Chat with Bariatric Surgeon, Dr. Cirangle, 10 May 2004

<**MODERATOR**> I want to welcome all our member to the surgeon chat this evening. If you would like to ask Dr. Cirangle a question, please type it out and hit enter and it will be submitted. We answer the questions in the order in which they are received, so please get your questions in as soon as possible.

What surgery would be the most beneficial for a person who is 5'4 and weighs about 340, lap band or rny?

That depends on your eating habits and exercise practices. Actually neither may be the best - the Duodenal Switch may be a better option.

I had RNY 6 mos ago. My surgeon never prescribed vitamins for me and never said what to take. He is now GONE....and I am unsure what I need to be taking. Or what labs I should have my pcp do, can you help me?

Was your surgery done in HI?

no

You should be taking the following: Multivitamin with folate and iron (twice the adult dose per day), Vitamin B12 500 micrograms per day, Calcium 1500 mg per day. You should have nutritional labs drawn at the one year mark.

When do you normally get a fill if you have the lap band, 1 mo, 2mo, etc?

That varies from patient to patient. The first fill is generally not done until at least 5-6 weeks after the initial surgery. After that, it is based on your weight loss and sense of "restriction".

I have a question...How will I take my heart medications after surgery???

The same as you take them now.

I have a colostomy and was turned down for the RNY procedure. Have you heard of anyone having it done with an ostomy ?

Why do you have a colostomy?

diverticulitis and anal stenosis

It is still possible to have a gastric bypass in your situation - you should get a second opinion.

please tell me how long the surgery takes

Gastric bypass about 2 hours, lap band about 1 hour.

I am concerned about being on a respirator when I come out of surgery, can you tell me the percentage of patients who require this?

It is very rare - less than 5%. Generally these are patients who are in excess of 500 pounds and have significant underlying medical problems.

What are the typical tubes that a person is hooked up to after surgery? Ng tube etc?

The only tube that I use is a foley catheter and only in the RNY gastric bypass. Lap Band patients do not have any tubes. I never use an NG tube.

I have surgery in 4 days. What is the best advice you can give to someone who is feeling like backing out of surgery?

If you are not sure that surgery is for you - Do not have it.

I am having a hard time finding a doctor who does the DS Surgery that accepts Blue Shield PPO. Do you know why this is so hard? Are other people find this as difficult as me?

I am one of only about 30 or 40 surgeons in the country that performs the DS, so there are not many out there. Most Blue Shield programs will not authorize the DS. Most bariatric surgeons are not contracted with insurance companies unless they are at a university or are new to the field (ie have little experience).

I had a proximal rny... was wondering if you have a harder time absorbing meds (capsules) after surgery... (ex: I'm on fluoxetine 20mg... after surgery I switched to liquid... about 3months post surg I switched back to pills... felt like I was going through withdrawals so went back to liquid) am I just not absorbing it the same way?

A proximal RNY should not significantly affect the absorption of your medication. If the liquid seems to work better, than it is best to stay on this for about a year and then try again with the pills.

after I have surgery, will I have a drain?

That depends on your surgeon, I do not use drains routinely.

i had a gastric bypass 2 years ago. I HAD A SECOND Operation for a fistula. The surgeon could not find the fistula. The next day i had a another surgery for a perforated ulcer. The fistula leaked for 10 months. IT opened again after 6 months. and it is open now after being closed for 5months. AM i in any danger? do you think this will keep happening for the rest of my life?

It sounds like you should see another surgeon for a second opinion.

I've had a hysterectomy, and I already have to up my calcium. I know I'll need even more post-op.What's the best way to get necessary calcium?

All forms of calcium are pretty equal. The most important is to find one that you will take and to take it with a food that is rich in protein.

what are some things you can do to prepare your body for surgery?

Start exercising regularly and lose 5-10 pounds before your surgery. This will minimize your chances of having problems. It also helps to find a good protein supplement (liquid) that you like before your surgery.

I weigh 342 whats the most weight that I could lose?

That depends on your height. You can lose 100% of your excess weight if you follow a good program and have your surgery done by an experienced bariatric surgeon.

I have done alot of research and feel the DS surgery is best for me. Can you tell me what would be the deciding factor as to the surgery being Open or Laproscopic?

I always perform it laparoscopically.

DO YOU DO GASTRIC BYPASS ON A 14 YR OLD?

I would prefer to perform a Lap-Band procedure in someone that age.

I had rny surgery about 4 yrs ago. I lost about 100 lbs and have stopped. My surgeon says he did not bypass enough and now wants to go back in and bypass more. What risks am I looking at? More risks, less risks? Is Death one of them?

Death is always one of them (even the first time around). The risks are always higher the second time - at least double. Make sure your surgeon has experience with revisions procedures.

I'm concerned about hair loss with lapbanding. How common is it and how well does the hair grow back??

The hair always grows back. It is less common with the Lap-band than with the gastric bypass. There are things that you can do to minimize this problem if it occurs.

What is a stricture?

A stricture is a narrowing of one of the connections that are made at the time of surgery. The most common location is where the stomach attaches to the small intestine.

is there a way to decrease sagging skin before and after surgery

The best way to minimize this is to make sure you exercise at least 4-5 days per week. Much of this is determined by your age and your genetics.

What do you recommend for your patients when it comes to protein? real food or shakes/drinks?

Initially shakes are necessary, however once they have advanced to a regular diet (3-5 weeks after surgery), foods such as eggs, fish, turkey and shellfish are best.

I have talked to a few people who have had weight loss surgeries and want to begin the process, I know my insurance will cover it, how/where do I begin?

Where do you live??

Santa Barbara, CA

The most important is to obtain a consultation from an experienced bariatric surgeon in your area. He should be able to discuss the pros and cons of each of the procedures with you and get your insurance company to authorize the one which is best for you. if you would like to come to San Francisco, I would be happy to help We also see patients in San Luis Obisbo.

are fistulas common and should they last 2 years?

Fistulas are the result of unresolved leaks and generally do not last that long.

My mom is thinking about surgery but i am a little worried. she is 58 and has a lot of health problems. one being heart disease. is it wise for someone with that to consider surgery?

There is no way for me to advise you specifically in this forum, however I have operated on 58 year olds and they have done well. The most important thing is to make sure before surgery, your mom gets a thorough evaluation to determine if she would be able to tolerate surgery.

I have herniated disks in my neck and now my chiropractor thinks I have herniated one or more in my low back. How much success have your patients had in relieving back pain or fixing back problems such as herniated disks by being banded??

Weight loss helps, however it is not a cure for this problem. Most herniated discs will resolve with time and anti-inflamatory medication. Perhaps the wisest thing I could suggest to you is to see a spine surgeon and not a chiropractor about this problem.

What are some of the most important questions to ask your surgeon on your initial consult?

How many procedures have you done and what is your complication rate? Which types of surgery do you do? Do you do them laparoscopically?

Hello Dr. I have heard about the lab band but my surgeon insists on open rny why would this be preferred?

Because he is not up to date. Please see another surgeon - be very wary of any doctor who tells you that open surgery is better than laparoscopic surgery or who doesn't offer you a choice in procedures.

I would like to learn more info about the lap band. I am so undecided about which surgery is best for me, but I think I like the fact that the lap band is less evasive. What are the pros and cons of the lap band?

This is a complicated topic, certainly not one that can be thoroughly discussed in a forum such as this. The simple answer is this PRO - reversible, adjustable, and lower incidence of serious complications CON - less weight loss on average, patients must be motivated to succeed.

What would you recommend for post op patients to take of headaches and or body aches with flu symptoms?

Tylenol and plenty of fluids. If it is not better within 24 hours call your doctor.

Which procedure is best if your bmi is 55? thanks

That depends on many things. It would be impossible to tell you what is best for you without sitting down and talking with you for an hour or so.

I had RNY surgery about 3 yrs ago and I have a hernia. I have these muscle spasms at times that take my breath away. Like the wind is knocked outta me. Is this my hernia or my old stomach having spasms?

Hernia generally cause a dull ache, not intense pain as you describe. You should see your doctor and have your hernia repaired.

Hi dr I had my surgery 7 weeks ago and feeling great? when if at all is it ok to drink diet coke?

I do not recommend drinking any carbonated beverages. At this point you should be focused on making sure that you eat enough protein and drink enough water throughout the day. Diet coke offers absolutely no nutritional value.

What affects will surgery have on pregnancy?

You should never become pregnant sooner than 2 years after your gastric bypass as it can be very dangerous for your baby. As far as after that, there should not be any additional issues that other mothers do not experience.

After lapband surgery - are you ever able to take medication like Aleve again??

I do not recommend it as it can cause ulcers.

do you normally go to ICU after the RNY or only if there is a problem with the surg.

I do not send my patients to the ICU routinely.

I drink a two liter of diet coke a day. Why can you not drink while you eat and just how much soda if any is ok after surgery

You drink entirely too much Diet Coke - please see the above comment. You should not drink while you eat because it will increase the amount of calories you consume and also may increase the incidence of food getting stuck in the connection between your stomach and your intestine.

<**MODERATOR**> LAST QUESTION OF THE EVENING, GOES TO.....

I have had gall bladder surgery 10 years ago - will that affect my ability to have my surgery done laproscopically?

I do laparoscopic surgery on patients who have had their gallbladder out all the time - it should not be a problem.

<**MODERATOR**> TO LEARN MORE ABOUT DR. CIRANGLE AND THE PROCEDURES HE PERFORMS, PLEASE VISIT http://www.hawaiiweightloss.com or http://www.lapsf.com/ TO SCHEDULE A CONSULT, PLEASE CALL 808-561-5511

I would like to remind any of the patients from Hawaii that I will be presenting an educational seminar to anyone interested in weight loss surgery tomorrow at 6 pm it will be at the Outrigger Waikiki hotel on 2335 Kalakaua.

<**MODERATOR**> THANK YOU FOR JOINING US, DR. CIRANGLE.

Thanks to everyone who participated and good luck in your quest for better health.

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