good evening I'm dr. Maccabee tonight I'm going to be giving you a educational
talk about weight loss surgery and what we do at the weight loss surgery
Institute of the Central Coast that is a bariatric surgery program here in Santa
Maria Hospital Santa Maria Marian Regional Medical Center and the program
has been developed and built but myself and our nurse Carrie Smith over about
the past five years and these educational lectures which are for
patients and family are designed to make sure that you know everything you need
to know about surgery this way when you come and see me in person we can talk
and have an educated discussion about what it is that we're trying to do so
there will be patients perhaps coming in during the time while we're talking and
I'll just welcome them just came in through the back door is doctor Dawes
Tom welcome I'm actually gonna put you on first now doctor Dawes is a medical
doctor who helps us with our medically supervised weight loss program so not
only do we do do we offer surgery but we also offer supervised diet and
occasionally medical therapy Tom my laptop was stolen last week and all of
the changes to the talk that included your intro are not here tonight because
I haven't rebuilt it so you're going to have to go ex tempore we're also
videotaping for our youtube educational program and so with that and no intro
this is dr. das who in a couple minutes is going to tell you about what he does
in the medically supervised weight loss program great well thanks Dave for me
I am the newest joined a team and I'm family physician who has been
specializing in medical weight loss I've been part of the center now for about a
year and what I do is look at different patients who may or may not be
interested in surgery with dr. Maccabee what I offer is we can look at
medications that we can try for weight loss I also run a medically supervised
weight loss program which uses Ideal Protein which is a food product line
that helps you lose weight pretty pretty rapidly about 3 to 5 pounds per week and
it's a nutrition lifestyle campaign that basically looks at all aspects of your
life and it goes through how to shop cook provide for your family and loud
I'm here so um basically it would it wouldn't be surgery we're looking for
people who have a BMI and dr. Maccabee is going to go over that with you the
body mass index of about 35 or below and we can use the program for pre surgical
patients or patients that are going to have surgery or for patients that want
to try medically supervised weight loss on their own in addition I'll go over
many of the other conditions that that happen when you're when you have a when
you have obesity including diabetes high blood pressure sleep apnea and we'll
look at all the other conditions like this lymphedema a cholesterol
issues and we'll evaluate those for you I can get you referred to our dietician
so we have dietitians in the center and we will be doing psychological
evaluations with clinical social work once we've gone through all of that and
you become a candidate for medication I'll be managing medications for you for
weight loss as well we're developing a program to that end at any point if you
decide that very logic surgery is where you want to be we will get you back in
with dr. Maccabee to do so so essentially I can work in conjunction or
directly with dr. Maccabee for working with his aftercare program for his
surgery patients or I can work with you prior and I left some cards over there
and I'd be happy to CN a.m. you in consultation or dr. Maccabee determines
that you know you're not a surgical candidate or not interested in surgery
right away so any questions thanks very much Tom thanks appreciate it okay that
was excellent timing okay all right here we go oh yes sir
back to here go to here okay so in the next 45 minutes we're going to talk
about what is obesity what is surgery who qualifies what are
the operations that we do what are the risks and benefits of surgery
what is our program what a surgery cost if you're having surgery out-of-pocket
what are the steps to have surgery what is an emergency that you need to call me
about the bottom line why we do surgery is this this is what you look like or
some patients might look like before and after
Jessica those are her real pants this was a year and a half after her gastric
bypass 125 pounds she's one of the first patients that we operate on I haven't
seen her in a couple years actually actually haven't seen her in one year
she's doing great in order to know if you can have an operation you have to
know your BMI your body mass index it's your weight divided by your height
squared it's a it's a number that accounts for how tall you are if you
come in and you don't know what I'll just figure it out on my iPhone
just type it in but other you can figure out yourself you have to have a BMI more
than 35 to qualify for an operation so for me I'm 6 feet tall
and I'm 185 pounds today so my BMI is about 26 so insurance wouldn't be
interested in offering me an operation because my BMI isn't over that threshold
of 35 you have to have a BMI of more than 35 and a medical problem related to
it or a BMI more than 40 and no medical problem necessarily if your BMI is
between 35 and 40 in general you have to have either diabetes or high blood
pressure or sleep apnea anymore sometimes reflux sometimes there's other
things we can use to help justify a surgery there's a bunch of other less
common medical problems if your BMI is more than 40 then insurance companies
are usually interested in offering you an operation because in the long run it
makes you healthier and actually saves them money that's the idea in California
where 10 years ago 60 percent of our population was overweight or obese we're
in good company it's not like this is an uncommon thing anymore in Santa Maria
where we are there's a hundred thousand people seventy percent of those people
are Hispanic and 70 percent of the overall population there is overweight
or obese so that means about 50 percent of the Latino population and about 30
percent of the white population of Santa Maria itself is overweight or obese if
you look at San Luis Obispo County which is to the this is the County as opposed
to the city to statistics 2009 20 percent were overweight or obese it's a
slightly thinner population there but still that's 25 percent of the
population as people who are theoretically wanting to talk about
weight loss so how do we get here why are we fat what's wrong with this slide
anybody yeah so the dogs get an exercise but the
truck guy in the truck isn't so I took this with my iPhone on Pismo Beach last
year I thought it was hilarious although it's not really funny right so we're big
for a lot of reasons we don't exercise enough most of us it's really easy to
get calories you know this person never got out of the car so first they took
the old dog for the walk on the beach right dog hop then they went to the
drive-thru and got two double-doubles and a big animal fries and that's oh
that's twelve or fifteen hundred calories which is really all the food
you needed in the whole day but that's only one meal and you never even got out
of your car to do it and then we drink too many calories too so the trente
treinta latte whatever this super Starbucks drink is is it's literally the
size of your stomach and that's almost a thousand calories in just nine hundred
calories in those and that's what you got between breakfast and lunch right so
we generally eat more than we need to and we exercise the last thing we need
to how do you lose weight permanently well the truth is there's no real fat
Buster pill there's no diet that works permanently unless you keep doing it
this is a picture of dr. oz testifying that the one of the pills that he was
selling on TV was only a short-term solution and not a real long-term diet
aid in general we already know this how do you lose weight you eat less and you
do more duh we know that but it's very hard to actually do that in real life
when your brain is saying there's good food let's eat surgery does help you eat
less surgery will help you curb your appetite and it will make it more
uncomfortable for you to overeat but what surgery does not do is help you do
more it does not make you exercise surgery is not going to change your
exercise or lifestyle habits the Wellness Center next door which you guys
all walk through which is the gym and physical therapy and rehab facility
attached to the hospital is available to all of our patients and either John or
well Joel's gone now but John or his new partner will help you with learning how
to exercise if you don't already know or how to do work with your body that
you're not used to doing in order to have success so what's wrong with being
big what's wrong with obesity unfortunately all of these medical
problems are related to that so it shortens your life the average life
expectancy of a patient with the BMI more than 40 is several years I think
it's eight years shorter than someone who's lean with a BMI of 25 so you
actually live less and while you're alive you have more problems blood clots
in your legs arthritis in your bones usually knees and ankles are a big
problem for people type 2 diabetes is the biggest one that I see like
three-quarters of our patients have diabetes and our on medication for that
high blood pressure is another one I forget where it is it's somewhere over
here and that leads to heart attacks breathing problems including sleep apnea
with need for a mask at night anybody here have sleep apnea and use a CPAP
machine about half the hands are up high cholesterol arthritis limited mobility
all these different medical problems are related to being big and when you lose
weight most of them get better or and sometimes go away completely
so this slide from more than ten years ago showed that morbid obesity has seen
what I just said significantly increased mortality high blood pressure sleep
apnea diabetes in red because that's the biggest thing that we see lipid
disorders degenerative joint disease causes fertility issues in women and one
of the big things that I'll emphasize to all women who are still having periods
is that you need to use birth control after surgery for at least the first
year because it is likely you will get pregnant even if you weren't planning on
it or even if you've had trouble getting pregnant in the past we've had I've lost
count between eight and ten babies born to our patients in the past couple years
who lost weight and then successfully got pregnant
16 years ago obesity was the number two cause of preventable deaths in this
country it's now higher than that was very expensive for our country cost 150
billion dollars in 2008 that's all of the associated expenses with taking care
of the medical problems from obesity and those numbers have only gone up as well
so there's lots of information that shows that surgery pays for itself if
you pay for surgery up front you get the money back plus more down the road as
medical problems get better so that's why insurance companies and even private
health care organizations like Kaiser Permanente are interested in paying for
these operations in order to save themselves
money by making you healthier why do we do surgery why not do something else
well the truth is that only surgery has proven effective over the long term for
most patients with morbid obesity you can't read the fine print probably but
this is the 1991 consensus conference from the National Institute of Health
those are the people who advised Medicare and which makes Medicare rules
that was the conclusion in 1991 and every subsequent conference since then
so 95 99 2003 all the way to now so this is a picture of a great big huge guy
having an operation like 30 years ago he's having a gastric bypass in the 70s
and we're still doing essentially not exactly the same operations but we're
still doing surgery because there isn't a better solution
why don't diet and exercise work how come all those are the things that we
try don't really work the truth is that I don't actually know being obese is a
complex problem our brains are wired to pursue food it's in our brainstem it's
like food shelter and sex that's what your brain wants to pursue and you can't
just turn that off and we all have taste buds and we like things that taste good
and as I said we live in a society where it's easy to get calories they're cheap
they taste really good and you don't have to do a lot of exercise to get them
our guts actually make hormones that increase and change your appetite has
anybody here ever heard of ghrelin anybody ever heard of that hormone
ghrelin so ghrelin is a hormone that's made by your gut and this is a study
from the New England Journal from Wallace 2011 now where they looked at 50
people who had who didn't have diabetes who were obese and they put him on a
diet so they had all these people and they put him on a diet and they all lost
some weight I think was about 10 pounds forget exactly after 10 weeks they took
him off the diet and when they were on the diet for 10 weeks their weight went
down and that ghrelin hormone level went up so go on a diet and lose weight and
the hormone goes up which is your appetite hormone right lose weight
appetite goes up does that make sense then they went looked at him a year
later when the diet was over for almost 40 weeks and a year later guess what the
hormone levels never came down stayed high and everybody had regained their
weight plus a little bit more so lose 10 gain 15 right and then you do another
diet and you do it again lose 15 gain 17 so every year you're actually gaining
weight even though you're trying to lose weight
that's called yo-yo dieting have you guys anybody do that
so the repetitive lose weight and gain more weight cycle is what surgery helps
you break so this is a picture of a patient I operated on when I was in
Oregon in 2000 something he did a gastric lavage he was a policeman he
couldn't get in the car he couldn't get behind the wheel had a big belly
couldn't get his duty belt on he had a gastric bypass after eight
months he's lost almost 100 pounds a year later he's at 200 pounds normal guy
in a t-shirt you can't see his scars and he decided he didn't want to go back to
policing and he became a semi-pro golfer but why do we do surgery because surgery
really works surgery really changes lives and the diet and exercise programs
that most people have been through don't often work that well so this is another
real patient she's from here from I think 2 or 3 years ago and you can see
here's her before picture after her sleeve operation in 12 months she lost
96 pounds so that's before she took a picture of herself every three months so
that's a year later and then a bit after that along comes the baby so as I said
pregnant women I'm sorry women who can get pregnant have a greater likelihood
of becoming pregnant after this surgery although we don't call it a fertility
operation so why do I do surgery I do surgery because I like doing it so this
is me doing a gastric bypass in 2003 with an old mentor of mine dr. Deveny
who's retired now we get to use flat-screen TVs and fancy tools and
little tiny trocars for me surgery's fun for the patient here maybe not as much
fun but the bottom line is we do surgery for morbid obesity because only surgery
works and this is me doing that same operation here a couple years ago 10
years later so although we're always trying to innovate and find and do new
things we haven't found a better solution than the gastric bypass which
is still the mainstay operation that we use although I do a lot of sleeve
surgery now as well this is another real patient from Oregon beforehand
and 420 pounds he has diabetes high blood pressure and sleep apnea he's so
big he can't get out of a bed without a bar to pull himself up on you can see
he's got a great big belly that's covering his privates and that makes his
a hygiene difficult is in a wheelchair part of the time he had a gastric bypass
this is him in the recovery room with little incisions that have little
band-aids over them and a year later actually not even here six month later
his skin is like a balloon that got stretched and can't stretch back so he's
left with a big extra skin envelope that was called a panas we call that panis
and it got kind of inflamed at the bottom taking that off is called a
Panniculectomy me most people call that a tummy tuck I do a lot of those today I
did for gastric bypass surgeries and a panniculectomy me I do about one a week
anymore as patients come back to us years later and that's what his tummy
tucks scar looks like in a year and a half after that he's gone from for what
was it 420 the 260 so he's lost 160 pounds his blood pressure is gone
sleep apnea is gone diabetes is gone he's off all of his medications and he's
a normal guy in a shirt even though he has that big belly button scar and he
brings me a big bag of mushrooms anymore every spring because he's out in the
forest running around because he's normal again that's the point it's not a
wheelchair anymore another patient from here from 2013 May 2013 290 pounds she
had a gastric bypass before and after same patient no more surgery another
before patient she's kind of a jokester she likes that one 240 pounds before her
sleeve 144 pounds after her Sleeve she had a tummy tuck - some people do
that not most people don't a lot of times I don't recognize patients when
they've come in later so March of 2014 260 pounds she had a sleeve you know a
year later she comes back for her fall of 136 pounds I'm like who are you I've
never even seen you before that's pretty common not everybody only has one
operation this woman had a sleeve operation in when she went from 300
pounds to got cut off but that says about 220 but she was having terrible
reflux after her sleeve and the sleeve surgery can sometimes make reflux worse
so she had another operation in October of 2015 I converted her into a gastric
bypass and probably at least ten percent of people who have sleeve
surgeries will go on to having a gastric bypass down the road or some other some
other extra operation but now she's 190 pounds she brought her baby and she's
one of the ladies in the slideshow with the with her new child that I'm not
going to get to show you tonight and she's very happy another patient before
surgery says 280 pounds there over 300 in a wheelchair when we first got
started then let's see sorry this was before this is after with her daughter
another patient this is a woman who's not very tall so she's only 213 pounds
but her BMI is 43 so she had a sleeve and then afterwards down to 146 BMI of
27 normal again so another patient before BMI 50 to 370
pounds had a sleeve year later down to 230 so that's a what was that 130 pound
weight loss and she has a baby now to had her baby last year there she is
five week old son I don't think she named the baby David but you should
think about that and this is important actually that she had been having
miscarriages for several years previously so if you're a woman and
you're going to have surgery you need to think about and prevent having a baby
for at least after the year after surgery because while you're losing
weight for the first year after surgery you don't want to try and support a
pregnancy also those two things don't go well together sometimes although most of
the time in fact every experience I've had is that women have healthy
straightforward pregnancies and the babies are healthier than if they had
been born before the woman had surgery next slide before after before we
operate on men - Larry after so we went from 310 to 190 at a sleeve another lady
with a baby not everybody sends me appropriate pictures you don't have to
send me those who has doubts about surgery anymore the
answer is pretty much nobody who endorses weight loss surgery pretty much
everybody so the National Institute of Health that's why I said who makes
Medicare guidelines and that's why this is a Medicare covered operation American
Diabetes Association International Diabetes Federation American Heart
Association remember 20 years ago American Heart was all about don't smoke
now they're all about take a walk and lose weight that's their major goal
anymore the ASMBS is the association that of surgeons that supervises
bariatric surgery in this country we're an accredited program there's a great
deal of scrutiny and supervision over these weight loss surgeries that are
done in the United States and to be an accredited program you have to go
through a lot of work to get your hospital ready to go we've just passed
our second accreditation a couple months ago and we're very happy about that
so if surgery is so great and who shouldn't have surgery there's a few
people who I might say you shouldn't have an operation if you're really
really big and we do BMI more than 60 all the time but occasionally I'll see
someone with a BMI of 80 or 90 like 500 or 600 pounds and I'll say maybe you
should have your operation at a hospital that has a bigger ICU like a university
medical center like Stanford or UCLA maybe once a year we have to do that
people who have unrealistic expectations of surgery they think I'm going to make
them into a Barbie doll or fix the other parts of their life that need fixing I
can't do that I can help you to curb your appetite and make your stomach
smaller but fixing your life and the other things is something that you're
going to have to take control of people who are actively smoking I will not
operate on if you're smoking you have to stop because smoking plus surgery leads
to ulcers which leads to coming to the emergency room in the middle of the
night and it's always on Saturday night at 2:00 in the morning and then I'm
grumpy so no smoking plus surgery if you're actively using alcohol or other
drugs you need to stop that because those things don't go well with surgery
if you have untreated emotional illness like bipolar disorder or you're
depressed or someone in your families recently died and you're dealing with
all these other issues divorce loss of a house whatever you
to get those things fixed up first most of the time people who see me take at
least three months and sometimes as long as a couple years to get to their
surgery so it's not like we have our lecture today and you go to the
operating room next week this is a process that we work through if you have
out-of-control high blood pressure or diabetes you have to get that stuff
sorted out first and remember doctor Dawes who is here earlier today if you
don't have your own primary care doctor to help you with that and you should all
have a primary care doctor Dr. Dawes or someone else will help you with it so
this is a picture of a stomach ulcer you guys can't probably tell but this is the
liver lifted up here this is the connection between the intestine and the
stomach and you can see there's a hole that's about that big in the front of
the stomach where the ulcer perforated through and made an emergency and that
person would die if they didn't have an operation in about a day or two that's
it's the same as perforated ulcer surgery from a long time ago and so I
have to close that hole and put in drains and they're in the ICU for a long
time and it's a pain so don't smoke this is our hospital across the street the
Marian Regional Medical Center is an accredited bariatric surgery center we
do wear a blue distinction center that means we can date Blue Cross and Blue
Shield and all that and there's actually three hospitals on the Central Coast
that are all dignity hospitals French hospital area Grande and here and all
those hospitals send all of the bariatric stuff all of the weight loss
surgery stuff to this hospital this is the center for these operations on the
Central Coast anywhere really between the South Bay Area and Ventura there's
three operations that we do but I really don't do lap bands anymore
did anybody come here wanting a lap band okay this is a lap band I keep one in my
pocket to show to people it's a rubber ring that's like a napkin ring that goes
around the top of your stomach and it's attached to this tubing and this port
that lives under your skin that I can poke a needle into and adjust I take a
lap band out of someone roughly once a month but I haven't put one in in about
three or four years now because they don't work very well and I'll show you a
little bit about that but if you came wanting a lap band more likely I'm going
to tell you that you should be thinking about having a sleeve operation the
sleeve surgery is more surgery than the lap in but it's much more effective the
gastric bypass as I said is the bigger surgery the most effective
surgery that we do and I do roughly half sleeves and half bypasses anymore so to
review these the gastric bypass divides the stomach into two pieces and then the
intestine gets divided and a piece of the intestine is brought up and sewn to
the stomach and the food goes down into your small stomach pouch which is about
the size of a hard-boiled egg and then it bypasses your stomach and goes down
this intestine where you digest it and you don't digest it until down here so
we've bypassed the first 100 centimeters or so of your intestine and food is
digested in the bottom portion of your intestinal tract so you eat less because
your stomach is only this big and you absorb less because we bypass about this
much of your intestine that much the sleeve operation is removing the side of
the stomach but leaving the normal direction of food in the stomach and
then in the intestine and we don't mess with the intestines at all so here you
absorb everything you eat but you eat less and your stomach is about the size
and shape of a banana sugar color the banana operation it would make more
sense but it's supposed to look like a shirt sleeve so it's called a sleeve
surgery in Spanish it's a manga operation which makes even less sense
and then this is a lap band which I said I don't do so the gastric bypass is the
most effective surgery people lose 70 or 80 percent of their extra body weight so
extra body weight means if you're 100 pounds overweight you'll probably lose
70 or 80 pounds you're not going to lose 70% of your total weight food isn't
absorbed until it gets down below where the connection is so there's some things
that aren't absorbed very well calcium and vitamin b12 and for some people iron
are not absorbed very effectively after this surgery so you have to take a
supplement for the rest of your life if you're a woman you probably have to take
calcium and iron anyway so maybe it's not a big deal but everyone who has out
has a gastric bypass has to pay attention to their diet and take a
vitamin supplement for the rest of your life I don't really think that's a big
price to pay or a big deal but for a lot of people they're worried about that if
your stomachs only this big you have to pay attention to your diet anyway
because if you fill your stomach up with cheetos and Diet Coke you're going to
get malnourished and end up rude up down the road anyway because
you're not getting proper nutrition so if your stomach's only this big you have
to fill it up with good high quality high nutrition food and we're going to
teach you what that is and how to do that but most of you already know that
it's mostly protein it's usually fresh vegetables and sometimes some
supplements but it's generally not potato chips and you know the in-and-out
burger meal that I showed you before
advantages of gastric bypass the weight loss is really excellent 75 or 80
percent body weight loss you can eat normal food the results are excellent
for 10 to 20 lifetime years we know that for doing these operations for a long time
the disadvantages are that you don't eat very much at any one meal you can get
nutrient deficiencies if you don't pay attention to your diet over the long
term the complication right having a leak or a problem or a twist or
something that brings you back to the operating room emergently after surgery
is about one in 200 or less about a half a percent and our leak rate here is just
about exactly that for complications from this surgery the surgery is
actually not any safer than the sleeve surgery although it's more complicated
the risk of having a complication is about the same for either one so don't
make that the reason why you choose a surgery the sleeve operation where we
remove the side of the stomach and leave the narrower banana-shaped tube of
stomach and then leave everything else downstream is a little bit shorter a
gastric bypass takes me about an hour and 15 minutes a sleeve operation takes
me a little bit less than an hour but because it's faster doesn't mean it's
necessarily simpler or safer it's just a different operation this very long
staple line here along the stomach can leak or things can have problems with it
but in general doing this makes you feel full sooner after you eat a smaller meal
usually that much say half a sandwich or a cup of soup or four or five bites of
sushi if you eat more than that you usually get chest pain and some people
actually throw up but most the time they stop eating but then you do absorb
everything that you eat so if you're already on medications that you have to
stay on forever like arthritis medicine or if you have ulcerative colitis or
our bad depression and you're going to need medications forever this might be a
better choice because you can guarantee that you're going to absorb everything
that you eat when you take it so that your absorption will be better this is
sort of like the medium operation gastric bypass is big sleeve is like
medium/large I don't really do a small operation anymore for whatever reason
the sleeve surgery works better for men than for women and the weight loss
profile for men is generally more weight lost faster so often times if I have a
man and a woman and they're the same age and the same overweight I'll tell the
man to have a sleeve and the woman to have a bypass because then they'll have
more equivalent outcomes the sleeve is not quite as good for diabetes if you're
on insulin as well if you're on insulin for diabetes I'm going to recommend you
have a gastric bypass most of the time there's the Lap Band not doing them
that's why I'm not doing them because we took a lot of them out over the past 10
years so to remind you the gastric bypass is the biggest tool biggest
hammer sleeve is more like the medium-sized hammer lap-band was too
small a tools didn't really work enough for us to be enthusiastic about it every
patient has different needs and parameters so I wrote here that the
gastric bypass has more risk than the sleeve that's not really true it's about
the same risk the bypass is a little bit better weight loss than the sleeve but
it changes your diet and your absorption a little bit more the sleeve in and the
bypass at this hospital both cost the same if your self-pay patient insurance
doesn't care as I said I don't really recommend bands anymore if you wanted to
ban them probably going to point you towards a sleeve if you have a lot of
weight to lose or you're on insulin or bad reflux I'm going to tell you
probably to have a gastric bypass any surgery has risks anything that I can do
to you comes with a small risk okay there's no such thing to surgery without
risk the risks are very small one in some hundreds or even less than that but
anybody can have bleeding or an injury to something on the inside that creates
a problem that requires another surgery to fix open meaning making an open
incision instead of doing it through those five little laparoscopic incisions
a leak or an infection in side that requires another surgery can
happen to anyone although we haven't had one in quite a long time
knock on wood a blood clot that can form in your leg during surgery and then
break off and go to your heart and block up your heart or your lungs can happen
that's called a pulmonary embolism we're terrified of those I put everybody
on blood thinners either before or after surgery we haven't had a pulmonary
embolism in more than a thousand operations here we did a thousand and
sixty so far as of last week anyway again we take a lot of precautions but
bad things can happen that's the point death is possible although it's
extremely unlikely we've had two patients die related to surgery here in
the five years and thousand-plus operations that we've done they were
both men they were both approximately 45 years old
they both had sleeve surgeries one of them had a heart attack seven days after
surgery and one of them had a brain aneurysm explode about two weeks after
surgery and so those aren't things that are directly related to the operation
itself thought the operation broke but the stress of the surgery and the
anesthetic caused something to happen in them after surgery so we have to take
the responsibility for that so the point of that is don't have surgery if you can
avoid it if you can lose weight any other way I risk or harm that could
happen so the lesson there is this I can make it work oh we're stuck on risks
Kerry you might have to advance it manually oh I turned it off oops haha
fixed it so you should only have surgery if you can't lose weight any other way
if you can do the cabbage soup diet or the dr. Dawes ideal protein diet and get
to where you want to be and stay there stay away from me that's fine I have
plenty of work to do this is a decision that you make it's not a decision I'm
telling you I'm not saying you should have surgery I'm saying this is a tool
that I can offer you but you have to use that tool correctly if you don't change
your life if you don't change what you eat and how you eat and when you eat and
who you eat with and what your wife puts in the fridge for you and what you did
on your lunch hour and with your weekends you may not get the result that
you're looking for and if you're not going to do that don't
bother have the operation don't accept the risk unless you really want the
rewards right so here's a patient who had a leak Karl had a complication he
had a leak where the stomach and the intestine came apart and there was an
infection that started up in his abdomen I had to take him back to the operating
room two more times he had a bunch of extra endoscopy where I had to put a
scope down his throat to try and fix that and he was in the hospital for more
than a month I think all together and he was on TPN with IV nutrition going in
his veins at home for a couple weeks and ultimately he did great and all of the
leaks and I think we've probably had roughly have to count I think it's eight
in the lifetime of the program so far have done fine Karl lost 120 pounds
after eight months and that's what he looks like when he comes to clinic now
he's a happy guy but you know it wasn't a smooth easy come into surgery have go
home two days later and on with your life kind of event for him this is
another patient who had six repeat operations after her leak now she was a
revision I didn't do her first time surgery but I was trying to fix
something that was broken from a previous operation and redo operations
revision surgery whether it's fixing a gastric bypass or taking out a lap band
or doing something else as higher risk than first time surgery so she had all
these different episodes ten days in the hospital she had a feeding tube that
stuck out of her belly for like three months before I could take that out but
she's now a volunteer here and she wears a green shirt and she'll probably visit
you in the hospital afterwards she's one of our most enthusiastic patients
another patient young woman who had a leak after her gastric bypass used in
the hospital for ten days ultimately lost more than 150 pounds and she looks
great and later on in the show I'll show you her belly so you can see that the
scars don't really add up too much this is our operating room team there's me
there's dr. Felix there's dr. McCluskey Kevin mounts is our nurse first assist
who does every single operation with all of us
and he's done cumulative ly more surgery than all of us now together this is a
bunch of slides about the data that I was trying to tell you about before the
data that shows that weight loss surgery really works and is effective and is
safe this is a paper from Journal of American Medical Association from 2012
that came out of a group of patients in Utah almost 1,200 more than a thousand
patients who had gastric bypass and what they showed is that gastric bypass works
better than diet plus exercise plus insulin and then if you diet and medical
therapy your diabetes never goes away but if you have gastric bypass the
majority of the time your diabetes gets better and goes away this is another
study that came this is kind of a famous paper published by dr. Ming groan
showing that if you do diet and insulin your blood sugar levels remain high
without ever going down if you have a gastric bypass your blood sugar levels
at two years actually go to normal pretty quickly and there's a third
operation called a biliary pancreatic diversion that's also called a duodenal
switch anybody ever heard of a duodenal switch or D.S. is another less
common operation that's really good for diabetes but I don't do it because it
has increased issues with absorption and causes malabsorption and other medical
problems that we don't like taking that we think are not worth it so if you look
at this paper here this is a published by dr. hütter from Harvard and they
looked at a lot of patients having sleeve surgeries and what they showed in
this paper here I'm going to show you the picture of it is that lap-band
patients lose some weight sleeve patients lose more weight and bypass
patients lose the most weight and he's showing be a BMI loss of BMI ah sorry
let me go back what the wrong way what dr. hütter showed in this paper is that
after 12 months sleeve patients had lost about 11 BMI patient BMI points and
bypass patients had lost about 14 BMI points and if you look at our
data from here what you can see is that our
patients are doing either the same or better than patients who are published
from large-volume University hospitals so this is gastric bypass patients three
years out from surgery here in Santa Maria or the average starting weight is
293 pounds and after two years they've fallen to 189 pounds which is actually
better than the weight loss in the paper that I just showed you and then at three
years out people have regained a little bit of weight and gone from 189 to 202
so a lot of people experience late weight regain where they put on a few
pounds three four or five years later and that's usually because they got kind
of lazy and aren't doing as much as they used to because the excitement of
surgeries weren't off sleeve patients lose a little bit less weight they go
from 273 to 194 and then also regain a bit of weight and then patients who are
having a revision of their operation changing one thing into something else
or fixing a gastric bypass generally do very well with here it is 235 to 166
pounds so this is a slide I'm really proud of and I think that you can sort
of figure out where you fit on these curves dr. hunters data this is data
from a guy named dr. Phil Shauer Dr. Shauer is probably the most prominent
bariatric surgeon in the United States he's at the Cleveland Clinic now he's
the one who trained dr. McCloskey my partner who you may be working with if
not with me and what his data shows is that medical therapy at three years out
doesn't do much for you his sleeve patients lose about eight BMI points and
his bypass patients lose about ten BMI points and then regain a little bit
after three years and so again our data is similar to that actually a little
better there's our beta this is looking for let's see that's weight loss I
showed you that this is the same slide again that looks at what happens to your
blood sugar levels and those are actually normalizing and this is looking
at hemoglobin a1c which is another measure of blood sugar levels this is a
paper that shows that lap bands don't work I'm going to skip it if you look at
what happens to medical problems after surgery after gastric bypass this is dr.
showers data I told you I showed you one of his graphs so one year after gastric
bypass if you had high blood pressure 70% of people's
high blood pressure is cured 80% of people's diabetes is cured 60% of
cholesterol 75% of sleep apnea 70% of reflux are all cured asthma tends to get
better but doesn't go away arthritis tends to get better but only get you
know if you've already worn out your knee the surgery is not going to fix it
the cartilage in your knee but most of these medical problems diabetes asthma
leg edema cholesterol sleep apnea high blood pressure reflux arthritis improve
or go away completely this is the same information presented a different way
and looking at sleeves so band surgery gray sleeve surgery blue bypass surgery
green if you have diabetes bypass cures diabetes and 80% of people but the
sleeve isn't quite as good that's why I said if you're on insulin probably are
going to pick a bypass high blood pressure similar sleep apnea about the
same reflux a little bit better with bypass so to review bypass bigger
surgery more weight loss better medical issue resolution sleeve medium lap bands
don't do them any surgery is just a tool if you don't change your life around
using this tool you will not have as good an outcome I think I've already
said that surgery is the springboard to changing your life it's like you're
going to jump off a diving board and you got to figure out what the dive is going
to be but you have to swim afterwards too if you just go off the diving board
and don't do anything you will not have the result that you want our program
consists of me Dr. McCloskey dr. Felix Carrie Smith is our nurse we have our
own nurse practitioner nurse Ana who will all meet with we have our own
dietician Breanna Wilson has left us and we have a new dietician whose name is
Maggie who's starting next week who's terrific we are as I said a center of
excellence that term isn't really used anymore we're now called an accredited
center where a Blue Cross Center of distinction I got to fix that slide
there don't tell me I only operate at
arian hospital across the street if you go to French hospital or area grande
with an emergency or something and it's related to one of the surgeries that we
do they'll have you come back here and we'll take care of you in this hospital
this is the hospital was built in 2012 it's a new facility has 200 beds it's
really super nice Hospital and it was kind of purpose-built for doing
weight-loss surgery with wide doorways and big wheelchairs and heavy-duty
everything so it's ready to ready for big patients this is some of our clinic
staff there's nurse Carrie there's some of our front office staff there's dr.
Felix that's me that's Dr. McCloskey that's dr. Felix that's nurse Carrie
that's our operating room team we have all new operating room stuff for doing
these surgeries although it's been used a thousand times now so it's not quite
new anymore all the patients have private rooms in the hospital upstairs
they're a lot bigger than they look we have our own dietician we have our own
mental health provider your surgery your insurance company will likely require
you have a psychiatric evaluation or a mental health exam before having surgery
we'll do that for you in our clinic we have someone who does most of those we
have our own pharmacists who will go over your medications after surgery we
have the Wellness Center next door for learning how to exercise again we have
educational seminars twice a month here plus once in San Luis Obispo plus once
in Lompoc every month so we're trying to do community outreach for education we
have support groups if you want to meet patients and have me not be there and do
all the talking that's fine most insurance covers surgery Medicare
Medical Blue Cross Blue Shield Western growers Aetna Cigna I miss any TRICARE
yeah medical CenCal all of those if you do not have an insurance part of the
coverage surgery these numbers are wrong surgery here costs about fifteen
thousand dollars give or take and that is I can guarantee you the cheapest for
legitimate surgery you can find in this state and if you're foolish enough to go
to Mexico to get a cheaper surgery don't come to us with your problems afterwards
what do you need to do first thing you need to do is call your
insurer and ask if you have bariatric coverage if you have anthem BlueCross in
state if you have medical CenCal Medicare or any of the other ones it's
almost certainly going to be yes but if you have an insurance product that I
haven't mentioned or you have a small product call and find out first because
not every insurance company will pay for weight loss surgery then you should see
your doctor and tell them you want to referral because as I said you should
have a primary care doctor who's managing your blood pressure and other
issues if you don't already have a doctor we'd be happy to see you anyway
we won't turn you away but we will help you get established with a physician in
addition to starting your bariatric surgical workup generally takes at least
three months to get into the operating room from the time you start sometimes
it takes a lot longer everybody's going to come to this lecture everybody's
going to meet with me or dr. Felix or dr. McCloskey everybody is going to have
many months of dietitian visits if you have Anthem Blue Cross they require that
you do six consecutive months of diet visits before they let me do your
surgery so you have to meet with our dietician six times in a row without
missing any months so it's March if you start now it's April April May June July
August September you could have your surgery at the end of September or
October if you started this month that's generally what they mean Medicare
requires four months send Cal requires one month only which is nice although
everybody gets two or three visits anyway everybody gets labs women over 40
get mammograms everybody needs a colonoscopy if you're over 50 and you
haven't had one if you're over 55 or you're having trouble or you're in a
wheelchair I'm going to make you get a cardiac stress test or some kind of exam
of your heart if you're smoking I won't operate on you so we'll have to help you
fix that everybody comes to the educational seminar everybody gets a
psychiatric evaluation everybody meets with our nurses at least once and
sometimes many times once you're ready you get this big three-ring binder full
of information that has about that much stuff in it and you have a whole nother
nursing visit that lasts a half a day where you go through it all again and
there's actually even a quiz at the end of it although no one's ever failed I
generally do surgery on Mondays most operations take me
an hour and two hours I usually do five or six operations per day most about
half people go home on Tuesday and the other half people go home on Wednesday
so most people are in the hospital overnight sometimes two nights but
you'll stay in the hospital until you're ready to go home however long that is
most people are up and walking around on the day of surgery a pharmacist will
meet you in the hospital after surgery to go over your medications the
dietician will meet with you again you'll see me a lot of times you'll see
nurse carry a bunch of times and you'll be up and walking around and pretty
quickly feel pretty good again this is a reminder if you're having surgery with
me leave me at least one finger nail to put the blood oximeter device on last
year I had all these ladies go and I'll get all these pedicures and manicures
and then they all came to the hospital with beautiful fingernails and we
couldn't get their oxygen levels so leave me one fingernail otherwise we got
to put on your privates walking around and drinking right after surgery sorry
I'll stay still I want you walking on the day of surgery
because being upright makes your lungs expand and helps prevent pneumonia keeps
the blood going in your legs and prevents those blood clots those are the
big things that we're scared about after surgery most people go back to work
within a week or two kind of depends on what you do some people take more time
especially if you're heavy lifting or doing a lot like patient care stuff but
I've done easily a dozen operations on nurses and staff in my hospital and
virtually all of them have been back at work the following week because they're
motivated and want to return to work kind of depends on what you want if
you're on birth control pills I want you to stop those a month before your
surgery to reduce your risk of blood clots women with estrogen patches the
same thing I give you blood shots while you're in the hospital to keep your
blood thin so you don't get those blood clots but you don't have to do that at
home and if you're up out of bed and walking around right after surgery that
blood clot risk Falls to zero very quickly what do you do after surgery
well you're walking around you come and see me after one week and then after
four weeks and then after three months and then after six months and then every
year for the rest of your life so the follow-up after surgery is very
intensive to make sure that things are going well a lot of people after a year
and a half have that saggy skin and end up wanting a
tummy tuck which I do more and more of so this is going to be a disappointment
because Tyler's post panniculectomy picture isn't here that's before surgery
that's the day after surgery that's the saggy skin and there's supposed to be a
slide here of after his tummy tuck which I don't have sorry but this is other
patients walking the halls after surgery you can see they've got their little
leopard fuzzy slippers on and they're going up and down so I really want you
out of bed moving around right after surgery this is what incisions look like
right after surgery I usually staple them shut with little metal staples each
one of those is about this big this is what those scars look like a couple
months later remember when I said there was that woman who had the the
complication and had to have a second surgery the same week because she had a
leak this is actually her belly so you can see the scars are almost invisible
even after a couple surgeries not everybody you can find their scars at
all right if you get a bunch of tattoos I can't see them this is what you're
this is what redundant abdominal skin can look like and sometimes that skin is
really not very healthy and when you take it off it looks like that this is a
femme teen pound specimen but if you look at what her scar looks like
afterwards and that's what her belly looks like afterwards my point is this I
don't hold myself up as a plastic surgeon I'm not trying to make people
look good in bikinis but the operations for the tummy tuck even though they
leave a scar generally are very functional and they leave people very
happy because they their clothing fits and all the rashes and infections that
they're getting go away so I have a bunch of before and after tummy tuck
pictures here the younger you are and the less you weigh and the younger your
skin is the better your scar will come out but everybody gets us some kind of
scar there's another before if your tummy is hanging down and covering your
privates in general I can get the operation done after before after
surgery and before tummy tuck after tummy tuck and that's what her scar
looks like so those are all that's a pretty common panniculectomy me scar before
after with the tummy after tummy tuck so men have these
surgeries as well any surgery can have a problem this is my thing again it's very
uncommon less than 100 people have a complication but if you have surgery and
you have severe pain you're short of breath you have chest pain your shoulder
hurts if you feel like you're going to die you got to give me a call don't take
two aspirin and wait till the morning and say I hope it feels better I don't
want to bother him on a Saturday night that's not what we want here you either
need to come to the ER or you need to give us a call and figure it out pretty
much right away after these operations you're pretty much through the woods
after about two weeks gastric bypass you're out of the woods
after one week's leave you're out of the woods after two weeks but in general
after a couple weeks you're safe and nothing bad is going to happen but in
that first period of time if you're having a medical problem please give us
a call if you don't feel well signs of problems fast heart rate severe
vomiting pain in your chest fevers more than a hundred degrees a
fast pulse rate like your pulse is beating really fast sweaty forehead
severe diarrhea or new back chest or shoulder pain that should prompt a phone
call at minimum Bobby's a volunteer she had surgery will you come and say a
couple things
doctor asked me to come in and just present myself I was at my highest
weight 241 and 5'1" so I met the criteria I also used a
C-Pap at night because I had sleep apnea and I also have hypertension these are
just closer up pictures my physician recommended that I have the surgery
because like you have done everything else my whole life experiences the up
and down so I had the sleeve I started with dr. Maccabee but then dr. Felix
actually did the surgery and that was in June of 2015 and I'm right now I weigh
130 pounds so I'm actually below the focus is on
getting healthy but I kind of already wanted to know what I was supposed to be
weighing myself thinking a lot of this your psychological outlook I think
That's part of why it's been successful for me and that Black binder
that you're going to get that he mentioned refer to that a lot that will
help you along your journey and you won't have any questions five
months after my surgery my hypertension meds, I three...Done. Before
that the CPAP done I gave that machine away as I had bursitis in my hips and
I realized maybe ten months later I don't have bursitis in my hip now so I'm doing a
lot of things you know I ignored a lot of the warning signs the red flags
probably things that you've experienced too but when I knew I was going to be a
grandma that was really my motivator and I'm gonna be a grandma
again I just found out. So you know it's my husband oh you're going to be
chasing after two in here but my hips won't hurt now so there's a lot to
look forward to this is like a new lease on life I come and talk at these
seminars twice a month and I also visit in the hospital usually the day of your
surgery I've cut back a little bit so if you're there on Tuesdays you'll probably
see me that's usually when I go and just probably more talk to the family than
you because you're getting probably out there you've already been educated
enough but I'll stick around after if you have any questions about food or
clothes or reactions from people in anything you might want to know Bobby
thank you very much I think the next slide is You too nope oh there you are
so before well there's the real after over there but there's not thank you all
right that's our whole talk if you have questions the website of the hospital is
very good I keep my own website but I and I have links to youtube videos and
things like that on there I would caution you about taking information off
the internet a lot of what people put up there is not edited not filtered and not
any good so be careful about what you read and make an appointment if you
don't already have one good night you guys thank you for coming
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