Scott Webb: Today on the Health Works Here podcast, we're going to hear from Diane. Diane suffered from numerous health conditions, including reflux, hives, and asthma. Then, Diane met Dr. Laura Doyon at Emerson Health and her life was changed thanks to weight loss surgery. Today, we're going to hear Diane's heartbreaking and inspirational story.

This is the Health Works Here podcast from Emerson Health. I'm Scott Webb. So, I want to thank you both for joining me. Uh, Dr. Doyon, we've spoken before and Diane, you are Dr. Doyon's patient, and we were just kind of talking about something that just happened to you recently and how that was only really possible because of what Dr. Doyon has done for you. So, we've done it like this before where we kind of hand the keys to the doctor and let them sort of drive. So, I'm going to do that, Dr. Doyon. I'm going to hand it over to you and let you speak with Diane.

Dr. Laura Doyon: Hi, Diane. It's great to talk to you. I'm thrilled to hear how you're doing nearly a year after our surgery. So, very much looking forward to that. I think we should start by I think everybody needs to hear your story because you were first sent to me to help manage reflux and a hiatal hernia. But there is a lot more to your story, which makes you so interesting and makes you, just for me, such a gratifying experience of helping you. So, do you want to tell us a little bit about your story of, you know, how did you come to find me?

Diane: Okay. Actually, it started about 10 years ago that I had heartburn and then that advanced to the acid reflux. And then, a few years afterwards, I was building a cabinet with Steve and I broke out in hives. Then, I ended up in intensive care for quite some time and nobody could figure out what was wrong with. So, they decided that I had chronic hives and these hives would attack my throat, so I couldn't breathe. And they were able to keep the hives under control through medications, but they never fully went away.

Afterwards, it just started as the doctor said, it was like my hives were on steroids. So, they started to give me Xolair injections. But the pain in my chest was worsening and my breath was being taken away more often and my acid reflux was totally out of control. So, my doctor suggested another upper GI. And when he saw this, he saw a hiatal hernia. And he suggested Dr. Doyon. I said, "Dr. Doyon?" I said, "She's a weight loss doctor." So, that is how I came to you.

Dr. Laura Doyon: Absolutely. Yeah. And many gastroenterologists will send me patients who are suffering from terrible reflux that seems to be driven by a hiatal hernia, and so I do surgery to repair the hernia and prevent reflux from happening in the esophagus. In your situation, your weight was also a factor in this because we had a BMI over 35, and that's an inflection point for me and other surgeons who do this type of procedure to prevent reflux with a hernia, where instead of doing something called a funduplication, instead I spoke to you about doing gastric bypass as the anti-reflux portion of the surgery alongside the hiatal hernia repair. Sometimes you'll find this advice sort of unexpected. Do you want to share for us how did you take that advice or what was your thought when I presented this plan to you?

Diane: Like I said, it's like, "A weight loss person?" And I just said, "Okay." And I even remember asking you, "If I lost the weight, you know, would you do still do the surgery?" And I'm so glad you were the doctor and not me. Because where I am now, I just can't believe the way that my life has changed. So, I was a little stunned

Dr. Laura Doyon: Yeah.

Diane: about the weight loss.

Dr. Laura Doyon: Right.

Diane: But after I went through the process at your office and I understood, and I was not so afraid, what you need to understand it wasn't so much the weight loss surgery, it was I was afraid I was going to die because the hives were so bad. And my last words to the anesthesiologist is, "Don't forget about the hives." And he assured me that-- I'm sorry.

Dr. Laura Doyon: It's okay.

Diane: That it was going to be okay.

Dr. Laura Doyon: Yeah. Yeah. We have a really expert team of anesthesiologists that I trust completely. I work with them daily. I'm so glad that they were able to help get you through the surgery and help reassure you at that scary time when you're in that waiting area before surgery. It's a time that most people anticipate quite a bit. But we got you through surgery.

Diane: yep. And also too, your staff was just really there for me, you know, with all of my absurd questions and stuff, because I had so many.

Dr. Laura Doyon: Yeah. Yeah. The staff loves what they do and I can tell how gratifying they find the process of watching people go through surgery, is because they are invested, they're genuine, they want to take the time. So, I'm really glad that you got that experience too, because you deserve that.

Diane: Thank you.

Dr. Laura Doyon: So, tell the listeners what was it that we were so surprised about. Your reflux, as I predicted, improved after hiatal hernia repair and gastric bypass. But what else improved? Why is your story so remarkable?

Diane: All right.

Dr. Laura Doyon: Take your time.

Diane: So for many years that I did not live life, I couldn't go outside because I couldn't handle the weather, whether it be hot or cold. I had the acid reflux at night, so I never slept through the night. Then all of a sudden, this asthma appeared from wherever. And then, all of the medications that I was on, it was like I was fighting the fatigue all day long. I was constantly tired. And so then, I started drinking a lot of diet Coke and then I was on a rollercoaster, crazy. And then, the problems eating at the end of it was just awful. I mean, I would even drink something and bend over and it would come back up.

Dr. Laura Doyon: Yeah.

Diane: Then, I couldn't exert myself because I couldn't exercise or even do like housework. And the worst thing about it is I dreaded taking a shower because the hives would get so bad. So, that was my life, you know, was like before the surgery.

Dr. Laura Doyon: It's almost like your body was on this runaway spiral, where each problem seemed to aggravate the others.

Diane: Yes. Yep. And so, it was like I basically lived in my house for years because I was not even able to walk from the car to a store. I was always dropped off at the beginning of the store, at the entrance of the store. I mean, we would have family gatherings, picnic gatherings, and I would be in the house and everybody would have to come in and visit me. And even people hugging me or anything, I just didn't even want to be touched because of the hives.

Dr. Laura Doyon: Yeah. So afraid of the hives jumping up, yeah. Must have been terrifying.

Diane: But I do remember your words, that I just sat there and I told you all of these symptoms. And you said that you had other patients and that you have seen these decrease with all the asthma and everything.

Dr. Laura Doyon: Absolutely. I think that one of the less described and maybe underappreciated effects of gastric bypass is that not only does it really help reflux, but for people suffering from what I'll describe as inflammatory side effect of weight, it seems that weight has an inflammatory effect on the body, things like asthma, hives, unexplained allergic phenomenon can get better. And I was banking on that with your story of reflux and out of control adult-onset asthma plus the hives, my suspicion was that everything would get better with the hiatal hernia repair and the gastric bypass anatomy.

Diane: Yes. And it did because I am on no medicine.

Dr. Laura Doyon: That's incredible. Can you tell people how much medication were you taking when we met?

Diane: There was about 12 of them at least a day.

Dr. Laura Doyon: Isn't that something to celebrate maybe?

Diane: Oh, yeah, because it's like it's totally out. And I still say, you know, like, "Oh, I have to go and take my meds" and I actually mean my vitamins.

Dr. Laura Doyon: Well, we heard about how your life was limited in terms of how you could participate in life and enjoy life before surgery. So, what types of experience have you had since surgery?

Diane: Oh my. It's still happening after a year. Even yesterday, I held a puppy for the first time.

Dr. Laura Doyon: Wow.

Diane: So, that was-- oh, my gosh, just the smell. But the first thing I did, but you have to remember, I know I sound like I'm a little crazy, but I'm really not.

Dr. Laura Doyon: No, never.

Diane: But my first test to myself, I went with a very good friend of mine tulip-picking.

Dr. Laura Doyon: I remember.

Diane: And I remember walking up the hill and I was just waiting for my breath just to be taken away, and it never happened. And I said, "Okay." And I even remembered I even had two different kinds of coats on just in case something happened. So then, she says, "Diane, you're supposed to be picking the tulips." It's like, "I know, but I was afraid to bend down because the acid reflux."

Dr. Laura Doyon: Right.

Diane: And it was really weird because actually, when you pick tulips, you actually have to bend and really pull on them to get the bulb out. So, I'm sitting there going, "Okay, if that doesn't happen, I know it's gonna be a hive breakout," and nothing happened. Absolutely nothing happened. I looked at my bunch of flowers and I never saw anything so beautiful in my life.

Dr. Laura Doyon: Oh, wow.

Diane: So because of that, I went out and I planted. Oh, by the way, I was not even gardening at all. So, I planted 70 bulbs of tulips to mark this.

Dr. Laura Doyon: Wow. What a perfect way to memorialize your success. I mean, the visual is just incredible. I love that.

Diane: And then, the next thing I did, which I didn't want to do, but Steve just insisted, and it was for a few weekends, but I finally went to the beach. And I was so scared. And he goes, "No." He goes, "If anything happens, we can go." Because he's been through a lot of it with me, so he knew. But the first time, I went very early in the morning, nine o'clock when most people weren't even there and I left when people were coming because it wasn't the hive breakout or the asthma or anything. It was the sun was so strong for my skin.

Dr. Laura Doyon: Yeah.

Diane: So, we left and I returned. I really believe it was the next weekend because I was so excited to feel the sand in my toes, that I went with an umbrella. And all day long, I just went in and out of the umbrella and reading and I felt normal. I actually went in the water and it was just amazing. And after that, we even went and we walked the shops.

Dr. Laura Doyon: Wonderful.

Diane: And this is something I have never been able to do. And also too, I look forward to showers now. I just want everybody to know that.

Dr. Laura Doyon: How about one other little anecdote that I remember you telling me in the office? What about the wedding that you went to with Steve?

Diane: Steve and I would always go to weddings, of course, together. Sounds dumb now that I say that. But we would go to weddings and we would never be able to dance together because of the hives, I mean, whether it'd be slow or fast, even the slow ones. But the last wedding we went to, we actually danced slow and fast. So, every aspect of my life, it's like a new day every day because my son got a puppy and I actually got to hold the puppy. My daughter is pregnant and I get to go for walks with her. And now, I really look forward to the baby because I will actually be able to hold the baby.

Dr. Laura Doyon: I mean, it's hard to even put words to just to how wonderful and gratifying this is. And there's no crying in surgery, but I'm trying, I'm working really hard to not get choked up on this side, Diane. Your experience has been amazing. I'm so happy for you.

Diane: Yep. I mean, before it was like I used to think about a baby and, you know, that I would not be able to take the baby anywhere, to the zoo, to parks, to even enjoy the life of being a grandmother. And now, I have all these things that I have to remember, that it's my daughter's baby and not mine, that I could do just so many things, but I'm sure she'll, you know, let me go with her. But there's just so many things to experience.

Dr. Laura Doyon: That's what grandparents are for. Oh, I'm so happy for you. I mean, I think for me, your story really illustrates how gratifying it can be to be in the position of being the surgeon, listening to the number of things, you know, the individual assortment of things that somebody is coming in with, and trying to select the best possible plan and the best possible surgery so that if I can treat more than one condition at the same time with one, you know, elegant procedure, then why not go forward with that plan and make things as good as possible for you after surgery. And I just feel like you exemplify that. So, thank you for trusting me.

Diane: You changed my life. I mean, this was life changing. And also I just want the doctors and people to know out there, I met a young woman recently and she had the surgery and I asked her about hives and she said she didn't have any hives. I said, "What about asthma?" She goes, "That's so funny, I don't have it anymore." Because it was around Christmas time and she had the asthma like I did. It gets really, really bad seasonal. You know, at certain times of the year, it gets out of control. "Come to think of it," she goes, "I didn't have asthma." So, I think there's a lot more that might be researched. Is there any research on this?

Dr. Laura Doyon: Yeah. So, there's actually a good amount of research showing that what we think of as weight loss surgery is also treating some of the inflammatory effect of obesity, of excess weight. There's a number of studies showing that people who suffer from obesity have higher levels of inflammatory markers in their bloodstream and those inflammatory markers are likely responsible for things like asthma, your hives and, interestingly, also probably have a role in causing people to develop cancer or heart disease. And there's data showing that people who suffer from weight have a higher risk of developing heart disease and cancer, and that risk can be mitigated or reduced by having weight loss surgery. So, the answer is yes. There's data showing this. I don't think that it's something at the top of people's minds when they're thinking about weight management. But there's definitely strong literature to support these things. So, I'm just thrilled that you were able to experience it in your own body.

Diane: I always say that I didn't suffer like I did for no reason. I want people to know that there is help, you know.

Dr. Laura Doyon: Yup, absolutely.

Diane: And that is my main reason for doing this podcast, is that people will know.

Dr. Laura Doyon: Absolutely. I thank you for helping to get the word out. We really appreciate you.

Diane: Thank you.

Scott Webb: Well, Diane, it's so great to hear your inspirational story and what you've been through, and really hope that it inspires listeners to realize that there is help available, Dr. Doyon and others there at Emerson Health. And doctor, while I've got you on the line, I want to maybe just ask some sort of, you know, baseline questions a little bit. Like what's the relationship with bariatric surgery and conditions like reflux, hives, asthma? Because this has been so educational today, maybe you can sort of take us through that, the relationship as far as you understand. And also, you know, how does surgery help with these issues? Why does it help with these issues?

Dr. Laura Doyon: I have seen many patients similar to Diane's story, who present to me with, say, a hiatal hernia and terrible reflux, but they happen to have excess weight. And so, their starting BMI might be over 35 or over 40, for example. And there is strong data to support changing how the anti-reflux part of the hiatal hernia repair works. So instead of doing a hiatal hernia repair plus something called a fundoplication, which is the wrapping of the upper stomach around the lower esophagus to help block acid, for a person who has a higher weight, again that BMI of 35 is sort of the cutoff, instead we recommend treating the reflux with a gastric bypass. Because it seems that this is a longer lasting procedure for a person at a higher weight category, and I can talk more about why that is. And I usually explain some of the dynamics of this with some hand drawn pictures during the office visit.

And so by performing a gastric bypass instead of fundoplication, I end up pulling acid away from the stomach and esophagus with the drainage effect of a bypass. I also typically lower the weight of the person, which helps prevent less squeeze on the stomach and less push of acid back up into the esophagus. And over time, the gastric bypass is more durable for a person who has excess weight than a fundoplication might be, which can tend to fail over time if it's done in a person who has very high weight. So, those are some of the reasons why this field of surgery recommends gastric bypass for people who have a BMI over 35.

In Diane's situation, it had added benefit of treating some of the inflammatory effects of weight. She described this runaway train type experiences having reflux compounded by new-onset asthma compounded by hives, requiring a number of medications that affected how she felt, not being able to get adequate sleep, not getting the ability to exercise during the day and this, in turn, affected her weight, so it was this sort of never-ending cycle.

.And so surgery was able to reverse that cycle that her body was sort of set on. And it does that by controlling the reflux, as I mentioned. It also does that by affecting the inflammatory pathways in the body. So, obesity tends to create a pro-inflammatory state in the body. And this has been well researched and a number of studies have shown that inflammatory markers in the bloodstream are elevated in persons who suffer from obesity. And these inflammatory markers are probably some of the things that prod chronic disease to continue, such as heart disease, asthma, certain types of cancer. And so by performing a weight loss procedure, when there's less weight, this also affects the inflammatory condition, so there's less inflammation, which is what helps correct those conditions.

Scott Webb: Well, Dr. Doyon, this has been really fascinating today, educational, inspirational, everything I look for in a podcast, whether I'm hosting or listening, and I'm sure listeners agree. So as we close up shop here today, if someone's suffering from one or many of these conditions, why do you recommend that they come see you?

Dr. Laura Doyon: Well, my approach is that I explain to the patient-- you know, first of all, I listen to everything they're experiencing and I try and do a really good job of getting a history of what they're dealing with and what's important to them and what their goals are, so that I can best identify how I can help them. And then based on that information, I'll suggest, you know, a plan A versus a plan B surgery, and we'll talk about the pros and cons of each. And this helps them get information from somebody who's an expert in what surgical procedures could offer. Never kind of pressured commitment, this is informational. And if it sounds like it's something that they're interested and feels like that this may help them with what they're currently struggling with, then we go forward with some testing and some planning to get them prepared for surgery.

Scott Webb: Yeah. Well, it's awesome and it certainly sounds like patients are in good hands at Emerson Health. So doctor, great to have you on again. And I'm sure that we'll speak again. Maybe we'll do more of these patient testimonials. But in the meantime, thanks so much. You stay well.

Dr. Laura Doyon: All right. Thanks a lot. Take care. Bye-bye.

Scott Webb: And visit emersonhealth.org/swl or call Emerson Center for Weight Loss at 978-287-3532 for more information. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify, or wherever podcasts can be heard.