[Thu Oct 03 23:13:45 PST 2002]
<**MODERATOR**> LISA, YOU HAVE THE FIRST QUESTION:)
Now that I have hit goal, what can I do to keep from gaining weight again?
That is great that you hit goal but you must never let your guard down. Keep a regular exercise program and monitor what you eat. Late weight gain is something to watch for and can be avoided if you keep your total daily calories low(1000-1500) and exercise regularly.
<**MODERATOR**> CARRIE YOU HAVE THE NEXT QUESTION PLEASE:)
i had open rny feb 8 02 5 9 370 now 5 9 225 i notice it has slowed and i can accomodate more food is this norm or should i worry about staple line dissruption,not transected. i think im distall. also how long will the loss for me continue estimate please. im on a plateau now but was losing 1 to 3 a week
If you are worried about staple line disruption you should have an upper GI x-ray. You have had a good weight loss so far, keep up the good work and it should continue.
ty
<**MODERATOR**> HOOSIER HELEN YOU HAVE THE NEXT QUESTION PLEASE:)
I 54 yrs old, scheduled for LAP RNY for Jan 31, 03. I am concerned about nutrition after surgery, I currently take alot of supplements, will I be restricted after surgery with my choice of nutritional supplements?
You will be restricted in everything you take after surgery but eventually your pouch will increase and you will be able to consume a little more. Supplements is a very broad term so that is a difficult question to answer.
<**MODERATOR**> STEPHANIE T YOU HAVE THE NEXT QUESTION:)
Hi Dr.. Jossart. I've heard of many people having to have their gallbladder removed after WLS due to the rapid weight loss. Is there anything we can do to reduce our risk of gall stones? (besides taking bile producing salts...my surgeon says there's not enough data to support that approach)
Recent data suggests that if you take actigall during rapid weight loss you can reduce the chance of needing your gallbladder out from 28% to 2%.
cool. thanks!
<**MODERATOR**> STEPH IN NJ/NY YOU HAVE THE NEXT QUESTION:)
should a person with obstructive sleep apnea be in icu post op for at least a day? Is there anyway/what's the best [if any] way to prevent or make hair loss minimal???
In general people with sleep apnea should be in a monitored setting for the first day or two. This can be the ICU or another monitored floor. Nothing proven for hair loss but with time it almost always grows back to the way it was before surgery.
<**MODERATOR**> DENISE YOU HAVE THE NEXT QUESTION:)
In your experience, how common is protein malnutrition after the DS? I'm post-op and I really struggled with my protein intake during the first two months (I'm vegetarian, which didn't help). My 3-month labs showed slightly low albumin. My protein intake is close to what my surgeon says it should be now (at least 70 grams per day), but I've heard it takes a long time to reverse protein deficiencies.
I guess I'm asking if I should be worried!
Protein def is the the big fear with the DS. Your surgeon needs to follow you closely. If your albumin is low you may be in trouble. I suggest you stay in close touch with your surgeon and if it is me we should talk tomorrow but I don't think it is.
No, it's not you. Thanks. :-)
<**MODERATOR**> MIAMIGIRL YOU HAVE THE NEXT QUESTION:)
Hi Dr.. Jossart, Thank you for taking the time to speak to us. Are there any statistics yet on WLS on the elderly? I am concerned how the operation itself will affect me when im old......
Interestingly, the risk of dying from obesity is significant so without surgery becoming old may not be an option. As you age you tend to lose weight so in your 80's you may need more supplements but by that time your pouch will hopefully be big enough to compensate.
Thank you for your time.... have a Good-Night :)
<**MODERATOR**> SAM YOU HAVE THE NEXT QUESTION:)
Dr.. Jossart, what is the difference in weight loss with an open rny and a lap rny? What are the pros and cons band vs.stitching?
Should be no difference between open and lap but some surgeons may leave a bigger pouch vs a smaller pouch and this may affect weight loss. The second half of your question is too difficult to answer in the short time I have.
<**MODERATOR**> EAGLE EYE YOU HAVE THE NEXT QUESTION:)
What is Protonix for and how long do DS patients need to take it?
Protonix is a powerful antacid and DS patients should only need while they have reflux or vomiting symptoms. Most seem to resolve by the end of one year.
<**MODERATOR**> STEVE-SHELLY YOU HAVE THE NEXT QUESTION:)
<~Steve~Shelly~> Hello Doctor... What about arthritis meds, Ridura as well as Nsaids? Should they be stopped prior to surgery, if so how far before?
Nsaids should be avoided after a Roux en Y but can be taken in limited amounts after a DS. Hopefully arthritis would improve with weight loss to the point where you would not need those meds.
<~Steve~Shelly~> ~~~Thank you so much~~~
<**MODERATOR**> FIRECRACKER YOU HAVE THE NEXT QUESTION:)
I am a diabetic and I have signs of early kidney damage because I am leaking protein in my urine, I am pre-op and I have heard that Diabetes can go in remission or go away after surgery. my question is right now I am not suppose to be eating allot of protein rich foods, but yet in order for the surgery to be successful I need to take in protein after surgery to lose weight, so in my case would eating high protein foods or Dr.inking protein shakes harm me, what advice would you give one of your patients that had my situation going on. Because the morbid obesity is causing major health problems like squeezing my airway shut but I don't want to damage my kidneys further either because I must lose weight
Most likely your diabetes will go away shortly after surgery and your kidney function will improve. Protein supplements up to 70 grams a day should be OK.
<**MODERATOR**> HEATHER YOU HAVE THE NEXT QUESTION:)
Hi Dr.. Jossart-I actually have 2 questions please. In your experience do sufferers of endometriosis have a higher adhesion occurrence? And what is your opinion of soy protein (for the vegetarians) rather than animal protein?
I have only taken care of a few endometriosis patients and if they did not have pelvic surgery their adhesions were minimal. Soy protein is OK but I don't think you can get by on just that.
thank you
<**MODERATOR**> LISA N YOU HAVE THE NEXT QUESTION:)
I had my gall bladder removed laproscopically about 6 yrs ago. Would I still be able to have the RNY done laprocscopically?
Usually, that is not a problem at all.
Thank you
<**MODERATOR**> LAURA YOU HAVE THE NEXT QUESTION:)
I'm having surgery in a week and I'm scared because I think I have a eating disorder and I have not been totally upfront with my surgeon about this. I don't eat all day, then right before bed I clean the kitchen out. I binge eat. I even eat in my sleep. It's uncontrolable and I'm afraid it will ruin my upcoming surgery. I'm 21 yrs old with a BMI of 50. Should I procede with my surgery?
That's a tough problem but for most patients eating habits change quite a bit after surgery and so do tastes so I think it is OK but you really should tell your surgeon as hiding things is a bad idea.
<**MODERATOR**> VICKIE YOU HAVE THE NEXT QUESTION:)
Thanks for being here Dr.. Jossart, I'm 43, I'm Apple Shaped and I'm not a mushy fat, I'm solid. Will this "tool" work for me? and will my middle ever go away? I am dedicated to making this work.
That is not a lot of information to give an opinion on but it does work for most people.
<**MODERATOR**> LISA D. YOU HAVE THE NEXT QUESTION:)
After reaching your goal weight how does your body know when to stop losing the weight?
Usually your body starts to conserve. Your pouch dilates some and the intestines try to absorb a little more so it is unusual to lose too much weight. It can happen and this is a reason for people to have the operation reversed.
<**MODERATOR**> STEPH IN NJ/NY YOU HAVE THE NEXT QUESTION:)
MY DOC MENTIONED SOMETHING ABOUT THERE BEING A CHANCE, ALBEIT A LOW POSSIBILITY, THAT THE LAP PROCEDURE MAY END UP HAVING TO BECOME AN OPENRNY SHOULD A PROBLEM OCCUR DURING THE LAP PROCEDURE, WHAT TYPE OF "PROBLEMS" WOULD JUSTIFY SWITCHING TO OPEN, MIDWAY? DO MORE DEATHS OCCUR DURING SURGERY OR POST OP AND FROM WHAT [MOST COMMONLY]?
Reasons for open are bleeding, fragile tissues, poor visibility, misfiring of staplers, leak that can't be fixed laparoscopically. Patients who have the procedure done open usually do OK. Patients who do poorly are those who have complications that are not picked up early enough
.
<**MODERATOR**> DEE YOU HAVE THE NEXT QUESTION PLEASE:)
I had my open incision packed today by my surgeon, they said a home nurse will come and repack everyday...but now the home nurse can not come until Sunday. That is 3 days..won't I need to have this treated before then. I have no idea how to or the supplies to do it myself. Thank you.
You should have your incision Dr.essings changed. Call your doctor.
<**MODERATOR**> CARRIE YOU HAVE THE NEXT QUESTION:)
i have pcos, will this effect my weight loss? slow it? and will my r n y have increased chances of a baby in the future when im oked to have one
PCOS does not change weight loss much. You should be able to conceive easier after weight loss.
ty
<**MODERATOR**> KROSCHKA YOU HAVE THE NEXT QUESTION:)
I have my first appointment with a surgeon on Tuesday. What would you say is the average time between a first meeting with a surgeon and the actual surgery? (Assuming the insurance company agrees to the surgery after a first request?)
6 weeks
<**MODERATOR**> EAGLE EYE YOU HAVE THE NEXT QUESTION:)
Have you had any patients who had the DS and they stopped losing weight at 3 months?
Absolutely, the DS can fail but usually it is because the patient is eating lots of sugar and not exercising.
<**MODERATOR**> BOB SOMMER YOU HAVE THE NEXT QUESTION:)
when will you and Dr. C be instructing me on post op diet, what to purchase, how much to consume, etc? Is there anything I should go out and purchase ahead of time?
If you have time tomorrow Dr. C could probably talk to you about this. There is also the three pages on the website you can download.
You should also have an appointment with the dietitian prior to surgery. Contact Ginger about this on Monday.
already made one for tuesday
<**MODERATOR**> JENNIFER YOU HAVE THE NEXT QUESTION:)
My pre-op ecg showed an inverted t-wave. "nonspecific t-wave abnormalities" was listed. What is the most likely cause of this. I am 33, and exercise irregularly, but do 45 min on an eliptical machine keeping my heartrate elevated over 150 bpm, and have had no chest pain.
It is common for obese patients to have abnormal ecg's due to how the leads are placed on the chest wall. Since you can exercise so much you are probably OK.
<**MODERATOR**> THERESA, YOU HAVE THE NEXT QUESTION:)
Dr.. Jossart since you perform all three major surgeries...have you noticed differences in post op complications between the three surgeries, how serious, different and or long term have they been?
Rarely have a complication with a Lapband™ or Roux en Y. Most complications are with the DS. A good marker to always ask a surgeon is how many patients need reoperations and how many are readmitted. In the last 3 years I have only had to reoperate on 2 Roux patients compared to 3 DS patients in the last year.
<**MODERATOR**> SAMANTHA SHOEMAKER YOU HAVE THE NEXT QUESTION:)
my bmi is 34 weight of 220 at 5'7" was approved by Dr. and ins but outside medical opinion of family/friends is negative they say I am not BIG enough, your opinion please, i have no health related problems. Also I have severere abd adhesions, can this complicate surgery or after? I had peritonitis after undiagnosed appendix.
BMI of 34 is below the NIH criteria.
<**MODERATOR**> CAROL YOU HAVE THE NEXT QUESTION PLEASE:)
I am 38. My weight is 300lbs.I have been denied once by my insurance. What is vocational rehab?
I'm sorry carol I do not understand the question but you should be approved for surgery, consider an attorney to help you prove medical necessity.
<**MODERATOR**> STEPH IN NJ/NY YOU HAVE THE NEXT QUESTION:)
I AM 15 DAYS PRE-OP AND I JUST HAVE TO KNOW...WILL THEY BE INSERTING THE CATHETER BEFORE OR AFTER I AM UNDER ANASTHESIA? MY BLOODWORK SHOWS THAT MY DHEAS AND FREE TESTOSTERONE LEVELS ARE HIGH, BUT A PELVIC/ABDOMEN CT SCAN SHOWED NO TUMORS/CYSTS, ETC...SHOULD I STILL BE WORRIED ABOUT THE BLOODWORK?
after anesthesia. Sounds like you have had a good evaluation and just need your levels checked after surgery.
whew
<**MODERATOR**> JENNIFER YOU HAVE THE NEXT QUESTION:)
I am having my surgery in MI, and I live in Cincinnati, OH. 4 days post-op, I am considering flying to South Carolina to recover for 2 weeks, then back to the surgeon in MI for follow-up. Does this sound reasonable? I am having Roux en Y. My BMI is 40. No prior surgeries.
It does not sound reasonable but will probably be OK. Why not have the surgery in South Carolina?
Surgeon in MI is excellent
DOREEN GO AHEAD
Dr.. Jossart why would my surgeon leave a gauze in my GI tract?
I do not know why gauze would be in your GI tract. Sometimes the wound is packed with it
Thanks
<**MODERATOR**> ZOBELLE, YOU HAVE THE NEXT QUESTION:)
Dr.., can you remind me again how long a person will generally be on liquids... and then pureed.... and then on to normal food?
Liquids should be about 2 weeks just to avoid vomiting and ripping out sutures or staples. after that you slowly advance to pureed, soft etc. as you can tolerate
<**MODERATOR**> STEPH IN NJ/NY YOU HAVE THE NEXT QUESTION:)
i have had 2 surgeries on my knee [torn acl/meniscus removal] and a ankle fracture where pins were inserted and later removed [afriad of blood clots post op]....all times, i have had a rough time w/anesthesia wherby i had to be given an oxygen mask for an hour following, and to top it off, i have obstructive sleep apnea and have been told my tonsils /adenoids are large and should be removed...which will be my biggest hurdle/danger?
Recovering from surgery will be tough if you can't walk well so work hard at your Physical therapy
<**MODERATOR**> will, YOU HAVE THE NEXT QUESTION:)
will a male with gynocomastia benefit greatly with the open RNY?
I do not think weight loss will impact on gynecomastia if it is true gynecomastia. You should see an endocrinologist about that.
<**MODERATOR**> SUNNY ALBERTA YOU HAVE THE NEXT QUESTION:)
i had my gallbladder out and i vomited terribly from the anasetic is this a danger in a rny will it pull out staples on the inside and outside and if so what should i do
Anesthetics are much better now so hopefully you will be fine.
ty
I will need to log out now as it is ten PM so thank you everybody
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