February 22, 2024 • 33 mins
Have you ever thought about the paradox of surgeries? Why would a life-saving procedure like bariatric surgery be shrouded in stigmas and misconceptions, while other complex surgeries, such as orthopedic ones, escape this judgment? This is the complex world we navigate in our latest episode, as we, your hosts Dr. Maria Iliakova and Tammie Lakose, challenge these misconceptions and strive to bring a better understanding of bariatric surgery to our listeners.
Bariatric surgery is far from an 'easy way out' for weight management. We converse about the extensive requirements, paperwork hurdles and potential risks that underscore the seriousness of this procedure. We also shed light on the often-overlooked psychological dimension of this surgery, as patients grapple with significant mental health challenges alongside physical transformations.
As we wrap up this enlightening journey, we'd like to invite you, our listeners, to be a part of our ongoing conversation. Share your thoughts, questions, or suggestions - your feedback is the catalyst that shapes our content and uncovers the topics you're keen to explore. Stay tuned for future episodes where we continue to delve into the multifaceted world of bariatric surgery. Until then, keep learning, keep questioning, and let empathy guide your understanding. Thank you for joining us, and we look forward to hearing from you.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Core Bariatrics podcast, hosted by
bariatric surgeon Dr MariaIliakova and Tammie Lakose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatric podcast doesnot offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Tammie, you know what I wish wehad.
What do you wish we had?
I wish we had an easy way.
Speaker 2 (00:33):
You know why why?
Speaker 1 (00:35):
Because we'd use it For sure, for sure, and we'd be
millionaires.
Speaker 2 (00:40):
Billionaires, yes, and we'd be billionaires,
billionaires, maybe eventrillionaires.
But seriously, don't you thinkit'd be great if we had an easy
way?
Speaker 1 (00:48):
Yes, 100%.
Speaker 2 (00:51):
So when people say surgery, well, that's the easy
way out, what do you think?
Speaker 1 (00:55):
about that.
Do you think people have notbeen through this process and do
not understand actually howhard it is?
Speaker 2 (01:01):
You're absolutely right.
I think that's true.
It drives me crazy sometimes tohear that people think that
surgery getting cut on and goingthrough the whole process is
easy.
Would anybody ever say thatabout a different process?
Speaker 1 (01:15):
Oh, probably not Absolutely, and it infuriates me
100% after going through thisprocess.
Speaker 2 (01:24):
Yeah, exactly.
So if we had an easy way, Ipromise we would take it, I
promise.
I wouldn't put people throughsurgery if I had an easier way
for people to manage theirweight and get all the benefit
out of it.
But you know what?
Speaker 1 (01:39):
What.
Speaker 2 (01:40):
There sometimes isn't one.
Speaker 1 (01:41):
No no.
Speaker 2 (01:43):
No, yeah, and here's the thing that really this makes
me think of.
Let's think of some things thataren't easy, like getting on
Google and looking for somethingthat you want to buy, or
grabbing your iPhone or yourAndroid and using a map on there
, or something like that.
Yeah, finding directions Supereasy.
(02:04):
At this point, we can evenremember using paper maps to get
around.
Speaker 1 (02:09):
I do not, but yes, right.
Speaker 2 (02:13):
Well, maybe I'm aging myself a little bit, but when I
was a kid, I remember mygrandpa cranking out their maps
and that's how we would get fromplace to place and his is suzu,
which is the company thatdoesn't exist anymore, but
anyway, so that's what I mean is, if we had a way to do what
Google does or what map systemsdo, or any of these things, I
promise we would use them, butwe don't have Right, right, no,
(02:39):
so that's what we're going totalk about today is that surgery
is not so much of an easy way.
If I had an easy way, I wouldtotally use it and everybody
would totally get it.
Speaker 1 (02:51):
Absolutely.
Speaker 2 (02:53):
No.
So, Tammie, can you explain tome a little bit about why
surgery isn't necessarily theeasy way to manage weight?
Speaker 1 (03:03):
Well, for one.
For the rest of my life I amgoing to have this stigma on me
of you had bariatric surgery andyou took the easy way out.
Mentally that takes a toll onsomeone, and so me personally, I
don't mind, I'm strong enoughto handle that.
I will tell someone on thestreet that I don't even know
(03:25):
I've had bariatric surgery andI'm proud of that.
So I'm willing to open up thatconversation where some people
might not be able to handle thatjudgment.
So hopefully we can get awayfrom that.
But as of right now, not aneasy way out because, guess what
?
You're going to deal with thatmental aspect forever.
Speaker 2 (03:48):
Of other people judging you.
It sounds like of other peoplehaving an opinion about what you
did.
Speaker 1 (03:52):
Oh, absolutely, Even if they say they don't have an
opinion you can most people cansee right through your bull crap
.
Speaker 2 (04:00):
I see.
So even if people are sayingthat you're feeling like they're
judging or they're having anopinion, they're just not
necessarily expressing itAbsolutely, absolutely, and I
think everybody that has hadbariatric surgery has felt that
feeling and why do you thinkthat is?
Why do you think that otherpeople sort of interject an
opinion on this specific kind oftreatment?
(04:22):
Because it's not like we haveopinions about people having,
like, their gallbladders takenout or a hernia surgery, or if
someone needs some kind oforthopedic surgery for their
bones or something.
But why do you think this isdifferent?
Speaker 1 (04:35):
Well, I want to touch , based on the whole orthopedic
thing that you just brought up,because, look, a person could
live with their pain, their lackof mobility right, they could,
but there is a surgery to helpthat.
So you're absolutely right.
Why is bariatric surgeryconsidered the easy way out,
(04:55):
when it gives you the tools, itgives you the opportunity to
live a better life, where, ifsomeone has a hip replacement
and even gets metal put in theirbody, their knee, whatever, why
is that same judgment not there, especially, you know.
Speaker 2 (05:14):
That's a broken good point.
I really never thought of that,because, you're right,
something like a hip replacementor a knee replacement or a
scope or something like that isa quality of life surgery, right
.
You do it so that you can movebetter, so that your knees hurt
less, your hips hurt less, andlots of people go through that,
absolutely Right.
Athletes go through them.
A lot of older people gothrough them through normal wear
and tear, and it's not like wehave a judgment call to say, oh
(05:36):
my gosh, you took the easy wayout.
We took it in Absolutely.
Speaker 1 (05:42):
And the healthiest person that who isn't obese or
has always eaten, drank theirmilk, right, right.
There's no way to predict if aperson is gonna need a hip
surgery, a knee replacement.
There's nothing that they couldhave done differently to
prevent most cases to need thosethings Right.
Speaker 2 (06:05):
Right, that's such a good point.
I really have never thought ofit that way and that's a good
analogy.
Speaker 1 (06:10):
But to answer your question, about why I think
people do have that judgment orthat thought is honestly being
uneducated.
Being uneducated, that likewhat the surgery entails.
What kind of lifestyle doesthis make a person have?
Because, guess what, you can'tput a person's stomach back,
(06:32):
right, right?
Speaker 2 (06:34):
Well, and that's a good point, because I think a
lot of people think of it aseither or Like you have surgery
and it's a magic bullet and allof a sudden, weight is not a
problem for you anymore and it'salways fit for forever, right,
like?
How many people say that?
Even sometimes people who walkin and expect.
Speaker 1 (06:47):
Absolutely that happens.
Speaker 2 (06:48):
Come on, guys, as the rest of you do your best, and
it's not an either or approach,it's very much a end, it's an
end, so it's a half surgery, butthere's I mean, you went
through the process.
There's so much education inpreparation to make sure that
people know how to take care ofthemselves and their bodies
Afterwards, and that's alifelong commitment.
Speaker 1 (07:07):
Absolutely, and so, as I told you previously that,
as Educated as I truly am, Istill Was learning things about
this surgery that again made merealize, nope, this isn't
necessarily the easy way out.
This is the way that I had totake To get to where I felt
(07:28):
better, and so the point thatI'm getting to is that, like the
sleeve, surgery is not arestrictive, just Restricted
right to get you fuller fasterand all of that that there's
actually metabolic and hormonalchanges happening.
That Helps something that Icouldn't help.
Speaker 2 (07:49):
Oh, yeah, absolutely, because there's only so much
that diet and exercise can do ormedications can do, which is
why surgery is ultimately somuch more effective for most
people who have extra weight,and that's that's kind of the
stereotype that we really haveto break is.
A lot of people who aren't inmedicine, but even a lot of
people who are, think of surgeryas like a cheat code because it
(08:14):
fast-forward the processor andachieves more.
But that's kind of the point,exactly more effective.
It's a more effective treatmentand we shouldn't punish people
for using a more effectivetreatment.
It's sort of like yeah, you'reright Like if you had knee pain
or something like that and youcould either use a brace or you
could get surgery.
Sometimes a brace isn't enough,or sometimes physical therapy
(08:34):
isn't enough, so you progress tohaving surgery and then surgery
can definitely be enough forsome people to treat their pain
or to treat their Immobility orother problems.
Yeah, yeah, and I definitelythink of this kind of surgery as
the same, it's not for everyone, but for the people who can
benefit from it it's a massivechange that can't be
(08:55):
Accomplished any other way.
There's no other way to resetthat thermostat through
medications or without surgery,absolutely.
Do you think that there's anelement of fear involved in how
people perceive this and inpeople thinking that this is the
easy way?
Speaker 1 (09:11):
Absolutely so.
I think that some people andI'm gonna say from experience I
was very on a uneducatedjudgmental.
I was Tammie shame on you I wasnot very confident, whatever,
whatever, I had that samejudgment at some point, and so
(09:32):
there is yes, I think fear has alot to do with it that, um,
someone is going to fear thatthere, they may not make it out
of surgery, be, they're going tohave issues.
Speaker 2 (09:49):
And judgment.
Speaker 1 (09:51):
Right and right that they're gonna have to change.
Speaker 2 (09:56):
Yeah, yeah, because there's definitely an
accountability aspect to this.
Right, because it's sort oflike I Don't know if you get a
gym membership or something likethat and if you don't go, it's
like whatever.
But if you do something thatalters your body, like
Physically changes your body andputs you at some level of risk,
potentially right, becausethese things can have
complications associated withthem.
(10:18):
Sometimes it's a totallydifferent level of commitment
and it's not reversible, right,like you can go back and, like
you said, put, put that stomachback in.
Right, who are?
I knew a bypass, really.
There's not really a good wayto do that or a safe way to do
that.
So, yeah, you're right, theseare not reversible changes,
they're not things you can gotake back if you don't feel like
(10:39):
it later on.
Speaker 1 (10:40):
Yeah, yeah, and so I just think that People that are
thinking this is the easy wayout truly just aren't educated
on the whole Whole process andwhy people do this.
Maybe they're scared of theydon't want to have that judgment
on them or scared of surgery.
Speaker 2 (10:58):
Yeah, yeah yeah, I would you're if also kind of
cost is associated with this too, because a lot I mean you're,
you're a coordinator of theprogram and You've seen this
there's people who don't qualifybased on their health insurance
, or they don't have healthinsurance that covers this, even
if they would normally qualifyunder guidelines and things like
(11:19):
that.
So do you think that cost is anelement here too, and how
people perceive this?
Speaker 1 (11:24):
Yeah, and that costs not even for surgery but cost
post-op.
Right, there's a little.
Oh, that I feel like there is alittle extra cost there because
you are gonna have to takevitamins and stuff.
But yeah, this surgery, like inour program, you see us minimum
of four times.
And each of those office visitsare probably $300, and then you
(11:48):
also see a dietitian.
That is another hundred dollarsor so just giving up roundabout
price.
I don't know the exact price,but so right, with very that
times four.
And Then we usually require ascope, which is a whole
procedure in itself.
And then we may require you tosee a sleep specialist, get a
sleep study, see a pulmonologist, so, and also mental health
(12:12):
evals, and some insurances donot cover these mental health
evals.
So, that's an autopilot pocketcost as well.
So there's a lot of costpreoperatively alone and not
everybody can afford that.
Speaker 2 (12:28):
Yeah, I wonder if that is a big element here,
because the more we talk aboutit, I think, the more it becomes
obvious.
This is kind of the hard way.
That's a easy way.
Yeah good, like you're sayingit's.
There's cost associated,there's time, there's
preparation, there's potentiallymaking yourself vulnerable
because you're undergoing a lotof scrutiny.
(12:49):
Really, you're being put undera magnifying glass through this
process quite a bit and I wonderif some of this Thought that
this is the easy way is kind ofa defense mechanism so that
people don't have to considerthis option or so that people
like really can, can make it outto be more negative than it is.
Speaker 1 (13:06):
Yeah, I think you're.
You're totally onto somethingbecause, as I've said in the
past, that I have been anegative person and now looking
at being or I'm positive, morepositive, you know, looking back
, absolutely I was a negativeperson and shed negatives Right
(13:28):
Light on surgery per se.
Speaker 2 (13:31):
Right.
Right, because it's kind ofeasy to poo-poo something and
then, as a result, be not, youknow, not encouraging of other
people about it.
And it's easy to poo-poo thingsyou don't know Right, and
typically that happens it's outof misunderstanding or fear, or.
But I will say one thing I doactually think that it is
important to know and be reallytransparent about the fact that
(13:53):
these procedures do have riskassociated with them, and that's
one another reason that they'renot really the easy way out by
any means, because both sleevesand bypasses, and then the other
kinds of surgeries, even bands,which aren't done very often
anymore but are still donesometimes.
Well, actually, the reason thatthey're not done very more is,
one, they didn't work.
They don't work as well asother surgeries.
(14:14):
But two, they actually havehigher complication rates.
So bands, for instance, canslip, bars can get into the
tissue of the stomach or theesophagus, the tube that's
between the mouth and thestomach, and can cause really
bad problems if that's the case.
And so, yeah, like, all ofthese procedures require people
to go under the knife right andfleet for surgery, have
(14:37):
anesthesia and have recoveryperiods and all of that.
And actually bariatricsurgeries are some of the safest
surgeries in all of thesurgical field, because there's
so many rules and regulationsand standards and all of that,
which is good, but at the sametime it's still surgery,
absolutely Right.
Yes, still something thateither can have a complication
(14:59):
but at a minimum is something wecan't go back and undo after
it's done Exactly Yep, and so Ikind of want to.
Speaker 1 (15:07):
This popped in my head too, because I myself have
like ADHD and people with thatare medicated for ADHD.
Again, some people look at itas the easy way out, or even
medicating children.
Again, this is all parents,whatever you want to do, for I
shouldn't even have brought kidsinto this, but some people may
(15:29):
look at me and be like, wow,you're taking the easy way out
of your ADHD.
There's a ton of things thatyou can do to prevent some of
your sporadic brain or whateveryou want to say, but at the end
of the day, there is a chemicalimbalance in my brain that sure
I can do things to ease some ofthe symptoms, but there's
(15:54):
nothing that'll help me as wellas my medication does.
So, again, that's a really goodpoint.
Dying and exercise can helpAbsolutely, but at the end of
the day, for most people it'snot the end of the wall.
Speaker 2 (16:09):
Yeah.
Yeah that's so true Because,right, it's not an either or and
that's the tough part I thinkabout everything is a man.
Believe me, if I had a pill forthis, if I had a way to wave a
magic wand or a magic pill, ohmy goodness, would we use it,
right?
The hard reality of it is, andthe reason why I say that is
(16:31):
because I personally and I thinkyou agree too I don't have any
morality tied up with weight.
I don't think it's amorality-based problem.
I don't think people did it tothemselves and I just don't
believe that, and science backsthat up.
So if we had an easy way totreat this and to manage this
(16:51):
that avoided all of these riskythings that could be risky, why
wouldn't we?
You know what I mean.
That's the thing that reallystrikes me sometimes is why do
we want this process to be hard?
Yeah, right, what does that sayabout us as individuals or us
as a society?
That we want the process to bedifficult?
That doesn't make any sense tome.
(17:12):
It doesn't.
Speaker 1 (17:15):
It's just like I've had people say an epidole for
having a baby.
Even my doctor is like look,yes, there's risk to that right,
there's risk to surgery,there's risk to an epidural,
there's risk to everything youdo, but why not suffer?
Speaker 2 (17:39):
Yeah, why suffer if you don't have to?
And that's again personalchoice there.
People can have any kind ofbirthday watch or any kind of
you know, like that's nobody'schoice but theirs.
But to say that somebodydeserves to have a more
difficult time of it than theywant to, or that they have to,
like that's just.
I don't understand why we wantto punish people because it
(17:59):
feels sometimes certainly beinga provider in this field that we
expect people to be punishedfor their rights or punished for
the ways that we treat them.
And that, to me, is really thething that bugs me about this
approach that we make peoplefull guilty for whatever choice
(18:20):
they make and there's no rightchoice they can possibly make.
Speaker 1 (18:23):
Right, and nobody else should have a say in what
choice or an opinion about whichchoice you make.
Speaker 2 (18:31):
Exactly, exactly, exactly.
So that's anyway.
I really hope that that issomething that more people here,
that we have more providershere, because this same approach
is just as bad from people whoprovide medical care as it is
(18:51):
from people who receive thisaffair.
Speaker 1 (18:53):
Absolutely.
When I told my primary caredoctor that I needed his notes
for insurance purposes, that wehave tried, you know, wait, you
know other things.
He's kind of like, are you surethat's what you want to do?
But I think at the end of theday he's just not as educated
about this specific specialty,Right?
Speaker 2 (19:16):
Right, right, and I don't think there's any shame in
that.
This is a field that's prettynew.
You know all things told.
The bypass surgery has existedfor decades, but it was actually
used as an anti-reflex surgerybefore it was used as a weight
management surgery.
So that switched because peoplewere getting it done to prevent
ulcers and they were getting itdone for reflux and heartburn
(19:38):
basically.
And then I was noticed thatpeople were losing weight and
that became an indication fordoing a bypass by insurance
codes and things like that.
But the sleeve surgery, wherewe take out about 70 to 80% of
the stomach, didn't actually getapproved as a bariatric surgery
until 2011 by the firstinsurance company.
So it's really not that old ofa procedure in terms of like
(20:01):
insurance coverage or even beingavailable for people for the
purpose of weight management.
So the industry is definitelycatching up still a lot, because
anyone who was trained beforethat time really didn't have
exposure to bariatric surgerybeing an option for people.
And even the ways that we dothese surgeries has really,
(20:23):
really changed and the way thatwe support people, educate
people all of that, what we knowabout these surgeries and how
they work, has changed reallydrastically over the past 10, 20
years and a lot of the, likeyou said, there's still a lot of
skepticism from primary care,from other surgeons, from
cardiologists, from everyone.
(20:46):
Really, I don't think it's anyone particular feel.
Speaker 1 (20:50):
Right, and I think this is again just the beginning
of education and support, likebuilding all of those things.
We can only get better.
We can only educate more.
Speaker 2 (21:02):
Exactly, exactly, exactly.
Yeah, because I think thatthere's kind of like a couple of
things here that we're hittingon One, which is you know, if
there were an easy way, whywouldn't?
Speaker 1 (21:13):
we.
Speaker 2 (21:14):
And that's very truly .
Why wouldn't we?
Right?
And two, you know there'sdefinitely reasons that people
either don't think of bariatricsurgery as an option or have
built-in preconceived notions ofit or judgments of it, and so
trying to sort of break thosedown person by person or by crew
(21:35):
, Absolutely yeah, and so, yeah,you touched base on time.
Speaker 1 (21:40):
I mean, I had to be in the program for six months.
That is one appointment a month.
Each appointment is about anhour or so long and that's if
your provider is running on timeand not chatting too much,
Right?
Or if you even you can justknow you're running usually on
time, or even if you a lot ofthe time, me and the dietitian.
(22:03):
Really I had a lot of questionsand there's just not enough
time.
But my insurance required sixmonths.
Some insurances required 12months.
Some insurances require 36months of documented obesity or
trying to help lose weight.
(22:25):
All of that so yeah.
Speaker 2 (22:28):
Yeah, we actually had .
I think you were involved withboth of those patients, but we
had two patients this year thatwere denied their surgeries
because Initially there wasn'tdocumentation going back three
years, and it wasn't just threeyears of documentation.
The insurance company wantedphotos and documented notes from
that per those.
Those individuals had to haveprimary care notes as well and
(22:52):
I'm like who on earth goes totheir primary care doctor at
this point, like once a year, ona regular basis?
Who provides Photos in thatdocumentation?
We don't take photos in ourdocumentation on a regular basis
.
I was like what?
Speaker 1 (23:05):
Yeah, that was.
That was crazy.
That's required.
That was crazy and we did.
We went above and beyond tolike yo Insurance.
This is not right.
Speaker 2 (23:15):
Oh yeah, we filed right, we filed appeals and
things like that, but one ofthose actually we did not win
because that patient did nothave a BMI that was over 35 for
three years and that was theirrequirement that she had to meet
criteria, not just now, notjust within the time she was in
the program, but for three yearsprior three years.
That's me just, you know thatkind having to jump that kind of
(23:39):
poop and making the poop be inthe stratosphere instead of on
earth.
It's just, it's discrimination,honestly.
I think that that's just plaindiscrimination.
It's not based on science, it'snot based on good patient care,
it's not based on having, youknow, supports that allow people
to live high quality lives andbe present for their families
(24:01):
and their work, and you knoweverything.
Speaker 1 (24:04):
That's just straight up this, this mentality that we
don't want people to access thiscare because we don't believe
it just like medical weight loss, were struggling to get things
approved and Some insurancesallow it, some don't and some
have and decided right not toright at the beginning of the
year.
A lot of patients I've beengetting Forms saying we are not
(24:26):
going to be covering thismedication.
Speaker 2 (24:28):
So Exactly exactly and with a lot of things.
I mean, I do think we touchedon cost a little bit earlier and
you're right, there's a lot ofupfront cost but there's
actually really good.
There was a study that was donea few years ago that that
followed people for years andyears after surgery and it
showed that the return oninvestment was basically
realized in about two to threeyears, right, so what you're
(24:51):
investing now, or what aninsurance company is investing
now, decreases the risk offuture health problems.
There's even one study this iskind of interesting, or actually
, I think, two studies that showthe people's salaries, like
their incomes, go up aftersurgery, which is kind of
interesting, and there's a lotof factors that were like how,
how fascinating, you know,because people's lives change,
(25:13):
not just in what medicationsthey take and like what their
health outcomes are, but waybigger picture than than just
this one, and I can touch basedon the salary thing of if I
didn't have surgery, I wouldhave never stepped out my
comfort zone and applied to be abariatric coordinator, which
was Quite more pay than being arespiratory therapist in my case
(25:36):
.
Speaker 1 (25:37):
So I think people you know having the confidence and
all of that, that's why theirsalaries go up is because
they're willing to step out oftheir comfort zone.
Speaker 2 (25:49):
That's fascinating.
That's so fascinating and Ithink that's that's kind of a
silver lining.
I don't think anybody goes intosurgery saying, oh, I'm gonna
make 20% more neck first, maybewe should maybe that would be a
good way to, you know, promotethis.
Speaker 1 (26:04):
Yeah, but there's just so many silver linings to
this process but that does notmake it easy and that doesn't
make it not have challenges, andthat's, that's the approach
that I wish more peopleunderstand and I want to touch
base on another aspect thatpeople don't think about, and
(26:25):
Sure, if they want to think thatgetting to surgery is easy, but
, like postoperatively, again,you have vitamins that you have
to take every day, guilty offorgetting to take those, you
know can't indulge in thingswhich, mentally, let's talk
about.
Mentally, the yes, anxiety anddepression can get worse.
(26:48):
That's why we Require mentalevaluations, just to make sure
there's no underlining stuffthat can really Come to surface
after surgery.
But me myself, I feel like I amvery self-aware of my anxiety,
my depression.
I'm really good at keying in onthat and, you know, treating it
(27:09):
how I need to.
But that still doesn't takeaway the fact that Some of my
mental health has been a littleworse.
My anxiety has gotten a littleworse and I I think that anxiety
has to do with yeah, do peoplethink that this was the easy way
out and what are they thinkingabout me, like you know.
Speaker 2 (27:30):
So yeah mental health has a big play in the aftermath
and Because you take away thatcomfort of eating when you're
emotional and you got to figureout a new way to cope Right, and
that's a good point, becauseit's sort of it changes so many
things about what is normal inyour life, because your, your
(27:54):
normal, becomes different in allthe way absolutely.
Great.
We've heard people say, and Ithink you've even said like you
run circles around familymembers and that can cause
that's great in some ways, butit can cause some annoyance or,
you know, frustration and somerifts.
What you find to be aninteresting thing to do is
(28:15):
different, because you you'vementioned yourself like going
out more or Wanting to go outmore, and that sometimes isn't
what everybody else in thefamily Expects or wants to do,
yeah, yeah.
Speaker 1 (28:24):
My husband, you know we've always gone out, but he
said he never expected that Iwould do just a complete 180.
And how I used to say, no, Idon't want to go out anymore, I
can't find anything to wear, orjust didn't feel in the mood to
go out Probably anxiety,depression.
And now I'm just like, yes,let's go out, let's go out,
(28:47):
let's go out.
And so that's a relationshipchange that we're.
We are Figuring out as wellthat we are navigating and
absolutely it's not easy.
Speaker 2 (29:01):
And would you say that it was easy to meet all of
the expectations that you had,or even know what to expect for
after surgery?
Speaker 1 (29:12):
You have no idea what to expect after surgery,
because everybody's different,right?
People always ask me what wasyour pain level?
What level, like all the thingsthat I'm like?
Well, here was my experiencebut you could have a totally
different experience.
Speaker 2 (29:31):
Right, exactly.
Yeah, because you're absolutelyright.
There's a few things that arestandard for everyone.
Like you said, there's vitamins.
You have to drink 64 ounces offluids a day.
We want you to stay activeevery day, like there's some
basic tenants that apply toeveryone, but how people
experience everything is goingto be unique, absolutely.
Speaker 1 (29:50):
And how much weight you lose, how it looks coming
off.
And that's another thing.
That's not easy is looking atyour body.
So looking at my body obese, itwas hard, but I feel like now
it's almost harder because ofloose skin and stuff like that.
Speaker 2 (30:10):
So a lot of mental it's just a lot of mental, a lot
of mental, a lot of physicalchanges and changes are never
easy, especially all at once,and it is that way, isn't it?
It's kind of like drinking froma fountain.
Speaker 1 (30:27):
Yeah, hmm.
Speaker 2 (30:30):
Well, you know, I do want to just say that I really
do wish that we had easier waysfor people to do well after
surgery.
Even in the current state, Iwish there were easier ways to
treat and help people thatweren't surgery, and I think
(30:51):
we're starting to see a lot moremovement in that area and I'm
really, really proud to becreating some things with you,
tammy, and you leading the wayto creating some things that
really support people aftersurgery, because I think this is
a way that we make people'slives just a little bit easier.
Speaker 1 (31:12):
Absolutely, absolutely, because having
people in your court makes lifebetter, definitely.
And people that understand andtruly are not judging you, and
you know that for a fact.
So I'm selfishly doing this.
We're building this communityfor me so I can have friends.
Speaker 2 (31:34):
No, oh my gosh, I love it, but also for me, I feel
kind of selfish about this too,because these are the kinds of
things that make it so rewardingto see people do well and to
see people really thrive and beable to do all the fantastic
things that they walk in wantingat the end of the day, all the
goals and things like that, andlong term, it's really really
(31:56):
hard to do on your own, and somaybe creating some easy paths
for people that would be cool.
That would be great.
Speaker 1 (32:05):
Add another thing to the list, right.
Speaker 2 (32:08):
Right.
Well, thank you so much forbeing willing to talk to me
today team about this, because Iknow the easy way is something
we have talked about a lot andis out in the world as a
discussion point for BariatricSurgery a lot.
But I'm glad we kind of tackledthis and hopefully have helped
other folks just feel maybe alittle better, a little easier
(32:29):
today.
How about?
Speaker 1 (32:30):
their decision, absolutely so make sure.
Thank you all for listening,make sure you follow our podcast
here so you get notified thatwe uploaded another episode.
And again, feel free to leavecomments to let us know what you
want to hear, what you want totalk about, because we are
listening.
This is not only my platform tohelp other people, but your
(32:56):
platform to tell us how we canhelp you.
Speaker 2 (33:00):
That's right.
Thanks so much, guys, see younext time.
Bye.
Welcome to Core Bariatrics podcast, hosted by
bariatric surgeon Dr MariaIliakova and Tammie Lakose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatric podcast doesnot offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Tammie, you know what I wish wehad.
What do you wish we had?
I wish we had an easy way.
Speaker 2 (00:33):
You know why why?
Speaker 1 (00:35):
Because we'd use it For sure, for sure, and we'd be
millionaires.
Speaker 2 (00:40):
Billionaires, yes, and we'd be billionaires,
billionaires, maybe eventrillionaires.
But seriously, don't you thinkit'd be great if we had an easy
way?
Speaker 1 (00:48):
Yes, 100%.
Speaker 2 (00:51):
So when people say surgery, well, that's the easy
way out, what do you think?
Speaker 1 (00:55):
about that.
Do you think people have notbeen through this process and do
not understand actually howhard it is?
Speaker 2 (01:01):
You're absolutely right.
I think that's true.
It drives me crazy sometimes tohear that people think that
surgery getting cut on and goingthrough the whole process is
easy.
Would anybody ever say thatabout a different process?
Speaker 1 (01:15):
Oh, probably not Absolutely, and it infuriates me
100% after going through thisprocess.
Speaker 2 (01:24):
Yeah, exactly.
So if we had an easy way, Ipromise we would take it, I
promise.
I wouldn't put people throughsurgery if I had an easier way
for people to manage theirweight and get all the benefit
out of it.
But you know what?
Speaker 1 (01:39):
What.
Speaker 2 (01:40):
There sometimes isn't one.
Speaker 1 (01:41):
No no.
Speaker 2 (01:43):
No, yeah, and here's the thing that really this makes
me think of.
Let's think of some things thataren't easy, like getting on
Google and looking for somethingthat you want to buy, or
grabbing your iPhone or yourAndroid and using a map on there
, or something like that.
Yeah, finding directions Supereasy.
(02:04):
At this point, we can evenremember using paper maps to get
around.
Speaker 1 (02:09):
I do not, but yes, right.
Speaker 2 (02:13):
Well, maybe I'm aging myself a little bit, but when I
was a kid, I remember mygrandpa cranking out their maps
and that's how we would get fromplace to place and his is suzu,
which is the company thatdoesn't exist anymore, but
anyway, so that's what I mean is, if we had a way to do what
Google does or what map systemsdo, or any of these things, I
promise we would use them, butwe don't have Right, right, no,
(02:39):
so that's what we're going totalk about today is that surgery
is not so much of an easy way.
If I had an easy way, I wouldtotally use it and everybody
would totally get it.
Speaker 1 (02:51):
Absolutely.
Speaker 2 (02:53):
No.
So, Tammie, can you explain tome a little bit about why
surgery isn't necessarily theeasy way to manage weight?
Speaker 1 (03:03):
Well, for one.
For the rest of my life I amgoing to have this stigma on me
of you had bariatric surgery andyou took the easy way out.
Mentally that takes a toll onsomeone, and so me personally, I
don't mind, I'm strong enoughto handle that.
I will tell someone on thestreet that I don't even know
(03:25):
I've had bariatric surgery andI'm proud of that.
So I'm willing to open up thatconversation where some people
might not be able to handle thatjudgment.
So hopefully we can get awayfrom that.
But as of right now, not aneasy way out because, guess what
?
You're going to deal with thatmental aspect forever.
Speaker 2 (03:48):
Of other people judging you.
It sounds like of other peoplehaving an opinion about what you
did.
Speaker 1 (03:52):
Oh, absolutely, Even if they say they don't have an
opinion you can most people cansee right through your bull crap
.
Speaker 2 (04:00):
I see.
So even if people are sayingthat you're feeling like they're
judging or they're having anopinion, they're just not
necessarily expressing itAbsolutely, absolutely, and I
think everybody that has hadbariatric surgery has felt that
feeling and why do you thinkthat is?
Why do you think that otherpeople sort of interject an
opinion on this specific kind oftreatment?
(04:22):
Because it's not like we haveopinions about people having,
like, their gallbladders takenout or a hernia surgery, or if
someone needs some kind oforthopedic surgery for their
bones or something.
But why do you think this isdifferent?
Speaker 1 (04:35):
Well, I want to touch , based on the whole orthopedic
thing that you just brought up,because, look, a person could
live with their pain, their lackof mobility right, they could,
but there is a surgery to helpthat.
So you're absolutely right.
Why is bariatric surgeryconsidered the easy way out,
(04:55):
when it gives you the tools, itgives you the opportunity to
live a better life, where, ifsomeone has a hip replacement
and even gets metal put in theirbody, their knee, whatever, why
is that same judgment not there, especially, you know.
Speaker 2 (05:14):
That's a broken good point.
I really never thought of that,because, you're right,
something like a hip replacementor a knee replacement or a
scope or something like that isa quality of life surgery, right
.
You do it so that you can movebetter, so that your knees hurt
less, your hips hurt less, andlots of people go through that,
absolutely Right.
Athletes go through them.
A lot of older people gothrough them through normal wear
and tear, and it's not like wehave a judgment call to say, oh
(05:36):
my gosh, you took the easy wayout.
We took it in Absolutely.
Speaker 1 (05:42):
And the healthiest person that who isn't obese or
has always eaten, drank theirmilk, right, right.
There's no way to predict if aperson is gonna need a hip
surgery, a knee replacement.
There's nothing that they couldhave done differently to
prevent most cases to need thosethings Right.
Speaker 2 (06:05):
Right, that's such a good point.
I really have never thought ofit that way and that's a good
analogy.
Speaker 1 (06:10):
But to answer your question, about why I think
people do have that judgment orthat thought is honestly being
uneducated.
Being uneducated, that likewhat the surgery entails.
What kind of lifestyle doesthis make a person have?
Because, guess what, you can'tput a person's stomach back,
(06:32):
right, right?
Speaker 2 (06:34):
Well, and that's a good point, because I think a
lot of people think of it aseither or Like you have surgery
and it's a magic bullet and allof a sudden, weight is not a
problem for you anymore and it'salways fit for forever, right,
like?
How many people say that?
Even sometimes people who walkin and expect.
Speaker 1 (06:47):
Absolutely that happens.
Speaker 2 (06:48):
Come on, guys, as the rest of you do your best, and
it's not an either or approach,it's very much a end, it's an
end, so it's a half surgery, butthere's I mean, you went
through the process.
There's so much education inpreparation to make sure that
people know how to take care ofthemselves and their bodies
Afterwards, and that's alifelong commitment.
Speaker 1 (07:07):
Absolutely, and so, as I told you previously that,
as Educated as I truly am, Istill Was learning things about
this surgery that again made merealize, nope, this isn't
necessarily the easy way out.
This is the way that I had totake To get to where I felt
(07:28):
better, and so the point thatI'm getting to is that, like the
sleeve, surgery is not arestrictive, just Restricted
right to get you fuller fasterand all of that that there's
actually metabolic and hormonalchanges happening.
That Helps something that Icouldn't help.
Speaker 2 (07:49):
Oh, yeah, absolutely, because there's only so much
that diet and exercise can do ormedications can do, which is
why surgery is ultimately somuch more effective for most
people who have extra weight,and that's that's kind of the
stereotype that we really haveto break is.
A lot of people who aren't inmedicine, but even a lot of
people who are, think of surgeryas like a cheat code because it
(08:14):
fast-forward the processor andachieves more.
But that's kind of the point,exactly more effective.
It's a more effective treatmentand we shouldn't punish people
for using a more effectivetreatment.
It's sort of like yeah, you'reright Like if you had knee pain
or something like that and youcould either use a brace or you
could get surgery.
Sometimes a brace isn't enough,or sometimes physical therapy
(08:34):
isn't enough, so you progress tohaving surgery and then surgery
can definitely be enough forsome people to treat their pain
or to treat their Immobility orother problems.
Yeah, yeah, and I definitelythink of this kind of surgery as
the same, it's not for everyone, but for the people who can
benefit from it it's a massivechange that can't be
(08:55):
Accomplished any other way.
There's no other way to resetthat thermostat through
medications or without surgery,absolutely.
Do you think that there's anelement of fear involved in how
people perceive this and inpeople thinking that this is the
easy way?
Speaker 1 (09:11):
Absolutely so.
I think that some people andI'm gonna say from experience I
was very on a uneducatedjudgmental.
I was Tammie shame on you I wasnot very confident, whatever,
whatever, I had that samejudgment at some point, and so
(09:32):
there is yes, I think fear has alot to do with it that, um,
someone is going to fear thatthere, they may not make it out
of surgery, be, they're going tohave issues.
Speaker 2 (09:49):
And judgment.
Speaker 1 (09:51):
Right and right that they're gonna have to change.
Speaker 2 (09:56):
Yeah, yeah, because there's definitely an
accountability aspect to this.
Right, because it's sort oflike I Don't know if you get a
gym membership or something likethat and if you don't go, it's
like whatever.
But if you do something thatalters your body, like
Physically changes your body andputs you at some level of risk,
potentially right, becausethese things can have
complications associated withthem.
(10:18):
Sometimes it's a totallydifferent level of commitment
and it's not reversible, right,like you can go back and, like
you said, put, put that stomachback in.
Right, who are?
I knew a bypass, really.
There's not really a good wayto do that or a safe way to do
that.
So, yeah, you're right, theseare not reversible changes,
they're not things you can gotake back if you don't feel like
(10:39):
it later on.
Speaker 1 (10:40):
Yeah, yeah, and so I just think that People that are
thinking this is the easy wayout truly just aren't educated
on the whole Whole process andwhy people do this.
Maybe they're scared of theydon't want to have that judgment
on them or scared of surgery.
Speaker 2 (10:58):
Yeah, yeah yeah, I would you're if also kind of
cost is associated with this too, because a lot I mean you're,
you're a coordinator of theprogram and You've seen this
there's people who don't qualifybased on their health insurance
, or they don't have healthinsurance that covers this, even
if they would normally qualifyunder guidelines and things like
(11:19):
that.
So do you think that cost is anelement here too, and how
people perceive this?
Speaker 1 (11:24):
Yeah, and that costs not even for surgery but cost
post-op.
Right, there's a little.
Oh, that I feel like there is alittle extra cost there because
you are gonna have to takevitamins and stuff.
But yeah, this surgery, like inour program, you see us minimum
of four times.
And each of those office visitsare probably $300, and then you
(11:48):
also see a dietitian.
That is another hundred dollarsor so just giving up roundabout
price.
I don't know the exact price,but so right, with very that
times four.
And Then we usually require ascope, which is a whole
procedure in itself.
And then we may require you tosee a sleep specialist, get a
sleep study, see a pulmonologist, so, and also mental health
(12:12):
evals, and some insurances donot cover these mental health
evals.
So, that's an autopilot pocketcost as well.
So there's a lot of costpreoperatively alone and not
everybody can afford that.
Speaker 2 (12:28):
Yeah, I wonder if that is a big element here,
because the more we talk aboutit, I think, the more it becomes
obvious.
This is kind of the hard way.
That's a easy way.
Yeah good, like you're sayingit's.
There's cost associated,there's time, there's
preparation, there's potentiallymaking yourself vulnerable
because you're undergoing a lotof scrutiny.
(12:49):
Really, you're being put undera magnifying glass through this
process quite a bit and I wonderif some of this Thought that
this is the easy way is kind ofa defense mechanism so that
people don't have to considerthis option or so that people
like really can, can make it outto be more negative than it is.
Speaker 1 (13:06):
Yeah, I think you're.
You're totally onto somethingbecause, as I've said in the
past, that I have been anegative person and now looking
at being or I'm positive, morepositive, you know, looking back
, absolutely I was a negativeperson and shed negatives Right
(13:28):
Light on surgery per se.
Speaker 2 (13:31):
Right.
Right, because it's kind ofeasy to poo-poo something and
then, as a result, be not, youknow, not encouraging of other
people about it.
And it's easy to poo-poo thingsyou don't know Right, and
typically that happens it's outof misunderstanding or fear, or.
But I will say one thing I doactually think that it is
important to know and be reallytransparent about the fact that
(13:53):
these procedures do have riskassociated with them, and that's
one another reason that they'renot really the easy way out by
any means, because both sleevesand bypasses, and then the other
kinds of surgeries, even bands,which aren't done very often
anymore but are still donesometimes.
Well, actually, the reason thatthey're not done very more is,
one, they didn't work.
They don't work as well asother surgeries.
(14:14):
But two, they actually havehigher complication rates.
So bands, for instance, canslip, bars can get into the
tissue of the stomach or theesophagus, the tube that's
between the mouth and thestomach, and can cause really
bad problems if that's the case.
And so, yeah, like, all ofthese procedures require people
to go under the knife right andfleet for surgery, have
(14:37):
anesthesia and have recoveryperiods and all of that.
And actually bariatricsurgeries are some of the safest
surgeries in all of thesurgical field, because there's
so many rules and regulationsand standards and all of that,
which is good, but at the sametime it's still surgery,
absolutely Right.
Yes, still something thateither can have a complication
(14:59):
but at a minimum is something wecan't go back and undo after
it's done Exactly Yep, and so Ikind of want to.
Speaker 1 (15:07):
This popped in my head too, because I myself have
like ADHD and people with thatare medicated for ADHD.
Again, some people look at itas the easy way out, or even
medicating children.
Again, this is all parents,whatever you want to do, for I
shouldn't even have brought kidsinto this, but some people may
(15:29):
look at me and be like, wow,you're taking the easy way out
of your ADHD.
There's a ton of things thatyou can do to prevent some of
your sporadic brain or whateveryou want to say, but at the end
of the day, there is a chemicalimbalance in my brain that sure
I can do things to ease some ofthe symptoms, but there's
(15:54):
nothing that'll help me as wellas my medication does.
So, again, that's a really goodpoint.
Dying and exercise can helpAbsolutely, but at the end of
the day, for most people it'snot the end of the wall.
Speaker 2 (16:09):
Yeah.
Yeah that's so true Because,right, it's not an either or and
that's the tough part I thinkabout everything is a man.
Believe me, if I had a pill forthis, if I had a way to wave a
magic wand or a magic pill, ohmy goodness, would we use it,
right?
The hard reality of it is, andthe reason why I say that is
(16:31):
because I personally and I thinkyou agree too I don't have any
morality tied up with weight.
I don't think it's amorality-based problem.
I don't think people did it tothemselves and I just don't
believe that, and science backsthat up.
So if we had an easy way totreat this and to manage this
(16:51):
that avoided all of these riskythings that could be risky, why
wouldn't we?
You know what I mean.
That's the thing that reallystrikes me sometimes is why do
we want this process to be hard?
Yeah, right, what does that sayabout us as individuals or us
as a society?
That we want the process to bedifficult?
That doesn't make any sense tome.
(17:12):
It doesn't.
Speaker 1 (17:15):
It's just like I've had people say an epidole for
having a baby.
Even my doctor is like look,yes, there's risk to that right,
there's risk to surgery,there's risk to an epidural,
there's risk to everything youdo, but why not suffer?
Speaker 2 (17:39):
Yeah, why suffer if you don't have to?
And that's again personalchoice there.
People can have any kind ofbirthday watch or any kind of
you know, like that's nobody'schoice but theirs.
But to say that somebodydeserves to have a more
difficult time of it than theywant to, or that they have to,
like that's just.
I don't understand why we wantto punish people because it
(17:59):
feels sometimes certainly beinga provider in this field that we
expect people to be punishedfor their rights or punished for
the ways that we treat them.
And that, to me, is really thething that bugs me about this
approach that we make peoplefull guilty for whatever choice
(18:20):
they make and there's no rightchoice they can possibly make.
Speaker 1 (18:23):
Right, and nobody else should have a say in what
choice or an opinion about whichchoice you make.
Speaker 2 (18:31):
Exactly, exactly, exactly.
So that's anyway.
I really hope that that issomething that more people here,
that we have more providershere, because this same approach
is just as bad from people whoprovide medical care as it is
(18:51):
from people who receive thisaffair.
Speaker 1 (18:53):
Absolutely.
When I told my primary caredoctor that I needed his notes
for insurance purposes, that wehave tried, you know, wait, you
know other things.
He's kind of like, are you surethat's what you want to do?
But I think at the end of theday he's just not as educated
about this specific specialty,Right?
Speaker 2 (19:16):
Right, right, and I don't think there's any shame in
that.
This is a field that's prettynew.
You know all things told.
The bypass surgery has existedfor decades, but it was actually
used as an anti-reflex surgerybefore it was used as a weight
management surgery.
So that switched because peoplewere getting it done to prevent
ulcers and they were getting itdone for reflux and heartburn
(19:38):
basically.
And then I was noticed thatpeople were losing weight and
that became an indication fordoing a bypass by insurance
codes and things like that.
But the sleeve surgery, wherewe take out about 70 to 80% of
the stomach, didn't actually getapproved as a bariatric surgery
until 2011 by the firstinsurance company.
So it's really not that old ofa procedure in terms of like
(20:01):
insurance coverage or even beingavailable for people for the
purpose of weight management.
So the industry is definitelycatching up still a lot, because
anyone who was trained beforethat time really didn't have
exposure to bariatric surgerybeing an option for people.
And even the ways that we dothese surgeries has really,
(20:23):
really changed and the way thatwe support people, educate
people all of that, what we knowabout these surgeries and how
they work, has changed reallydrastically over the past 10, 20
years and a lot of the, likeyou said, there's still a lot of
skepticism from primary care,from other surgeons, from
cardiologists, from everyone.
(20:46):
Really, I don't think it's anyone particular feel.
Speaker 1 (20:50):
Right, and I think this is again just the beginning
of education and support, likebuilding all of those things.
We can only get better.
We can only educate more.
Speaker 2 (21:02):
Exactly, exactly, exactly.
Yeah, because I think thatthere's kind of like a couple of
things here that we're hittingon One, which is you know, if
there were an easy way, whywouldn't?
Speaker 1 (21:13):
we.
Speaker 2 (21:14):
And that's very truly .
Why wouldn't we?
Right?
And two, you know there'sdefinitely reasons that people
either don't think of bariatricsurgery as an option or have
built-in preconceived notions ofit or judgments of it, and so
trying to sort of break thosedown person by person or by crew
(21:35):
, Absolutely yeah, and so, yeah,you touched base on time.
Speaker 1 (21:40):
I mean, I had to be in the program for six months.
That is one appointment a month.
Each appointment is about anhour or so long and that's if
your provider is running on timeand not chatting too much,
Right?
Or if you even you can justknow you're running usually on
time, or even if you a lot ofthe time, me and the dietitian.
(22:03):
Really I had a lot of questionsand there's just not enough
time.
But my insurance required sixmonths.
Some insurances required 12months.
Some insurances require 36months of documented obesity or
trying to help lose weight.
(22:25):
All of that so yeah.
Speaker 2 (22:28):
Yeah, we actually had .
I think you were involved withboth of those patients, but we
had two patients this year thatwere denied their surgeries
because Initially there wasn'tdocumentation going back three
years, and it wasn't just threeyears of documentation.
The insurance company wantedphotos and documented notes from
that per those.
Those individuals had to haveprimary care notes as well and
(22:52):
I'm like who on earth goes totheir primary care doctor at
this point, like once a year, ona regular basis?
Who provides Photos in thatdocumentation?
We don't take photos in ourdocumentation on a regular basis
.
I was like what?
Speaker 1 (23:05):
Yeah, that was.
That was crazy.
That's required.
That was crazy and we did.
We went above and beyond tolike yo Insurance.
This is not right.
Speaker 2 (23:15):
Oh yeah, we filed right, we filed appeals and
things like that, but one ofthose actually we did not win
because that patient did nothave a BMI that was over 35 for
three years and that was theirrequirement that she had to meet
criteria, not just now, notjust within the time she was in
the program, but for three yearsprior three years.
That's me just, you know thatkind having to jump that kind of
(23:39):
poop and making the poop be inthe stratosphere instead of on
earth.
It's just, it's discrimination,honestly.
I think that that's just plaindiscrimination.
It's not based on science, it'snot based on good patient care,
it's not based on having, youknow, supports that allow people
to live high quality lives andbe present for their families
(24:01):
and their work, and you knoweverything.
Speaker 1 (24:04):
That's just straight up this, this mentality that we
don't want people to access thiscare because we don't believe
it just like medical weight loss, were struggling to get things
approved and Some insurancesallow it, some don't and some
have and decided right not toright at the beginning of the
year.
A lot of patients I've beengetting Forms saying we are not
(24:26):
going to be covering thismedication.
Speaker 2 (24:28):
So Exactly exactly and with a lot of things.
I mean, I do think we touchedon cost a little bit earlier and
you're right, there's a lot ofupfront cost but there's
actually really good.
There was a study that was donea few years ago that that
followed people for years andyears after surgery and it
showed that the return oninvestment was basically
realized in about two to threeyears, right, so what you're
(24:51):
investing now, or what aninsurance company is investing
now, decreases the risk offuture health problems.
There's even one study this iskind of interesting, or actually
, I think, two studies that showthe people's salaries, like
their incomes, go up aftersurgery, which is kind of
interesting, and there's a lotof factors that were like how,
how fascinating, you know,because people's lives change,
(25:13):
not just in what medicationsthey take and like what their
health outcomes are, but waybigger picture than than just
this one, and I can touch basedon the salary thing of if I
didn't have surgery, I wouldhave never stepped out my
comfort zone and applied to be abariatric coordinator, which
was Quite more pay than being arespiratory therapist in my case
(25:36):
.
Speaker 1 (25:37):
So I think people you know having the confidence and
all of that, that's why theirsalaries go up is because
they're willing to step out oftheir comfort zone.
Speaker 2 (25:49):
That's fascinating.
That's so fascinating and Ithink that's that's kind of a
silver lining.
I don't think anybody goes intosurgery saying, oh, I'm gonna
make 20% more neck first, maybewe should maybe that would be a
good way to, you know, promotethis.
Speaker 1 (26:04):
Yeah, but there's just so many silver linings to
this process but that does notmake it easy and that doesn't
make it not have challenges, andthat's, that's the approach
that I wish more peopleunderstand and I want to touch
base on another aspect thatpeople don't think about, and
(26:25):
Sure, if they want to think thatgetting to surgery is easy, but
, like postoperatively, again,you have vitamins that you have
to take every day, guilty offorgetting to take those, you
know can't indulge in thingswhich, mentally, let's talk
about.
Mentally, the yes, anxiety anddepression can get worse.
(26:48):
That's why we Require mentalevaluations, just to make sure
there's no underlining stuffthat can really Come to surface
after surgery.
But me myself, I feel like I amvery self-aware of my anxiety,
my depression.
I'm really good at keying in onthat and, you know, treating it
(27:09):
how I need to.
But that still doesn't takeaway the fact that Some of my
mental health has been a littleworse.
My anxiety has gotten a littleworse and I I think that anxiety
has to do with yeah, do peoplethink that this was the easy way
out and what are they thinkingabout me, like you know.
Speaker 2 (27:30):
So yeah mental health has a big play in the aftermath
and Because you take away thatcomfort of eating when you're
emotional and you got to figureout a new way to cope Right, and
that's a good point, becauseit's sort of it changes so many
things about what is normal inyour life, because your, your
(27:54):
normal, becomes different in allthe way absolutely.
Great.
We've heard people say, and Ithink you've even said like you
run circles around familymembers and that can cause
that's great in some ways, butit can cause some annoyance or,
you know, frustration and somerifts.
What you find to be aninteresting thing to do is
(28:15):
different, because you you'vementioned yourself like going
out more or Wanting to go outmore, and that sometimes isn't
what everybody else in thefamily Expects or wants to do,
yeah, yeah.
Speaker 1 (28:24):
My husband, you know we've always gone out, but he
said he never expected that Iwould do just a complete 180.
And how I used to say, no, Idon't want to go out anymore, I
can't find anything to wear, orjust didn't feel in the mood to
go out Probably anxiety,depression.
And now I'm just like, yes,let's go out, let's go out,
(28:47):
let's go out.
And so that's a relationshipchange that we're.
We are Figuring out as wellthat we are navigating and
absolutely it's not easy.
Speaker 2 (29:01):
And would you say that it was easy to meet all of
the expectations that you had,or even know what to expect for
after surgery?
Speaker 1 (29:12):
You have no idea what to expect after surgery,
because everybody's different,right?
People always ask me what wasyour pain level?
What level, like all the thingsthat I'm like?
Well, here was my experiencebut you could have a totally
different experience.
Speaker 2 (29:31):
Right, exactly.
Yeah, because you're absolutelyright.
There's a few things that arestandard for everyone.
Like you said, there's vitamins.
You have to drink 64 ounces offluids a day.
We want you to stay activeevery day, like there's some
basic tenants that apply toeveryone, but how people
experience everything is goingto be unique, absolutely.
Speaker 1 (29:50):
And how much weight you lose, how it looks coming
off.
And that's another thing.
That's not easy is looking atyour body.
So looking at my body obese, itwas hard, but I feel like now
it's almost harder because ofloose skin and stuff like that.
Speaker 2 (30:10):
So a lot of mental it's just a lot of mental, a lot
of mental, a lot of physicalchanges and changes are never
easy, especially all at once,and it is that way, isn't it?
It's kind of like drinking froma fountain.
Speaker 1 (30:27):
Yeah, hmm.
Speaker 2 (30:30):
Well, you know, I do want to just say that I really
do wish that we had easier waysfor people to do well after
surgery.
Even in the current state, Iwish there were easier ways to
treat and help people thatweren't surgery, and I think
(30:51):
we're starting to see a lot moremovement in that area and I'm
really, really proud to becreating some things with you,
tammy, and you leading the wayto creating some things that
really support people aftersurgery, because I think this is
a way that we make people'slives just a little bit easier.
Speaker 1 (31:12):
Absolutely, absolutely, because having
people in your court makes lifebetter, definitely.
And people that understand andtruly are not judging you, and
you know that for a fact.
So I'm selfishly doing this.
We're building this communityfor me so I can have friends.
Speaker 2 (31:34):
No, oh my gosh, I love it, but also for me, I feel
kind of selfish about this too,because these are the kinds of
things that make it so rewardingto see people do well and to
see people really thrive and beable to do all the fantastic
things that they walk in wantingat the end of the day, all the
goals and things like that, andlong term, it's really really
(31:56):
hard to do on your own, and somaybe creating some easy paths
for people that would be cool.
That would be great.
Speaker 1 (32:05):
Add another thing to the list, right.
Speaker 2 (32:08):
Right.
Well, thank you so much forbeing willing to talk to me
today team about this, because Iknow the easy way is something
we have talked about a lot andis out in the world as a
discussion point for BariatricSurgery a lot.
But I'm glad we kind of tackledthis and hopefully have helped
other folks just feel maybe alittle better, a little easier
(32:29):
today.
How about?
Speaker 1 (32:30):
their decision, absolutely so make sure.
Thank you all for listening,make sure you follow our podcast
here so you get notified thatwe uploaded another episode.
And again, feel free to leavecomments to let us know what you
want to hear, what you want totalk about, because we are
listening.
This is not only my platform tohelp other people, but your
(32:56):
platform to tell us how we canhelp you.
Speaker 2 (33:00):
That's right.
Thanks so much, guys, see younext time.
Bye.
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