| January 24, 2005
Chat with Dr. Cirangle at ObesityHelp.com
<Moderator>
Hello and welcome to this evenings chat with Dr. Paul Cirangle. If you
would like to ask Dr. Cirangle a quesiton, please type it out and hit
enter. Your question will be submitted to the surgeon in the order in
wihch it was rec'd.
<Moderator>
Dr. Paul T. Cirangle MD FACS, will be giving a free obesity surgery information
seminar this Tuesday, January 25th at the Outrigger Waikiki on the Beach
at 6pm. The Outrigger is at 2335 Kalakaua Ave in Honolulu. Please call
or email for details, Amy@LapSF.com or 866-957-3627 or toll-free at
(866) WLS-DOCS.
<Moderator>
Learn all the details about the surgical weight reduction options as well
as the advantages of laparoscopy. Dr. Cirangle is a laparoscopic expert
in the Lap-Band and Roux-en-Y Gastric Bypass procedures. Dr. Cirangle
is an HMSA provider. Please join us to have all your questions answered,
friends and family encouraged to attend too.
<Aiela> can
you tell me what is the difference between the lapband surgery and the
other bypass surgery?
<Dr.
Paul Cirangle> There are many differences, however the most fundamental
is that the LapBand does not require that any permanent changes be made
to your stomach or gastrointestinal tract. The LapBand is a plastic ring
that fits around the top of your stomach to help control your appetite
and the amount of food that you consume.
<Rita> How often
should a lap band patient get fills? My surgeon says every 6 mos, but
I have heard of other surgeons saying only when you feel like you can
eat more.
<Dr.
Paul Cirangle> I believe that each patient is different. When your
weight loss slows or if you begin to feel more hunger, a band adjustment
can usually help. The average patient requires 2-4 fills in the first
year, however some have none while others may have 4-6.
<Melissa> How
soon after lap bypass procedure can you return to work?
<Dr.
Paul Cirangle> Virtually all patients can return to work within 10-14
days unless they perform strenuous manual labor -and then it may be longer.
<Ronda preop>
Dr. I got your email this weekend about the seminar tomorrow. What will
you be doing at the seminar, will it be a group discussion or will you
meet one on one with us?
<Dr.
Paul Cirangle> It will be a combination. I will be addressing individual
questions and issues and also trying to discuss the important issues surrounding
each of the procedures that I perform as well as weight loss surgery in
general.
<Krissy> What
are the advantages of the lapband compared to the rny surgery?
<Dr.
Paul Cirangle> The main advantages are as follows: 1) the band is a
less risky surgery 2) the band is adjustable and reversible 3) the band
is a shorter hospital stay and quicker return to work and 4) there is
no rearrangement of the intestinal tract or stapling of the stomach with
the lapband.
<christina>
I am 18 months post op and i have wuit losing weight eventhough i am doing
45-60 min on an eliptical 3 days a week and moderate strength training.
how do i just start my metabolism without reducing caloric intake
<Dr.
Paul Cirangle> If you would like to lose more weight at 18 months,
you will need to increase your workouts to 5 days per week and decrease
your calorie and carbohydrate intake by 10-15%.
<Cheryl G.>
Hi Dr. Cirangle! I have a BMI of 55. Can I have the RNY gastric bypass
done on me laprascopically?
<Dr.
Paul Cirangle> Absolutely. I have operated on patients laparoscopically
with BMI's of >80.
<Mark> Hello
Dr. I am looking to have weight loss surgery. Does your office help me
to get insurance approval? My BMI is 46. Thank you for your time.
<Dr.
Paul Cirangle> Mark. Absolutely. Our office will not only obtain the
insurance authorization, but will also assist you in any way that you
need to make surgery a reality for you.
<Ron> Hi Doc.
I am almost 4 mos post op from rny, but I have been on a plateau since
2 mos post op. Do you think my surgery has failed or am I failing the
surgery?
<Dr.
Paul Cirangle> Hard to say Ron. Most patients, if they are eating properly
and performing exercise 4-5 days per week will lose at least 10-15 pounds
at 4 months postop (that is per month).
<lil lo> I would
like to know, what type of diet to follow 6-12 months after vbg wls?
<Dr.
Paul Cirangle> My recommendation is 800-900 calories per day with no
more than 40 grams of carbohydrates each day. Make sure to get 90-100
grams of protein and exercise 4-5 days per week for 45 minutes. This will
vary some depending on the amount of weight that you would still like
to lose.
<Cheryl G.>
With the RNY gastric bypass procedure, what happens to the rest of the
stomach that is no longer used for digesting food?
<Dr.
Paul Cirangle> It continues to secrete digestive juices and function
normally - it just does not participate in storing food any longer.
<Riena> being
18 mos post op, I have stopped losing weight. Is there a way to start
losing again or is my window of opportunity closed? I had RNY
<Dr.
Paul Cirangle> You can still lose weight, but it will be much harder
than when you first had your surgery. Please see my reply to Christina
above. In short 800 or less calories per day and 5 days of exercise for
45-60 mins.
<judyt> does
this kind of surgery help diabetes
<Dr.
Paul Cirangle> Excellent question Judy. In more than 90% of patients
who are diabetic preoperatively, after surgery they will no longer need
medications and will have normal blood sugars. Weight loss surgery is
the only known cure for diabetes at the current time.
<GREG 2 DAYS TO
GO> Dr. I am having Open RNY surgery in two days and was wonder if
any advice to take before the big day?
<Dr.
Paul Cirangle> I feel strongly that there is a very real difference
in open vs. laparoscopic surgery. If you can find a surgeon who performs
this procedure laparoscopically - definitely do so. If not, make sure
that you get up and walk immediately after surgery and use the breathing
machine that they give you in the hospital frequently to help keep your
lungs clear.
<Becky> I am
scheduled for surgury on Feb. 24th and I am really getting scared. What
is the death rate of this procedure?
<Dr.
Paul Cirangle> This is quite dependent on the surgeon who performs
your surgery. The national average is about 1%, however some surgeons
may have death rates 2x this high. Knock on wood, my group has not had
a death in more than 3 years and 1000 surgeries.
<christy> i
need to quit smoking before my surgery how should i replace food and ciggarettes
<Dr.
Paul Cirangle> With healthy choices. Exercise and a low calorie, low
carbohydrate diet are my recommendations.
<PrincessQ>
Hello Dr. Cirangle. Can you tell what kind of surgeries you perform? And
also, what type of weight loss surgery do you think is the best to have?
<Dr.
Paul Cirangle> I perform 4 surgeries for weight loss in addition to
revisions for patients who have failed previous procedures - 1) LapBand
2) RNY Gastric Bypass 3) Duodenal Switch and 4) the Vertical Gastroplasty
-- all laparoscopically. I try and fit the operation with the patient
to maximize the results (weight loss) and minimize the chance for complications.
<Mikey> I am
6'4 and about 390 lbs. My pcp says I need to have this surgery, my knees
are shot. What procedure would you suggest for me?
<Dr.
Paul Cirangle> That depends on your age and your medical conditions.
I believe that when a patient is matched with the appropriate procedure,
they should expect to lose at least 70-80% of their excess weight. Most
people lose more than this in my experience.
<christy> my
insurance requires 5 yr weight history i didnt have insurance until 2002
how can i fulfill this requirement
<Dr.
Paul Cirangle> Your weight history is a separate issue than your insurance.
What they are looking for is your weight for the past 5 years and the
types of programs that you have tried to lose weight with (diet plans).
This is not dependent on your insurance status.
<amy> why is
it so difficult to find a surgeon that performs DS?
<Dr.
Paul Cirangle> Because it is a very difficult operation to perform.
Across the country, probably fewer than 40 surgeons perform the DS - far
less perform it laparoscopically.
<Loretta> How
effective is medications, such as Lexpro, Coreg, Cozaar, etc, absorbed
in the first few months after RNY surgery. Will the dose need to be increased?
Will it be better absorbed with solid foods or protein shakes?
<Dr.
Paul Cirangle> Medication absorption should not be affected in any
significant way in a properly performed RNY gastric bypass. As patients
lose weight, most either reduce their dosage of their medications or stop
them completely because high blood pressure, diabetes, and other problems
resolve.
<Linda21249: After
WLS( May 2003)> I have lost104 lbs. would like to loose 40 more.. As
of Nov i have been treated for Ostoarthritis of Knees, had physical therapy
with Ice packs following.. No meds.. Then 3 shots of Synvisc.. On MY Last
shot,,(5 days later.. I developed extreme stiffness.. Other than IBuprofin(
LIquid childrens) 4tsps per doze every 6 hrs.. Is there anything else
i can take? After 5 days on the medicine i have developed stomach upset,
and constipation,,
<Dr.
Paul Cirangle> You may need a joint replacement. I would caution any
patient who has had a gastric bypass against using anti-inflammatory drugs
such as motrin as they can cause serious ulcers (even in liquid form).
<Marshall> Hello
Dr. Can you tell me if you perform the DS surgery and what your opinions
are on this surgery?
<Dr.
Paul Cirangle> I do perform the DS, and I do it laparoscopically. I
think that for the right patient it is an excellent procedure. It requires
more meticulous follow-up and monitoring however than the other procedures.
<jenny: Good Evening....I
am 49 yrs. old...and had the RNY about 19 months ago. Why is it some people
seem to lose to goal without difficultly....My loss was kind of stair
steps...but I am currently 200-205 for the past 6 months. I work on the
diet and excercise and go down and few then go back up. I am a size 18.....not
looking for perfection just would lik eto make it down to 170----maybe
a size 14.
<Dr.
Paul Cirangle> The weight loss that you get really depends on the effort
that you put into the first 10-14 months after surgery. This is when 95%
of your weight loss will occur after the RNY gastric bypass. At 19 months
postop, the only way you will lose more weight is by increasing the frequency
and intensity of your exercise routine and reducing your calorie and carbohydrate
intake. In some patients, I have been successful in using Opti Fast supplements
to help as well.
<mary> Are kidney
transplant recipients elegible for gastric bypass?
<Dr.
Paul Cirangle> They are, but in my opinion on a case by case basis.
<preopangel>
Hello doctor..I never thought i could find a place where i could talk
to a doctor like this. I am very obese and I am thankful to know you are
someone here to help me. I have tried many diets in my lifetime and I
have failed them all. Can you help me to understand why weight loss surgery
would be ok for me? I am scared yet hopeful.
<Dr.
Paul Cirangle> Weight loss surgery drastically reduces the level of
the hormones in the body that stimulate appetite - this is why they work
so well. Virtually all of the patients that I have operated on have failed
at least 6-10 diet plans - their average weight loss has been more than
83% of their excess weight. There is no reason to think that you cannot
be this successful as well. ObesityHelp
is a great resource for patients like yourself looking for answers.
<Tammy C> I
was wondering I am 7 months post-op lost 72 pounds so for but, I have
not lost anything is five weeks, still drinking my water, walking 2 miles
a day and eating the right foods
<Dr.
Paul Cirangle> My suggestion - keep a daily food journal. www.FitDay.com
is a great way to do this. Make sure that you are eating 800 or less calories
each day and 40grams or less carbohydrates. Focus on lean meats, eggs,
fish, tofu etc. Increase the intensity of your exercise so that you walk
3-5 miles or incorporate hills into the routine. This should restart your
weight loss.
<Cathy Carver>
As you get closer to your goal weight, does the rate at which the pounds
are lost slow down?
<Dr.
Paul Cirangle> Cathy - how are you. Glad you could be here. Absolutely.
As you approach your ideal body weight, your loss will definitely slow
down. This is a protective mechanism so that you don't lose too much weight
<kristine> Hello.
I have read so many news items about the morbidity rate; I'm hoping you
can clear that up for me, specifially, how many patients die from the
RNY lap? Basically, how safe is this proceedure?
<Dr.
Paul Cirangle> Please see my answer above to Becky. The mortality rate
nationally on average is about 1%. This is very surgeon dependent. Some
surgeons have rates that are significantly higher than this - that is
why it is important to chose one who is experienced. My partners and I
have not had a death in over 5 years (knock on wood).
<gary> i am
6 days post op. on full liquids. is a full cup of cream soup too much
?
<Dr.
Paul Cirangle> Cream soup is not a great food choice - lots of calories
and very little nutrition. Drink a protein shake or a glass of skim milk.
<Alexis> Hello
Doctor! I was wondering what made you decide to be a weight loss surgeon.
Was there someone in your life that prompted your career or was it your
research?
<Dr.
Paul Cirangle> It is the patients. I think that they are the best and
most rewarding patients to work with. As a doctor, it is not very often
that you get the opportunity to give someone their life and lifestyle
back - this happens every day with weight loss surgery patients.
<Tamela> I am
16 months out of surgery and have lost 170lbs. how soon should I look
at skin removal surgery
<Dr.
Paul Cirangle> I recommend that you wait until your weight has been
stable for 3-6 months. I think that a consultation with a plastic surgery
as soon as you have reached your goal weight is important however so that
you have some time to plan and find one that you are comfortable with.
Congratulations - that is excellent. You are an example for all of the
patients in this chat.
<Moderator>
And, the last question of the evening, goes to..
<Terri G.> Are
there any long term effects to WLS?
<Dr.
Paul Cirangle> Terri - absolutely. There are too many to discuss in
a forum such as this. Anyone who is considering weight loss surgery should
invest the time and have a consultation with an experienced surgeon so
they can determine for themselves whether weight loss surgery is right
for them.
<Moderator>
Thank you, Dr. Cirangle for joining us this evening. Members, to attend
the free obesity surgery information seminar this Tuesday, January 25th
at the Outrigger Waikiki on the Beach at 6pm. The Outrigger is at 2335
Kalakaua Ave in Honolulu. Please call or email for details, Amy@LapSF.com
or 866-957-3627 or toll-free at (866) WLS-DOCS.
<Dr.
Paul Cirangle> Thanks all - and good luck in your quest for good health
and a healthy lifestyle.
<Moderator>
Thank you and have a great evening, Dr. Cirangle.
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