December 5, 2024 • 41 mins
Centered on Health 12-5-24 - Advances in weight loss surgery with Dr. Robert Farrell
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Episode Transcript
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Speaker 1 (00:01):
It's now time for Centered on Health. With that his
Health on use Radio waight forty WYJS. Now, here's doctor
Jeff Tubbins.
Speaker 2 (00:16):
Health here on news Radio eight forty whas. I'm your host,
doctor Jeff Publin, and I want to tell you that
as recently as twenty twenty one, the CDC says that
about thirty eight point four percent of people in Kentucky
are ob or overweight and sixteen percent of our kids.
And Kentucky continues to be at the top of the
(00:39):
list of states that struggle with this issue. And every
year about two hundred and fifty thousand bariactid surgeries are
done here in the United States. So to help us
discuss this and the advancements in our weight loss surgery,
we have doctor Robert Ferrell joining us tonight. I want
to welcome back doctor Ferrell to our show. He has
always helped us with a great informative hour on this
(01:02):
topic weight loss surgery, and we know that this is
a huge part of our culture and our lives. Doctor
Ferrell is a buryaccid surgeon with the Baptist Hospital Medical Group.
He did his medical school at the University of Louisville
and he did his residency at the Saint Louis University
School of Medicine and Medical Center and his fellowship at
the Carolina Medical Center in Charlotte, North Carolina. Doctor Ferrell,
(01:25):
welcome back to Center on Health.
Speaker 1 (01:29):
Thanks for having me.
Speaker 2 (01:31):
We always love having you, and you know you always
teach us so much. And I just want to start
by saying we've had you on before, and this is
such a popular topic, and why do you think it's
become such a major topic of discussion in our culture today.
Speaker 1 (01:49):
Well, I think you said it perfectly there. The statistics
don't lie. It's an expanding problem where more of us
are dealing with the problem than not in some level,
whether it's being you know, overweight, or obeste or morbidly
abste and everybody you know, we say with cancer, everybody
knows somebody that's had cancer, and in effective, well, now
(02:11):
everybody knows somebody that's that's dealing with the problems from obesity,
and so it's kind of on the on the forefront
of everybody's mind.
Speaker 2 (02:20):
So start us off by by helping us understand what obesity,
what the definitions currently are for obesity.
Speaker 1 (02:30):
So in the in the medical terms, we use what's
called the body mass index or BMI, and that's a
formula based on your height and your weight, and it
puts you into a category and you become obese when
your BMI goes over thirty and then morbidly obese when
your b and I goes over thirty five. And you know,
(02:53):
for most people to put that, you know, in terms
of people think, well, you know, they're not sure what
that means. But really that could be you know, your
two hundred pounds or two hundred and twenty, two hundred
and thirty pounds, it's not the patient that is four
or five hundred pounds, is what was often commonly thought of, right, So.
Speaker 2 (03:15):
What drew you to this specialty? Yeah, I know you
probably started off training as a as a general surgeon,
I presume. And then what threw you to this particular
type of puru?
Speaker 1 (03:26):
Well, I think all physicians, you know, but in particular surgeons,
we want to fix things as quickly and as efficient
as possible. So whether it's a patient that you know,
has a broken bone that needs to be said, or
infected goal a lot of that needs to be removed,
you know, we want to try to fix things. And
when you do veriatric surgery. You get an opportunity to
(03:48):
fix a multitude of problems. We're not you know, just
our goal is not to band aid these things. Our
goal is actually to reverse the damage being caused by
them and an oftentimes make them go away. So whether
it's hypertension or diabetes, sleep bat near or horrible joint pain,
those type of things, we get to see patients completely
(04:11):
you know, resolve.
Speaker 3 (04:12):
And we had a patient today she came to the
office bought us some Christmas cookies, which is ironic, but
she you know, she's had surgery and now she had
an adamoplasty, and she's also over two hundred pounds showing us.
Speaker 1 (04:24):
So she wears uh size six pants and hugging us.
And you know, you go through a moment like that
and you're like, you've you know, you fundamentally have totally
changed somebody's life. It's pretty powerful.
Speaker 2 (04:38):
I would imagine and and tell you started to say
a little bit about it. What are the things that
can get better? You know, obesity obviously causes other health issues,
but what have you seen in terms of health improvement
not just from losing weight, but what other medical things
can actually improve by having surgery.
Speaker 1 (05:00):
Yeah, we say, you know, being overweight or beast. I mean,
it's a hedge tote disease. There's not a body system
that is not affected in some way. And a lot
of things people you know, you know, don't even think about.
I mean, hypertension and diabediously bat me, those are things
that people think about. But you know, we talk about
liver disease being a big problem. We talk about increased
(05:23):
risk of cancer being a big problem. We talk about
infertility being a big problem. And then you know, joint pain.
We're seeing more and more patients that are needing, they
have disabilitating knee, are hit pain and they need joint replacements,
but they can't get them because their BMI puts them
in a category where the surgeons just don't feel like
(05:45):
it's safe to operate. And so we're seeing more and
more of those patients coming in seeking you know, they're
not what I would say, horribly overweight, but if their
BMI is you know, forty or forty five, they need
to get down to be my thirty five or less
to have surgery. And they're they're choosing this as an option.
Speaker 2 (06:06):
And help us sort of set the stage. I mean,
we know that there's this explosion of sort of these
DLP ones and weight loss medicines. We're going to talk
about those later, but in general, how successful are non
operative measures? Like when people come to see do you
actually delay surgery to try diet exercise? What do you
(06:29):
recommend for patients on their first visit with you in
terms of whether surgery is sort of the right next
step for them?
Speaker 1 (06:37):
You know, I think that you know, we want to
meet all the patients and there's no perfect formula. We
kind of want to lay out all the options that
are present. Certainly, you know, we've been doing this a
long time and we have a good feel for where
people are ultimately going to be successful when people come
in a lot of patients come in with their own
(06:58):
sort of ideas, and we want to work with My
big thing is, I don't want this to be a
sort of you know, one visit, one surgery and that's it,
that's over, we never see you again kind of thing.
This is, you know, a chronic lifetime condition, and we
want to be sort of like with a teamwork approach
where we're kind of with you really forever, because there's
(07:21):
going to be challenges, no matter, even the most successful
patient in the world, there's going to be challenges at
some point, and there's gonna be ups and down. Then
we have to understand that. And so you know, for
some patients it might be just you know, improving their diet,
having them see their dietitian. For some patients, that might
be going on medications. For many patients it's going to
(07:43):
be going to surgery route and then backfilling it with
some of these other things we're talking about. But it
just it really it's a sort of a tailored approach
for each individual patient.
Speaker 2 (07:57):
And just out of curiosity, you know, we heard some
of the six that I put at the beginning in
terms of the childhood obesity. Is there an age that
you think is too young to think about this? Or
maybe I should ask at what age do you think
it's appropriate to consider something as aggressive as a surgery?
Speaker 1 (08:17):
So about the health patients to have surgery would have
to be eighteen years older, and that's an insurance requirement
right now. But there are adolescent programs in the country
that are associated with some of the bigger children's hospitals,
and they are doing surgery on adolescents. There's some psychosocial
(08:38):
things that you have to go through and what we
call Tanner staging to make sure that they've reached physical
maturity before you start creating malabsorption situations. But there are
patients that you know, as young as fifteen or sixteen
have been operated up.
Speaker 2 (08:56):
And is there on the other end, is there an
age that's too role.
Speaker 1 (09:02):
Yeah, that's a great question. I get asked that a lot.
I don't think. So there's nothing that the insurance makes
you not do. And the way I look at each
patient is, you know, I've I've operated on and done
their extra surgery on seventy five year olds. I think
my partner's done not even older than that. Some patients
in their mid seventies come in and they you know,
(09:22):
they could pass for being in their fifties. Unfortunately, some
patients come in their fifties, they look like they're they're
in their eighties, of course, so we take it individually
and see what kind of shape they're in and what
their goals are, and you know, you know a lot
of times they got you know, legitimate reasons for wanting
to do and wanting to live healthier and enjoy the
(09:44):
sort of what I would call the fourth quarter of
their life and we want to try to help them
to do that.
Speaker 2 (09:50):
That's fantastic. Well, we are going to jump into those
surgeries when we come back from this break. We are
listening to Center on Health with Thattic Health here on
news radio A forty w h as. I'm your host,
doctor Jeff Publin. We're talking tonight with doctor Robert Farrell
about advances in weight loss surgery. Our phone number is
five oh two five seven one eight four eighty four.
(10:10):
If you want to call in and ask any questions
about this process or questions about weight loss surgery, we
will see you on the other side of the way.
(10:34):
Welcome back to Centate on Health with Fastest Health here
on news radio eight forty WHAS. I'm your host, doctor
Jeff Publin, and we're talking tonight with doctor Robert Ferrell,
who is a buriatic surgeon with the Factist Hospital Medical Group.
We're talking about advances in weight loss surgery and welcome back,
doctor Ferrell. Our phone number is five oh two five
(10:57):
seven one eight four eighty four and our producers on
standby to take your phone so doctor Ferrell help us
before we get into the octro surgeries. That you do.
If you could give us a little understanding of the
surgery in general, in terms of the anatomy. What types
of things are happening to our anatomy when you do
(11:18):
various types of stereotric surgeries.
Speaker 1 (11:23):
Sure, so you know, the main thing we're focusing on
is you know, a patient's stomach obviously, and in a
lot of cases we're trying to create some form of
what we call restriction to the stomach, and we're trying
to either make stomach smaller or restrict the amount of
food that can be swallowed at any one time, which
(11:44):
will then you know, if patients are eating less food,
they're going to lose weight. And then the secondarily, there
are some surgeries where we will also create a second
element called malabsorption, where we will have food bypass some
of the intestine where it's normally absorbed, and because we're
(12:04):
not absorbing as much you know, calories, patients will lose
weight by that means as well. So both by restriction
and then also malabsorption in some of the sergers.
Speaker 2 (12:17):
And what would you say is the most common weight
loss surgery that you do.
Speaker 1 (12:22):
The most common we're doing now is the sleeve gets
stractomy that you know started We started doing that around
two thousand and nine. It started, like anything, kind of
slow and picked up speed and by the mid you know,
twenty teens, it overtook. Lap banding is the most popular
(12:45):
surgery and it's remained that way really, you know, for
the last at least ten years or so.
Speaker 2 (12:52):
And have any kind of fallen out of favor, like
the lap band are you still doing those or the
actual gastric bypass Are those still being done in this
era of the fleet dissectoy or have they fallen out
of failing?
Speaker 1 (13:06):
Great question. Yeah, I would say the lap banding that's
fallen out of favor largely with most accredited bari aster centers.
There could be reasons to do one here or there.
There's still a small amount of them being done, but
for the most part, what we find is we have
patients coming into us that have lot bands in and
(13:28):
are not happy or having trouble, have had them in
for ten or fifteen years, and they really just want
them removed, and then in some cases we will revise
it to another surgery. The gaser bypass is still being done,
and that there are some new variations of the gas
bypaths that are gaining popularity. That surgery is where the
(13:51):
malabsorption part comes in. So for some patients they want
to try to lose a little bit more weight, or
you know, there's some you know, different nuances and issues.
You know, sometimes theahs have family members that had to
bypass and they want once so we will do those
too as well.
Speaker 2 (14:13):
And I know that this probably is a three three
hour seminar on its own, but how do you decide
How does a patient decide what surgery might be right
for them?
Speaker 1 (14:25):
Yeah, I mean, you know, for some patients there's there's
no right answer. Anyone would be fine for them, you know,
So when they come to the office, we will talk
about all the surgeries and show them how they work.
And you know, in a lot of cases, the sleeve
gas direct to me is a great entry point in.
It's a great way to get patients losing weight, get
(14:47):
them more healthy, get them exercising again, and often it's
all that they really need. In some cases, again, they
might lose one hundred pounds with a sleeve gaess trectomy
and they might want that revised at some point to
a bypass to lose more. And that's the reasonable thing
to do. So it just it really again is tailored
(15:09):
an individuals to each patient.
Speaker 2 (15:12):
So tell talk to us through the lens of a patient.
So somebody is making the decision to have this done.
What's the general process is seen coming to see you,
any work up that needs to be done, the how
long the surgery takes in the recovery, what sort of
a point a to point the time frame or process
(15:34):
that a patient might think about them that they'll go
through with this.
Speaker 1 (15:39):
Sure, you know, we we have a great team in
our office here about this hospitle and and that's an
important part of this because there can be a number
of hurdles that to be jumped over, but you know,
we kind of have a team that helps to sort
of navigate through that process. But we'll see a patient,
you know, and then depending on their health that they're
in reasonably good health and no major issues, we do
(16:00):
have to have them have some preoperative testing done, we
have some lab work done. We want to take a
look inside their stomach with what's called an endoscopy, look
down and make sure that there's nothing crazy going on
in terms of like an ulcer or a some kind
of you know, tumor or mass. And then also we're
looking for idle hernies if they're present or not. I
(16:22):
tell patients that's not a deal breaker if you have that,
but we want to know about it because we would
likely fix it at the time when we're doing the
bariatric surgery and will help cut down on the brief
walks afterwards. And then after we do the edd and
you know, any other testing that we have to do,
we submit them for insurance approval, and then once they're
(16:43):
approved for surgery, we go ahead and get them scheduled.
And this whole process can take It can be beariable,
but it can be depending on patient's insurance, can take
one to three months. And then once we bring him
the surgery, you know, though, undergo the surgery and usually
stay one night in the hospital and then in most
(17:03):
cases be able to be discharged home. And I think
most patients are surprised with you know, how mobile they are,
because you know, they have visions of this being some
kind of you know, it is a big surgery, but
you know, they have visions that they're gonna go home
and be in bed for weeks and not be able
to move. But we want patients out of bed, out
(17:26):
walking the night of surgery. You know, we want them active,
and you know, most of the time we'll see patients
back three to five days after the surgery. They're driving
them off to the appointment, they're walking down the hallway.
You know, they're a little sore maybe, but quickly getting
over it. And they're they're just generally very surprised at
(17:47):
how quick they can recover from this.
Speaker 2 (17:51):
And I guess maybe using what sounds like kind of
the more common ones we might think about with the
sleeve got struck to me, or the pass or maybe
even the lap band, could you kind of compare and
contract a little bit about the recovery from differences and
maybe how much weight loss one could expect from the
various procedures that you do.
Speaker 1 (18:14):
Sure, sure, you know with the lap band again, you know,
we're really not doing too many of those anymore. But
you know, in general, you know, we would see, you know,
if we put a lot band in weight loss was
a little slower. You know, we would tighten a lap
band up to get it more restrictive for a patient
and they couldn't eat as much, and you know, we
(18:37):
might see, you know, over a year's time around, you know,
fifty to sixty pounds of weight loss, you know, per
one hundred pounds. You know, when we do a sleeve,
you know, on patients, I generally tell patients that are
really good. Goal is one hundred pounds at a year.
Certainly we have patients that can lose more than one
hundred pounds. We've had patients one hundred and fifty pounds more,
(19:00):
but these are averages. I kind of shoot for one
hundred pounds. So when I see patients back, you know,
I'll see them at three months and six months and
nine months, and we're kind of gauging where they're at
on that scale. You know, by six months, you know,
I want to see them at more than fifty pounds down,
and you know, I tell them that's you know, that's
my job is to kind of push them and tell them,
(19:21):
you know, you're you're meeting goals, You're where you want
to be, You're on target, or you know, if they're not,
I have to tell them that too. And we have
to we have to kind of kick it in gear
here and figure out, you know, we not exercise the
are we not making some of the lifestyle changes that
are very very important to having success. But like I say,
it's a team. It's kind of teamwork between us, and
(19:45):
that's where we're seeing patients frequently. And also I find that,
you know, I got to be like a coach and
a motivator, but that's where you get the most success
from patients.
Speaker 2 (19:55):
And what do you you you started to mention it.
I find it really fascinating. You know, will make this
commitment and it's a big commitment. And what do you
see as the most common reasons for failure after a
surgery like this or do you not see that very often?
Speaker 1 (20:12):
Sure? I mean, you know, of course, before surgery and
everybody wants to do this well, I mean, you know
our self atient you if there was a red button
to hit to be skinny and feel great and healthy,
everybody would hit the red button. You know, nobody chooses
to struggle with these problems. But you know, before surgery,
everybody kind of believes that I'm going to do this,
(20:33):
and I'm going to do that, and I'm going to
you know, I'm going to do it all right, and
then you know, we have surgery and the buying is
very high rate. After surgery, patients are very dedicated to
their diet and starting to exercise and do things. But
I find that as time goes on, we get out
to you know, nine months a year and more than
a year after surgery. You know, bad habits have a
(20:55):
funny way of creeping back in. They're like weeds in
a garden that just starts showing up, and we gotta
we gotta cut those down. And whether it's you know,
getting off your diet, or whether it's you know, not
exercising right anymore, it's it's a lot of the same
things that happen the first And that's why I got
to bring that up all the time and say, you know,
(21:16):
we don't want you to be paranoid, but we want
you to be vigilant. You know, we want you to
get into healthy habits and understand that these have to
be maintained to keep the weight loss that they have fantastic.
Speaker 2 (21:28):
Well, we're talking tonight to doctor Robert Ferrell about advances
in weight loss surgery. There is still time to call in.
Our phone number is five oh two, five seven one
eighty four eight four five oh two five seven one
eight four eight four. This is centered on health with
Actor's Health here on News Radio eight forty w ahs.
I'm the host, doctor Jeth Publin, and we will be
(21:49):
right back after these messages. Welcome back to senat on
Health with doctor Help here on the radio A forty whas.
(22:13):
I'm your host, doctor Jeff Colman. We're talking tonight with
doctor Robert Ferrell about advances in wait box surgery. Doctor
Ferrell is a bariactic surgeon with the Doctor's Hospital Medical Vision.
He's been educating us about the different types of surgery. So,
doctor Ferrel, I just want to ask you. The last
time that you were on, I actually had a patient
(22:33):
who was going to call in, but she never got
a chance to And then I happened to see her
again this week randomly, and she really wanted me to
talk to you about this question that she has about
bariactric surgery, which is she was told that because she
has Barriss esophagus, which is a change in the lining
of the esophagus from reflux and a diagnosis of Crone's disease,
(22:56):
that she really wasn't a candidate for any type of
bariactic surgery. Is that Is that an accurate statement in
terms of being limited and choices and things like that.
Speaker 1 (23:07):
Wow, well, she's got to do you there, I don't
think that I wouldn't say that's completely accurate. You know,
it does bear some consideration as to what the right
surgery for her to be. And you know, like anything
in medicine, there's risks and there's benefits, and I think,
(23:28):
you know, depending on her situation, the benefit here could
certainly outweigh any potential risks. But it does. She's got
it on both sides for sure. So we would have
to kind of talk to her about how bad is
her prone's disease, how many flariffs she had, how much
medication she on, if we were going to think about
(23:50):
doing some form of a bypass, And then also conversely,
you know how bad her barras is in terms of
inflammation in the esophagus, if we're going to do the
sleeve geest strecting.
Speaker 2 (24:04):
Down and as a goat fro twologists, obviously I'm very
curious about this. Is that because you won't have access
to look at the esophagus as well after a surgery,
or because the reflux could work in the underlying problem.
Speaker 1 (24:19):
Yeah, I think we'd be a little worried about if
there was a reflux or even silent reflux, So we
would want to make sure that she didn't have like
I talked about, a idle hernia, even if she had
the smallest turnaive, we'd want to tighten that up to
try to you know, I'm going to use medical jargon
to lower esophageal spinker. Only doctor Telviland knows about that.
But we want to get as snug as possible and
(24:42):
try to not let acid get from the stomach up
into the esophagus, which could further damage the lining. But
then also there's been great advances in terms of the
GI world in terms of how we treat barretts too,
so there's a lot of options here to potentially get
her the weight loss you need, but also you know,
monitor her and keep good surveillance on or make sure
(25:04):
nothing else happens.
Speaker 2 (25:05):
Well, thank you, I know, I know she'll be listening
to this and looking forward to that answer. You know,
as this these medicines come out and we're going to
touch on them. But as we learn about the surgeries
and the medicines, there's a whole culture here, and there's
some myths and there's some things that I think we
need to put out there and talk about so one
(25:26):
of the one of those is you know, where did
this idea of like one surgery in your lifetime kind
of come from? Is that? Is that an accurate statement
or where do you fall in that conversation?
Speaker 1 (25:40):
Yeah, I mean that's unfortunately that is sometimes an accurate statement.
It's a pet peeve of mine. It's what is said
is insurance companies often will say that you get one
surgery for patient for lifetime, which I think is absolutely
ridiculous because we don't treat anything else to medicate in medicine.
And you know, if a patient has a heart attack
(26:02):
and we treat the heart attack and we send them
and then three years later they have another heart attack,
we don't just let them die in the parking lot.
We treat them again. Right. But but somehow in this
it's it's you know, it's a one, one and done
situation where you get one surgery and you've got to
be perfect and you can have no problems afterwards. Now,
(26:25):
I will say that a lot of insurance companies are
being more reasonable as this problem has expanded and gotten
more of the population. Uh, but we do so encounter
that from times the time.
Speaker 4 (26:37):
Some insurances, you know, and It's really interesting because it
goes a little bit against kind of what you said
earlier culturally, which is we should be treating this like
a chronic condition, this issue of obesity and the health
management of it.
Speaker 2 (26:55):
It's not like you're you do the surgery and then
you're done forever. Right, But why do we treat obesity
or the surgery almost like it's not a konic condition.
What do you think is going on there?
Speaker 1 (27:08):
Yeah, I think that there's a lot of blame that's
put on the patients, and I think it's unfair to
some degree. You know, life is still going to go
on whether you have surgered or not. And I tell patients,
you know, there's going to be death in your family,
there's going to be you know, job loss, there's going
to be other stressors. There's going to be your relationship issues.
(27:28):
All these things, you know, can cause patients to to
have depression, to get off tracked, and not like we said,
follow their diet, follow their exercise plan. It's it's just
natural in life that that those things are going to happen.
And you know, we encourage patients when they see that
happening to get in and see us and get back
(27:49):
on track, but you know sometimes you know, sometimes passed
and they need to be you know, given you know,
a fair chance to be treated. Uh, you know, because
a lot of them can benefit from additional treatment and
we can really help them with that.
Speaker 2 (28:07):
And speaking of that, you know, these GLP ones and
this new wave of appetite suppressing medications that you know
originally were approved for diabetes, and we found this to
be kind of a off suit of their effectiveness. Where
do they fit in terms of your practice and what
are you seeing in terms of their impact on the
(28:29):
bariactive surgery.
Speaker 1 (28:32):
Well, we certainly use them. They've been like everybody else
thrust on us here in the last year or so,
where they've become enormously popular, and you know, I think
we're all trying to still figure out the perfect algorithm
where they fit in. I think that you know, if
you go on the the the studies and you look
(28:53):
at the weight loss that they produce, if people actually
read the studies, they'd be a little disappointed and see
and you know, the percentages and overall numbers. But I
do think that they definitely have a place. Sometimes it's
early in the process to get patients in better shape,
to potentially have a procedure. Sometimes, you know, patients come
(29:15):
and see this and they really don't have that much
weight to lose, and that's all they need is these medications.
And then sometimes it's on the on the backside after surgery.
You know, I'll give you a great example. You know,
we have lots of patients who had surgery before COVID
and really through new part of their own you know,
they were doing great, they were exercising, they were eating well,
and then all of a sudden, gym's clothes and you
(29:36):
couldn't get food and everything was haywire and people were
losing their jobs and you know, and then the next
thing is, you know, there was some weight percidivism that
happened during that period. So for some patients have come
back to see us, going on a GLP one has
been you know, something that's really helped them to sort
of get back on track. So we could use it
(29:58):
there too.
Speaker 2 (30:00):
And what you know, earlier we talked a little bit
about the health benefits of surgery, not just on losing weight,
but on some of these other chronic medical conditions. What
are we learning about the d LP ones and similar things.
Heart disease. You know, things like that are what what
are we seeing in that area.
Speaker 1 (30:23):
We're seeing we're seeing definite improvement and risk reduction in
risk of cardiogenic effects, and that's really where they're starting
to gain a foothold with insurances and getting some approval,
you know, like you like you mentioned they started as
diabetes medications, and they've sort of like all great medications,
(30:43):
viagrap being one of the great examples of our lifetime,
it starts in one area and it moves to something else.
These medications have started in diabetes but now have moved
over into the weight loss lane. And but there's been
a real reticence to cover these medications from insurance companies,
from employers. Now that some of the data is coming
(31:06):
out showing improved risk of having party oogenic complications, we
are seeing a little better coverage and I would anticipate
as time goes on that will improve. But there have
been studies that have been very clearly done that showed
although there is improvement with these medications by far and away,
there's significantly better improvement with surgery. It's it's a significant
(31:36):
improvement in risk reduction when you have surgery.
Speaker 2 (31:40):
Doctor Ferrell here tonight talking to us about weight loss
surgery and advances in weight loss surgery. I'm your host,
doctor Jeff Calvin. We're going to take our final break.
You are listening to Centered on Health with Doctic Health
here on news radio eight forty WHA. I want to
remind you that if you miss any part of this
show or want to hear all this excellent information again,
(32:01):
that you can download the iHeartRadio app. It is free,
it is easy to use, and it gives you access
to tonight's show in its entirety. This is Senate on
Health with Factors Health News Radio A forty w a
h S will be like that. Welcome back to Senate
(32:32):
on Health with Baptist Health here on news radio A
forty w h AS. I'm your host, doctor Jeff Publin,
and we're talking tonight with doctor Robert Ferrell advances in
weight box surgery. Doctor Fararell is a buryatic surgeon with
the Baptist Hospital Medical Group. I want to remind everybody
to download the iHeartRadio app to listen to this segment,
(32:53):
or any of our previous segments, or any of the
features that our app has to offer. So doctor Parall
One of the things that I really love highlighting on
this show are things that are up and coming or
a little bit newer, things that maybe our listeners don't
know about or haven't heard about. And at the Baptist program,
there's some new surgical techniques you guys are starting to explore.
(33:14):
Can you tell us a little bit about those?
Speaker 1 (33:18):
Yeah, So there's a new surgery called an OAGB and
it stands for one anastomatic gastric bypass and it is
a gastric bypass, but we it's kind of goes by
the nickname many bypass. And we've been doing this now
for several months and having great results with this surgery.
(33:42):
So this is for patients that you know, you know
where we see this. A lot of patients that have
had a lead gets stractomy, either in our program or
somewhere else throughout the state, and they either had some
weight regain or they didn't lose as much as they
wanted to lose. Are want to lose more, and so
this becomes a surgery that we can do without doing
(34:06):
a full gas or bypass on them, but they can
basically get the same results of having a full gas
or bypass and with a little bit less risk and
complication and faster recovery. So everybody's been very excited to
be doing these surgeries.
Speaker 2 (34:23):
And what's the general difference with it is it's just
less pieces that are rerouted or how is it an
improvement over the what makes it many compared to the
regular bypass?
Speaker 1 (34:36):
So in a regular bypass, you have two anasthemosis or
two connections that have to be made, so you have
to bypass in two places. With a mini bypass, you
only do it in one place, so you only have
to put the ball together and then sew it together
in one place. So you know, by definition you've just
got half all the half the risk that you would
(34:59):
have with a will bypass.
Speaker 2 (35:01):
I see, and and so things that would go into
kind of our next conversation, which is what are kind
of some of the more even though there may be
not be common, what are the more important side effects
or complications from these surgeries that you have to be away?
Speaker 1 (35:23):
Well, you know, ever since we started doing these laparoscopic
and now about this health we do most of these
surgers robotic, which gives us increased precision and visualization. Uh,
it really cuts down on quote unquote complications, but it
is a big surgery, and we always tell patients that
there's always a risky surgery of bleeding or infection or
(35:43):
damage the surrounding structures. So we always go over that
at their preoperative visit and talk to them about it.
These risks are very low, you know. But you know,
the big thing when we're doing these surgeries that we
talk about is making sure that when we cut balot
and put it back together that those connections are water
tight and nothing is leaking out which could cause abscesses
(36:07):
or infections or problems. So you know, we always show
veriatric surgeons we'll be in a we'll be in some
kind of nursing home, retirement home someday, just talking about
it's a leak. It's a league, it's a league, you know,
just mumbling that the whole time, because it's all we
ever think about. Ninety nine point nine nine nine percent
of time, patients call and they're having pain or problems
we haven't come in and we see them and we're
(36:29):
worried about it being a leak. It's almost never a leak,
but we always you know, want to make sure we
rule out the worst thing first and then we work backwards.
Speaker 2 (36:37):
From there and at the Gasha introologist. You know, I
see a lot of these patients, you know that come
into our office for various reasons, and you know, I'm
always talking to them about, you know, the fact that there,
you know, anatomy has been rerouted and that that's a
change from how they were born. So in that mindset,
what are some of the supplements or important lab works
(37:00):
that patients who undergo, especially the bypass surgery, what should
they be getting monitored or taking a supplement after surgery.
Speaker 1 (37:10):
Yeah, that's a great point, and that's that's really become
extremely important when the patients has malabsorption type surgery, so
some form of a bypass, but also with sleeve gets tract,
it means there are a lot of bands. It's also
important we want to make sure that they're on a
bariatric multi vitamin, which has about four times the amount
of supplementation then your standard centrum or one a day
(37:34):
type of vitamin. And then it's very important that patients
come in and get regularly have their labor checked. So
we checked quite frequently in the first year. We'll do
it at the month after surgery, and then six months
and then the year, and then after that. We usually
like to do it yearly, and we're looking at there's
important you know, vitamin D, you know vitamin allow of
(37:58):
your vitamin B complexes, Vitamin B one, which is diamond.
Patients that get low in this can have neurological complications
and problems. So we were going to make sure that
that that level stays good. So it's just important that
patients follow up because sometimes we're all patients say, well,
I'll just go to my family doctor, and there's nothing
wrong with that, but a lot of times the family
(38:19):
doctors aren't keyed into some looking for some of the
things that we might be looking for. So we really
encourage them to see us at least once a year,
even though.
Speaker 2 (38:28):
That is something so you do, you see them and
you try and guide that monitoring of those things or
due you ultimately turn that over to like the primary
care for.
Speaker 1 (38:39):
No, we want to see them in an ideal world,
you know, we try to see them and even if
patients relocate to other parts of the country, we'll reach
out to surgeons that we know and and and try
to plug them in because we feel like it's that important.
Speaker 2 (38:56):
So just in the final final moments here. You know,
I think they're they're developing a little bit of a
conflict sometimes where some people indicate, you know, you take
these medicines, that's cheating, or you take these surgeries and
that's cheating. If somebody is considering getting help with either
a surgery for for the weight loss or one of
(39:17):
these medications, what would you say to them if they
were concerned about that kind of perception.
Speaker 1 (39:24):
Yeah, I hear that a lot of decisions. You know,
hear the cheating word, and and that's that couldn't be
any further from the truth. You know, what you seeking help,
whether it's through medication or through surgery or combination. That's
one of the hardest things you can do. You're looking
in the mirror and you're telling yourself, you know, what
I'm doing isn't working. I've been on diets, I've tried,
(39:46):
and and I'm getting I'm getting more so off, I'm
getting sicker. And you know, facing that, coming in and
admitting that you know you need some help and then
getting that help can often reverse all those problems and
make patience quite a bit more healthy.
Speaker 2 (40:03):
Well, that is well said, and I could not agree more.
And I hope everybody is listening to that, Doctor Ferrell,
thank you again for giving us such an amazing education
on this topic. That's going to do it. For tonight's
segment of Centered on Health with Baptist Health, I am
your host, doctor Jeff Publin. I want to thank doctor Ferrell,
our guests. I want to thank our producer Best for
putting this show together for us. And I hope that
(40:26):
you guys enjoyed the show and you listen every Thursday
night at seven o'clock for another episode of Centered on
Health with Baptist Health. I hope you have a great weepend.
(40:54):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of the
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. This show is not designed
to replace a physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or
concerns you may have related to your personal health or
(41:17):
regarding specific medical conditions.
Speaker 3 (41:19):
To find a Baptist Health provider, please visit Baptistealth dot com.
It's now time for Centered on Health. With that his
Health on use Radio waight forty WYJS. Now, here's doctor
Jeff Tubbins.
Speaker 2 (00:16):
Health here on news Radio eight forty whas. I'm your host,
doctor Jeff Publin, and I want to tell you that
as recently as twenty twenty one, the CDC says that
about thirty eight point four percent of people in Kentucky
are ob or overweight and sixteen percent of our kids.
And Kentucky continues to be at the top of the
(00:39):
list of states that struggle with this issue. And every
year about two hundred and fifty thousand bariactid surgeries are
done here in the United States. So to help us
discuss this and the advancements in our weight loss surgery,
we have doctor Robert Ferrell joining us tonight. I want
to welcome back doctor Ferrell to our show. He has
always helped us with a great informative hour on this
(01:02):
topic weight loss surgery, and we know that this is
a huge part of our culture and our lives. Doctor
Ferrell is a buryaccid surgeon with the Baptist Hospital Medical Group.
He did his medical school at the University of Louisville
and he did his residency at the Saint Louis University
School of Medicine and Medical Center and his fellowship at
the Carolina Medical Center in Charlotte, North Carolina. Doctor Ferrell,
(01:25):
welcome back to Center on Health.
Speaker 1 (01:29):
Thanks for having me.
Speaker 2 (01:31):
We always love having you, and you know you always
teach us so much. And I just want to start
by saying we've had you on before, and this is
such a popular topic, and why do you think it's
become such a major topic of discussion in our culture today.
Speaker 1 (01:49):
Well, I think you said it perfectly there. The statistics
don't lie. It's an expanding problem where more of us
are dealing with the problem than not in some level,
whether it's being you know, overweight, or obeste or morbidly
abste and everybody you know, we say with cancer, everybody
knows somebody that's had cancer, and in effective, well, now
(02:11):
everybody knows somebody that's that's dealing with the problems from obesity,
and so it's kind of on the on the forefront
of everybody's mind.
Speaker 2 (02:20):
So start us off by by helping us understand what obesity,
what the definitions currently are for obesity.
Speaker 1 (02:30):
So in the in the medical terms, we use what's
called the body mass index or BMI, and that's a
formula based on your height and your weight, and it
puts you into a category and you become obese when
your BMI goes over thirty and then morbidly obese when
your b and I goes over thirty five. And you know,
(02:53):
for most people to put that, you know, in terms
of people think, well, you know, they're not sure what
that means. But really that could be you know, your
two hundred pounds or two hundred and twenty, two hundred
and thirty pounds, it's not the patient that is four
or five hundred pounds, is what was often commonly thought of, right, So.
Speaker 2 (03:15):
What drew you to this specialty? Yeah, I know you
probably started off training as a as a general surgeon,
I presume. And then what threw you to this particular
type of puru?
Speaker 1 (03:26):
Well, I think all physicians, you know, but in particular surgeons,
we want to fix things as quickly and as efficient
as possible. So whether it's a patient that you know,
has a broken bone that needs to be said, or
infected goal a lot of that needs to be removed,
you know, we want to try to fix things. And
when you do veriatric surgery. You get an opportunity to
(03:48):
fix a multitude of problems. We're not you know, just
our goal is not to band aid these things. Our
goal is actually to reverse the damage being caused by
them and an oftentimes make them go away. So whether
it's hypertension or diabetes, sleep bat near or horrible joint pain,
those type of things, we get to see patients completely
(04:11):
you know, resolve.
Speaker 3 (04:12):
And we had a patient today she came to the
office bought us some Christmas cookies, which is ironic, but
she you know, she's had surgery and now she had
an adamoplasty, and she's also over two hundred pounds showing us.
Speaker 1 (04:24):
So she wears uh size six pants and hugging us.
And you know, you go through a moment like that
and you're like, you've you know, you fundamentally have totally
changed somebody's life. It's pretty powerful.
Speaker 2 (04:38):
I would imagine and and tell you started to say
a little bit about it. What are the things that
can get better? You know, obesity obviously causes other health issues,
but what have you seen in terms of health improvement
not just from losing weight, but what other medical things
can actually improve by having surgery.
Speaker 1 (05:00):
Yeah, we say, you know, being overweight or beast. I mean,
it's a hedge tote disease. There's not a body system
that is not affected in some way. And a lot
of things people you know, you know, don't even think about.
I mean, hypertension and diabediously bat me, those are things
that people think about. But you know, we talk about
liver disease being a big problem. We talk about increased
(05:23):
risk of cancer being a big problem. We talk about
infertility being a big problem. And then you know, joint pain.
We're seeing more and more patients that are needing, they
have disabilitating knee, are hit pain and they need joint replacements,
but they can't get them because their BMI puts them
in a category where the surgeons just don't feel like
(05:45):
it's safe to operate. And so we're seeing more and
more of those patients coming in seeking you know, they're
not what I would say, horribly overweight, but if their
BMI is you know, forty or forty five, they need
to get down to be my thirty five or less
to have surgery. And they're they're choosing this as an option.
Speaker 2 (06:06):
And help us sort of set the stage. I mean,
we know that there's this explosion of sort of these
DLP ones and weight loss medicines. We're going to talk
about those later, but in general, how successful are non
operative measures? Like when people come to see do you
actually delay surgery to try diet exercise? What do you
(06:29):
recommend for patients on their first visit with you in
terms of whether surgery is sort of the right next
step for them?
Speaker 1 (06:37):
You know, I think that you know, we want to
meet all the patients and there's no perfect formula. We
kind of want to lay out all the options that
are present. Certainly, you know, we've been doing this a
long time and we have a good feel for where
people are ultimately going to be successful when people come
in a lot of patients come in with their own
(06:58):
sort of ideas, and we want to work with My
big thing is, I don't want this to be a
sort of you know, one visit, one surgery and that's it,
that's over, we never see you again kind of thing.
This is, you know, a chronic lifetime condition, and we
want to be sort of like with a teamwork approach
where we're kind of with you really forever, because there's
(07:21):
going to be challenges, no matter, even the most successful
patient in the world, there's going to be challenges at
some point, and there's gonna be ups and down. Then
we have to understand that. And so you know, for
some patients it might be just you know, improving their diet,
having them see their dietitian. For some patients, that might
be going on medications. For many patients it's going to
(07:43):
be going to surgery route and then backfilling it with
some of these other things we're talking about. But it
just it really it's a sort of a tailored approach
for each individual patient.
Speaker 2 (07:57):
And just out of curiosity, you know, we heard some
of the six that I put at the beginning in
terms of the childhood obesity. Is there an age that
you think is too young to think about this? Or
maybe I should ask at what age do you think
it's appropriate to consider something as aggressive as a surgery?
Speaker 1 (08:17):
So about the health patients to have surgery would have
to be eighteen years older, and that's an insurance requirement
right now. But there are adolescent programs in the country
that are associated with some of the bigger children's hospitals,
and they are doing surgery on adolescents. There's some psychosocial
(08:38):
things that you have to go through and what we
call Tanner staging to make sure that they've reached physical
maturity before you start creating malabsorption situations. But there are
patients that you know, as young as fifteen or sixteen
have been operated up.
Speaker 2 (08:56):
And is there on the other end, is there an
age that's too role.
Speaker 1 (09:02):
Yeah, that's a great question. I get asked that a lot.
I don't think. So there's nothing that the insurance makes
you not do. And the way I look at each
patient is, you know, I've I've operated on and done
their extra surgery on seventy five year olds. I think
my partner's done not even older than that. Some patients
in their mid seventies come in and they you know,
(09:22):
they could pass for being in their fifties. Unfortunately, some
patients come in their fifties, they look like they're they're
in their eighties, of course, so we take it individually
and see what kind of shape they're in and what
their goals are, and you know, you know a lot
of times they got you know, legitimate reasons for wanting
to do and wanting to live healthier and enjoy the
(09:44):
sort of what I would call the fourth quarter of
their life and we want to try to help them
to do that.
Speaker 2 (09:50):
That's fantastic. Well, we are going to jump into those
surgeries when we come back from this break. We are
listening to Center on Health with Thattic Health here on
news radio A forty w h as. I'm your host,
doctor Jeff Publin. We're talking tonight with doctor Robert Farrell
about advances in weight loss surgery. Our phone number is
five oh two five seven one eight four eighty four.
(10:10):
If you want to call in and ask any questions
about this process or questions about weight loss surgery, we
will see you on the other side of the way.
(10:34):
Welcome back to Centate on Health with Fastest Health here
on news radio eight forty WHAS. I'm your host, doctor
Jeff Publin, and we're talking tonight with doctor Robert Ferrell,
who is a buriatic surgeon with the Factist Hospital Medical Group.
We're talking about advances in weight loss surgery and welcome back,
doctor Ferrell. Our phone number is five oh two five
(10:57):
seven one eight four eighty four and our producers on
standby to take your phone so doctor Ferrell help us
before we get into the octro surgeries. That you do.
If you could give us a little understanding of the
surgery in general, in terms of the anatomy. What types
of things are happening to our anatomy when you do
(11:18):
various types of stereotric surgeries.
Speaker 1 (11:23):
Sure, so you know, the main thing we're focusing on
is you know, a patient's stomach obviously, and in a
lot of cases we're trying to create some form of
what we call restriction to the stomach, and we're trying
to either make stomach smaller or restrict the amount of
food that can be swallowed at any one time, which
(11:44):
will then you know, if patients are eating less food,
they're going to lose weight. And then the secondarily, there
are some surgeries where we will also create a second
element called malabsorption, where we will have food bypass some
of the intestine where it's normally absorbed, and because we're
(12:04):
not absorbing as much you know, calories, patients will lose
weight by that means as well. So both by restriction
and then also malabsorption in some of the sergers.
Speaker 2 (12:17):
And what would you say is the most common weight
loss surgery that you do.
Speaker 1 (12:22):
The most common we're doing now is the sleeve gets
stractomy that you know started We started doing that around
two thousand and nine. It started, like anything, kind of
slow and picked up speed and by the mid you know,
twenty teens, it overtook. Lap banding is the most popular
(12:45):
surgery and it's remained that way really, you know, for
the last at least ten years or so.
Speaker 2 (12:52):
And have any kind of fallen out of favor, like
the lap band are you still doing those or the
actual gastric bypass Are those still being done in this
era of the fleet dissectoy or have they fallen out
of failing?
Speaker 1 (13:06):
Great question. Yeah, I would say the lap banding that's
fallen out of favor largely with most accredited bari aster centers.
There could be reasons to do one here or there.
There's still a small amount of them being done, but
for the most part, what we find is we have
patients coming into us that have lot bands in and
(13:28):
are not happy or having trouble, have had them in
for ten or fifteen years, and they really just want
them removed, and then in some cases we will revise
it to another surgery. The gaser bypass is still being done,
and that there are some new variations of the gas
bypaths that are gaining popularity. That surgery is where the
(13:51):
malabsorption part comes in. So for some patients they want
to try to lose a little bit more weight, or
you know, there's some you know, different nuances and issues.
You know, sometimes theahs have family members that had to
bypass and they want once so we will do those
too as well.
Speaker 2 (14:13):
And I know that this probably is a three three
hour seminar on its own, but how do you decide
How does a patient decide what surgery might be right
for them?
Speaker 1 (14:25):
Yeah, I mean, you know, for some patients there's there's
no right answer. Anyone would be fine for them, you know,
So when they come to the office, we will talk
about all the surgeries and show them how they work.
And you know, in a lot of cases, the sleeve
gas direct to me is a great entry point in.
It's a great way to get patients losing weight, get
(14:47):
them more healthy, get them exercising again, and often it's
all that they really need. In some cases, again, they
might lose one hundred pounds with a sleeve gaess trectomy
and they might want that revised at some point to
a bypass to lose more. And that's the reasonable thing
to do. So it just it really again is tailored
(15:09):
an individuals to each patient.
Speaker 2 (15:12):
So tell talk to us through the lens of a patient.
So somebody is making the decision to have this done.
What's the general process is seen coming to see you,
any work up that needs to be done, the how
long the surgery takes in the recovery, what sort of
a point a to point the time frame or process
(15:34):
that a patient might think about them that they'll go
through with this.
Speaker 1 (15:39):
Sure, you know, we we have a great team in
our office here about this hospitle and and that's an
important part of this because there can be a number
of hurdles that to be jumped over, but you know,
we kind of have a team that helps to sort
of navigate through that process. But we'll see a patient,
you know, and then depending on their health that they're
in reasonably good health and no major issues, we do
(16:00):
have to have them have some preoperative testing done, we
have some lab work done. We want to take a
look inside their stomach with what's called an endoscopy, look
down and make sure that there's nothing crazy going on
in terms of like an ulcer or a some kind
of you know, tumor or mass. And then also we're
looking for idle hernies if they're present or not. I
(16:22):
tell patients that's not a deal breaker if you have that,
but we want to know about it because we would
likely fix it at the time when we're doing the
bariatric surgery and will help cut down on the brief
walks afterwards. And then after we do the edd and
you know, any other testing that we have to do,
we submit them for insurance approval, and then once they're
(16:43):
approved for surgery, we go ahead and get them scheduled.
And this whole process can take It can be beariable,
but it can be depending on patient's insurance, can take
one to three months. And then once we bring him
the surgery, you know, though, undergo the surgery and usually
stay one night in the hospital and then in most
(17:03):
cases be able to be discharged home. And I think
most patients are surprised with you know, how mobile they are,
because you know, they have visions of this being some
kind of you know, it is a big surgery, but
you know, they have visions that they're gonna go home
and be in bed for weeks and not be able
to move. But we want patients out of bed, out
(17:26):
walking the night of surgery. You know, we want them active,
and you know, most of the time we'll see patients
back three to five days after the surgery. They're driving
them off to the appointment, they're walking down the hallway.
You know, they're a little sore maybe, but quickly getting
over it. And they're they're just generally very surprised at
(17:47):
how quick they can recover from this.
Speaker 2 (17:51):
And I guess maybe using what sounds like kind of
the more common ones we might think about with the
sleeve got struck to me, or the pass or maybe
even the lap band, could you kind of compare and
contract a little bit about the recovery from differences and
maybe how much weight loss one could expect from the
various procedures that you do.
Speaker 1 (18:14):
Sure, sure, you know with the lap band again, you know,
we're really not doing too many of those anymore. But
you know, in general, you know, we would see, you know,
if we put a lot band in weight loss was
a little slower. You know, we would tighten a lap
band up to get it more restrictive for a patient
and they couldn't eat as much, and you know, we
(18:37):
might see, you know, over a year's time around, you know,
fifty to sixty pounds of weight loss, you know, per
one hundred pounds. You know, when we do a sleeve,
you know, on patients, I generally tell patients that are
really good. Goal is one hundred pounds at a year.
Certainly we have patients that can lose more than one
hundred pounds. We've had patients one hundred and fifty pounds more,
(19:00):
but these are averages. I kind of shoot for one
hundred pounds. So when I see patients back, you know,
I'll see them at three months and six months and
nine months, and we're kind of gauging where they're at
on that scale. You know, by six months, you know,
I want to see them at more than fifty pounds down,
and you know, I tell them that's you know, that's
my job is to kind of push them and tell them,
(19:21):
you know, you're you're meeting goals, You're where you want
to be, You're on target, or you know, if they're not,
I have to tell them that too. And we have
to we have to kind of kick it in gear
here and figure out, you know, we not exercise the
are we not making some of the lifestyle changes that
are very very important to having success. But like I say,
it's a team. It's kind of teamwork between us, and
(19:45):
that's where we're seeing patients frequently. And also I find that,
you know, I got to be like a coach and
a motivator, but that's where you get the most success
from patients.
Speaker 2 (19:55):
And what do you you you started to mention it.
I find it really fascinating. You know, will make this
commitment and it's a big commitment. And what do you
see as the most common reasons for failure after a
surgery like this or do you not see that very often?
Speaker 1 (20:12):
Sure? I mean, you know, of course, before surgery and
everybody wants to do this well, I mean, you know
our self atient you if there was a red button
to hit to be skinny and feel great and healthy,
everybody would hit the red button. You know, nobody chooses
to struggle with these problems. But you know, before surgery,
everybody kind of believes that I'm going to do this,
(20:33):
and I'm going to do that, and I'm going to
you know, I'm going to do it all right, and
then you know, we have surgery and the buying is
very high rate. After surgery, patients are very dedicated to
their diet and starting to exercise and do things. But
I find that as time goes on, we get out
to you know, nine months a year and more than
a year after surgery. You know, bad habits have a
(20:55):
funny way of creeping back in. They're like weeds in
a garden that just starts showing up, and we gotta
we gotta cut those down. And whether it's you know,
getting off your diet, or whether it's you know, not
exercising right anymore, it's it's a lot of the same
things that happen the first And that's why I got
to bring that up all the time and say, you know,
(21:16):
we don't want you to be paranoid, but we want
you to be vigilant. You know, we want you to
get into healthy habits and understand that these have to
be maintained to keep the weight loss that they have fantastic.
Speaker 2 (21:28):
Well, we're talking tonight to doctor Robert Ferrell about advances
in weight loss surgery. There is still time to call in.
Our phone number is five oh two, five seven one
eighty four eight four five oh two five seven one
eight four eight four. This is centered on health with
Actor's Health here on News Radio eight forty w ahs.
I'm the host, doctor Jeth Publin, and we will be
(21:49):
right back after these messages. Welcome back to senat on
Health with doctor Help here on the radio A forty whas.
(22:13):
I'm your host, doctor Jeff Colman. We're talking tonight with
doctor Robert Ferrell about advances in wait box surgery. Doctor
Ferrell is a bariactic surgeon with the Doctor's Hospital Medical Vision.
He's been educating us about the different types of surgery. So,
doctor Ferrel, I just want to ask you. The last
time that you were on, I actually had a patient
(22:33):
who was going to call in, but she never got
a chance to And then I happened to see her
again this week randomly, and she really wanted me to
talk to you about this question that she has about
bariactric surgery, which is she was told that because she
has Barriss esophagus, which is a change in the lining
of the esophagus from reflux and a diagnosis of Crone's disease,
(22:56):
that she really wasn't a candidate for any type of
bariactic surgery. Is that Is that an accurate statement in
terms of being limited and choices and things like that.
Speaker 1 (23:07):
Wow, well, she's got to do you there, I don't
think that I wouldn't say that's completely accurate. You know,
it does bear some consideration as to what the right
surgery for her to be. And you know, like anything
in medicine, there's risks and there's benefits, and I think,
(23:28):
you know, depending on her situation, the benefit here could
certainly outweigh any potential risks. But it does. She's got
it on both sides for sure. So we would have
to kind of talk to her about how bad is
her prone's disease, how many flariffs she had, how much
medication she on, if we were going to think about
(23:50):
doing some form of a bypass, And then also conversely,
you know how bad her barras is in terms of
inflammation in the esophagus, if we're going to do the
sleeve geest strecting.
Speaker 2 (24:04):
Down and as a goat fro twologists, obviously I'm very
curious about this. Is that because you won't have access
to look at the esophagus as well after a surgery,
or because the reflux could work in the underlying problem.
Speaker 1 (24:19):
Yeah, I think we'd be a little worried about if
there was a reflux or even silent reflux, So we
would want to make sure that she didn't have like
I talked about, a idle hernia, even if she had
the smallest turnaive, we'd want to tighten that up to
try to you know, I'm going to use medical jargon
to lower esophageal spinker. Only doctor Telviland knows about that.
But we want to get as snug as possible and
(24:42):
try to not let acid get from the stomach up
into the esophagus, which could further damage the lining. But
then also there's been great advances in terms of the
GI world in terms of how we treat barretts too,
so there's a lot of options here to potentially get
her the weight loss you need, but also you know,
monitor her and keep good surveillance on or make sure
(25:04):
nothing else happens.
Speaker 2 (25:05):
Well, thank you, I know, I know she'll be listening
to this and looking forward to that answer. You know,
as this these medicines come out and we're going to
touch on them. But as we learn about the surgeries
and the medicines, there's a whole culture here, and there's
some myths and there's some things that I think we
need to put out there and talk about so one
(25:26):
of the one of those is you know, where did
this idea of like one surgery in your lifetime kind
of come from? Is that? Is that an accurate statement
or where do you fall in that conversation?
Speaker 1 (25:40):
Yeah, I mean that's unfortunately that is sometimes an accurate statement.
It's a pet peeve of mine. It's what is said
is insurance companies often will say that you get one
surgery for patient for lifetime, which I think is absolutely
ridiculous because we don't treat anything else to medicate in medicine.
And you know, if a patient has a heart attack
(26:02):
and we treat the heart attack and we send them
and then three years later they have another heart attack,
we don't just let them die in the parking lot.
We treat them again. Right. But but somehow in this
it's it's you know, it's a one, one and done
situation where you get one surgery and you've got to
be perfect and you can have no problems afterwards. Now,
(26:25):
I will say that a lot of insurance companies are
being more reasonable as this problem has expanded and gotten
more of the population. Uh, but we do so encounter
that from times the time.
Speaker 4 (26:37):
Some insurances, you know, and It's really interesting because it
goes a little bit against kind of what you said
earlier culturally, which is we should be treating this like
a chronic condition, this issue of obesity and the health
management of it.
Speaker 2 (26:55):
It's not like you're you do the surgery and then
you're done forever. Right, But why do we treat obesity
or the surgery almost like it's not a konic condition.
What do you think is going on there?
Speaker 1 (27:08):
Yeah, I think that there's a lot of blame that's
put on the patients, and I think it's unfair to
some degree. You know, life is still going to go
on whether you have surgered or not. And I tell patients,
you know, there's going to be death in your family,
there's going to be you know, job loss, there's going
to be other stressors. There's going to be your relationship issues.
(27:28):
All these things, you know, can cause patients to to
have depression, to get off tracked, and not like we said,
follow their diet, follow their exercise plan. It's it's just
natural in life that that those things are going to happen.
And you know, we encourage patients when they see that
happening to get in and see us and get back
(27:49):
on track, but you know sometimes you know, sometimes passed
and they need to be you know, given you know,
a fair chance to be treated. Uh, you know, because
a lot of them can benefit from additional treatment and
we can really help them with that.
Speaker 2 (28:07):
And speaking of that, you know, these GLP ones and
this new wave of appetite suppressing medications that you know
originally were approved for diabetes, and we found this to
be kind of a off suit of their effectiveness. Where
do they fit in terms of your practice and what
are you seeing in terms of their impact on the
(28:29):
bariactive surgery.
Speaker 1 (28:32):
Well, we certainly use them. They've been like everybody else
thrust on us here in the last year or so,
where they've become enormously popular, and you know, I think
we're all trying to still figure out the perfect algorithm
where they fit in. I think that you know, if
you go on the the the studies and you look
(28:53):
at the weight loss that they produce, if people actually
read the studies, they'd be a little disappointed and see
and you know, the percentages and overall numbers. But I
do think that they definitely have a place. Sometimes it's
early in the process to get patients in better shape,
to potentially have a procedure. Sometimes, you know, patients come
(29:15):
and see this and they really don't have that much
weight to lose, and that's all they need is these medications.
And then sometimes it's on the on the backside after surgery.
You know, I'll give you a great example. You know,
we have lots of patients who had surgery before COVID
and really through new part of their own you know,
they were doing great, they were exercising, they were eating well,
and then all of a sudden, gym's clothes and you
(29:36):
couldn't get food and everything was haywire and people were
losing their jobs and you know, and then the next
thing is, you know, there was some weight percidivism that
happened during that period. So for some patients have come
back to see us, going on a GLP one has
been you know, something that's really helped them to sort
of get back on track. So we could use it
(29:58):
there too.
Speaker 2 (30:00):
And what you know, earlier we talked a little bit
about the health benefits of surgery, not just on losing weight,
but on some of these other chronic medical conditions. What
are we learning about the d LP ones and similar things.
Heart disease. You know, things like that are what what
are we seeing in that area.
Speaker 1 (30:23):
We're seeing we're seeing definite improvement and risk reduction in
risk of cardiogenic effects, and that's really where they're starting
to gain a foothold with insurances and getting some approval,
you know, like you like you mentioned they started as
diabetes medications, and they've sort of like all great medications,
(30:43):
viagrap being one of the great examples of our lifetime,
it starts in one area and it moves to something else.
These medications have started in diabetes but now have moved
over into the weight loss lane. And but there's been
a real reticence to cover these medications from insurance companies,
from employers. Now that some of the data is coming
(31:06):
out showing improved risk of having party oogenic complications, we
are seeing a little better coverage and I would anticipate
as time goes on that will improve. But there have
been studies that have been very clearly done that showed
although there is improvement with these medications by far and away,
there's significantly better improvement with surgery. It's it's a significant
(31:36):
improvement in risk reduction when you have surgery.
Speaker 2 (31:40):
Doctor Ferrell here tonight talking to us about weight loss
surgery and advances in weight loss surgery. I'm your host,
doctor Jeff Calvin. We're going to take our final break.
You are listening to Centered on Health with Doctic Health
here on news radio eight forty WHA. I want to
remind you that if you miss any part of this
show or want to hear all this excellent information again,
(32:01):
that you can download the iHeartRadio app. It is free,
it is easy to use, and it gives you access
to tonight's show in its entirety. This is Senate on
Health with Factors Health News Radio A forty w a
h S will be like that. Welcome back to Senate
(32:32):
on Health with Baptist Health here on news radio A
forty w h AS. I'm your host, doctor Jeff Publin,
and we're talking tonight with doctor Robert Ferrell advances in
weight box surgery. Doctor Fararell is a buryatic surgeon with
the Baptist Hospital Medical Group. I want to remind everybody
to download the iHeartRadio app to listen to this segment,
(32:53):
or any of our previous segments, or any of the
features that our app has to offer. So doctor Parall
One of the things that I really love highlighting on
this show are things that are up and coming or
a little bit newer, things that maybe our listeners don't
know about or haven't heard about. And at the Baptist program,
there's some new surgical techniques you guys are starting to explore.
(33:14):
Can you tell us a little bit about those?
Speaker 1 (33:18):
Yeah, So there's a new surgery called an OAGB and
it stands for one anastomatic gastric bypass and it is
a gastric bypass, but we it's kind of goes by
the nickname many bypass. And we've been doing this now
for several months and having great results with this surgery.
(33:42):
So this is for patients that you know, you know
where we see this. A lot of patients that have
had a lead gets stractomy, either in our program or
somewhere else throughout the state, and they either had some
weight regain or they didn't lose as much as they
wanted to lose. Are want to lose more, and so
this becomes a surgery that we can do without doing
(34:06):
a full gas or bypass on them, but they can
basically get the same results of having a full gas
or bypass and with a little bit less risk and
complication and faster recovery. So everybody's been very excited to
be doing these surgeries.
Speaker 2 (34:23):
And what's the general difference with it is it's just
less pieces that are rerouted or how is it an
improvement over the what makes it many compared to the
regular bypass?
Speaker 1 (34:36):
So in a regular bypass, you have two anasthemosis or
two connections that have to be made, so you have
to bypass in two places. With a mini bypass, you
only do it in one place, so you only have
to put the ball together and then sew it together
in one place. So you know, by definition you've just
got half all the half the risk that you would
(34:59):
have with a will bypass.
Speaker 2 (35:01):
I see, and and so things that would go into
kind of our next conversation, which is what are kind
of some of the more even though there may be
not be common, what are the more important side effects
or complications from these surgeries that you have to be away?
Speaker 1 (35:23):
Well, you know, ever since we started doing these laparoscopic
and now about this health we do most of these
surgers robotic, which gives us increased precision and visualization. Uh,
it really cuts down on quote unquote complications, but it
is a big surgery, and we always tell patients that
there's always a risky surgery of bleeding or infection or
(35:43):
damage the surrounding structures. So we always go over that
at their preoperative visit and talk to them about it.
These risks are very low, you know. But you know,
the big thing when we're doing these surgeries that we
talk about is making sure that when we cut balot
and put it back together that those connections are water
tight and nothing is leaking out which could cause abscesses
(36:07):
or infections or problems. So you know, we always show
veriatric surgeons we'll be in a we'll be in some
kind of nursing home, retirement home someday, just talking about
it's a leak. It's a league, it's a league, you know,
just mumbling that the whole time, because it's all we
ever think about. Ninety nine point nine nine nine percent
of time, patients call and they're having pain or problems
we haven't come in and we see them and we're
(36:29):
worried about it being a leak. It's almost never a leak,
but we always you know, want to make sure we
rule out the worst thing first and then we work backwards.
Speaker 2 (36:37):
From there and at the Gasha introologist. You know, I
see a lot of these patients, you know that come
into our office for various reasons, and you know, I'm
always talking to them about, you know, the fact that there,
you know, anatomy has been rerouted and that that's a
change from how they were born. So in that mindset,
what are some of the supplements or important lab works
(37:00):
that patients who undergo, especially the bypass surgery, what should
they be getting monitored or taking a supplement after surgery.
Speaker 1 (37:10):
Yeah, that's a great point, and that's that's really become
extremely important when the patients has malabsorption type surgery, so
some form of a bypass, but also with sleeve gets tract,
it means there are a lot of bands. It's also
important we want to make sure that they're on a
bariatric multi vitamin, which has about four times the amount
of supplementation then your standard centrum or one a day
(37:34):
type of vitamin. And then it's very important that patients
come in and get regularly have their labor checked. So
we checked quite frequently in the first year. We'll do
it at the month after surgery, and then six months
and then the year, and then after that. We usually
like to do it yearly, and we're looking at there's
important you know, vitamin D, you know vitamin allow of
(37:58):
your vitamin B complexes, Vitamin B one, which is diamond.
Patients that get low in this can have neurological complications
and problems. So we were going to make sure that
that that level stays good. So it's just important that
patients follow up because sometimes we're all patients say, well,
I'll just go to my family doctor, and there's nothing
wrong with that, but a lot of times the family
(38:19):
doctors aren't keyed into some looking for some of the
things that we might be looking for. So we really
encourage them to see us at least once a year,
even though.
Speaker 2 (38:28):
That is something so you do, you see them and
you try and guide that monitoring of those things or
due you ultimately turn that over to like the primary
care for.
Speaker 1 (38:39):
No, we want to see them in an ideal world,
you know, we try to see them and even if
patients relocate to other parts of the country, we'll reach
out to surgeons that we know and and and try
to plug them in because we feel like it's that important.
Speaker 2 (38:56):
So just in the final final moments here. You know,
I think they're they're developing a little bit of a
conflict sometimes where some people indicate, you know, you take
these medicines, that's cheating, or you take these surgeries and
that's cheating. If somebody is considering getting help with either
a surgery for for the weight loss or one of
(39:17):
these medications, what would you say to them if they
were concerned about that kind of perception.
Speaker 1 (39:24):
Yeah, I hear that a lot of decisions. You know,
hear the cheating word, and and that's that couldn't be
any further from the truth. You know, what you seeking help,
whether it's through medication or through surgery or combination. That's
one of the hardest things you can do. You're looking
in the mirror and you're telling yourself, you know, what
I'm doing isn't working. I've been on diets, I've tried,
(39:46):
and and I'm getting I'm getting more so off, I'm
getting sicker. And you know, facing that, coming in and
admitting that you know you need some help and then
getting that help can often reverse all those problems and
make patience quite a bit more healthy.
Speaker 2 (40:03):
Well, that is well said, and I could not agree more.
And I hope everybody is listening to that, Doctor Ferrell,
thank you again for giving us such an amazing education
on this topic. That's going to do it. For tonight's
segment of Centered on Health with Baptist Health, I am
your host, doctor Jeff Publin. I want to thank doctor Ferrell,
our guests. I want to thank our producer Best for
putting this show together for us. And I hope that
(40:26):
you guys enjoyed the show and you listen every Thursday
night at seven o'clock for another episode of Centered on
Health with Baptist Health. I hope you have a great weepend.
(40:54):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of the
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. This show is not designed
to replace a physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or
concerns you may have related to your personal health or
(41:17):
regarding specific medical conditions.
Speaker 3 (41:19):
To find a Baptist Health provider, please visit Baptistealth dot com.
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