natural treatment for the disease naturally hernia

(music playing) hello, i'm dr. robert chastanet. i am a private practice weight loss surgeon. my company is chesapeake weight loss consultants. i work through the bon secours system, and operate at maryview medical center. today, i'd like to talk aboutthe surgical treatment of obesity. obesity is a chronic disease of life threatening, it's costly, genetically relatedand let's make no mistakes about it.

everything we do here in this officeis to treat your medical problems. this is not to get people skinny to put you in a bikini. this is to make you healthy and what we'll learn is actually live longer and make many of your medical problems go away. one thing i like to explain to people is when people get heavy, and they develop extra fat. it's not just skin deep. it involves all the organs of your body. around your neck. around your heart. in your liver.

and when these areas get full of fat, the body doesn't work as well as it should. and then people start to get medical problems. so, let's continue on. when we talk about surgical treatment of obesity, we talk about what's called a body mass index. now on the screen here you cansee this is how you calculate it. a much easier way is just togoogle bmi. body mass index. and that will spit out a number.normal is between 18 1/2 and 25.

overweight is 25 to 30 and anything over 30 is considered obese. in america, only one third of a people are actually normal weight now. one third are overweight and a full one third of people are now obese. and it is that last category, people that are obese, that would be candidates for weight loss surgery. and in fact, your bmi must be between 35 and 40. associated with one medicalproblem to be a candidate for surgery.

if it is over 40 you don't even have tohave a medical problem to have surgery. what this next slide shows, and what i'm gonna explain to you is that when people get heavy they actually die at a younger age. in fact, someone who is age 25 to 40 actually dies much, much sooner than someone who is not. the number i remember is a20-year-old man with a bmi over 40 will die at an average 12 yearssooner than his younger counterpart. so, we're not actually just making you healthier.

we're actually helping you live longer. and this chart also shows as you are in the normal range your risk of dying is low. but, as you get heavier, your risk of dying from all the medical problems that develop, goes up dramatically. this list shows a partial list actually of all the medical problems that develop once you get heavy. such as sleep apnea. high blood pressure.

diabetes. high fat. cholesterol. infertility in young women. heart disease. something we call urinary stress incontinence. if you laugh, sneeze and cough, and you lose some urine. that is not the normal part of aging. that can be made much better if you reduce your weight. acid reflux. cancer. we actually know that there are several cancers, especially breast, uterine and colon cancer

that increases as you get heavier. this is something we didn't even know when i was in medical school many years ago. but, in fact these cancers areat a lesser rate once you lose weight. so, why do we lose weight? well, of course it is to improve your health. to make your medical problems go away. and you must balance the risk of surgery verses the risk of not having surgery.

at maryview, we are a center of excellence. and what that means is that we have all the specialists at the hospital. in the operating room. special furniture. special equipment to take the best care of you. and the national institutes of health, back in 1991, they're the one who set the criteria who were candidates for surgery. and as a center of excellence, we follow all their guidelines. specifically, if your bmi is between 35 and 40.

you have to have one major medical problem related to your weight, such as diabetes, high blood pressure or sleep apnea. if your bmi is over 40 you don'thave to have any medical problems at all. who are candidates for surgical weight loss through the bon secours system? well, you have to meet the bmi criteria. you have to quit smoking. because we now know that peoplewho smoke have a much, much higher risk of medical complications and problems after surgery.

you have to have a be dedicated to a lifestyle that is healthy afterward. and a lot of this we will teach you ahead of time. i use the nutritionists. the registered dieticians through the bon secours system to teach you before surgery how to eat properly. how to read labels. and this helps ensure the proper success afterward. i would like to speak to youabout the three different surgical options.

and all of these are available through the bon secours system that i perform. everything is done laparoscopically. what that means is, instead of having a big up and down incision like they use to do in the past. everything is done minimally invasive through small holes. the advantage of that is less pain. less likely to get infection. less likely to get hernias.

now-a-days this is how all bariatric surgery is done. and the three options that we have are what we call the band, the laparoscopic sleeve and thelaparoscopic roux-en-y gastric bypass. all three of these options work. such as we alter your anatomy soyou cannot eat as much as you could before. you can eat a smaller amount. the sleeve and the gastric bypass, in addition, change the internal hormones that are made by the stomach and intestines.

so, it resets the set point in your brain when you become hungry. so, people with the sleeve and the gastric bypass, they are not as hungry afterward. now, in time your appetite will come back a little bit. but, it's never quite as strong as it was before surgery. and so, all operations work restrictive. but, in addition, the sleeve and the gastric bypass have a hormonal component.

the gastric bypass also has a small mal-absorptive component. meaning that as the food goes through you, you don't quite absorb all the calories. this chart shows the breakdown of the operations over time. and as the years gone by, the gastric band has kind of fallen out of favor now. less than 10% of the operations done in this country are the band. and it partly because the band does not have the hormonal effects as the other operations.

and the weight loss is not as predictable, nor as good as the other two. the sleeve actually has supplanted the gastric bypass as the number one weight loss surgery in this country. but, let me just start here talking about the band. the band was first started in europe in 1985. it was approved here in america in 2001. and the way the band works,it's nothing more than a glorified balloon that is put around the very top part of the stomach.

it is connected to this tube that goes through this port that is under your skin. you will not see the port, but you can feel it. and what happens is after the surgery, six weeks later you come into the office here. and using a special needle through your skin, i inject saline into this port. it goes around this band and it tightens up the band. so, it's actually no bigger

the opening is no bigger than a pencil. so, when you eat your food it goes into this little pouch. it stretches the pouch. that sends signal to your brain. causing you to not be hungry and not to eat as much. the food then must slowly trickle through this opening into your stomach. the problem with the band, quite frankly, is that if you do not chew your food well, and eat very, very slowly,

people have problems with their band. they can have nausea, vomiting. if you eat a salad with a small piece of carrot. and you don't chew it well, you're gonna vomit that up. so, that's one of the reasons why people have steered away from the band in recent years. when we talk about weight loss surgery we also talk something what we call an excess weight loss. so, where you start at with your normal weight.

and then your ideal body weight, that difference is called your excess body weight. now, with the band in the first year afterward, you would expect to lose about a third of that weight loss difference. the next year it might go to 40. and then it tops off at about 45%. very people lose more with the band. we'll see with the other operations

the weight loss is generally much greater. the next operation i want to explain to you is this sleeve gastrectomy. and this is now the number one operation for at least the last two years in this country. this operation is different. there is no implantable plastic parts. what this does is we actually make a cut, cut, cut, cut, cut. and we remove this big part of your stomach.

so, your stomach, instead of being the size of a coke, liter bottle of a coke, it's now like the shape of a banana, much, much smaller. so, people can't eat as much. and they feel full much quicker. what we've actually learned now-a-days is that this big part of your stomach here makes a hormone called ghrelin. ghrelin is the only known hormone that actually makes you hungry. so, after this operation, people just don't have an appetite.

so, they eat far less. in time, your appetite will come back a little bit. but, it's never quite as great as it was ahead of time. so, with this operation most people in the first year, year and a half, will lose about 75% of the difference of your excess weight. now in time, because that stomach tube grows and stretches, people can eat a little more.

so, there's a little bit more weight regain with the sleeve. and in my hands most people average off at about 60% of their excess weight loss. this a good operation becauseif you do not have any implantable plastic parts, it does not alter your digestion downstream. so, there's not malabsorption associated with this. after the first month i allowmy patients to go back to regular pills. and all the regular medications. now, the next operation is the gastric bypass.

we have been doing this operation since the late 1960s. initially it was done through a big open operation. now-a-days it's all done laparoscopically. the gastric bypass is different in that you eat your food. it goes into a small pouch that is no bigger than an egg. we cut across the stomach just like it's shown here. and then downstream i cut across your intestines. i turn this on the side. this gets hooked here. then the tip of my finger, so to speak,

gets hooked up to the very proximal stomach. so, was you eat the food goes into this little pouch. it then goes down this way into your intestines. that small little pouch does get bigger and stretch with time. eventually, most people can eat a small meal like the size of a lean cuisine type of meal. what you will be taught, and what you're gonna hear, over and over, is that when you eat your food after any of these operations you must eat your protein first.

so, you chicken, your fish, your eggs, your cheese. you eat that first. at thanksgiving, you don't fill upon mashed potatoes and green beans. you have to eat your chicken and your turkey first. the food then will trickle downthis way and go into your intestines. now, this operation, you would expect to lose about 75% of the difference between whereyou start and your ideal body weight. so, that's your excess weight loss. and it may take a year,

year and a half to get to that point. but, that's my goal. this operation, just like the sleeve, does reduce the ghrelin levels as well. so, people just don't have an appetite after surgery. now, in time, your appetite again will come back. but, it's never as strong as it used to be. those hormonal changes will also cause taste bud changes. people tell me after this operation,

things tend to taste too sweet. those same hormonal changes also dramatically change the the way you process glucose or sugar. and for that reason, people who are diabetic after this gastric bypass remarkably, that medical problem gets better. in fact, many of the people who have diabetes go home absolutely no medication from the hospital. several years ago, the term for weight loss surgery,

bariatric surgery was actually changed to bariatric and metabolic surgery because of the drastic improvements of diabetes and sugar. and things like that. so, i personally think that the gastric bypasses is underutilized for people with these medical problems. especially if you have diabetes i would strongly recommend the gastric bypass. so, again the recovery after this operation,

for the band you're generally in the hospital one night. for the sleeve and gastric bypass, it may be one or two nights depending on how well you do. the day after surgery, i have my patients undergo an upper gi where we watch as you drink some liquid on x-rays. and we watch as it goes through your intestines. if everything is well, then you would start drinking liquids. and i send you home, only if you prove to me that you can drink enough

so you do not become dehydrated. generally, i see all my patients back one week here in the office to make sure everything is well. and then one month later. the usual restrictions depend on what you do. what type of job you do? but, in general, i recommend my patients not lift more than 15 pounds for the first two weeks. as far as time off from work,

two weeks is also a good number to tell your employer. it depends on what you do. i've had some people go back to work as soon as one week after surgery. i have some people who have to wait a full month depending on what their job entails. this slide shows the risks of you dying after surgery. and it's gotten very, very low with bariatric surgery. the risk of you dying within 30 days after surgery is now one to two out of a thousand.

i'm gonna knock on a lot of wood right now, because i've never had a patientdie from my weight loss surgery. but, the risk is there. it's very, very low. it's actually lower than having your gallbladder removed. much lower than having a hip replacement. point nine percent. and heart surgery is over three percent risk of dying. so, bariatric surgery is much,much safer than it's been in the past. and a lot of this has to do with the way we do it now.

the laparoscopic route. here i talk about the decision making for which operation is the best of you. of course we will talk in personwhen you come see me in the office. you do not need to make any decision right away. because the evaluation and the test that i do beforehand are the same irregardless of which operation you perform. the gastric bypass has the best weight loss over time. and if you are very, very heavy

with the body mass index over 50 or even 60 that's probably what i would recommend for you. again, it's the best at treating your diabetes. in fact, many people, as i mentioned have what we call complete remission. where the diabetes goes away completely. if you have terrible heartburn, that's also a very, very good operation for you. the sleeve gastrectomy

as mentioned is the most popular now-a-days. but, the one drawback is that it can sometimes make heartburn worse. so, if you are on nexium or omeprazole or take a lot of antacid pills before surgery, that may not be the best operation for you. the adjustable gastric band is the only operation that is totally and very easily reversible. quite honestly, that has fallen out of favor.

and very few people get their bands. in the last three years, i must say that i've probably taken out more bands and converted them to different operations than i've actually put in. so, but, that still is an option if you really, really want that particular operation. the results of bariatric surgery, you must factor the weight loss is very, very good. but, it's more importantly to make your medical problems better.

and to make you live longer. and to make you have a happier, healthier life. to allow people to do all the things that they couldn't do in the past. get down on the floor. play with their grandkids. go to amusement parks. ride that roller coaster. it makes your work and your personal life change dramatically. the resolution to medical problems are great after weight loss surgery. respiratory problems especially. asthma gets better.

diabetes may be resolved completely, about 86% of the time in those people who have a gastric bypass. high blood pressure isn't as reliably cured with this operation. only in the 60 to 70% range. that's because there's a much highergenetic component to high blood pressure. if your mother, father, brother and sister if everybody's on blood pressure medicines, you will probably be too. although you may need less medicines.

you may not need three. you may need just one. but, it generally does get better. heart disease gets better. stress incontinence. that urine leak we talked about. that goes away in a lot of people. arthritis. especially in the weight bearing joints. the lower back. the knees. the hips. the feet. that all gets better.

when i was in the navy, the orthopedic surgeons was the number one referringphysicians to our bariatric clinic. for the people that needed knee replacements. hip replacements. high blood fats or high cholesterol. that gets better as well. and after six months, many people come off their anti-cholesterol medicines as well. heartburn, reflux disease gets much better,

especially with the gastric bypass. so, some frequently asked questions. what results can i expect? well, again, for the sleeve and the bypass, it's about 75% excess body weight loss in the first year, year and a half. the sleeve patients tend to have a little bit of weight regain after the first year. but, it's very, very good.

how long in the hospital? generally, one or two days at most. how long should you be off from work? generally, one to two weeks at most. how long does surgery take? well, for me the band is less than an hour. the sleeve is about one hour and fifteen minutes. and the gastric bypass. that's the longest. that's about two hours and fifteen minutes.

it's all a blink of an eye to you. you're totally asleep for all of these operations. at maryview we have a new long-acting medication. that i put it all the hole trocar sites. and that keeps the areas numb for the first three days. that makes lots of your pain go away. should you throw up all the time? no. in fact, most people should not throw up all the time. if you eat too fast or too quickly after any of these operations,

you will not feel well. and that's one of the things that you have to learn about before surgery. is learn to eat slowly. and to chew your food very, very well. should you have diarrhea all the time? absolutely not. should you eat baby food all the time? no. for the first month i do have my patients have a soft diet, which consists of chicken salad, tuna salad, egg salad.

that type of thing. but, after that we slowly advance you to more regular foods. i will say that the one food that does not go well after surgery is white fluffy bread. it kind of turns into a glob and just doesn't pass well. so, if you go to subway after surgery. i want you to open your sandwich. eat your lettuce, tomato, your meat. all the good stuff on the inside.

throw that bread away. you really don't need it afterward. other foods that sometimes cause problems are rice and spaghetti. and quite honestly, i would just assume you not eat a lot of those carbohydrates afterward. you have to again learn to eat your meat. your protein source first. and then if you have some room left over and you want some vegetables or salad, that's fine.

can i get pregnant after surgery? yes. in fact, ladies that have problems getting pregnant beforehand, they can easily become pregnant after surgery. and the recommendation is not to get pregnant for at least one year after surgery. surgery, is it dangerous? yes, all surgery is dangerous. there is a risk of major problems. and we will talk about these one on one before you choose which operation you would like.

again, the risk of surgery is far great, excuse me, far less than it was. the risk of surgery is far less than what it was in the past. can it be reversed? the only operation easily reversible was the band. what to ask about our bariatric program? well, here at through the bon secours system, our hospitals are centers of excellence. we do many, many cases every year.

we have all the specialists for you. we also have support groups every month. in fact, we require you to go to at least one support group before you have surgery. we want you to talk to people who have had these operations and decide for yourself, which might be best for you. we want you to hear from people who've had operations in the past. what the operations entail and how they like. what they like. what they don't like.

so, for success, you must know that surgery is only one part of the puzzle. you have to learn to eat properly, to exercise. to not drink sweet liquids between meals. and it's a lot of education goes into this. one thing i tell my patients is that the important things you will hear more than once. you'll hear it from me. you'll hear it from the nutritionist.

you'll hear it at the support group meeting. so, we want your success. surgery is just one part of the puzzle. but, learning to make healthy food choices learning to increase your activity. coming to a support group. these are all important things for that success. i want to invite you to contact my office. and arrange for a one on one appointment

where we will discuss you and your medical problems. and which option may be best for you. again, you don't have to make any decision right now. thank you for watching this presentation. now, i'd like you to continue watching the registered dietician talk about eating and drinking after the surgery for success.