conditions what exactly does that mean often we hear about the mortality rate associated with covet 19 and it is followed by the wording underlying conditions in previous el paso physician programs here on pbs el paso we have focused specifically on that question when it comes to covid19 the answer the dangerous answer to that is two conditions obesity and diabetes those are the two main underlying conditions that we have that really worsen your chances of getting better or surviving of covid19 according to the cdc texas has one of the highest rates of obesity in the nation and additionally hispanics which el paso is about 80 percent of have the highest age-adjusted occurrence of obesity obesity can seriously harm your health and can increase the risk for numerous health conditions such as stroke heart disease diabetes among others and specifically right now in this day and age covid19 if traditional diet and exercise has not helped up to this point then we are looking at bariatric surgery that is this evening's topic during this hour we've got experts addressing concerns about obesity and the medical consequences as well as discussing some steps that you can help you put you on a healthier way of life and again get yourself a little bit more help when fighting other issues that you've got going on in your lifetime this is a live program as you already know so think of some questions of your own you like to call and ask us about the telephone number to call is eight eight one zero we are also streaming live on youtube you can enter pbs el paso public broadcasting system so pbs el paso into that line on youtube this evening's program is underwritten by the hospitals of progress uh progress the hospitals of providence which has a lot of progress we also want to thank the texas tech palo foster school of medicine and their medical students for providing medical students and just help in general to man our phones and get the questions our way and as always the el paso county medical society for bringing this program to you each and every month i'm catherine berg and you're watching the el paso physician thanks again for joining us we're going to talk about uh some of the underlying conditions that we talk about often when you hear about mortality rates with covid19 with us this evening is dr michael lara who is the co-medical director and fellowship-trained bariatric surgeon he's been on the show several times in the past and we welcome you back thank you for being here and we also have becky ariano who is the program manager of the hospitals of programs of providence keep calling it progress the hospital is a providence weight loss center and so becky is going to be the person that kind of talks us through when people are interested and wondering if they qualify etc so with those two disciplines dr lara i know you've been here several times in the past and i know that we again are very specifically looking at covet issues right now uh obesity is a problem it's a major problem and as we were saying earlier that texas is one of the highest rates of obesity in the nations and we have a lot of hispanics here we have a lot of diabetes here in el paso so if i can have you explain to the audience what you do all day every day and maybe bring into covet 19 of how your outlook and your perspective of people with obesity has changed quite a bit during this time so i'm a general surgeon i've been here in el paso over 20 years and so i perform i guess my week is split half of it is general surgery gallbladders hernias colon cancer some breast cancer and then the other half of it is um bariatric surgery and right now i'm only performing the roux and white gastric bypass and the sleeve gastrectomy okay so and both of which we have videos right this evening so tell me again which two we have again we've got the gastric bypass gastric bypass and the sleeve gastrectomy okay and we'll talk about a lot a little bit this evening as well and um and so i guess you were asking me what's changed in this past right well um initially what i was seeing is people when there was a complete shutdown you know both in the hospital and in the clinic setting people were just afraid to come period and it caught us also by surprise you know who knew that it was going to last this long but then we adapted telemedicine zoom seminars etc and as this pandemic has progressed now i'm seeing the patients seeing their relatives hearing the the you know the public announcements and seeing the effect or the possibility of them contracting covet and if they are overweight and get and have hypertension sleep apnea high cholesterol diabetes now they're looking for us right and um so that's the change i've seen initially it was stay home shut down and now them reaching out to us and saying hey i saw what happened to my neighbor i saw what happened to my dad and i don't want to go that route and so i want to get this thing before i catch that and i know that as you well know being obese increases the severity of the illness if you do contract it and also i think that they say triple the likelihood that if you do get it you're going to end up hospitalized exactly and i and i usually at this point would pivot and ask becky some questions or have her to introduce you but i feel like this segway is so vitally important so being obese and i know that there's uh you know being overweight mildly obese obese morbidly obese and we don't need to get into that right now but what is it that is the issue with being obese and not being able to be uh to get out of covid as easily as others let's be specific on what we're talking about we need to realize that obesity is a disease you know if you realize that in and of itself then okay your that's first step and so a lot of obese patients and what people don't realize is that they're walking around like in an inflammatory state yes so if you're walking around an inflammatory state then all that is going to lead to a lot of them on then are walking around with a compromised immune system and so if you get covet then the likelihood of you being able to amount the immune response it is a lot different than if you were not obese and then we know that being obese puts you now at high risk is all those comorbids that we talked about diabetes the sleep apnea hypertension right now your body has to work that much harder against them and so the mortality goes up significantly right um i wanted to give a shout out really quick to our medical student and ryan i apologize i didn't introduce you at the beginning of the show but if you all have some questions that you'd like to call in and ask us with this evening it is a live program and ryan fonseca from the texas tech paulo foster school of medicine who's in his first year and this is his first time here but he will be taking the phone calls and then passing the questions on my way so that is uh i just want to introduce you to ryan really quick on that note becky as the program manager for the weight loss center at hospitals of providence um this is where and i know dr lara talked a little bit about it but there's always that question of when is being overweight too overweight to go on and live to live a healthy life and so what i'd like for you to do is talk about what you do all day every day and you're often i'd imagine the front line of people calling in saying well how does this work how do i know am i just a little overweight am i morbidly obese am i mildly obese talk about that a little bit right so what i do all day every day is exactly that so my responsibility is to help those patients answer their questions to you know know let them know if they are a candidate and the steps they need to take so that we can so dr lara can see him there at the office and um not only that but um get them approved for the surgery which is you know the biggest thing because a lot of people they're scared they think that their insurance doesn't cover right so here's the ugly question and i usually don't like to talk about insurance on this program but this is a big one because this really is a situation and how you qualify for insurance to help out or not um and again i know that you deal with those questions sometimes it's like oh man i'm like five pounds more but does this somebody try to gain five pounds so they can qualify et cetera we're going to get back to um the different because i do want to talk about bmi i want to talk about uh ibw etc but what is it that that people when they telephone the center what is it that they're looking for to give to their insurance companies or what are insurance companies asking for maybe that's the better way of asking questions what are insurance companies asking for so every insurance is different of course so it's a matter of me checking their criteria and reading the clinical policy so they want to make sure that they are a candidate with a bmi of either 35 or greater with a court morbid condition and the morbid conditions that count are high blood pressure sleep apnea or diabetes and then also there's some insurances that you just need a bmi of 40 without having one of those conditions so i do screen the calls i you know ask what or determine figure out what their bmi is so that you know i can check to see if it's going to be a cover benefit with their insurance and so just for the audience bmi i know we have mass on but it's body mass index and you can go to almost any search engine and find out how to calculate that but since we're here on the air right now let's talk to the audience how they can calculate their body mass index and why is that so important when we look at insurances and in just a moment we'll talk about ibw as well so for your bmi girl he'll be ibw guy how does that sound okay so the bmi is really easy to calculate all the all you need is your weight okay and then uh you'll multiply it that's what i do times 703 and then you divide that by inches so if you're five six yeah it's uh 66 inches and then uh times two and that's how you get your bmi okay and if you can't remember that that's good so we can't remember it either again you can go to any search engine put in bmi body mass index and it will give you a little calculator of how right you can figure out what your body mass index is um dr ladda let's talk about now the difference between body mass index and then there is ibw which is um say it again ideal body weight so that includes now the age the sex of the person etc so talk a little bit about that because bmi again you can find that on the web you can get to it there but ibw might be a little bit more difficult to calculate bmi is important because it's what the national institute of health and then they're dictated they came up with this criteria and then the insurance is followed suit and so you have to meet by criteria those bmi numbers that she just went over okay 35 to 40 with a cold morbid or greater than 40 and just in and of itself that'll follow by you but um ideal body weight comes into play when you're when a person is trying to get an idea as to how much weight they'll lose if they get one of these surgeries okay so ideal body weight is those life insurance charts that were in the back of the classroom when we were growing up and we'd look at it at the time we all fell into the category right right now we don't um so that's what those life insurance companies were saying you should wait you're a female you're 5'4 and you should weigh this amount that's your ideal body weight we take what a patient is currently weighing today subtract their ideal body weight and that gives us how much excess weight they're carrying okay and now and once we determine that number how much excess weight they're carrying then i can give them an idea as to what amount of weight they'll lose if they get either a sleeve or bypass and on average i tell them with a sleeve you can lose 60 to 70 percent of your excess weight and with the bypass you can lose maybe another an additional 10 so maybe 80 almost 90 percent of the excess weight and if you achieve that percentage of weight loss with either procedure you're deemed a success because that is comparing that to the national goal weight loss with either one of these surgeries and what i'd like to do is uh gracie if you can kind of queue up i'm going to ask becky a question first but if we can cue up the two videos that we have because we have two videos that essentially shows exactly what's happening inside the body and how uh the weight loss surgery occurs there's two different types as you just talked about and becky what i'd like to do with you uh while we're cueing those videos up is when people call the center is there that automatic expectation of hey i want to have a surgery or is there hey how can i uh be able to lose weight and there's traditional methods and i guess that's what i want to talk about is the exhaustion of traditional methods that usually is when they start coming to the center is that correct and so i'd like to just kind of take it from there yeah that is correct that is when they're that's their last straw once they call the center so of course we just you know they tell us everything that they've been through while they're um successful and then plus unsuccessful diets and all that which is really important for insurances too because once we generate a literal medical necessity we do put their failed attempts which is important as well but yeah that that is um you know where they already they've already tried everything and a lot of the times they know that this is going to be their new life so here here's that again odd question but very important when people are addressing an insurance company and you say they've tried everything what is it that they have to prove that they have tried um and i'm asking only because that's that's the big question on the table right it's like well you know i've tried a couple of diets whatever do they have to prove within a certain number of years you know does it have to be a certain number of doctor visits how is it that they they calculate that and yes and it depends on every insurance exactly what you think you're right so some of them do require for them to do a weight management program where they need to go on a monthly basis to see the dietitian to discuss diet weight and exercise because when you need to prove to them that they're going to be compliant with with what is required of them and then there's some insurances that don't even require that however they require for us to let them know okay what are the diets that they've done in the past and how successful and unsuccessful were they okay so we you know put that in writing for them to to let them know that the patients have failed in the past okay um and here's my next question and i think to myself okay if i'm an insurance company owner right now it would behoove me to help somebody lose weight because then all the co-mobilities that we were talking about then there would be less chances of them having complications with other issues um before we go into because we've got the sleeve video lined up but before we go into that what are some of the other complications that can be alleviated when people are able to lose a significant amount of weight the resolution of the diabetes their sleeping pattern you know they the sleep apnea gets resolved their high blood pressure i mean they it just changes their whole entire life and we're talking about heart issues cardiology all that good stuff and i'd like you to kind of keep that on the tip of your tongue so to speak because we're going to talk a little bit more about that in a moment um and before we go to this video i wanted to and i wanted to bring this out several times during the show um for those of you that are interested in getting the covet vaccine and i hope everyone is interested in getting the covenant back seat uh-huh i got the guys like uh-huh so um there's some new information that i have here for you to register for the vaccine e p for el paso covid vaccine.com so that's a place that you can go to i just received that information from patsy slaughter who's the executive director of the el paso county medical society she sent that over my way today that that is new information and a new website that you can go to you can still always go to el pasostrong.org however the new website that you can go and register to is covid vaccine.com if you're not really great with the computer here's a telephone number that you can call too yes there are going to be some hold time so be expecting that a telephone number nine one five two one two six eight four three i'll repeat that and i'll do it several times throughout the program nine one five two one two six eight four three um and we do have that on the screen thank you very much for putting that up there so the video that we have here and dr uh lara i'd love for you to explain so this is the sleeve that we were talking about earlier of one of the two popular uh procedures that are that are in bariatrics right now so whenever we can cue that up and get that going um i'll have dr lotta just kind of walk through it here we go okay so we're gonna i'm gonna do this with laparoscopy those are trocars or small tubes to which put the camera um a right one is there so there's six for the bypass and six for the sleeve and these are gonna be where we put our instruments through one for my right hand one for my left hand the middle one by the belly button for the camera and then right and left hand on the opposite side of the belly for the assistant this is showing normal flow of liquids in an adult stomach an adult will usually be able to fit about two to three liters of fluid in the stomach and you can see after it close the stomach it goes down the small intestine what i'm going to do is decrease their stomach size by about 80 85 percent and that piece of stomach that is cut off there to the right is removed there's not an end there's not an out there's not a blood supply it's cut and so it needs to come out and then the patient is left with a more narrow longitudinal sleeve shaped stomach and that's going to send signals that they're less hungry they're not going to be able to eat as much and they're going to feel full with smaller portions thus getting achieving early satiety and that all those things are what lead to um weight loss okay and so when you say that rest of the stomach needs to come out that's all done through just literally pulled through the whole it's fascinating to me and i know that you described this at one time uh several years ago but how is it that the rest of the tissue is taken out because those patients come in and they've been empty out nothing by mouth you know for since the midnight the night prior and then we also um suction things out and so it's pretty pliable and um yeah you're right you're just going to take some stretching but um it's once it's still to a very small incision about the size of your thumb right and we're able to get it out and that's how i wanted to bring it up because there's not a whole extra you know cut or incision made it is all done through the the holes that we have there too um we'll cue up the uh gastric bypass but what i'd like to do with becky um is there's a lot of preparation prior to having either one of these surgeries with the patients correct right um so once someone is um qualified by the insurance or again there's a pay as you go uh situation two in case insurance does not cover it so that is also an option let's talk about that really quick cause otherwise i'll forget and the show will be over i'm like um so if insurance doesn't cover it uh that's something if i can have you just address that really quickly okay so if the insurance doesn't cover it um there's some options that we do have available number one we do have a lending company that we can provide the phone number to the patients too so they can possibly get a loan number two we are working on a payment plan option it's not established yet but we are working on that so that's going to help a lot of our patients as well okay um you know i do recommend people also sometimes when they don't have the benefit they're 401k sometimes it's really good and giving out loans and you just paying back to yourself a lot of things can work a lot of things can work so what i'm going to ask now is prior to going to the gastric bypass is when someone is preparing for surgery how long usually do they prepare for is it a couple of weeks is it a couple of months are there certain things that you're asking them to prepare their bodies for because obviously there's going to be different behaviorals behavioral habits that they should adopt once either one of these surgeries are are done so what is it that they usually have to prepare for is it a change in diet is it exercise etc etc so it could be a change in diet depending on dr lara's evaluation and but mostly it's always insurance what they need to prepare for it's either going to be right away or it's going to be two to three months or sometimes six to seven months and then that's about the process and again it depends on the insurance okay so uh let's let's talk about medically yeah the fact that they're gonna there's some interest gonna make them wait till three months of documented attempts at conventional weight loss okay but from my part it just if a patient's bmi is extremely high and i know that inside is going to be a difficult surgery with more complications higher chances of wound infection then i may have them lose some diet some weight beforehand and then in that case they work with the dietitian start working on the caloric intake the carbs and then yes you know something that i was going to mention earlier obese patients on average have decreased pulmonary function and so less reserve and what i always tell them is because they're telling me doctor let's just hope that you're on that day and that everything goes well and get a good night's sleep and i tell them you know what you got to do you got to start walking now because you can't just come from the lazy boy you're operating you're going to struggle and you know so because it's under general anesthesia and so i tell them just start walking get a pedometer get a fitness tracker get a smart watch and just utilizing those has shown that anybody who uses those will increase their walking about a mile an extra mile a day so try to get into 10 000 steps and that'll help and that's exactly what i was looking for and that goes with almost any surgery but specifically here too that you want to get as in good shape as possible prior to the surgery so that the recovery from the surgery is that much better because there will be again with the sleeve and gastric bypass there are going to be different um um issues that they will have afterwards and not issues that's a wrong word right but they're good but there would be different bodies you've always got a wound infection pneumonia a uti a blood clot and all of those are related to a lot of them inactivity not getting up and getting that so that's why doing that minimally invasive minimally invasive is not that painful does that if you don't i tell the patient if you're not having pain you're going to be ringing that cow belt to tell the nurse help me get out of bed and let's walk right as opposed to if you have a lot of pain with the way they used to do this with a big incision what was the nurse going to give you morphine and then that patient now is conked out doesn't want to get out of bed and as soon as they do they're hurting so laparoscopy is what changed this game and that's what ultimately led to you know decreased complications and you know a faster recovery return to work etc right and there is too and i'd love to talk about this there is an absolute commitment that the patient has to have after the surgery um and since we've already looked at the sleeve and i think that's with both of the surgeries what kind of a commitment are you looking for becky and your team looking for what kind of a commitment from the patient um are you looking for going forward after the surgery it's when you ask that because i have a contract it's a carbon copy they keep one and i keep one and i sit there with them and i go over the steps what i need them to commit to okay and number one is follow-up i got i have to see them follow okay if i don't see you i don't know whether or not you're taking the right amount of protein in whether or not you're drinking the right amount of water whether or not you're doing the vitamins the minerals the supplements are losing weight enough not enough too much so they got to commit to that and then and and once they commit to that and they come to see me in the follow-up clinic they're going to get an evaluation by the nurse number the dietitian so there's three people that are going to see them on every follow-up visit and they're willing to do that and how often do they follow up is it is it instrumental like for example is it the first okay at two weeks at three months six months a year a year and a half and they're after every year okay that is forever okay and it's forever and i like that because that matters you know this is the only or this and there's some orthopedic procedures that are um monitored by over govern by governing bodies and ours is um it's called it's mbsa qip and they come around say that slowly okay but we need most programs or if you want to be a legitimate bariatric program you need to obtain credentialing by this government body and they come around every two years and they look at what we're doing and how we're doing it our complication rate our follow-up rate et cetera so that's why i tell the patient you know you have to commit to me because what we do affects everyone that affects you guys yeah affects us it takes the hospital and affects future patients absolutely um we're getting a ton of questions here from the audience ryan thank you you're doing awesome job what i'd like to do before we get into these i would like to show the video now if we could and this will be of the gastric bypass surgery and again dr lada is going to walk us through that as that is shown up there okay so again six small incisions and those are about the size of of your little pinky and um middle one camera the one on the right side of the patient for the assistant left left side patient actually assistant right side for the surgeon come in and in this surgery you're gonna make a cut out using the all your existing stomach to create your new stomach and your new stomach is going to be about the size of the palm of your hand about the size of an egg and they're going to come downstream cut the small bowel and bring it up in a candy cane-like fashion and connect it to that new little stomach and now food will come down get the new little stomach it'll you'll see it right now and give the again the patient the feeling of fullness and decrease hunger and then fluid will go down from there but i think this video oh no there it goes so that's just showing the reconnection downstream to get continuity so there's the blue is the food of the liquid and the green is your bile gastric juices coming from your old stomach and then they meet in that y area and then form the common channel okay so this one if i can go back the sleeve is going to work strictly by restricting the amount right the patient can eat right the bypass works by restriction and then there's also something that we call a component of malabsorption so we the patient will not absorb all the calories they eat because of the fact that we have bypassed a segment of intestine exactly and that is why this is the follow-up part another reason why the bypass is more recommended for patients who are diabetics because that's the other question that people ask which surgery is for me doctor two things type 2 diabetes very aggressive in your family i would i'm going to make you i'm going to or i'm going to lean toward a bypass the other thing is if a patient has very bad reflux heartburn gerd then also more towards bypass because those two diseases are respond better to a bypass and earlier we're talking about el paso and how unique it is nationally the sleeve is now the most common procedure interesting but here okay i find myself performing about 50 50 and the reason is is because the the large hispanic population and the large percentage of those patients affected by diabetes so i'm gonna be really honest with him and i'm gonna tell him hey i'm doing this to make you healthier which is the one that's going to help your diabetes more bypass right and and that's so spot on too and becky i'm going to ask you from here we were talking about what you do prior to these surgeries but now let's talk about part of the follow-up so there's going to be and use the perfect word malabsorption so going forward obviously you talk to the patient about all the stuff they're going to have to do afterwards but when they come in for their follow-ups do you find for the most part that people are again taking on the responsibility on their own what is it that they're going to like you said follow up for the rest of your life the vitamins that they need to take the diet again because if you're not able to absorb everything that you did before what are some of the things that you let these patients know as they're they're finishing their surgeries right for the most part they are pretty responsible they do come you know for their follow-up visits where dr lara monitors everything uh the key also here's the dietitian they yeah they come and they you know they the progression of their diet how everything has changed their protein needs but for the yeah for the most part they do come for their follow-up it is very important for them to come and mostly all of our patients are responsible they will they will come and so what extra vitamins are people needing to take is there extra vitamin d extra calcium what what are some of the the uh normally absorbed vitamins and minerals that are not able to be absorbed as much right so dr lara does um request or prefer a certain type of bariatric vitamins that the patients can absorb okay versus over the counter okay i mean he will work with your whatever is available but it there we do have a list of certain uh recommended vitamins vitamins either b12 they're calcium okay multivitamin and um vitamin d3 okay so just standard across the board for both surgeries those are those are the good feel vitamins too yeah yeah so i tell patients especially if you're female right you need to be taking a multivitamin you need to be taking calcium to help you change the test if you're getting osteoporosis right and so really the only other thing we're throwing into the regimen is a b12 and some d3 and d3 and every noun the b12 can be injection or sublingual okay so on that note that's a whole nother show injection vitamin injections uh and also i know we're the sun city get outside a little bit vitamin d from the sun is beautiful just make sure you there's been no sun the last three days i know in a weird way i kind of enjoy the rainy weather i can't i can't complain at all um i'm going to go here to questions from the audience specifically from the audience i'm just going to throw them out whoever wants to take them but with the current covid19 guidelines in hospitals when can someone receive bariatric surgery great question which is one of the reasons we're doing this program that there are certain floors and hospitals that are very coveted related but others that are reserved for what happens to be going on in people's lives anyway so dr laura i'd love for you to talk about that so i'll repeat it with current covet 19 guidelines in hospitals when can someone receive bariatric surgery currently right now at all hospitals we are they are open to inpatient surgeries which is what this is referred to because it's considered inpatient because the patient is going to be admitted and right like you said there's um in all hospitals there's specific units or portions of the hospital that are all covered and then there's floors and parts of the hospital that are non-covered a lot of hospitals too everyone has to be tested prior to um going through surgery and so if there's a positive test that patient is not going to get to those doors and then um but right now yes um they are allowing inpatient and the sleeve is an overnight state and the bypass is two nights okay sleeve is one night get surgery stay the night the next morning after your um dietary class and you're out of there and the um bypass is two nights three days okay and explain because you brought it up and i love that what is it that the what everybody's looking at after so you've got one night for the sleeve two for a gastric bypass what are you looking for the body to do prior to being able to go home that you walk that your pain is under control and that you're tolerating the diet that's the number one thing the num the you know when i i started doing this what 5 16 17 years ago the complication rates were higher and that the fear back then was um blood clot wound infection etc nowadays my number one reason for a patient readmission is dehydration so it's a struggle with the diet so that is why now i've shifted the pre-op teaching to emphasize how to prevent dehydration and um here at the the hospital's providences we have an iv infusion center and so we can utilize that center for iv fluids to prevent an admission via the er etc right and um to nip this in the bus before because the dehydration is a horrible thing i mean if you're dehydrated it's gonna affect you're gonna get a headache you're gonna be lethargic it's gonna affect your kidneys your pancreas etc so um that is um nowadays like i said it's fairly safe and as long if you get through the early um healing phase without struggling with dehydration you'll be okay so without being in the infusion center is it i mean it seems like it's so simple as just drinking extra water but it's not the case exactly so that's my surgery can trigger nausea right you see gas so when i'm doing a seminar i tell patients yeah you're probably sitting here thinking i love to drink water i can chug a gallon but the problem is nausea so people react to surgery different and and we're actually i'm cutting the stomach right you know and they've undergone general anesthesia so um they may be nauseous for multiple different reasons and if they're nauseated they're not going to want to drink so that's where they just got to power through it and we give them tips you know sometimes put the get the water and stick it in the microwave for a few seconds or try this try that that's where the dietitians come into play and just try to get that in that early process it's it's always it's a transient thing i tell them though there's not permanent i mean i've never had a patient with permanent nausea right right so it's just and then there's a lot of there's a lot of changes going on yeah yeah and then there's a lot of medication regimens that we can try but again most anti-nausea medicines cause people to feel sleepy and so they don't like them you know especially if you have small children or you want to get back to work you can't be popping the zofran finnergan because then you're not going to get out of bed right so it's yeah and getting out of bed is important too is you've got to walk around and do your thing another question here from the audience and this is actually a great question because this is a medical show and they're asking about liposuction versus bariatric surgery so it's good to talk about this because they're two very very very different things on that note i'm just going to let you handle that question any way you want to because when you watch media you see something in the magazine and you have billboards like oh liposuction again that's that's not cosmetic it's cosmetic it's a quick thing there is a role for it in certain people but if you're trying cosmetic cosmetic surgery lipo is not going to help your diabetes higher pressure you're going to look better in front of the mirror you're going to fit into that stress but if you want your whole body to have a positive change your sugars to get better your blood pressure to drop you get off the sleep machine um diabetes help everything with very vascular issues because bariatric surgery is just it's a systemic weight loss and i like that you said that too because we're looking at a medical procedure not that liposuction is that you said it's cosmetic and i and i respect that too but this is also a behavioral change when you're looking at bariatric surgery these are behavioral changes that are implemented before and especially after the surgeries um to help keep that weight off with liposuction it's just gone and then it just comes back but there's not going to be a change because it's if you if the patient buys into this as a behavioral change you've just had a patient who's going to succeed for the rest of their life right but if they don't then they're going to struggle if they buy into the fact that we tell them you got to take in this amount of protein you got to do these vitamins you got to drink the water and and when they start losing the weight and they realize hey i'm no longer on insulin hey i'm no longer on metformin hey i'm no longer on high blood pressure medicine and i don't really need that machine and they're like they realize how positively and how quickly that's impacted them then they're like i'm never going to go back to that right but the patient who constantly fights that and doesn't appreciate the benefits you gotta you're gonna lose them right exactly um another question here from the audience becky i'm gonna throw this one your way uh question is how quickly can i start losing weight so again you're you're one of the you know when you're looking at the clinic and you're head of the clinic it's okay i've had my surgery a week ago um and and maybe this is something that's part of the consultation prior to having surgery so the question is how quickly can i start losing weight on bariatric surgery and what are the risks involved you talked about some of the risks but in general that's the question from the audience right so when they come in for like their two-week appointment it's amazing to see that people have already lost a great amount of weight i mean we're talking 10 pounds to 13. oh my goodness in two weeks so yeah it's almost a pound a day so it's it's very quick okay very quick and what is it that's contributing to that and i know we talked about there's obviously less that fits into the stomach um the absorption the vitamins but is that all you know just in general when someone's asking well that's a pound a day how long does that last so i'm just going to throw out a number i'm going to throw out 400 pounds just because it's an easy number to deal with okay so there's 400 pounds and losing a pound a day you know within a month that's 30 less pounds so two months is at 60 less pounds is there a tapering down of poundage do you know what i'm i know what i'm trying to ask you i'm getting it thank you dr mata thank you very much that brings us back to x's weight loss remember ah yes exactly that's what i told you that's right okay okay so in the first two weeks the patient is probably going to lose about between 10 and 15 10 10 to 20 of their excess weight okay so that's where that's why she said 10 13 14 15 pounds because you're assuming that patient is 100 pounds overweight so ex there you go that's the thing the goal is for the patient to lose about 50 of the excess weight so that 400 pound patient i don't know what their excess weight is but if they're carrying an extra 300 pounds by six months they should or they can lose other 150 pounds of the extra 300 they're carrying and by the year you're hoping they have lost 80 percent and 80 is deemed a success okay so um that's where you that's where you start working with the page time you know what you're a little behind or you're ahead of the game you're doing everything good and then you and the patient gets there in the first year now you patience that's the other thing the patient can lose continue to lose weight for an additional six months to a year but the the it really starts plateauing after that is my big question so uh and the plateauing is natural because you don't want to be zero pounds at the end of the day exactly so when you're talking about ideal body weight so there is mossy metals we're talking about a year um again you've got the quick poundage that that leave and then there is a there's a small plateau and then going forward too and the reason i want to say this is that i want to have realistic expectations that we're talking about because you're going to lose a lot of weight right away and then there's going to be a point too where your body is like okay well now i'm kind of getting used to this we're two months in um you're getting used to the diet you're making sure you have a lot of fluid intake you're getting used to making sure that all the vitamins that you need the minerals that you need are in your body and there and there's that certain that time frame um and just over the different shows that we've had um then it goes to maybe a couple pounds a week from there and then or two or three pounds a week until you hit that year right okay and um and then if and that's where the evaluation by the nurse and the dietitian when they come see us at the clinic is key because then you focus on what is missing if they're not getting if they're not hitting those points what is it that's missing right is it protein is it lack of exercise is it what is it so um that's when we can tweak it and get them back on schedule because you can always get somebody back on track in that first year year and a half right what i tell patients so that's the other thing is why in the front end of this they got to be a hundred percent yes they got to be in it's a one-shot deal you know i can't go i can't see a patient three years after the fact and be like oh you know what let's go back to what you were what you felt like the first two weeks after it doesn't work that way right this is a resetting of the internal we call it the internal thermostat right whatever you want to call it it's the behavioral change and that's something i want to talk about a lot too so the behavioral change you got to be in it to win it and i think you know depending on different studies that you read like with covid it takes about 30 days to create a new habit like 30 days of doing the exact same thing to create that habit and then 60 days it's like quitting smoking it's like everything else um and then when you have that under your belt you start getting to that point i have to ask this because it's a question from the audience and it used to be something we talked about years ago lap band surgery is that just something that's not happening at too all anymore leading to um esophagitis um balloon mega esophagus so um and i used to i was taking i think the last time we were here we talked about it but we did a little bit that i was removing but um now there's very few people out there with this band still in place um i haven't removed the band well i haven't placed a band in years and i haven't had a band maybe in about 18 months okay and so on that same note because we're about at the point where i'm just going to start asking you uh what questions you want to go through with this when a is there a better success rate long term with the sleeve surgery versus the gastric bypass surgery is that something that is even interchangeable with these and i know you said in el paso there is more of a gastric bypass than than other parts of the country which makes perfect sense um but just in general long term long term kind of end up at the same point okay it's in between there that you can see more of a fallout on patients with sleep because if you noticed on the in the picture beyond the distal portion of the stomach they keep their normal anatomy so really like i said before they're only you're only working on the amount they can eat so when you're doing that now the patient still has the freedom to make the wrong choices once everything heals so a donut something high in sugar something something high in carbs is perhaps once they heal the sleep is not going to make him as sick and send them the negative feedback that a bypass will rise okay it's a very small portion with a piece of intestines hooked up to it and if they eat that donut they eat that carb it's gonna plop into the small bowel and that'll send a negative signal to them saying hey you ate something wrong they start sweating they get diaphoretic they get nauseous they're dry heaving so that type of feedback in some patients will keep them on the right track longer right so that that's the only difference now if you have a very disciplined patient who says you know what if i see that i'm losing weight and i'm healthier i just need that little help yeah then yeah the sleeve is going to be fine but if you have a patient that tells you and i appreciate the honesty of the patients because i'm saying like oh no i know my willpower exactly right and i need all the help i can get which one's for me bypass and again it's all about throwing it out there and being honest um i'm going to stop the questions from the audience for just a second i'm going to give some information out and then i'm going to ask you all just to talk about what you wanted to talk about as you were driving over here so in the meantime again uh there is a new covid vaccine website and the telephone number i just want to make sure that we get that out there when the vaccine is available for you to take it this is the el paso county medical society and the el paso physician asking you do take the vaccine it's good for you it's good for everybody around you and it will get everybody back on track but the the address for um the email address not the email address the website address ep just think of el paso ep covid vaccine.com.org but epcovidvacine.com for a telephone number um 91521 it's on your screen but again 915-212-6843 just in case you missed it we are streaming live on youtube you can find pbs el paso in the el paso physician on youtube you can also find the show again on pbs el paso just go to watch and then also at the el paso county medical society website and you'll be able to find it there epcms.com so i know sometimes we go so fast that it just boom all that information gets there so becky on your way over here or since they said hey becky you got to be on tv thursday night and you're like oh my god what do i say so now's the time to say it what is it that you would like to get across to the audience that we either may not have spoken about yet or something you'd like to re-emphasize that we have spoken about okay so um well i think we pretty much talked about everything that's super important but um just to let the audience know just to make them comfortable we are offering zoom appointments so our seminars first of all are via zoom right now and we haven't talked about your seminars this would be a great time to do that right so we are um holding them zoom you just call our office 915-832-2485 and we can register you for those seminars or you can go to the providence website and register there okay and then um what is the providence website it's uh i think it's the hospital's approach the hospitals of providence okay yes and then you choose the bariatric and then you can register there okay and also once we schedule you for that appointment dr lara is seeing the patients via zoom as well just to keep that you know patient safe and for them not to feel overwhelmed having to go out to a clinic or an appointment right excellent uh dr lara uh again i know it's it's we've got maybe seven minutes left or so so whatever it is that you want to get out and seven minutes is actually a really long time i'm sorry you don't have another question i do have another question actually so well i'll do that so it says two doctor lotta remember in the old days i'd show you the piece of paper says two doctor lotta so it says two dr lara i have h b p obesity high cholesterol which other medical clearances from which doctors do i need in order to qualify for the bariatric surgery that's kind of a question for both of you but that is a very specific question from the audience so initially just come see us or log on get on the zoom and just have just know your doctor's names and that's that's very important because a lot of times i'll be like well i saw a cardiologist well what's his name i don't know but if you just come by if you just have all your doctors your dog your pcp's name and whatever specialist you have their name we will generate a letter during the initial encounter with that doctor's name and by now you know all the doctors and specialists in el paso are familiar with bariatric surgery and we just generate that letter give it to the patient via email or fax whatever their choices and then they take it to their specialist and in that letter we specifically state what we need in order for that patient to get cleared for surgery pre-operatively so beforehand don't worry about it just come to us know your medical history and know your specialist names okay so going back to uh coming to us what is the telephone number to the clinic do you have the top here i should have asked you first no it's 9-1-5 832 2485. and when somebody calls that phone number what do they expect they expect for me to answer becky will be answering the phone she's kind of cute okay so becky's going to be answering the phone and what are some of the very common like most common questions straight out of the mouth on a very first phone call how do they start the process okay what and if their insurance covers more importantly so yes you will be guided on how to start the process and the how to start the process is attending a seminar okay okay at the seminar you'll learn everything about the surgeries and then right there we can continue with an appointment at that time we get your insurance information as well and uh we verify make sure that it's a cover benefit if not follow the other options when are your seminars the reason the seminar is so important because you keep hearing about harp on seminar seminars because it's educational right they need to know what's going to be going on get themselves into right that's step number one because you're right they could think i'm going to go to these guys and they're going to do lipo on me but they're going to prescribe some magic diet pill this is a surgical weight loss center so that's why step number one start educating these patients man i would love for you you said diet pill and it's january and it's on every don't try this diet pill diet pill talk about diet pills just in general okay i have no i have nothing against them they work but they're side effects to them you know and that's and then and their work does what is a diet but what's it doing to you physiologically increasing your metabolism in an artificial way yeah so making sometimes you feel like your heart's going to jump out of your chest or you're up in the middle of the night you know okay yeah they scare the heck out of me right i mean you just you hear it and then it's like oh and then you might die you know with all that with all the stuff they put behind there so that's and that's the problem with it the side effects the fact that um the effect of it is transient and then um there it can be expensive or just getting the the renewal you know the new subscription prescription um so that's that's why so the idea is that they're trying to fix okay and the idea is that it's trying to change your metabolism increase your metabolism but again there's only so long it's going to work because again behavior will change and that's what's so your body gets more mm-hmm or your body gets i'm sorry your body gets smart and starts yeah the effects are not as if yeah it's not as effective uh question here from the audience and i want to respect it because we're about to run out of time but is aids a factor in whether or not you can be approved for bariatric surgery again a very specific question from the audience i wanted to honor that is that not a factor at all um so that's it from there so what i'm going to do dr a lot is there anything that you wanted to bring up we have a whopping three minutes that we haven't talked about yet number one get vaccinated yes i got back to you all i had was a sore arm and patients of mine both coming into this and after post-op patients have been vaccinated fine so i'm going to ask you as the doctor on the air so i'm trying to sign myself up but here i am i'm 53 years old i'm healthy i'm trying to sign up but it's like no too bad you're in the last of the last of the last groups how do we get people not to lose their patience in waiting for their turn you know and again i will say ep covid vaccine.com sign yourself up if you can also el paso strong you're in a different situation because you're a doc have you been able to get vaccinated yes okay uh so just talk about the normal person out there that doesn't have any you know the under 65 issues etc yeah i could say just understand that i can see behind the scenes that they're doing everything possible to get these vaccines and um so it's not like somebody's holding something or something on that and the process here in el paso is actually very streamlined right it is good yes but unfortunately they're just not doubling available i have to give a shout out to niko tejada who's on uh i guess before the holidays and he was talking about the the roll out and it was super impressive so el paso is actually doing very very well right compared to the rest of the state houston yeah we've done very well yeah so el paso needs a bit of a pat on the back to our our first line workers on everybody who is disseminating the vaccine it is just the supply that's not getting to us but um we are when i say we el paso is in a better situation than most of the country when it comes to that so hospitals of poverty it's his of providence has been really good about that again uh i want you to go to el paso strong dot epstrom.org or el pasostrong.org sorry that's the one that's spelled out and then also this website which is ep covid vaccine.com yes this is where the patients come in you might have to go back you might have to refresh your screen go back over and over and over again but it matters telephone number is 212-6843 ryan you were a rock star today thank you so much ryan fonseco who is a first-year medical student who's been helping out with getting all of our questions this way i want to say thank you again very much to patsy slaughter at the el paso county medical society and also elsa shapiro because they make sure that i've got the right information before we hit the show on what the most up-to-date information is on what's happening with covid here in el paso and again to check your bmi just go to any search engine bmi and you can calculate your weight at that point i appreciate very much you guys watching the el paso position we've got a program again next week and it's going to be all about eye issues that are affected because of covet 19. so again we're trying to keep on that theme we appreciate you watching this has been the el paso physician i'm catherine berg and good night [Music] [Music] you