[Thu Sep 19 22:59:28 PST 2002]

<**MODERATOR**> ATTENTION EVERYONE

HELLO DR. CIRANGLE

Good Evening

WELCOME DR. CIRANGLE

Thanks for the welcome

<**MODERATOR**> JESS POST 27DAYS YOU HAVE THE FIRST QUESTION FOR OUR GUEST:)

I am 27 days post-op and still having a hard time keep food down, however I have no troubles with low-carb/high protein supplements… Is this healthy? Do you recommend supplements and if so what kind?

Supplements are fine. As long as you can intake 6-8 glasses of liquid per day and 70 grams of protein, you shouldn't have any problems

<**MODERATOR**> JODIE YOU HAVE THE NEXT QUESTION FOR OUR GUEST PLEASE:)

Thank you!

What can a person taking antidepressants expect to undergo before surgery?

All of my patients are on a liquid diet only for at least 2 weeks

Jodie - can you clarify your question

I take antidepressants and was denied surgery

I am currently seeking a second opinion

I also had to take the mmpi

Taking antidepressants is not a reason not to have surgery

as long as your depression is under control and your therapist feels that you are a good candidate

.Isn't depression often a result of being obese?

Yes, it is

thanks doctor

<**MODERATOR**> ANNE IN DALLAS YOU HAVE THE NEXT QUESTION PLEASE:)

There are many surgeons performing weight loss surgery now. Could you share with us what you would consider to be the *minimum* things a surgeon perfoming the Roux en Y gastric bypass operation (lap) should be doing in order to prevent complications? For instance, some surgeons use a special sort of tape now under the staples for an even greater measure of protections against leaks. Please help us understand how to choose the surgeon performing the operation in the safest manner possible. Thank you so much for being here! :)

I believe that experience and a comprehensive program are the most important

Make sure your surgeon has done a minimum of 50 procedures and ask about the results

In addition, at least 40-50% of their practice should be weight loss surgery

<**MODERATOR**> LANA YOU HAVE THE NEXT QUESTION PLEASE:)

I have a inactive throid would that stop me from having surgery?

Thyroid problems if treated preoperative do not pose a problem for surgery

<**MODERATOR**> DAWN DAVIS YOU HAVE THE NEXT QUESTION PLEASE:)

Hi, from Cumming, Ga bmi 53.5 waiting for a date : ) Why are some "open's" scar only about 4" and some are from sternum to almost pelvic?also... We would like to give our Dr. a gift of appreciation for all that he does for everyone. What in your opinion would be something special or something you may have recieved that meant a lot to you?

thank all of you wls Dr.'s for doing what you do

the size of the incision is dependent on the surgeons ability to see the necessary organs - the more difficult it is to see, the larger the scar. As far as a gift, something personal such as a picture or plaque in my opinion is always very special.

<**MODERATOR**> JENNIFER YOU HAVE THE NEXT QUESTION PLEASE:)

Does everyone have to be put on ventilator and do skin tags go away after surgery

Most patients only need to be on the ventilator in the operating room, and do not require it postoperatively. Skin tags do not go away by themselves

<**MODERATOR**> LS YOU HAVE THE NEXT QUESTION:)

What disadvantagous nutritional effects have you seen from long term DS patients even though they have conformed to the required diet of a DS patient? (Nutritional problems from malabsorbtion)

very few patients develop nutritional problems if they are compliant with their diet and the procedure was done by an experienced surgeon . Statistically across the nation, it is about 0.7%

<**MODERATOR**> MOLLY YOU HAVE THE NEXT QUESTION FOR OUR GUEST:)

How do you determine when to do duodenal switch rather than rny? Is it for the more severely obese patients? And do you have a lot of patients who come to you from out of the area for D/S because they cannot find a doctor locally?

Generally, the DS operation is done on patients who either personally prefer to have that procedure or who have a BMI of 50 or greater. We do perform the DS on a fair number of patients from out of town

<**MODERATOR**> TINA G. YOU HAVE THE NEXT QUESTION:

I have history of heart attack and coronary artery bypass surgery. Have you operated on others with similar problems?

This should not be a problem if your heart is functioning normally now and the blockages have been repaired. I personally have not operated on many patients with your situation.

Thank you, doctor

<**MODERATOR**> DORIE37 YOU HAVE THE NEXT QUESTION PLEASE:)

I'm preop for open RNY and I'm sure I've got sleep apnea going to have my doctor test me...My Question is....my psychiatrist has me on several nightly meds(clonopin/riperdal) and I know this effects the muscles etc...and I found out from support group on the topic this causes more problems with breathing....What recommendations do you have for me and others in similiar situation....I'm scared to take the meds now. Thank you for your time,God bless!

Patients who either have symptoms of sleep apnea or are concened about it should have a sleep study. If the sleep study shows sleep apnea, then CPAP or BiPAP will fix the problem. You should not be afraid to take your medicine.

<**MODERATOR**> OAKLEYJOE YOU HAVE THE NEXT QUESTION:)

Hi Thanks so much for being here. I found your group on the surgeon directory here last week and was wondering if you do revisions. I'm in oakley and my surgeon moved away. Also, when was your next support group meeting? Or, do you have information seminars? I also have a friend with a BMI of 50. he needs convincing though.

I had an RNY 2 years ago. Lost 80 pounds, regained 30.

Surgeon did the distal instead of the proximal... or the other way around (I forget which is which). Didn't bypass enough intestine, aparently.

We do indeed perform revision surgery on patients who have failed previous procedures. Our support group meets the last Thursday of every month at the Davies medical Campus. You can call 415 561-1310 to get directions if you like.

Cool,

info seminars?

or just support groups?

some groups make a distinction.

Our support group meeting always starts with a 45 minute informational session for people who would like more information

I guess the general public is invited to the support groups? Ahh.. great. Thanks!

anyone may attend our support group meetings

<**MODERATOR**> VICKIE YOU HAVE THE NEXT QUESTION PLEASE:)

Dr. Can post ops drink alcohol in moderation after their weight loss. Aside from empty calories, is alcohol harder on one's body because of being switched, having a smaller stomach or some other cause than pre-operatively?

I don't recommend consumption of alcohol for patients who have had the DS. The alcohol is absorbed much more rapidly and can cause metabolic disturbances.

Such as what?

low potassium, dehydration etc

<**MODERATOR**> LORI S. YOU HAVE THE NEXT QUESTION:)

Why do people with DS have more gas than they did prior to surgery?

the bypass causes fat malabsorption and an alteration in the bacterial flora of the bowel. this can cause malodorus stools and gas problems

<**MODERATOR**> TONI/10 DAYS YOU HAVE THE NEXT QUESTION:)

Had pre Op testing today and was informed i will be under anestesia for 5 hours??? is this correct for LAP RNY?? I have apnea with cpap pressure of 11 how much does this increase risk. As well the procedure being done in a surgical center rather than major hospital is this safe?

Most experienced Lap surgeons perform the surgery in 1.5 to 2.5 hours. CPAP is not a risk factor - only untreated sleep apnea. These operations should always be done in a hospital with an ICU and the appropriate ancillary facilities.

<**MODERATOR**> BOBSOMMER YOU HAVE THE NEXT QUESTION:)

Dr C. You and Dr J are doing my RNY on 10/16. I'm 327 now. Is is realistic for me to get down to 180 - 200? And is there anything I can do exercise wise to help get rid of/tighten up the resulting loose skin post surgery?

Mr. Sommer - I have no doubt that you will reach your goal because of your attitude and motivation. Exercise will help with the toning, however the final determinant of excess skin will be your age and genetics.

thanks

<**MODERATOR**> MARY YOU HAVE THE NEXT QUESTION:)

In the event of some kind of "emergency"(?), can the Roux en y be "undone?"

It can, but is fairly difficult. these surgeries should always be viewed as "permanent"

many thanks and God bless

<**MODERATOR**> E*D YOU HAVE THE NEXT QUESTION:)

138LBS> I HAD MY WLS SURGERY ON 1/7/02. I WEIGHED 403. NOW I WEIGH 265. DO YOU THINK I WILL BE ABLE TO REACH AT LEAST 160LBS. I HAD 5FT BYPASSED.

138LBS> PLUS I TAKE SYNTHROID.275 I HAD THYROID CANCER

Your fate is in your hands. I always tell patients that they get out of the procedure what they put into it. You have done extremely well - If you continue there should be no reason why you couldn't reach your goal.

<**MODERATOR**> CROW YOU HAVE THE NEXT QUESTION:)

I AM 11 MONTHS POST OPAND HAVE LOST 290 POUNDS I HAD THE RNY OPEN. HOW MANY CARBS A DAY SHOULD I BE GETTING IN? AND HOW MANY CARBS ARE TO MANY IN A DAY? MY LOSS IS SLOWING DOWN ALOT AND I NEED 215 POUNDS OFF MORE TILL I REACH GOAL.THANK YOU

I recommend a max of 800 calories per day. 25% or less should come from carbs. You can go to www.fitday.com to help you balance your diet.

THANK YOU DR

<**MODERATOR**> SANDRA YOU HAVE THE NEXT QUESTION PLEASE:)

i am a 33yr old african/american woman w/ high blood pressure and type 2 diabetes i was wondering if i would be a good candidate for the gastric bypass surgery and is there a high risk of death associated w/this surgery i forgot to mention in the beginning that i do weigh 262lbs the risk of death is the only thing that is really holding me back from having the surgery but then again i could die from complications associated w/diabetes and high blood pressure could you please give me some advice and what type of doctor or surgeon would i look for thank you so much for being here and answering my questions are you currently taking any new patients if not do you have any referrals in the colorado area that you could refer me to?

We are always happy to see new patients. Unfortunately, with surgery, there is always a risk of dying. The risk is small, but present. The risk of you dying from the diabetes and HTN is probably greater than that for the surgery

thank you doctor i know my decision now

** REFERENCE INFO: For background info, check out Dr. Cirangle's web site: http://www.lapsf.com/morbidobesity.html

<**MODERATOR**> MDNGHT YOU HAVE THE NEXT QUESTION PLEASE:)

Where can I find accurate info on 15-20-30 years post surgery(I know these surgeries have been performed for the past 40 years), I want to know the risks, and deaths associated with this surgery and complications that arise years in the future. I am seriously considering an RNY and also want to know how my thyroid meds will be affected.Thank You.

Any experienced weight loss surgeon can give you accurate statistics. If you are looking on your own, a literature search through the National Library of Medicine should yield some good data

<**MODERATOR**> SHELEALOHA YOU HAVE THE NEXT QUESTION:)

I am a touch over 62 inches yet not quite to the half mark. Is it normal to go bump the patients height to the following inch when measuring. This small portion of an inch is bumping my height to the point where I no long fit the criteria for a 40 BMI...it is now at 39.66 is this standard to do this and if so why be bumped for such a small amount? Thank You.

Everyone does things differently. I will generally round the numbers up if > .5 or down if <.5

Thank You.

<**MODERATOR**> VIKKI YOU HAVE THE NEXT QUESTION

If your pre-op stomach shows ulcers,is it still operable?Also, I have the implant Norplant for birth control for 10 yrs. now (going on a third set soon) does that need to be removed for surgery?

Your ulcers will have to be treated and following treatment checked to assure that they have resolved. It is my understanding that the Norplant is no longer on the market - probably doesn't need to be removed though

vikki-thank you dr.C.

<**MODERATOR**> LEYANN YOU HAVE THE NEXT QUESTION PLEASE:)

Dr , first thanks for being here, and my question is...do you find that problems stemming from surgery seem to be more related with comorbidities, or just from the surgery itself??Also, if I go for long periods of time without eating I get a headache, in your opinion, is this going to worsen with this surgery because of the lower amounts of food?

Most problems occur because the surgery is complicated and most patient's health is not perfect. I don't think you will have a problem with headaches. Actually the headache is probably from not drinking enough rather than eating enough.

thank you dr

DR CIRANGLE'S WEBSITE: HTTP://WWW.LAPSF.COM

<**MODERATOR**> KAT YOU HAVE THE NEXT QUESTION PLEASE:)

Is'nt asthma worst when you are heavy and can't walk up five stairs. Is this one of thing that can get better with this surgery.

asthma may improve after surgery, however if it is due to bronchospasm or irritable airways it may not.

MODERATOR - ONE MORE QUESTION PLEASE.

<**MODERATOR**> STEVES NY DS YOU HAVE THE LAST QUESTION:)

Thank U Moderator...Hello Doctor I had Open DS 16 Months ago no problems at all. I am 5' 11" tall I have gone from 422 to 234 and in the last 2 months I have held with no loss of weight I swim 2-3 times a week and watch the carbs and get all protean with diet. Is there anything I can do to contune to lose or restart the weight Loss from this extended platue? Or have I peeked and will not lose anymore? and What % of DS'ers Regain and what % of weight Lost is regained after weight loss stops?

My only suggestion would be to increase your exercise frequency to 4-5 times per week and cut down even further on your carbs. The DS is remarkably good at keeping the weight loss for the long term because of the malabsorption

THANK YOU DR. CIRANGLE! THANK YOU MEMBERS! FOR MORE INFORMATION, PLEASE VISIT DR. CIRANGLE AT: HTTP://WWW.HAWAIIWEIGHTLOSS.COM

THANK YOU DR. CIRANGLE.

Contact our office to speak directly with a weight-loss specialist at 808-561-5511 or toll free at (866) WLS DOCS.