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Melanie Cole, MS (Host): Palmdale Regional Medical Center bariatric program has recently owned an accreditation with Aetna as an institute of quality. My guest today is Dr. John Yadegar. He’s the chief of surgery and medical director of the metabolic and bariatric surgery center at Palmdale Regional Medical Center. Dr. Yadegar, tell us about this accreditation with Aetna. What is this and tell us about some of the others that you’ve received.

John Yadegar, MD (Guest): Sure. Good morning Melanie. Thank you for the opportunity. So absolutely we really are privileged to receive yet another recognition by the medical bodies and the insurance bodies. As you know, bariatrics over the last 15 years or so has gone through a huge evolution in terms of the bodies that supervise, including the medical and surgical bodies that supervise these programs to ensure that we are always evaluating our outcomes and making sure that we deliver the service that allows for excellent results in. So as part of this and as an extension of these, various insurance companies mandate subsequently evaluation of these programs to ensure that the quality that is delivered is second to none with the appropriate choices for the surgery and patient selection and delivering the optimal surgical procedure. Of course, their follow up and subsequent improvements in health and outcomes.

So this award that we received with Aetna is our fifth that we have now received in the line of recognitions. We are very proud of that. It is absolutely significant in reflecting the teamwork that goes into these programs because there’s really a multidisciplinary. It includes the engagement of the hospital, of the staff, the nursing, the coordination with the nurse coordinator with the surgical team and surgical staff, the nutritionist, the pharmacy, the surgeon of course. And the entire, entire team of people that are engaged in managing a patient from the moment a patient seeks consultation for bariatric surgery through their preparation leading up the surgery, the surgery, and then there follow up afterwards. Then assessing their quality of life afterwards.

So the awards that the program has so far obtained includes the American Society of Metabolic and Bariatric Surgery in conjunction with the American College of Surgeons. The program is also awarded a Blue Cross and Blue Shield central distinction. The same with Cigna and, of course, now Aetna. It has also been awarded multiple awards through Healthgrades, which is one of the bodies that assesses the standards of medical care. Also we’ve been awarded by Kaiser as one of their centers of distinctions. So this really speaks volumes about the care that goes as a holistic program in caring for these patient populations. We’re delighted to offer this, and we continue to hopefully improve every step of the way. This is not the end for us. We really strive to always seek perfection, and this is yet another milestone. So we are delighted and grateful for that.

Host: It is wonderful doctor. Now tell us. With all of those accreditations and distinctions, what do you want a patient to be looking for when they are looking at a bariatric surgery facility?

Dr. Yadegar: So I think it’s really important to understand that a program really has to encompass the patient’s journey through this whole process. When they do look at the integrity of a program, the person really needs to understand okay. Is this just a place that I walk in through the doors, get surgery, and leave and I'm done? Or is this a place that I can actually go to be given the time to discuss my challenges and make sure that I get a good assessment and a risk stratification and suitability of surgery. And have an opportunity to discuss my options whether they are surgical or non-surgical. If they are surgical, what would be the best choice for me? To recognize that the program has a history, and to really search out what are outcomes the program has had. What capabilities the surgical team has. how many operations have they done? What is their follow up like? Do they offer support groups? Are they going to be available for me if I have a question? Can I reach out to my doctors when I need them?

So these are all very simple questions, but if you don’t really think it through you may take it for granted or just assume it. That would be not a good thing. You really want to be objective, have your list to go through. Okay. There’s coverage 24/7. I can talk to my doctor when I want to. I can talk to my nurse coordinator. I can go to the hospital if I have a question. These are things that I think distinguishes our program from a lot of others because we have a policy where the patients have 24/7 access. Everybody’s a trained staff. They have the cellphone directly to the surgeon. They have the direct access to the nurse coordinator. They have the direct access to the office staff. That way a patient knows that if they are going through this journey that they have a full support leading to surgery and beyond.

This is a lifelong commitment on behalf of a patient who seeks to get weight loss. They have to understand. It’s not just getting an operation. It really involves them making the right moves leading up and beyond. Eating correctly, keeping their activity, making sure they continue to take their supplements, make sure they follow up with their doctors to ensure that their success is ongoing. We have now a lot of data on 15 and 20 year follows up that suggest that a good portion of patients maintain a significant amount of weight off years away from surgery. That comes through engagement that is ongoing between the patient, their surgeon, their physicians, and their entire group that have continued to care for them.

Host: That was a great explanation Dr. Yadegar. Now as we’re discussing bariatrics and if somebody knows that this is a tool to help them change their lives, what can they expect as far as life after surgery like this as far as lifestyle management? You mentioned if they're adhering to these things, the supplements and the exercise programs that you mentioned. What is it like for them to go out to restaurants or to cook at home, to learn to cook if they're somebody who never really knew how to do that. Tell us a little bit about life after.

Dr. Yadegar: So, you know, with the advents and progress made in bariatrics, the industry—certainly in the food industry—has risen to the challenge. I'm delighted to see that the opportunities that are out there are now a lot better and a vast choice and array of things that patients can indulge in that are healthy eating options. Certainly I will tell you from a global standpoint that after weight loss surgery, the patient’s lifestyle in majority, if not entirely all, but in majority—we’re talking 99%—improves in multifacets. This is in terms of their overall health, which some have sleep apnea—which is a condition when they fall asleep, they can stop breathing for a short period of time. That can long-term effect their cardiovascular system. They get rid of that. The vast majority get rid of diabetes. The vast majority get rid of cholesterol, or their blood pressure, or their joint problems. By getting rid of these, they reduce their risks, they improve their longevity. They reduce their risk of developing certain cancers such as uterine, breast, ovarian, or prostate or colon cancer. So the quality improves. The risk of diseases and development of diseases, such as heart disease and strokes, drops. Their longevity improves. So there’s absolutely improvement in medical side.

Also there’s quality improvement in daily things. Their ability to have more energy, the ability to be able to do more or run after your kids. Simple things. Being able to tie your shoelaces. Simple things like getting on an aircraft and not having to ask for seatbelt extension. These are things that none of us really think about, often taken for granted, but it really is a burden on a lot of patients that have struggles with obesity. So these aspects of their quality of life improves. They're much more confident, self-assured. Aesthetically they feel often pleased about the results of their weight loss.

Then their social life changes. A lot of patients who’ve had obesity over the years tend to avoid social interactions. After they lose their weight, they're a lot happier to go out with friends and go out and enjoy their social time. Whether it’s around the table having meals with their friends or other aspects. As I started to say, the options for these patients now is so much more vast because you go down the supermarket isle. You have now so many options with regards to gluten free options, with low sodium options, with low calorific foods and high protein options. In terms of supplemental nutrition, there’s vast array of protein products that are out there in liquid form and powder form.

Part of this program is emphasis on education. So we really take our time beginning even before surgery and after through support groups and other forms to let patients know these are the kinds of products that you want to seek out through the websites, through the supermarkets, through the various restaurants. As you probably see yourselves, in a lot of restaurants now the items have calorific values associated with the food put right next to the food. So patients can be very selective objectively. It takes a little bit of time, but as long as they change their frame of mind, they tune into it, they certainly can enjoy their lives as they did before. Continue to have celebrations, Thanksgiving, Christmas and all the holidays with their families. They prepare more selectively. They prepare more optimally. They eat healthier. We often see that when on member of the family does this, others jump on. The whole family starts to eat better and healthier.

Eating is a social aspect of our lives and is a family time when people sit around a table. So it’s a best time to allow exchanges, interactions, and to educate your other members of the family how to eat better. How to be healthier. We see that. We emphasize that in this program. I would tell you the majority, as I said 99% of our patients will tell you their quality of life has vastly improved. They eat better, they are healthier, and they get rid of a lot of their meds and they actually end up cost saving through this process. Which is a delight. They can spend that money on their vacations and other things. So it’s a real life-changing experience. That’s what makes this whole thing so exciting for anybody who’s in the profession because we see these transformations. It’s really a metamorphosis from that cocoon to the butterfly that flies and spreads its beautiful wings. It’s a delight to see a patient do that. It gives us all the positive energy we need to continue and offer these services to these patients. We are very grateful for it.

Host: I can certainly hear your passion, Dr. Yadegar, for what you do and helping so many people. As we wrap up, tell the listeners what that you would like them to know about this accreditation and the wonderful services that you offer at Palmdale Regional Medical Center, what they should be looking for, and what they should think about when they're considering bariatric surgery.

Dr. Yadegar: So I would say that you don’t want to rush into any decision. That a patient should really evaluate their options, make sure that they have given all the alternatives the merit that it deserves with regards to starting to eat healthy and keeping a lifestyle that is active. Then if they feel that they’ve done all that, which majority of times patients, by the time they consider a surgical option they have already been through that process. Then to inquire about the details of the program and they can approach the hospital certainly through the bariatric program office. Then they can approach us through our direct office, and I’ll send them information and we will meet with them. They want to feel comfortable and get reassured about the fact that they will be treated with utmost support and respect during the whole journey.

Often patients have had negative experiences with some of their health providers through the years. So it’s important that they feel this is a setting that is entirely focused on them as front and center. The program has had a 15 year established reputation and, hence, resulting in these certifications. That they will, God willing, go through this and be going through the transformation in a safe environment with good outcomes and ongoing support, and that they are always, always welcome to reach out and ask questions. If they need anything to let us know. We are here for them. So the message is if you feel this is the right decision for you and you want more information, we are just a phone call away and we will be delighted to help them in any form we can.

If you are thinking of having bariatric surgery and would like more information, please feel free to call the following number 661-723-7833. We look forward to going on the journey to better health with you. I wish you all the best. Thank you.

Host: Thank you so much Dr. Yadegar. You are one of our favorite guests. As always, this was a fantastic segment. Thank you for sharing your expertise and giving such great advice to people that are considering bariatric surgery. That wraps up another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. Head on over to our website at palmdaleregional.com for more information and to get connected with one of our providers. If you found this podcast informative, as I did, please share on your social media and be sure to check out all the other fascinating podcasts in our library. 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. I'm Melanie Cole.