Centered on Health 6-13-24 - New procedure, Endoscopic sleeve gastrectomy with Dr. Lanny Gore

Centered on Health 6-13-24 - New procedure, Endoscopic sleeve gastrectomy with Dr. Lanny Gore

Episode Transcript

(00:00):
It's now time for Centered On Helpwith Baptis's Help on use Radio. Wait
forty tell me JS. Now,here's doctor Jeff Tubblin. Well, good
evening, everybody, and welcome totonight's episode of Centered On Health with Baptist
Help here on news Radio eight fortywhas. I'm your host, doctor Jeff

(00:21):
Publin, and we're host. We'regreeted tonight with with our producer mister Jim
Fenn, who is always on standbyto take your calls. Our phone number
is five oh two, five sevenone eight four eighty four. We have
a great guest tonight tonight we havedoctor Lanny Gore. He's been on our
show before and he's here tonight totalk to us about bariatric surgery and some

(00:45):
new procedures within endoscopic sleeve guest stetinyand other procedures. Now, I know
that you're out there, and Iknow that you have a lot of questions
because I do too, So pickup that phone five oh two, five
seven one eight four eight four andget all your all your questions since answered.
Tonight. We do have doctor LannyGore, who is a bariatric surgeon
with Actic Hospitals and in southern Indiana. He attended the University of Louisville for

(01:08):
both his medical school and residency training. As a bariatric surgeon, he specializes
in lap band ruined why Ste've gotstrecthony, robotic surgeries, and he's going
to touch educate us tonight about someadvancements in the field of bariatric Surgerys,
Welcome to tonight's show, Doctor Gore. Thank you very much. I'm happy

(01:29):
to be here. Well, I'mexcited to have you with It's our first
time getting to do this together.And I know that this is such a
huge topic. In fact, Ithink for many, many years, I
think one of the biggest healthcare issuesfacing our community was tobacco, and I
think statistics show that obesity is kindof rivaling tobacco as a health crisis.

(01:52):
What are your thoughts about that inour community. Well, that's true.
Morbid obesity is really up there withcigarettes. Smoking is the biggest cause of
preventable death. It really is atthe root of a lot of different medical
problems. And the great thing aboutmy joh why I enjoyed doing what I
do. We can really focus ona lot of different medical problems when we

(02:15):
focus on mobid obesity. We cansee people get off their blood pressure medicine,
get off their diabetes medicine. They'reable to get a hip replacement that
they weren't allowed to have because theywere overweight, or they're just more mobile
or have a better quality of life. So mobid obesity, I hope does
get more attention and that it deserves. I think I remember, you know,

(02:40):
growing up, and we know fromlong ago, there was a time
when you know, doctors would makerounds with nurses and smoke cigarettes out in
the hospital hallways, right or ora doctor would recommend this particular type of
cigarette because it's safer, And nowwe've had a pretty good progremress and know
that it's smoking's pretty harmful. Ihope that we can focus now on morbid

(03:07):
obesity in that way, and somedaywe will make some similar progress and understand
that you know, the things aboutour diet, or about our sedentary lifestyle,
or about our own biology that makesus at risk of becoming OBEs.
I hope we can put that atthe forefront and prioritize it as something to

(03:30):
focus on in order to make patientshealthier and from a twenty thousand foot view.
What is bariatric surgery? What Iknow, We're going to get into
a little bit of details of theindividual ones, but in general, what
is that approach taking with a patient? Right, Well, we're making changes

(03:52):
to the intestine to affect someone's satietyor their their fullness, the satisfaction with
eating. We are literally making changesin the gut that change hormones in the
body, hormones that has become morepopular now like GLP and other hormones like

(04:16):
grilling and others that really affect ourhunger. And there's a lot of different
ones, different parts of the intestinesto create different ones that act on our
brain that affect how full we are, how satiside we are. Well,
these operations affect those hormones and theyalso literally affect the volume of food that
we can eat. And then howthe food moves through the gut is affected

(04:40):
by very action surgery. So we'retrying to achieve weight loss by surgically manipulating
the intestine in different ways. Andthis can be from a rather less invasive
type of a procedure to a moreinvasive type of procedure. So procedures can
vary from simple doing something to makethe volume of food you can hold in

(05:01):
your stomach smaller to really causing foodto actually skip over parts of the intestine.
And so that's that's the major strategies. But we're finding that these changes
actually do affect other hormones in theintestine and so it can have a compounding
effect. And that's what bariatric surgeryis. That's fantastic. And I know,

(05:29):
I mean, we're all familiar andwe're going to talk a little bit,
hopefully later about some of the medicationsthat are out for weight loss.
So when somebody's sitting there, they'relistening to this show, they're hearing me
talk and they're hearing you talk,and they're wondering, how should I am
I the right person to consider bariatricsurgery? Like who is the right person
who should be thinking about possibly talkingto their primary care or scheduling at confol

(05:53):
basin with somebody right. Well,something that maybe a lot of people don't
realize is that many insurance companies willpay for your very active surgery. Now,
you do have to meet some criteria. So the most common criteria is
to have a body mass index orBMI of forty or greater, and you

(06:15):
can simply google that a BMI calculator, or you may be able to put
one on your iPhone, but youjust simply put in your height, in
your weight, and if your BMIis forty or greater, most insurance companies
will pay for your very active surgery. Now those numbers are going to come
down. Many insurance companies will covera BMI of thirty five or greater if

(06:38):
you have a particular medical problem that'srelated to obesity. So some common types
would be type two diabetes, highblood pressure, sleep at mea liver disease,
some kind of fatty liver disease forexample, and then those numbers may

(06:59):
come down in the future. Someinsurance companies are starting to cover very active
surgery with a BMI of thirty ifyou have liver disease or type two diabetes.
So the American Society of Metabolic andBariactric Surgery, that's the society I
belong to, the professional society thatmakes recommendations regarding bary actual surgery. They

(07:19):
have recommended that these BI numbers betrended down, so for instance, instead
of a BMI forty, we maysee that go down to the thirty five
and from thirty five to thirty andmaybe even sometimes slightly less than thirty in
some situations in the future because andthe reason for these numbers, it's just
statistically, this is where people starthaving health problems related to their weight.

(07:46):
And so when we see that thestatistics are there that show that obesity is
causing these health problems, it makessense to the insurance companies to pay for
these operations because they're going to bepaying less money for your healthcare actually by
paying for your surgery. And whatare you seeing as far as ages?

(08:09):
Is there a minimum age that somebodycould consider this? I mean, I
know we're seeing obesity all in allof our age groups. When is it
appropriate to consider somebody being old enoughto consider something else that Yeah, most
very act surgeons will treat people ateighteen years of age illegal adult age.

(08:30):
There is some like pediatric surgeons whodo do very actual surgery in some teenagers.
So that is something that is beingdone. Because we're actually seeing that
the rate of morbid obesity and adolescentsis actually quadrupled in the last twenty years.
So it is a severe problem.And so because the problem is causing

(08:54):
severe health problems. And we're seeingwe're seeing teenagers with diabetes, We're seeing
people in their twenties with heart disease, significant heart disease. So when when
those kind of severe medical problems areoccurring, that's when we start having,
you know, get more aggressive withhow to how to battle this problem.

(09:16):
As far as the other end,how old, I have operated on more
than a few people in their seventies. Uh, And again we have a
we have a variety of different proceduresthat you know, have varying degrees of
risk and potential complications. And soyou know, it may be that even

(09:37):
though someone may be in their seventies, they can still have very actric surgery
that may still help them lose weight, still help them be more mobile,
and you know, still improve theirhealth at that point. Fantastic. Well,
we are talking with doctor Lanny Goretonight, bariatric surgeon with Doctor's Hospital
in Southern Indiana about buriacive surgery andnew procedures including and then just gotti shlivea

(10:03):
stecsany and some other newer procedures.I'm doctor Jeff Tublin. You are listening
to centert on help with Baptist Healthhere on news radio eight forty wh as
our phone number five oh two fiveseven one, eight four eight four give
us a police want to be partof the conversation, We'll be right back,

(10:31):
Alana. Welcome everyone back to Centeredon Health with Baptist Health here on
news radio eight forty whas. I'myour host, doctor Jeff Publin, and
tonight we are talking to doctor LannyGore, who is a bariatric surgeon with
the Baptist Hospital Group and in SouthernIndiana who's talking to us tonight about bariatric
surgery and new procedures. So welcomeback, doctor Gore. I'm going to

(10:56):
remind our listeners that the phone numberis five oh two five one on a
four four and our producer Mischage intentis on standbyers. So doctor Gore,
I just want I'm going to throwthis out there as a question to kind
of introduce getting into some of thesetechniques that you use. But you know,
there's some shows out there about weightloss procedures and stuff, and a
lot of times patients are asked tolose weight before they can even be expandidate

(11:22):
for surgery. So if somebody's ina real bind and they need buriactic surgery.
How are they supposed to do that? How do they get started?
Okay, So in our program,patients that like are barely meeting the qualifications
the bariactal surgery, Like they're onthe lower end of the of the weight

(11:43):
for a very edue patient, we'renot going to really expect them to lose
a lot of weight. But thereare some patients who have a lot of
weight to lose and it's to thepoint where their weight may make the operation
very difficult. And some patients theirliver can actually be so big it can
make the operation hard to do,and so we have something called a liver

(12:03):
reduction diet. We do just acouple of weeks before surgery, but we
usually are seeing these patients about sixmonths before surgery, and we have them
see our dietitian and we try toset goals for them and meet with them
once a month for about six monthsto try to help them adopt a healthier

(12:24):
lifestyle, healthy diet, moving more. And we understand that the whole reason
they're there is to lose weight,and they've probably tried some things also,
but we still want to make surethat they know the basics about good diet,
about the fact that you know,moving and try to find out is
there some type of exercise they cando, a lot of people can't.
When they reach a high way,it's very difficult for them. So,

(12:46):
yeah, it can be very challenging, and we do have situations where things
get really challenging. But the vastmajority of time, I would say over
ninety percent of the times, probablyover ninety five percent of the time,
we are able to make some progress. We are able to see some weight
loss through these measures. Because althoughyou know, bear after surgery is the

(13:09):
most effective way to help someone loseweight, but even these great operations that
help, they're not going to doeverything. It does require you to make
some changes. You can't just haveone of these operations and then eat whatever
you want and don't worry about takinga walk or anything like that. That's

(13:30):
actually not true. So we knowthat, you know, most of vast
majories, people can make some changesthat's going to positively influence their life.
So then we get some of theweight off that way, and then after
surgery they're able to keep that weightoff and lose a lot more because now
their body is responding to food muchdifferently, and they're getting fuller by just

(13:52):
eating smaller amounts of food, orhormones are different and they're actually less hungry.
I have a lot of patients onme that, well, you know,
I used to be a sweet toothand now I don't like sweet stuff.
I don't like it, or theywant drink because it's too sweet now.
And so we see a lot ofchanges like that, and those changes
can be very useful to someone tryingto lose weight and for somebody who's thinking

(14:18):
about making that step and calling theoffice and setting up appointment, tell us
a little bit about what the Ithink you started to but what's the pre
opt evaluation, like what what doesyour team consists of, what should they
expect in sort of that pre surgeryphase of things, right, So we

(14:39):
often will go into detail about whattheir diet is, like what what do
they eat on most occasions, maybewhat diets they tried in the past,
what efforts they've used in the pastto lose weight. We often will highly
recommend a high protein diet because proteinis really the most satisfying of the three

(15:01):
macronutrients. It also is what protectsis from muscle loss. When we're losing
weight, we do, you know, try to recommend a efforts to basically
put you in a calorie deficit.Now it can vary for different people,
but overall we tend to go witha higher protein diet, also making sure

(15:22):
you're eating lots of fiber. Andwhat that means is you're eating fruits and
vegetables and you're eating a lot offood sources with protein. And so we
try to give people, you know, the examples, even recipes, lists
of food they should choose from thatsort of thing. We try to also

(15:43):
figure out some exercise goals for them. And then most of the time,
when someone is preparing to go throughvery actual surgery, their entrance company requires
a psychiatric evaluation. Now this doesn'tmean that if you've got a psychiatric problem,
you absolutely can't have surgery. Notreally what it's about. It's just
making sure that if you do haveany psychiatric issues, they're being addressed,

(16:04):
either your in therapy or you're havingyou're being treated with medication for it.
And just to make sure those thingsare being addressed. And then patients have
you know, realistic goals and realisticexpectations as well. We're also using this
time to educate them about the surgery, educate them about what to expect after

(16:26):
surgery, and give them support andencouragement because it is difficult to lose weight.
It's very hard and you need support, and so we try to provide
not only the education, but themoral support and encouragement that you need because
it can be very demeaning. Youcan feel kind of down and kind of

(16:48):
bad about yourself when you get inthis situation. You can want to avoid
people and avoid relationships and things likethat. So we want to give people,
you know, not only the educationthat they need, but you know,
the moral encouragement and make them feelkind of part of our team and
part of our program. And Ithink that's very important as you're getting ready

(17:11):
to go into surgery. No,it sounds well constructed. So what are
the most common surgeries that you performfor weight loss and how do you make
the decision of which one is rightfor a particulation? Right, Well,
the most common procedure that we dois called the gastric sleeve or vertical sleeve.
Gastrectomy is another word for it,but anyway, in the gastric sleeve,

(17:36):
it's pretty simple. We're simply makingthe stomach smaller. So by removing
a portion of the stomach, yourstomach goes from like this large pouch to
this narrow tube and you're, youknow, not able to store a lot
of food at once. And it'svery safe, very simple, very low

(17:57):
chance of any complication or side effectswith gasous sleep. And so that's why
it becomes so popular because by removingpart of the stomach, we're also able
to affect a hormone called grillin,which is a hunger hormone, and you
have less amount of this hormone inyour body, and so you're less hungry,
less desire to eat, and thenyour stomach smaller. So when you

(18:19):
do eat, you can eat asmall amount of food, and a lot
of people it's like about a halfa cup to a cup of food at
a time, and you feel full. And now you know, a person
could go ahead and eat again infour to six hours probably, but a
lot of people don't because their hungeris less. And this is what helps

(18:41):
people maintain that low calorie intake sothat they can lose weight. I think
you know the biggest reason why peoplefail at diets. It's difficult to stick
to a diet, it's difficult toresist hunger. That is very hard to
do, and so these operations iswhat makes it necessary. And so gasri

(19:04):
sleet has become the most commonly performedprocedure of the last decade. Then the
next most common procedure that I performis called a ruin why gas bypass.
That's also one of the oldest aryactricoperations. First versions of it were being
done back in the nineteen fifties.With the advent of lathoscopic surgery in the

(19:27):
nineties and early two thousands, itbecame more and more popular because now because
of laparoscopic surgery, patients could toleratethese procedures a lot better. And what
I mean by lathroscopic surgery is we'remaking small incisions in the abdomen and doing
the operation that way, and soby doing that you can recover faster from
an operation. For both of theseoperations, it's just one night in the

(19:49):
hospital and you go home the nextday. That means you're going to recover
faster and get to work faster.But anyway, with gastrick sleeve, as
I said, we're making the stomachsmaller. With gastric bypass, We're not
only making the stomach smaller, We'rethen attaching that smaller stomach to a portion
of the intestine which is normally foundfurther downstream. And so your food literally

(20:11):
skiffs over part of your intestine,and so your intestine is not absorbing that
food as much as it would.It's called malabsorption, and so that adds
to the effects of the weight loss. And so that so gas your bypass
is a little more complicated procedure.There are some complications associated with gas with

(20:34):
bopass that you don't have to worryabout with gashous sleeve. So a gas
your five passed. There is thepossibility of someone getting an ulcer. There's
about a five percent chance of thathappening, and so we really don't want
people that smoke to have a gaswith bypassuse. That would further increase your
risk of getting one of these ulcers. And also if someone is heavily dependent

(20:55):
on steroids or insets, which arethe drugs A lot of people say for
authritics, saying if you're taking thatstuff like on a daily basis, you'd
have to stop that if you werethinking of having a gas you bot pass.
But even though gases have more riskand involved. It can actually be
an operation that could cause a littlemore weight loss than gastrous slye. So
that's why we still have it.That was going to be my question is

(21:19):
does the amount of weight loss intendedto be lost affect the decision of which
of those surgeries you might right?Right? So, one of the reasons
why a gas with botpass may beperformed instead of a gasroous slye is because
we want to achieve greater weight loss. Also, if someone is a severe
diabetic requiring a lot of insulin,and they may be better served by having

(21:41):
a gas with botpass. Now,agasous sleeve can still greatly improve a lot
of people's health, but AGAs youboat pass is probably going to be a
little bit more successful at treating thediabetes. And also, gas throop bob
pass can actually be a good operationfor someone with your reflux. So,

(22:02):
if you're the kind of person thereflux is so bad that even medications don't
really control it that well, youmight want to think about a guess shoos
bypads because it can actually be verygood at reducing that reflex significantly. You
are listening to doctor Lanny Gore,who is a bariatric surgeon with Doctor Hospital

(22:22):
in southern Indiana. He is talkingto us tonight about bariatric surgery and new
procedures on Doctor Jeff Colin, youare listening Who's sent It on Health with
Doctor's Health here on news radio eightforty w h as our phone number five
oh two, five seven one foureighty four. If you'd like to call
in, you'll be right back.Welcome back to sent It on Health with

(23:00):
after Help here on news radio eightforty WHA. I'm your host, doctor
Jeff Covlin, and we're talking tonightto doctor Lanny Gore, a bariactic surgeon,
about bari after surgery, some newprocedures and weight loss. So,
doctor Gore, I'm going to throwout a three parter for you, if
we could give us a global viewof how much weight should somebody expect to

(23:23):
lose with these surgeries over what periodof time? And when is too When
is it too much weight? Okay, well, it's usually a percentage of
your excess weight. And so certainly, you know, if someone weighs,
you know, two hundred and thirtypounds are not going to lose as much
weight as so many weighs five hundredpounds, and so it's often a percentage,

(23:45):
So we can see anywhere from aboutfifty percent to seventy percent of the
excess weight being lost. So,for instance, if you've ever looked up
your ideal weight and you see thatyou know, some some number that you
didn't weigh since you were you know, fourteen or fifteen years old comes up.
You know, if an average sizeda woman looks up her ideal weight

(24:10):
on one of these charts and seeshe should weigh one hundred and forty pounds,
and let's say she's two hundred fortypounds, she's one hundred pounds of
her weight, and then for herparticular case, she's probably going to lose
somewhere around fifty to seventy pounds,for instance, And so that's what we
can see. Now, different proceduresare going to have different results, so
you know, a more aggressive procedureis going to have more weight loss.

(24:34):
So gastric sleeve a very safe procedure, but the weight loss is going to
be closer to that fifty to sixtypercent range, but it could certainly vary.
And then on average gastric bypass you'regoing to see you know, more
of a sixty to seventy plus percentagebeing lost in a lot of those patients.
So certainly your lifestyle, you know, your activity affects that. You

(24:59):
know, if you're a relatively youngpatient who then after surgery also gets very
strict about their diet and also getsthe exercise, they're going to, you
know, have a lot more successcompared to maybe an older patient who has
bad needs and bad back and can'treally do a lot of aggressive exercise.
So the results are going to varybased on that. As far as time,

(25:22):
most of the weight that is lostis going to be lost during that
first year after surgery. It's usuallyaround a year, although that can vary
too by a few months. Anywherefrom eight months to eighteen months is where
we're going to see a lot ofthe weight being lost. And then the

(25:42):
third component, too much weight loss. Well, fortunately I don't see that
very often. It's rare that Isee that. In some of the times
I've seen that as someone who's hada gas with bot pass maybe many years
ago, and they may have actuallydeveloped some kind of other problem, whether

(26:06):
it be a bale instruction or someother complication of the procedure that's affecting their
diet and inability to eat. Sothe weight gets very low, their BMI
actually gets very low, or theiroverall weight their muscle is very low as
well, and so they're starting toeven have maybe things like bottom inefficiencies and
things like that, and so wemay have to intervene in some way to

(26:30):
correct that. But fortunately that's veryrare to see that. I don't think
I've ever seen it with a gashof sleep before, and I've only seen
it maybe a couple of times.Who guest should by pass good to know
well. As a gasthorn enterologist,the word end of stopic always gets my
attention, and so I know there'stalk about an end of stopic sleeve gastrectomy,

(26:55):
and tell us about that procedure.Is that surgery trained or GI doing
that, who's doing it? Andwhat is it? Why is it beneficial?
Yeah? So, first of all, indoscopic means that we're putting a
scope in the mouth and we're gettingdown into the stomach that way, and

(27:15):
so we're not making any incisions onthe abdomens. So both surgeons and gas
genurologists are doing this procedure. Ihave been trained to do the procedure.
I've actually used the device that isused to do this procedure. I've been
using it for years to make smallchanges in people that have already had some
type of Bariact surgery. So ifsomeone in for instance, to someone's catagasic

(27:37):
bypass, I can use the deviceto make part of their stomach just a
little bit smaller, or make anopening in the stomach to the intestine a
little bit smaller that can kickstart theirweight loss again. The same device is
developed by the company called Apollo.This device can be used to make stitches

(28:00):
in the stomach so that we basicallysew the stomach to itself on the inside,
so that the stomach cannot fully expandand it stays in this contracted state.
So, because it kind of resemblesour gastric sleeve operation that we do,
it's called the endoscopic sleeve gastroplasty isthe name for it, or EESG.

(28:22):
So the ESG or endoscopic sleeve isa pretty new procedure, and we're
now offering ancipations at Baptistel Floyd andI'm hoping we can get some people interested
in that now. It is anew procedure, So we don't really have
a lot of long term data onthat, but the new data is promising.

(28:45):
We're seeing a significant weight loss withsleeve gastrectomy, so we've seen anywhere
from twenty five percent to forty percentexcess weight loss within endoscopic sleeve. There
was actually a report just two monthsago in Jamma that actually compared endos gopicsly

(29:07):
with the hot drug osipic or seemaglue tide because a lot of people are
losing weight on that medication. Theendoscopics leave was superior to seema glue tide.
So there may be some patients outthere who may be life the idea
of having a procedure that's less invasive, it doesn't require any incisions. Also,

(29:27):
there may be people out there whoseentrance company does not cover very actually
surgery and may be paying for thisout of pocket. And this is going
to be probably about half the causeof you know, some of these surgeries
that you may also another advantages Youcan go home often the same day after
having this procedure done, and sothose are a lot of the advantage of

(29:51):
it. Now disadvantage, well,it's a new procedure. We don't know
a lot of the long term resultsof this procedure. An obvious concern would
be how long these stitches going toremain in place? Are these stitches going
to break? Are they going tocome loose eventually? So that is I
guess the concern that people are wonderingabout. But they are permanent features.

(30:12):
They're designed to stay there and keepthe stomach closed down. It's just we
simply don't know yet how long they'regoing to last. But the recent study
that looked at it versus sema gluetide was a five year study and at
least at five years, they didshow some consistent weight loss with ESG.

(30:36):
You know, I hope people arelistening and that they heard a couple of
really important things that I heard yousay, which is that these surgeries tend
to be the most effective way tolose weight. And for those that might
be out there and might be onthe fence about having surgery and being opened
up for even laproosophically, I hopethey're hearing this because that it sounds like

(31:00):
there's some real advantages to the lessinvasiveness of this type of approach. But
on the other hand, I knowthat there's some newer techniques that are are
on the more aggressive for more weightloss, but are making improvements in some
of the bypass area. When wecome back, I want to hear a
little bit about about that to kindof balance out that that spectrum for us.

(31:23):
Right, we're going to take takeour final break. Here. You're
listening to Send It on Health withBaptist Health here on news Radio A forty
w h A S. I'm yourhost, Doctor Jeff Pelblin. We're talking
tonight with doctor Landy Gore, buryaticsurgeon. Download the iHeartRadio app to listen
to tonight's so in its entirety.We will be right back after this.

(31:56):
Welcome back to Send It on Healthwith Baptist Help here on news Radio AGE
forty w h AS. I'm yourhost, doctor Jeff Covlin. We're talking
tonight to doctor Lanny Gore about buriaccidsurgery. He's a very active surgery with
Doctor Hospital and in Southern Indiana.The number to download the iHeartRadio app to
re listen to any of this orany of our previous segments and to have

(32:17):
access to all the other features theapp has to offer. So doctor,
right before we went to break.We had talked a little bit about one
of the newer, lesser invasive surgeries. There's some newer, more aggressive surgeries
that are out there. Could youtell us what those are and why do
we want more and more aggressive surgeries? Okay, So a procedure that we're

(32:43):
also now offering is called the SADIEprocedure as SADI are also known as SADIE
S. It stands for single andanthemosis do out to know illeal bypass with
sleeve. Oh, so, thisparticular procedure does involve creating a gas or
sleeve, but then then connecting thelower portion of that sleeve stomach to the

(33:07):
intestine. And so it has someaspects of sleeve, some aspects of gastric
bypass, and it can cause evenmore weight loss than a gas root bypass.
And I guess saying it's more aggressive, Well that's yes and no.
Yes, it can cause more weightloss and potentially lead to you know,

(33:31):
malabsorption in a small percentage of cases, but by and large, there's promising
results with SADIE and it may evenbe safer than gastric bypass because there's no
there's much less risk of the ulcerthat I mentioned earlier that you give a
gastro bypass, and there's a typeof valle obstruction that some people with gastrip

(33:53):
bypass can get called an internal hernia, and we're not seeing that with a
SAD procedure. So it may insome ways have an advantage over gastry fivepaths
in that it actually has some lessrisk in some regarding some of the complications.
So this procedure has been endorsed bythe American Society of Metabolic and Very

(34:15):
Active Surgeon's actually the newest procedure justbasically recommended in the last couple of years
by them, and so I thinkwe're going to see it performed more and
more frequently. And it also maybe a good procedure for someone who's had
a gas with sleeve and is nowlooking to lose more weight, or maybe
they've had some weight regain and wantto try a different procedure because the sleeve

(34:37):
portion of the procedure and them hasalready been done and so it becomes a
shorter procedure and maybe even easier toperform in a gastry fivepas. And so
that's why I think we're going tosee this procedure perform more and more frequently.
Now hopefully insurance companies will start coveringit a little better than they are.

(34:58):
There are some insurance companies that arenot mentioning it as one of the
bari actual procedures that they cover,and so we're having to kind of work
around that and and and so that'skind of our challenge right now is trying
to you know, figure out ifinsurance companies are going to cover this operation
for a lot of people. Butit is, you know, an operation

(35:20):
that is more aggressive than a gasrioussleep, probably on par with with how
complicated it is with gas with bypaths, but it might actually be a little
safer in some ways than a gastriebypass. And so therefore I think we'll
likely see it are performed more.It has an advantage also, I mentioned

(35:44):
affecting the hormones and hunger definitely affectsthose things. It's even more successful at
treating diabetes than gas with bypass,and so it's going to have a lot
of advantages for people that have youknow, severe health problems related to their
obesity diabetes, and it's going tohelp them, you know, basically cure

(36:04):
their diabetes and other medical problems it'srelated to obesity. Well, we will
definitely have to have you back whenthat's being done more and see where we're
getting with that. And now havea little bit of a loaded question for
you, because if you actually knowthe answer to this, you might be
the only one who does. Butyou mentioned these weight loss medications earlier.

(36:24):
How do they fit in this landscapeof bariactive surgery. Who should get the
medicine, who should get surgery?And are they ever used together? What
do we know in twenty twenty fourabout this? Well, I think obesity
treatment needs to be a combination ofall these techniques. I mean, we

(36:45):
want our patients to lose weight howeverthey can. So we may be using
these drugs preoperatively to help people loseweight before surgery. We may be using
it after surgery and those people thatmaybe aren't losing as much weight as they'd
like to, or maybe it's beena few years since their surgery and they're
starting to regain a little bit ofweight, So we're using it in both

(37:06):
situations. We actually are offering apure medical program also right now, so
for people not even interested in surgery, but they want good dietary counseling.
They want the opportunity to be prescribedthese medications. We do offer that,
and so we feel that these drugsare successful. Now statistically they don't achieve

(37:32):
the weight loss that veriactric surgery does, but they certainly are the most successful
weight loss medications that have been designedso far. And I think we're going
to see more drugs and life thesecome out in the future. In fact,
just attended a conference and there aremore types of these medications coming through,

(37:52):
and there's new studies all the timeabout maybe then having other benefits on
even other organism and other types ofhealth problems. That's going to be interesting
to hear more about. But Ithink we want to use these medications along
with surgery, much like cancer istreat you know, we treat cancer with
a combination of surgery and medications,and so it's going to be that type

(38:16):
of approach, and we really needto do everything we can a lifestyle change,
diet, medicine, surgery, whateverit takes to really treat this disease.
That is, you know, nowas big as smoking as are preventable

(38:37):
cause of death. Well I hopethat But again another thing I'd like to
say, these medications are new,we don't know the long term effects.
You know that that's something to keepin mind. These medications are expensive,
it's hard for a lot of patientsto get these medications, and supposedly you
have to be on these medications forthe rest of your life. Stuff medical

(39:00):
you're likely to regain your weight,so that's something to think about. And
there are actually people who don't respondvery well of these medicines, and even
they can't handle the side effects,so it's not going to be it's not
a cure all yet. It's certainlythe best medicines that they've developed, but
it's not a total fix yet.Well, it's great to have all these

(39:22):
options, doctor Gore. We aredefinitely going to have to have you back.
I mean, this is just ahot topic, a lot of information.
Thank you so much for explaining allof this to us. I hope
our listeners got so much out ofthis. That'll do it. For tonight's
segment of cent It on Health withDoctor's Health, I'm your host, doctor
Jeff Publin. I want to thankour guest, doctor Lanny Gore for sharing
all of his expertise with us.I want to thank our producer which is

(39:44):
in then and you the listener,join us every Thursday night for another segment.
Next week we have our famous doctorAngela Sanlin. Our pharmacists to talk
to us about pharmacy issues for nextweek and over the counter medications. We
will talk to you next week anda great end case to them. This

(40:06):
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(40:29):
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