Transcription:
Bariatric Surgery at Memorial Health System

Melanie Cole (Host): Being seriously overweight can lead to so many life-threatening medical conditions; diabetes, high blood pressure, sleep apnea and so many more. However, there are many options, both surgical and nonsurgical to help you live a healthier life. My guests today in this panel-style discussion are Dr. Emmanuel Agaba, he’s a surgeon with Marietta Memorial Hospital Department of Bariatric and General Surgery and Ashley Lockhart and Alyse Shapaka, both Physician’s Assistants at Memorial Health System. Dr. Agaba, I’d like to start with you. Let’s define obesity for the listeners and what other comorbid conditions can arise from this? Tell us what is really considered obese?

Emmanuel Agaba, MD (Guest): Obesity is defined as when your BMI is greater than 32-35% of your ideal body weight. And this comes with a lot of medical comorbidities such as diabetes, high cholesterol, hypertension, sleep apnea, issues related to being able to conceive. For example, obese patients are more likely to have polycystic ovarian syndrome. And several other medical problems.

Host: Ashley, going to you here. When we’ve heard the term bariatric surgery, are there certain parameters to consider bariatrics? Who can qualify for this type of tool to help with weightloss?

Ashley Lockhart, PA (Guest): To qualify for bariatric surgery, there are a couple of different qualifications and it’s all based on the BMI and your comorbidities or the diseases that one would have that is related to their obesity. So, if their BMI is over 35 but under 40 and they have a comorbid condition that was just mentioned by Dr. Agaba; then they would qualify for surgery. However, if they do not have one of those comorbidities that was mentioned by Dr. Agaba just a moment ago; then their BMI would need to be over 40 in order to qualify for bariatric surgery.

Host: Alyse, tell us about what is bariatric surgery. What’s it like for the patient?

Alyse Shapaka, PA (Guest): I think something that you said that is really good is that bariatric surgery is a tool. It is a tool that we give our patients in that if they are using that with diet and exercise that we recommend; they can be successful long-term with losing quite a lot of weight and being able to keep it off.

As far as what surgery is like for our patients here at Marietta Memorial, we do most of our procedures on one day and most of our patients go home the next day. And we try to do them all laparoscopic with tiny little cuts on the belly so that it’s not quite as painful for our patients as well. And usually within four weeks to six weeks, patients are back to their normal activities, back on regular foods and feeling a lot better already.

Host: Ashley, I’ve heard over my years in the fitness industry people say that bariatric surgery is an easy out and as Alyse just said, it is a tool and it’s not an easy out. I’ve witnessed that myself. What do you tell people when they think to themselves oh well this is taking the easy road out, what do you tell them?

Ashley: I actually tell them that it’s the exact opposite. That once you’ve received this tool, there’s a lot of responsibility and obligation to your diet and your exercise regimen to remain healthy and also your follow-up and your medication regimen with supplements and specific medications you have to be on afterwards to prevent ulcers. That there’s actually more responsibility to remain healthy and to continue the journey than there is even before the surgery. Meaning that the surgery itself and the rehabilitation period afterwards that Alyse mentioned is actually a very tedious process and there is a lot of responsibility involved with complying with the dietary and activity restrictions and recommendations so that you don’t end up compromising the surgical procedure just performed and also that it takes just as much or more work after surgery to lose the weight and to remain healthy and to keep the weight off than if you hadn’t had the surgery itself.

So, there’s a lot for the patient to endure during the process before surgery to prepare for surgery and the recovery period and even on after for the remainder of their life.

Host: Well continue Ashley, for us if you would, when you talk about before the procedure is even really contemplated or considered; is there psychological counseling involved? What do you want them to know about that whole procedure that they have to go through before they can actually have the surgery?

Ashley: The minimum time required is usually specifically dictated by insurance telling us the minimum they will require for the patient to be involved in the program prior to surgery but also taking into consideration the individual needs of the patient to ensure they are mentally, emotionally and physically optimized prior to surgery for success.

So, part of that process is a psychological evaluation by a psychologist that we have here in the program. His focus is on the bariatric population prior to surgery and what he’s doing is just reviewing in depth the social and psychological and emotional history of the patient so that he can identify any potential areas that are in need of focusing on and optimizing so that they do have the success after surgery. For example, one thing that we do mention from our very first information session before they even begin the program is that the surgery cannot cure what we call head hunger or the mental and emotional association that we as humans have with food.

And so that would be something to intervene with counseling on during this preoperative workup and phase as they try to – they meet with the dietician and begin the dietary and lifestyle changes and as they continue through that, we can help them identify if they are struggling with that and ensure that we address that prior to proceeding with surgery. We can do our best to optimize the results after surgery.

Host: Dr. Agaba, what type of surgeries are you performing at Memorial Health System? We’ve heard over the years, we’ve heard gastric bypass, and sleeve gastrectomy and all these terms are thrown around. Tell us what it is you’re doing.

Dr. Agaba: Mainly here at Memorial, we mainly perform two bariatric procedures namely, gastric bypass and gastric sleeve. The gastric sleeve essentially involves removing about 70-80% of the patient’s stomach and thereby at the conclusion of the operation, the patient has a banana shaped stomach which because of this size-restriction, will make the patient not be able to eat as much as they previously were eating.

The gastric bypass on the other hand, involves making a small stomach about the size of a golf ball and rerouting the small bowel to this new golf ball sized stomach. That works on two premises. Basically, the size of the stomach is much smaller and therefore the patients are not able to eat as much and also, we have on the average about 150 centimeters to 200 centimeters of the small bowel that is bypassed and therefore not able to absorb foods as a result. So, based on these two processes, the patients are made to lose weight.

Host: Then tell us a little bit about why someone would choose one over the other, the malabsorption one or a bigger surgery. How do you decide with a patient Dr. Agaba?

Dr. Agaba: Okay. In deciding what type of procedure to recommend to a patient, what I look at specifically is what is the patient’s long-term goal that is what is he hoping to achieve from this operation. What are his comorbidities. Typically, if you have hiatal hernia with acid reflux most patients are better served with a gastric bypass and if you have diabetes also you are better served with gastric bypass. The patient with diabetes can also benefit from sleeve gastrectomy.

Alyse: And I would like to add too that at Marietta Memorial, we are a small enough hospital, we know all of our patients by name and a lot of the times a factor that play into what surgery they end up getting is their own personal preference. We recommend what’s best for them if it really is clear, but a lot of the times they come in and tell us which one they think they would like, and they would do the best with. So, we do take that into consideration as well.

Host: Ashley, what is it like after the surgery for the patient? Speak about the immediate as far as can they eat, are they on liquids only, do they worry about dumping syndrome? What is life like and also, how are the families involved?

Ashley: After, immediately after the surgery, regardless of which procedure you has, you do leave the hospital on a liquid diet. Also, adding to that, with protein shakes, really focusing on increasing the protein for the healing and the health purposes during that time. But they are on what we call a bariatric stage one diet which is the liquid diet. Depending on which surgery you’ve had, depends on how long you are on that diet. With the sleeve, you would be on that for a total of four weeks before advancing to the next stage. Whereas with the bypass, you are only on it for two weeks and then you can advance to the next stage.

After finishing stage one diet, they are moving on to a pureed diet for two weeks and then to a regular diet thereafter. The reason for that is just to ensure that we are allowing the operation that we have performed and the body to actually heal so that we don’t do any harm to those anastomoses or to our actual surgical procedure by just eating a solid piece of steak right after surgery or something of that sort.

During this time, we do stress that it is very important for the patient to have the support from their family. There are lifting restrictions for those six weeks, so they are significantly restricted on that. Because of the dietary changes and just the natural healing process of the body after surgery; they may not have the energy that they had prior to surgery, that they feel that they need to continue the chores around the home or caring for other children, so we do ask that they have some family available to assist with different activities of daily living such as that.

We do, just like I kind of mentioned before, the emotional support of such a large surgery and then such drastic dietary and activity restrictions after surgery; it can be emotionally difficult for the patient as well. So, that is why that is part of the psychological evaluation prior to surgery to ensure that they are stable, but they also have that support after surgery should they need that.

Host: So, Alyse, I’d like to start with you as we wrap up this fascinating segment. It’s so informative for people to hear. What would you like listeners to know, that are considering bariatric surgery and as Ashley said, the support that they need to have in place before they even consider this type of surgery and what you want them to know about the importance of all of these parameters.

Alyse: I would say to anybody that’s considering bariatric surgery, in our program, the first step is to come to an information session and so if you are even considering it, want to know a little bit more; that’s a great first start. There’s no obligations for attending that. You can come and just learn more about the surgeries that we do offer and what the preoperative process looks like and after surgery what that process looks like as well.

And as far as support, like Ashley said, we do like for our patients to have support at home, but we like to think of our own bariatric program here as a support system as well. We, like I mentioned know all of our patients by name and we have staff that are on-call 24 hours, that are always there to answer patient’s questions or concerns and we are never opposed to somebody calling in and asking us something. And we encourage them to do that. So, we are also a support system as well, but I would say if somebody is considering bariatric surgery and thinks that that can be the tool that gets them to a healthier lifestyle, then they should definitely look into it because it’s a great opportunity that we can do here right at Marietta.

Host: Ashley, next to you. What would you like the listeners to know about how you all work together and your multidisciplinary team and what they can expect when they do attend one of these informational sessions or begin this whole process?

Ashley: What we do have with the bariatric program like you said, is a multidisciplinary team that is actually very special and much different than most other surgical departments because of the unique specialty. And we are an office in which every part of the multidisciplinary team is in the same area, the same part of the hospital, same office so there’s constant communication about the needs of the patients and how each part of the team can work together to accomplish what’s needed to help the patient with that need or the next step.

There’s frequent communication throughout the program to make sure that there’s some fluency for the patient, that it’s not too overwhelming and confusing and that we help guide them along to ensure that they are able to meet all the requirements prior to surgery without too much additional stress or delaying in the progress through the program to get to their surgical day which they are all looking forward to form day one.

And like Alyse said, just to kind of reiterate, there’s something special about this office in that we do know every patient’s name. We are very familiar with their personal struggles that they share with us because they feel comfortable and use us as a support system and so we know each individual not only by their name but their individuality and their personal experience in the program and outside of the program.

We also are able to work really well. If somebody is – if they were in surgery and the patient has a question or a need, every other part of the team is aware of where that patient is at in their process in the program before or after surgery and are able to help them and meet their expectations. We also, it’s a program for life. This is a new lifestyle, a new way of life. It’s just not another diet or like we talked about earlier, it’s not the easy way out where it will just meet their expectations.

Life immediately without much effort, life is going to continue to happen and we follow them for life to ensure that we can be that support for them to ensure that they can continue the lifestyle and answer any questions that they may have that will come up and may make it difficult for them to do that. So, I’d say most of our patients probably all of our patients feel that they can call or stop by the office at any time and somebody will be able to assist them with what they need at that time.

Host: Dr. Agaba, last word to you and by the way, you have a wonderful team. These ladies, I can tell, I can hear their passion and their support at this very difficult time for people to make this huge life changing decision. What should people that are severely overweight think about when considering bariatric surgery and considering the program at Memorial Health System?

Dr. Agaba: I’ve actually been blessed with the wonderful team who will work very well as a team and also with the patients. It’s a major compliment on our part that we are fortunate to have such a wonderful team. For the patients to consider weightloss surgery and weightloss surgery is so safe that it can be done even for people in their 80s. Just like it is commonplace nowadays to have patients in their 80s have a knee replacement or even having heart valves.

So, weightloss surgery is clearly very safe and here at Memorial, we continue that tradition and we welcome all patients regardless of their BMI, we will be able to work with them to get to a safe BMI where we can safely perform surgery.

Host: What great information. Thank you, all of you for being on with us, sharing your expertise and explaining the process of bariatric surgery with us today. That wraps up this episode of Memorial Health Radio with Memorial Health System. Head on over to our website at www.mhsystem.org for more information on bariatric surgery and to get connected with one of our providers. If you found this podcast informative, as I did, please share on your social media and be sure to check out all the other fascinating podcasts in our library. I’m Melanie Cole.