Scott Webb: The LAMP Program at Salinas Valley Health is more than a weight loss program. But for those in need of bariatric surgery, Dr. Tarun Bajaj can accommodate, and he's joining me today to tell us about the surgery and how it can help folks not only to lose weight, but also change their lives. This is ask the experts from Salinas Valley Health. I'm Scott Webb.

Doctor, I understand that in order to be considered a candidate for bariatric surgery, the person has to participate in the Lifestyle and Metabolic Program, the LAMP Program, which I know a little bit about. Maybe you could provide some of the brief information on the program, just to give a little foundation to listeners.

Dr. Tarun Bajaj: The LAMP Program was something that we developed here in Salinas, specifically for our population that we knew a lot of their medical issues may be related to their lifestyle and their potential excess weight. And so, Dr. Oppenheim started the clinic up and Michelle Roberts, our coordinator who's  putting the patients through this program so that they can work on why they are having the medical issues or hopefully preventing any future medical issues by working on their weight. And so, that's usually the first step in subsequent steps related to potential bariatric surgery.

Scott Webb: So, let's talk then about the surgery. What do people need to know if they're considering weight loss surgery?

Dr. Tarun Bajaj: So, there's a few steps that I want my patients specifically to go through first, and there's other steps that they need to go through separate, which may be dictated by either Dr. Oppenheim or sometimes even their insurance companies. But for me specifically, I need to make sure that they don't have a history of reflux. And if they do, that it's really well controlled. I need to make sure that they don't have a hiatal hernia, which is when their stomach ends up partially in their chest. And then, I need to make sure  that they have no bacterial infection of their stomach because that'll increase their risk of the acid reflux as well.

That being said, most of the patients need to be on some sort of regimen beforehand and that, again, may be dictated by Dr. Oppenheim or by their insurance as far as to show some sort of weight loss. And then, the LAMP Program itself, we have nutritionist, dieticians, psychiatrists. Some patients may need to be evaluated for their sleep apnea. And so, these are all small steps that they can help take before the surgery so that they get the most benefit after the surgery.

Scott Webb: I guess, I'm wondering, you know, like with colonoscopies, everyone always talks about the prep. Is there any kind of prep involved when we think about the sleeve gastrectomy surgery? Is there anything patients need to do besides perhaps trying to lose some  weight before you get to that point? But once it's determined that they're, you know, cleared to go by insurance and otherwise, what do they need to do to prepare for it?

Dr. Tarun Bajaj: So, I personally ask the patients to at least do one packet of a stool softener/laxative, just so that they're "cleaned out," even if it's slightly. It'll just give me a little extra room in there to do the surgery laparoscopically, which is with the small incisions and a camera, rather than having to do a big incision and end up doing what's called an open surgery.

Scott Webb: Wondering, the sleeve surgery, is this for a lifetime? Is there sort of an expiration date on this? Or once you have it done, does it last forever?

Dr. Tarun Bajaj: Yes. So, what I end up doing is if you consider the stomach a pouch or a big purse, let's say, what I end up doing is I remove maybe a third to a half of it and staple across all the way from where it connects to the intestine all the way up to where it connects near the esophagus. And then, I take that part that I've cut off or stapled off through the abdominal wall. And so, it is something permanent. You can't necessarily grow it back or anything like that. You can't stretch it, but that's where all the steps before the surgery are important because we want to make sure that you, again, are going to get the best benefit from another step in your journey to becoming a healthier person.

Scott Webb: Yeah. That's a great way to put that. It really is a journey and a part of that journey, I'm sure, is the recovery. So, what's the recovery like from this surgery?

Dr. Tarun Bajaj: So for us right now at this hospital, what we're doing is we're admitting the patients overnight. I do have them do a special contrast study where they drink a die the day after surgery to make  sure that everything is moving through the stomach properly or their new stomach properly. And then once that is cleared, then we'll start them on their protocol diet and they'll be discharged the day after surgery.

Scott Webb: Now, let's talk about the nutrition and the changes sort of immediately afterwards, and then the weeks and the months and, you know, then obviously for the rest of their lives.

Dr. Tarun Bajaj: Sure. So, we start off with a clear liquid diet. So, the recommendation is water or anything that you can see through. And then, we have them follow the protocol that we've come up with where they'll do that for a good one to two weeks. And it'll be every hour, they'll take a little medicine cupful of the fluid just to make sure that they stay hydrated. So, that's more important than any type of true nutrition per se. And so for sure, patients right after the surgery are going to lose weight just because they're not taking that much as far as caloric intake. But with time, once the swelling of the stomach goes down and once the body realizes that there isn't the capacity that there once used to be, then we work through the protocol for almost six months. You're doing a different diet every few weeks. Ultimately, you'll get to that point where you're doing the three square meals, but because I've taken a third, if not half of the capacity that you used to have, you sure won't have a square meal the same size that you did 6, 8, 10 months before the surgery.

Scott Webb: Yeah. As you say, the stomach can't really grow back, right? So when we think about then, in terms of like folks staying on track, obviously there's the nutrition part of it, the dieting part of it, and then I'm sure also lifestyle. I'm sure you recommend things, whether that's to start  walking or running or just generally getting some exercise and things. So, what about lifestyle and also nutrition in terms of staying on track?

Dr. Tarun Bajaj: So for lifestyle, I won't have patients be lifting anything more than 20 pounds. But I do encourage them, like you said, walking, anything that is a little more than just going from one room in the house to the other room in the house.

Scott Webb: Sure. Yeah.

Dr. Tarun Bajaj: That's number one. And that starts even the day of surgery and it should continue lifelong. Movement is key with any type of lifestyle change. And then, as far as nutrition goes, Michelle, as well as Dr. Oppenheim, and then the nutritionist or dieticians will all work with the patients post-operatively to ensure that they are nutritionally repleted, be it with multivitamins or, if need be, protein shakes and the like, just to make sure that we aren't creating deficiencies now that we've taken part of the stomach out.

Scott Webb: You know, we framed this as a journey, which it is of course. So in terms of support, how long do folks have that support? You know, I think there's a sense for many people after they have the surgery, whatever it might be, you know, and the bill's been paid, that they're kind of on their way and on their own. But I don't get that sense from the LAMP Program. So, maybe you can tell folks what's the support like and how long are you there for them?

Dr. Tarun Bajaj: I personally am there if and when they need me. I will see them two weeks after the surgery to make sure that they're healing from the surgery. But the LAMP program itself with Michelle, Dr. Oppenheim and the others, we are available essentially 24/7. And so if there's extra support that they need, we are establishing support groups as well for those that are not having had surgery yet or those that have already had surgery and they just need that little extra push to maintain themselves on their journey, et cetera. And so, there is always going to be support and that is one of the things with bariatric surgery. There are multiple studies that show the longer that the patients have the support, the better off their health is in the long run.

Scott Webb: That's awesome. Great to have your time today, doctor. Thanks so much. You stay well.

Dr. Tarun Bajaj: Thank you.

Scott Webb: And to learn more about the Lifestyle and Metabolic Program and bariatric surgery, call 831-269-7798. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member and subscribe, rate, and review this podcast and check out the entire podcast library for additional topics of interest. This is Ask The Experts from Salinas Valley Health. I'm Scott Webb. Stay well and we'll talk again next time.