Weight Loss Surgery Podcast - Bariatric / Lap Band / RYGB / Gastric Bypass / Vertical Sleeve Gastrectomy Reeger Cortell, FNP-C

A lot has changed in the past 4 weeks since last I turned on my recorder, the majority of that having to do with the Coronavirus global pandemic. First, let me begin by saying I dearly hope you and yours are healthy and safe. Next, I want to pick up where I left off, one month ago. When I signed off in mid-March I told you that I was home on quarantine waiting for my own COVID-19 test results because a few days before that I had left work early with a fever, a dry cough, and pressure deep in my lungs. I was tested on March 14th. It took six anxiety producing days to get my results back but they were negative. Thank you so much to those of you who reached out to let me know you where praying for me and thinking about me. That warmed my heart more than I can ever express.
Now on to this episode, I asked Dr Walt Medlin if he would be willing to just talk with me while the recorder was running so that we might compare and contrast our thoughts and experiences on not only how this pandemic is affecting bariatric surgery in general and our practices specifically, but also how we move forward from this.
Before I cut to the episode thought, as those of you who are on my email list know, I have put out a call for Kid jokes. Initially my deadline was April 4th, but because I am publishing this episode now, I am extending to my deadline to April 25th. I want to create a WLSP episode entirely made up of kid jokes. I want to fight despair with a little kid joke humor. For those of you that don't know, for many years now at the conclusion of every single episode I have ended with a kid joke or two. If you have never heard this, then you just need to stick around to the very, very end, like literally that last 30-60 second of the recording time and you will hear the jokes. Its been like my little thing, like when you wait after all the credits of the Pirates of Caribbean or Ice Age movies and you get a little nugget, well, kid jokes are my nuggets at the end.
So now, rather than wait to the very end I want to make an entire episode of kid jokes, not because there is a lot to laugh about these days but rather to help us find a little light in this darkness. But I need your help. Me telling all the jokes, well frankly, that just wouldn't work. Will you help me? Will your kids help me? You family? Your friends? Everyone and anyone can call in. Please call the WLSP Google voice mail number 541-583-0099. You can also find the number at my website, WLSP dot com. Wont you help?
And one more thing before I cut to the episode, this podcast is listener supported. If you want to become a patron you can do so at Patreon or PayPal.
Discussed in this episode
Walt Medlin, MD Bariatric Surgeon and a person who is affected by obesity. The episode that has not yet been published on revisional surgery Mother Nature’s time out Rebuilding the airplane mid flight No elective surgeries until… When we can operate again… Working from home via Telehealth How to keep our bariatric surgery program alive Being proactive with your health Getting used to hunkering down, what next? The levels of worry and preparing Weight gain due to quarantine means something different for people with the disease of obesity Loss of structure- Who are we without our routines? Creating a new structure What will life look like after this? How or will this change us? The importance of recognizing and allowing emotions Bravery is not the absence of fear Helping at the right place at the right time in the right way- know how best to help Limiting social media As we move away from so many things, what are we moving towards? Quality of Life and Quantity of Life. Getting honest about Moral Injury and how to recover Team Hope and Optimism As always I hope you found this episode helpful along your way. You can find link to this episode and all prior episodes at my website, WLSP dot com. Regarding the kid joke episode, thank you to all of you who already called in your kid jokes and

Hi everyone, this Reeger Cortell, your friendly bariatric surgery nurse practitioner and this is the Weight Loss Surgery Podcast, where in normal times, we talk about obesity and bariatric surgery one episode at a time. But these are not normal times. 
At this moment is 9:34 in the morning, PST, on March 16, 2020. 2 months ago, heck even one week ago, I did not know talking about the coronavirus would be my next episode. Just last weekend, which feels like 100 yrs ago, Dr Walt Medlin and I recorded a great episode on bariatric surgery revisions. I was really looking forward to publishing that episode this weekend. But times have changed and rapidly. 
We have gone from in January, 2020 just learning about a novel Coronavirus which started making people sick with severe pneumonia in December in Wuhan, China to the World Health Organization declaring COVID-19 (the infection that results from the coronavirus) a global pandemic on 3/11/2020 the likes of which none of us have seen in our life time. All in less than Three months. As of this morning  169,000 people have been infected (and those are just the ones we know about) and 6,500 people have died. The death toll for this new virus is greater outside of China than inside, in the US school are closed in 33 states, with more closing, restaurants are closing, and the CDC recommends that any and all gatherings of 50 or more people be cancelled for the next 8 weeks. Hour by hour this situation is changing. My heart goes out to everyone, everywhere. 
There is so much information out there, good, scientific evidenced-based information that is open-sourced and available to all of us. Therefore, I am not going to make this episode about proving why we should all be on high alert and rightly concerned. We have not contained the coronavirus. It is out there. Sadly, and frustratingly, the gavel is down on that one and the jury has gone home. 
But rather, I want to use this platform, use my voice, to speak to directly to my listeners who are pre-bariatric surgery patients that are scheduled for their surgery in the near future. What do I mean by the near future? It’s hard to say exactly but why don’t we just round it out to at least the next 1-2 months, perhaps more. In the very least between March 16th to April 16th.
I am sure you are wondering if you should move forward with your surgery? How could you not be asking this question? But on the other hand, I bet you are thinking, ‘Are you kidding me? After all this time, and money, and prep, and waiting, and hoop jumping, and learning (thanks for using this podcast as a resource), and, and, and now this? A Global Pandemic is the reason you might not get your surgery?’ Perhaps you are thinking, ‘the heck with that, lets just do the surgery and we will figure out other issues, including coronavirus if and when we need to.’   
And perhaps you are a looking to your bariatric surgery center for guidance. I do know that at least in USA many programs have stopped group visits in different settings- seminar, classes, and support groups. We are all pivoting to offer what we usually offer in face-to-face visits to some form of virtual setting or at least environments that allows for the two words we have all become so familiar with- social distancing. 
What an oxymoron than phrase is, right?  It's right up there with "Bittersweet," "Clearly Confused," and "Deafening Silence". And I can think of many things I’d like to do that start with the word, "Social" but not one of those things ends in the word "distancing." 
But back to bariatric surgery; Programs in the US and around the world have made adjustments and we are all hoping that that will be enough. However, I am rapidly coming to the conclusion it is not enough. We need all hands on deck for this one, folks. And by "all hands on deck" I actually mean off the deck, so to speak, and away from each other. 
To paraphrase Dr Micheal Klompas from the Annals o

In this episode I bring you my conversation with Marilyn Clark. Marilyn is a certified Nutrition & Lifestyle Coach, a radical self-care advocate, an obesity survivor, a bariatric patient, and a nutrition nerd.
As part of our conversation, Marilyn shares her history as a person affected by obesity, how/why/and when she came to her decision to include bariatric surgery, specifically Roux-en-Y Gastric Bypass, as part of her treatment plan, and what her journey has been like since then. Her story will be both familiar to many of you and inspiring to all of you.
Discussed in the episode
Support the podcast at either Patreon or Paypal Marilyn’s early years, first diet at age 11. Complicated relationship with her parents. Adulthood: Gain weight, lose weight, gain weight, lose weight, gain weight. First considerations of bariatric surgery: Sleeve Gastrectomy Researching bariatric surgery- Is it the right choice for her? Insurance stumbling blocks but not giving up. Connecting with the bariatric surgery program Sacramento Bariatric Medical Associates and surgeon, Laura L. Machado, M.D., who performed her surgery. Choosing Roux-en-Y Gastric Bypass instead of the Sleeve. Getting honest with herself about changes she needed to make regarding her mindset, her work, her sleep, her nutrition, her physical activity, and her stress level. Who, when, and why to tell people about having bariatric surgery. Finding her calling to help others and the beauty of how this also helps her. Understanding your WHY.  The importance of a Gratitude Practice. Letting go of the victim narrative. Surround yourself with positive people. Life is a matter of choices, one after another. Learn something everyday. Evolving relationship to food. Why follow-up matters. The stars align- opening her new gym, SL8 Fitness Reeger’s concluding thoughts. Connecting with Marilyn Clark
Instagram Twitter Facebook Facebook Group: Healthy Habits Bootcamp Website Coaching Program: Reverse The Regain Email List Connecting with Reeger
Email: reeger@weightlosssurgerypodcast.com    Facebook Twitter Instagram Website

I want to share this poem by Alberto Rios because I love it and I have a rooftop from which I can share it. 
A House Called Tomorrow
You are not fifteen, or twelve, or seventeen—
You are a hundred wild centuries
And fifteen, bringing with you
In every breath and in every step
Everyone who has come before you,
All the yous that you have been,
The mothers of your mother,
The fathers of your father.
If someone in your family tree was trouble,
A hundred were not:
The bad do not win—not finally,
No matter how loud they are.
We simply would not be here
If that were so.
You are made, fundamentally, from the good.
With this knowledge, you never march alone.
You are the breaking news of the century.
You are the good who has come forward
Through it all, even if so many days
Feel otherwise.  But think:
When you as a child learned to speak,
It’s not that you didn’t know words—
It’s that, from the centuries, you knew so many,
And it’s hard to choose the words that will be your own.
From those centuries we human beings bring with us
The simple solutions and songs,
The river bridges and star charts and song harmonies
All in service to a simple idea:
That we can make a house called tomorrow.
What we bring, finally, into the new day, every day,
Is ourselves.  And that’s all we need
To start.  That’s everything we require to keep going. 
Look back only for as long as you must,
Then go forward into the history you will make.
Be good, then better.  Write books.  Cure disease.
Make us proud.  Make yourself proud.
And those who came before you?  When you hear thunder,
Hear it as their applause.
Alberto Rios

In this episode I bring you my conversation with Ted Kyle, RPh, MBA. Ted founded ConscienHealth in 2009. He is a pharmacist and healthcare innovation professional who works with health and obesity experts for sound policy and innovation to address obesity. He serves on the Board of Directors for the Obesity Action Coalition, advises The Obesity Society on advocacy, and consults with organizations addressing the needs of people living with obesity. His widely-read daily commentary, published at conscienhealth.org/news, reaches an audience of more than 15,000 thought leaders in health and obesity. His peer-reviewed publications focus upon weight bias and policy related to health and obesity. As such, Ted is perfectly positioned to share with us his list of the Top 10 Milestones in Obesity and Health over the past 10 years.
Discussed in this episode, # 10-# 1: 
10. The Rise of ObesityWeek: We discuss what is ObesityWeek and why does this conference matter.
9. The Mediterranean Diet Hits a Speed Bump: In 2018 the original authors of the PREDIMED study audited the study’s data and execution and they found problems. For about 14 percent of the study’s 7,447 subjects, assignment to a treatment group was not random. Taking those problems into account, they still found lower rate of cardiovascular events for people in the Mediterranean diet groups (compared to a lower-fat diet). But the bold claim of cause and effect evaporated. The original conclusions said the diet “reduced the incidence” of cardiovascular events. The new conclusion says “the incidence was lower.” This difference might seem small but it’s the difference between causality and association.
8. Plants Are IN, But Carbs Are OUT: As demonstrated by the new Dietary Guidelines for Americans in 2020. 
7. Vibrant Support and Advocacy for People with Obesity: The rise of the Obesity Action Coalition.
6. Sugar Is Poison: Dr Robert Lustig's Sugar-is-Toxic video
5. A Whole New Specialty for Obesity Care: American Board of Obesity Medicine came into existence. 
4. Surgery for Diabetes: Understanding that Bariatric Surgery is an endocrine surgery that changes the hormonal communication between the gut, adipose (fat) tissue, and the brain. The logic is inescapable. Type 2 diabetes is a cruel, progressive disease that slowly, but surely destroys a body from the inside out. Strokes, heart disease, amputations, organ failure – they’re all part of a bleak picture. Intensive medical care can slow it down. But metabolic surgery can put it into remission. Three years ago (2016), a remarkable consortium of 45 expert organizations endorsed metabolic surgery for type 2 diabetes. And yet, 97 percent of people who might benefit still don’t receive metabolic surgery. 
3. New Drugs for Obesity Treatment: Liraglutide (Saxenda), Naltrexone & Bupropion (Contrave), Phentermine & Topiramate (Qsymia), and Lorcaserin (Belviq), with more coming.
2. Sleeves Take Over from Bands: Bands peaked in 2007. As of 2018 Vertical Sleeve Gastrectomy is the #1 procedure of all bariatric surgeries.
1. Less Explicit Bias: Bias comes from selective blindness to facts. Explicit bias refers to attitudes and beliefs we have about a person or group on a conscious level. Implicit bias refers to thoughts and feelings we hold without conscious awareness regarding a person or group. Some of the more common biases we can hold against a person are based on their weight, sexuality, race, age, skin tone, or disability.
The risks of implicit and explicit bias is that people become sicker because of denial and inaction. Less (NONE!) of both types of biases would be better but less explicit bias is certainly a start. 
Thanks for Listening! 
Support the podcast at either: Patreon or PayPal
Connect with Ted Kyle: ConscienHealth.org, LinkedIn, Twitter, Facebook, Instagram, email: Ted.Kyle@conscienHealth.org
Connect with Reeger Cortell: Facebook, Twitter, Instagram, email: reeger@weigh