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Bill Klaproth (Host):  So, you’re interested in bariatric weightloss surgery, but you’ve heard all of these different things and are unclear as to what is true and not true. So, let’s get you some answers and go through the top myths about bariatric surgery with experts on this topic from St. Joseph’s Healthcare. We’ve got Danielle O’Brien, a Registered Nurse and the Bariatric Program Coordinator and Evelyn Mariani and Registered Dietician with Bariatric Surgeon William Graber. Danielle and Evelyn, thanks for your time. Danielle, let’s start with you and get to our first myth. This surgery is for weightloss only.

Danielle O’Brien, RNC, BSN, CBN (Guest):  Well yes, I mean one of the reasons patients do have this surgery is for the weightloss factor. But there are so many other indications to why patients have these procedures or why they should have these procedures. We know for a fact, bariatric surgery decreases premature death by 40%, 76.8% of patients who were diabetic, no longer suffer from diabetes or diabetes is in remission after they have this procedure done. Cardiovascular disease risk decreases by 82% and it can improve quality of life in 95% of patients who have these procedures. I oftentimes have patients tell me this was a tool that they used to take back their life from suffering from these other issues. So, yes of course, weightloss is a good piece of it, but all this other disease resolution is a big deal too. We want to get that out there. So, if patients are suffering from these things, we want them to contact us to see maybe I’m a candidate for weightloss surgery. So, we definitely want to get that out there.

Host:  All right. Our first myth busted. This surgery isn’t just for weightloss only. Danielle, let’s stay with you and get to another myth. This surgery is dangerous and risky.

Danielle:  Yeah, I think people do think that and we definitely want to get the message out that bariatric surgery actually the mortality rate for bariatric surgery is less than the mortality rate of having your gallbladder removed, having hip replacements done, cardiac bypass surgeries. So, it’s very, very low risk of death and we know it’s an effective tool. So, definitely want to break that myth that it is a dangerous surgery. We perform nearly 500 laparoscopic cases a year here at St. Joseph’s Hospital and have very, very good outcomes. Most of our patients go home postoperative day one and they do very well.

Host:  All right another myth busted. Thank you, Danielle. Evelyn, let’s turn to you now. Here’s another one that people think. I cannot eat real food. Bust that myth for us.

Evelyn Mariani, MD, RD, CDN (Guest):  Sure. I’d be happy to. That is one of the big misconceptions with these surgeries. The thing is these surgeries that we primarily perform work on the concept of restriction. So, at the beginning, there is a way to eat to help facilitate healing. So, it’s a major abdominal surgery, so anything that you take in by mouth has to go through everything that just had surgery on it, so it is going to take a little bit of time for healing up. So, there’s some liquids and soft and smooshy stuff you have to do at the beginning but the eventual is actually to get to a real solid dense meal because that can be very filling actually in comparison to some of the things that you have to eat early after surgery for safety and comfort purposes. So, I like to give patients this example. Eventually we would want you eating the chicken, rice and green beans dinner let’s say that you may have had for a meal recently, cooked however, spiced however, seasoned however it might have been. The meal may look the same, however, you are going to be taking it in different. It’s going to be a fraction of the amount of food that you could have taken in potentially with your normal sized stomach. So, a fraction of a stomach that’s left is going to mean fraction of the amount of solid food that you can take in comfortably.

Host:  Okay, so another myth busted. You will be able to eat real food albeit in smaller proportions. So, Evelyn let’s stay with you. Here’s another myth. The weightloss comes from not absorbing calories in food.

Evelyn:  Yes. So, back to thinking about eating real food again. These surgeries work on restriction. You should be taking in solid foods that you get full on less of and that’s where the weightloss comes from. It’s not that you’re taking in food and not absorbing those calories. The ones I should say that we primarily perform, they work on restriction. So, it works on making it so that you’re taking in less and getting full but it’s not that you are not absorbing the calories. And this is where sometimes there can be pitfalls with weight regain or not losing because if a person is not exactly taking in the best foods that are very filling, they will still absorb the foods – the calories in the foods that they are taking in and if they are in the form of something that they can take in very easily; you could see where they could end up taking in more and more and that’s where we sometimes see weight regain or not losing to the potential.

Host:  Well thank you Evelyn. There you go another myth busted. You still will absorb calories even after bariatric weightloss surgery. Danielle, let’s switch back to you. Here’ another myth. I will feel unwell and be sick after surgery.

Danielle:  Yeah, definitely actually not even an issue to think about. I can tell you as I stated before, most patients go home the next day after surgery. When I go into see patients on that first day after surgery, I hear oh my goodness, I feel so much better than I thought I would ever feel. So, really, patients are able to resume their normal activities after they get out of the hospital. They can get back to work within two weeks barring no heavy lifting, pushing or pulling. That’s just our restriction that we do give patients for six weeks after surgery. But really, they can resume normal activities and they feel pretty decent to do so. I have heard sometimes a little bit of fatigue in the first week or so after surgery, but your body is trying to heal and that kind of thing. And you are learning how to drink appropriately, and you are following the diet that we put you on to help you heal. But typically, patients say they have so much more energy as early as three weeks after surgery, more energy than they had felt in a long, long time even. So, definitely not an issue and most feel really, really good after surgery.

Host:  All right. Great job. Glad we busted that myth. Evelyn, we’re going to turn back to you now. Here’s another one that people think. I can’t have a healthy pregnancy or healthy baby after surgery. It is too risky. But that myth for us.

Evelyn:  For sure. It’s actually quite the contrary. There’s a lot of good evidence showing that a woman who is pregnant after having surgery and having the weightloss actually has chances for better outcomes compared to if carrying a pregnancy with continued obesity. So, we’ve had many, many healthy pregnancies and babies after surgery. The mom has to change the vitamins just slightly and the diet is still pretty much the same. You can still take in the foods that you need to for after surgery. You can stay hydrated. We switch the vitamins around a little bit. And so, yes, we actually have even had many women come to us to have surgery in order to help them to get pregnant. So, sometimes obesity goes along with some fertility issues and we have had women come to us and get pregnant pretty soon after having surgery. We do want them to wait 18 months to make sure everything is stabilized but I will say, we’ve had pregnancies before that and have still had great outcomes again, in people who never thought that they’d be able to get pregnant.

Host:  Well that is really important point. It just seems to make sense with less weight and better health you would have an easier time with pregnancy. Evelyn, let’s stay with you. Here’ another big myth. Please bust this for us. The surgery is not covered by insurance.

Evelyn:  Sure. So, that’s another one that we think is keeping people from coming to have surgery sometimes. They think it is not covered, it’s going to be very expensive, there will be issues. We are in the state of New York, the surgery is actually covered very well in this state. Most commercial plans, Medicaid, Medicare actually cover these insurances too as well. It is a matter of following the steps of what the insurance company is asking for and each one of them have their own stipulations for before they would authorize surgery. And I tell patients this all the time too, especially when they are wondering about the safety and effectiveness of surgery like this. We always say if it wasn’t safe and if it wasn’t effective; there wouldn’t be insurance companies that would be covering this. And it’s covered widely and very well. That’s evidence pointing to these are things that work. So, yes, covered very well by insurance.

Host:  Well there’s your top bariatric surgery myths busted. Danielle and Evelyn, thank you for your time. And while we have you both here, Danielle I just quickly want to ask you about robotic bariatric surgery which St. Joseph’s Health began in February 2019 performing RNY, sleeve and revision surgeries. Can you give us a quick update on this. How many surgeries have you performed at this point as of this recording in December 2019, how many XI robots are in use and let us know, is everyone a good candidate for this?

Danielle:  Sure, sure. So, yeah, as you said, we started using the robot to do our bariatric surgery procedures here in February. So, up until just last week, I’ll say, we’ve done 63 cases. We’re happy to have the area’s leading robotic assisted bariatric surgeon Dr. Vladan Obradovic, he is the surgeon that performs those right now with us. And the program is going very well. We’ve dedicated two full operating room days to him to perform these and really anybody can be a candidate. Obviously, it’s patient preference and it’s a decision that will be made between you and Dr. Obradovic on being a candidate for this or not. So, we’re very excited to have this as another option to continue doing these life changing surgeries.

Host:  Absolutely. Well Danielle and Evelyn this has been great. You have busted a lot of myths and given us some great information about bariatric surgery and robotic bariatric surgery as well. Thank you both. Great job ladies.

Danielle:  Thank you.

Evelyn:  Thank you.

Host:  That’s Danielle O’Brien and Evelyn Mariani. For more information please visit www.sjhsyr.org, that’s www.sjhsyr.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is St. Joseph’s Health MedCast from St. Joseph’s Health. I’m Bill Klaproth. Thanks for listening.