late to start now.

Is it normal to be tired for several months after RNY procedure even though I follow a vitamin regimen faithfully?

Most patients find an increased energy level. However, it is not unusual to be tired, you need to make sure you are not protein deficient, nor are you deficient in things such as folate, vit B12, etc etc... Your surgeon should be able to test you for micronutrient and mineral deficiencies.

I HAD THE LAP RNY ON NOVEMBER 17TH AND THE LAST COUPLE OF WEEKS I HAVE BEEN EXPERIENCING PAIN ON MY LEFT SIDE UNDER MY RIBS. IT CAN BE VERY INTENSE. IS THIS NORMAL OR DID I DO SOMETHING WRONG?

What is your current diet? Is the pain associated with any particular food? How fast and how much liquid are you drinking at each sitting? Are liquids going down well?

Soft solids, no pain with any foods. I feel I am sipping slowly at around 1/2 cup at a time.They go down well.

You need to contact your surgeon. At this point in your recovery, if pain is just spontaneous without association with diet or bowel movements, you may have something as simple as constipation or as serious as a bowel obstruction from adhesions, internal hernias, or other surgical issues. You may need x-ray evaluation to determine this and sometimes just to have exploratory laparoscopic surgery to figure it out. Other things such as strictures can be fixed with endoscopy and balloon dilation by an EXPERIENCED gastroenterologist.

5 mnths post op, i had/have problems drinking all the protein drinks, heart pounding, sweats, have to lay down, and my hair is falling out in gobs, i am taking biotin for my hair, but there seems to be no end in sight, help

Wendy, what has your surgeon told you?

i haven't been back yet. i went to the 3 mnth and now i am waiting for the 6 month check up.

OK. You are experiencing dumping. What kind of protein drink are you having? Hair loss may be part of your weight loss. How much protein are you ingesting each day?

I was drinking myoplex, and one time i tried the fruity kind but that sent me to the hospital with hives, i am starting to drink the myoplex again, and the muscle milk gave me dumping

How much protein, carbs, cals are in each serving of Myoplex?

i am bad and not sure, but i eat a cup of ham & cheese and turkey for lunch every day, nuts, ....Carbs are low, its the low carb type, and if i drink 2, its 40 grams per day. Of protein..........that is what my dr told me 40 g per day...what is the recommended that you suggest

It has too many carbs. Pick a different one. How much protein are you eating/drinking each day? Are you taking vitamin B12 sublingual? How about flax seed oil, or the Hair/Nail supplement at GNC. Try that.

I think Wendy meant 40 grams of CARBS each day! I think Myoplex has 55g of protein per serving.

My doctor has done about 140 open RNY but only 8 lap and that is why I am worried about having the lap. He is a Doctor at Travis Airforce base and so maybe there is just not enough people who make the grade to have the lap, do you think its ok to go for the Lap?

London, you have to be comfortable with your surgeon to undergo surgery. I'm not sure what you mean about making the grade. All of my patients who qualify for the RNY have it done laparoscopic.

do you feel carbonation is something to avoid? I have heard yes and no. What do you say and why?

Yes, ... I will give you an example of why.... When you down a half can of CocaCola versus the same amount of water, which makes you feel TOO full? The Coke of course. This effect is from the carbonation and thus will expand your stomach which may make your pouch larger and allow you to eat more, defeating your surgeon's intentions.

How can you tell the difference from over eating causing vomiting or a stricture causing vomiting?

If you eat 2-3 ounces of food, you should not be vomiting. If you are you may have a stricture or some other problem. You need to talk to your surgeon.

<**MODERATOR**> I WILL GIVE YOU THE LAST QUESTION FOR THE NIGHT Dr. Jossart :)

during the rny surgrey why do they not always take out the gallbladder? I know 2 people that went through the same clinic and one came out and the other ones did not please explain

Laura, I cannot read the mind of your surgeon (where was it?), but in general, gallbladder removal during weight loss surgery is not required. The risk of forming gallstones requiring removal is anywhere from 25-34%, but Actigall taken for 6 months during your most rapid weight loss period, can reduce your risk down to as much as 2%

Good night everyone!

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