| February 10, 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!
<Linda> I had
the lapband done in May 04 and believe i have a bout of the flu, sice
yesterday afternoon. I have only had propel and gatorade and cant even
seem to keep that down very well. Is it ok to take Imodum AD? Or do you
reccomend anything?
<Dr.
Cirangle> I would contact your primary care MD and have them take a
look at you. It shouldn't be a problem, but I try not to give medical
advice on the phone or over the internet.
<tami> how much
truth is there to the ability to "stretch" the pouch? Will overeating
at a sitting stretch it?
<Dr.
Cirangle> Overeating will definitely "stretch" your pouch.
It may not be significant after just one episode, however chronic overeating
can definitely be a problem.
<Christi> I
am a preop and worried about getting septic, why and how often does this
occur?
<Dr.
Cirangle> Sepsis is usually the result of a leak which statistically
occurs about 2-4% after a gastric bypass.
<brandy5yearspostop>
hi doc im5 years post op and have had my 6th hernia repair 2 mos ago and
now the dr. says theres another one is their something i can do to prevent
them from coming back? all these surgeries r making me depressed. dr.
said he put a plastic mesh in last time and he assured me no more hernias
<Dr.
Cirangle> Unfortunately, hernias are common after open gastric bypass
- perhaps as frequently as 30-40%. The liklihood of having a recurrence
of your hernia increase with each one. This is why many surgeons are such
strong advocates of laparoscopic surgery. Other than avoiding strenuous
activity, there really isn't very much that you can do to prevent these
problems.
<Laura> Is gastric
bypass as dangerous as I have heard it is?
<Dr.
Cirangle> In the hands of some surgeons - yes. However, if you choose
an experienced bariatric surgeon who performs these procedures regularly,
the overall risk of a serious complication should be less than 1%.
<Tom 81 lbs 2 mths>
one thing that I have noticed since my surgery is that my once bad back
has gotten much worse. I am wondering if this is something common and
do you have any suggestions as to how to make it better?
<Dr.
Cirangle> This is not common and actually is exactly the opposite of
what I would suspect. I would see your doctor and get a referral to an
orthopedic surgeon for evaluation.
<Leslie> Hi
Dr. Cirangle, I have my pre-op appt with you monday and surgery on thursday,
I know I'm going to be asking you questions then but I just was thinking
about this now and figured it was best to ask now in case I forget...In
my weight loss manual from your office, I see the minimum grams of protein
is 70, is there a maximum amount I shouldn't go over?
<Dr.
Cirangle> Not really. Actually, research has shown that the average
adult should get about 80-100 grams per day. As long as your kidneys are
functioning normally, you can eat as much protein as you like. I look
forward to seeing you on Monday!
<Pam in SDak>
Hi Doctor. I had open RNY on Nov 29,04. Since then I've lost 40lbs. The
weight seems to be coming off very slowly, is this normal?
<Dr.
Cirangle> I generally expect my patients to lose about 20-30 pounds
per month after the gastric bypass for the first couple of months. You
weight loss is determined by the number of calories that you eat (I recommend
800 or less per day) and the amount of exercise that you do (I recommend
45 minutes 5 days per week).
<Jennyfer> Is
it possible to develope a hernia along the incision line (open RNY) months
after surgery?
<Dr.
Cirangle> yes - see my comments above. Your chance of developing a
hernia is about 30-40%. Generally they occur within the first 2 years
after surgery.
<nicole> how
long does it take to hear from the insurance company?
<Dr.
Cirangle> Depends which insurance that you have and who is filling
the request. It can be as little as a couple of days or as much as 4-6
weeks.
<MichelleC - preop>
My surgeon has done thousands of other GI procedures, taught the laproscopic
technique at the Mayo clinic but has only done a few actual RNYs, should
I be concerned or trust his experience?
<Dr.
Cirangle> I would be very concerned. It is generally felt that it takes
at least 100 of these procedures before a surgeon will perform at their
best and have the least number of problems.
<lablack> If
someone has been told they have to see a deition for one year and they
do how low on a bmi can they go before the insurance will not cover them
still, I have some health problems but am with sugar
<Dr.
Cirangle> This question can only be answered by your specific insurance
company - I would give them a call and inquire.
<Patricia N SC>
Does going on a liquid diet 2 weeks before surgery (RNY) help shrink the
liver to optimize the chance of having it Lap?
<Dr.
Cirangle> If the diet is a healthy one such as Optifast. I generally
tell my patients that losing 5-15 pounds before surgery generally makes
the surgery easier both for you and the surgeon.
<Shawnalynn>
One of my questions to just confirm what I think I already know is...you
will not do surgery on someone that has Graves Disease, correct?
next question is at what point of remission would you require someone
to be in to do the surgery
<Dr.
Cirangle> I will operate on someone with Graves Disease as long as
their thyroid hormones are well controlled. It shouldn't be a problem.
<MichelleC - preop>
I'm 5'8", 235 and have a large body frame. How long post lap-RNY
can I begin serious body building? And is it realistic to think that I
could have a seriously athletic body post op? (I'm thinking along the
lines of Serena Williams)
<Dr.
Cirangle> If your operation is done laparoscopically, then you should
be able to go to the gym and lift weights 4 weeks after your surgery.
I actually have patients who have done this and look great!
<ellen> I am
going to have you do a fill in a week or two and I am worried that it
could be too tight but of course I want it tighter than now.....is this
common. I have the smaller band that holds 4 or 5cc total. I have had
one fill of 1.9 cc with Dr Rumbaut in Monterrey in Dec.
<Dr.
Cirangle> I perform the first fill for patients who have had their
band in Mexico using fluoroscopy so it should not be an issue. Other patients
have had this concern. It is rare to have problems if the doctor who is
doing your fills is experienced.
<XxTrKl> Question:
I had open RNY on 11/23/04. I have lost only 30 lbs. I get 80=100grams
of protien a day, and over 80 oz. of water or Crystal Light. I eat about
800-900 calories a day. I do water arobics 2 hours a day 3-5 times a day.
I DON'T over eat. I eat to eat protien. I just can't figure out why I
am not loosing faster? I have begged my doc to check me out, and he finally
did a Upper GI 'to appease' me. It was ok I heard today. Dr. released
me after only 2 weeks post-op. I am so
<Dr.
Cirangle> Please see my comments above to a similar question. I would
recommend that you keep a daily food diary - it may be that you are eating
too many grams of carbohydrates. An easy way to do this is to go to ww.FitDay.com
- you can keep an accurate log of not only the calories that you are eating,
but the number of carb grams as well. I recommend that patients eat no
more than 40 grams per day.
<barbl> The
national average of people dying from the rny surgery is 1 in 200. What
does the profile of a person who dies from this surgery look like. Are
there commonalities among those who don't survive?
<Dr.
Cirangle> Those who are at higher risk include: diabetics, smokers,
age greater than 50, history of pulmonary embolism in the past, those
who are in wheelchairs or unable to walk and perhaps more importantly
those who are operated on by inexperienced or inadequately trained surgeons
at hospitals that don't regularly do these types of surgeries.
<Kelly Liles>
Hi Dr. Cirangle. Dr Jossart did my surgery on Jan 11, 05. I have lost
about 27 lbs so far. I have not had any dumping problems yet. Just the
opposite. I can only tolerate meat. What can I take to loosen the stool?
<Dr.
Cirangle> Great weight loss - you are doing very well. Many people
experience intermittent constipation. I recommend the following: increase
the amount of water/fluid that you are drinking, integrate salad and vegetables
into your diet, and if you still have a problem take supplemental metamucil
or fibercon. You can occasionally take 2 or 3 tablespoons of milk of magnesia
as well.
<Tammy> I am
having Lap RNY, and was wondering if proximal or distal was better and
why?
<Dr.
Cirangle> I believe that a distal RNY is only appropriate for those
undergoing a revision procedure (already had a weight loss surgery and
didn't do well). For virtually everyone else with a BMI of less than 60,
the proximal RNY is probably the best choice between the two.
<Barry Plotkin>
for an Open RNY, what would you say would be the avg time, after a surgery
without complications, that you'd have to recover@home before returning
to a desk job?
<Dr.
Cirangle> Probably 3-4 weeks - occasionally up to 6 weeks. With a Lap
RNY it is about 2.
<Patricia N SC>
Some protein drinks have 50g some 20g, etc. How much can we actually absorb
in a day?
<Dr.
Cirangle> You will probably absorb most of what you drink. My suggestion
is to find one that you like.
<Kim Filip>
I have had the lap band for 6 almost 7 months. I had a fill at 6 weeks
it wasn't enough then a fill a month later that lasted me for 4 months.
Then I went for a fill a week ago-I had no restriction all of a sudden
so they fille me up to 2.2-it did nothing, I had to go back and now they
have me at 2.8. It's good but not as tight as when I had the earlier fill's
when I was just 1.8. My question is how much tighter can you go-I thought
you would get to a sweet spot and stay.
<Dr.
Cirangle> As you lose weight, your sense of restriction will decrease.
At some point however, things will stabilize. This is usually close to
your goal weight.
<tarnished halo>
ok doc.. here is my question. I was 6 weeks preggers and had really bad
cramps which I thought was just cramps..it turned out to be contractions
and I lost the baby, could this is attributed to me having wls 1 year
ago??
<Dr.
Cirangle> I never recommend anyone who has had WLS become pregnant
for a full 2 years after surgery.
<mike berkwit>
I am over 18 years post op from a bilio pancreatic bypass and have long
term anemia for which I have had to resort to Procrit shots to control.
Do you have any recommendations for a fix for this anemia
<Dr.
Cirangle> B12 deficiency can cause anemia - I would imagine you have
already tried this. The only other thing would be to reverse the BPD -
if your anemia was severe enough that is what I would recommend.
<Rodger> Is
there any significant difference between performing Lap RNY with a male
or female patient?
<Dr.
Cirangle> Males tend to be more difficult for the surgeon because they
tend to carry most of their weight in their belly.
<Katie> My insurance
provider (BC/BS of FL) has excluded coverage for bariatric procedures.
Are there any *prescriptions* you recommend to be researched by someone
like me who will need to lose 150+ lbs please? I would like to research
3+ prescriptions & ask my doctor which ones might be ok for me too.
<Dr.
Cirangle> Consider paying for the surgery yourself.
<Christi> can
you stretch your pouch to the size of your old stomach?
<Dr.
Cirangle> No - you shouldn't be able to do that. You can however gain
every single pound back that you have lost if you do not look at WLS as
a tool and use it to change your lifestyle and eating habits.
<LisaLisa> I
have a hard time eating at least 1/2 cup or 4 oz of food at a time...is
that normal?
<Dr.
Cirangle> You shouldn't feel as though there is a "minimum"
amount of food that you should eat. Most of my patients eat less than
that depending how far out from surgery they are.
<tami> what
would you say is an appropriate number of calories per day...I am 7 mos
out.
<Dr.
Cirangle> 800 if you had the RNY.
<Gayle> I am
considering having the gastric bypass but i have pulmonary hypertension
and I'm wondering if this puts me at greater risk during and after surgery
<Dr.
Cirangle> Absolutely it does.
<LisaLisa> Since
my surgery, I have a hard time with bm's...is this because of the iron...it's
soooo frustrating!!!
<Dr.
Cirangle> See my comments above regarding constipation.
<XxTrKl> My
doctor 'tried' something he had heard about. He made the insision under
my left rib cage. I was the first one he did this too. Is there something
because of that that could be preventing me from loosing weight as fast
as other? Something about a vegas nerve?
<Dr.
Cirangle> Not that I am aware of. The location of your incision should
have nothing to do with how much weight you lose.
<Brenda Z> what
is the biggest pro of bypass over lapband? if any
<Dr.
Cirangle> Statistically it has a greater weight loss, however I certainly
have many patients who have had a band who have lost just as much as RNY
patients.
<Vickie> Is
there any way I can avoid the nausea that seems so common when people
begin solid foods?
<Dr.
Cirangle> Eat small amounts, take small bites, chew well and try one
new food at a time. Don't eat and drink at the same time. Most of my patients
do not have trouble with nausea.
<ruthsan> My
doc recommended 3 meals 5 oz, everyone talks about 80-100 grams of protein
would something negative happen if I had less protein?
<Dr.
Cirangle> Yes - your wounds will not heal, your hair will fall out,
and you will feel tired and fatigued.
<stcynghty1>
hello doc i will be 2 years post op on june 4 and lately when i eat i
have been getting sharp burning pain in my right upper quaderant right
under my breast i don't know what it is?
<Dr.
Cirangle> You may have gallstones.
<Laura RNY 9/7/04>
I'm 5 months postop. Is there anything to help with the loose skin other
than plastics? I'm trying every cream I can find and it is getting depressing
with my hair falling out and my skin looking wrinkled and hanging.
<Dr.
Cirangle> Eating a healthy diet, taking your vitamins, drinking plenty
of water and exercising 5 days per week is the only thing I know that
will help. Look on the bright side - A bit of loose skin is a small price
to pay for your health and a better lifestyle.
<Moderator>
last question goes too...
<Tammy> In your
opinion, is there any way to slow down or prevent hair loss after RNY
surgery?
<Dr.
Cirangle> Yes. Make sure you get your protein each day (80-100 grams).
In addition certain vitamins also seem to help. Biotin 300 mcgs, zinc
50mg, coEnzyme Q10 100-200mg, primrose oil 500mg and finally flax seed
or fish oil (omega fatty acids). The good news is that the hair loss is
temporary - when you hit your goal weight it should all come back.
<Moderator>
Thank you for joining us this evening, Dr. Cirangle. We appreciate you
taking time out of your busy schedule to join us. Excellent chat, as always.
<Moderator>
Laparoscopic Associates of San Francisco. Website: http://www.lapsf.com/
phone: 415-561-1310 fax: 561-1713 Email: WeightLoss@lapsf.com
<Dr.
Cirangle> Thank you all and best of luck. Good night all.
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