Episode 58 - Teri Gets The Skinny on Bariatric Surgery with Dr. Carson Liu

Transcript

Teri Struck: I’m Teri Struck, host of Beauty Now, a weekly podcast that brings you the latest in cosmetic surgery, skin, lasers, lifts, breast augs, Brazilian butt lifts, neck, nose, lashes, hair and much, much more. Today we’re welcoming Dr. Carson Liu, a bariatric surgeon who’s going to tell us all about the lap band procedures and the bariatric surgeons. Welcome Dr. Liu.

Dr. Carson Liu: Thank you very much.

Teri Struck: I know very little about bariatric surgery. I do know that there’s millions of people across the United States and Europe that are overweight and struggling with their weight and this is kind of a last resort, is that correct?

Dr. Carson Liu: Yes. Most people who are looking for weight loss surgery have tried diet and exercise as a primary treatment and have failed. If they have failed then they look into surgery and there’s different levels of surgeries. Bariatric surgery entails all types of weight loss surgeries.

Teri Struck: How many pounds overweight generally do you have to be to be considered for bariatric surgery?

Dr. Carson Liu: Usually at least 75 pounds with a medical illness or a hundred pounds over your ideal body weight.

Teri Struck: And I’ve heard of people actually sticking weights and stuff into their clothes so that they can qualify. Do you guys look out for that or are you real strict about the 75 pounds? Or what if you’re 65 pounds, what do you suggest?

Dr. Carson Liu: If you’re 65 pounds it’s tougher to have most insurance companies cover it, so these criteria that I have outlined are usually insurance guidelines for coverage, and that is part of the reason why people work themselves around the weight criteria. In general, you know, this is elective surgery and I tell patients if you’re looking to have your insurance cover it we should just wait until you qualify and you should try medical weight loss before entertaining the thought of surgery.

Teri Struck: Don’t you try to suggest that to all the patients to try, and I’m sure they all have. I mean I’m sure when you get to that point you’ve lost hope and control and everything else.

Dr. Carson Liu: Absolutely. Most of my patients I’ve seen they have tried, literally say they have tried every diet under the sun, so they know every diet and every program, they’ve tried all the commercial programs, and they’re at their wits end. It does take a lot of courage and a lot of self-resolution to come to the grips that you’re going to actually take a surgical intervention to help with their weight loss. Two-thirds of Americans are overweight at this point and we are literally eating ourselves to a state of illness.

Teri Struck: So, you’re talking about the morbidly obese that did the bariatric option, is that true?

Dr. Carson Liu: Yes, we’re talking about the morbidly obese. We do have obese patients who seek out the lap band procedure electively. It has been published internationally stating that people who have a BMI of 30 and over, which would put them about 50 pounds overweight, will benefit with a better quality of life with the lap band in place.

Teri Struck: And for our listeners that don’t know BMI, that’s body mass index, correct?

Dr. Carson Liu: Yes. The body mass index is a calculation of their weight divided by their height where it’s in the metrics systems of kilograms over meters squared. Overweight is considered 27, 28 BMI, obesity is considered 30 and over, and morbid obesity is usually considered 35 and over.

Teri Struck: So when a patient comes into you, how do you give them a consultation?

Dr. Carson Liu: When they come in they’ll first have their height measured and they will have their weight measured without their shoes. We do check to make sure they’re not padding themselves down with other weights. And we have them undergo a bio impedance measurements, so we measure the percentage of fat. When you’re looking at the BMI strictly, a body lifter or somebody like Arnold Schwarzenegger is going to have a high BMI because they have a lot of muscle mass. We also look at the percentage of fat in addition to their weight and height.

Teri Struck: That’s a really good point. So how do you actually measure the muscle as opposed to the fat?

Dr. Carson Liu: We actually use a bio impedance machine, which sends a small electrical current, it’s painless, and we can measure the amount of fat and the amount of lean body mass. And we do this every time a patient comes in to make sure that they’re exercising as well as having enough protein in their diets to have a healthy weight loss. The ultimate goal here is to lose fat and preserve as much muscle after weight loss surgery, whether you get the gastric bypass or the lap bands. And we do measure that as a baseline and then we measure it going forward every time they come back to visit me.

Teri Struck: Well I think most of the media, from what the average person is seeing, is seeing bariatric surgery as extremely dangerous. What do you say about that?

Dr. Carson Liu: Well I say it’s just the opposite with the lap bands. Everybody has these misconception of gastric bypass being dangerous because they know some of the complications. The lap band procedure is an adjustable gastric band that we place at the top of the stomach, it takes about 20 to 30 minutes. And it’s an outpatient procedure, you go home in 10 minutes to as far out as an hour, and as soon as you recover you’re actually walking out from the surgery and going home, you sleep in your bed. You know, pain medication is children’s liquid Tylenol, so there’s very little discomfort after the procedure. It is the least invasive procedure. It’s all done through a 5 millimeter laproscope, and we’re able to do it on the TV monitor and it’s pretty much like Star Trek, you’re operating with minimal intervention on the patients pain level in terms of their down time. Most people can go back to work in two days.

Teri Struck: Wow, that’s incredible. So explain more about the lap band. So you’re going to go in there and you’re going to do this little Star Trek procedure, but what is it exactly that you’re putting in there?

Dr. Carson Liu: The lap band is just a silicon band with a balloon on the inside of the band that allows us to adjust the restriction. So if you can picture a hourglass with the sand going through, the patient gets to control how fast the food goes through the stomach, and when you slow down the food that stretches out that stomach that’s above the band and it sends a signal to the brain saying that you’re full. So all we’re doing is tricking the brain into think that you’re full with a lot less food, and for a lot of these patients that never felt full in their entire life they’ll tell me that it’s amazing, they finally have an off switch with the band in place.

Teri Struck: I did watch that show, they had a special reality show on the struggles of patients in the hospital and it was heart breaking. But were those patients that are, you know, maybe over 200 pounds overweight – excuse me – do they do the gastric bypass as opposed to the lap band?

Dr. Carson Liu: No, I’ve done patients who are, you know, 480 pounds with the lap band who have successfully lost 280 pounds, and it is the least invasive so that’s the one thing to remember is it’s also the safest procedure out there. The patients just have to get the band adjusted. It’s a clinic visit and we inject saline into the access port, which goes into the balloon around the band, and it allows them to continue to lose weight going forward. So the band is useful for people who are extremely morbidly obese to those people who are just obese.

Teri Struck: So it sounds like that maybe the bariatric, is that used anymore?

Dr. Carson Liu: In 2009 the lap band is being performed more often than the gastric bypass.

Teri Struck: The gastric bypass. So, why would you do a gastric bypass as opposed to the lap band now?

Dr. Carson Liu: At this point it is pretty much being driven by the patients, and the patients understand the differences between the adjustable gastro band versus gastric bypass. They understand that they’ve encountered people who have had complications from the gastric bypass, so they end up choosing to have the lap band. The only reason why a patient would get a gastric bypass is if their insurance would not cover one procedure over the other or they went to a surgeon that had a particular bias towards doing gastric bypasses rather than lap bands.

Teri Struck: So the gastric bypass, do the patients have to eat certain things afterwards? I’ve heard that you can never eat normal food again, and what’s the reality?

Dr. Carson Liu: The reality of the gastric bypass is that you have some difficulty with usually chicken breasts, and you’re going to have problems with greasy food and really high sweet feed. You get this diarrhea, what we call dumping syndrome with the gastric bypass. What the lap band, the main thing that you can’t eat is bread, and it basically restricts the amount of food that you can eat and if you eat too much with the lap band it ends up causing you to spit up food.

Teri Struck: So if a patient eats bread with the lap band they would spit it up?

Dr. Carson Liu: Exactly. They would either spit it up or in three to four hours it would pass through. But it’d be enough of a negative experience and they will not want to eat bread again.

Teri Struck: You can’t do that temporarily. So tell us about the lap band, like how long do people keep it in place? Is this something they keep in forever or just ‘til they lose the weight, and how do they train themselves to actually be able to eat on their own?

Dr. Carson Liu: That’s a good question. The band itself is reversible, so when we take it out there’s no alteration in the anatomy of the patients gastrointestinal system. But, you know, I’ve placed over a thousand four hundred of these and only about nine patients have requested to have this removed, and everyone else is walking around with their band, most of them with their band balloon wide open without any saline in their balloons. So most of these people are keeping it in forever, but they have the option of taking it out a year or two later if the balloon is completely empty and they’ve really altered their behavior of eating. Ultimately what we’re trying to do is get them to eat healthy and get them to chew their food more and get them to eat in very small portion sizes. If they can do that on their own over time, it usually takes about four to five years, alter their behavior of eating, and they have their entire life to develop their eating behavior, we will entertain removal of the band, but for now most of these patients, since my early patients in 2002 are still walking around with the band, the band still works, it’s a extra measure of a safety net for these patients because they know they have control to lose more weight if they ever need it.

Teri Struck: Well and also, tell us about more complications. What do they experience? What’s the negative about the lap band? I heard that you can get heartburn and things like that.

Dr. Carson Liu: Heartburn is rare. We’re actually presenting a paper on reversing heartburn with the lap band, so if you have heartburn, you get the lap band your heartburn will go away. That used to be a fear of the lap band with induced heartburn issues. If you have heartburn it mainly means that your lap band is too tight and you need to get it adjusted by a surgeon. If you have heartburn the other symptom is that it could indicate that the band has slipped a little bit down too far and that you need to get the band opened up surgically and moved about two centimeters higher and that would get rid of the heartburn. So the heartburn usually indicates that the band is either too tight or the band needs to be moved a couple centimeters up higher, and that happens with massive weight loss. People have lost over a hundred, a hundred and twenty pounds, the band can moved down. So that’s the couple centimeters that give them chronic heartburn. And if that’s the case, we can just laproscope them with three 5 millimeter incisions and take care of the problem.

Teri Struck: And how fast do they lose weight? What’s the typical weight loss per month lets just say?

Dr. Carson Liu: It varies from men versus women. Men all lose weight faster…

Teri Struck: I know, I hate you guys.

Dr. Carson Liu: I know. I don’t know why that is but, you know, for men we…For men and women in the first three months of weight loss after the lap band insertion is very quick, and then after that three month period we’re looking at six to ten pounds a month as a pretty good weight loss. If you’re losing less than six to ten pounds, you’re not happy, you can come on in and have a lap band adjustment as a routine clinic visit, it takes about fifteen minutes to have the band adjusted.

Teri Struck: And do you offer counseling with this or do people seek outside counseling?

Dr. Carson Liu: We have counseling, but if they have the lap band we also have a psychologist available to them. A psychologist has screened them initially before surgery to make sure they’re a good candidate, and we also encourage a support group or other commercial weight loss programs like Overeaters Anonymous or Weight Watchers if they choose to do so. If they choose the lap band they also have, you know, Lindora online of the weight loss, they also have Fit Day, which is a monitoring device to see how much they exercise, and they also have, if you’re a female they have membership to Curves for about ten weeks.

Teri Struck: And that’s really important because you do want to promote a healthy lifestyle along with this solution to such a debilitating problem.

Dr. Carson Liu: That’s what I try to instill in the patients that the band, number one, is a powerful tool to help you reduce the volume of food. But ultimately the patient will be responsible for making the right choices of healthy foods and they need to exercise. So it all really boils down to diet and exercise, but the lap band is a powerful tool to help them to lose weight.

Teri Struck: Plus I would assume it would give them hope and inspire them to not be so depressed, to get and just to try to walk or do something.

Dr. Carson Liu: I think it’s a real fact that both the inflammatory markers of the blood go down with minimal weight loss, 30 to 40 pound weight loss, the inflammation goes down, the markers in the blood, such as seri active protein correlating with heart attacks actually normalize and Substance P, which is a substance that builds in the blood sugar for pain, goes down to normal levels. So these patients are able to walk and exercise, and when they start losing 30 to 50 pounds they get motivated to exercise, and then another 50 pounds sheds and the next thing you know in about a year, year and a half they’ve lost a hundred pounds.

Teri Struck: Well that would motivate anybody to be happier. We’re going to have to take a short break. We’re talking with Dr. Carson Liu, a bariatric surgeon. We’re going to be able to link his website to ours, personallifemedia.com. We’ll be right back.

Teri Struck: I’m Teri Struck with Beauty Now, and we’re talking with Dr. Carson Liu. He’s from UCLA, a professor and he’s board certified in bariatric surgery. Welcome back Dr. Liu.

Dr. Carson Liu: Thank you.

Teri Struck: We were just talking about all the different things and how a lap band could help you to lose weight if you’re obese, and it is such a complicated subject. So you just keep on talking about it. I did have one other question; are you able to drink alcohol when you’re on the lap band?

Dr. Carson Liu: Yes, you can. Of course everything in moderation is recommended, and publications came out in Australia about eight years ago, stating that if you actually drank Australian red wine with the lap band, you seemed to have lost more weight than the people who just had the lap band procedure…

Teri Struck: Why is that Australian red wine? That’s really interesting.

Dr. Carson Liu: Well you have to keep in mind that the research on that paper was funded by the Australian Red Wine Vineyards, so we don’t know how…

Teri Struck: Ha, ha.

Dr. Carson Liu: It was, but it was an interesting article and maybe the taninzens in the red wine help as an antioxidant or people, you know, have one glass of wine before or after a meal and it will not hurt.

Teri Struck: Well red wine is always better for you because it has resveratrol in it, so it has more of the vitamins from the skin.

Dr. Carson Liu: Exactly…

Teri Struck: But they’re telling you one or two, and especially for women in think they say one and for men you can have two. Again not fair, ‘cause men lose weight faster. So tell us more about the lap band procedure, that it seems to be the more popular procedure. Tell us about diabetes and the lap band.

Dr. Carson Liu: Sure. First of all, the one thing to remember about the lap band is it’s an outpatient procedure, it’s about an hour to perform and patients have very little pain, and those are the primary things that have motivated patients who seek out the lap band surgery. The things that surgeons, such as all the bariatric surgeons who do these procedures are addressing the medical illnesses. So we’re looking at it and we see about a 93 percent reversal rate in diabetes with weight loss. So we’re definitely seeing once you shed some weight, and it doesn’t have to be a lot of weight, the diabetes reverses, they’re off their medication, their hemoglobin A1C, which is a blood marker for glycosylated hemoglobin, is normalized, and it’s just an amazing thing to see that they actually have a simple outpatient procedure to get rid of diabetes. Now there is a catch to this, and that’s usually that people who’ve had long term, long standing diabetes have had, you know, 10-15 years of oral medication and then they were put on insulin, and then when they were put on insulin they gained even more weight because it acts like a growth hormone and they skyrocket in the weight, and those are the patients that are hard to reverse their diabetes, there’re probably seven percent that really we can’t reverse. So there is a time limit in terms of how long they’ve been on the oral medication and how ill their pancreas is in terms of secreting insulin, ‘cause at some point the medications that we use to treat diabetes, adult onset diabetes, will cause them to require insulin and at that point it’s very hard to get rid of their diabetes.

Teri Struck: And I assume that you do a full work-up so you determine all their health problems before the surgery?

Dr. Carson Liu: Absolutely, and we are looking at their baseline medical illnesses, so we normally address their joint pains, we address their coronary artery disease, we want to make sure it’s safe to proceed with general anesthesia for about a half an hour to forty-five minutes, and we’ve never had anybody die from the lap band, so that’s the other reassuring thing for patients to know that, you know, no one has ever died from the procedure and…

Teri Struck: What about the baratric?

Dr. Carson Liu: What about the bariatric…

Teri Struck: What about the bariatric, you call the gastric bypass?

Dr. Carson Liu: Yeah, the gastric bypass, people have always encountered, people have developed blood clots in the legs and they go up to the lungs and it’s called a pulmonary embolism…

Teri Struck: Right.

Dr. Carson Liu: That can happen…

Teri Struck: Now what is a symptom of that, because I know that a danger is that you go home and you don’t really know you’re in distress and then it could be too late. What’s a symptom of a pulmonary embolism?

Dr. Carson Liu: The symptoms are very subtle, so only 50 percent of the people have some calf pains revealing that they have a blood clot in the legs. Some of the blood clots come from deep veins of the pelvis. When they break off and go to the lung the only thing that the patient will feel, and that’s only about half of the patients, they’ll feel a little pain in their deep breathing and they really need to go to the emergency room and get…

Teri Struck: And don’t be embarrassed. You don’t want to die of embarrassment. I mean…

Dr. Carson Liu: No.

Teri Struck: that’s true with any surgery.

Dr. Carson Liu: Right, and you’ll be put on blood thinners and they’ll work you up to see if you have a blood clot going into your lungs. And if you feel short of breath definitely go the emergency room, tell them you had a gastric bypass, prolonged bariatric surgery. It’s usually the longer the surgery, the more dehydrated the patients are after the surgery that the lungs are able to get blood clots and those are the life threatening possibilities.

Teri Struck: That’s good advice. What is the oldest patient that you’ve had?

Dr. Carson Liu: Seventy… he’s actually 73 years old right now. He drives in from Las Vegas to get his lap band adjusted. He’s a terrific guy, he’s lost a lot of weight and…

Teri Struck: That’s great.

Dr. Carson Liu: he’s very happy with the lap band.

Teri Struck: What’s the youngest?

Dr. Carson Liu: The youngest has been 14.

Teri Struck: 14 years old, wow. And is there any, it’s probably better that they’re younger, correct? Or is it always a risk because of the obesity?

Dr. Carson Liu: I think when they’re younger they have other issues, so teenage girls have other issues. They tend to gain a little weight during puberty, and I think the impact on a teenager is much more life changing than it is lets say for a 60 or 70 year old. So if you actually get the weight off of a teenager, lets say 16, 18, 19, you’ve really changed their life path because they’re no longer the outcast of their peers, they’re no longer…

Teri Struck: That is so important for any parents listening. I mean please get counseling about it to help your child ‘cause it so painful. You see so many kids today taking their lives. They have Face Book and they have all these different things and ways, other ways to torture teenagers that we didn’t have when we were growing up, and it’s really important for their self-esteem to feel good about themselves.

Dr. Carson Liu: Exactly, and…

Teri Struck: Not to be healthy. I mean, you know, of course to be healthy, but their self-esteem would be huge for life, I could see that.

Dr. Carson Liu: The teenagers, we request that they go through a psychiatrist and a psychologist and make sure that, you know, they have a good endocrine work-up, make sure there’s no hormonal issues. But the kids who are, you know, a hundred pounds overweight as teenagers will grow up to become morbidly obese, almost 75 percent chance that they’ll never burn that off and will require surgery, and it is a huge impact on their life. Even though they don’t have any medical problems themselves, they’re going to have a huge life change. We’re going to operate on a 16 year old in a couple weeks who has a couple medications for heartburn already, so he’s on adult medication for heartburn and is on borderline blood pressure and is going to be placed on blood pressure medication at the age of 16, so it’s pretty amazing to see this happen…

Teri Struck: But isn’t there joint pain and things like that. I mean, just even as younger people. I was listening to somebody the other day saying that their feet hurt so bad and they had Plantar Fasciitis and I, you know, I had to say, “I think you need to take some weight off”, which is hard to say to somebody that you know, it’s a really hard thing to say.

Dr. Carson Liu: Exactly, and, you know, I see people all the time who are morbidly obese as teenagers but I don’t say anything. I think part of the problem is that the parents and the child need to come to the realization that there’s something out there available, but it’s such a sensitive issue that you don’t want to approach strangers and say, “Hey, you need weight loss surgery”, you know…

Teri Struck: It’s so true. I mean, but I also think it’s, you know, you’re really dispelling a lot of myths today that for the average person that watches TV and these news shows, of course they’re going to show all the dangers, and it’s, you know, you see how these people die of, you know, gastric bypass, but you don’t see all the successful ones.

Dr. Carson Liu: Exactly. And it’s overblown in terms of the issues with the gastric bypass. If it’s done by the appropriate people and those surgeons have had a lot of experience, those complication risks are very, very low. That’s one thing that you have to keep in mind that people have had it since, and doing these weight loss procedures, they will be honest with you and tell you what the exact risks are involved with these procedures. Patients can do their homework nowadays on the internet and they can do their homework by talking to other patients that have had the surgery. The main thing to remember is that you want to choose the least invasive safest procedure out there.

Teri Struck: Which in your opinion is right now the lap band.

Dr. Carson Liu: I believe that is the safest, the least amount of down time and the least amount of pain and discomfort.

Teri Struck: Well I definitely learned something today. I thought that if you’re, you know, morbidly obese, which a couple hundred pounds over weight, that you would have to have the gastric bypass, but you’re saying you can have the lap band.

Dr. Carson Liu: Absolutely. And we have people in the BMI of 30 and 35 that have the lap band but they’re paying out of their pocket for it, insurance is not covering it, and they’re paying anything over a certain amount of their income, seven and a half percent of their income is tax deductible because of its use for weight loss, so…

Teri Struck: And there is financing companies available, and this is your life, right. I mean, there are different companies that will help finance your weight loss?

Dr. Carson Liu: Absolutely. So we work with finance companies that basically bring the monthly payments down to a little less than three hundred dollars, about two hundred and ninety dollars a month, and people say, “Well I can forgo getting a car for now. I want to get this lap band and get my life into better health”, and with that comes a lot more self-esteem and happiness with it.

Teri Struck: And I wish that for everybody listening to Beauty Now. This has been a really great show. Thank you so much Dr. Carson Liu. Go to personallifemedia.com, we’re going to connect his website, and he’s out of LA. You want to go to a board certified surgeon, I, we stress that on every single show, and somebody who has had a lot of, lot of experience, and you can find him. And thank you so much for being with us today and answering all of our questions.

Dr. Carson Liu: Thank you very much for the time.

Teri Struck: I’ll have to have you back because we could, I could ask you 20 more questions, but I really feel like this has been a great show. And if you want to know on bariatric surgery you can look up Dr. Carson Liu’s website, we’re going to connect it to personallifemedia.com. If you’d like transcripts of today’s show, go to personallifemedia.com and email me at t-e-r-I- @personallifemedia.com ([email protected]). Thanks for being with us.