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All right.

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Welcome to the

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next installment of

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Live Well with UCI Health.

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I'm Ryan Manno

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with KOST 103.5 and iHeart Radio.

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I am thrilled to be

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sitting across from Doctor

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Annie Wang,

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a board-certified general surgeon

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specializing in

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minimally invasive

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gastrointestinal and other weight

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loss surgeries. Yeah. That's right.

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Yes, Did I get it?

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Yes,

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I also do like abdominal

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wall reconstructions,

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but I do a lot of different things.

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Yeah, but that's the key

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to what we're talking about today.

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Yeah.

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Is that like a good conversation

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starter for you.

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Like when you're meeting people

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like I do

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abdominal wall reconstructions?

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I start with

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I do minimally invasive surgery

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that tend to impress

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a lot of people that I make.

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I do a lot of things with little cuts.

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That's so cool.

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And as we've been doing this,

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that's one of the

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I will say

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before we

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jump into our topic today,

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we're going to talk about weight

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loss and surgeries

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and all that and GLP-1s.

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I have been so fascinated to learn

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about how little

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we need to cut anymore.

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We've made remarkable advances.

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And basically how we do it

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is we use long instruments,

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and it actually has even advanced

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the surgeries

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we are able to offer as a whole.

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Yeah.

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Like,

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if we think about surgeries

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deep in the pelvis

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or for my part, at surgeries

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high up in the chest,

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it's a lot easier

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with little instruments

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because some of those places

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you can't even reach with a big cut.

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Yeah.

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And so so not only is it safer

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than before,

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but also we're able to do more things.

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Sure. Yeah. That's awesome.

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Well, let's, let's start with this,

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because of of what you do and,

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you know, look,

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there's a lot of focus on it

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right now.

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There's a lot of talk and buzz around

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GLP-1s and,

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you know, feeling

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better, looking better.

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How should we view obesity?

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Yeah.

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So this is actually a really

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interesting topic.

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Even within our field of obesity,

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we've been kind of

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feeling around in the dark

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to figure out a way

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that helps patients. The best.

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And,

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and so now the experts

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are starting to come together

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reviewing all the data

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from all the patients

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we've treated over

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the last few decades.

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And some of the big conclusions

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that we're starting

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to kind of

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emerging concepts is

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obesity is a chronic

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relapsing and remitting disease,

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you know,

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so, you know, when we see on TV

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they talk about it as yoyo diets.

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But what it

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really is is a disease

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that's treated for a little bit

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and then has started coming back.

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And so when we view,

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obesity as a disease, it's

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much easier for me as a doctor

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to talk about it with my patients.

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Yeah.

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Because then the patients

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don't feel like,

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oh, we're just here for my vanity.

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You know, it's a it's a disease

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that has consequences

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for all your organ systems.

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You know,

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the ones that my patients feel

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first are acid reflux.

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They get really bad

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joint pain

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from carrying all of the weight

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all of the time.

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They also can have

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very high risk of heart

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attacks, strokes,

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even a lot of different cancers.

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And so treating obesity,

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I like to think of it as a surgery

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that sets you up for long

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term success.

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Right. And so,

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and so that's why we do what we do.

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And, and, and I kind of,

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encourage patients to

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think about it from that lens

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so they don't kind of bring that

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shame piece about and worried

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that it's just for my vanity.

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It's really not, is it?

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Just like on a personal level,

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I guess personal and professional.

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Is it

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is it difficult for you

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to start to have

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some of those conversations

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with people? It is. Yeah.

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And, you know,

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I know a couple of years ago

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we were talking about, in the media.

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We were looking at things

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like body positivity and like,

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oh, so-and-so is fat shaming

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and things like that.

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And it makes us not, clinicians,

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not just me

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and my whole job,

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but primary care

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doctors, cardiologists.

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It's really hard for them

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to bring up that topic

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without damaging that patient,

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patient doctor relationship

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that we worked so hard to build.

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And so sometimes we say,

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you know what?

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There's other pressing issues

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at this visit.

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Let's just put them on the back burner

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for now. Right.

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But the way I think about it

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now is it's an important conversation

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to have

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so that they can avoid

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that open heart surgery down the line.

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Yes.

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And it's and and and they can avoid

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a cancer diagnosis chemo and

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and things like that.

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And so for me it's I,

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I start from a place of

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you are when you're in my office,

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me and my whole team

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of wonderful social workers

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and, dietitians, we I foster,

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work very hard to foster

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a very positive environment.

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So our patients feel like

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they can talk about anything with us.

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But at the same time,

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that means that I start

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the conversation.

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Sometimes they're

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not ready to hear it.

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Yes, but I

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at least start with a question.

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And then,

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that usually opens up

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a lot of things that they were worried

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to talk about with me.

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And they're like,

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oh, it's so good

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that you bring that up.

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Yeah, I can talk about this with you.

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And I feel safe to do so. Yeah.

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And so I think if this is something

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that's on a patient's mind,

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please bring it up with your doctor.

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That eliminates

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a lot of our fear of, like that

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damaging our relationship with you.

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And it makes that conversation

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so easy on our end. Yeah.

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So let's talk about, like,

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you know, the the stuff that you do.

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Bariatric surgery versus,

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you know, like we were saying,

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GLP ones are everywhere right now.

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Is it a matter of versus to you,

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Doctor Wang I don't think so.

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I think bottom line is

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obesity is a disease,

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but the patient

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is the captain of the ship, right?

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It's your body.

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You have the choice to do

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treat it however you like.

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My job as the doctor at our visit

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is to give you all the options, right?

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My, my, I have a team

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where one of someone on my team

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prescribes these medications.

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And so I don't see it

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as an antagonistic relationship.

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Between the two,

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I say,

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what option fits the best

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with you at this moment in your life?

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And then we go through the pros

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and cons of all of the options. Right.

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And so I love bariatric surgery.

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Because it's

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the only thing that's in the data

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that has the most durable long

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term success okay.

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And so patients we

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we now have

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can you can you pause one second. Why.

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What do you mean by

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I go a little deeper on that. Yeah.

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So when we talk about success

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with weight loss

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surgery, the numbers

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that we can compare are

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how long have you kept the weight off?

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Okay.

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And so

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we've been doing bariatric surgery

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for decades.

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So we've got long term follow up

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data up to like 20 years.

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And patients are keeping

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that weight off for all of that time.

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And the conversely,

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the GLP ones have been on the market

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for just 2 to 3 years.

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They do have really good signal

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of like dropping the weight.

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But weight loss is not as much as,

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bariatric surgery,

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but some people really do

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very well with these medications.

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But what we also know about these meds

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is when you stop taking them,

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the weight bounces back.

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Okay, listen, I'm

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going to just be honest with you.

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We were even talking about this before

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we turned on the cameras.

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I have lost 44 pounds in the last.

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I don't know,

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16, 15, 16 months, whatever.

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I notice

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if if I don't hit my weekly dose,

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I don't even a couple days

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later, I'm just like, I.

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It comes back.

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All I want to do is eat. Yeah.

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You know what I mean?

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And I can feel it just like that.

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So it's you're.

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I mean, I'm living proof

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that what you just said

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is completely accurate. Yeah.

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And that weight does come back

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if you're not careful.

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And so, you know,

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I always say that's not kind of,

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it's definitely still

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the patient's decision

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to decide what route

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they feel the most comfortable with.

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Yeah.

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And but like

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if they are ready for surgery,

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that's the one I encourage patients

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to really consider. Okay.

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Because that's one thing to do

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upfront that

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then they're set

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for the rest of their life.

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What what are the different

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I've heard of,

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you know, gastric bypass, sleeve.

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What are the procedures

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What are the procedures

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that we're doing

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now that you’re doing?

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Yeah, those are exactly the two

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that are standard of care.

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First up, operations that we do.

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So the sleeve, it's

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the most commonly offered surgery

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in the United States.

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What we do is,

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you know,

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I like to think of the

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the stomach as, like a purse.

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Okay.

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That's what it looks like

00:08:20:08 - 00:08:21:19

in the operating. Why not?

00:08:21:19 - 00:08:23:03

And with the sleeve,

00:08:23:03 - 00:08:24:12

we're cutting that purse

00:08:24:12 - 00:08:26:06

to look like a banana.

00:08:26:06 - 00:08:26:16

Okay.

00:08:26:16 - 00:08:27:20

And so that's how it helps

00:08:27:20 - 00:08:29:17

you lose weight at any one time.

00:08:29:17 - 00:08:31:19

Your stomach can only accommodate

00:08:31:19 - 00:08:32:22

that amount of food.

00:08:32:22 - 00:08:33:06

Right.

00:08:33:06 - 00:08:36:13

And so, that is kind of the

00:08:36:15 - 00:08:37:15

had the jump start

00:08:37:15 - 00:08:39:18

to help you lose that weight.

00:08:39:18 - 00:08:42:13

The sleeve is a great operation.

00:08:42:13 - 00:08:43:19

And a lot of patients like it

00:08:43:19 - 00:08:44:04

because it's

00:08:44:04 - 00:08:46:10

a relatively shorter operation.

00:08:46:10 - 00:08:48:12

It's about an hour to,

00:08:48:12 - 00:08:50:15

to for the operation.

00:08:50:15 - 00:08:51:20

And, and that's

00:08:51:20 - 00:08:53:20

why it's the most popular right now.

00:08:53:20 - 00:08:54:06

Yeah.

00:08:54:06 - 00:08:55:21

The other operation

00:08:55:21 - 00:08:57:06

has been around the longest,

00:08:57:06 - 00:08:58:03

and it's like what

00:08:58:03 - 00:09:00:09

we call the tried and true operation.

00:09:00:09 - 00:09:01:19

It's the gastric bypass.

00:09:01:19 - 00:09:03:11

This one's a little bit more complex.

00:09:03:11 - 00:09:06:08

So you gotta follow me on my first go.

00:09:06:08 - 00:09:07:05

We cut it down

00:09:07:05 - 00:09:09:00

instead of to an, to a banana.

00:09:09:00 - 00:09:10:14

We cut it down to the size of an egg.

00:09:10:14 - 00:09:12:10

And so it's even more restrictive.

00:09:12:10 - 00:09:14:02

So there's a slight edge

00:09:14:02 - 00:09:15:21

on how much weight you lose with it.

00:09:15:21 - 00:09:16:13

Okay.

00:09:16:13 - 00:09:18:03

And then that egg,

00:09:18:03 - 00:09:19:22

we connect it to your intestine

00:09:19:22 - 00:09:21:17

further down in the,

00:09:21:17 - 00:09:23:06

in the digestive tract.

00:09:23:06 - 00:09:24:20

So now the calories that you eat,

00:09:24:20 - 00:09:25:04

not only

00:09:25:04 - 00:09:26:10

do you eat less of it,

00:09:26:10 - 00:09:27:03

it's got a shorter

00:09:27:03 - 00:09:29:00

high way to get absorbed.

00:09:29:00 - 00:09:31:04

The rest of your stomach and that,

00:09:31:04 - 00:09:34:09

first portion of the intestine that,

00:09:34:11 - 00:09:37:11

has important digestive juices to,

00:09:37:16 - 00:09:38:22

mix with the foods that you eat.

00:09:38:22 - 00:09:40:00

We have to

00:09:40:00 - 00:09:40:18

help that meat,

00:09:40:18 - 00:09:41:23

the foods that you eat.

00:09:41:23 - 00:09:43:16

So we have to make a second connection

00:09:43:16 - 00:09:44:23

to help those cut together.

00:09:44:23 - 00:09:46:03

So we're rerouting everything in here.

00:09:46:03 - 00:09:46:15

Yeah.

00:09:46:15 - 00:09:47:23

You're laying new tracks and stuff

00:09:47:23 - 00:09:48:18

Okay, got it.

00:09:48:18 - 00:09:50:11

So it is a more extensive operation.

00:09:50:11 - 00:09:53:00

So some patients are a little bit more shy.

00:09:53:00 - 00:09:54:23

But when we look at the long term

00:09:54:23 - 00:09:56:16

data, patients who have undergone

00:09:56:16 - 00:09:57:14

a bypass

00:09:57:14 - 00:09:59:00

tend to have lower heart attack

00:09:59:00 - 00:10:00:17

and stroke rates in the long run.

00:10:00:17 - 00:10:01:09

Yeah.

00:10:01:09 - 00:10:02:03

We also find

00:10:02:03 - 00:10:04:08

better diabetes, hypertension

00:10:04:08 - 00:10:06:00

and cholesterol control.

00:10:06:00 - 00:10:07:00

But you actually achieve

00:10:07:00 - 00:10:09:00

all of these co-morbidity control

00:10:09:00 - 00:10:11:08

really nicely with the sleeve as well.

00:10:11:08 - 00:10:11:16

Okay.

00:10:11:16 - 00:10:12:17

And so both of those

00:10:12:17 - 00:10:14:17

are great options for patients.

00:10:14:17 - 00:10:17:17

And sometimes for certain patients

00:10:17:19 - 00:10:19:07

it's not so much like

00:10:19:07 - 00:10:20:19

which one do you like.

00:10:20:19 - 00:10:22:03

It's more of hey,

00:10:22:03 - 00:10:24:06

I reviewed like everything about you,

00:10:24:06 - 00:10:25:13

the surgeries you've had,

00:10:25:13 - 00:10:26:22

your medical problems.

00:10:26:22 - 00:10:28:11

I actually think this operation

00:10:28:11 - 00:10:30:05

is the preferred one.

00:10:30:05 - 00:10:31:19

Because I think this is

00:10:31:19 - 00:10:32:15

these are all the benefits.

00:10:32:15 - 00:10:34:02

So you'll make a recommendation

00:10:34:02 - 00:10:34:20

based on what you.

00:10:34:20 - 00:10:35:11

Yeah, it's

00:10:35:11 - 00:10:37:10

a very comprehensive because. Yeah.

00:10:37:10 - 00:10:38:02

First, like,

00:10:38:02 - 00:10:39:03

it's not like a random thought.

00:10:39:03 - 00:10:40:13

Yeah. Yeah of course.

00:10:40:13 - 00:10:40:21

Yeah.

00:10:40:21 - 00:10:41:13

And so

00:10:41:13 - 00:10:43:07

and so you know, we take the time

00:10:43:07 - 00:10:44:20

to really think about that.

00:10:44:20 - 00:10:46:12

My social workers

00:10:46:12 - 00:10:48:12

will also sit down with you and...

00:10:48:12 - 00:10:50:07

Oh, man, Alison, is fantastic!

00:10:50:07 - 00:10:53:02

Shout out Alison, way to go.

00:10:53:02 - 00:10:54:09

She knows we're doing this.

00:10:54:09 - 00:10:55:20

So she's going to watch this

00:10:55:20 - 00:10:56:16

I love it.

00:10:56:16 - 00:10:57:11

But she...

00:10:57:11 - 00:10:59:04

she really gets to know our patients.

00:10:59:04 - 00:11:00:08

Like, what kind of things

00:11:00:08 - 00:11:02:00

make them want to eat more food?

00:11:02:00 - 00:11:02:08

Yes.

00:11:02:08 - 00:11:03:23

What are the things that make them

00:11:03:23 - 00:11:05:18

not exercise as much?

00:11:05:18 - 00:11:08:07

Is there any sort of

00:11:08:07 - 00:11:10:19

family or support system issues

00:11:10:19 - 00:11:12:04

that may become a barrier

00:11:12:04 - 00:11:14:19

to their success after surgery?

00:11:14:19 - 00:11:16:07

And then we've got a fantastic

00:11:16:07 - 00:11:17:09

dietitian team.

00:11:17:09 - 00:11:18:14

There's,

00:11:18:14 - 00:11:19:17

three of them, and,

00:11:19:17 - 00:11:21:12

and we go through with people

00:11:21:12 - 00:11:22:22

what to expect.

00:11:22:22 - 00:11:23:16

After surgery,

00:11:23:16 - 00:11:24:10

what's your diet

00:11:24:10 - 00:11:26:04

going to be like after surgery

00:11:26:04 - 00:11:27:20

and what we expect you to maintain

00:11:27:20 - 00:11:28:22

for the rest of your life

00:11:28:22 - 00:11:30:04

with the surgeries

00:11:30:04 - 00:11:31:17

and so there's a lot of guidance.

00:11:31:17 - 00:11:33:20

And like, I follow my patients

00:11:33:20 - 00:11:35:03

for their whole life.

00:11:35:03 - 00:11:35:14

You know,

00:11:35:14 - 00:11:36:09

after the surgery,

00:11:36:09 - 00:11:37:08

it's every few months

00:11:37:08 - 00:11:38:05

to make sure you're losing

00:11:38:05 - 00:11:39:09

the weight appropriately.

00:11:39:09 - 00:11:40:16

After that, it's an annual visit,

00:11:40:16 - 00:11:42:11

just like with your PCP,

00:11:42:11 - 00:11:43:15

so that we're making sure

00:11:43:15 - 00:11:45:01

that everything's still working great.

00:11:45:01 - 00:11:45:19

Yeah.

00:11:45:19 - 00:11:47:09

Okay, so when I'm on the GLP ones,

00:11:47:09 - 00:11:48:03

I feel like it.

00:11:48:03 - 00:11:51:03

It turns the food noise off, right?

00:11:51:08 - 00:11:52:11

Does that same thing

00:11:52:11 - 00:11:53:10

happen

00:11:53:10 - 00:11:56:06

to someone whose stomach is smaller?

00:11:56:06 - 00:11:56:15

Right.

00:11:56:15 - 00:11:57:03

Like or do

00:11:57:03 - 00:11:59:05

they still have the desire for food

00:11:59:05 - 00:12:00:05

and then end up stretching

00:12:00:05 - 00:12:01:08

their stomach out again?

00:12:01:08 - 00:12:02:09

Yeah. So does that make sense?

00:12:02:09 - 00:12:03:04

Is that right?

00:12:03:04 - 00:12:03:14

Yeah.

00:12:03:14 - 00:12:04:22

Yeah, that's exactly the right

00:12:04:22 - 00:12:06:17

answer question.

00:12:06:17 - 00:12:07:19

So part of it

00:12:07:19 - 00:12:10:03

is because your stomach is smaller,

00:12:10:03 - 00:12:11:10

you feel full.

00:12:11:10 - 00:12:12:08

Very okay.

00:12:12:08 - 00:12:13:16

But but what about the mental

00:12:13:16 - 00:12:14:12

but because to me

00:12:14:12 - 00:12:15:13

that's always been my issue.

00:12:15:13 - 00:12:16:00

Like, yeah,

00:12:16:00 - 00:12:16:16

if I'm bored

00:12:16:16 - 00:12:17:05

I just think, oh,

00:12:17:05 - 00:12:18:00

I'll just eat something

00:12:18:00 - 00:12:19:10

or whatever I think about, well,

00:12:19:10 - 00:12:20:20

you know, it sounds good right now,

00:12:20:20 - 00:12:21:19

but I don't.

00:12:21:19 - 00:12:22:02

Yeah,

00:12:22:02 - 00:12:22:20

I lose that

00:12:22:20 - 00:12:24:12

when I'm on that medication. Yeah.

00:12:24:12 - 00:12:26:11

And then the reason that is,

00:12:26:11 - 00:12:28:11

is because those medications mimic

00:12:28:11 - 00:12:30:09

the hormones that send that signal

00:12:30:09 - 00:12:31:10

to your brain, okay?

00:12:31:10 - 00:12:32:20

Those hormone levels

00:12:32:20 - 00:12:35:01

drop with bariatric surgery or.

00:12:35:01 - 00:12:35:14

And they

00:12:35:14 - 00:12:36:08

they're affected

00:12:36:08 - 00:12:37:18

by the bariatric surgery.

00:12:37:18 - 00:12:39:01

So it to some extent

00:12:39:01 - 00:12:40:10

it does do that as well.

00:12:40:10 - 00:12:41:02

Fascinating.

00:12:41:02 - 00:12:42:23

And in fact,

00:12:42:23 - 00:12:44:11

you know how they'd say like, oh,

00:12:44:11 - 00:12:46:06

they invented these medications

00:12:46:06 - 00:12:47:15

to treat diabetes. Yeah.

00:12:47:15 - 00:12:48:16

What started them down

00:12:48:16 - 00:12:50:03

that path was when they looked

00:12:50:03 - 00:12:51:15

at gastric bypass patients

00:12:51:15 - 00:12:52:20

and they said,

00:12:52:20 - 00:12:53:00

well,

00:12:53:00 - 00:12:54:08

why is it that these patients

00:12:54:08 - 00:12:55:13

have incredible

00:12:55:13 - 00:12:57:12

sugar control right out of surgery,

00:12:57:12 - 00:12:59:18

like literally the day after surgery?

00:12:59:18 - 00:13:01:21

Some of them don't need as many meds

00:13:01:21 - 00:13:03:16

as they did before.

00:13:03:16 - 00:13:04:15

And then they started

00:13:04:15 - 00:13:05:23

digging into the hormones.

00:13:05:23 - 00:13:06:20

And that's eventually

00:13:06:20 - 00:13:07:23

how we got these meds.

00:13:07:23 - 00:13:11:07

No way. And so, you know,

00:13:11:09 - 00:13:13:00

we part of what,

00:13:13:00 - 00:13:14:07

a lot of us in the obesity

00:13:14:07 - 00:13:15:16

community are thinking about

00:13:15:16 - 00:13:17:04

is maybe GLP one

00:13:17:04 - 00:13:18:21

isn't the only hormone.

00:13:18:21 - 00:13:20:13

And how they're finding more hormones

00:13:20:13 - 00:13:21:18

is they're studying

00:13:21:18 - 00:13:23:08

some of these models of weight

00:13:23:08 - 00:13:24:09

loss surgeries

00:13:24:09 - 00:13:26:02

to, to really understand

00:13:26:02 - 00:13:28:01

like what other hormones are.

00:13:28:01 - 00:13:28:19

Can we

00:13:28:19 - 00:13:30:07

understand better to

00:13:30:07 - 00:13:32:12

to make drugs better.

00:13:32:12 - 00:13:35:00

At what point would you recommend

00:13:35:00 - 00:13:36:14

someone really give some,

00:13:36:14 - 00:13:37:20

some real serious

00:13:37:20 - 00:13:39:04

thought to, you know,

00:13:39:04 - 00:13:41:14

consideration to buy a gastric bypass

00:13:41:14 - 00:13:42:06

surgery.

00:13:42:06 - 00:13:45:05

So not just gastric bypass

00:13:45:05 - 00:13:47:21

but even the sleeve surgery. Okay.

00:13:47:21 - 00:13:49:20

The, the guidelines right now

00:13:49:20 - 00:13:50:19

recommend that

00:13:50:19 - 00:13:55:01

if your body mass index is above 35

00:13:55:03 - 00:13:56:14

or, it's above 30,

00:13:56:14 - 00:13:58:20

and you have comorbidities of obesity

00:13:58:20 - 00:13:59:21

that you should see us.

00:13:59:21 - 00:14:00:17

Well, that's very hard

00:14:00:17 - 00:14:02:04

for a patient to understand.

00:14:02:04 - 00:14:03:07

So what

00:14:03:07 - 00:14:04:04

I recommend

00:14:04:04 - 00:14:06:11

is that you get your height

00:14:06:11 - 00:14:07:11

and your weight.

00:14:07:11 - 00:14:08:05

The day that you're thinking

00:14:08:05 - 00:14:08:20

about this question,

00:14:08:20 - 00:14:09:21

you stand on a scale

00:14:09:21 - 00:14:11:01

and you get your weight,

00:14:11:01 - 00:14:12:04

and then you can look

00:14:12:04 - 00:14:15:03

for BMI calculators online.

00:14:15:03 - 00:14:17:17

And calculate your body mass index.

00:14:17:17 - 00:14:18:11

It's that simple.

00:14:18:11 - 00:14:19:02

You need your height and weight.

00:14:19:02 - 00:14:20:21

I've never done this. Yeah.

00:14:20:21 - 00:14:22:04

And, they're

00:14:22:04 - 00:14:23:16

they're all over the internet.

00:14:23:16 - 00:14:25:19

I think ChatGPT can do this, too.

00:14:25:19 - 00:14:27:08

Yeah,

00:14:27:10 - 00:14:28:23

they can do a lot, a lot,

00:14:28:23 - 00:14:31:06

but I can't do the operation. No.

00:14:31:06 - 00:14:32:00

Yeah.

00:14:32:00 - 00:14:35:00

And, if that number is,

00:14:35:02 - 00:14:37:21

35, make an appointment.

00:14:37:21 - 00:14:39:02

Maybe it's with me.

00:14:39:02 - 00:14:39:14

Maybe it's

00:14:39:14 - 00:14:41:07

with your primary care doctor.

00:14:41:07 - 00:14:43:23

With one of us.

00:14:43:23 - 00:14:45:12

And say, I think I,

00:14:45:12 - 00:14:46:22

I think I need to think about

00:14:46:22 - 00:14:49:15

how to tackle this problem of obesity.

00:14:49:15 - 00:14:50:12

And then we work

00:14:50:12 - 00:14:51:09

with you to figure out

00:14:51:09 - 00:14:52:09

what are the options

00:14:52:09 - 00:14:54:04

that may work the best in your life.

00:14:54:04 - 00:14:54:20

Yeah.

00:14:54:20 - 00:14:57:13

You mentioned something about,

00:14:57:13 - 00:14:58:04

you know,

00:14:58:04 - 00:14:59:05

staying with your patients,

00:14:59:05 - 00:15:01:06

following up with them for, you know,

00:15:01:06 - 00:15:03:00

forever, basically.

00:15:03:00 - 00:15:04:16

What does that look like?

00:15:04:16 - 00:15:06:15

Like the full after surgery thing

00:15:06:15 - 00:15:07:22

when you say follow up with them,

00:15:07:22 - 00:15:08:07

like what?

00:15:08:07 - 00:15:10:13

What does life look like for you

00:15:10:13 - 00:15:11:14

as their surgeon

00:15:11:14 - 00:15:13:19

and for them and together.

00:15:13:19 - 00:15:14:07

Yeah.

00:15:14:07 - 00:15:16:21

So, based on how we describe

00:15:16:21 - 00:15:18:04

some of these operations,

00:15:18:04 - 00:15:19:20

it's actually very,

00:15:19:20 - 00:15:21:18

easy to think that,

00:15:21:18 - 00:15:23:14

the way that we eat is changing.

00:15:23:14 - 00:15:23:21

Okay.

00:15:23:21 - 00:15:25:06

And so it's, and,

00:15:25:06 - 00:15:26:06

and we're doing a lot

00:15:26:06 - 00:15:28:09

to manipulate the GI tract.

00:15:28:09 - 00:15:30:01

And so there are certain

00:15:30:01 - 00:15:32:07

vitamin deficiencies,

00:15:32:07 - 00:15:34:16

that are more common,

00:15:34:16 - 00:15:35:05

in patients

00:15:35:05 - 00:15:36:14

who have had surgery compared

00:15:36:14 - 00:15:38:04

to the general population.

00:15:38:04 - 00:15:40:00

And so I monitor for those,

00:15:40:00 - 00:15:41:09

but as long as we're sticking

00:15:41:09 - 00:15:43:22

to the diet plan leading up to surgery

00:15:43:22 - 00:15:45:15

should be okay.

00:15:45:15 - 00:15:47:17

But it's, but we check in on that.

00:15:47:17 - 00:15:48:18

We check in on what?

00:15:48:18 - 00:15:49:18

What your weight is,

00:15:49:18 - 00:15:50:09

because, again,

00:15:50:09 - 00:15:52:07

obviously a chronic disease,

00:15:52:07 - 00:15:52:22

you know, weight

00:15:52:22 - 00:15:54:20

recurrence may still happen,

00:15:54:20 - 00:15:56:17

though it is much lower percentage

00:15:56:17 - 00:15:58:19

than with the medications.

00:15:58:19 - 00:15:59:20

And so we kind of stay on

00:15:59:20 - 00:16:01:09

top of it and see, like

00:16:01:09 - 00:16:02:10

if things are starting

00:16:02:10 - 00:16:03:14

to not look great,

00:16:03:14 - 00:16:05:00

we're right there for you. Okay.

00:16:05:00 - 00:16:07:11

But do you know, like, can you

00:16:07:13 - 00:16:08:12

maybe you want to answer this.

00:16:08:12 - 00:16:08:20

That's fine.

00:16:08:20 - 00:16:09:15

If you want to plead the fifth,

00:16:09:15 - 00:16:10:23

do you know when someone's

00:16:10:23 - 00:16:12:18

not sticking to the plan

00:16:12:18 - 00:16:13:22

and they're trying to tell, you know,

00:16:13:22 - 00:16:14:21

I've been doing it and you're like,

00:16:14:21 - 00:16:16:15

come on, you know, you haven't.

00:16:16:15 - 00:16:17:22

There are certain towels.

00:16:17:22 - 00:16:19:07

Yeah I bet. Yeah.

00:16:19:07 - 00:16:22:05

So what I do is I have my patients

00:16:22:05 - 00:16:23:21

lose some weight on a trial

00:16:23:21 - 00:16:26:00

run of the diet before the surgery.

00:16:26:00 - 00:16:26:06

Okay?

00:16:26:06 - 00:16:27:10

And if you don't lose weight,

00:16:27:10 - 00:16:29:05

that is one of the signals to me

00:16:29:05 - 00:16:30:17

that you may not be ready

00:16:30:17 - 00:16:32:00

for the surgery.

00:16:32:00 - 00:16:33:12

We work a little bit harder,

00:16:33:12 - 00:16:34:21

and it's not because, you know,

00:16:34:21 - 00:16:36:17

I really need you to lose weight.

00:16:36:17 - 00:16:38:02

Like my surgery is going to do

00:16:38:02 - 00:16:39:07

some of that work.

00:16:39:07 - 00:16:41:04

But I also know that patients

00:16:41:04 - 00:16:41:21

who can't

00:16:41:21 - 00:16:43:23

really realistically stick to the plan

00:16:43:23 - 00:16:45:12

in a long term fashion,

00:16:45:12 - 00:16:46:02

they're not going to be

00:16:46:02 - 00:16:47:14

that successful after surgery.

00:16:47:14 - 00:16:49:03

And I don't want to set my patients

00:16:49:03 - 00:16:50:15

up for something like that. No.

00:16:50:15 - 00:16:51:21

And then the other part of

00:16:51:21 - 00:16:53:06

it is the preoperative

00:16:53:06 - 00:16:54:11

weight loss actually

00:16:54:11 - 00:16:55:22

shrinks the liver away

00:16:55:22 - 00:16:56:23

and makes the surgery

00:16:56:23 - 00:16:58:01

easier and lower

00:16:58:01 - 00:17:00:17

risk of complications on my end.

00:17:00:17 - 00:17:01:05

And that

00:17:01:05 - 00:17:01:21

and those are kind

00:17:01:21 - 00:17:04:09

of the biggest reasons why I kind of

00:17:04:09 - 00:17:05:17

have them do that, even

00:17:05:17 - 00:17:07:07

leading up to the surgery.

00:17:07:07 - 00:17:09:20

And, and, you know, I

00:17:09:22 - 00:17:11:07

there's not really a point in

00:17:11:07 - 00:17:12:09

lying to me

00:17:12:09 - 00:17:14:00

or your doctors about this stuff

00:17:14:00 - 00:17:15:00

because you're

00:17:15:00 - 00:17:16:02

the one living the life.

00:17:16:02 - 00:17:19:22

And if things are not working out,

00:17:20:00 - 00:17:21:18

you know, we do food journals

00:17:21:18 - 00:17:22:09

and you can

00:17:22:09 - 00:17:23:14

look at your own food journal

00:17:23:14 - 00:17:25:14

and kind of be reflective about it

00:17:25:14 - 00:17:28:00

and see your own progress.

00:17:28:00 - 00:17:29:23

And once you've identified, actually,

00:17:29:23 - 00:17:30:21

you know what I mean?

00:17:30:21 - 00:17:31:21

It's like at midnight

00:17:31:21 - 00:17:33:15

I start having these. Great. Yes, yes.

00:17:33:15 - 00:17:35:11

Let's let's talk about that. Sure.

00:17:35:11 - 00:17:37:06

Then we have a lot of options. Right.

00:17:37:06 - 00:17:38:13

But as long as we keep

00:17:38:13 - 00:17:40:05

the lines of communication open,

00:17:40:05 - 00:17:40:19

we've got a lot of

00:17:40:19 - 00:17:43:07

different strategies to help you.

00:17:43:07 - 00:17:44:07

But of course,

00:17:44:07 - 00:17:45:19

everyone's got to come to the table

00:17:45:19 - 00:17:47:02

with honesty.

00:17:47:02 - 00:17:48:11

You touched on a couple of these

00:17:48:11 - 00:17:50:19

in one of your, your answers.

00:17:50:19 - 00:17:53:06

What are you know what are the key

00:17:53:06 - 00:17:56:08

benefits to, to having a procedure

00:17:56:08 - 00:17:57:22

like this.

00:17:58:00 - 00:17:58:12

You talked about

00:17:58:12 - 00:17:59:20

comorbidities like,

00:17:59:20 - 00:18:02:20

you know, like decreasing, right.

00:18:02:20 - 00:18:03:07

Yeah.

00:18:03:07 - 00:18:06:07

So a lot of patients, who,

00:18:06:08 - 00:18:07:18

have really hard time

00:18:07:18 - 00:18:10:02

controlling their diabetes and their,

00:18:10:02 - 00:18:10:21

their sugar control

00:18:10:21 - 00:18:11:15

every time they talk

00:18:11:15 - 00:18:12:21

to their primary care,

00:18:12:21 - 00:18:14:14

they're, like, already on insulin.

00:18:14:14 - 00:18:15:18

They don't feel that great.

00:18:15:18 - 00:18:17:02

Sometimes these surgeries

00:18:17:02 - 00:18:19:02

can kind of help,

00:18:19:02 - 00:18:21:08

the with the insulin resistance

00:18:21:08 - 00:18:22:15

a little bit. Okay.

00:18:22:15 - 00:18:23:11

Though at that point

00:18:23:11 - 00:18:24:17

it's a little bit too late.

00:18:24:17 - 00:18:26:16

We the best time to help

00:18:26:16 - 00:18:27:13

with a lot of these

00:18:27:13 - 00:18:28:14

comorbidities is

00:18:28:14 - 00:18:30:23

before they even happen.

00:18:30:23 - 00:18:32:03

That being said, yeah,

00:18:32:03 - 00:18:35:02

we do see reduced rates of cancer,

00:18:35:07 - 00:18:36:16

reduced rates of heart attacks

00:18:36:16 - 00:18:38:07

and strokes.

00:18:38:07 - 00:18:39:07

That the things that

00:18:39:07 - 00:18:41:09

my patients feel immediately,

00:18:41:09 - 00:18:42:08

other than needing

00:18:42:08 - 00:18:43:18

to take less medications

00:18:43:18 - 00:18:44:16

for the blood pressure

00:18:44:16 - 00:18:46:05

and the diabetes is

00:18:46:05 - 00:18:47:22

they can live a life now. Yes.

00:18:47:22 - 00:18:49:12

You know, a lot of my patients,

00:18:49:12 - 00:18:50:14

one of the biggest things

00:18:50:14 - 00:18:52:01

I actually make my patients come

00:18:52:01 - 00:18:54:00

see me and it's really great, is

00:18:54:00 - 00:18:55:17

my wife's about to have a baby,

00:18:55:17 - 00:18:56:10

and I'm scared

00:18:56:10 - 00:18:57:07

I can't keep up

00:18:57:07 - 00:18:58:14

when they're on the football team

00:18:58:14 - 00:18:59:21

or something like that. Yeah.

00:18:59:21 - 00:19:02:17

And, a lot of my patients, like,

00:19:02:17 - 00:19:04:18

even 3 to 6 months out from surgery,

00:19:04:18 - 00:19:05:12

they're telling me

00:19:05:12 - 00:19:07:00

they're running five K's.

00:19:07:00 - 00:19:09:03

They are keeping up with their kids.

00:19:09:03 - 00:19:11:13

They are so relieved

00:19:11:13 - 00:19:13:16

that their body can function again.

00:19:13:16 - 00:19:15:13

And that, to me, is more

00:19:15:13 - 00:19:17:19

the most important part of the surgery

00:19:17:19 - 00:19:20:03

is that you can live your life again.

00:19:20:03 - 00:19:21:18

That's awesome. Yeah.

00:19:21:18 - 00:19:23:06

And then like back to the body

00:19:23:06 - 00:19:25:12

positivity thing to me,

00:19:25:12 - 00:19:26:13

I don't really care

00:19:26:13 - 00:19:27:23

what my patients look like.

00:19:27:23 - 00:19:29:22

Like if you are,

00:19:30:00 - 00:19:31:22

larger or smaller,

00:19:31:22 - 00:19:32:19

what matters to me

00:19:32:19 - 00:19:35:03

is that you can use your body,

00:19:35:03 - 00:19:36:12

you can function,

00:19:36:12 - 00:19:38:20

you can do the things you want to do.

00:19:38:20 - 00:19:40:03

You can swim,

00:19:40:03 - 00:19:42:01

do the water aerobics, or,

00:19:42:01 - 00:19:43:13

you know, run on a field again,

00:19:43:13 - 00:19:45:02

like all of these things

00:19:45:02 - 00:19:45:16

that that's

00:19:45:16 - 00:19:47:21

what matters to me the most.

00:19:47:21 - 00:19:48:23

And so

00:19:48:23 - 00:19:50:03

I don't really worry

00:19:50:03 - 00:19:52:14

too much about body positivity.

00:19:52:14 - 00:19:54:05

The most important is

00:19:54:05 - 00:19:55:05

I get my life back.

00:19:55:05 - 00:19:56:06

Yeah, 100%.

00:19:56:06 - 00:19:57:12

And look, and maybe this is vain,

00:19:57:12 - 00:19:58:16

I don't know, there's something to it.

00:19:58:16 - 00:20:00:20

And I, again, I'll use my cell

00:20:00:20 - 00:20:02:13

and as an example, like,

00:20:02:13 - 00:20:04:10

you feel better when, you know,

00:20:04:10 - 00:20:05:10

you look better

00:20:05:10 - 00:20:06:01

and you feel better

00:20:06:01 - 00:20:07:09

when you fit into your clothes better.

00:20:07:09 - 00:20:09:11

And when you it's it's really

00:20:09:11 - 00:20:11:04

I mean, that's a huge benefit.

00:20:11:04 - 00:20:12:06

I know it's not like something

00:20:12:06 - 00:20:13:03

you can treat as a doctor.

00:20:13:03 - 00:20:13:11

It's not like,

00:20:13:11 - 00:20:14:18

you know, you're going to look better

00:20:14:18 - 00:20:15:21

in clothes. That doesn't matter.

00:20:15:21 - 00:20:16:21

You know, it's about health

00:20:16:21 - 00:20:17:14

obviously, for you.

00:20:17:14 - 00:20:18:08

But there is something

00:20:18:08 - 00:20:21:08

to be said for waking up and feeling

00:20:21:10 - 00:20:22:22

better about how you look

00:20:22:22 - 00:20:24:11

or how you feel in your own skin.

00:20:24:11 - 00:20:24:23

Yeah,

00:20:24:23 - 00:20:27:07

and the reality of the matter is,

00:20:27:07 - 00:20:29:00

unfortunately, obesity

00:20:29:00 - 00:20:31:00

is a very visible disease.

00:20:31:00 - 00:20:32:19

And so it's very common

00:20:32:19 - 00:20:33:23

actually for me

00:20:33:23 - 00:20:35:04

to hear from my patients.

00:20:35:04 - 00:20:36:14

They've been bullied their whole life

00:20:36:14 - 00:20:37:18

because of the way they look.

00:20:37:18 - 00:20:39:00

They get treated differently

00:20:39:00 - 00:20:40:18

walking out in the real world.

00:20:40:18 - 00:20:42:05

And then one of the things

00:20:42:05 - 00:20:43:13

that actually a lot of patients

00:20:43:13 - 00:20:44:17

work hard to cope with

00:20:44:17 - 00:20:46:01

is it's really hard

00:20:46:01 - 00:20:47:00

to deal with the fact

00:20:47:00 - 00:20:48:07

that the world treats me different

00:20:48:07 - 00:20:49:19

now that I look different.

00:20:49:19 - 00:20:51:05

And that's another reason

00:20:51:05 - 00:20:53:03

why we are so diligent about,

00:20:53:03 - 00:20:53:21

like finding,

00:20:53:21 - 00:20:55:09

like really understanding

00:20:55:09 - 00:20:56:17

the things that,

00:20:56:17 - 00:20:57:17

have plagued our patients

00:20:57:17 - 00:20:58:14

for a long time

00:20:58:14 - 00:20:59:20

so that these are things that we can

00:20:59:20 - 00:21:00:20

watch out for, like,

00:21:00:20 - 00:21:01:17

hey, just so you know,

00:21:01:17 - 00:21:02:20

these are things that we know

00:21:02:20 - 00:21:04:20

may be triggering for our patients

00:21:04:20 - 00:21:06:01

after surgery. Interesting.

00:21:06:01 - 00:21:06:22

And kind of

00:21:06:22 - 00:21:07:23

keep your eye out for stuff.

00:21:07:23 - 00:21:09:22

Yeah, that's cool that you do that.

00:21:09:22 - 00:21:10:20

So those are the benefits.

00:21:10:20 - 00:21:11:19

Let's talk about the risks.

00:21:11:19 - 00:21:12:19

Potential risks?

00:21:12:19 - 00:21:15:00

Yeah, there's the risk...

00:21:15:02 - 00:21:17:20

with surgery, always.

00:21:17:20 - 00:21:19:13

every time we cut the bowel

00:21:19:13 - 00:21:20:07

or the stomach,

00:21:20:07 - 00:21:22:17

there's a risk of leakage. Sure.

00:21:22:17 - 00:21:24:02

Patients with obesity

00:21:24:02 - 00:21:25:13

are at higher risk of things

00:21:25:13 - 00:21:27:02

like blood clots to the lungs

00:21:27:02 - 00:21:29:10

or the legs with surgery.

00:21:29:10 - 00:21:31:04

And there's also,

00:21:31:04 - 00:21:32:11

risk of things

00:21:32:11 - 00:21:35:05

like ulcers in the stomach.

00:21:35:05 - 00:21:36:07

As well as we talked

00:21:36:07 - 00:21:38:08

about the vitamin deficiencies.

00:21:38:08 - 00:21:41:00

And so we do, a lot of things

00:21:41:00 - 00:21:42:01

to kind of minimize

00:21:42:01 - 00:21:44:09

these risk around the time of surgery.

00:21:44:09 - 00:21:46:03

We do very intense diet

00:21:46:03 - 00:21:47:11

changes to minimize

00:21:47:11 - 00:21:48:20

the pressure around where

00:21:48:20 - 00:21:51:03

we've sewn things together.

00:21:51:03 - 00:21:53:15

We also counsel our patients,

00:21:53:15 - 00:21:55:00

about things to look out

00:21:55:00 - 00:21:56:01

for, to call us,

00:21:56:01 - 00:21:57:13

you know, any abdominal pain

00:21:57:13 - 00:21:59:00

after these surgeries?

00:21:59:00 - 00:22:00:06

Not really anticipated.

00:22:00:06 - 00:22:02:07

You need to be calling us. Yeah.

00:22:02:07 - 00:22:03:23

And then,

00:22:04:01 - 00:22:05:10

and just having a very, like,

00:22:05:10 - 00:22:07:03

well oiled machine

00:22:07:03 - 00:22:08:10

with our whole team, like,

00:22:08:10 - 00:22:10:07

we all know what to look out for

00:22:10:07 - 00:22:11:22

so that if the patient reaches out

00:22:11:22 - 00:22:13:08

to any of us with these issues,

00:22:13:08 - 00:22:14:22

we're on it, you know?

00:22:14:22 - 00:22:17:22

And, what I tell all my patients is

00:22:18:00 - 00:22:19:17

I can't prevent complications.

00:22:19:17 - 00:22:21:03

But what I can promise

00:22:21:03 - 00:22:22:12

is that our whole team

00:22:22:12 - 00:22:25:05

is there for you if anything happens.

00:22:25:05 - 00:22:26:16

And we've dealt with a lot of it,

00:22:26:16 - 00:22:27:13

like UCI is

00:22:27:13 - 00:22:29:11

the tertiary referral center

00:22:29:11 - 00:22:31:21

for the Orange County area,

00:22:31:21 - 00:22:33:12

actually the whole Inland Empire.

00:22:33:12 - 00:22:35:03

And so we've seen it all.

00:22:35:03 - 00:22:36:07

So we can definitely deal

00:22:36:07 - 00:22:38:17

with whatever happens.

00:22:38:17 - 00:22:40:14

What is the recovery process

00:22:40:14 - 00:22:42:00

like typically on average.

00:22:42:00 - 00:22:43:06

So how long

00:22:43:06 - 00:22:45:03

how long are we laid up for

00:22:45:03 - 00:22:45:18

in the hospital?

00:22:45:18 - 00:22:46:20

What's that look like after

00:22:46:20 - 00:22:48:00

so with the sleeve,

00:22:48:00 - 00:22:48:22

the banana surgery.

00:22:48:22 - 00:22:49:17

Yeah, that's

00:22:49:17 - 00:22:51:02

what we're going to call it. Now.

00:22:51:02 - 00:22:52:12

The old person is now a banana.

00:22:52:12 - 00:22:53:05

Yeah, yeah.

00:22:53:05 - 00:22:54:07

So with that surgery,

00:22:54:07 - 00:22:55:07

you stay in the hospital

00:22:55:07 - 00:22:57:02

for one overnight, okay. At home.

00:22:57:02 - 00:22:59:02

That's it, that's it.

00:22:59:02 - 00:23:00:15

And then we follow up with you

00:23:00:15 - 00:23:02:13

in 1 to 2 weeks after surgery. Yeah.

00:23:02:13 - 00:23:04:18

And and we're,

00:23:04:18 - 00:23:06:06

I, we usually ask patients

00:23:06:06 - 00:23:07:17

to take about a month off work

00:23:07:17 - 00:23:08:07

so they could really

00:23:08:07 - 00:23:09:21

focus on the diet.

00:23:09:21 - 00:23:10:18

But most people don't

00:23:10:18 - 00:23:11:20

really have a lot of pain

00:23:11:20 - 00:23:13:00

beyond that first week.

00:23:13:00 - 00:23:13:22

No way. Wow.

00:23:13:22 - 00:23:15:13

Yeah. Is the diet when you.

00:23:15:13 - 00:23:15:19

Okay?

00:23:15:19 - 00:23:17:22

So let's say you're home after this.

00:23:17:22 - 00:23:19:08

Is the diet immediately

00:23:19:08 - 00:23:19:19

different, even,

00:23:19:19 - 00:23:21:05

like a liquid diet for a week? Yeah.

00:23:21:05 - 00:23:22:14

So even before surgery,

00:23:22:14 - 00:23:24:10

we do two weeks of a liquid diet.

00:23:24:10 - 00:23:25:13

And that's helping that.

00:23:25:13 - 00:23:26:21

Look at that liver shrink

00:23:26:21 - 00:23:28:09

like we were talking about.

00:23:28:09 - 00:23:29:22

And then that continues for that

00:23:29:22 - 00:23:31:19

first two weeks after surgery.

00:23:31:19 - 00:23:32:22

And then the next two weeks

00:23:32:22 - 00:23:34:21

we do a pureed diet,

00:23:34:21 - 00:23:36:11

and then it's a soft diet.

00:23:36:11 - 00:23:37:03

And then we slowly

00:23:37:03 - 00:23:38:18

go back to regular food

00:23:38:18 - 00:23:40:13

because the stomach is smaller.

00:23:40:13 - 00:23:41:09

You have to eat

00:23:41:09 - 00:23:43:20

smaller meals about six times a day

00:23:43:20 - 00:23:46:03

instead of three square meals. Right.

00:23:46:03 - 00:23:49:00

And then we also very, very strongly

00:23:49:00 - 00:23:49:20

tell patients

00:23:49:20 - 00:23:51:14

to stick to a high protein,

00:23:51:14 - 00:23:53:08

high fiber diet.

00:23:53:08 - 00:23:54:13

The proteins help

00:23:54:13 - 00:23:56:03

you heal from the surgery,

00:23:56:03 - 00:23:58:01

and the fiber and the proteins help

00:23:58:01 - 00:23:59:13

you feel full for longer.

00:23:59:13 - 00:24:00:17

So you're not craving

00:24:00:17 - 00:24:02:04

a lot more foods.

00:24:02:04 - 00:24:03:23

Carbohydrates, especially after

00:24:03:23 - 00:24:05:19

these surgeries, can make patients

00:24:05:19 - 00:24:07:14

not feel as well anymore.

00:24:07:14 - 00:24:08:15

And so we try to stick

00:24:08:15 - 00:24:09:23

to a low carb diet

00:24:09:23 - 00:24:11:04

after the surgery as well.

00:24:11:04 - 00:24:12:19

So that's the banana. Yeah.

00:24:12:19 - 00:24:13:19

What about the egg?

00:24:13:19 - 00:24:15:16

So the only difference with the egg

00:24:15:16 - 00:24:17:06

is you stay one more overnight okay.

00:24:17:06 - 00:24:18:09

Two nights at the hospital.

00:24:18:09 - 00:24:20:00

Nights versus one. Yeah. Yeah.

00:24:20:00 - 00:24:21:14

And then everything else actually

00:24:21:14 - 00:24:24:05

largely feels about the same. Yeah.

00:24:24:05 - 00:24:25:11

And then with the,

00:24:25:11 - 00:24:26:08

with both surgeries,

00:24:26:08 - 00:24:27:21

we want to try to prevent ulcers.

00:24:27:21 - 00:24:29:08

So we tell patients,

00:24:29:08 - 00:24:32:19

you got to quit smoking and alcohol,

00:24:32:21 - 00:24:35:07

and, and even marijuana products

00:24:35:07 - 00:24:37:03

for six months before surgery

00:24:37:03 - 00:24:38:17

and then going into the.

00:24:38:17 - 00:24:40:19

You can never have those things again.

00:24:40:19 - 00:24:42:19

And then if you like to take things

00:24:42:19 - 00:24:45:15

like ibuprofen, Motrin, naproxen,

00:24:45:15 - 00:24:47:02

don't think about stopping that

00:24:47:02 - 00:24:49:07

and switching to maybe a Tylenol

00:24:49:07 - 00:24:51:10

or something else to control the pain.

00:24:51:10 - 00:24:51:18

Also,

00:24:51:18 - 00:24:52:17

knowing that a lot of that

00:24:52:17 - 00:24:54:14

your pain is going to go away

00:24:54:14 - 00:24:56:06

with the weight loss. Yeah.

00:24:56:06 - 00:24:57:18

And so we just got to find

00:24:57:18 - 00:24:58:17

something that works

00:24:58:17 - 00:24:59:11

so that you don't

00:24:59:11 - 00:25:01:18

threaten your surgery,

00:25:01:18 - 00:25:02:02

while you're

00:25:02:02 - 00:25:03:02

just trying to feel better.

00:25:03:02 - 00:25:04:01

That's really important to know.

00:25:04:01 - 00:25:04:15

I didn't know that.

00:25:04:15 - 00:25:06:06

You can't go back to those.

00:25:06:06 - 00:25:06:11

Like,

00:25:06:11 - 00:25:08:07

if someone you know, like to have a

00:25:08:07 - 00:25:10:08

I don't know. Yeah, a nightly drink.

00:25:10:08 - 00:25:10:18

They can't.

00:25:10:18 - 00:25:11:19

They're not doing that.

00:25:11:19 - 00:25:13:16

Yeah. It's it's hard. Yeah.

00:25:13:16 - 00:25:14:08

And you know

00:25:14:08 - 00:25:16:00

we kind of talk about the stresses

00:25:16:00 - 00:25:18:09

that happen after weight loss.

00:25:18:09 - 00:25:19:21

And a lot of times

00:25:19:21 - 00:25:21:02

because food

00:25:21:02 - 00:25:22:09

has been a source of comfort

00:25:22:09 - 00:25:23:21

for a lot of our patients,

00:25:23:21 - 00:25:24:23

when that's taken away

00:25:24:23 - 00:25:26:01

with the surgery,

00:25:26:01 - 00:25:26:18

sometimes people

00:25:26:18 - 00:25:28:13

turn back to their old vices

00:25:28:13 - 00:25:29:08

and then like,

00:25:29:08 - 00:25:30:14

things just snowball

00:25:30:14 - 00:25:31:20

out of control for sure.

00:25:31:20 - 00:25:34:20

So we we stick to a very, very tight,

00:25:34:22 - 00:25:37:02

no no drugs and alcohol situation.

00:25:37:02 - 00:25:40:07

Okay. Yeah.

00:25:40:09 - 00:25:41:18

Does,

00:25:41:18 - 00:25:44:07

does obesity affect fertility.

00:25:44:07 - 00:25:46:00

Yes it does. Yeah.

00:25:46:00 - 00:25:48:23

And so a lot of times,

00:25:48:23 - 00:25:50:00

my patients will tell me,

00:25:50:00 - 00:25:51:01

like I've been trying

00:25:51:01 - 00:25:54:01

to conceive with my, partner

00:25:54:02 - 00:25:55:13

and it's just not happening.

00:25:55:13 - 00:25:57:08

Or the other thing that actually,

00:25:57:08 - 00:25:59:09

I hear about even more commonly

00:25:59:09 - 00:26:00:11

is, women

00:26:00:11 - 00:26:02:17

who come see me and they said,

00:26:02:17 - 00:26:04:07

and they're like, I have obesity.

00:26:04:07 - 00:26:05:00

Let's treat it.

00:26:05:00 - 00:26:08:00

And then I ask them, oh, by the way,

00:26:08:01 - 00:26:10:00

do you have really heavy periods?

00:26:10:00 - 00:26:11:00

And across the board

00:26:11:00 - 00:26:11:15

they're all either

00:26:11:15 - 00:26:13:18

say I really, really heavy periods

00:26:13:18 - 00:26:15:13

or I don't have periods anymore.

00:26:15:13 - 00:26:15:22

And it's

00:26:15:22 - 00:26:16:20

because when

00:26:16:20 - 00:26:18:10

you have an accumulation

00:26:18:10 - 00:26:19:18

of fat in the body,

00:26:19:18 - 00:26:20:12

one of the places

00:26:20:12 - 00:26:23:12

the fat likes to go to is your

00:26:23:12 - 00:26:26:06

pituitary gland in your brain.

00:26:26:06 - 00:26:27:20

And that's where a lot of your,

00:26:27:20 - 00:26:29:18

reproductive hormones are made,

00:26:29:18 - 00:26:31:04

and it gets all out of whack

00:26:31:04 - 00:26:32:18

with obesity.

00:26:32:18 - 00:26:34:11

And so treating the obesity

00:26:34:11 - 00:26:36:14

we do know from earlier

00:26:36:14 - 00:26:38:02

at really studies that are emerging

00:26:38:02 - 00:26:39:03

that we can't

00:26:39:03 - 00:26:39:23

that regulates

00:26:39:23 - 00:26:42:11

your, menses after surgery.

00:26:42:11 - 00:26:44:16

And there's some

00:26:44:18 - 00:26:46:23

some signal in the data that's,

00:26:46:23 - 00:26:48:01

starting to emerge

00:26:48:01 - 00:26:50:21

that a lot of patients can have,

00:26:50:21 - 00:26:53:08

successful pregnancies after surgery.

00:26:53:08 - 00:26:54:17

That being said,

00:26:54:17 - 00:26:56:08

we do not want patients

00:26:56:08 - 00:26:57:00

to get pregnant

00:26:57:00 - 00:26:58:06

within that first year

00:26:58:06 - 00:27:00:08

after bariatric surgery

00:27:00:08 - 00:27:01:17

just because that's the

00:27:01:17 - 00:27:02:03

the year

00:27:02:03 - 00:27:02:13

where you are

00:27:02:13 - 00:27:04:08

going to make the most progress

00:27:04:08 - 00:27:05:06

on your weight loss.

00:27:05:06 - 00:27:06:16

Oh, and so it does pose

00:27:06:16 - 00:27:08:20

a certain risk to the,

00:27:08:20 - 00:27:10:23

the infant as well as the mom. Yeah.

00:27:10:23 - 00:27:12:22

And so we are,

00:27:12:22 - 00:27:15:09

very strict about that as well.

00:27:15:09 - 00:27:16:18

And so if that's something

00:27:16:18 - 00:27:17:07

you're interested

00:27:17:07 - 00:27:19:02

in, you can still see me

00:27:19:02 - 00:27:20:11

and we can make a plan

00:27:20:11 - 00:27:21:15

like let's say,

00:27:21:15 - 00:27:23:08

actually, I understand that.

00:27:23:08 - 00:27:24:00

Let's treat

00:27:24:00 - 00:27:25:21

that fertility piece first.

00:27:25:21 - 00:27:26:06

Let's get

00:27:26:06 - 00:27:26:21

you plugged in

00:27:26:21 - 00:27:28:08

with someone that we know

00:27:28:08 - 00:27:29:23

who can help you with that.

00:27:29:23 - 00:27:30:21

And then when you have that

00:27:30:21 - 00:27:33:08

baby, come back and see me or,

00:27:33:08 - 00:27:34:18

hey, you know what?

00:27:34:18 - 00:27:36:01

You're you're you're young.

00:27:36:01 - 00:27:37:17

You got time ahead of you.

00:27:37:17 - 00:27:39:22

Let's let's do this piece first. Sure.

00:27:39:22 - 00:27:42:22

So that you can kind of have a safer,

00:27:43:02 - 00:27:45:00

pregnancy a year out from them. Yeah.

00:27:45:00 - 00:27:45:13

Right. Yeah.

00:27:45:13 - 00:27:48:02

And so a lot of that is very tailored

00:27:48:02 - 00:27:49:15

and personalized to the patient

00:27:49:15 - 00:27:50:16

that's sitting across from me

00:27:50:16 - 00:27:53:02

in the exam room, and

00:27:53:02 - 00:27:54:06

we make that plan together.

00:27:54:06 - 00:27:55:10

Okay, so you mentioned that

00:27:55:10 - 00:27:57:20

UCI Health and you... what word

00:27:57:20 - 00:27:58:22

did you use? Tertiary?

00:27:58:22 - 00:28:00:12

Tertiary referral center.

00:28:00:12 - 00:28:01:09

That's the word I like.

00:28:01:09 - 00:28:03:20

I like that what sets,

00:28:03:20 - 00:28:05:10

what sets you guys apart?

00:28:05:10 - 00:28:06:10

So, because we are academic

00:28:06:10 - 00:28:08:11

So, because we are academic

00:28:08:11 - 00:28:10:15

University Hospital,

00:28:10:15 - 00:28:13:21

we, take on the responsibility

00:28:13:21 - 00:28:14:17

in our region

00:28:14:17 - 00:28:15:22

of treating patients

00:28:15:22 - 00:28:19:02

where the community or the private,

00:28:19:04 - 00:28:20:15

hospitals to say

00:28:20:15 - 00:28:22:15

this is a too complex of a case.

00:28:22:15 - 00:28:23:02

This patient

00:28:23:02 - 00:28:24:18

maybe suffered some,

00:28:24:18 - 00:28:27:02

complications from another operation.

00:28:27:02 - 00:28:29:06

They need a third set of eyes on this,

00:28:29:06 - 00:28:31:03

and then that's when they turn to us.

00:28:31:03 - 00:28:32:23

And so that's one of the biggest

00:28:32:23 - 00:28:34:17

benefits of our center

00:28:34:17 - 00:28:37:16

is we see a lot of, complex cases.

00:28:37:18 - 00:28:39:16

And and so that means that,

00:28:39:16 - 00:28:41:20

yeah, whatever happens,

00:28:41:20 - 00:28:43:13

we got something to figure out.

00:28:43:13 - 00:28:44:05

Yeah, yeah,

00:28:44:05 - 00:28:45:08

we've got a team to figure out.

00:28:45:08 - 00:28:46:05

Of course.

00:28:46:05 - 00:28:47:03

Is there anything else

00:28:47:03 - 00:28:48:00

that you want people to know?

00:28:48:00 - 00:28:48:22

Like what is your...

00:28:48:22 - 00:28:50:11

If you were to just say,

00:28:50:11 - 00:28:51:11

this is my message

00:28:51:11 - 00:28:52:21

for someone who may be watching

00:28:52:21 - 00:28:53:21

this, hearing this,

00:28:53:21 - 00:28:55:20

who is really struggling

00:28:55:20 - 00:28:56:23

and they don't know what to do.

00:28:56:23 - 00:28:58:07

What is your what are your

00:28:58:07 - 00:28:59:19

what are your words to this person?

00:28:59:19 - 00:29:01:18

Reach them.

00:29:01:20 - 00:29:03:21

It's never too late.

00:29:03:21 - 00:29:04:08

Good.

00:29:04:08 - 00:29:04:20

And don't

00:29:04:20 - 00:29:08:05

let the anxiety of acknowledging

00:29:08:05 - 00:29:09:07

that there is a problem

00:29:09:07 - 00:29:10:07

get in the way of us

00:29:10:07 - 00:29:11:19

solving that problem.

00:29:11:19 - 00:29:14:05

And so if obesity is something that's

00:29:14:05 - 00:29:15:16

really impacting your life,

00:29:15:16 - 00:29:16:11

and that's something

00:29:16:11 - 00:29:18:10

that you think about,

00:29:18:10 - 00:29:19:06

plug your numbers

00:29:19:06 - 00:29:21:01

into that BMI calculator

00:29:21:01 - 00:29:22:09

and make an appointment to see me.

00:29:22:09 - 00:29:22:19

Good.

00:29:22:19 - 00:29:24:05

We can figure it out okay.

00:29:24:05 - 00:29:25:08

You're wonderful. Honest.

00:29:25:08 - 00:29:26:10

And I'm not kidding.

00:29:26:10 - 00:29:27:10

I feel like you should host

00:29:27:10 - 00:29:28:06

a TV show for, like,

00:29:28:06 - 00:29:29:06

kids and explain this,

00:29:29:06 - 00:29:30:07

because the way you put the banana

00:29:30:07 - 00:29:31:17

and I followed everything

00:29:31:17 - 00:29:33:17

you said in a very like,

00:29:33:17 - 00:29:34:19

I don't know, my office,

00:29:34:19 - 00:29:35:12

I have pictures.

00:29:35:12 - 00:29:37:01

You do it even easier to follow.

00:29:37:01 - 00:29:37:21

I love that

00:29:37:21 - 00:29:38:17

you make everything

00:29:38:17 - 00:29:40:08

so like, understandable.

00:29:40:08 - 00:29:41:15

And that's a skill

00:29:41:15 - 00:29:42:05

in and of itself.

00:29:42:05 - 00:29:42:23

So thank you.

00:29:42:23 - 00:29:44:19

No, thank you for having me.

00:29:44:19 - 00:29:45:22

This is super, super fun.

00:29:45:22 - 00:29:47:17

I'm Ryan Manno.

00:29:47:17 - 00:29:48:16

Oh, that's Doctor Wang.

00:29:48:16 - 00:29:50:01

Live Well with UCI Health.

00:29:50:01 - 00:29:51:07

Thanks for watching and listening.