Bariatric Seminar Video

Bariatric Seminar Video


Alright, well welcome everyone this
evening. I’m Dr. Bonacci. I’m gonna be giving the seminar talk here this evening.
This first picture is not me – I’m going to show you pictures of all
the surgeons in our group because chances are, if you go through this
process, you will meet more than one of us along the way. So this is Dr. Cudjo,
this is Dr. Smith, Dr. Pilkington and then myself. And actually, just a few
months ago, we added a fifth surgeon to our group. This is Dr. Klee. So the goal
or the objectives of this talk tonight is to help you identify obesity as a
chronic disease and a growing public health concern, help you recognize the
indications or reasons for performing bariatric surgery, give you a
brief history of bariatric surgery as it’s evolved through the ages, and also
review the various procedures that we perform including the
laparoscopic band gastric bypass and sleeve gastrectomy. So this is a map of the
United States in 1995 and what this map is showing is our rates of obesity amongst
the 50 United States. So here you can see in 1995 most states have ranges of
obesity anywhere between 15 to 20 percent or 10 to 15 percent so pay
attention to how this map changes as we go through the years. So here in 2000 –
another color has cropped up as many states now have rates of obesity between
20 to 25 percent. In 2005 you see that trend growing even further – now there’s even a
few states with rates of obesity greater than 30%. In 2009 you can kind of
appreciate that that trend continues to grow more and more as the time goes on. Comparing
1990 to 2010 see the drastic change as far as rates of obesity
amongst the United States. And currently one-third of the US adult
population is considered obese and that number continues to grow every year. Here’s
the most recent data we have from 2013. You can see that there’s even some
states now with rates of obesity above 35 percent so this is again a growing
public health concern that continues to get worse and worse. So what is it that
we use to define obesity? That is a number called the body mass
index and this is a ratio based on somebody’s height and weight. If you go
to a doctor’s office, chances are you see these charts on the wall that help you
calculate what your BMI is so all you would have to do is find your height on
the top line and then follow that down to where the weight is and where those
two lines intersect that is what somebody’s body mass index is. Unfortunately
we can’t do much to change our height – it’s the weight that
fluctuates, really to change somebody’s BMI. Somebody is considered to have a
healthy BMI if the BMI is 18 to 25. Someone’s considered overweight if the
BMI is 25 to 30. Obese is considered 30 to 35. Severely obese 35 to 40. And
morbidly obese is greater than or equal to 40 for the BMI. So who is it that
qualifies for weight loss surgery? Well that’s typically here on the end
the class 2 and class 3 or morbidly obese patients. Those patients are going
to stand to benefit the most based on the risks of surgery.
Obesity is a deadly disease. It is the second leading cause of preventable
death behind only smoking and as more and more people stop smoking, you’ll see
that that is likely going to replace smoking as the leading cause of
preventable death. About 400,000 people die unnecessarily every year as a direct
result of obesity. Alright, so why is it that obesity is so deadly? Well that’s
because some of the health problems that are related to obesity. This is a diagram
that’s kind of showing the risks of obesity especially when somebody is
younger in age. If you look at, in this example, here’s a patient whose age is 20
and for that person who is 25 you can see well they don’t stand to lose any
years of their life as a result of obesity. But as their BMI gets higher and
higher, you can see that that same 20 year old who now has a BMI of more than
45 could potentially lose anywhere between 12 to 14 years of their life as
a result of obesity. So the younger somebody is with the higher rate of
obesity the more years of life that they can lose as a result of that. I mentioned
that there are certain health conditions related to obesity – that’s part
of the reason that obesity is so deadly. Well this diagram here kind of shows
rates of diabetes, heart disease, hypertension that are closely linked to
obesity and as the BMI increases higher the chance of developing
these conditions go right along with it. There is a a syndrome called syndrome X
or metabolic syndrome where patients with obesity can also suffer from
cardiovascular disease, diabetes or high blood pressure, and so for these
unfortunate patients right here where those three circles intersect, they
have a very high rate of mortality because of those health problems. So when
we look at treating obesity these are some of the things that we’re helping to
hopefully resolve or correct, in addition to just losing weight. There’s
various cancers that are associated with obesity as well cancers of the colon in
men, prostate cancer, cancers of the esophagus are more common in patients
with obesity. In women, cancers of the ovaries the uterus or the inside lining
in the uterus called the endometrium, the cervix, or even the breasts are higher in
patients with obesity as well. There are various lung-related
complications or what we call pulmonary complications related to obesity as well.
Asthma is actually very common in patients with obesity. And obesity acts or works
as a restrictive lung disease where there’s excess weight that’s carried on
the chest or midsection and it actually limits the amount or the ability of the
lungs to expand. Part of the reason this is a problem is that for a long time, the
prescribed treatments for obesity is exercise well obesity leads to a
decrease exercise tolerance so it’s unfortunately a vicious cycle. Patients
aren’t able to exercise so they end up gaining weight and then they can’t even
exercise even further. Sleep apnea is very common in patients with obesity. Chances
are somebody in the audience here tonight uses a CPAP machine we see
these very commonly in patients with obesity. There are higher rates of what’s
called pulmonary hypertension where there’s a higher blood pressure and the
blood vessels that go to the the heart and lungs and this can be severe enough
that patients actually need to end up having a heart or lung transplant as a
result of that. There’s various metabolic complications related to obesity as well.
High levels of cholesterol or a cholesterol-related molecule called
triglycerides can be seen in higher rates in patients with obesity. There’s also
higher levels of circulating estrogen and in some women
they suffer from something called polycystic ovarian syndrome and this can
lead to issues with fertility. It’s often linked to obesity as well and a
lot of these women who have difficulty conceiving children when they’re
successful with weight loss they’re actually able to go on and have
children. Also what we call hypercoagulability or the higher
tendency of forming blood clots. This can happen partly because if blood
doesn’t circulate well it can tend to collect and form blood clots. And this can
happen in the veins in the legs. So if obesity is limiting the blood flow
draining from our legs to go back to the heart, that blood will tend to pool in
those veins and can start to form blood clots and can lead to some serious
problems as a result of that. Gastrointestinal complications GERD or
what we refer to as acid reflux or heartburn – very common in patients with
obesity. The body is a pressure system so whenever we carry excess weight around the
midsection that pressure is exerted on the wall of the actual stomach organ. And
there’s a muscle at the end of the esophagus which is working to try and
control acid from coming up in the esophagus. Well if you increase the
pressure on the wall of the stomach that pressure of that muscle can be overcome
and now you start getting stomach acid coming up into the esophagus so that’s
what leads to heartburn or acid reflux. Gall stones or gall bladder disease is
very common in patients with obesity. In this country we spend about 800 million
dollars every year on obesity-related gallbladder disease, so not an
insignificant amount of money. Genitourinary complications, stress
incontinence – again this has to do with the pressure system of the body. This is
more common in women compared to men because the urethra, which is the tube
that carries urine from the bladder to the outside world, is shorter in women
and women often undergo the stress of childbirth which can kind of take a toll
on that anatomy as well. So if somebody were to cough or sneeze they can have a
leakage of urine as a result of that. In some cases, the pressure in the pelvis
is so significant that it can actually cause the pelvic organs to extrude through
their openings and that’s what we call a prolapse. That can happen to the
uterus, it can happen in the bladder, it can even happen to the rectum as well. There’s
also higher rates of sexual dysfunction in patients with obesity as
well. Orthopedic complications – I see many patients in my office suffering from
arthritis or joint pains what, we call arthralgias, chronic back pain. Again, this
excess weight takes a toll on the joints: the hips, the knees, the back – all these joints are dealt the task of carrying
this excess weight and it can take a toll over several years. Many patients I
see may have had a joint replaced already or they have been in contact
with an orthopedic surgeon to see about having a joint replacement. Well what the
orthopedic surgeons are realizing is that patients actually fare better if
they are successful with weight loss before they have their joints replaced. So
what the surgeons are telling patients is well you may want to seek
out bariatric surgery and lose weight first so you’ll have a better outcome
with the joint replacement. Psychosocial complications. Well, depression is very common
in obesity. It’s about a 90% rate of
patients with morbid obesity also suffer from depression. There are higher levels
of anxiety and overall lack of self esteem. Unfortunately, obesity is still one
of the accepted social biases, if you will,
where somebody can make a judgment about you based on the way that
you look. Well a good example of this is if you fly in an airplane you might be
asked to pay for an extra seat as a result of that, so unfortunately that’s the
way things still are. There are quality of life issues and loss of job potential. There’s
been studies looking at income potential for people who are obese compared to
their non-obese counterparts, and those studies do show that people who are
obese tend to make less than their non- obese peers. Also, patients with obesity
tend to develop inappropriate coping strategies, so one of the things that a
lot of patients turn to is food because it makes you feel good. If you
have something that you enjoy eating it relieves anxiety, it makes you feel
better. Well again, this is kind of a vicious cycle. If you turn to food to
make yourself feel better, it ends up leading to increase in weight
gain as well. So these are some of the things that we have to kind of address
in order to be successful as far as our treatment strategy.To understand obesity,
you have to know it’s a complex, complicated disease that has many things
that contribute to it. There’s approximately a 25 to 30 percent genetic
component to obesity, where if you look at parents that are obese they tend to
have children that are obese as well. There’s also an environmental component. Well
here in Michigan, unfortunately, in another couple of months we’re going to
start seeing some white stuff fall to the ground and that can make it
difficult or even dangerous to try and get outside to exercise. In some of the
southern states obviously it’s it’s not as much of a problem but that’s
one of the things that we have to understand here at Michigan. So to have an
effective treatment strategy we have to understand these
various contributing factors. There’s been changing perceptions about obesity
through the years. In the past it was seen as a weakness or a failure, and the
only prescribed treatments for it were diet and exercise. Weight loss surgery
used to be viewed as dangerous and extreme. Presently, however, obesity is
considered a disease that is chronic, progressive and debilitating and in many
people will ultimately lead to an early death. Surgery is now an acceptable and
proven method of treating obesity and surgery is also an acceptable and proven
method of treating the comorbidities related to obesity as well, so things
like high blood pressure, diabetes, sleep apnea – these are things that we can help
significantly improve, if not completely reverse, with surgery as well.
Surgical treatment is not for everybody though. We have to establish criteria as
I mentioned before to see who’s going to benefit most by undergoing the risks of
surgery. So as far as diet and exercise this is what we refer to as non-operative
weight loss. Most programs, believe it or not, are quite successful. Up
to 90% of patients lose weight with diet and exercise programs. The reason they
fail though is the maintenance of the weight loss. About 95
percent of the weight that is lost will be regained usually within five years
after patients go out of these programs. And many patients ultimately will regain
more than they lost initially so that’s why diet and exercise alone fail to
achieve the long-term weight control in most people. What about weight loss
medications? Well there’s been various ones through the ages a lot of people
may remember the fen-phen combination was popular back in the 90s. Well
unfortunately this led to many severe derangements of the heart valves and so the
FDA ultimately took it off the shelves and that seems to be the trend for a lot
of these medications is they’re on the market for a matter of several months to years
and then, as more people take them, they find side effects they end up
pulling them from the shelves. Back in 1991 the National Institutes of Health
looked at how we treat obesity and this is kind of their banner statement that
they made is that weight loss surgery was the only proven method of long-term
weight loss for the severely obese patient. So as far as establishing
criteria like I mentioned before, at our treatment center we treated adults so
patients are 18 years or older. Most insurances require a BMI or body mass
index of 35 or greater with another
comorbidity, so as I mentioned before diabetes, high blood pressure, sleep apnea,
high cholesterol – there’s a lot of them out there that insurances will use to
justify surgery. Or if patients have a BMI of 40 or greater alone without any
health problems insurances will often cover surgery as well. Often many
insurances want documentation of failed non-surgical approaches to weight loss
and patients have to be prepared to attend both pre and post surgery
follow-up sessions in order to be successful. You’re going to hear me say
several times through this talk tonight that these surgeries are not a
perfect magical answer. They are a tool to help you be successful, but most
patients that are making these changes and are committed to the changes will be
successful. You have to be prepared to make these lifestyle changes and
hopefully be a permanent change for you. Many insurances will require that
patients undergo mental health stability as well, so I tell patients well just
like we’re going through a process of making sure your heart and your lungs
are ready to tolerate surgery, we want to make sure that your mind is ready to
tolerate the stresses that come after surgery as well. So as far as surgical
management, there’s a number of operations that have been used in the
treatment of obesity and collectively they’re known as what’s called bariatric
surgery. This comes from a Greek word meaning weight and treatment. In the
United States last year, more than 220,000 bariatric procedures were
performed. I am part of what’s called Great Lakes Surgical Associates and
myself and all the other surgeons that I showed you pictures of earlier partner with
the hospitals to provide these surgeries. We perform the laproscopic
adjustable gastric band, the Roux-en-Y gastric bypass, and the
sleeve gastrectomy. And we actually here in Midland are doing the robotic daVinci
sleeve gastrectomy here as well, so some patients may prefer to have that done. So
I mentioned all these are performed laparoscopically. The advantages of
laparoscopic surgery are quite profound: fewer wound complications because the
incisions are smaller; there’s less risk of infection; less chance of hernia
because those incisions are smaller; with smaller incisions comes less pain so
patients have faster recovery compared to what’s called open surgery where you
make a large incision and believe it or not we actually have a better view of
the anatomy inside because most of those structures and organs are tucked up high
underneath the rib cage so we actually have a better view
of surgery when we perform things laparoscopically. So to kind of illustrate
that point you can see on the left side of the
screen this is a typical of incisions for laparoscopic surgery and then compared
to what we term open surgery with a larger incision where there’s higher
rates of infection, hernia formation, more pain and discomfort. Next we’ll talk about
the Roux-en-Y gastric bypass. gastric bypass. So again this
procedure is performed laparoscopically. The average amount of weight loss as
far as excess weight loss at three years is about sixty-two percent, so if you have
somebody whose current weight is 250 pounds and their ideal body weight is
150 pounds that person has a hundred pounds of excess body weight. So if we
were using those numbers for this patient that would be about 62 percent
or about 62 pounds for that weight loss. What happens with the gastric bypass is
the upper part of the stomach here is cut and partitioned and stapled
into a small pouch and then part of the small intestine downstream is divided
and then reconnected to that pouch. So when somebody with a gastric bypass
eats, food is gonna come down the esophagus, it’s going to go into this pouch here
and then it’s going to empty into the small intestine. It’s not until it
joins up with the rest of the digestive juices from the small intestine here
that things start to get absorbed. So not only does it limit the volume of
calories somebody eats by creating restriction but also limits the amount
of calories that are absorbed. This is the one that a lot of people have
thought about when they talk about having their stomach stapled because
this has been around for several years. These surgeries are quite safe and we’ll
go through the various risks of them all, but the gastric bypass does have low
rates of complications. These surgeries help change some of the signals to your
stomach where we don’t necessarily completely grasp all the hormones
that are involved in this process but patients will often feel
fuller longer, they don’t feel the hunger they used to feel beforehand, and so a
lot of patients with issues like diabetes – they can have improvement in
their blood sugars and resolution of their diabetes not strictly because of the
weight loss that they have but sometimes some of the changes that happen after
these surgeries. When we do this procedure, if somebody’s had a lot of
prior surgeries and there could be a lot of scar tissue in there may limit our
ability to do the surgery because we have to not only work on the stomach
itself but also on the small intestine. So if I have somebody who’s had a lot of
prior abdominal surgeries I might tell them well it may not be possible to
do a gastric bypass. As far as the malabsorption part, this is something
that the body does adjust a little bit too as well because our body does adapt. So
as far as how long that lasts sometimes that can be lifelong, sometimes
patients may not notice as much malabsorption as time goes on over
several years. So as far as the risks and complications well what we call
dehiscence or separation if you will that’s where any of these tissues that
we cut, divide or reconnect, we count on those areas healing
together and so if that weren’t to happen and those areas separated well you
could have a leakage of either stomach or intestinal contents inside the
abdominal cavity. That can make somebody very sick if it happens so one
of the things you’ll hear from us after these services there’s a very
structured diet that patients follow to help allow things healing okay. There is
a risk of forming ulcers after a gastric bypass and this can happen at the
connection between the stomach and the small intestine. Our stomach has
protection against its own stomach acid but the small intestine doesn’t
necessarily have that same protection so if you have a patient that has this
connection between the stomach and the small intestine and stomach acid is
going into that small intestine, it can sometimes lead to an ulcer. This is seen
a lot more commonly in patients that smoke after surgery so we really
strongly stress that patients smoking is a big no-no after these surgeries
because of some of the complications that can lead to. There’s also something
called dumping syndrome which is sometimes seen in patients with a
gastric bypass. It’s often where somebody ingests a high carbohydrate meal that
will empty quickly into the small intestine and with all those
carbohydrates it sucks a lot of fluid into the small intestine so somebody can
feel pretty miserable when that happens. They can feel faint, they can feel sick
to their stomach or vomit, they may have some diarrhea, they just feel pretty
lousy for about half hour or forty-five minutes but often it’s related to that
high carbohydrate meal that they took in. So if somebody takes a step back and
says “oh yeah I ate that piece of chocolate cake” well I don’t want to feel
that way ever again. So they often realize what they need to avoid to
prevent dumping syndrome. I mentioned the malabsorption component
of this surgery well that can sometimes lead to vitamin or mineral deficiencies.
Things like B12, calcium, iron – these things can sometimes become deficient in
patients after a gastric bypass because of the malabsorption component. And also
because the way the surgery is conducted when we divide the stomach and create
this pouch we no longer have typical access to the old part of the stomach or
this very first part of the small intestine if we were to do what’s called
an upper endoscopy because that pathway has now been averted. It may be difficult
to detect if somebody were to have an ulcer in that old part of the stomach
and develop bleeding from that so these are some things that patients have
to understand and realize. If someone were to develop a cancer of the stomach we may
not be able detect that through normal means because
of changes in the the pathway or the highway if you will that we create.
Sometimes patients can experience increased gas or flatulence after
surgery. Part of this, again, speaks to the malabsorption part of the surgery where
whatever your body doesn’t absorb in the small intestine empties into the colon
and there’s millions upon millions of bacteria in the colon that make use of
that extra nutrition and sometimes a by-product or that can be increased gas. So
what can you expect after the gastric bypass procedure? Well recovery takes time
and patience and again the diet is strict. The diet after
surgery to allow those staple lines and areas of connection to
heal it involves basically two weeks of a clear liquid diet mixed with protein
powders or protein shakes and then after that six weeks of basically a full
liquid diet. Things like yogurt, pudding, cream soups are included on that
but nothing you’re really gonna have to chew it all and the concern is that if
you have to choose something to swallow when it gets into the stomach pouch or
in those connections it can put undue stress on them and cause them to break
down. So the length of time to return to normal activities can vary from patient
to patient. Most patients, the majority, are gonna
feel pretty well back to normal within the first couple of weeks after surgery.
We do ask that patients follow activity restriction of usually nothing more than
15 pounds for about four weeks and that’s really just to protect the
incisions so that patients don’t get hernias at those incisions. Again some
patients are able to return to work within a few weeks and weight loss happens
fairly quickly after surgery. Other patients may take a little bit longer
so it just depends on the individual patient as far as how rapid the weight
loss is. But typically we expect usually about three to four pounds of weight
loss per week is what we tell patients primarily. There was a study that looked
at the median time for various things for gastric bypass patients and so the
majority of patients were started on an oral diet within a day and a half after
surgery. The majority of patients left the hospital after two days and the
majority returned to work at twenty one day. So those are kind of some
averages but I’d say that like I said most patients within a couple of weeks
they’re going to feel well enough to to work. So I mentioned about dumping
syndrome earlier – this is kind of a diagram that displays that. So again some
people consider it a complication, others use it as a reinforcement partly because
they recognize that okay there was a something that had a lot of
carbohydrates that made me feel pretty miserable and so I don’t want to do that
again so they kind of tend to avoid those things. So next we’ll talk about the
sleeve gastrectomy. This is a laparoscopic procedure. This was actually
the first stage of a two-stage procedure called the duodenal switch where
patients with a really high BMI, the plan was to do the sleeve gastrectomy first
and then they would do the second part which was the duodenal switch at a later
date. Well what they found for these patients is they often lost a fairly
significant amount of weight with the surgery of the sleeve gastrectomy alone
and many patients didn’t have to go back and have that second procedure performed
so it kind of grew into its own surgery. This is easily the most common
surgery that’s now performed in the US for weight loss and part of that reason
is because after about four or five years most insurances started to cover it and so
that’s what it really helped it catch on. no implanted medical device, and part
of the reason the surgery works is it does change the hormone signaling that
happens. There is a hormone in our body called ghrelin that stimulates our
appetite and at least in part it’s released from this part of the stomach
here what’s called the fundus which has been removed during surgery. So we’re
turning the stomach into a long slender tube just like the sleeve of a shirt –
that’s kind of how it gets its name. There’s not any plastic sleeve of
material though. So when we have done this surgery this part of the stomach
over here now has no blood supply to it so we have to take that part of the
stomach out so that one part I mentioned – the fundus – is removed as well and so a
lot of patients that have the surgery will say you know “I don’t have a
constant hunger I used to feel beforehand.” You’ll also notice that if
you follow the path that food goes well it’s going to go the exact same route
that it did before. We’re not rerouting the intestines so
the the risk of vitamin deficiencies or malabsorption is significantly reduced
with this surgery compared to the gastric bypass. So essentially what this
surgery does to be effective is it invokes restriction. The amount of the stomach
that we remove is about 80 to 85 percent of the volume. So
patients who used to consume lots and lots of calories at one sitting just
aren’t physically able to do so because of the much smaller volume of the
stomach. So as far as the risks of the get of the sleeve gastrectomy
well hernias can happen after any surgery that would also apply for the
gastric bypass again just at the incisions. That’s partly why we do limit
activity afterwards. Constipation, diarrhea, again sometimes this can happen
after bariatric surgeries. Constipation might be a little bit more common than
diarrhea partly because we’re affecting somebody’s overall fluid intake with
these surgeries and so one thing to help combat constipation is actually drinking
adequate liquids and water. Well when we limit the volume of the stomach, patients
may have a harder time getting in their fluid at least early on after surgery. Dehydration
can happen. Again, that speaks to not taking in as much fluids as
patients often do beforehand. Gall bladder disease can happen after any
weight loss surgery and partly because if your body is losing a lot of weight,
part of the byproducts that are broken down can lead to forming gall stones so
that’s why sometimes patients can end up needing to have their gall bladder out
after they have these surgeries. It used to be where when they did these
surgeries they would go ahead and take out the gallbladder to kind of preempt
that from happening but, what they found is a number of patients actually would
have never had problems with their gallbladder whatsoever. So we don’t
usually take the gallbladder out at the same time because it’s the minority
that will end up developing issues. Vitamin deficiency – again for the gastric
sleeve it’s much less compared to the gastric bypass because there’s no
malabsorption but we still do encourage patients to take multivitamins to help
combat or prevent that from happening. Acid reflux – GERD – can happen, again partly
because of the pressure system. When we reduce the volume of the stomach it does
lead to an increased pressure in the stomach and so if somebody has a fairly
weak valve at the end of the esophagus that can lead to sometimes acid reflux
or heartburn. A lot of times it’s behavioral. I tell patients “if you eat to
full capacity of that sleeve well you’re gonna have
potentially more of an issue with acid reflux whereas if you take your time and
eat slowly often your body will realize okay I’m full, I’m at that point I don’t need
to have any more.” Gastrointestinal inflammation or
swelling, well again this can happen anytime after any type of abdominal
surgery. Intestinal leakage – again that staple line where we’re dividing the
stomach, we’re expecting that to heal so we have to be very strict as far as the
diet afterwards to allow that to happen. Something called a stoma obstruction –
this can happen. Let me kind of go on this diagram here: so along this staple
line when we do this surgery we have a what’s called a bougie inside the
stomach to help gauge the size that we’re leaving behind. Well, after surgery
sometimes there can be some swelling in that area and so if this area becomes
narrowed down because of the inflammation well that can make it
harder for fluid to go through there. Most the time if patients experience
this it’s short-lived within the first day or two after surgery and just
allowing enough time for that inflammation to subside helps it resolve.
Stretching the stomach – well this is partly where we tell patients it’s
important to pay attention to your body signals, to eat slowly because if
patients are eating to full capacity that sleeve, that’s the concern is that
as time goes on are they gonna stretch the stomach back open. Well I’ll guarantee
you they will never stretch the stomach back to the original
size but will they stretch it enough so that they affect their long-term weight
loss and so that’s partly why we tell patients you need to avoid carbonated
beverages, there’s certain things that we want you to avoid to help lessen that
from happening. But the most important thing usually is just taking time to eat.
We do live in a society where we eat too quickly and as a result of that we
consume a lot of excess calories which we would have otherwise avoided if we
just take our time to eat. Vomiting and nausea – well that can happen anytime you
do surgery on the stomach and that’s kind of how the body responds to that
stress. Again this is often short-lived and related primarily to some of the
anesthesia perhaps or just some of that swelling that happens along the stomach. So
after a sleeve gastrectomy, while recovery will take time and patience and
as I mentioned before the diet is strict, you can experience discomfort and pain
as your body heals, obviously having surgery having incisions there’s going
to be some healing that’s involved with that. The length of time to return to
normal activities will vary from patient to patient but it’s fairly similar to
the gastric bypass that I talked about before. Again the capacity the stomach is
going to be drastically altered after the surgery so being
very cautious and taking in fluid and oral intake slowly is going to be very
important. And myself and members of the health care team will advise you as far
as returning to work and so forth but again those same rules I mentioned
before usually apply so most patients within a week or two are gonna be
feeling well enough to go back to work. As far as the actual lifting
restrictions or strenuous activity, usually that’s four weeks. I tell
patients that it’s really a matter of letting their body be their guide as far
as when they can go back to work. I had some patients return to work as quickly
as three or four days, granted they just sit at a desk all day – they don’t have to
do much in that respect. I tell patients those are kind of the exceptions but I
have had some patients go back as soon as that quickly after the procedure. So
at this point you must be telling yourself well this has to be magic well
of course it’s not magic. These surgeries are only tools to help you lose excess
weight – you still need to make these permanent lifestyle changes in order to
have long-term success; however, the bariatric surgery benefits are profound:
over 96% of the health problems related to obesity are completely resolved and reverse
usually within days to months after surgery. Again there’s huge
physical and emotional benefits. Looking at some of these disease processes that
we help improve: depression – there’s actually a 47% reduction; there can
be a 46% improvement in migraine headaches; 25 to 66% controlled diabetes
; 42 to 66 percent resolution of high blood
pressure. There’s a disease of the liver that is is tied to obesity called
non-alcoholic fatty liver disease and there’s a 37 % resolution of that. Arthritis
and joint pain: 41% resolution; stress incontinence 50% resolution.
There’s a 39% improvement in asthma; sleep apnea 45 to 76%
resolution. So again significant improvements that
we can make for patients with various comorbidities related to obesity. So at
our treatment center we have a team approach. Myself and my partners in our
group that are trained in advanced laparoscopic and bariatric surgery, we
have various experienced office staff, skilled nurses, dietitians at the
hospital as well as other hospital staff. We have various support groups as well.
We have behavioral specialists, insurance specialists, medical specialists, as well
various medical specialists including cardiologists, pulmonologists,
psychiatrists that have special training as far as treating patients with obesity.
So the next steps to regaining your life well the first one is you’re here at the
seminar this evening hearing the information I have to tell you. We are
gonna give you some paperwork tonight and also most insurances do ask that you
obtain a letter from a primary care physician stating why you’d be a good
candidate for surgery. We’ll contact you and you’ll have a consultation scheduled
with myself or one of my partners and that’s where we’ll go through your
specific health issues, prior surgeries, go through all your history and kind of
discuss what surgeries may or may not be a benefit for you. Depending on somebody’s
baseline health we might have to schedule some other
appointments as well so if I have a 35 year old female having the surgery, am I
worried about them having a heart issue during surgery? Well of course not, not
likely. But if I have a 60 year old male who’s had two prior heart attacks, well
obviously that patients gonna have to go further undergo further testing likely
having to see a cardiologist before they had surgery. We also perform what’s
called an upper endoscopy on all of our patients. So this is an outpatient
procedure so you go home the same day and we use a flexible camera to look
down the throat at the inside lining of the esophagus, the stomach, and the start
of the small intestine. That’s going to allow us to see if there’s anything that
we would need to treat before surgery or might prevent a patient from going
forward with surgery. So the good news is you get sedated when you have that
procedure so you’re probably not gonna remember much of anything from it. You
can go home the same day as I mentioned but because of that sedation somebody
else has to give you a ride home. So one of the things that we check for is
there’s a bacterial infection that can occur in the stomach from a bacteria
called H pylori and that bacteria can actually eat a stomach ulcer so we often
will do a biopsy of the stomach lining to check for the bacteria. The other
thing that we do is we will look to see if there’s a hiatal hernia because
that’s something that at the time of surgery we might be able to fix at the
same time as well. So we also ask that patients attend a support group meeting
before surgery and support group meetings are very important because
you’re going to hear a lot of information from previous patients that
have gone through this process and the hope is that if other patients are very involved
in these support groups that
they’re gonna be a beacon of information for other patients to come after them. And
actually there’s been studies looking at participation in support
groups and those patients that are more active and involved in support groups
actually do better in the long term. We also have a nutrition class that you
attend before surgery and you also meet with some members of the anesthesia
department where they’ll explain or discuss their role in your care as well. So
you have various decisions when you go through this process: discuss
options with our weight loss team, attend the support groups because of their wealth
of information, talk with your own doctor because chances are they’ve had some
other patients in their practice that have gone through this
process as well. Talk with your family as well because after surgery they’re gonna
be a huge resource for you as far as your recovery and I always shudder when
I first meet patients only on the day of surgery and they just have their
family over so I’m just having my sleeve done. Well it I mean it’s a big
surgery so it’s important to have these family members involved early on. And
also do your own research. Learn as much as you can. The Internet is a wealth of
information. If you so desire you can go on YouTube and actually watch these
surgeries being done. But keep in mind that not everything that you read or see
on the internet is necessarily true that’s why we say get the facts not the
fiction. So the bottom line is if your BMI is 35 or greater you have three
choices: non-operative weight loss like we talked about with diet and exercise
when there’s nearly a hundred percent chance of failure; operative weight loss
that we talked about here tonight where there’s an 85 to 90 percent chance you
will lose the life-threatening weight and have a chance to get your life back;
or our patient can try and just live with their weight and deal with it and
unfortunately miss out living life to its fullest. So the good news is we can
help you regain your life. We perform these surgeries at two locations here in
this hospital in Midland and then also the hospital in Alma. Both hospitals are
part of MidMichigan Health and both medical centers are accredited by an
accrediting agency which is abbreviated MBSAQIP. Some insurances in the past
have required that patients have their surgeries performed at centers that are
accredited by this so we can meet that need for patients. And both centers have
been designated as a Blue Cross Blue Shield Blue Distinction Center and also
both centers are accredited by the Joint Commission so everything
that most patients would potentially require to have the surgeries done. This
is a picture of the hospital that’s in Alma – MidMichigan Medical Center – Gratiot,
and this is a drawing of the building that we’re in here this evening in
Midland. Here’s the picture one of the hospital rooms in Alma. Patients that
have a gastric band typically it’s a one day stay or sometimes even outpatient
procedure. Gastric bypass and sleeve gastrectomy is typically a 1 to 2 day
hospital stay. Part of that just depends on how patients are feeling after
surgery to decide when they go home. As far as the support groups, again we do
ask that you attend one before surgery and as I mentioned earlier there’s been
studies that that show improved success after patients that are very involved in
support groups so we do encourage patients to be active in the support
groups. We have four locations where we perform these: Alma, Gladwin, Midland and
Mt Pleasant to help the needs of patients throughout our center of our
state. So that is where I’m going to stop here so if there’s any questions I’d be
more than happy to take any questions you guys may have.

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