14: Navigating Weight Loss with Journey Clinic

Azure Adkins, MD, bariatric surgeon with Norman Regional's Journey Clinic joins the Vedalas for an in depth look at the process of bariatric weight loss. Dr. Adkins describes the types of bariatric surgeries they offer, the pros and cons of each surgery type, the types of services patients have access to and eliminating the stigma surrounding obesity. This episode has extremely valuable information for anyone looking into bariatric weight loss solutions!

Guest Bio:
Azure Adkins, MD, is a fellowship trained bariatric and minimally invasive GI surgeon who is board certified in general surgery at Norman Regional's Journey Clinic. 

Her special interests include:

• Bariatric surgery
• Endoscopy
• Nutrition and lifestyle counseling
• Robotic surgery
• Minimally invasive surgery

Dr. Adkins finished medical school in 2013 at The University of Texas Houston Medical School and completed her general surgery residency at Kaiser Permanente Los Angeles Medical Center. She then completed her Advanced GI (gastrointestinal), MIS (minimally invasive surgery) and Bariatric Surgery fellowship at Alta Bates Summit Hospital in Oakland, California. Dr. Adkins chose to pursue a career in bariatric surgery because she enjoys working with her hands and having an immediate positive impact on the lives of her patients. She said she wants her patients to know that she will treat them as if they are her own family and provide individualized care with compassion and empathy every step of the way.

Links:
Azure Adkins, MD
Journey Clinic Website
Blog - Spatz Success Stories
Blog - Bariatric Surgery: It's Not Just for Weight Loss
Journey Clinic Blog

This podcast is for educational purposes only. The information in this show is not to be used as medical advice. If you are needing medical care, please consult with your physician.

Norman Regional is hiring! See all our open opportunities here: https://careers.normanregional.com/careers-home/

Transcript

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Welcome, friends.

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Dr. Veer Vedala here.

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And I'm Dr.

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Krishna Vedala, and.

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We are. The Vedala Bros.

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Welcome to season
two of our podcast, Vital Visions,

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where we delve into all things
vital, empowering our community.

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One health topic at a time. Absolutely.

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And to our returning listeners,
it's fantastic to have you back

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and to our new listeners.

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Buckle up, because in this podcast
we explore emerging medical research,

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the latest in technology

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and crucial health care topics
that resonate with our community here

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at Norman Regional.

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Plus, we also sprinkle in some health
and wellness tips for good measure.

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That's the spirit.

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And each episode,
we're also joined by incredible guests,

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from medical professionals
to local community leaders

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and even some of our friendly neighbors.

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Together, we tackle various issues
affecting our community.

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So whether you're a health enthusiast
or just looking to stay informed

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about healthy living trends,
consider this podcast to

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be your ultimate go to resource.

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So join us as we navigate the journey
to healthier lives

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and explore
the latest trends in wellbeing.

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Welcome to Vital Visions
Where Health meets Community.

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Welcome back, my friends. Dr.

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Veer Vedala again
here, joined by my co-host, Dr.

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Krishna Vedala.
And we are the The Vedala Brothers.

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Thank you again for joining us for yet
another episode of Vital Visions,

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where we discuss all things vital.

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Today, we have a very great topic
to discuss with you guys.

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the word pandemic's significance
used to come from a popular board game

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released back in 2008,
but in recent years,

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pandemics
and epidemics have become common dialog

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from infectious diseases
such as COVID 19 influenza

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and HIV to addiction based ideologies
such as tobacco and the opioid crisis.

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The United States has not been immune
to these public health concerns,

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but there is one epidemic in our country
that reigns supreme, that being obesity.

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According to the CDC, as of 2020,

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over 42% of American adults
were classified as obese,

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and 70% have been classified
as obese or overweight.

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The prevalence of obesity among children
and adolescents has also increased,

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with approximately 19% of individuals age
2 to 19 years old

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being obese.
We rank number 12th in the world

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in the most obese nations,
not just in the U.S.A.

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The obesity epidemic is a global health
crisis

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characterized by widespread prevalence
of excess body weight and adiposity.

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It has become a significant public health
concern with detrimental effects

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on individuals, physical
and mental well-being,

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and an increased risk of numerous
chronic diseases.

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However, in recent years, the escalating
rates of obesity have spurred significant

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advancements in the development
of innovative treatment options,

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while lifestyle

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modifications such as diet and exercise
are a cornerstone of obesity management,

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groundbreaking approaches
including pharmacotherapy, endoscopic

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procedures and surgical interventions
have emerged as effective tools

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in combating severe obesity.

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And here to talk to us today
about such procedures and surgeries

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is our very own bariatric surgeon
from Norman Regional Journey Clinic, Dr.

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Azure Adkins.

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Dr. Adkins,
thank you so much for joining us today.

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Thanks for having me.

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Krishna, you want to give a guest intro
to our guest?

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Well, of course, yes, yes, yes.

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Today, once again,
we have a doctor Azure Atkins.

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And as you said before,
she is one of our wonderful bariatric

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surgeons with the Journey Clinic
here in Norman Regional.

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And so, Dr.

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Adkins, once again,
thank you so much for being here

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and for spending your morning with us.

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but first, one of the questions
we want to ask you is,

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what got you interested
in bariatric surgery?

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So, yeah, again, thanks for having me.

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I'm really glad to have the opportunity

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with Northern Regional
and you guys to talk about

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not just obesity
but Journey Clinic specifically too.

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I went to medical school
and wasn't sure what I wanted to do.

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kind of liked surgery.

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So did general surgery residency.

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And during residency
you get to do all kinds of

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different rotations,
pediatric surgery, surgical oncology.

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And I got to do bariatric surgery,
and I found it really rewarding

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because the surgeons had long
term relationships with their patients.

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So a lot of general surgery is very short
term.

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Like patients have appendicitis,
you take out their appendix

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and you wish them well
and hopefully never see them again, right?

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So with things like surgical oncology
or cancer surgery,

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I felt like it was kind of depressing
sometimes.

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I didn't like that.

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Every time you saw the patient again,
it was like,

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Is it bad news this time or good news?

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Is the cancer back? With bariatric surgery

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The vast majority of the time
with the follow ups.

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Long term, it was to see patients
thriving and doing well afterwards.

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And I felt like
that was really encouraging.

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And that way I could build

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relationships longer term
and really see patients do well.

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So I did a fellowship in metabolic
and bariatric surgery

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and advanced GI,
minimally invasive and robotic surgery

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that's extra year after general surgery,
training and basically tried

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to focus my practice
on bariatric and metabolic surgery.

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Wow. That's,
that's, that's a lot of training.

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there, how long, how many years was that?

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So general surgery residency
for me was five years.

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Some programs require research years 
that add more time.

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I did not do that.

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Yeah, and then the fellowship
was extra year on top of that.

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So you're looking at almost
6 to 7 years of additional training

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on top of four years in medical school.
Yeah.

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So I mean really good info
for our pre-med and,

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and medical student listeners right
now, right.

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Yeah. Yes.

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That's, that's great.

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Well, thank you for that. Dr. Adkins.

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so since

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we're here to talk about
not just obesity, but Journey Clinic,

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can you tell us a little bit more
about Journey Clinic?

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I don't know if a lot of our listeners
know that there's a resource like Journey

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Clinic available and, and what it,
what it entails.

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Yeah. So Journey Clinic is amazing.

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I'm actually from Texas originally, and
my first job after I finished training was

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I moved back to Austin to be near family
and the job was not exactly the best fit.

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So I happened to be reached out to
by a surgeon at Journey Clinic named Dr.

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Farukhi, one of my partners,
and talked to him and he told me

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how amazing the clinic was
and to talk to his other partner, Dr.

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Nelson, who actually basically founded
Journey Clinic 20 plus years ago.

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So I talked to both of them, really
felt like we had similar kind of

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we were very simpatico in terms of patient
care, and the clinic sounded amazing.

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So I got brought up here
by Norman Regional

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got to tour the clinic,
which is an incredible space.

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You guys should come check it out
any time.

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We'll give you a tour.

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But it's a beautiful clinic
and I was really hooked

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and luckily my family was on board with me
taking the opportunity here,

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so we moved up.

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But the thing that to me
is the most incredible about Journey

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Clinic is that we are ASMBS COE.

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So so that's called
a basically center of excellence.

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So there's a lot of metrics
and statistics

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that we have to meet to be able to achieve
that qualification.

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There are only a few clinics for obesity,
medicine and bariatric surgery

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in Oklahoma
that actually meet those qualifications.

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And Journey Clinic
is one of the longest running.

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So that's part of it that we know.

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I know it's a safe place for patients,
that we take good care of patients

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and that we really meet kind of the
requirements to be a center of excellence.

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And then in addition to that,
the clinic is unique

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because we have a medical weight loss kind
of arm and a surgical weight loss arm.

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So when patients walk in the front door,
it actually kind of

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at the front desk medical weight
loss and surgical weight loss.

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And we really take care of patients

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with everything, like you mentioned,
kind of lifestyle measures, medications.

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We have dietitians
that are on staff in the office with us.

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We have a psychologist that's there
in the office and a therapist.

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Everyone sees the physical
therapy department at Norman Regional.

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And we have a lab,
you know, in our office as well.

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So it's really like a full service,

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multidisciplinary, comprehensive approach
that we can give to patients there.

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Yeah, And I think that is fantastic.

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And as we know, in primary care,
we see obesity a ton.

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And obesity is such a complex,

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multifaceted disease that we really need
a multidisciplinary approach.

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And one of the best place
to be able to get that is a full fledged

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bariatric and a center of excellence
like Journey Clinic.

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And we cannot emphasize
that enough for our viewers, because

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it's obesity isn't just a medical illness,
it is a complex illness

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and has many different factors
coming into it.

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And once again, Journey Clinic,
as we emphasized earlier today, it looks

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at all overall encompassing factors,
including behavioral counseling and diet.

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and so it is, it's a it's a great place
to go to,

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especially if you're
struggling to lose weight.

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and so yeah, it's, it's, it's, it's
we're glad that,

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Norman Regional has such an amazing center
like the Journey Clinic.

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So, Dr.

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Adkins,
what are some of the different types

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of bariatric surgery procedures
that are available at the Journey Clinic?

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Yeah.

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So basically
there are three main types of surgery

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that we offer and perform.

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there is a type of surgery
that used to be done a lot

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that we don't do anymore,

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but we do take care of patients with,
and that's called the lap band.

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Many people have heard of it.

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There are lots of patients

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who still have lap bands in place
and we do take care of those patients.

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a lot of the time
we are removing those lap bands.

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We do not place them anymore.

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But the three main types of surgery

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that are performed now are the
sleeve gastrectomy, which is the most

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commonly performed weight loss surgery
in the world.

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In America,

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it's about 60 to 70% of the operations
that are performed for metabolic

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and bariatric surgery
and then we do the Roux-en-Y gastric

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bypass. This surgery was the most common
about ten or 15 years ago.

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Now it's about 20% of the surgeries
that are performed for weight loss.

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And then we do duodenal switch
or also known as SADI-S.

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There's kind of two different techniques.

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And in essence, it's
a combination of a sleeve with a bypass.

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We also do revisional surgery,
which is basically people

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who've had previous weight loss surgery

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that for whatever reason need
something changed about their operation.

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We do perform those as well.

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That's awesome.

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So basically you would say

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most of the surgeries, except
we don't do the band anymore, right?

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And then, you know, we are discussing
earlier reading about this

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and there's a lot of new endoscopic
procedures that are, up and coming.

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And we heard that Journey Clinic does
offer some of those solutions as well.

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Yeah, we do a
something called the Spatz Balloon.

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So essentially this is a balloon

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and it's filled with a sterile solution
that is placed endoscopicly.

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So it's an outpatient procedure,
which means patients come in,

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they get put under anesthesia
for usually just under an hour,

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maybe 30 minute procedure
where the balloon is placed with a camera

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down the mouth
and through the throat into the stomach.

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The unique part about this balloon
and there's a few different balloons

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that are on the market.

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This balloon is adjustable,
so it's the only balloon

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where fluid can be put in or taken out.

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So sometimes if patients, 
the balloons too full, for example,

222
00:11:35,769 --> 00:11:36,903
and they're having side effects.

223
00:11:36,903 --> 00:11:38,936
Then instead
of having to remove the balloon

224
00:11:38,936 --> 00:11:41,302
altogether,
like some of the other balloons that exist

225
00:11:41,302 --> 00:11:44,702
with this balloon, you can take fluid out
to make it more comfortable.

226
00:11:45,968 --> 00:11:46,835
the balloon stays

227
00:11:46,835 --> 00:11:50,134
in, I believe, for about nine months
usually, and then it has to be removed.

228
00:11:50,134 --> 00:11:54,900
That's kind of the the process
with the balloon, but so it requires

229
00:11:54,900 --> 00:11:57,900
a few different endoscopic procedures,
but there's no incisions

230
00:11:57,900 --> 00:11:58,866
or anything like that.

231
00:11:58,866 --> 00:12:01,866
So it does
have a very good safety profile.

232
00:12:02,032 --> 00:12:03,332
And we do offer that balloon.

233
00:12:03,332 --> 00:12:06,832
It's not covered by any insurance plans,
but we do have

234
00:12:06,832 --> 00:12:10,065
a very competitive pricing
that we've worked out for that as well.

235
00:12:10,265 --> 00:12:12,131
And how frequently is this procedure

236
00:12:12,131 --> 00:12:15,464
used in comparison to the other procedures
we talked about earlier?

237
00:12:16,297 --> 00:12:19,897
I think because of mainly
the it's not covered by insurance,

238
00:12:19,897 --> 00:12:25,129
while bariatric surgery like a sleeve
or a bypass often is covered by insurance

239
00:12:25,129 --> 00:12:29,962
that that, you know, puts things in the
favor of surgery in terms of numbers wise.

240
00:12:29,962 --> 00:12:35,628
Also that surgery is a longer term 
solution than the balloon.

241
00:12:35,628 --> 00:12:41,060
With the balloon, we do very extensive
counseling and dietician visits as well.

242
00:12:41,060 --> 00:12:45,660
But it is a shorter term,
you know, procedure essentially.

243
00:12:46,360 --> 00:12:48,993
That's a as amazing, it's
almost kind of like a like a

244
00:12:48,993 --> 00:12:52,325
like a bakri balloon
or like a - - type situation,

245
00:12:52,325 --> 00:12:56,725
kind of where you can insert
is it just water saline?

246
00:12:56,725 --> 00:13:00,924
Basically, Yeah saline 
that's like colored with a blue fluid

247
00:13:00,924 --> 00:13:02,057
so that if the balloon,

248
00:13:02,057 --> 00:13:05,057
for whatever reason popped or something
that it would be evident

249
00:13:05,057 --> 00:13:06,424
because the fluid is a different color.

250
00:13:06,424 --> 00:13:09,723
Wow. But yeah, basically

251
00:13:09,723 --> 00:13:13,056
after a few months, generally there's
kind of a check in with the patient.

252
00:13:13,056 --> 00:13:14,222
How are they doing?

253
00:13:14,222 --> 00:13:17,155
If everything's going well,
then they don't need another procedure

254
00:13:17,155 --> 00:13:20,022
until the end of that nine month period
when the balloon's removed.

255
00:13:20,022 --> 00:13:23,521
If after a few months their weight loss
has slowed down, for example,

256
00:13:23,521 --> 00:13:26,521
then more fluid can be
added to the balloon at that point

257
00:13:27,287 --> 00:13:30,887
or if they're having any side effects
like some reflux issues or something

258
00:13:30,887 --> 00:13:34,186
like that, then some fluid can be removed
from the balloon at that point.

259
00:13:34,620 --> 00:13:35,220
That's amazing.

260
00:13:35,220 --> 00:13:39,552
In fact that's a really cool
thought process or idea of of

261
00:13:39,552 --> 00:13:40,285
to I guess promote

262
00:13:40,285 --> 00:13:44,785
I guess the, the, the mechanism would be
restriction of space then.

263
00:13:44,785 --> 00:13:45,618
Right. Yeah.

264
00:13:45,618 --> 00:13:46,718
Well that's really cool.

265
00:13:46,718 --> 00:13:50,251
kind of like taking a little step back.

266
00:13:50,251 --> 00:13:54,483
you know, part of our goal
here is for our listeners

267
00:13:54,483 --> 00:13:57,583
who are maybe medical students
or residents or even primary care

268
00:13:58,050 --> 00:14:01,649
physicians, we need to be able
to counsel our patients a little bit

269
00:14:01,716 --> 00:14:05,915
and give them a little head's
up of kind of how bariatric surgery works

270
00:14:05,915 --> 00:14:09,015
and, you know,
if we didn't have such an interest in,

271
00:14:09,448 --> 00:14:12,948
you know, obesity medicine, I don't know
if we would have read as much about it.

272
00:14:13,248 --> 00:14:16,380
And so I was wondering if you could just
kind of in layman's terms, like

273
00:14:17,014 --> 00:14:17,747
kind of explain

274
00:14:17,747 --> 00:14:21,580
how the mechanism of surgery actually
works and promoting weight loss works.

275
00:14:22,046 --> 00:14:22,413
Yeah.

276
00:14:22,413 --> 00:14:27,079
So essentially
the different types of surgery

277
00:14:27,212 --> 00:14:31,645
mainly are restrictive in terms
of making the size of the stomach smaller.

278
00:14:32,478 --> 00:14:34,645
The sleeve is essentially removing

279
00:14:34,645 --> 00:14:37,744
about 75 to 80% of the stomach
permanently from the body.

280
00:14:37,744 --> 00:14:39,511
So it goes from being about the size

281
00:14:39,511 --> 00:14:42,410
and shape of a football
to more like banana size.

282
00:14:42,410 --> 00:14:45,710
Obviously patients feel full a lot faster
with a smaller stomach,

283
00:14:45,710 --> 00:14:48,943
but it also affects 
some of the hormones that drive hunger.

284
00:14:48,943 --> 00:14:51,109
So patients also tend to feel less hungry.

285
00:14:52,275 --> 00:14:55,475
These surgeries,
all of them actually are very safe.

286
00:14:55,475 --> 00:14:58,075
They're generally performed
laparoscopically or robotically.

287
00:14:58,075 --> 00:15:00,208
So these are very small incisions.

288
00:15:00,208 --> 00:15:03,707
Patients generally take about two weeks
off of work to really learn

289
00:15:03,707 --> 00:15:07,040
how to deal with their new stomach,
take very small sips of fluids.

290
00:15:07,740 --> 00:15:11,239
But in terms of recovery,
like getting up and walking,

291
00:15:11,239 --> 00:15:13,339
we have them do that
the same day of the surgery.

292
00:15:13,339 --> 00:15:17,205
The majority of patients
leave after one night in the hospital

293
00:15:17,205 --> 00:15:20,305
with very minimal discomfort
or pain from the operation itself.

294
00:15:21,071 --> 00:15:26,404
And essentially they are seen
very frequently afterwards for follow ups.

295
00:15:26,971 --> 00:15:30,037
The kind of lead up to surgery
is also critically important.

296
00:15:30,037 --> 00:15:33,736
We, like I said, have dietician visits
that are required.

297
00:15:34,570 --> 00:15:38,336
everyone sees physical therapy
to start working on kind of a long term

298
00:15:38,336 --> 00:15:39,669
exercise plan.

299
00:15:39,669 --> 00:15:42,802
And then psychology
evaluation is also important.

300
00:15:42,968 --> 00:15:46,435
Obviously your mental health is
just as important as your physical health.

301
00:15:46,968 --> 00:15:52,167
So if somebody is not mentally in a place
where, you know, a major anatomic change

302
00:15:52,167 --> 00:15:55,333
is going to be good
for their mental health, then, you know,

303
00:15:55,367 --> 00:15:58,366
sometimes you have to put a pause
on doing a surgery.

304
00:15:58,466 --> 00:15:59,399
But that's part of the benefit

305
00:15:59,399 --> 00:16:02,432
of having the medical weight
loss side of the office is that

306
00:16:02,432 --> 00:16:04,065
we're able to still help people,

307
00:16:04,065 --> 00:16:07,032
even if their surgery's not
the right thing for them in that moment.

308
00:16:08,598 --> 00:16:12,398
No. So what kind of post-operative care

309
00:16:12,398 --> 00:16:16,197
can, can patients expect
when undergoing one of these procedures?

310
00:16:16,830 --> 00:16:17,130
Yeah.

311
00:16:17,130 --> 00:16:20,930
So, being a center of excellence
means that, you know,

312
00:16:20,930 --> 00:16:24,829
we stick to a very strict schedule
in terms of long term follow up.

313
00:16:26,262 --> 00:16:29,629
The first year after the surgery,
patients are seen very frequently.

314
00:16:29,662 --> 00:16:31,528
We do check multiple different vitamin

315
00:16:31,528 --> 00:16:34,528
levels and labs
to make sure that everything is in range.

316
00:16:35,261 --> 00:16:37,594
So two weeks post-op, six weeks, three

317
00:16:37,594 --> 00:16:40,594
months, six months
and a year are kind of the bare minimum.

318
00:16:40,794 --> 00:16:41,727
And all of those appointments

319
00:16:41,727 --> 00:16:44,760
are actually scheduled
at the time of their surgery scheduling.

320
00:16:44,760 --> 00:16:47,626
So that's already all booked out
ready for them.

321
00:16:47,626 --> 00:16:50,526
And we're available 24 seven 365

322
00:16:50,526 --> 00:16:53,559
the rest of the year
for any emergencies or anything also.

323
00:16:54,692 --> 00:16:55,158
And then long

324
00:16:55,158 --> 00:16:58,191
term, we want to see patients
at least on a yearly basis.

325
00:16:58,191 --> 00:17:02,091
So those appointments
also get scheduled out so that people can

326
00:17:02,091 --> 00:17:05,090
come consistently and get their labs
checked and check in with us.

327
00:17:06,890 --> 00:17:08,223
That's amazing.

328
00:17:08,223 --> 00:17:11,223
very consistence then, 
and then close follow up.

329
00:17:11,223 --> 00:17:14,889
Seems like the, the best approach.

330
00:17:14,889 --> 00:17:18,922
So I think Krishna
kind of alluded to this.

331
00:17:18,922 --> 00:17:21,921
what kind of

332
00:17:22,221 --> 00:17:24,088
so in general I was reading that

333
00:17:24,088 --> 00:17:27,087
bariatric surgery is a super safe
procedure.

334
00:17:27,121 --> 00:17:30,720
They're like comparing the rates to like
appendectomy and gallbladder surgery,

335
00:17:31,053 --> 00:17:34,486
which is amazing, for
the amount of benefit you gain from it.

336
00:17:34,486 --> 00:17:34,786
Right?

337
00:17:34,786 --> 00:17:38,852
But what are some of the,
I guess, side effects that people can have

338
00:17:38,852 --> 00:17:40,485
from bariatric surgery?

339
00:17:40,485 --> 00:17:42,885
Yeah.
So I mean, you bring up a good point.

340
00:17:42,885 --> 00:17:46,051
It is kind of a statistic
that we like to talk about

341
00:17:46,051 --> 00:17:49,751
for especially physicians
who may not know how safe it is.

342
00:17:49,751 --> 00:17:53,117
Now that gallbladder surgery
actually has a higher

343
00:17:53,117 --> 00:17:56,183
30 day risk profile than weight
loss surgery. Wow.

344
00:17:56,183 --> 00:17:57,883
But, of course, you know,

345
00:17:57,883 --> 00:18:02,582
with any operation, there are risks, 
sort of the general risks of surgery.

346
00:18:02,582 --> 00:18:02,916
Right.

347
00:18:02,916 --> 00:18:03,882
Bleeding or infection

348
00:18:03,882 --> 00:18:07,082
issues, problems with the anesthesia,
those are all theoretically possible.

349
00:18:07,082 --> 00:18:10,148
We do a lot of pre-op workup
to make sure that there aren't

350
00:18:10,148 --> 00:18:11,648
any unexpected surprises.

351
00:18:11,648 --> 00:18:17,380
but nonetheless, after surgery, patients
can have issues like with nausea or

352
00:18:17,380 --> 00:18:21,513
vomiting, especially as they're learning
kind of the new size of their stomach.

353
00:18:21,513 --> 00:18:24,046
Long term.

354
00:18:24,046 --> 00:18:27,346
There are issues sometimes with acid
reflux or heartburn, especially with

355
00:18:27,346 --> 00:18:31,078
the sleeve procedure,
compared to the gastric bypass.

356
00:18:31,078 --> 00:18:34,178
So we do tend to do gastric bypass
sometimes a little bit more

357
00:18:34,178 --> 00:18:38,177
for patients who have long term GERD
or acid reflux heartburn problems.

358
00:18:39,244 --> 00:18:41,944
there
are also issues with certain medications,

359
00:18:41,944 --> 00:18:43,577
especially with the gastric bypass.

360
00:18:43,577 --> 00:18:45,410
So the gastric bypass differs

361
00:18:45,410 --> 00:18:48,409
from the sleeve in that
we make a small pouch of the stomach,

362
00:18:48,676 --> 00:18:53,275
but then we cut the intestine downstream
from that, reattach it to that

363
00:18:53,275 --> 00:18:56,275
stomach pouch, and then we reattach
the intestine to itself.

364
00:18:56,608 --> 00:19:00,441
So in essence, bypassing
the majority of the stomach

365
00:19:00,441 --> 00:19:03,574
and the first part
of the small intestine or duodenum.

366
00:19:04,040 --> 00:19:08,307
So that surgery, obviously,
you can tell us a little bit more complex

367
00:19:08,307 --> 00:19:12,573
to perform, but it has the exact same
recovery, same small incisions.

368
00:19:12,839 --> 00:19:15,472
You wouldn't really know
which surgery you had from the outside.

369
00:19:15,472 --> 00:19:17,305
The diet is the same.

370
00:19:17,305 --> 00:19:21,605
The main difference is that, like I said,
it's a little bit better for reflux,

371
00:19:21,605 --> 00:19:25,537
but it does have a little bit higher 
risk of complications, like with vitamin

372
00:19:25,537 --> 00:19:28,637
deficiencies because things aren't
absorbed the same when you remove

373
00:19:28,637 --> 00:19:31,837
part of the intestine from the
the pathway that the food takes.

374
00:19:32,736 --> 00:19:35,769
Also, risk of ulcers exists
with the gastric bypass,

375
00:19:35,769 --> 00:19:38,169
especially with patients who smoke.

376
00:19:38,169 --> 00:19:41,102
Obviously, we don't operate on
anyone who's actively smoking,

377
00:19:41,102 --> 00:19:44,102
but if people go back
to smoking after surgery,

378
00:19:44,102 --> 00:19:47,234
especially with the bypass, it's
extremely high risk for complications

379
00:19:48,101 --> 00:19:49,534
as well as taking NSAIDs.

380
00:19:49,534 --> 00:19:52,600
So those are drugs like Motrin,
Ibuprofen and Aleve.

381
00:19:52,600 --> 00:19:57,400
Gastric bypass patients are not to take
those medications lifelong

382
00:19:57,400 --> 00:20:00,233
because they have a high risk of ulcer
formation in the stomach.

383
00:20:00,233 --> 00:20:03,999
So obviously we try to counsel patients
about this pretty extensively

384
00:20:04,599 --> 00:20:05,732
before surgery.

385
00:20:05,732 --> 00:20:08,065
But I do think sometimes
there's some confusion.

386
00:20:08,065 --> 00:20:11,098
Sleeve patients are allowed to take
those medications.

387
00:20:11,098 --> 00:20:12,598
Their ulcer risk is similar to

388
00:20:12,598 --> 00:20:15,331
someone who's not had surgery
on their stomach before.

389
00:20:15,331 --> 00:20:16,664
That's really good to know.

390
00:20:16,664 --> 00:20:19,663
So you have a little bit more weight
loss potential with the bypass,

391
00:20:19,897 --> 00:20:22,163
but a little bit more ulcer risk as well.

392
00:20:22,163 --> 00:20:22,696
Okay.

393
00:20:22,696 --> 00:20:28,262
Are there any indications to do
like, like a, like an upper GI endoscopy

394
00:20:28,429 --> 00:20:29,395
at a certain time

395
00:20:29,395 --> 00:20:33,595
post surgery or anything like that,
or is it basically just based on symptoms?

396
00:20:33,995 --> 00:20:38,027
Yeah, that's actually an area of interest
for me specifically,

397
00:20:38,027 --> 00:20:42,427
because of the sleeve
having this potential risk of reflux.

398
00:20:42,793 --> 00:20:44,460
So it's about 30% of patients

399
00:20:44,460 --> 00:20:47,793
after a sleeve that can get new or worse,
acid reflux or heartburn.

400
00:20:48,359 --> 00:20:51,192
So there is a lot of research being done

401
00:20:51,192 --> 00:20:57,125
right now on the kind of benefit
of doing like a post-op scope

402
00:20:57,125 --> 00:21:01,058
or upper endoscopy
to see if there's any damage from reflux.

403
00:21:01,457 --> 00:21:04,857
Long term acid reflux
can cause damage in the esophagus.

404
00:21:05,257 --> 00:21:09,123
So I think there's probably
a pretty high chance

405
00:21:09,123 --> 00:21:12,389
that in the relatively near
future we'll be recommending essentially

406
00:21:12,389 --> 00:21:15,389
like a screening, post-op
follow up endoscopy.

407
00:21:15,822 --> 00:21:19,388
But as of now,
that's not like a standard of care.

408
00:21:19,388 --> 00:21:22,388
So we do it based on symptoms.

409
00:21:22,521 --> 00:21:26,254
Like I said, we see patients long term
if they come like we like them to.

410
00:21:27,287 --> 00:21:30,153
So if they're saying, you know, I'm doing
great for my sleeve,

411
00:21:30,153 --> 00:21:33,486
I'm down such and such amount of weight,
I'm off of my medications,

412
00:21:33,486 --> 00:21:37,786
but I'm having some heartburn issues,
then of course, we do investigate that.

413
00:21:38,252 --> 00:21:41,852
And then you also kind of touch base
on on vitamin deficiency.

414
00:21:41,852 --> 00:21:44,851
One of the things we we've heard
from the primary care

415
00:21:44,851 --> 00:21:48,751
perspective is B12
is is a major one or any other vitamin

416
00:21:48,751 --> 00:21:51,750
deficiency specific
that they need to look out for.

417
00:21:53,217 --> 00:21:56,217
Calcium and D,
You know, the vast majority of patients

418
00:21:56,616 --> 00:22:00,049
in the entire country
are low in vitamin D,

419
00:22:00,049 --> 00:22:05,615
So we do have patients on a bariatric
specific multivitamin, often chewable,

420
00:22:05,615 --> 00:22:07,682
because that gets absorbed
a little bit easier.

421
00:22:07,682 --> 00:22:12,014
And then three times a day, calcium and D
and then we do offer B12 injections

422
00:22:12,014 --> 00:22:14,081
monthly in our office.

423
00:22:14,081 --> 00:22:17,547
If patients want it done there or we prescribe it and they do it for themselves.

424
00:22:19,013 --> 00:22:21,913
and then any issues with iron absorption.

425
00:22:21,913 --> 00:22:23,546
Yeah, with the gastric bypass.

426
00:22:23,546 --> 00:22:26,812
Sometimes we do
see some iron absorption changes

427
00:22:27,112 --> 00:22:30,978
because of skipping most of the stomach
and part of the small intestine.

428
00:22:30,978 --> 00:22:34,844
especially women
who tend to have lower iron levels anyway.

429
00:22:35,144 --> 00:22:37,444
And we do recommend the multivitamin
with iron.

430
00:22:37,444 --> 00:22:40,844
We have done iron infusions
as well for patients who have low iron.

431
00:22:40,844 --> 00:22:45,510
A lot of the time actually it's before
surgery that they have that issue and with

432
00:22:45,510 --> 00:22:48,843
some diet changes and a multivitamin
with iron tends to improve.

433
00:22:49,376 --> 00:22:51,775
Do you do the iron infusions
in your clinic, at Journey Clinic?

434
00:22:51,775 --> 00:22:53,975
No at Norman Regional in the Infusion Center. 

435
00:22:53,975 --> 00:22:55,908
But we do b12 shots at Journey Clinic.

436
00:22:55,908 --> 00:22:59,608
And yeah, we do on IV fluids in our clinic
if we need to

437
00:22:59,608 --> 00:23:02,741
or if patients are having
some dehydration issues or whatnot

438
00:23:03,307 --> 00:23:05,840
during business hours,
we're able to offer IV infusion.

439
00:23:05,840 --> 00:23:07,873
That's that's amazing and such.

440
00:23:07,873 --> 00:23:10,739
I think of like
all kinds of valuable resources.

441
00:23:10,739 --> 00:23:13,772
We can we can use and then,

442
00:23:13,772 --> 00:23:17,339
so that you can either
like kind of tilt back a little bit.

443
00:23:17,339 --> 00:23:20,438
I kind of understand what
the patient experience would be if

444
00:23:20,538 --> 00:23:21,571
like we could summarize it.

445
00:23:21,571 --> 00:23:24,571
So basically,
when we make a referral to Journey Clinic,

446
00:23:24,738 --> 00:23:29,037
the patient first gets established,
a journey clinic, and then kind of gets a

447
00:23:29,537 --> 00:23:32,670
multidisciplinary approach,
talks to the physical therapist,

448
00:23:32,670 --> 00:23:35,669
talk to the dietitian,
talk to the psychologists.

449
00:23:36,236 --> 00:23:39,336
and then once they've gone
through those different checkpoints,

450
00:23:39,336 --> 00:23:41,135
then they would get scheduled
for the surgery.

451
00:23:41,135 --> 00:23:42,335
Is that correct? Right.

452
00:23:42,335 --> 00:23:45,435
So when we get a referral,
one of the first things we do is

453
00:23:45,435 --> 00:23:48,868
we have an entire team of specialists
for insurance.

454
00:23:48,968 --> 00:23:50,334
Okay. Wow, that's amazing.

455
00:23:50,334 --> 00:23:53,767
The insurance process
can be very daunting and confusing.

456
00:23:54,600 --> 00:23:57,866
So we have specialists for that
that basically look at the patient's

457
00:23:57,866 --> 00:24:03,066
insurance and make sure that we are able
to give patients the exact plan for what

458
00:24:03,066 --> 00:24:06,465
they would need to do to have their
a surgery covered by their insurance.

459
00:24:06,965 --> 00:24:09,165
So some insurances cover surgery,
some don't.

460
00:24:09,165 --> 00:24:13,264
Some have specific requirements that are
needed to have surgery be approved.

461
00:24:13,997 --> 00:24:16,264
So we go through all of that
with the patient ahead of time

462
00:24:16,264 --> 00:24:20,263
so that ideally there's no surprises
in terms of the process for them

463
00:24:21,396 --> 00:24:23,096
if they don't have insurance.

464
00:24:23,096 --> 00:24:28,262
We do a surgery for cash pay and again,
we have competitive pricing for that

465
00:24:28,262 --> 00:24:32,995
as well and payment options and plans 
through Norman Regional financing.

466
00:24:33,428 --> 00:24:36,994
So once the patient
is kind of aware of that, then they go

467
00:24:36,994 --> 00:24:40,527
ahead and get scheduled for what we call
an I C visit or initial consult.

468
00:24:40,860 --> 00:24:43,693
And that's generally
with one of the three of us surgeons, Dr.

469
00:24:43,693 --> 00:24:45,793
Nelson, Dr. Farooqui and myself.

470
00:24:45,793 --> 00:24:49,292
And we go over the entirety

471
00:24:49,292 --> 00:24:53,325
of their medical and surgical history,
their social history.

472
00:24:53,325 --> 00:24:54,425
We make sure that basically

473
00:24:54,425 --> 00:24:57,425
they're up to date on any cancer screening
that they may need.

474
00:24:58,391 --> 00:25:01,191
I kind of explain it to patients as though

475
00:25:01,191 --> 00:25:04,824
surgery is like getting ready for surgery
is like training for a marathon.

476
00:25:04,824 --> 00:25:06,790
You wouldn't decide
that you're going to run a marathon

477
00:25:06,790 --> 00:25:08,956
and then do it next weekend.
You would get injured.

478
00:25:08,956 --> 00:25:10,923
Your time would be terrible, right?

479
00:25:10,923 --> 00:25:12,123
You want to prepare for it.

480
00:25:12,123 --> 00:25:15,955
So preparing for surgery
is kind of a similar idea.

481
00:25:15,989 --> 00:25:18,955
And everything
you really want it to be kind of peaking

482
00:25:18,955 --> 00:25:21,088
at the time of the surgery
where you're in the best shape

483
00:25:21,088 --> 00:25:24,221
that you can be to have
a safe and effective operation.

484
00:25:26,587 --> 00:25:30,153
So sometimes what we tend to see
is patients

485
00:25:30,153 --> 00:25:33,953
that have had some form
of bariatric surgery in the past

486
00:25:34,053 --> 00:25:37,719
ten or 15 years ago and then now they're
getting back to gaining weight again.

487
00:25:37,719 --> 00:25:43,352
And often, that may lead to necessity
for medical management

488
00:25:43,685 --> 00:25:47,984
Again, obesity, especially with the rise
of some of these injectables.

489
00:25:47,984 --> 00:25:51,217
Like Ozempic and Mounjaro,
how frequently do you see

490
00:25:51,217 --> 00:25:54,217
the necessity
for medical management of obesity?

491
00:25:54,617 --> 00:25:56,716
post bariatric surgery.

492
00:25:56,716 --> 00:26:01,516
So weight recurrence 
after surgery does exist.

493
00:26:01,682 --> 00:26:06,215
So you kind of talked about how
these different methods are tools, right?

494
00:26:06,215 --> 00:26:08,981
So it is a very effective tool.

495
00:26:08,981 --> 00:26:12,314
Weight loss surgery has an effectiveness,
long term,

496
00:26:12,514 --> 00:26:15,514
significant weight loss,
at least about 50 to 60%.

497
00:26:16,147 --> 00:26:18,980
Patients who exercise regularly
and come for regular follow up

498
00:26:18,980 --> 00:26:22,613
have a longer term success rate. But

499
00:26:23,746 --> 00:26:24,679
yeah, to

500
00:26:24,679 --> 00:26:27,679
your point, when patients
have some weight regain,

501
00:26:27,812 --> 00:26:30,245
especially if they're coming in
and checking in with us,

502
00:26:30,245 --> 00:26:33,245
then we can implement
some of these other tools,

503
00:26:33,378 --> 00:26:36,244
sometimes revisional surgery right,
if they need that.

504
00:26:36,244 --> 00:26:39,744
But the majority of the time is kind of
getting back on track in terms of,

505
00:26:40,144 --> 00:26:43,610
you know, nutritional aspects or,
you know, their exercise routine.

506
00:26:43,610 --> 00:26:46,743
and then additionally, medication

507
00:26:46,743 --> 00:26:50,009
use can be a very effective adjunct
there.

508
00:26:50,109 --> 00:26:53,342
There's a lot of research being done
now too, on post-op patients.

509
00:26:53,342 --> 00:26:58,641
In the shorter term with medication use, 
which does really seem to maximize

510
00:26:58,641 --> 00:27:04,740
the weight loss and the benefits of weight
loss in terms of remission,

511
00:27:04,740 --> 00:27:08,040
rates of like diabetes, hypertension,
cholesterol issues.

512
00:27:08,573 --> 00:27:12,173
I went to the ASMBS,
so that's our like society

513
00:27:12,173 --> 00:27:14,072
for metabolic
and bariatric surgery meeting.

514
00:27:14,072 --> 00:27:16,772
That was just about two weeks ago.

515
00:27:16,772 --> 00:27:20,405
And there was a very interesting
talk about how we need to think of obesity

516
00:27:20,405 --> 00:27:21,738
as a chronic disease.

517
00:27:21,738 --> 00:27:25,237
Kind of like in the same vein
as cancer treatment.

518
00:27:25,237 --> 00:27:29,204
So thinking of treatments
as neoadjuvant adjuvant.

519
00:27:29,204 --> 00:27:31,803
So that means, you know, treatment
before surgery

520
00:27:31,803 --> 00:27:33,370
that would be neoadjuvant
treatment, right?

521
00:27:33,370 --> 00:27:36,369
Or treatment with or after surgery
that would be adjuvant treatment.

522
00:27:36,669 --> 00:27:41,668
So obviously diet, exercise,
nutritional aspects, mental health, right,

523
00:27:41,668 --> 00:27:44,668
those are all adjuvant
and neoadjuvant treatments.

524
00:27:44,901 --> 00:27:47,934
And then to kind of think
about weight recurrence as sort of like

525
00:27:48,268 --> 00:27:50,067
if a patient has cancer. Right.

526
00:27:50,067 --> 00:27:52,534
And their cancer comes back,
we don't blame the patient.

527
00:27:52,534 --> 00:27:54,867
Right. So same thing with obesity.

528
00:27:54,867 --> 00:27:58,499
If a patient has obesity, they get surgery

529
00:27:58,499 --> 00:28:02,166
or they take medications, they lose weight
and then some of the weight comes back.

530
00:28:02,166 --> 00:28:02,499
Right.

531
00:28:02,499 --> 00:28:06,765
Instead of blaming the patient,
you didn't diet properly or you've,

532
00:28:06,765 --> 00:28:09,598
you know, haven't been exercising enough

533
00:28:09,598 --> 00:28:12,931
rather than doing that, that
we really look at obesity for what it is,

534
00:28:12,931 --> 00:28:15,197
which is a chronic disease
that we even don't

535
00:28:15,197 --> 00:28:19,297
fully understand
the exact metabolic consequences

536
00:28:19,297 --> 00:28:23,196
of how people get to this point
where diet and exercise

537
00:28:23,196 --> 00:28:24,796
are not effective anymore for them.

538
00:28:25,796 --> 00:28:26,129
Right.

539
00:28:26,129 --> 00:28:30,295
And I think I think that's such
an important point that you make, Dr.

540
00:28:30,295 --> 00:28:34,361
Adkins, like even within our own CME,
you know,

541
00:28:34,628 --> 00:28:37,594
and are explaining to our patients,
we're like if you think about it, like

542
00:28:37,594 --> 00:28:41,160
even if you think of related obesity
to cancer example,

543
00:28:41,160 --> 00:28:43,860
but even like high blood pressure
when it comes to medical therapy,

544
00:28:43,860 --> 00:28:47,059
if you put someone on BP meds
and take out their BP meds,

545
00:28:47,459 --> 00:28:49,326
their blood pressure is going to go up
anyways. Right.

546
00:28:49,326 --> 00:28:52,325
And I think we have to
we have to think of obesity

547
00:28:52,325 --> 00:28:53,559
as more of a chronic disease

548
00:28:53,559 --> 00:28:56,558
and remove the stigma
so we can better help our patients.

549
00:28:56,591 --> 00:28:59,058
Can I ask you a question
for just like my own learning?

550
00:28:59,058 --> 00:29:00,158
Yes of course.

551
00:29:00,158 --> 00:29:01,791
You know, again,
none of a lot of our listeners,

552
00:29:01,791 --> 00:29:03,624
we hope, are going to be medical students
and residents.

553
00:29:03,624 --> 00:29:07,657
And this is this is an important concept
for them because they need to know

554
00:29:08,656 --> 00:29:11,656
different types of surgery
and what are the options out there?

555
00:29:11,956 --> 00:29:13,822
How does revisional surgery work?

556
00:29:13,822 --> 00:29:16,322
Like, I'm
trying to understand that concept.

557
00:29:16,322 --> 00:29:19,322
So it definitely has a higher
risk profile.

558
00:29:19,322 --> 00:29:21,921
Obviously,
if you've been somewhere before,

559
00:29:21,921 --> 00:29:23,954
there's going to be scar tissue
and things like that.

560
00:29:23,954 --> 00:29:27,954
It's I would say at this point,
a lot of the revisional surgery

561
00:29:27,954 --> 00:29:30,420
is for things like a lap band.

562
00:29:30,420 --> 00:29:34,953
You know, when we remove a lap
band, often patients have weight

563
00:29:34,953 --> 00:29:37,952
that they would like to lose still
because the lap band lost

564
00:29:37,986 --> 00:29:40,985
its effectiveness or was never effective.

565
00:29:41,185 --> 00:29:45,085
So doing something like a gastric bypass
after the lap band is removed,

566
00:29:45,385 --> 00:29:46,651
we often do it at the same time.

567
00:29:46,651 --> 00:29:49,517
So remove the lap band
and then do a bypass in kind of one.

568
00:29:49,517 --> 00:29:51,217
Go.

569
00:29:51,217 --> 00:29:54,017
And then like I said,
sometimes with the sleeve surgery,

570
00:29:54,017 --> 00:29:57,850
if patients develop pretty significant acid
reflux or heartburn issues.

571
00:29:57,850 --> 00:30:01,882
Sometimes we are revising them to
something like a gastric bypass to treat

572
00:30:01,882 --> 00:30:02,716
the reflux.

573
00:30:04,049 --> 00:30:05,615
It's not typical to have

574
00:30:05,615 --> 00:30:09,515
to like remove more stomach pouch
or things like that.

575
00:30:09,515 --> 00:30:12,714
There's, I think, some thoughts out there

576
00:30:12,714 --> 00:30:15,780
that people can stretch their stomach
or their pouch after surgery.

577
00:30:16,380 --> 00:30:21,313
There's no really convincing data that
that is a real thing, sort of imagining,

578
00:30:21,313 --> 00:30:25,712
you know, if your stomach was 75% of
it was removed from your body.

579
00:30:25,712 --> 00:30:26,079
Right.

580
00:30:26,079 --> 00:30:27,979
How could that remaining stomach ever

581
00:30:27,979 --> 00:30:30,978
stretch to anywhere near
what it was able to be for?

582
00:30:31,012 --> 00:30:34,344
So what I tell patients is, you know,
I could make someone's stomach the size

583
00:30:34,344 --> 00:30:38,211
of my pinky finger, but a milkshake
will go down all day, every day.

584
00:30:38,244 --> 00:30:38,611
Right.

585
00:30:38,611 --> 00:30:41,410
So it's still about what you fill
the stomach with. Yeah.

586
00:30:41,410 --> 00:30:45,576
So high calorie, high density foods
with, you know, minimal fiber.

587
00:30:45,576 --> 00:30:46,043
Right.

588
00:30:46,043 --> 00:30:49,876
Are still going
to put people over a caloric kind of edge.

589
00:30:51,009 --> 00:30:51,675
So it's still

590
00:30:51,675 --> 00:30:55,475
really important,
even after surgery, to continue eating

591
00:30:56,041 --> 00:30:58,608
healthy foods,
which consist of mainly fruits,

592
00:30:58,608 --> 00:31:01,641
vegetables, whole grains,
you know, good protein sources

593
00:31:02,007 --> 00:31:05,407
which are not all meat, protein
and meat are not, you know, synonymous

594
00:31:05,407 --> 00:31:10,506
necessarily beans, lentils, quinoa
are all good sources of protein as well.

595
00:31:11,039 --> 00:31:11,639
Yeah.

596
00:31:11,639 --> 00:31:16,339
And and beyond like the, 
like you talked about the bypass

597
00:31:16,339 --> 00:31:20,138
and there's no revisions like bypass and,
you know, or like the duodenal switch

598
00:31:20,138 --> 00:31:23,138
or something, and there's no revisions
after that, right?

599
00:31:23,371 --> 00:31:26,371
You can always do more surgery.

600
00:31:26,937 --> 00:31:27,837
Yeah. Yeah.

601
00:31:27,837 --> 00:31:32,370
There are some people out there
that are revising someone from bypass

602
00:31:32,370 --> 00:31:36,236
to a duodenal switch, for example,
which requires

603
00:31:36,236 --> 00:31:40,035
basically undoing the bypass and
then redoing it into a duodenal switch.

604
00:31:40,502 --> 00:31:42,368
Very high risk for complications.

605
00:31:42,368 --> 00:31:44,235
Those types of surgeries

606
00:31:44,235 --> 00:31:48,001
a lot of the time revisional surgery
is also kind of forced upon us.

607
00:31:48,001 --> 00:31:51,934
If somebody, for example, has an ulcer
from their bypass, that's not healing.

608
00:31:52,200 --> 00:31:56,100
You know, generally that's because
of smoking issues or something like that.

609
00:31:56,733 --> 00:32:00,333
Sometimes we have to do sort of an urgent
or emergent revisional operation.

610
00:32:00,333 --> 00:32:03,332
But yeah, the kind of

611
00:32:03,665 --> 00:32:06,498
saying that I tell patients
is, you know, when you meet a surgeon,

612
00:32:06,498 --> 00:32:07,798
there's always two options, right?

613
00:32:07,798 --> 00:32:09,465
Do surgery or don't do surgery.

614
00:32:09,465 --> 00:32:12,864
So someone can always choose
to do surgery, right?

615
00:32:13,131 --> 00:32:14,297
Or not to do the right.

616
00:32:14,297 --> 00:32:16,630
Not to do. Yeah. And, sorry.

617
00:32:16,630 --> 00:32:17,563
One more question to ask this haha I

618
00:32:18,597 --> 00:32:19,163
apologize.

619
00:32:19,163 --> 00:32:24,063
I'm sorry man, we have this problem all the time. 
So is it possible to reverse a bypass

620
00:32:24,063 --> 00:32:26,929
because the stomach is still
and still there, Right?

621
00:32:26,929 --> 00:32:31,628
Nothing's removed from the body
with the bypass Reversing a bypass

622
00:32:31,628 --> 00:32:34,761
is definitely not commonly performed,

623
00:32:34,761 --> 00:32:39,660
but instances like Non-Healing ulcer, 
severe malnutrition issues

624
00:32:39,660 --> 00:32:43,893
which generally are because
of mental health issues like patients

625
00:32:43,893 --> 00:32:48,592
who turn to alcohol, for example,
when they, their food addiction

626
00:32:48,592 --> 00:32:51,592
If they have that, becomes
alcohol addiction,

627
00:32:51,625 --> 00:32:53,192
they can have issues with the bypass.

628
00:32:53,192 --> 00:32:54,558
It could require reversal.

629
00:32:54,558 --> 00:32:57,891
But I would say more commonly,
if we have to do it, it's really

630
00:32:58,091 --> 00:33:02,124
for an emergency situation like a twisted
intestine or something else like that.

631
00:33:02,124 --> 00:33:05,224
And it's sort of unavoidable, but

632
00:33:05,490 --> 00:33:09,456
it's extremely high risk
to re operate on gastric bypass.

633
00:33:09,456 --> 00:33:13,656
So, you know, generally
it's not something that we would reverse.

634
00:33:14,222 --> 00:33:15,455
I'm learning so much right now.

635
00:33:16,922 --> 00:33:17,588
But a

636
00:33:17,588 --> 00:33:21,121
sleeve, on the other hand, is something
where you can't reverse, correct?

637
00:33:21,255 --> 00:33:21,688
Right.

638
00:33:21,688 --> 00:33:26,054
So 75% of the stomach is pulled out
through actually a very small incision.

639
00:33:26,054 --> 00:33:30,020
But yeah, it's gone forever
and get sent off to the pathology lab.

640
00:33:30,020 --> 00:33:32,686
They make sure there's nothing
scary inside of there.

641
00:33:32,686 --> 00:33:37,152
And then,
yeah, that's not doesn't exist anymore.

642
00:33:37,152 --> 00:33:39,152
So the stomach does stay smaller.

643
00:33:39,152 --> 00:33:42,952
like I said, it can't really stretch out
to what it used to be before,

644
00:33:43,018 --> 00:33:46,351
so it's mainly about filling
that sleeved stomach

645
00:33:46,351 --> 00:33:49,417
with foods that are,
you know, high benefit, right?

646
00:33:49,751 --> 00:33:53,617
Like high protein and high fiber content.

647
00:33:54,583 --> 00:33:57,750
Well, since Veer got two extra
questions, I guess I get a chance too.

648
00:33:57,750 --> 00:34:01,516
Moving on from surgery,
one of the things that we've noticed

649
00:34:01,816 --> 00:34:04,649
in the obesity
continuing medical education curriculum

650
00:34:04,649 --> 00:34:08,781
that we're well, we've been studying
is the the rise in the role of genetics

651
00:34:08,781 --> 00:34:11,881
and epigenetics
that play in terms of obesity.

652
00:34:12,381 --> 00:34:13,981
Could you tell us a little bit about

653
00:34:15,114 --> 00:34:15,680
if does the

654
00:34:15,680 --> 00:34:18,680
Journey clinic offer
any kind of genetic testing?

655
00:34:18,747 --> 00:34:21,946
and what how much of a role
do you think that genetics

656
00:34:21,946 --> 00:34:25,879
in the epigenetics area really do
play in terms of determining obesity?

657
00:34:26,412 --> 00:34:31,445
Yeah, I love this question because at
Journey Clinic, we have a monthly meeting

658
00:34:31,445 --> 00:34:35,378
where all of the providers get together
and we talk about kind of like

659
00:34:35,911 --> 00:34:39,244
how the clinic's running any new testing
or things that we want to implement

660
00:34:39,244 --> 00:34:41,443
or changes
that we want to make to the process.

661
00:34:41,443 --> 00:34:45,076
And after going to the meeting
that I went to with ASMBS.

662
00:34:45,076 --> 00:34:46,909
I saw a very interesting study

663
00:34:46,909 --> 00:34:50,842
that was actually out of OU Tulsa
about genetic testing for obesity.

664
00:34:50,842 --> 00:34:55,708
And they had a very high rate of patients
test positive for a certain mutation

665
00:34:55,708 --> 00:34:57,608
that predisposes patients to obesity,

666
00:34:57,608 --> 00:35:01,607
that genetic testing
is actually completely free of charge.

667
00:35:02,741 --> 00:35:05,407
So where we are will offer it.

668
00:35:05,407 --> 00:35:07,840
We do offer it already
actually at the clinic,

669
00:35:07,840 --> 00:35:11,373
but it's just requires
some paperwork, cheek swab or blood test.

670
00:35:11,373 --> 00:35:13,039
You can do it either way

671
00:35:13,039 --> 00:35:17,472
and then there's a specific medication
that can target that mutation.

672
00:35:17,472 --> 00:35:19,705
It's called Setmelanotide

673
00:35:19,705 --> 00:35:23,404
that can be used also in conjunction
with other treatments like surgery.

674
00:35:23,404 --> 00:35:25,737
So it's a leptin deficiency,
basically, or.

675
00:35:25,737 --> 00:35:27,437
I believe so.

676
00:35:27,437 --> 00:35:28,770
Okay. Wow, that's. Fascinating.

677
00:35:28,770 --> 00:35:31,203
But yeah, related to leptin for sure.

678
00:35:31,203 --> 00:35:32,970
One of the gut hormones, right?

679
00:35:32,970 --> 00:35:38,736
So basically that medication
is not often covered by insurance.

680
00:35:38,736 --> 00:35:41,735
So, again, you know, sometimes
you have to play this game with insurance

681
00:35:41,735 --> 00:35:45,601
companies, but I think it is
definitely an area of ongoing research.

682
00:35:45,601 --> 00:35:50,101
Undoubtedly, there's things that we
really don't understand about epigenetics.

683
00:35:50,534 --> 00:35:54,367
I tell patients all the time, almost
everyone knows someone who doesn't eat

684
00:35:54,367 --> 00:35:57,366
healthily, doesn't exercise
and is very thin, right?

685
00:35:57,433 --> 00:36:00,532
So the opposite of that can also be
true, right?

686
00:36:00,532 --> 00:36:03,499
There are patients who exercise regularly,
they eat very healthily

687
00:36:03,499 --> 00:36:07,098
and they cannot lose weight,
you know, and keep it off long term.

688
00:36:07,532 --> 00:36:10,531
So why is that?
What is it a genetic issue?

689
00:36:10,531 --> 00:36:14,431
Is it something like the gut microbiome,
which is another area of interest for me.

690
00:36:15,497 --> 00:36:18,030
So I think there's a lot more to come.

691
00:36:18,030 --> 00:36:21,130
You know, it's
definitely an evolving field and I'm keeping

692
00:36:21,163 --> 00:36:24,163
an eye on things
like the injectables as well,

693
00:36:24,362 --> 00:36:26,762
because there's a few things
that are in testing right now

694
00:36:26,762 --> 00:36:31,761
with the glucagon as well as other
gut hormones that kind of come into play

695
00:36:32,428 --> 00:36:36,727
in terms of how people absorb
or how foods kind of get

696
00:36:36,727 --> 00:36:39,727
processed in terms of the liver
and things like that as well.

697
00:36:40,260 --> 00:36:42,360
And just a note for our listeners.

698
00:36:42,360 --> 00:36:46,126
Epigenetics
basically is the study of changes

699
00:36:46,526 --> 00:36:51,059
that are caused by modification
of the gene expression with alteration.

700
00:36:51,059 --> 00:36:55,392
But than there's basically no changes
in the genetic code itself.

701
00:36:55,392 --> 00:36:59,024
It's just outside of the DNA
alteration of the gene.

702
00:36:59,024 --> 00:37:01,791
So were you going to say something Veer? 
I'm sorry.

703
00:37:01,791 --> 00:37:03,690
No, I think Dr.

704
00:37:03,690 --> 00:37:08,956
Adkins made a great segue into the
do the gut biome inside question for her.

705
00:37:08,956 --> 00:37:12,556
I've been reading a lot about the whole
prebiotic probiotic supplementation

706
00:37:12,556 --> 00:37:16,189
and how that improves or it's supposed
to improve your metabolic rate.

707
00:37:16,189 --> 00:37:19,088
Have you heard about that
or you recommend that for patients?

708
00:37:19,088 --> 00:37:19,388
Yeah.

709
00:37:19,388 --> 00:37:22,854
So I've read some interesting
studies out of Europe as well

710
00:37:22,854 --> 00:37:26,587
where like children were given a probiotic
and the children grew up

711
00:37:26,587 --> 00:37:30,187
and the ones who received the probiotic
were less likely to have obesity

712
00:37:31,353 --> 00:37:33,353
or studies where

713
00:37:33,353 --> 00:37:37,586
patients had to get a fecal transplant
because of a C diff infection.

714
00:37:37,652 --> 00:37:42,218
And after the fecal transplant,
their weight ballooned significantly

715
00:37:42,452 --> 00:37:45,984
and their gut microbiome had changed
because of receiving someone

716
00:37:45,984 --> 00:37:48,651
else's gut microbiome via
the fecal transplant.

717
00:37:48,651 --> 00:37:53,350
I'm very fascinated 
by the entire concept, especially for me.

718
00:37:53,350 --> 00:37:58,116
I stick to a Whole Foods plant based diet
myself, which is vegan essentially.

719
00:37:58,116 --> 00:38:01,182
So no meat, no dairy,
no animal products whatsoever.

720
00:38:01,616 --> 00:38:05,015
And part of the benefit of this diet,
in my opinion,

721
00:38:05,015 --> 00:38:08,815
is that it's very high in prebiotics
and probiotics kind of naturally.

722
00:38:08,881 --> 00:38:12,481
So, you know,
is there going to be a probiotic pill

723
00:38:12,481 --> 00:38:13,881
that you can buy over the counter

724
00:38:13,881 --> 00:38:17,014
that's going to cause weight loss
without changing diet?

725
00:38:17,014 --> 00:38:18,480
You know, maybe I don't know.

726
00:38:18,480 --> 00:38:23,413
In my opinion, as of right now, at least,
the best way to get probiotics

727
00:38:23,413 --> 00:38:25,112
and probiotics
is going to be through foods.

728
00:38:25,112 --> 00:38:28,112
Yeah, I got to start eating the yogurt
my wife seems to keep telling me to.

729
00:38:28,512 --> 00:38:29,912
Yeah, your. Nondairy.

730
00:38:29,912 --> 00:38:32,011
Nondairy. Veer is not a big fan of.

731
00:38:32,011 --> 00:38:33,311
Yogurt. Kimchi.

732
00:38:33,311 --> 00:38:36,311
Kimchi, sauerkraut. Yes. Great.

733
00:38:36,311 --> 00:38:36,877
So, Dr.

734
00:38:36,877 --> 00:38:40,077
Adkins, can you please tell me, 
tell us a little bit more about,

735
00:38:40,077 --> 00:38:43,010
robotic surgery
and the rise of robotic surgery

736
00:38:43,010 --> 00:38:46,009
specifically
over the last couple of years?

737
00:38:46,276 --> 00:38:46,676
Yeah.

738
00:38:46,676 --> 00:38:51,009
Again, this is a kind of evolving field,
so there's sort of one major player

739
00:38:51,009 --> 00:38:52,509
in robotics.

740
00:38:52,509 --> 00:38:55,408
It's called the intuitive da Vinci Robot.

741
00:38:55,408 --> 00:38:59,708
Norman Regional
does have multiple of these robots.

742
00:38:59,708 --> 00:39:01,074
They're sort of the newest,

743
00:39:01,074 --> 00:39:04,440
greatest technology
in terms of visualization of the camera.

744
00:39:04,707 --> 00:39:08,006
The surgeon is able to sit down
and sit at a console with their face

745
00:39:08,006 --> 00:39:09,073
kind of in a screen.

746
00:39:09,073 --> 00:39:12,606
And it's not a true robot
because an actual robot,

747
00:39:12,606 --> 00:39:15,539
you press a button
and it's programed to do certain things.

748
00:39:15,539 --> 00:39:18,305
This robot is fully controlled
by the surgeon at all times,

749
00:39:18,305 --> 00:39:20,805
and the surgeon is in the room
with the patient at all times.

750
00:39:20,805 --> 00:39:22,638
So it's very safe.

751
00:39:22,638 --> 00:39:27,670
But essentially it's
a, a newer form of laparoscopy.

752
00:39:27,670 --> 00:39:31,603
So small incisions, but with a nicer
camera and wristed instruments

753
00:39:31,603 --> 00:39:36,569
that articulate much closer to what
actual hands do rather than laparoscopy,

754
00:39:36,569 --> 00:39:40,369
which is also called straight stick,
where it's more straight instruments.

755
00:39:40,502 --> 00:39:44,801
So there are multiple other companies,
as I'm sure you can imagine.

756
00:39:44,801 --> 00:39:48,501
They're developing
and creating surgical robots

757
00:39:48,501 --> 00:39:51,167
to try to compete with the Da Vinci robot
that exists.

758
00:39:51,167 --> 00:39:54,167
They're going through trials
and FDA approvals.

759
00:39:54,400 --> 00:39:56,733
So I'm super interested to see kind of
what develops.

760
00:39:56,733 --> 00:39:58,933
There's lots of kind of

761
00:39:58,933 --> 00:40:03,265
AI components to this that are being added, 
deep learning algorithms.

762
00:40:04,499 --> 00:40:06,798
you know, I'm not that into social media

763
00:40:06,798 --> 00:40:09,465
in terms of like keeping up
with high school classmates, but

764
00:40:09,465 --> 00:40:13,831
there's a ton of groups on robotic
surgery, bariatric surgery where people

765
00:40:13,831 --> 00:40:18,163
post videos and you're able to learn
and grow with surgeons all over the world

766
00:40:18,163 --> 00:40:22,663
and really use resources
much better that way than it used to be.

767
00:40:22,663 --> 00:40:25,029
Much more, you know, in training
you were kind of

768
00:40:25,029 --> 00:40:27,962
this is where your hospital is,
this is who your attending surgeon is.

769
00:40:27,962 --> 00:40:29,662
You have to follow them around
and that's who

770
00:40:29,662 --> 00:40:31,828
you learn from,
which obviously we still do.

771
00:40:31,828 --> 00:40:32,628
But now

772
00:40:32,628 --> 00:40:36,561
the entire world of surgery is opened up
where we can watch videos of each other,

773
00:40:36,594 --> 00:40:40,094
comment on things and tell, you know, 
this technique has worked for me.

774
00:40:40,827 --> 00:40:44,593
And it's really growing and evolving,
I think, in a good way for everyone.

775
00:40:45,160 --> 00:40:46,959
The world is really becoming
a smaller place.

776
00:40:46,959 --> 00:40:47,893
Yeah, it really is.

777
00:40:47,893 --> 00:40:51,092
And it's sometimes scary,
but there's so much opportunity to learn.

778
00:40:51,325 --> 00:40:54,725
Especially when when you mentioned the two,
the two letters,

779
00:40:54,892 --> 00:40:58,624
AI, I was just like, my gosh,
where are we going next?

780
00:40:58,624 --> 00:41:00,424
well, Dr.

781
00:41:00,424 --> 00:41:02,724
Adkins, we just wanted to say
thank you so much for being here.

782
00:41:02,724 --> 00:41:05,757
We really appreciate you coming in
and answering all of our questions for us

783
00:41:06,323 --> 00:41:07,223
before we head out,

784
00:41:07,223 --> 00:41:10,923
is there anything that you would like
to say, to our viewers, to our listeners,

785
00:41:11,489 --> 00:41:16,289
and any advice you can give to any future
potential bariatric surgeons?

786
00:41:17,322 --> 00:41:17,822
Yeah,

787
00:41:17,822 --> 00:41:21,588
you know, for listeners,
I think the main thing is that

788
00:41:21,588 --> 00:41:25,554
we as a society really need to work
on the stigma that surrounds obesity.

789
00:41:25,554 --> 00:41:29,420
And just like small things, you know,

790
00:41:29,420 --> 00:41:33,420
like saying patients with obesity
rather than obese patient, right.

791
00:41:33,719 --> 00:41:36,086
Labeling, things like that.

792
00:41:36,086 --> 00:41:38,619
And really,
you know, not just telling people,

793
00:41:38,619 --> 00:41:41,618
eat less, exercise more,
you know, it's not helpful.

794
00:41:41,618 --> 00:41:44,318
Obviously, most people who are overweight
have heard that before.

795
00:41:44,318 --> 00:41:45,684
Right.

796
00:41:45,684 --> 00:41:46,751
And really. Yeah.

797
00:41:46,751 --> 00:41:50,884
Kind of keeping up with educating yourself
about what is up and coming

798
00:41:50,884 --> 00:41:53,883
in terms of different treatment options,
I think is super important.

799
00:41:54,883 --> 00:41:57,550
I'm always happy to talk to anyone
who has interest

800
00:41:57,550 --> 00:42:00,816
in surgery
or just obesity care in general.

801
00:42:00,816 --> 00:42:02,649
Our clinic is amazing.

802
00:42:02,649 --> 00:42:03,849
Like I said, Dr.

803
00:42:03,849 --> 00:42:07,581
DeMattia, as our obesity medicine doctor,
she has multiple nurse practitioners

804
00:42:07,581 --> 00:42:09,348
working with her as well.

805
00:42:09,348 --> 00:42:12,514
I think, you know, the main thing
is that we meet people where they're at.

806
00:42:12,581 --> 00:42:16,114
So whatever help
they need, we're able to help provide

807
00:42:16,314 --> 00:42:18,013
different treatment options for them.

808
00:42:18,013 --> 00:42:22,346
That is evidence based
and like I said, a center of excellence,

809
00:42:22,479 --> 00:42:25,412
which you know is,
I think, extremely important

810
00:42:25,412 --> 00:42:28,179
for the safety and efficacy of the care
that the patients receive.

811
00:42:30,312 --> 00:42:31,345
Well, thank you again, Dr.

812
00:42:31,345 --> 00:42:31,745
Adkins.

813
00:42:31,745 --> 00:42:33,778
We really appreciate
you being here with us

814
00:42:33,778 --> 00:42:37,144
and talking about such an important topic,
such as obesity.

815
00:42:37,144 --> 00:42:39,344
And I feel like
we all share a similar passion for

816
00:42:39,344 --> 00:42:40,810
and we've learned a lot today.

817
00:42:40,810 --> 00:42:42,643
We've learned a lot.
It's been eye opening.

818
00:42:42,643 --> 00:42:46,276
There's some stuff that we just don't, 
you know, it's.

819
00:42:46,476 --> 00:42:47,443
Learn in med school.

820
00:42:47,443 --> 00:42:48,176
Yeah, it's.

821
00:42:48,176 --> 00:42:51,375
It's beyond our normal, normal learnings
and even even,

822
00:42:51,942 --> 00:42:55,575
you know, at being able to ask you
those intricate questions that you deal

823
00:42:55,575 --> 00:42:58,008
with on your day to day
job has been, has been great.

824
00:42:58,008 --> 00:43:02,241
So we can, we can better,
you know, talk to our patients about,

825
00:43:02,540 --> 00:43:05,373
about what they can expect
and when we place referrals.

826
00:43:05,373 --> 00:43:08,740
So with that
being said, for everyone listening,

827
00:43:09,939 --> 00:43:12,206
big, big things to come out of this topic,

828
00:43:12,206 --> 00:43:15,105
have been, we've got to lose the stigma
about obesity.

829
00:43:15,105 --> 00:43:17,172
you're not alone in this.

830
00:43:17,172 --> 00:43:20,438
Please come talk to your primary care
physicians for the Norman

831
00:43:20,438 --> 00:43:23,504
Regional Family and Journey Clinic
has been an invaluable resource

832
00:43:23,504 --> 00:43:28,137
for us, with up and coming technology
and a center of excellence.

833
00:43:28,137 --> 00:43:30,570
And we have amazing providers
like, like Dr.

834
00:43:30,570 --> 00:43:31,203
Adkins and Dr.

835
00:43:31,203 --> 00:43:34,869
DeMattia working to help us
and our patients and, and,

836
00:43:35,036 --> 00:43:36,036
anything else you want to add?

837
00:43:36,036 --> 00:43:40,002
Krishna? No, I think once again,
we cannot emphasize enough,

838
00:43:40,002 --> 00:43:43,002
the importance of having Journey Clinic
within the Norman community,

839
00:43:44,701 --> 00:43:48,934
over some of the other
different areas that I at.

840
00:43:48,934 --> 00:43:52,667
I've never seen a clinic
that is so devoted to,

841
00:43:52,667 --> 00:43:56,466
encompassing the different
and addressing all the different factors

842
00:43:56,466 --> 00:43:57,400
when it comes to obesity,

843
00:43:57,400 --> 00:44:01,099
whether that is nutrition,
that is surgery with that is medicine,

844
00:44:01,099 --> 00:44:04,099
whether that is behavioral
therapy Journey Clinic has it all.

845
00:44:04,099 --> 00:44:07,565
And now we've even talked about
how we're looking into doing genetics.

846
00:44:07,565 --> 00:44:07,898
Right.

847
00:44:07,898 --> 00:44:13,264
And so, to all of our listeners,
please utilize this resource it's, it's

848
00:44:13,264 --> 00:44:17,130
a very unique resource to have and we're
thrilled that Norman Regional has this.

849
00:44:17,863 --> 00:44:20,596
so just go online,

850
00:44:20,596 --> 00:44:23,596
look into Journey Clinic
and we're always here to help.

851
00:44:23,896 --> 00:44:24,962
Yeah.

852
00:44:24,962 --> 00:44:28,895
And as always, guys,
be happy and be safe and stay classy, my

853
00:44:28,895 --> 00:44:30,528
Friends, and stay out of trouble.