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Melanie Cole (Host): Have you tried diets and exercise but continue to struggle with weight loss? Well, weight loss surgery at Palmdale Regional Medical Center may be an option for you. My guest today is Liz Roark. She's the bariatric coordinator and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Liz. So, tell us about bariatric surgery at Palmdale. What can patients expect the first time that they come in for an evaluation?

Liz Roark (Guest): They initially go into the surgeon's office and the surgeon actually does an evaluation and then he evaluates them based upon whatever co-morbidities they have. Those could be obesity related health conditions and he reviews what they need to do. At that point, he then makes recommendations that they need to have very specific diagnostic testing done prior to going to surgery.

Melanie: What kinds of testing do they have to go through and what's the evaluation like, as far as their health history?

Liz: Their health history is very independent based upon what health issues they have. We have some patients who come in that have numerous co-morbidities related to their obesity. Other people come in and they haven't developed comorbidities yet but they meet the requirements for bariatric surgery. Some of the things that they might order would be pulmonary function tests. Maybe they've got an underlying heart disease and they need to have cardiac clearance. Maybe they need to have clearance from a pulmonologist. If they've got a history of some kind of underlying blood disorder, they may need to have an evaluation with a hematologist. So, it's very wide and very broad in terms of the evaluations that each patient would need. So, it’s definitely individual, per patient.

Melanie: So then, what's the process if they decide that this surgery is for them? Is there counseling? Maybe psychological counseling or counseling on diet and exercise before they start this procedure?

Liz: All patients are required to have a psychiatric evaluation. The psychiatric evaluation is to make sure that they know what they're getting into in terms of the surgery because of the fact that it can be a roller coaster ride. Do they really understand what they're getting into? And the psychologist will discuss very, very specific, again, they'll talk about do they have any drug issues? Do they have any alcohol issues? Things down the road like that and that psychologist will make a decision about whether they feel that the patient is a good candidate psychologically to move forward with bariatric surgery. They also are required to attend educational classes.

Melanie: And what else besides the educational classes--because that's where I was going with that--would you like them to do or know before they surgery? Should they be trying to lose weight before they go into the surgery? Should they be exercising? What should they be doing before?

Liz: To be honest, they should be doing all of the above. The doctor does require that they have a five to ten percent weight loss prior to surgery and, yes, they need to start an exercise program. Because starting the exercise program before surgery will help them along the way because that's required after surgery. It helps establish that habit before they get to surgery.

Melanie: So then, once they've had the surgery, what can they expect for recovery and beyond?

Liz: You know, it actually is really pretty quick. People are amazed at how pretty quickly they recover. They're seen in the office approximately two weeks post-operatively and by the time they're seen in the office, they're moving forward from a clear liquid diet, which basically consists of water, their protein, sugar free popsicles, sugar free Jell-O, broth. Then, prior to seeing the doctor, we move them forward with some soft-textured food. I will sit with them before they go home and go over that specific diet. I call it “soft, smooshy food”. A moistly scrambled egg. I even let them know they can eat the whole egg, the egg white, egg beaters--the choice is theirs and most patients, giving the example of an egg, they get maybe through maybe a quarter of an egg and they're full. So, they definitely have to realize that and they frequently tell me this, "Gosh, there's a disconnection between my stomach and my head. I think I can eat more, but I can't eat more. My body won't let me eat more."

Melanie: Wow. Now, if they've had LAP Band surgery, do they feel that in there afterwards and when they eat and get that full feeling?

Liz: The fullness with the LAP band is a little bit different in terms of the fact that with a bypass, or sleeve, you have some movement, you know, you have a little bit of give when that food, especially with a bypass, is going through what, for lack of a better term I'll call "where the connection was made between the stomach and the bowel that was brought up." So, there's a little bit of give. With the band, it's rigid. It stays there, so they'll definitely, if they eat something that they shouldn't, or maybe they've had some chicken that's really dry, a bypass patient will feel that. However, if it's really too dry, the LAP band patient really has a hard time getting food through if their food is not chewed to a, pretty much you could say, a pureed consistency.

Melanie: Is there a concern about reflux after this type of surgery?

Liz: With the band and the sleeve, yes.

Melanie: So, what do tell people about any of these things that they might encounter because this, as you say, is a tool to help lose weight and, you know, it's something that's very new to them?

Liz: Right, and I have this conversation frequently. First of all, I do not want them to go further than the guidelines that we're giving them. I do not want them eating or drinking something that's not on the list that we want them to have. Again, the first two weeks is water, protein, sugar free popsicles, sugar free Jell-O, broth. We even let them have a teaspoon of fat free blended yogurt, unsweetened applesauce, and fat free, sugar free pudding. Soft, you know, and a lot of times it's so they can take their medications on the pudding or the yogurt, but I don't want them going forward because there have, in the past been people who try to push the edge of the envelope a little bit and they can get into a little bit of trouble. They feel like something's stuck, or they get sick. They become dehydrated and then they end up in the emergency room which is definitely what we do not want to have happen to them. So then, they're moved on to the soft, smooshy food. It's very, very specific and they are told do not move forward. There is something that many patients who have bariatric surgery they call it "head hunger". The patients will tell me, "I never realized how mental this is because I have to really think before I put something in my mouth." And I remind them, it's on the list that you were given that I sat and have gone over with you. And I can tell you that 100% of the patients have seen that list prior to even coming to the hospital. They get the information at their pre-op appointment. They get that same information in their education class. I sit with the patient prior to surgery before they go into the operating room because of the fact that they usually have a family member there and, you know, they're feeling still pretty good, so I can have that conversation with the patient and the support person/family member who might be there and go over all that stuff while they're still fresh and alert and not feeling bad because they've had surgery. So, there are lots of opportunities. Then, prior to them going home, I sit next to their bedside and go over it again.

Melanie: I bet you are just wonderful with the patients. And what about multi-vitamins? Does that come into the picture?

Liz: Oh, definitely. They start multivitamins the day after they go home. They're also encouraged prior to surgery to start their vitamin regime.

Melanie: So, then in just the last few minutes, Liz--and it's such great information and you're so well-spoken--what should people considering bariatric surgery think about when seeking care? What's the most important information you like people to know?

Liz: If you're considering bariatric surgery, I really, really want you to know that you really need to commit. This is definitely a lifelong commitment to lifestyle changes; to changes in your eating, to incorporating exercise into your lifestyle, to making sure that you're staying hydrated, that you're drinking at least those 64 ounces of liquids a day. It's definitely a complete lifestyle change.

Melanie: And why should they come to Palmdale Regional Medical Center for their care?

Liz: They should come to Palmdale Regional Medical Center because they get very specialized care. The staff at the bedside, the staff preoperatively, the staff in the OR and recovery room treat patients like they're their family. They know what they would like to have in their care and that really is reflected to the patients at the bedside during recovery. The staff is amazing. They work with the patients. They encourage the patients, the patients walk in the hall and the staff will see them and give them thumbs up, "Yay, way to go! You're doing a great job!" So, the staff is very involved. Our staff is educated in what the patients are doing.

Melanie: Thank you so much for being with us today, Liz. You're listening to Palmdale Regional Radio. For more information, you can go to palmdaleregional.com. That's palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Talk with your doctor about these risks to find out if bariatric surgery is right for you. This is Melanie Cole. Thanks so much for listening.