April 1, 2025 • 47 mins
Dr. Mark Moran and Dr. Umal Ssenkubuge, a Ugandan bariatric surgeon, explore the striking contrast between obesity rates in Uganda (2%) versus America (40%) while examining the direct connection between excess weight and back pain.
• Understanding how obesity causes low back pain through anterior pressure on the spine
• The importance of being "an active participant, not a passive recipient" in healthcare
• Setting realistic goals when addressing weight and pain issues
• Why consistency in health habits matters more than intensity
• Cultural differences in obesity causes – from convenience in America to status-seeking in Uganda
• The value of making small, sustainable lifestyle changes rather than seeking quick fixes
• How knowledge about your condition empowers better health decisions
• Why maintaining a relationship with one consistent healthcare provider improves outcomes
Visit onemonthmd.com to learn more about the causes, treatments, and prevention of low back pain.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
Welcome to another episode of Back to Back.
I am Dr Mark Moran and this isour special guest traveling all
around the world, dr UmarSubagubigabi.
Speaker 2 (00:19):
I promise you, we practiced that five times.
Senkubuge, that's what I said.
Speaker 1 (00:22):
Senkubuge, that's what you said, c'est un coup de
bouquet.
Speaker 2 (00:25):
That's what you said.
You're sure we can replay itover there.
Speaker 1 (00:28):
Have you ever seen the show Friends?
Speaker 2 (00:30):
Yeah.
Speaker 1 (00:31):
Okay.
So remember when Joey wastrying to learn French?
Yes, phoebe was like Jem'appelle, and he was like Je
m'appelle Joey and she's like.
Speaker 2 (00:42):
That is such a fun show.
Speaker 1 (00:44):
That is what I feel like when you're trying to teach
me how to say your last name.
Let's try it again.
Ready Dr Umar Senkubuge.
Is that pretty good?
Speaker 2 (00:57):
You did well.
Speaker 1 (00:57):
Do I basically speak Ugandese now?
Is that the word Ugandese?
Ugandese is a word.
Speaker 2 (01:03):
So Uganda has several tribes.
The official language isEnglish.
Thank you very much, but that'sLuganda that you're trying to
speak.
Speaker 1 (01:13):
So I come from, so I'm basically fluent in Uganese
Luganda.
I'm going to call it Uganese.
Speaker 2 (01:17):
Well, they don't make you like us.
This is the edition.
Speaker 1 (01:19):
That's the real thing .
This is the AI.
Speaker 2 (01:25):
This.
That's the real thing.
This is the AI.
Yeah, this is the AI.
Speaker 1 (01:28):
This is a trial version the beta.
Speaker 2 (01:30):
We're not going to get this thing done.
I know Sooner or later.
Speaker 1 (01:32):
We'll get it, we'll get down to business.
Okay, so anyway, dr UmarSengubuge.
Speaker 2 (01:37):
Sengubuge, that's good Proud of you, man, I'm
trying.
Speaker 1 (01:41):
He Proud of you, man, I'm trying.
He's a bariatric surgeon inUganda yes, right, and is
actually blazing trails to tryand establish an EMS system in
Uganda, because you guys don'thave one, right.
So, consequently, he's over inthe United States learning how
to be EMS people and he's goingto take all that knowledge back
(02:03):
to Uganda and make the world abetter place you couldn't have
said it any better.
Speaker 2 (02:07):
That's such an intro I love it.
Speaker 1 (02:09):
Thank you, and I'm going to go ahead and award you
best dressed guest of the night.
Speaker 2 (02:14):
I try, I walk up like this nice, I literally wore
these to bed.
These are my pajamas every daybut honestly, this is my daily
life back home you would nevercatch me back home dressed like
this I avoid buttons, likeeverything I don't do buttons,
it's impressions, firstimpressions.
I'm trying to impress you, man,your first impression is really
good, very good.
Speaker 1 (02:34):
So welcome to the show thank you very much.
Speaker 2 (02:37):
Today, we are going to talk about back pain.
Speaker 1 (02:38):
Of course we're going to talk about obesity your
specialty, not you personally,but what you practice.
Okay, right, and then we'regoing to see if we can teach the
viewers a couple things, andwe're going to have a couple
laughs, and I'm going to befluent in yuganese by the end of
this podcast you're doing greatso far so far I understand
everything I'm saying listen.
Speaker 2 (03:00):
I'm excited to be here.
I'm excited.
I look forward to ourconversation.
Speaker 1 (03:05):
Okay, so for our viewer, please tell us a couple
things about you that we want toknow.
Speaker 2 (03:13):
I am from Uganda.
This is how they make us Sixfeet tall, all lean muscle.
They just just just joking.
My name is Umar.
My friends call me.
Speaker 1 (03:26):
Do you need help pronouncing your last name?
Because I can pronounce it foryou.
Speaker 2 (03:28):
Seng Kubuge.
Speaker 1 (03:29):
Thank you very much Umar Seng, kubuge Seng.
Speaker 2 (03:31):
Kubuge Umar.
I cut into people for a living,take away parts that they do
not like and keep the good partswe give them shape.
What we do is make people livehappier, and Make people live
happier and happier is verysubjective.
So we help people, preventnon-communicable disease
progression.
So if we catch you before youget sick, we'll help you.
(03:51):
We'll walk that journey withyou.
I think helping is ratherambitious to say.
So we will walk that journeywith you to try and be your
wellness partners.
I think the best word iswellness.
Speaker 1 (04:05):
Wellness is a well good word.
That's what my team loves touse.
So, yeah, and so, on a typicalday in Uganda, like how many
surgeries are you doing or howmany patients are you seeing?
Speaker 2 (04:16):
So that's a very other tricky question because
where I come from, if you are adoctor you are pretty much
everything because of the lackof specialties.
That we, so you're a basketballplayer too if that qualifies as
a medical profession, I wouldbe rich are you an artist too?
Speaker 1 (04:36):
are you a rapper?
Can you rap for us right now?
Speaker 2 (04:38):
since you do, I can't say I rap, but I can speak some
words does that count for?
Um, so yeah, we, we, we do, wedo.
We don't do surgeries every day, so we phase out.
There's a process um whichstarts with consultations.
So we look at, you come in justlike a normal day.
So we have days where we onlydo consultations, then we have
(04:58):
days where we do pre-op, andthen we have operational days
where we get to do mostprocedures and then we have
follow-up days.
So it's a pretty busy, I wouldsay, business practice.
It's a pretty busy practicebecause with pop culture in the
western world, people havelearned that listen, this is how
I was born and I don't have toput in so much work.
(05:20):
If I can get the money, I canbasically just go and buy a new
body.
Yeah, so it's, it's.
Speaker 1 (05:27):
It's such an interesting concept um, you guys
don't have very much insuranceover there, right?
Speaker 2 (05:32):
oh no, everything is paid out of pocket everything's
paid out.
Yeah, so insurance coverage inmy country is about 0.5 percent,
so roughly about 0.5 percentwell, let's say 0.5% of 45
million people.
Speaker 1 (05:45):
Okay.
Speaker 2 (05:46):
So that is going to give you, give and take.
If the math is right, you'regoing to be around 250, 300
people that are insuredSomewhere or other.
The rest of it is really paidout of pocket.
Speaker 1 (05:57):
I have a trivia question for you.
Are you ready?
Oh my God, this is a Ugandatrivia question.
Speaker 2 (06:02):
Okay that I can do, because I just recently learned
to play Jeopardy in class.
Speaker 1 (06:05):
Jeopardy.
Okay, I just looked this up tofigure out if I knew anything
about Uganda.
Speaker 2 (06:10):
Let's go.
Speaker 1 (06:11):
You ready?
Okay, what is the obesity ratein Uganda?
Do you know the Jeopardy themesong?
I will not know Take a guess,take a guess, take a guess.
I'd rather you shoot and missthan never shoot at all.
What's the obesity rate inUganda?
Speaker 2 (06:31):
It's going to be very low.
Speaker 1 (06:34):
It is very low.
Speaker 2 (06:34):
It's going to even be less than 2%.
Speaker 1 (06:37):
It's about 2%.
Speaker 2 (06:40):
What is it though?
Speaker 1 (06:40):
It's about 2.3%, 2.3% , yeah.
Speaker 2 (06:44):
Yeah, I know that, because on my undergrad I did my
first research in malnutrition.
And the numbers are shocking.
Speaker 1 (06:51):
We have more malnourished people than we do
have obese people.
I'm sure, I'm sure, okay.
So next question, follow-upquestion.
So far you're doing very well.
You have 100 on your grade.
So far, yeah, on your grade sofar.
Speaker 2 (07:08):
Yeah, okay, that's a fast.
What's the obesity rate inAmerica?
I?
Speaker 1 (07:10):
would go 15%, 15%, it's higher 25?
.
Higher 30?
.
Higher 56%.
It's actually about 40%.
Speaker 2 (07:24):
That makes sense.
Speaker 1 (07:25):
The obesity in america right now is about 40
percent of americans are obese.
That's pretty bad that is.
Speaker 2 (07:32):
That's one of the other shocking things that I've
seen, one of the culture shocksI've seen coming uh, into the
united states.
Of course I've always come inand out, but coming and studying
and living in the united states, one of the most shocking
things I've seen is how out ofshape people are and it's really
the social determinants ofhealth.
They are not as balanced, theyare very.
(07:52):
People are very comfortablehere, for lack of a better word,
and we can't really say comfortthat's a sugarcoating word we
use, but people have anabundancy of everything here.
Whereas the scarcity that wehave back home kind of prevents
us from the extreme, so we bothare living on the extremes.
(08:13):
We need to find middle ground.
Speaker 1 (08:16):
Okay.
Well, I'm going to give you ahint on this next question.
How am I doing Middle ground?
So far, you're doing prettygood.
Speaker 2 (08:22):
Okay.
Speaker 1 (08:23):
Okay, all right.
What is the obesity rate foramerican kids age 6 to 19?
So it was about two percent inuganda, it's about 40 for
american adults.
What's the rate roughly forkids in america between 6 and 19
?
Speaker 2 (08:39):
well, that's gonna be even higher, higher.
Speaker 1 (08:42):
Maybe I'm waiting for your answer 35%.
It's about 20% 20%.
Speaker 2 (08:48):
That's good, there's hope.
That means there's hope.
Speaker 1 (08:52):
The way I see it is, one-fifth of kids are obese 20%
4 out of 10.
Americans adults are obese.
That's bad.
That's not good, because weknow there's all kinds of
problems that come from obesity.
I just read an article theother day about the leading
cause of death in the unitedstates.
Speaker 2 (09:13):
mortality is obesity it's cardiovascular disease
which is secondary to obesitythat's right.
Speaker 1 (09:20):
That's right.
So cardiovascular death isstill the biggest cause and
there's many factors that gointo cardiovascular death or
risk or disease yeah, one ofthem, which is obesity.
So as we start to tie all thesenumbers together between what
your country is like two percentokay.
Versus america, 40 of americansadults, are overweight.
That's a problem that's a bigproblem then you think about the
(09:43):
next generation, the kids 6 to19.
One-fifth of them are obese.
That's a problem because weknow from a medical perspective,
too much or excessive weightputs all kinds of problems on
your musculoskeletal systemright.
So I'm sure you understand that.
Do you ever have talks withyour patients about the
(10:04):
consequences of obesity onmusculoskeletal system or health
as a general?
Speaker 2 (10:08):
Absolutely.
I mean, let me just get back towhat you just said earlier.
I am thinking my head is goingoff right now, and it's going
off in a good sense.
You see how you're looking atobesity, causing the pressure
that brings to the human bodyRight First, pose it right there
, but then there's the pressureit brings to the economy.
That's another conversation.
Speaker 1 (10:28):
Oh yeah.
Speaker 2 (10:29):
And I'm looking at it from the leading cause of death
in America is cardiovasculardiseases which is
non-communicable diseases.
The leading cause of deathswhere I come from is infectious
diseases, and this is what Ikeep telling people that one of
the greatest innovations thatAmerica has given the world is
the love for fast food.
Speaker 1 (10:49):
Because now on the rise.
Speaker 2 (10:51):
If you look on the graph on the rise,
non-communicable diseases,specifically cardiovascular
diseases, are on a rampage risewhere we come from and we are
seeing it basically because nowfast foods have seen that
there's a greater market wherewe come from.
Speaker 1 (11:05):
Now, where I come from, it's very prestigious for
you to eat fast food I rememberyou telling me that for you to
go to a prestigious, like elitepeople, that's, that's what the
rich people go to.
Fast food, where do they go to?
Speaker 2 (11:15):
well, they go to kfc, they go to all these
drive-thrus because ofconvenience in now, whereas in
america we see that as part ofthe biggest contributors because
that's rather to the peoplethat don't have as much.
You know, that's what peoplethat don't have as much you know
to eat, because, man, groceriesin the US are very expensive.
Don't ask me how I know that.
(11:36):
So when you get the two factors, the two baselines, and then
pick up the common factor, itcomes to lifestyle.
Speaker 1 (11:42):
Yeah.
Speaker 2 (11:42):
Isn't that interesting Very interesting,
you're right.
Speaker 1 (11:45):
I mean americans certainly have a tendency to go
towards convenience and theywill pay for convenience right,
they'll pay for people todeliver their food.
They'll pay for delivery topeople to uh have fast food
ready for them.
They'll pay for maid services.
They'll pay for people to walktheir dogs.
They'll pay for all kinds ofthings because it's convenient
and they're choosing to go doother things.
Speaker 2 (12:04):
The abundance you talked about there's there's
just because, if you think aboutit, where I come from, I don't
have money literally to live offlater on to pay someone to walk
my my dogs.
I'm gonna use that, thatexample, to just, you know, put
in some break a sweat, like Ilike to take my, tell my
patients, or I'm not gonna paysomeone to deliver fast food for
(12:25):
me because of the status.
I am going to drive, walk anddrive and then get it.
It's very interesting thedifferent dynamics.
But to come to the question, doI ever talk to my patients
about obesity?
That's basically what we do fora living.
That's actually the core ofwhat our practice is.
It's helping someone move thisjourney, life journey together.
(12:47):
We want to become your wellnesspartners.
So we tell them about what youeat, how you eat it, when you
eat it, what it's going to do toyour body and then how do you
reverse it if it's not too lateto be reversed, if you can't
reverse it, then that's when wecome in to do interventions.
But the first point is that'swhere we spend most of our time.
I mean, like every firstconsultation is about one hour
(13:08):
and that's basically what we aretalking about to get to see
what are your needs, what areyour body needs and what do you
give your body and we realizethat people give their bodies
more than what they need.
Speaker 1 (13:18):
So is this pre-surgery?
This is pre-surgery, oh yeahthis is because if a patient can
do these lifestylemodifications and lose weight,
they don't need surgery.
Speaker 2 (13:27):
That's the hard work, that that is hard.
Speaker 1 (13:28):
Work is very hard.
I deal with the same thingabout if people can exercise or
increase the range of motion oftheir joints or eat healthy or
Try to not be sedentary, theywon't have as much pain.
So it's very hard to get thepatients to buy into what you're
recommending.
Speaker 2 (13:42):
I totally understand that and so again, like we were
talking and saying the othertime, we just relate that to a
car.
If you drive a car and you go200 miles, 200,000 miles,
without servicing your car, themoment that car gets to break
down, servicing is not going tohelp it.
You have to change the engine,or the motor, like you guys call
(14:03):
it.
So that's the same analogy weuse when you're talking to
people about wellness and andthe human body.
Speaker 1 (14:09):
we relate everything to the car, to the everyday life
, and then we have an hoursconversation about that I think
that's a great analogy, becausewe do constantly tell our
patients invest in yourselves,don't wait till the very end to
start taking care of yourself.
You got to invest yourself asyou go through life and prevent
the problems down the future.
So I totally am on board withyou on that, totally agree.
(14:30):
So we're talking about obesity.
What are some things or whatare some causes of obesity?
Speaker 2 (14:38):
um, well, we will.
Let's look at obesity this way.
Let's look at it as one aswhich, what this, what people
know?
But this weight is in my, is inmy family, the lineage, this is
in my genes.
And I argue with them and Itell them listen, I do not care
what caused it or what it is, itcan be reversed.
So there are people that havegenetic predisposition to it.
(14:59):
That's certainly a possiblecause but most, most of it is
muscle people gain.
You know what kind ofmedications you're on long term
medications, mostly steroids aregoing to increase.
Speaker 1 (15:08):
Medications can cause obesity, so there is also
lifestyle.
Speaker 2 (15:11):
The biggest is lifestyle.
This is the biggest problem iswhat we talked about the
convenience and regulating whatyou eat, how you eat it and when
you eat it right.
Speaker 1 (15:19):
So inactivity, inactivity and poor diet and
poor dieting Is causing obesitytoo.
Also, interestingly, poor sleepis a cause of obesity.
Speaker 2 (15:30):
Absolutely.
Speaker 1 (15:30):
Right.
So that's very important forour viewers to know that just
not sleeping enough can causeobesity.
I think it's because if you'reawake You're usually just
wasting time watching TV or notdoing exercise, and then you
start eating Just from habits ofeating and watching TV.
Speaker 2 (15:44):
I'm just guessing on that, and people should also
know that there's a differencebetween obesity on the scale and
overweight, right?
So, yeah, also rest.
If you don't, you know there'sa hormonal play that comes into
your body, of course there's youknow cortical, cortical levels
going up high stress levels andthen people.
When people get pregnant mostlyladies there's there's a lot of
hormones that come into playduring post pregnancy and during
(16:05):
pregnancy.
But again, all that weight isreversible and we can't, we
can't blame weight.
You know people that gainweight as a result of opus
pattern, weight gain to beobesity.
That just doesn't count.
Count right, it's going to be.
Again.
The biggest factor is going tobe diet and inactivity, the
refusal for people to modifythose two perfect.
Speaker 1 (16:25):
So on that, what do you tell your patients?
Is it better to just increaseyour activity and exercise, or
is it better to have a healthierdiet?
Speaker 2 (16:33):
it depends on which level we find them so where on
the journey that we find them.
In most cases, most of them comewhen you're pre-obese, when you
just so, of course there'sgoing to be a scale where
there's no more accepted weight.
Then there's going to be, ofcourse there's underweight.
That doesn't qualify to thisconversation.
There's underweight, there's nomore weight, there's going to
be overweight and then there'sgoing to be obesity.
(16:54):
Right Now, depending on whereon this scale that we find you,
the interventions are going tobe different.
If we find you in obesity,chances are how obese are you?
There are people that are veryobese and so that way, even
lifestyle modifications are notgoing to help you Because, again
, the outside is an indicationof what is going on on the
inside.
(17:15):
So much as we want you to shedoff the weight, there's also
other things that are going onin your body, like
cardiovascular diseases anddiabetes, that we have to take
control over.
So in most cases, medicationscome into place and surgery, but
in most cases, when we get intopeople's life, these are people
that are very cognizant oftheir weight.
Oh, I'm going out of shape.
So those are the people that welove.
I personally love to work withBecause one they are willing,
(17:37):
but because it's a pattern, it'sa behavior.
It is very hard for them tokind of get off that track to
start.
So we walk that journey withthem and tell them hey, let's
give them knowledge first of all.
People will resist knowledgebecause now there's Google,
there's AI, there's what myfriend did, there's all this
kind of I don't saymisinformation.
(17:59):
But what worked for Mark isdefinitely not going to work for
me.
Speaker 1 (18:03):
It's just different information.
Speaker 2 (18:05):
There's different and streamlined information.
Speaker 1 (18:07):
And everything's kind of tailor-made to what you're
searching for and your habitsand everything.
Certainly there's a bunch ofmisinformation along with good
information.
It's hard for the patients toweed through all that type of
stuff.
Speaker 2 (18:17):
So what we do is we, we first of all get their needs
assessment and then we walk thatjourney.
At that point, hey, if youchanged A, B, C, D and you're
authentically and honestlychanging it, because one of the
things that we see in thispractice is lying.
Speaker 1 (18:34):
Patients lie.
Oh, trust me, trust me.
You're saying patients lie.
Speaker 2 (18:37):
Yes, I know, patients lie, which is like I'm like
listen, you're going to pay meanyway, so we could as well save
you some money and time and dothe right thing.
So, yeah, we, we do thatjourney with them and then talk
to them about how do you changethe lifestyle.
That is the most hardest thingto do because it takes a lot of
unlearning and, as you mightknow, one of the hardest things
(18:58):
to do is to unlearn right.
So after the, if they arewilling to unlearn, then in most
cases they don't even progressto the medication and the
surgical point.
But then there are those thatcome into it hey, I have a
wedding in two months.
I am 200 pounds, I need to getback to 100 pounds.
Okay, okay, there's nothingthat is going to work unless
let's go in and do surgery.
(19:18):
And there's us when you come inwith cosmetic surgery, and
that's what you know, mostpeople know us for and you know
the practice that we run for.
But in most cases it's theearlier that I talked about.
Speaker 1 (19:31):
It's very interesting .
You say that patients need tobuy in to what you're saying,
because I have a lot of patientsthat are hesitant or resistant
to my recommendations, and youmentioned that.
Why are they going to pay youif they're not going to listen
to what you say?
I have that conversation manytimes with my patients because
it really comes down to trust.
The patients have got to buy into trusting you 100%.
(19:53):
If they're not going to trustyou to do what's best for them,
then they're going to slow downtheir progress.
So imagine going to a financialadvisor or somebody and say are
you going to do what's best forour money?
You have to trust what they'regoing to do.
It.
Advisor or somebody say are yougoing to do what's best for our
money?
You have to trust what they'regoing to do right.
It's the same thing when you goto a doctor.
You got to trust your doctorsbecause they're trying to do
what's best for you and makesure you find a good doctor,
because unfortunately disclosurethey're a bad doctor there are
(20:14):
doctors that don't have patientsabsolutely first priority.
So you got to find a good doctorand then, if you do trust them
and listen to him or her whenthey say these are our
recommendations, you can get toyour goal as fast if you follow
recommendations, or slower ifyou want to doubt me and not
really jump into the ship andthis is what we tell them.
Speaker 2 (20:34):
We tell them uh, your health is really a partnership
right, and unfortunately, or theunfortunate thing is that you
get to play as a much biggerpart than I do, because you are
living with yourself most of thetime, and this is what I tell
my patients.
I'm like the right way to dofact checking is first hear the
facts that I tell you don't,don't come to me with a, like a
(20:56):
list of you know template thatyou downloaded.
Someone like this is the fact.
Then it ceases being the fact.
Does that make sense?
Sure, like, let me tell youthen, go and check, as opposed
to no, I want you to do this.
Then you are becoming thedoctor, and that's actually one
of the the biggest problems thatwe face in our practice.
Speaker 1 (21:12):
So I'm going to give you a phrase that I want you to
use in uganda okay so it'll bespreading through the world
let's go I can say this is goingviral across the world.
I tell my patients we want youto be an active participant, not
a passive recipient, in yourhealth.
So the patients come in and saywhat are you going to do for me
, doc?
I said nope, I'm not doingsomething for you.
(21:32):
You are going to be activelyinvolved with your health care
and I'm going to help you beactively involved, but you're
not going to be a passiverecipient to what I'm telling
you.
You are going to be activelyparticipating in your health
care and your pain management.
I'm telling you you are goingto be actively participating in
your healthcare and your painmanagement.
So that's what I think weshould tell the patients is be
an active participant not apassive recipient of your
healthcare.
Speaker 2 (21:51):
That is so powerful Now that you think about it.
That is so powerful becauseoften time, it's that passive
passiveness that actually got usinto this place, and this is
what I always tell my patientsas well.
I'm like I wish you came to usearlier.
Speaker 1 (22:05):
Right.
Speaker 2 (22:06):
Yeah, but because you are passive about it, then this
is where we, this is how we go,but hey, we'll be out of
business if they didn't come,which would be great, which
would be great, but you're rightIf people would come in earlier
.
Speaker 1 (22:21):
it's already progressed.
So if someone came to you whenthey're 50 pounds overweight,
you're going to be a lot moresuccessful, and they will too,
instead of if they're 150 poundsoverweight and they can't see
you.
Speaker 2 (22:31):
It's the same thing with me.
Speaker 1 (22:35):
If patients come to me when they're 80 years old and
they've had arthritisprogressing for 50 years before
they come see me, it's going tobe a lot harder to get them
better, versus if they come tome when they're 30 years old and
it's just self-starting.
We say you're fine, we have alot of time to work with this.
Be an active participant inyour health, not a passive
recipient, and you can, insteadof going off this way, you can,
start being a healthier person.
Speaker 2 (22:53):
And that also makes me remember one of the things
that we do tell our patients isthat if you do not act now,
you're going to have to do threetimes the work tomorrow.
Now, you're going to have to dothree times the work tomorrow.
And remember if you do not do itnow, you're going to have to
put an X3 tomorrow, right?
So if we tell you, hey, come tous early, that feeling of pain
that you feel could be somethingmore than what you think, make
(23:17):
a trip to the doctor, it will beway cheaper.
We can catch it earlier,earlier than Google will catch
it, because Google is going tojust worry you and we could
actually have some facts andwork around it.
So I like the idea of being anactive participant, not a
passive recipient.
Speaker 1 (23:35):
There you go, spreading across the world right
now.
Speaker 2 (23:37):
It's gone viral.
I love it.
Speaker 1 (23:39):
So we talked about some causes of obesity and the
effects of that.
Do you know some reasons orsome ways to prevent obesity or
things you can do to preventobesity?
It's very basic stuff.
Speaker 2 (23:50):
I think we just talked about that.
First of all, be an activeparticipant.
Speaker 1 (23:53):
Be an active participant.
Speaker 2 (23:54):
Break a sweat.
Speaker 1 (23:54):
Break a sweat Active lifestyle participant break a
sweat.
Break a sweat, active lifestyle, that's right.
What else eat?
Speaker 2 (24:00):
eat healthy, eat healthy healthy lifestyle is
very important, that is veryimportant and and there's a
there's a clear balance.
I and I'm gonna ask you thisabout your practice there's a
clear balance about so I keeptelling people losing weight is
not much of what you eat.
Again, it's the, the modulation, because if you work out more
than you eat, surprisinglyyou're going to gain weight.
(24:21):
And you know this because whenyou see people go to the gym and
I'll give you a clear exampleSomeone goes to the gym, and
I've seen this with most of ourfemale patients.
They will go to the gym at thestart of the year, mark out on a
calendar new goals, new me,let's go Change diet, da-da da.
And then they start going tothe gym.
Well, they're seated behindtheir desk from 8 to 5, snacking
(24:43):
in between, eating a heavybreakfast and doing all that
kind of things, and then they goto the gym for two hours.
They're on their phone for 30minutes total.
They're lifting weights.
They are doing more burning ofthese calories that they
accumulated during the day thanthey are actually.
And then this is what theirbody thinks oh, we just depleted
this amount of energy levels,because the body stores the
(25:06):
energy that fuel, all the gasthat runs your car.
The body stores it as fat.
So when you deprive your body ofyou know the stores that have
that, either from glucose, andthen you go to the fat, the body
is going to think just likeyour savings account, would I
have depleted this, let me fillit up.
And that's how you gain moreweight, not knowing.
(25:29):
So.
We tell them be very carefulwhen you're active, because then
it's going to increase yourbasal metabolic rate.
You're going to eat morebecause your body demands are
going to be more and in theprocess you're going to eat more
because your body demands aregoing to be more and in the
process you're going to beeating more frequently, and
that's how you end up gettingmore weight.
So it's a very importantbalance that we tell people hey,
be very careful.
And that's why it's importantto go to a professional, because
(25:52):
a professional will tell youwhat you eat and how you eat it
and how you balance that withhow much you can't just stop
eating you can't just stopeating like you can't just keep
eating and you can't just eatonce a day.
Speaker 1 (26:02):
You got to balance it out, like you said yeah, it's a
balance, so I agree with you.
Another interesting thing I sawwas have smaller plates right,
yes, there's actually researchthat shows people that have
smaller plates aren't as obese.
So when you go to a restaurantor you go to a store, you buy
plates at home, use smallerplates and you'll lose weight
(26:23):
just from that mm-hmm the otherthing you said you mentioned
early was get a dog, becausedogs can be walked by you, not a
service right and the more youhave to get up and walk your dog
or go outside, then the moreyou're being active, the more
you're back and again there isthere is there is nothing like
insufficient activity.
Speaker 2 (26:43):
you know the way the heart works is.
You know the heart is one I'msure you know this, but I want
to make sure that our patients,or listeners, know this the
heart is one of, it's actuallythe one of the organs in your
body that do not depend on yourglucose, on your glucose levels,
right?
So the normal primary source offuel that your body that do not
depend on your glucose, on yourglucose levels, right?
So the normal primary source offuel that your body uses.
The heart uses fat, and so Iguess that's where the word
(27:06):
cardio came from, when you tellpeople that, hey, I don't care
if you walk, I don't care if yourun, I don't care if you swim,
we need you to move your body,just move.
Speaker 1 (27:15):
Get into the act of moving.
Speaker 2 (27:16):
And walking a dog or a pet is a very, very good way
to move it.
Speaker 1 (27:19):
And my patients that say I can't start an exercise
routine, I say don't think of itas a routine, Think of it as
one day.
Go 10 steps one day and thenthe next day go 11.
And every day just increase itby one step, or five minutes, or
one minute, but just start theactivity of exercising and be
consistent.
(27:39):
You got to dedicate yourself toit.
I'm not saying do it five hoursa day.
I'm not saying do it every day.
I'm saying start the habit ofgoing for a five minute walk.
It's very simple two or threetimes a week and then, as the
weather gets better, you startgetting more energy because
you'll build endurance, becauseyou actually didn't go for a 10
minute walk right you slowlybuild up on your endurance and
you'll see that it's a smalleffect.
Speaker 2 (27:57):
It's a small habit.
You create a habit, you starton it, stay in it and then,
before you know it, it gets onto you.
Speaker 1 (28:05):
That's very important .
Speaker 2 (28:07):
I love it.
I think one of the things thatwe need to include onto, that is
, one of the things that we tellyou again patients back home,
but also clients here is getinto the habit of consistency
around you.
Wake up at a consistent time, dosomething, get into a routine
kind of a routine and also get adoctor, get like someone that
is going to know you.
(28:28):
This business of hopping fromthis practitioner to this
practitioner, to thispractitioner, that's how you end
up.
You know getting all kinds ofum.
It's one thing if your doctoris not giving you results, or if
your doctor is not giving youresults or if your practitioner
is not giving you results.
It's the other thing if youstick in there and work with
them Because, again, remember,this is a partnership that
you've created.
Speaker 1 (28:46):
It's a relationship.
It's a relationship.
Speaker 2 (28:48):
The longer you're in a relationship, the better off
you feel, the more I know you orthe more I know something about
you, better service the momgoing to understand your body.
You've seen this where peoplethat have worked with one
practitioner for so long haveseemingly better results.
There's actual research Peoplethat have worked with one
practitioner for so long if thepractitioner is doing something
right, they have way betterresults than people that do
(29:10):
medical hoping from one personto another.
So that's also very importantwith information.
Speaker 1 (29:14):
So patients just to reiterate should find a good
doctor and stay with them andtrust them and make them part of
their family, because that'swhat they are.
They're trying to help them outfor global wellness and health
for the rest of their lives,Because things are going to
change.
Speaker 2 (29:26):
I mean, things are going to change in the way you
eat.
Things are going to change inthe way you was 10 years ago.
Speaker 1 (29:39):
I'm sure you were not , gray.
There's only one.
Speaker 2 (29:41):
Mark.
Speaker 1 (29:44):
Mark is constantly evolving.
The only thing constant ischange itself.
The way I understand it correctme if I'm wrong is you work
here via internet in Uganda fromlike 8pm to 4am yes, from about
6.30pm to 4am.
(30:07):
So that's my yeah from 6.30pm.
Speaker 2 (30:09):
That's my resting time.
Speaker 1 (30:10):
6.30pm takes us to San Antonio time almost like 10,
because then we aretransitioning to like 7am back
home so you work from here, 10o'clock here, to four o'clock
here over there through theinternet and then you slack off
and take two hours nap aboutthree three, and then you get up
, and then you go to yourstudent job here to learn ems
(30:34):
from eight to five, okay, andthen you start all over again.
Speaker 2 (30:39):
Yes, so this is the balance part of it.
Let me tell it my way.
Mark is just messing it up.
Speaker 1 (30:48):
Just another story.
Mark's messing up, that's fine.
Speaker 2 (30:53):
So because of the time difference, there's a huge
time difference About anine-hour time difference back
home.
So right now it's coming to 7pm.
Takes some time, so I wouldusually be asleep from like 5 pm
up to like 10.
All right, so five, six, seven,eight, nine, ten, that's about
six so you're hating me rightnow?
Speaker 1 (31:10):
oh no, do you think this is a dream or a nightmare?
Speaker 2 (31:13):
ask me tomorrow, and then I get up at around 10.
Guys are waking up back homeand then we do that.
Speaker 1 (31:21):
So I do that mostly if I have consults the bariatric
surgery.
Speaker 2 (31:25):
Well, smooth, consults, consults, and then I
go to bed at around give andtake, around 3.30, 4, depending
on the day, and then I'll be upat 6.
And then I start my day here,and then that goes on.
So I I read just a good seven,seven, eight hours.
Speaker 1 (31:43):
It's just off the the normal cycle of the everyday
because we learned earlier,sleep is very important.
Oh I sleep.
Speaker 2 (31:50):
I sleep and I rest.
I think so there's a differencebetween sleep and rest.
Speaker 1 (31:54):
Yeah, so really you're a full-time student and
you're a full-time employee.
That's a life baby-timeemployee.
Speaker 2 (31:57):
That's the life baby.
Speaker 1 (31:58):
Why do you slack off so much?
I'm just wondering.
Speaker 2 (32:03):
You make me feel bad.
But the tricky part is I thinkwe talked about that it's a
balance.
Speaker 1 (32:08):
Everything's a balance.
Speaker 2 (32:08):
You've got to learn that.
One of the advantages of beingin America is I'm very aware of
what to eat and what not to eat.
So I would regulate very muchwhat I eat based on how non-very
cheap things are here.
I would regulate how I eat, soI would eat a certain kind of
portion certain times of a weekand then that's how I really
(32:31):
catch up.
Otherwise I would benon-looking the way I used to
look 10 years ago.
Speaker 1 (32:36):
I remember you saying that food was very expensive
here and you had to buy a lotless compared to back home.
You could get a lot more.
That would last you for weeks.
Speaker 2 (32:45):
Yeah, that's one of the privileges I think of being
where I come from.
The very many is that you getto, for example, 80 bucks.
I would fill up an entirefridge full of fresh groceries.
Well, I don't know how much 80bucks would buy me here of fresh
food.
But I'm assuming that wouldn'tbe much.
(33:05):
So see, that's the reason I'mtelling you that I am very aware
of what goes into the body.
Speaker 1 (33:12):
It definitely wouldn't fill a fridge, that's
for sure.
Speaker 2 (33:14):
We certainly know it won't.
Speaker 1 (33:15):
But do you like Chick-fil-A French fries?
I like chicken nuggets oh, Ilike the chicken.
Yeah, oh yeah.
But do you like their frenchfries?
See, I have a problem withfrench people, uh-huh, and that
so I would think you would likethem, because you're frying them
, right no, I love fries.
Speaker 2 (33:37):
I just don't eat my chicken with watermelon.
Speaker 1 (33:39):
Okay, so can we stay for our viewing audience?
Two out of two doctors approveof Chick-fil-A French fries, and
we're talking about obesity.
Speaker 2 (33:47):
We should get an endorsement from Chick-fil-A.
They should watch this.
Speaker 1 (33:51):
We're talking about obesity, talking about French
fries.
Speaker 2 (33:53):
That's okay, Anyway moving on.
Speaker 1 (33:55):
We're talking about obesity and we're going to move
into low back pain.
Speaker 2 (33:59):
Yes, I know a little bit about that.
Now can I take over theinterview.
Speaker 1 (34:03):
Oh.
Speaker 2 (34:04):
Can I just hijack?
Speaker 1 (34:06):
Do we need to switch?
Speaker 2 (34:06):
seats.
Can I just hijack?
Speaker 1 (34:07):
Do you want to switch seats?
Speaker 2 (34:08):
Because I really want to know this is one of the most
complaints that people that areoverweight complain.
Speaker 1 (34:15):
I do consulting in Uganda from about 2am to about
10am every morning.
I feel as now.
Speaker 2 (34:25):
I would want to know from a specialist, from an
expert, what the relationship,what the relationship is with
mostly overweight and obesityand back pain.
What is it that connects thosetwo?
Speaker 1 (34:41):
Okay, that is such a good question.
I'm so happy you asked and itall comes down to I am seriously
asking.
It all comes down to weight andgravity.
Speaker 2 (34:51):
Okay.
Speaker 1 (34:51):
So when someone is overweight, they have more
weight pulling them forward anddown with their lumbar spine.
So instead of the spine beingevilly stacked and distributed
with the weight in the discs,it's pulling an anterior
pressure towards their frontwhich causes uh disc problems,
which then consequently causesfacetogenic problems because
they're putting more stress ontheir back, because they're
(35:13):
basically arching their backmuch more than they should be,
because the weight is pullingthem forward, which then causes
arthritis.
And it helps increase discdegeneration because they're
compressing their spine muchmore than someone who isn't
overweight.
So someone who's overweight iscompressing their spine so they
have disc problems.
They're pulling their spineforward like a hyper-arching
(35:34):
back thing, so it puts morepressure on the back of their
spine, where their joints are,which causes more arthritis or
accelerated degeneration of thejoints I have had.
Speaker 2 (35:43):
I have had patients ask me when you take away this
fat, can you put it more in theback area than they have asked
me to put it in the front area?
Um, that is just a by the way,but no one has asked me.
And and I keep asking couldthat be the reason that we don't
tell our body where to depositmost of the fat?
We don't really get to choose.
(36:04):
It will deposit in the biggestcavity, and what is one of the
biggest cavities that we have?
Speaker 1 (36:09):
Abdomen Usually abdomen for men, or thighs or
breasts for women is where a lotof excess weight goes, and so
it just causes anatomic changeswith gravity and stresses on the
spine, which leads to all theseother back problems so if I'm
overweight, should I?
Speaker 2 (36:26):
is it safe to say that I should walk with a stick,
or do I just shed the weight?
What do you recommend?
Speaker 1 (36:32):
I would say shed the weight, instead of keeping the
weight and walking with a stickmakes sense in the end, you want
to be light and fast, so youwant to maintain your ideal body
weight.
You want to maintain yourjoints by exercising and range
of motion, and to do that youneed to not have excessive
weight.
It's like carrying around two50-pound dumbbells throughout
(36:54):
your life.
It's really really bad on yourjoints, so you can lose a lot of
pain or problems with pain byjust maintaining an ideal body
weight and actually, in fact,obese people are 33% more likely
to develop low back pain thanpeople that aren't obese.
Speaker 2 (37:11):
That's why.
Speaker 1 (37:13):
So just obesity by itself will increase your
chances of developing low backpain.
Speaker 2 (37:18):
So what would you like to tell someone out there
that is obese with back problemsand they're telling now I have
arthritis problems or I havespondylitis problems and now I
can't even exercise.
Speaker 1 (37:33):
Right Deal with that all the time.
San Antonio has their fairshare of obese people with
diabetes and high blood pressure, but that's part of the
situation we're in and we'rehere to help.
So I tell them you have to beactively involved with your
health care.
You can't be a passive recipientof health.
You have to decide to changeyour path.
It's like you can keep on goingin the direction you're going
(37:56):
and things will get worse, oryou can make a conscious effort
to change the direction andchange your habits.
The example I give is if youare on 1604 and you never turn
and you're trying to get toAustin, you're never going to
get to Austin.
Speaker 2 (38:10):
It just doesn't go to Austin.
Speaker 1 (38:12):
So if you want to make a change in your path,
you're going to have to changethe way you're going and take a
road that goes to Austin.
If you get on i-10 trying toget to austin, it's never going
to happen.
So you got to make changes toyour lifestyle and your habits
to get to where you want to go.
And if you do want to be in aposition where you're not having
lifelong pain or increased painor suffering because you can't
(38:34):
do things with your kids, yourgrandkids, because you, because
you're in so much pain or theobesity is causing heart
problems, or you're on all thesemedicines that treat high blood
pressure and diabetes and allthese other things, you're going
to have to choose.
That's not where I want to go.
I want to go over here.
So then make the change,because nothing is going to
change unless you change.
Speaker 2 (38:52):
Well, doc, I have another question for you.
Well, I am on all this kind ofmedication and my doctor told me
I have to regulate the way Iwalk, how much exercises I do,
because of my heart issues.
And now, here you are tellingme that I have to be active, and
on top of that, I have aproblem with my back.
(39:14):
How do I go about thatsituation?
Speaker 1 (39:16):
Well, baby steps.
I talked in the last podcastabout make it first and 10, not
first and 75 do you watchamerican football?
Right, so they get the kickoff.
They start on the 25 yard line,the goal's 75 yards away.
They don't make it first and 75right they take a big goal and
they divide it up into muchsmaller, easily accomplished
goals.
First, intense I sell, just gofirst and 10, so we're gonna
(39:39):
lose five pounds okay okay,let's see if we can do that and
you can get into water and walkin water and exercise water,
because the buoyancy will take alot of stress off your spine
and your joints to enable you tostart building up an endurance
so you can be active again rightand as you start to lose weight
, you can start being moreactive outside the water.
The best pools, if you reallywant to know, are those pools
(40:01):
that have the beach entrances.
Do you know?
Speaker 2 (40:03):
what beach entrances are?
Speaker 1 (40:04):
Yes, so then as you're heavier, you can go
deeper in the water and there'smore buoyancy, and then, as you
lose weight and you gainexercise, you can come to more
shallow and you'll lose thebuoyancy and put more stress on
your joints.
Lose the buoyancy and put morestress on your joints Makes so
much sense.
So then I say, okay, we're herefor you, we're going to help you
, we're not going to do it foryou.
(40:24):
We're going to help you andwe're going to have small goals
to get you to where you want togo.
Speaker 2 (40:26):
You didn't get like this overnight.
You're not going to get out ofthis overnight.
Speaker 1 (40:30):
It took you years to get in this situation.
So we're going to plan to dothis, but we're going to keep on
heading towards your goal.
We're going to put you on I-35to get to Austin instead of I-10
.
That's never going to get youto Austin.
Speaker 2 (40:42):
I really, really, really love.
I love that.
I think that most of theproblems that we see I don't
know about your practice, butmost of the problems that we see
is people have had this problemfor 10, 15 years and then they
come like, hey, I only have twomonths to fix this.
So what advice would you givesomeone that is into the
business of quick solutions,quick fixes?
Speaker 1 (41:05):
I would tell them that we can do as much as you
want to do, but realize theshorter the duration you want to
make changes, the harder it'sgoing to be on you, which will
increase your chance of failure.
So you don't want to get amedical degree in one year.
Speaker 2 (41:19):
Yeah right.
Speaker 1 (41:20):
It's too much work, you will fail.
You're setting yourself up forfailure.
So make it a reasonable goaland that's one of the things you
do when you come up these notmaking it first and 75, but
first and 10, you come up with areasonable goal.
Now I said lose five pounds.
That's a reasonable first goal.
That's not going to be yourgoal the whole time, because you
know next month we're going tosay OK, let's see if we can lose
(41:41):
six pounds.
Or if you can't lose any weight, let's see if we can make you
walk twice as far, ok.
Or if you can't walk, let's saysee if you can get in a pool
and stay walking in a pool fortwice as long.
So there's different ways tomodify their health problems
that they're dealing with,whether it's obesity or pain or
(42:01):
whatever else, to try and getthem to once again be actively
involved with their health care.
But the shorter the duration,then the harder it's going to be
.
One of my other favoritesayings is if you fail to
prepare, prepare to fail.
So if you're going to giveyourself two months to lose 50
pounds and you've had years totry and prevent this, you're
preparing to fail because you'refailing to prepare so when I do
(42:23):
talks or lectures or doanything else.
I'm very adamant about preparingbecause I don't want to look
like an idiot.
I don't know what I'm talkingabout.
So I go and I prepare.
So I'm not failing to prepare,because then I would prepare to
fail.
Speaker 2 (42:35):
So it takes, takes a little dedication it takes a
little motivation.
Speaker 1 (42:39):
It takes us helping them.
We're helping.
We're not doing it for themlike you do with your patient,
but it's a team effort and theydidn't get like this overnight.
It's not going to go awayovernight.
It's going to take a change.
Speaker 2 (42:49):
And part of the team effort that I tell my patients
is find an accountable partner.
Speaker 1 (42:55):
Absolutely.
Speaker 2 (42:56):
Find someone that is going to push you when you're
slacking.
Find someone that is going toget you back on track, because
it's again like you said it's ajourney.
Speaker 1 (43:11):
It's not going to happen over time you better have
someone that is going to pushyou.
Another thing we like to say isknowledge is power, knowledge
is power.
So the more you know aboutsomething, the more you can take
control over that situation.
And a lot of times patientshave fear just because of
ignorance Not to say they'restupid, but because they just
don't have the knowledge of whatgoes on with that situation.
So become an active participantand learn what the causes of
(43:32):
obesity are, what the cure isfor obesity are, or what you can
do to minimize obesity, obesity, or what you can do to lose
weight.
So actively participate.
Another thing is you can go toour website.
It's one month MD dot com andyou can learn about the causes
and treatments and prevention oflow back pain, and you could be
an active participant in yourhealth instead of a passive
recipient.
Speaker 2 (43:52):
Look at that.
Speaker 1 (43:53):
All these things to help patients learn and use that
knowledge as power to controltheir life and control the
problems they're dealing withagain it's, it's.
Speaker 2 (44:01):
It's one of those things that we say your body is
a composition of differentsystems.
Don't treat one in isolation,because here we are thinking
well, obesity is just a more ofa shape looking issue and it's
giving you back issues.
So you have to radiate, put youknow coolant in your radiator,
as much as you have to fuel upor gas up your car.
(44:23):
Check on your tires, make surethat the body is doing when the
electric system is doing good.
Right.
Speaker 1 (44:28):
So I like, I like, I like that yeah, and an example I
give many times, which mypatients are probably sick of
because they've heard it so manytimes, is a patient come in and
they say you did a procedureand I'm still not better and I
say okay, well, think about acar.
If you had a car that didn'tstart and you took it to the
mechanic and they said oh,you're out of gas, you have a
(44:48):
bad alternator and your batterydoesn't work.
But I put gas in your car, yourcar is technically better, you
can now have gas, but you stillhaven't addressed other things
that prevent the car fromstarting.
You still have a dead batteryand you still have a bad
alternator.
So all those things willcontribute to a symptom of the
car isn't starting.
But don't think it's one thingthat needs to be fixed to solve
(45:09):
the car from starting.
It's multiple different things.
So in the situation of dealingwith weight loss or trying to
eat healthy, it's multipledifferent things that are going
to need to be done instead ofjust, oh, I'll take a pill and
I'll lose the weight.
No, you're going to change yourlifestyle, but it takes
multiple things to do to makelifelong changes.
It'll take 60 days to make achange become a habit right, but
then, after the habit is formed, then you continue to do it and
(45:32):
you reap the benefits youcouldn't have said hey, you
heard from the expert.
Speaker 2 (45:37):
He could not have said it Very good.
Speaker 1 (45:41):
Did you have any other questions for me?
Speaker 2 (45:44):
I think I've earned my money's worth.
Speaker 1 (45:46):
Oh yeah, you definitely have.
Are you going back to Ugandatonight, because you're done
with all American doctors?
Who's your favorite Americanpain doctor?
Speaker 2 (45:55):
I wouldn't say Mark, why are?
You taking so long to answerthat question?
I wouldn't say Mark, why areyou taking so long to answer
that question?
I?
Speaker 1 (46:00):
wouldn't say Mark, Like do you know any other
American pain doctors?
Speaker 2 (46:04):
But there's a doctor that does back-to-back, that's
the one.
Speaker 1 (46:08):
Well, I'm going to put on my podcast officially.
You are my favorite Ugandanbariatric surgeon, dr Umar
Slovanovich.
Speaker 2 (46:20):
That's Russian.
Speaker 1 (46:23):
How is it again?
Speaker 2 (46:24):
Yes, this is the only one thing.
You don't have to be Americanabout Sankubuge.
Speaker 1 (46:35):
Sankubuge.
Si, I did say that, okay, thankyou.
Thank you, see.
So Thank you very much Forcoming on.
This has been Very educational.
I hope you guys Learnedsomething.
I certainly learned a lot and Iappreciate your time.
Speaker 2 (46:50):
I did learn so much From you, mark Good.
Speaker 1 (46:52):
Thank you very much For having me, and we wish you
the best of luck With yourschooling and back home, about
starting something that willhelp out All Ugandan people.
Speaker 2 (46:59):
Absolutely, and maybe sometime we can get a pain
management doctor in Uganda.
Speaker 1 (47:05):
I'm thinking about opening a satellite site just on
Fridays.
Speaker 2 (47:10):
Friday is happening time.
Ugandans don't do anything onFriday except for happening.
Speaker 1 (47:14):
Perfect, that's what I'm going.
They just go dancing.
No, that's what I'm going.
That's how we deal with pain.
I'll have a site there.
I won't send any patients, I'lljust go dancing.
I hope you guys learnedsomething.
Please check back for our nextpodcast.
We appreciate all your help.
Always send any emails to us,because we want to answer your
questions too.
Thanks a lot.
Speaker 2 (47:30):
Thank you.
Welcome to another episode of Back to Back.
I am Dr Mark Moran and this isour special guest traveling all
around the world, dr UmarSubagubigabi.
Speaker 2 (00:19):
I promise you, we practiced that five times.
Senkubuge, that's what I said.
Speaker 1 (00:22):
Senkubuge, that's what you said, c'est un coup de
bouquet.
Speaker 2 (00:25):
That's what you said.
You're sure we can replay itover there.
Speaker 1 (00:28):
Have you ever seen the show Friends?
Speaker 2 (00:30):
Yeah.
Speaker 1 (00:31):
Okay.
So remember when Joey wastrying to learn French?
Yes, phoebe was like Jem'appelle, and he was like Je
m'appelle Joey and she's like.
Speaker 2 (00:42):
That is such a fun show.
Speaker 1 (00:44):
That is what I feel like when you're trying to teach
me how to say your last name.
Let's try it again.
Ready Dr Umar Senkubuge.
Is that pretty good?
Speaker 2 (00:57):
You did well.
Speaker 1 (00:57):
Do I basically speak Ugandese now?
Is that the word Ugandese?
Ugandese is a word.
Speaker 2 (01:03):
So Uganda has several tribes.
The official language isEnglish.
Thank you very much, but that'sLuganda that you're trying to
speak.
Speaker 1 (01:13):
So I come from, so I'm basically fluent in Uganese
Luganda.
I'm going to call it Uganese.
Speaker 2 (01:17):
Well, they don't make you like us.
This is the edition.
Speaker 1 (01:19):
That's the real thing .
This is the AI.
Speaker 2 (01:25):
This.
That's the real thing.
This is the AI.
Yeah, this is the AI.
Speaker 1 (01:28):
This is a trial version the beta.
Speaker 2 (01:30):
We're not going to get this thing done.
I know Sooner or later.
Speaker 1 (01:32):
We'll get it, we'll get down to business.
Okay, so anyway, dr UmarSengubuge.
Speaker 2 (01:37):
Sengubuge, that's good Proud of you, man, I'm
trying.
Speaker 1 (01:41):
He Proud of you, man, I'm trying.
He's a bariatric surgeon inUganda yes, right, and is
actually blazing trails to tryand establish an EMS system in
Uganda, because you guys don'thave one, right.
So, consequently, he's over inthe United States learning how
to be EMS people and he's goingto take all that knowledge back
(02:03):
to Uganda and make the world abetter place you couldn't have
said it any better.
Speaker 2 (02:07):
That's such an intro I love it.
Speaker 1 (02:09):
Thank you, and I'm going to go ahead and award you
best dressed guest of the night.
Speaker 2 (02:14):
I try, I walk up like this nice, I literally wore
these to bed.
These are my pajamas every daybut honestly, this is my daily
life back home you would nevercatch me back home dressed like
this I avoid buttons, likeeverything I don't do buttons,
it's impressions, firstimpressions.
I'm trying to impress you, man,your first impression is really
good, very good.
Speaker 1 (02:34):
So welcome to the show thank you very much.
Speaker 2 (02:37):
Today, we are going to talk about back pain.
Speaker 1 (02:38):
Of course we're going to talk about obesity your
specialty, not you personally,but what you practice.
Okay, right, and then we'regoing to see if we can teach the
viewers a couple things, andwe're going to have a couple
laughs, and I'm going to befluent in yuganese by the end of
this podcast you're doing greatso far so far I understand
everything I'm saying listen.
Speaker 2 (03:00):
I'm excited to be here.
I'm excited.
I look forward to ourconversation.
Speaker 1 (03:05):
Okay, so for our viewer, please tell us a couple
things about you that we want toknow.
Speaker 2 (03:13):
I am from Uganda.
This is how they make us Sixfeet tall, all lean muscle.
They just just just joking.
My name is Umar.
My friends call me.
Speaker 1 (03:26):
Do you need help pronouncing your last name?
Because I can pronounce it foryou.
Speaker 2 (03:28):
Seng Kubuge.
Speaker 1 (03:29):
Thank you very much Umar Seng, kubuge Seng.
Speaker 2 (03:31):
Kubuge Umar.
I cut into people for a living,take away parts that they do
not like and keep the good partswe give them shape.
What we do is make people livehappier, and Make people live
happier and happier is verysubjective.
So we help people, preventnon-communicable disease
progression.
So if we catch you before youget sick, we'll help you.
(03:51):
We'll walk that journey withyou.
I think helping is ratherambitious to say.
So we will walk that journeywith you to try and be your
wellness partners.
I think the best word iswellness.
Speaker 1 (04:05):
Wellness is a well good word.
That's what my team loves touse.
So, yeah, and so, on a typicalday in Uganda, like how many
surgeries are you doing or howmany patients are you seeing?
Speaker 2 (04:16):
So that's a very other tricky question because
where I come from, if you are adoctor you are pretty much
everything because of the lackof specialties.
That we, so you're a basketballplayer too if that qualifies as
a medical profession, I wouldbe rich are you an artist too?
Speaker 1 (04:36):
are you a rapper?
Can you rap for us right now?
Speaker 2 (04:38):
since you do, I can't say I rap, but I can speak some
words does that count for?
Um, so yeah, we, we, we do, wedo.
We don't do surgeries every day, so we phase out.
There's a process um whichstarts with consultations.
So we look at, you come in justlike a normal day.
So we have days where we onlydo consultations, then we have
(04:58):
days where we do pre-op, andthen we have operational days
where we get to do mostprocedures and then we have
follow-up days.
So it's a pretty busy, I wouldsay, business practice.
It's a pretty busy practicebecause with pop culture in the
western world, people havelearned that listen, this is how
I was born and I don't have toput in so much work.
(05:20):
If I can get the money, I canbasically just go and buy a new
body.
Yeah, so it's, it's.
Speaker 1 (05:27):
It's such an interesting concept um, you guys
don't have very much insuranceover there, right?
Speaker 2 (05:32):
oh no, everything is paid out of pocket everything's
paid out.
Yeah, so insurance coverage inmy country is about 0.5 percent,
so roughly about 0.5 percentwell, let's say 0.5% of 45
million people.
Speaker 1 (05:45):
Okay.
Speaker 2 (05:46):
So that is going to give you, give and take.
If the math is right, you'regoing to be around 250, 300
people that are insuredSomewhere or other.
The rest of it is really paidout of pocket.
Speaker 1 (05:57):
I have a trivia question for you.
Are you ready?
Oh my God, this is a Ugandatrivia question.
Speaker 2 (06:02):
Okay that I can do, because I just recently learned
to play Jeopardy in class.
Speaker 1 (06:05):
Jeopardy.
Okay, I just looked this up tofigure out if I knew anything
about Uganda.
Speaker 2 (06:10):
Let's go.
Speaker 1 (06:11):
You ready?
Okay, what is the obesity ratein Uganda?
Do you know the Jeopardy themesong?
I will not know Take a guess,take a guess, take a guess.
I'd rather you shoot and missthan never shoot at all.
What's the obesity rate inUganda?
Speaker 2 (06:31):
It's going to be very low.
Speaker 1 (06:34):
It is very low.
Speaker 2 (06:34):
It's going to even be less than 2%.
Speaker 1 (06:37):
It's about 2%.
Speaker 2 (06:40):
What is it though?
Speaker 1 (06:40):
It's about 2.3%, 2.3% , yeah.
Speaker 2 (06:44):
Yeah, I know that, because on my undergrad I did my
first research in malnutrition.
And the numbers are shocking.
Speaker 1 (06:51):
We have more malnourished people than we do
have obese people.
I'm sure, I'm sure, okay.
So next question, follow-upquestion.
So far you're doing very well.
You have 100 on your grade.
So far, yeah, on your grade sofar.
Speaker 2 (07:08):
Yeah, okay, that's a fast.
What's the obesity rate inAmerica?
I?
Speaker 1 (07:10):
would go 15%, 15%, it's higher 25?
.
Higher 30?
.
Higher 56%.
It's actually about 40%.
Speaker 2 (07:24):
That makes sense.
Speaker 1 (07:25):
The obesity in america right now is about 40
percent of americans are obese.
That's pretty bad that is.
Speaker 2 (07:32):
That's one of the other shocking things that I've
seen, one of the culture shocksI've seen coming uh, into the
united states.
Of course I've always come inand out, but coming and studying
and living in the united states, one of the most shocking
things I've seen is how out ofshape people are and it's really
the social determinants ofhealth.
They are not as balanced, theyare very.
(07:52):
People are very comfortablehere, for lack of a better word,
and we can't really say comfortthat's a sugarcoating word we
use, but people have anabundancy of everything here.
Whereas the scarcity that wehave back home kind of prevents
us from the extreme, so we bothare living on the extremes.
(08:13):
We need to find middle ground.
Speaker 1 (08:16):
Okay.
Well, I'm going to give you ahint on this next question.
How am I doing Middle ground?
So far, you're doing prettygood.
Speaker 2 (08:22):
Okay.
Speaker 1 (08:23):
Okay, all right.
What is the obesity rate foramerican kids age 6 to 19?
So it was about two percent inuganda, it's about 40 for
american adults.
What's the rate roughly forkids in america between 6 and 19
?
Speaker 2 (08:39):
well, that's gonna be even higher, higher.
Speaker 1 (08:42):
Maybe I'm waiting for your answer 35%.
It's about 20% 20%.
Speaker 2 (08:48):
That's good, there's hope.
That means there's hope.
Speaker 1 (08:52):
The way I see it is, one-fifth of kids are obese 20%
4 out of 10.
Americans adults are obese.
That's bad.
That's not good, because weknow there's all kinds of
problems that come from obesity.
I just read an article theother day about the leading
cause of death in the unitedstates.
Speaker 2 (09:13):
mortality is obesity it's cardiovascular disease
which is secondary to obesitythat's right.
Speaker 1 (09:20):
That's right.
So cardiovascular death isstill the biggest cause and
there's many factors that gointo cardiovascular death or
risk or disease yeah, one ofthem, which is obesity.
So as we start to tie all thesenumbers together between what
your country is like two percentokay.
Versus america, 40 of americansadults, are overweight.
That's a problem that's a bigproblem then you think about the
(09:43):
next generation, the kids 6 to19.
One-fifth of them are obese.
That's a problem because weknow from a medical perspective,
too much or excessive weightputs all kinds of problems on
your musculoskeletal systemright.
So I'm sure you understand that.
Do you ever have talks withyour patients about the
(10:04):
consequences of obesity onmusculoskeletal system or health
as a general?
Speaker 2 (10:08):
Absolutely.
I mean, let me just get back towhat you just said earlier.
I am thinking my head is goingoff right now, and it's going
off in a good sense.
You see how you're looking atobesity, causing the pressure
that brings to the human bodyRight First, pose it right there
, but then there's the pressureit brings to the economy.
That's another conversation.
Speaker 1 (10:28):
Oh yeah.
Speaker 2 (10:29):
And I'm looking at it from the leading cause of death
in America is cardiovasculardiseases which is
non-communicable diseases.
The leading cause of deathswhere I come from is infectious
diseases, and this is what Ikeep telling people that one of
the greatest innovations thatAmerica has given the world is
the love for fast food.
Speaker 1 (10:49):
Because now on the rise.
Speaker 2 (10:51):
If you look on the graph on the rise,
non-communicable diseases,specifically cardiovascular
diseases, are on a rampage risewhere we come from and we are
seeing it basically because nowfast foods have seen that
there's a greater market wherewe come from.
Speaker 1 (11:05):
Now, where I come from, it's very prestigious for
you to eat fast food I rememberyou telling me that for you to
go to a prestigious, like elitepeople, that's, that's what the
rich people go to.
Fast food, where do they go to?
Speaker 2 (11:15):
well, they go to kfc, they go to all these
drive-thrus because ofconvenience in now, whereas in
america we see that as part ofthe biggest contributors because
that's rather to the peoplethat don't have as much.
You know, that's what peoplethat don't have as much you know
to eat, because, man, groceriesin the US are very expensive.
Don't ask me how I know that.
(11:36):
So when you get the two factors, the two baselines, and then
pick up the common factor, itcomes to lifestyle.
Speaker 1 (11:42):
Yeah.
Speaker 2 (11:42):
Isn't that interesting Very interesting,
you're right.
Speaker 1 (11:45):
I mean americans certainly have a tendency to go
towards convenience and theywill pay for convenience right,
they'll pay for people todeliver their food.
They'll pay for delivery topeople to uh have fast food
ready for them.
They'll pay for maid services.
They'll pay for people to walktheir dogs.
They'll pay for all kinds ofthings because it's convenient
and they're choosing to go doother things.
Speaker 2 (12:04):
The abundance you talked about there's there's
just because, if you think aboutit, where I come from, I don't
have money literally to live offlater on to pay someone to walk
my my dogs.
I'm gonna use that, thatexample, to just, you know, put
in some break a sweat, like Ilike to take my, tell my
patients, or I'm not gonna paysomeone to deliver fast food for
(12:25):
me because of the status.
I am going to drive, walk anddrive and then get it.
It's very interesting thedifferent dynamics.
But to come to the question, doI ever talk to my patients
about obesity?
That's basically what we do fora living.
That's actually the core ofwhat our practice is.
It's helping someone move thisjourney, life journey together.
(12:47):
We want to become your wellnesspartners.
So we tell them about what youeat, how you eat it, when you
eat it, what it's going to do toyour body and then how do you
reverse it if it's not too lateto be reversed, if you can't
reverse it, then that's when wecome in to do interventions.
But the first point is that'swhere we spend most of our time.
I mean, like every firstconsultation is about one hour
(13:08):
and that's basically what we aretalking about to get to see
what are your needs, what areyour body needs and what do you
give your body and we realizethat people give their bodies
more than what they need.
Speaker 1 (13:18):
So is this pre-surgery?
This is pre-surgery, oh yeahthis is because if a patient can
do these lifestylemodifications and lose weight,
they don't need surgery.
Speaker 2 (13:27):
That's the hard work, that that is hard.
Speaker 1 (13:28):
Work is very hard.
I deal with the same thingabout if people can exercise or
increase the range of motion oftheir joints or eat healthy or
Try to not be sedentary, theywon't have as much pain.
So it's very hard to get thepatients to buy into what you're
recommending.
Speaker 2 (13:42):
I totally understand that and so again, like we were
talking and saying the othertime, we just relate that to a
car.
If you drive a car and you go200 miles, 200,000 miles,
without servicing your car, themoment that car gets to break
down, servicing is not going tohelp it.
You have to change the engine,or the motor, like you guys call
(14:03):
it.
So that's the same analogy weuse when you're talking to
people about wellness and andthe human body.
Speaker 1 (14:09):
we relate everything to the car, to the everyday life
, and then we have an hoursconversation about that I think
that's a great analogy, becausewe do constantly tell our
patients invest in yourselves,don't wait till the very end to
start taking care of yourself.
You got to invest yourself asyou go through life and prevent
the problems down the future.
So I totally am on board withyou on that, totally agree.
(14:30):
So we're talking about obesity.
What are some things or whatare some causes of obesity?
Speaker 2 (14:38):
um, well, we will.
Let's look at obesity this way.
Let's look at it as one aswhich, what this, what people
know?
But this weight is in my, is inmy family, the lineage, this is
in my genes.
And I argue with them and Itell them listen, I do not care
what caused it or what it is, itcan be reversed.
So there are people that havegenetic predisposition to it.
(14:59):
That's certainly a possiblecause but most, most of it is
muscle people gain.
You know what kind ofmedications you're on long term
medications, mostly steroids aregoing to increase.
Speaker 1 (15:08):
Medications can cause obesity, so there is also
lifestyle.
Speaker 2 (15:11):
The biggest is lifestyle.
This is the biggest problem iswhat we talked about the
convenience and regulating whatyou eat, how you eat it and when
you eat it right.
Speaker 1 (15:19):
So inactivity, inactivity and poor diet and
poor dieting Is causing obesitytoo.
Also, interestingly, poor sleepis a cause of obesity.
Speaker 2 (15:30):
Absolutely.
Speaker 1 (15:30):
Right.
So that's very important forour viewers to know that just
not sleeping enough can causeobesity.
I think it's because if you'reawake You're usually just
wasting time watching TV or notdoing exercise, and then you
start eating Just from habits ofeating and watching TV.
Speaker 2 (15:44):
I'm just guessing on that, and people should also
know that there's a differencebetween obesity on the scale and
overweight, right?
So, yeah, also rest.
If you don't, you know there'sa hormonal play that comes into
your body, of course there's youknow cortical, cortical levels
going up high stress levels andthen people.
When people get pregnant mostlyladies there's there's a lot of
hormones that come into playduring post pregnancy and during
(16:05):
pregnancy.
But again, all that weight isreversible and we can't, we
can't blame weight.
You know people that gainweight as a result of opus
pattern, weight gain to beobesity.
That just doesn't count.
Count right, it's going to be.
Again.
The biggest factor is going tobe diet and inactivity, the
refusal for people to modifythose two perfect.
Speaker 1 (16:25):
So on that, what do you tell your patients?
Is it better to just increaseyour activity and exercise, or
is it better to have a healthierdiet?
Speaker 2 (16:33):
it depends on which level we find them so where on
the journey that we find them.
In most cases, most of them comewhen you're pre-obese, when you
just so, of course there'sgoing to be a scale where
there's no more accepted weight.
Then there's going to be, ofcourse there's underweight.
That doesn't qualify to thisconversation.
There's underweight, there's nomore weight, there's going to
be overweight and then there'sgoing to be obesity.
(16:54):
Right Now, depending on whereon this scale that we find you,
the interventions are going tobe different.
If we find you in obesity,chances are how obese are you?
There are people that are veryobese and so that way, even
lifestyle modifications are notgoing to help you Because, again
, the outside is an indicationof what is going on on the
inside.
(17:15):
So much as we want you to shedoff the weight, there's also
other things that are going onin your body, like
cardiovascular diseases anddiabetes, that we have to take
control over.
So in most cases, medicationscome into place and surgery, but
in most cases, when we get intopeople's life, these are people
that are very cognizant oftheir weight.
Oh, I'm going out of shape.
So those are the people that welove.
I personally love to work withBecause one they are willing,
(17:37):
but because it's a pattern, it'sa behavior.
It is very hard for them tokind of get off that track to
start.
So we walk that journey withthem and tell them hey, let's
give them knowledge first of all.
People will resist knowledgebecause now there's Google,
there's AI, there's what myfriend did, there's all this
kind of I don't saymisinformation.
(17:59):
But what worked for Mark isdefinitely not going to work for
me.
Speaker 1 (18:03):
It's just different information.
Speaker 2 (18:05):
There's different and streamlined information.
Speaker 1 (18:07):
And everything's kind of tailor-made to what you're
searching for and your habitsand everything.
Certainly there's a bunch ofmisinformation along with good
information.
It's hard for the patients toweed through all that type of
stuff.
Speaker 2 (18:17):
So what we do is we, we first of all get their needs
assessment and then we walk thatjourney.
At that point, hey, if youchanged A, B, C, D and you're
authentically and honestlychanging it, because one of the
things that we see in thispractice is lying.
Speaker 1 (18:34):
Patients lie.
Oh, trust me, trust me.
You're saying patients lie.
Speaker 2 (18:37):
Yes, I know, patients lie, which is like I'm like
listen, you're going to pay meanyway, so we could as well save
you some money and time and dothe right thing.
So, yeah, we, we do thatjourney with them and then talk
to them about how do you changethe lifestyle.
That is the most hardest thingto do because it takes a lot of
unlearning and, as you mightknow, one of the hardest things
(18:58):
to do is to unlearn right.
So after the, if they arewilling to unlearn, then in most
cases they don't even progressto the medication and the
surgical point.
But then there are those thatcome into it hey, I have a
wedding in two months.
I am 200 pounds, I need to getback to 100 pounds.
Okay, okay, there's nothingthat is going to work unless
let's go in and do surgery.
(19:18):
And there's us when you come inwith cosmetic surgery, and
that's what you know, mostpeople know us for and you know
the practice that we run for.
But in most cases it's theearlier that I talked about.
Speaker 1 (19:31):
It's very interesting .
You say that patients need tobuy in to what you're saying,
because I have a lot of patientsthat are hesitant or resistant
to my recommendations, and youmentioned that.
Why are they going to pay youif they're not going to listen
to what you say?
I have that conversation manytimes with my patients because
it really comes down to trust.
The patients have got to buy into trusting you 100%.
(19:53):
If they're not going to trustyou to do what's best for them,
then they're going to slow downtheir progress.
So imagine going to a financialadvisor or somebody and say are
you going to do what's best forour money?
You have to trust what they'regoing to do.
It.
Advisor or somebody say are yougoing to do what's best for our
money?
You have to trust what they'regoing to do right.
It's the same thing when you goto a doctor.
You got to trust your doctorsbecause they're trying to do
what's best for you and makesure you find a good doctor,
because unfortunately disclosurethey're a bad doctor there are
(20:14):
doctors that don't have patientsabsolutely first priority.
So you got to find a good doctorand then, if you do trust them
and listen to him or her whenthey say these are our
recommendations, you can get toyour goal as fast if you follow
recommendations, or slower ifyou want to doubt me and not
really jump into the ship andthis is what we tell them.
Speaker 2 (20:34):
We tell them uh, your health is really a partnership
right, and unfortunately, or theunfortunate thing is that you
get to play as a much biggerpart than I do, because you are
living with yourself most of thetime, and this is what I tell
my patients.
I'm like the right way to dofact checking is first hear the
facts that I tell you don't,don't come to me with a, like a
(20:56):
list of you know template thatyou downloaded.
Someone like this is the fact.
Then it ceases being the fact.
Does that make sense?
Sure, like, let me tell youthen, go and check, as opposed
to no, I want you to do this.
Then you are becoming thedoctor, and that's actually one
of the the biggest problems thatwe face in our practice.
Speaker 1 (21:12):
So I'm going to give you a phrase that I want you to
use in uganda okay so it'll bespreading through the world
let's go I can say this is goingviral across the world.
I tell my patients we want youto be an active participant, not
a passive recipient, in yourhealth.
So the patients come in and saywhat are you going to do for me
, doc?
I said nope, I'm not doingsomething for you.
(21:32):
You are going to be activelyinvolved with your health care
and I'm going to help you beactively involved, but you're
not going to be a passiverecipient to what I'm telling
you.
You are going to be activelyparticipating in your health
care and your pain management.
I'm telling you you are goingto be actively participating in
your healthcare and your painmanagement.
So that's what I think weshould tell the patients is be
an active participant not apassive recipient of your
healthcare.
Speaker 2 (21:51):
That is so powerful Now that you think about it.
That is so powerful becauseoften time, it's that passive
passiveness that actually got usinto this place, and this is
what I always tell my patientsas well.
I'm like I wish you came to usearlier.
Speaker 1 (22:05):
Right.
Speaker 2 (22:06):
Yeah, but because you are passive about it, then this
is where we, this is how we go,but hey, we'll be out of
business if they didn't come,which would be great, which
would be great, but you're rightIf people would come in earlier
.
Speaker 1 (22:21):
it's already progressed.
So if someone came to you whenthey're 50 pounds overweight,
you're going to be a lot moresuccessful, and they will too,
instead of if they're 150 poundsoverweight and they can't see
you.
Speaker 2 (22:31):
It's the same thing with me.
Speaker 1 (22:35):
If patients come to me when they're 80 years old and
they've had arthritisprogressing for 50 years before
they come see me, it's going tobe a lot harder to get them
better, versus if they come tome when they're 30 years old and
it's just self-starting.
We say you're fine, we have alot of time to work with this.
Be an active participant inyour health, not a passive
recipient, and you can, insteadof going off this way, you can,
start being a healthier person.
Speaker 2 (22:53):
And that also makes me remember one of the things
that we do tell our patients isthat if you do not act now,
you're going to have to do threetimes the work tomorrow.
Now, you're going to have to dothree times the work tomorrow.
And remember if you do not do itnow, you're going to have to
put an X3 tomorrow, right?
So if we tell you, hey, come tous early, that feeling of pain
that you feel could be somethingmore than what you think, make
(23:17):
a trip to the doctor, it will beway cheaper.
We can catch it earlier,earlier than Google will catch
it, because Google is going tojust worry you and we could
actually have some facts andwork around it.
So I like the idea of being anactive participant, not a
passive recipient.
Speaker 1 (23:35):
There you go, spreading across the world right
now.
Speaker 2 (23:37):
It's gone viral.
I love it.
Speaker 1 (23:39):
So we talked about some causes of obesity and the
effects of that.
Do you know some reasons orsome ways to prevent obesity or
things you can do to preventobesity?
It's very basic stuff.
Speaker 2 (23:50):
I think we just talked about that.
First of all, be an activeparticipant.
Speaker 1 (23:53):
Be an active participant.
Speaker 2 (23:54):
Break a sweat.
Speaker 1 (23:54):
Break a sweat Active lifestyle participant break a
sweat.
Break a sweat, active lifestyle, that's right.
What else eat?
Speaker 2 (24:00):
eat healthy, eat healthy healthy lifestyle is
very important, that is veryimportant and and there's a
there's a clear balance.
I and I'm gonna ask you thisabout your practice there's a
clear balance about so I keeptelling people losing weight is
not much of what you eat.
Again, it's the, the modulation, because if you work out more
than you eat, surprisinglyyou're going to gain weight.
(24:21):
And you know this because whenyou see people go to the gym and
I'll give you a clear exampleSomeone goes to the gym, and
I've seen this with most of ourfemale patients.
They will go to the gym at thestart of the year, mark out on a
calendar new goals, new me,let's go Change diet, da-da da.
And then they start going tothe gym.
Well, they're seated behindtheir desk from 8 to 5, snacking
(24:43):
in between, eating a heavybreakfast and doing all that
kind of things, and then they goto the gym for two hours.
They're on their phone for 30minutes total.
They're lifting weights.
They are doing more burning ofthese calories that they
accumulated during the day thanthey are actually.
And then this is what theirbody thinks oh, we just depleted
this amount of energy levels,because the body stores the
(25:06):
energy that fuel, all the gasthat runs your car.
The body stores it as fat.
So when you deprive your body ofyou know the stores that have
that, either from glucose, andthen you go to the fat, the body
is going to think just likeyour savings account, would I
have depleted this, let me fillit up.
And that's how you gain moreweight, not knowing.
(25:29):
So.
We tell them be very carefulwhen you're active, because then
it's going to increase yourbasal metabolic rate.
You're going to eat morebecause your body demands are
going to be more and in theprocess you're going to eat more
because your body demands aregoing to be more and in the
process you're going to beeating more frequently, and
that's how you end up gettingmore weight.
So it's a very importantbalance that we tell people hey,
be very careful.
And that's why it's importantto go to a professional, because
(25:52):
a professional will tell youwhat you eat and how you eat it
and how you balance that withhow much you can't just stop
eating you can't just stopeating like you can't just keep
eating and you can't just eatonce a day.
Speaker 1 (26:02):
You got to balance it out, like you said yeah, it's a
balance, so I agree with you.
Another interesting thing I sawwas have smaller plates right,
yes, there's actually researchthat shows people that have
smaller plates aren't as obese.
So when you go to a restaurantor you go to a store, you buy
plates at home, use smallerplates and you'll lose weight
(26:23):
just from that mm-hmm the otherthing you said you mentioned
early was get a dog, becausedogs can be walked by you, not a
service right and the more youhave to get up and walk your dog
or go outside, then the moreyou're being active, the more
you're back and again there isthere is there is nothing like
insufficient activity.
Speaker 2 (26:43):
you know the way the heart works is.
You know the heart is one I'msure you know this, but I want
to make sure that our patients,or listeners, know this the
heart is one of, it's actuallythe one of the organs in your
body that do not depend on yourglucose, on your glucose levels,
right?
So the normal primary source offuel that your body that do not
depend on your glucose, on yourglucose levels, right?
So the normal primary source offuel that your body uses.
The heart uses fat, and so Iguess that's where the word
(27:06):
cardio came from, when you tellpeople that, hey, I don't care
if you walk, I don't care if yourun, I don't care if you swim,
we need you to move your body,just move.
Speaker 1 (27:15):
Get into the act of moving.
Speaker 2 (27:16):
And walking a dog or a pet is a very, very good way
to move it.
Speaker 1 (27:19):
And my patients that say I can't start an exercise
routine, I say don't think of itas a routine, Think of it as
one day.
Go 10 steps one day and thenthe next day go 11.
And every day just increase itby one step, or five minutes, or
one minute, but just start theactivity of exercising and be
consistent.
(27:39):
You got to dedicate yourself toit.
I'm not saying do it five hoursa day.
I'm not saying do it every day.
I'm saying start the habit ofgoing for a five minute walk.
It's very simple two or threetimes a week and then, as the
weather gets better, you startgetting more energy because
you'll build endurance, becauseyou actually didn't go for a 10
minute walk right you slowlybuild up on your endurance and
you'll see that it's a smalleffect.
Speaker 2 (27:57):
It's a small habit.
You create a habit, you starton it, stay in it and then,
before you know it, it gets onto you.
Speaker 1 (28:05):
That's very important .
Speaker 2 (28:07):
I love it.
I think one of the things thatwe need to include onto, that is
, one of the things that we tellyou again patients back home,
but also clients here is getinto the habit of consistency
around you.
Wake up at a consistent time, dosomething, get into a routine
kind of a routine and also get adoctor, get like someone that
is going to know you.
(28:28):
This business of hopping fromthis practitioner to this
practitioner, to thispractitioner, that's how you end
up.
You know getting all kinds ofum.
It's one thing if your doctoris not giving you results, or if
your doctor is not giving youresults or if your practitioner
is not giving you results.
It's the other thing if youstick in there and work with
them Because, again, remember,this is a partnership that
you've created.
Speaker 1 (28:46):
It's a relationship.
It's a relationship.
Speaker 2 (28:48):
The longer you're in a relationship, the better off
you feel, the more I know you orthe more I know something about
you, better service the momgoing to understand your body.
You've seen this where peoplethat have worked with one
practitioner for so long haveseemingly better results.
There's actual research Peoplethat have worked with one
practitioner for so long if thepractitioner is doing something
right, they have way betterresults than people that do
(29:10):
medical hoping from one personto another.
So that's also very importantwith information.
Speaker 1 (29:14):
So patients just to reiterate should find a good
doctor and stay with them andtrust them and make them part of
their family, because that'swhat they are.
They're trying to help them outfor global wellness and health
for the rest of their lives,Because things are going to
change.
Speaker 2 (29:26):
I mean, things are going to change in the way you
eat.
Things are going to change inthe way you was 10 years ago.
Speaker 1 (29:39):
I'm sure you were not , gray.
There's only one.
Speaker 2 (29:41):
Mark.
Speaker 1 (29:44):
Mark is constantly evolving.
The only thing constant ischange itself.
The way I understand it correctme if I'm wrong is you work
here via internet in Uganda fromlike 8pm to 4am yes, from about
6.30pm to 4am.
(30:07):
So that's my yeah from 6.30pm.
Speaker 2 (30:09):
That's my resting time.
Speaker 1 (30:10):
6.30pm takes us to San Antonio time almost like 10,
because then we aretransitioning to like 7am back
home so you work from here, 10o'clock here, to four o'clock
here over there through theinternet and then you slack off
and take two hours nap aboutthree three, and then you get up
, and then you go to yourstudent job here to learn ems
(30:34):
from eight to five, okay, andthen you start all over again.
Speaker 2 (30:39):
Yes, so this is the balance part of it.
Let me tell it my way.
Mark is just messing it up.
Speaker 1 (30:48):
Just another story.
Mark's messing up, that's fine.
Speaker 2 (30:53):
So because of the time difference, there's a huge
time difference About anine-hour time difference back
home.
So right now it's coming to 7pm.
Takes some time, so I wouldusually be asleep from like 5 pm
up to like 10.
All right, so five, six, seven,eight, nine, ten, that's about
six so you're hating me rightnow?
Speaker 1 (31:10):
oh no, do you think this is a dream or a nightmare?
Speaker 2 (31:13):
ask me tomorrow, and then I get up at around 10.
Guys are waking up back homeand then we do that.
Speaker 1 (31:21):
So I do that mostly if I have consults the bariatric
surgery.
Speaker 2 (31:25):
Well, smooth, consults, consults, and then I
go to bed at around give andtake, around 3.30, 4, depending
on the day, and then I'll be upat 6.
And then I start my day here,and then that goes on.
So I I read just a good seven,seven, eight hours.
Speaker 1 (31:43):
It's just off the the normal cycle of the everyday
because we learned earlier,sleep is very important.
Oh I sleep.
Speaker 2 (31:50):
I sleep and I rest.
I think so there's a differencebetween sleep and rest.
Speaker 1 (31:54):
Yeah, so really you're a full-time student and
you're a full-time employee.
That's a life baby-timeemployee.
Speaker 2 (31:57):
That's the life baby.
Speaker 1 (31:58):
Why do you slack off so much?
I'm just wondering.
Speaker 2 (32:03):
You make me feel bad.
But the tricky part is I thinkwe talked about that it's a
balance.
Speaker 1 (32:08):
Everything's a balance.
Speaker 2 (32:08):
You've got to learn that.
One of the advantages of beingin America is I'm very aware of
what to eat and what not to eat.
So I would regulate very muchwhat I eat based on how non-very
cheap things are here.
I would regulate how I eat, soI would eat a certain kind of
portion certain times of a weekand then that's how I really
(32:31):
catch up.
Otherwise I would benon-looking the way I used to
look 10 years ago.
Speaker 1 (32:36):
I remember you saying that food was very expensive
here and you had to buy a lotless compared to back home.
You could get a lot more.
That would last you for weeks.
Speaker 2 (32:45):
Yeah, that's one of the privileges I think of being
where I come from.
The very many is that you getto, for example, 80 bucks.
I would fill up an entirefridge full of fresh groceries.
Well, I don't know how much 80bucks would buy me here of fresh
food.
But I'm assuming that wouldn'tbe much.
(33:05):
So see, that's the reason I'mtelling you that I am very aware
of what goes into the body.
Speaker 1 (33:12):
It definitely wouldn't fill a fridge, that's
for sure.
Speaker 2 (33:14):
We certainly know it won't.
Speaker 1 (33:15):
But do you like Chick-fil-A French fries?
I like chicken nuggets oh, Ilike the chicken.
Yeah, oh yeah.
But do you like their frenchfries?
See, I have a problem withfrench people, uh-huh, and that
so I would think you would likethem, because you're frying them
, right no, I love fries.
Speaker 2 (33:37):
I just don't eat my chicken with watermelon.
Speaker 1 (33:39):
Okay, so can we stay for our viewing audience?
Two out of two doctors approveof Chick-fil-A French fries, and
we're talking about obesity.
Speaker 2 (33:47):
We should get an endorsement from Chick-fil-A.
They should watch this.
Speaker 1 (33:51):
We're talking about obesity, talking about French
fries.
Speaker 2 (33:53):
That's okay, Anyway moving on.
Speaker 1 (33:55):
We're talking about obesity and we're going to move
into low back pain.
Speaker 2 (33:59):
Yes, I know a little bit about that.
Now can I take over theinterview.
Speaker 1 (34:03):
Oh.
Speaker 2 (34:04):
Can I just hijack?
Speaker 1 (34:06):
Do we need to switch?
Speaker 2 (34:06):
seats.
Can I just hijack?
Speaker 1 (34:07):
Do you want to switch seats?
Speaker 2 (34:08):
Because I really want to know this is one of the most
complaints that people that areoverweight complain.
Speaker 1 (34:15):
I do consulting in Uganda from about 2am to about
10am every morning.
I feel as now.
Speaker 2 (34:25):
I would want to know from a specialist, from an
expert, what the relationship,what the relationship is with
mostly overweight and obesityand back pain.
What is it that connects thosetwo?
Speaker 1 (34:41):
Okay, that is such a good question.
I'm so happy you asked and itall comes down to I am seriously
asking.
It all comes down to weight andgravity.
Speaker 2 (34:51):
Okay.
Speaker 1 (34:51):
So when someone is overweight, they have more
weight pulling them forward anddown with their lumbar spine.
So instead of the spine beingevilly stacked and distributed
with the weight in the discs,it's pulling an anterior
pressure towards their frontwhich causes uh disc problems,
which then consequently causesfacetogenic problems because
they're putting more stress ontheir back, because they're
(35:13):
basically arching their backmuch more than they should be,
because the weight is pullingthem forward, which then causes
arthritis.
And it helps increase discdegeneration because they're
compressing their spine muchmore than someone who isn't
overweight.
So someone who's overweight iscompressing their spine so they
have disc problems.
They're pulling their spineforward like a hyper-arching
(35:34):
back thing, so it puts morepressure on the back of their
spine, where their joints are,which causes more arthritis or
accelerated degeneration of thejoints I have had.
Speaker 2 (35:43):
I have had patients ask me when you take away this
fat, can you put it more in theback area than they have asked
me to put it in the front area?
Um, that is just a by the way,but no one has asked me.
And and I keep asking couldthat be the reason that we don't
tell our body where to depositmost of the fat?
We don't really get to choose.
(36:04):
It will deposit in the biggestcavity, and what is one of the
biggest cavities that we have?
Speaker 1 (36:09):
Abdomen Usually abdomen for men, or thighs or
breasts for women is where a lotof excess weight goes, and so
it just causes anatomic changeswith gravity and stresses on the
spine, which leads to all theseother back problems so if I'm
overweight, should I?
Speaker 2 (36:26):
is it safe to say that I should walk with a stick,
or do I just shed the weight?
What do you recommend?
Speaker 1 (36:32):
I would say shed the weight, instead of keeping the
weight and walking with a stickmakes sense in the end, you want
to be light and fast, so youwant to maintain your ideal body
weight.
You want to maintain yourjoints by exercising and range
of motion, and to do that youneed to not have excessive
weight.
It's like carrying around two50-pound dumbbells throughout
(36:54):
your life.
It's really really bad on yourjoints, so you can lose a lot of
pain or problems with pain byjust maintaining an ideal body
weight and actually, in fact,obese people are 33% more likely
to develop low back pain thanpeople that aren't obese.
Speaker 2 (37:11):
That's why.
Speaker 1 (37:13):
So just obesity by itself will increase your
chances of developing low backpain.
Speaker 2 (37:18):
So what would you like to tell someone out there
that is obese with back problemsand they're telling now I have
arthritis problems or I havespondylitis problems and now I
can't even exercise.
Speaker 1 (37:33):
Right Deal with that all the time.
San Antonio has their fairshare of obese people with
diabetes and high blood pressure, but that's part of the
situation we're in and we'rehere to help.
So I tell them you have to beactively involved with your
health care.
You can't be a passive recipientof health.
You have to decide to changeyour path.
It's like you can keep on goingin the direction you're going
(37:56):
and things will get worse, oryou can make a conscious effort
to change the direction andchange your habits.
The example I give is if youare on 1604 and you never turn
and you're trying to get toAustin, you're never going to
get to Austin.
Speaker 2 (38:10):
It just doesn't go to Austin.
Speaker 1 (38:12):
So if you want to make a change in your path,
you're going to have to changethe way you're going and take a
road that goes to Austin.
If you get on i-10 trying toget to austin, it's never going
to happen.
So you got to make changes toyour lifestyle and your habits
to get to where you want to go.
And if you do want to be in aposition where you're not having
lifelong pain or increased painor suffering because you can't
(38:34):
do things with your kids, yourgrandkids, because you, because
you're in so much pain or theobesity is causing heart
problems, or you're on all thesemedicines that treat high blood
pressure and diabetes and allthese other things, you're going
to have to choose.
That's not where I want to go.
I want to go over here.
So then make the change,because nothing is going to
change unless you change.
Speaker 2 (38:52):
Well, doc, I have another question for you.
Well, I am on all this kind ofmedication and my doctor told me
I have to regulate the way Iwalk, how much exercises I do,
because of my heart issues.
And now, here you are tellingme that I have to be active, and
on top of that, I have aproblem with my back.
(39:14):
How do I go about thatsituation?
Speaker 1 (39:16):
Well, baby steps.
I talked in the last podcastabout make it first and 10, not
first and 75 do you watchamerican football?
Right, so they get the kickoff.
They start on the 25 yard line,the goal's 75 yards away.
They don't make it first and 75right they take a big goal and
they divide it up into muchsmaller, easily accomplished
goals.
First, intense I sell, just gofirst and 10, so we're gonna
(39:39):
lose five pounds okay okay,let's see if we can do that and
you can get into water and walkin water and exercise water,
because the buoyancy will take alot of stress off your spine
and your joints to enable you tostart building up an endurance
so you can be active again rightand as you start to lose weight
, you can start being moreactive outside the water.
The best pools, if you reallywant to know, are those pools
(40:01):
that have the beach entrances.
Do you know?
Speaker 2 (40:03):
what beach entrances are?
Speaker 1 (40:04):
Yes, so then as you're heavier, you can go
deeper in the water and there'smore buoyancy, and then, as you
lose weight and you gainexercise, you can come to more
shallow and you'll lose thebuoyancy and put more stress on
your joints.
Lose the buoyancy and put morestress on your joints Makes so
much sense.
So then I say, okay, we're herefor you, we're going to help you
, we're not going to do it foryou.
(40:24):
We're going to help you andwe're going to have small goals
to get you to where you want togo.
Speaker 2 (40:26):
You didn't get like this overnight.
You're not going to get out ofthis overnight.
Speaker 1 (40:30):
It took you years to get in this situation.
So we're going to plan to dothis, but we're going to keep on
heading towards your goal.
We're going to put you on I-35to get to Austin instead of I-10
.
That's never going to get youto Austin.
Speaker 2 (40:42):
I really, really, really love.
I love that.
I think that most of theproblems that we see I don't
know about your practice, butmost of the problems that we see
is people have had this problemfor 10, 15 years and then they
come like, hey, I only have twomonths to fix this.
So what advice would you givesomeone that is into the
business of quick solutions,quick fixes?
Speaker 1 (41:05):
I would tell them that we can do as much as you
want to do, but realize theshorter the duration you want to
make changes, the harder it'sgoing to be on you, which will
increase your chance of failure.
So you don't want to get amedical degree in one year.
Speaker 2 (41:19):
Yeah right.
Speaker 1 (41:20):
It's too much work, you will fail.
You're setting yourself up forfailure.
So make it a reasonable goaland that's one of the things you
do when you come up these notmaking it first and 75, but
first and 10, you come up with areasonable goal.
Now I said lose five pounds.
That's a reasonable first goal.
That's not going to be yourgoal the whole time, because you
know next month we're going tosay OK, let's see if we can lose
(41:41):
six pounds.
Or if you can't lose any weight, let's see if we can make you
walk twice as far, ok.
Or if you can't walk, let's saysee if you can get in a pool
and stay walking in a pool fortwice as long.
So there's different ways tomodify their health problems
that they're dealing with,whether it's obesity or pain or
(42:01):
whatever else, to try and getthem to once again be actively
involved with their health care.
But the shorter the duration,then the harder it's going to be
.
One of my other favoritesayings is if you fail to
prepare, prepare to fail.
So if you're going to giveyourself two months to lose 50
pounds and you've had years totry and prevent this, you're
preparing to fail because you'refailing to prepare so when I do
(42:23):
talks or lectures or doanything else.
I'm very adamant about preparingbecause I don't want to look
like an idiot.
I don't know what I'm talkingabout.
So I go and I prepare.
So I'm not failing to prepare,because then I would prepare to
fail.
Speaker 2 (42:35):
So it takes, takes a little dedication it takes a
little motivation.
Speaker 1 (42:39):
It takes us helping them.
We're helping.
We're not doing it for themlike you do with your patient,
but it's a team effort and theydidn't get like this overnight.
It's not going to go awayovernight.
It's going to take a change.
Speaker 2 (42:49):
And part of the team effort that I tell my patients
is find an accountable partner.
Speaker 1 (42:55):
Absolutely.
Speaker 2 (42:56):
Find someone that is going to push you when you're
slacking.
Find someone that is going toget you back on track, because
it's again like you said it's ajourney.
Speaker 1 (43:11):
It's not going to happen over time you better have
someone that is going to pushyou.
Another thing we like to say isknowledge is power, knowledge
is power.
So the more you know aboutsomething, the more you can take
control over that situation.
And a lot of times patientshave fear just because of
ignorance Not to say they'restupid, but because they just
don't have the knowledge of whatgoes on with that situation.
So become an active participantand learn what the causes of
(43:32):
obesity are, what the cure isfor obesity are, or what you can
do to minimize obesity, obesity, or what you can do to lose
weight.
So actively participate.
Another thing is you can go toour website.
It's one month MD dot com andyou can learn about the causes
and treatments and prevention oflow back pain, and you could be
an active participant in yourhealth instead of a passive
recipient.
Speaker 2 (43:52):
Look at that.
Speaker 1 (43:53):
All these things to help patients learn and use that
knowledge as power to controltheir life and control the
problems they're dealing withagain it's, it's.
Speaker 2 (44:01):
It's one of those things that we say your body is
a composition of differentsystems.
Don't treat one in isolation,because here we are thinking
well, obesity is just a more ofa shape looking issue and it's
giving you back issues.
So you have to radiate, put youknow coolant in your radiator,
as much as you have to fuel upor gas up your car.
(44:23):
Check on your tires, make surethat the body is doing when the
electric system is doing good.
Right.
Speaker 1 (44:28):
So I like, I like, I like that yeah, and an example I
give many times, which mypatients are probably sick of
because they've heard it so manytimes, is a patient come in and
they say you did a procedureand I'm still not better and I
say okay, well, think about acar.
If you had a car that didn'tstart and you took it to the
mechanic and they said oh,you're out of gas, you have a
(44:48):
bad alternator and your batterydoesn't work.
But I put gas in your car, yourcar is technically better, you
can now have gas, but you stillhaven't addressed other things
that prevent the car fromstarting.
You still have a dead batteryand you still have a bad
alternator.
So all those things willcontribute to a symptom of the
car isn't starting.
But don't think it's one thingthat needs to be fixed to solve
(45:09):
the car from starting.
It's multiple different things.
So in the situation of dealingwith weight loss or trying to
eat healthy, it's multipledifferent things that are going
to need to be done instead ofjust, oh, I'll take a pill and
I'll lose the weight.
No, you're going to change yourlifestyle, but it takes
multiple things to do to makelifelong changes.
It'll take 60 days to make achange become a habit right, but
then, after the habit is formed, then you continue to do it and
(45:32):
you reap the benefits youcouldn't have said hey, you
heard from the expert.
Speaker 2 (45:37):
He could not have said it Very good.
Speaker 1 (45:41):
Did you have any other questions for me?
Speaker 2 (45:44):
I think I've earned my money's worth.
Speaker 1 (45:46):
Oh yeah, you definitely have.
Are you going back to Ugandatonight, because you're done
with all American doctors?
Who's your favorite Americanpain doctor?
Speaker 2 (45:55):
I wouldn't say Mark, why are?
You taking so long to answerthat question?
I wouldn't say Mark, why areyou taking so long to answer
that question?
I?
Speaker 1 (46:00):
wouldn't say Mark, Like do you know any other
American pain doctors?
Speaker 2 (46:04):
But there's a doctor that does back-to-back, that's
the one.
Speaker 1 (46:08):
Well, I'm going to put on my podcast officially.
You are my favorite Ugandanbariatric surgeon, dr Umar
Slovanovich.
Speaker 2 (46:20):
That's Russian.
Speaker 1 (46:23):
How is it again?
Speaker 2 (46:24):
Yes, this is the only one thing.
You don't have to be Americanabout Sankubuge.
Speaker 1 (46:35):
Sankubuge.
Si, I did say that, okay, thankyou.
Thank you, see.
So Thank you very much Forcoming on.
This has been Very educational.
I hope you guys Learnedsomething.
I certainly learned a lot and Iappreciate your time.
Speaker 2 (46:50):
I did learn so much From you, mark Good.
Speaker 1 (46:52):
Thank you very much For having me, and we wish you
the best of luck With yourschooling and back home, about
starting something that willhelp out All Ugandan people.
Speaker 2 (46:59):
Absolutely, and maybe sometime we can get a pain
management doctor in Uganda.
Speaker 1 (47:05):
I'm thinking about opening a satellite site just on
Fridays.
Speaker 2 (47:10):
Friday is happening time.
Ugandans don't do anything onFriday except for happening.
Speaker 1 (47:14):
Perfect, that's what I'm going.
They just go dancing.
No, that's what I'm going.
That's how we deal with pain.
I'll have a site there.
I won't send any patients, I'lljust go dancing.
I hope you guys learnedsomething.
Please check back for our nextpodcast.
We appreciate all your help.
Always send any emails to us,because we want to answer your
questions too.
Thanks a lot.
Speaker 2 (47:30):
Thank you.
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