Weight Loss Surgery: An Expert Opinion AM 570 KVI October 28, 2007 Ross L. McMahon, M.D., F.R.C.S.C., F.A.C.S. Introduction

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1 Weight Loss Surgery: An Expert Opinion AM 570 KVI October 28, 2007 Ross L. McMahon, M.D., F.R.C.S.C., F.A.C.S. Please remember the opinions expressed on Patient Power are not necessarily the views of Swedish Medical Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That s how you ll get care that s most appropriate for you. Introduction Good morning, Western Washington, Seattle, Tacoma, Bellingham, wherever you may be with us or on the internet around the world. I'm Andrew Schorr. This is Patient Power, the only program on radio week after week and on the internet where we discuss leading medical topics, important topics for you and your family and the experts are the most credible. And we're not out to sell you anything. Our mission is to help you and your family make smarter choices. And, as you know, that's unlike most of the other health stuff you hear on the radio. So we're trying to help break through all that clutter. You know, one of the things that is so important to people now for long-term health is controlling your weight, and unfortunately so many of us, an increasing number, can't do it themselves. It is so difficult. Here in Washington State the number of people who are what they call morbidly obese, maybe over a hundred pounds overweight is going up, and it's the same thing all across America. Now, we could have whole other shows on why has that happened, but it is happening. And so increasingly then people are looking at surgical options, because, quite frankly, as you're going to hear, although it's a multibillion-dollar business for the most part those weight loss programs you hear about don't work. Maybe for a few people, I know Don Shula, the former Miami Dolphins coach, he and his wife were on, and they look thinner, on whatever program that is on TV, but most people gain the weight back. Most people do. And we've had Jared on from Subway fame, and he's been successful, but most people gain the weight back. So then you say, What about surgery? Well, you don't go into surgery without being well informed. Is it right for you? What are the risks? What are the risks if you don't do it? So you have to be a student. Well, I want you to meet someone who was a student of all that. Over four years she researched it. Robin Arnold from Kent, mother of an 18-year-old. She had gotten to be 280 pounds, and finally this past July she decided to have the lap band surgery, which is one of the options that we'll hear about. Robin, you did not take having surgery lightly, did you?

2 Deciding to have Surgery No, I did not. I spent four years going to different seminars that the various healthcare providers in the area put on to talk about their programs and what they could do, and I did an enormous amount of research. I had several family members and friends and coworkers who all had the Roux-en-Y gastric bypass. They're all about three and a half to four years out now. And so I had a lot of information, and I was never comfortable for me having the Roux-en-Y. So when Dr. McMahon came around offering the Lap-Band and having all the experience that he had with the Lap-Band, I felt very comfortable going forward at that point. Okay. And we're going to meet Dr. McMahon in just a minute, because he's a great addition to our Seattle medical community at Swedish Medical Center, and you're going to hear about their new weight loss surgery program and where that comes into play. But Robin, a couple of other questions. So you weighed 280 pounds, you're five foot seven? Seven, yeah. Five foot seven. You had the surgery in July, and now you're 230 pounds. Yes. And this is weight you put on after pregnancy years ago. You'd had gestational diabetes, you developed full-blown adult onset diabetes, and I think just a few months ago you were told besides all the meds you took for your diabetes you were going to have to go on insulin, right? I was. I was to the point where I was maxed out on the oral dosage that you could take. I was taking seven pills per day to try to manage just the diabetes and of course then you have hypertension and you have GERD and water retention, and so I was taking roughly 21 pills per day. And you were not healthy and you were looking maybe at a shorter life based on these illnesses you had. 2

3 Yes. About two years ago my health really declined. I ended up having a partial thyroidectomy, and from that point on I seemed to have been in the physician's office or in the emergency room pretty consistently. And I was pretty scared. I was just physically exhausted. Getting through a workday was all I could manage. There was no after life. There was no private life. I was physically exhausted Robin Arnold, do you take any medicine now? The only thing I take now is a multivitamin, and I also take Simvastatin for cholesterol, but I'm been assured that's probably hereditary. No diabetes medicines. No diabetes, no hypertension. I'm completely off of everything. How do you feel? Fabulous. Some people laugh at me, but I don't ever remember in my life feeling this good, physically and mentally. I have been obese for so many years that to be able, I'm thinking about going snowboarding, and I'm looking at buying snow shoes. Never in my life would I have been planning for something so exciting. I would have always been home on the couch And, ladies and gentlemen, she looks radiant today. Now, Robin, when someone has surgery for weight loss, as we'll talk about with your doctor, Dr. McMahon from Swedish in just a minute, it still takes a lot of work. There were things that you did that led to you gaining weight over many years. Surgery is an intervention, but what do you have to do now so that this really is a change in your life? Lifestyle Changes: Before and After Surgery I started six months prior to having the surgery. Before even meeting Dr. McMahon I started going to therapy, and I had one-on-one sessions with the therapist in regard to my weight to work on why I overeat, why food is a comfort for me, what I could do to change behaviors. And then when I met Dr. McMahon 3

4 he encouraged that work, and so I continued and I saw a therapist that he recommended. I joined a gym. I had started trying to walk, which isn't easy to do when you weigh that much, so I wasn't able to really lose much weight prior to the surgery, but I did lose about 15 pound which helped shrink my liver and that sort of thing to make the surgery better Robin, do you feel you've been given a second chance at life? I do. There are so many tests. Being 41 years old and having been obese for so long I worried that I had done damage to my heart that would be irreparable and that, well, even if I lose the weight I'd done all this damage. But there were so many tests that Dr. McMahon put me through. I even ended up having a heart catherization three days prior to the surgery because I failed the stress test. And I feel so much better having gone through all that testing because I know my heart, I have less than 10 percent cholesterol buildup, that's like a 20-year-old. My lungs are good. My kidneys are good. My joints are not irreparably damaged. So I honestly have a second chance at life. Everything is up to me now. I have this fabulous tool to help me, but I don't even have the words to tell you how happy I am. Well, it's obvious. And you have an 18-year-old son. Maybe he snowboards so my hope for you is you're going to go snowboarding with him this winter. We're going to take a break. We're going to meet a true medical expert in bariatric weight loss surgery, Dr. Ross McMahon, who is the medical director of the Swedish weight loss surgery program. It's new. It just opened in the spring. He's come from us from that university I hate to talk about, Duke University in North Carolina, because I went to UNC down the road. But he truly is an expert and a great addition to our medical community here. Also I want to thank our sponsors, Swedish Medical Center, University of Washington Medical Center, Harborview Medical Center, Evergreen and the Senior Guidebook. They make all this possible. Welcome back to KVI. Andrew Schorr here. We're talking about weight loss surgery. Well, nobody goes into surgery lightly, so you think, well, gee all this is advertised in the paper and on radio and on TV. Those programs work. There are all those celebrities who do it. They lost weight. I can too. I'm going to be just like them. I'm going to get the food sent to my house. I'm going to do all this. Robin, you tried all that, right? 4

5 I did. I'd done everything from Weight Watchers to cabbage soup to different medications. If it's been on the market I've done it. And it didn't work. It did not work. Weight Loss Programs Okay. Dr. Ross McMahon is your doctor. He is a leading certified what they call bariatric surgeon, and he's gone through years of training, and he's now the medical director of the weight loss surgery program at Swedish Medical Center in Seattle. Dr. McMahon, let's talk science here. The data on all those programs and all those pills and potions out there as far as helping people lose weight and keeping it off. Yeah. There is some data for weight loss management in patients who are a bit overweight. So if you're 20, 30 pounds overweight in some instances there's data that they can work for relatively short periods of time, mind you. Most of the data is for maybe upwards of a year, but the vast majority are published at 36 months But Robin was over a hundred pounds overweight, and there are a lot of people walking around now like that. Yeah. And there's absolutely no data to support any medically supervised or not supervised or supplemental program in patients who are that heavy. It just does not exist. And the reason why it doesn't exist is that anyone who has ever done it has come up with a negative result and either has decided not to publish their weight loss program doesn't work or the journals are just not interested in negative data. Okay. Dr. McMahon, how long have you been doing bariatric surgery for people who are seriously overweight? 5

6 Surgical Options for Weight Loss I've been doing the weight loss surgeries for a total of about 12 or 13 years but completely dedicated to the field for the last seven or eight. And hundreds of patients? Yeah, well, thousands Well, thank you for joining us in the Seattle medical community and your program now at Swedish Medical Center. So let's talk about it. There are two main choices these days, I understand, or at least what you believe in, for surgical options done laparoscopically, so not a big open incision, but with your laparoscopes. Minimally invasive, I guess we like to say. That's right. What are they, and help us understand the differences. Who are they right for, and how do you make the choice? Sure. So we basically have two main options. There are lots of other options for specific reasons but to the two main options are Roux-en-Y gastric bypass and the Lap-Band. They both work in quite different ways, and they both have different side effect profiles etc., but basically the Roux-en-Y gastric bypass reduces the size of your stomach significantly and reroutes your intestines a little bit in order to prevent any bile from coming up and irritating that small pouch that we create. Because we're actually reducing the size of your stomach there's staple lines and all the rest of it that go along with that, quite a bit of healing that goes along with that. And our patients are relatively sick when they go in and have surgery. So if there's a problem with that, if the patient doesn't heal right, then they can have very significant complications. Now, the majority of patients do quite well with that, so it still has a very low morbidity or chance of complications, a low risk of having major problems with it as well, but it's still there. Before we go on to the Lap-Band I just want to ask you, because people saw Al Roker on The Today Show and all this kind of stuff. So it can be very effective. 6

7 Typically, the people that this is right for are people who are sick to begin with because of their weight, correct? Yes. So they have a risk of dying, quite frankly, from the complications of being so overweight. Absolutely. And that's what, really, nobody thinks about when they talk about it when you see the interviews on the TV and on CNN and stuff. And what really annoys me probably more than anything is the fact that no one talks about the disease's morbidity, the chance of dying from the disease itself. If we were talking about prostate cancer we would be talking about the chance of dying of the disease versus surgery, and no one really talks about, oh, surgery is risky for people with prostate cancer. Well, it actually is kind of risky for people with prostate cancer, but, well, so is the disease. Well, the exact the same thing happens with obesity. The disease itself is actually very, very morbid. The chance of dying if your BMI, which is the way we calculate obesity, we use a calculation called the body mass index, but basically if you're a hundred pounds overweight and your BMI is 40, and those two sort of almost go along, then you have a one to two percent chance of dying every year of the disease itself. Wow. We have about 112,000 people die every year in the United States of obesity alone. Morbid obesity. It's an incredible statistic. And it works out to be over one percent per year of people who are morbidly obese die every year of their disease. So in my mind, very much like cancer, we want to treat that to prevent those deaths, and that's where surgery and stuff comes in. And so we reduce the risk of dying with surgery from about one to two percent per year down to less than half a percent per year, if not even less that than that. We talked about gastric bypass, Roux-en-Y gastric bypass. Sure. 7

8 The other choice that you often make and what Robin had. The Lap-Band. It's a small silicone band that goes around the top part of the stomach. We sew it in place, and it's attached to a little access port that we put underneath the patient's skin. And we can put fluid into the band and make it tighter, and we can take fluid out of the band and make it looser, and we can adjust the amount of restriction or the amount of reduction in patient's intake of food using that technique. So is it adjustably making your stomach smaller? Essentially. The amount of space above the band is fixed, but the passage is smaller and so it takes longer for the food to pass through the band when it is tighter. Okay. You can reverse that surgery? You can, but that's not the idea. But that is one of the major advantages from a patient's perspective that, yes, it is reversible. Okay. Back to Robin. Robin, you did all your research. For you, why did you choose Lap-Band? Lap-Band for me, I look at it as a tool. I didn't need a major surgery like the Roux-en-Y. That scared me on a personal level because I'm young, I'm only 41. If I were to, god forbid, get cancer or something, you always have the issue of not being able to absorb different foods or different minerals and vitamins and medications and that kind of thing with the Roux-en-Y, and I just didn't feel like I needed something that drastic. I needed help, but I just didn't want to go that far. I wanted to try this first. How do you feel? So you have this band around your stomach, how do you feel? 8

9 I feel wonderful. For the first time in my life I'm not hungry. I actually have to be very careful to say, to tell myself after a few hours, Robin, it's six hours you haven't eaten. Because the goal is to try to eat a small meal or a nice snack every four hours. Deciding on Lap-Band or Gastric Bypass Surgery Okay. Dr. McMahon, first of all, her comment about her age and that she wasn't that sick, help us understand how people make a choice, how you help recommend a choice. And I also want to know who these surgeries are not right for. Sure. Well, the two operations work in different ways but generally are applicable to most people. And what I do is I try to support the patient and have them make a choice. Some people make the choice because of a loved one or relative who's had a certain type of surgery. They've seen it's worked for them, and they're very comfortable with how that patient did or how that loved one did. And that's fine. Other people, like Robin, who really with the Roux being the major option, it just scared them, and they need something less scary for them to sort of go that route. In my mind, I'm happy with whatever gets them to have treatment. For instance, there's surgery and radiation therapy for prostate cancer. They both have a relatively similar sort of outcome. Surgery is scarier for some people than radiation. Radiation is scarier for some people. Because the outcomes are relatively the same I think it's patient's choice, and I think it's the same thing here. There's pros and cons with both the surgeries. For instance, with Lap-Band you get slightly less weight loss, but the different in a patient like Robin aren't much. It's about 15 pounds, which at the end of the day is trivial. And it takes longer to lose your weight with the Lap-Band, which I actually think is often an advantage, but there are some people out there who would consider that a major disadvantage. Okay. As far as who it's not right for, there are patients you reject. That's correct. Our patients go through a psychological evaluation and stuff, and basically we want to look for patients who would fight against the operation, who would not be able to take the changes of the operation and run with them. And we certainly don't take anybody with active psychological issues. They have to have them resolved. Not that we won't take people with psychological issues, that's fine. Most of our patients have something, but they have to be treated and stable. 9

10 And it's not to lose 20 pounds. Correct. They have to be morbidly obese. That's right. So basically somewhere in the neighborhood of, depending on how tall you are, 75 pounds to 100 pounds overweight or more. Or more. Is what we're looking at. Most of our patients are more. Ideally, we would want to treat patients who have other diseases and stuff, but that's not necessary because, really to be honest with you, they're getting preventative. Okay. Well, we're visiting with Dr. Ross McMahon, who is the medical director of the new Swedish weight loss surgery program here in Seattle, and Robin Arnold, one of his patients who did a lot of research not just at Swedish but all around the region, who could help her, what surgical option if it was to be surgery would be right for her, and it's made a big difference. We'll be right back with much more Patient Power live on AM 570, KVI. Welcome back live on Patient Power. We are talking about weight loss surgery, who is it right for? And we have a leading medical expert, Dr. Ross McMahon, who is the medical director of the surgical weight loss program at Swedish Medical Center, which is new. Whole multidisciplinary team connected with all the clinics and the whole network of Swedish hospitals and departments, and that's an advantage. And then we have with us Robin Arnold, 41, from Kent, mother of an 18-year-old who for many years tried to lose weight and just wasn't able to do it successfully. So just in July when she was weighing 280 pounds, five-foot-seven, she decided to have the Lap-Band surgery that many people have heard about. And it's worked out for her. Now she's down to 230. Robin, what's your goal? My goal is 160. I feel like I'll reach that. 10

11 I bet you will. It will probably take me another year, because I'm going really slow, which, believe it or not, is a good thing because I feel like every pound that comes off is off for the rest of my life. Life Changes after Surgery Amen. And you're going to do all that snowboarding this winter and you're going to be looking marvelous. You'll look great. Here's some questions we got. Dr. McMahon, I'll ask you this one and that is Sarah from Everett writes in and she says, "Dr. McMahon, as an expert, what's the biggest shock you hear most patients experience after surgery?" Interestingly enough, the thing that tends to make patients the most unnerved and probably the thing that they don't expect, most of our patients are female, about 80 percent of them are, and it's the feeling attractive again. The having people look at them, and basically prior to the surgery they've been able to hide a little bit behind their obesity and not get noticed, and then all of a sudden they're getting noticed. And that actually brings up a whole lot of sometimes fears and emotions and stuff that they haven't had to deal with in a very long time. And there is the occasional patient actually who needs some help with that. And I'm telling you Robin does look radiant on this Sunday morning. Robin, here's a question maybe you can answer. This is from Carrie in Redmond, Washington. "What's the best way to tell my family I'm having weight loss surgery, and what she they be prepared for?" Well, I have a family that most of the members are morbidly obese. There are only a couple of us that are within a normal weight range. So most of my family have already had or are thinking about having the surgery themselves. I'm very lucky my immediate family that lives here with me in Seattle is extremely supportive. My son actually now eats what I eat instead of all the junk, which I thought that would be a big struggle for me having him sitting there eating Chips Ahoy when I'm snacking on a carrot. But now he eats just like I did, and he loves it. 11

12 That's great. Now, you said you were in counseling. Is counseling a place to work some of this out if maybe a family wasn't as familiar with it and said, Oh, brother what's going on here. I would say yes. My counselor, has to get half the credit for this, because she helps me work through so many issues. And Dr. McMahon is dead on when he says that when you start getting attention it really gives you a lot of anxiety. I miss being invisible. Obese people in this society are invisible. I'm getting used to people looking at me now, but it is a very difficult issue. It really is. It's probably caused me more anxiety than anything else. The way I would say it, Robin, is you're giving yourself back to us as a gift. We want you to be part of an active society. You add a lot. That's what I would say if I were your counselor. That's what I would just say as your friend. And I hope people listening know that. It makes a difference to us. Here's another question for you, Robin. Lucy from Bainbridge Island writes and she says, "I tried for many years to lose weight. Why does finally, and this is her word, "succumbing to surgery feel like I've given up? And how can I make this feeling go away?" That's actually a big topic that we talk about in our support groups. Dr. McMahon's group has started a support group for all of us to get together once a month and discuss issues that we're having, and that is topic number one right now. I know for myself all my friends started having the surgery four years ago, and I was a little more afraid to do it, and I kept telling myself, well, I'm going to try this one more time. I'm going to go back to Weight Watchers one more time. I'm going to give it the old college try. And I would lose, again, 20 pounds, I'd gain back 30, and I was no better off. And finally I just got to the point where, through therapy I said, this is the time for me. I want to get this behind me. I want my health back. I was really afraid I was going to die if I didn't get this under control. So I would say don't feel that way. People who judge, I say walk a mile in my shoes. Take 22 pills a day and still feel horrible, and then we'll talk about why you should judge me. This is the best decision I've ever made, and I just encourage people to get out and research and figure out what is best for you, but don't wait another day. 12

13 Absorption of Vitamins and Minerals Okay, Lucy, it's not failure. It could be the beginning of a new life. Dr. McMahon, here's a question from Linda in Seattle. She s in, "I've heard that you don't absorb vitamins and nutrients as well after surgery. Is this true, and how do I ensure I get what I need post surgery?" It depends on which surgery we're talking about. The Roux-en-Y gastric bypass does reduce absorption of a couple vitamins and minerals, the main ones being iron and calcium, because the first part of small bowel which is bypassed is the area that tends to absorb those the best. So we always give our patients multivitamin and calcium supplements, and they have to take those pretty much for the rest of their life. They also have to make sure that their B-12 levels are okay, and so we give B-12 injections every six months or so just to make sure that they're at a good level. The intake of foods means that you don't generally get your recommended dietary intake of some vitamins and minerals, so a multivitamin is probably a good idea for a Lap-Band as well. There's no malabsorption at all. Pre-Operative Tests and Preparation Okay. And one other thing just briefly, when someone is considering surgery at Swedish Medical Center you do quite a work-up, don't you? We do, yes. What are some of the things you do? We see the patients in the clinic, and they get a thorough history and a physical. Then they go away, they have a battery of blood tests including most of the vitamins and stuff. So, for instance, here in Seattle almost everyone is vitamin D deficient, and so we want to make sure that we know about that ahead of time and we replace it if need be. We want to make sure their lung function is good, and so they have blood gases to see what their oxygen level is just walking around normally. We do a cardiogram. We do a barium swallow test to make sure that they don't have anatomy that would be difficult or tricky or we need to do another procedure in order to fix in order to be able to go ahead and do the surgery. And 13

14 we send our patients for psychological counseling, not counseling so much as evaluation to make sure that they're able to tolerate the changes necessary at surgery. And then postoperatively, we heard about the support group. So it's a relationship with your program or something that supplements it or takes the place of it, but there's work to be done afterwards. Oh, sure. And the biggest decision somebody has to make when they're deciding on surgery and stuff is to make sure that they sign up with a program that's got extensive post-op follow up. The surgery is important and then getting a surgeon who can do the surgery well and all the rest of it, that's important, but the surgery lasts an hour to two hours or so. It's a very short period of time. The majority of work with this type of weight loss is in the after care, and so you want to have a system and a program that has very extensive after care and can do all different types of after care. You don't want some place that only does one type of surgery, because if you end up having that surgery fail for you, you want to have other options. And unfortunately once people have been operated on by somebody, very few other surgeons want to touch those patients because they've had things done to them that they don't know about and they've failed and they don't know why they failed. So, really, you want to sign up for a place that's going to be able to take care of you no matter what the outcomes are, and that's pretty important. So I think the after care, to be honest with you, setting up the after care is really the important part of any program. The surgery itself, doing it well and doing it safely and all the rest of it is important but after care is far more. Very important point. Very important point. We're talking about weight loss surgery. And we're going to talk more broadly about the weight loss program at Swedish Medical Center because we've had Dr. Keebler on, and I know he's a bariatric expert too in the medical management, and we want to know where does that fit in, as we continue on Patient Power. We're talking about weight loss surgery, weight loss. We've been listening from Robin Arnold who is so inspiring, and it's made a big difference for her. Swedish Medical Center Weight Management Program Dr. McMahon, some questions for you. I mentioned before the break that for some people what you call the medical management of weight loss can help, and some 14

15 people much more obese move on to surgery. So we've had on one of your peers there at Swedish, Dr. Craig Keebler, and he's a specialist in the medical management, separate from these programs out there and sending food to your house and all that kind of stuff. Tell us about what where what Dr. Craig Keebler does at Swedish fits in with your surgical weight loss program. Sure. Actually, we're in the process of merging the two programs so that we'll have a comprehensive weight loss services program. And one of the reasons why we decided to do that was that for patients who are 20 and 30 pounds overweight surgery clearly is not an option, and they need treatment. One of the better treatments available in the area is definitely Dr. Keebler's program. And the other flip side of that is Dr. Keebler has all kinds of very, very important tips and tricks to help our patients succeed with how they eat, when they eat, what they do when they eat, what portions they eat. And I personally think that can be a very powerful tool for our surgical patients. So I envision the program being sort of a multidisciplinary program from the beginning, and this is just further evolution of that, bringing in the medical bariatricians into the program to provide our patients with even further counseling and strategies to make the adaption of a tool such as Lap-Band be even more effective than it can be just purely on its own. And again I sort of said after care is key, and that's really the progress in making the after care as comprehensive as possible is by having these experts within our program. America s Obesity Epidemic Yeah, it's really a tremendous service. And I think as Swedish has noted and all our leading hospitals is America has a tremendous weight problem, and, Robin, we're in this world of super size me. And talk about portion control, that I know Dr. Keebler talks about a lot, you have to know when to stop eating, when you're no longer hungry, when your body doesn't need the fuel. And I know you worked on that. It must be gratifying to each of you where Swedish now is putting this all together. Because our region and our country really needs it, doesn't it, Dr. McMahon? Oh, there's no question. Part of my presentation when I give my free seminars and stuff is a set of slides from the Centers of Disease Control that show obesity across the United States. And is shows different colors for different levels of obesity and 15

16 stuff, and I go over the last 20 years or so. And it's a dramatic transformation in the last 20 years, where in the beginning the country has a little bit of an incidence, 10 percent or so, to the last couple years where the incidence certainly in the Mississippi Delta is over 30 percent and in Washington is over 25 percent now. So obesity is a major epidemic in the country. The surgeon general has talked about it and has put a priority to try and help it. All the programs across the country have sort of been stemming up in order to try to look at this program. But the cut and dry of it, it doesn't really matter what the cause of it. It's here. We need to treat it. We don't want to have a health system that is overburdened by all the diseases that are associated with the disease. Let's get at the disease. Let's fix the disease, not fix the symptoms of the disease. Right. So, Robin, what would you say to somebody who's not walking around Green Lake today or a park down in Kent where you live because they're way overweight and they're feeling, like you said, some obese people can just feel invisible and their life is closing in, where surgery could be an option? What would you say to them? I would say to go to one of the seminars, whether it's Dr. McMahon's or a hospital that's closer to you, and listen to what they have to say. Listen to all of your options and talk with your family, your friends, and decide which option is best for you. But please don't just sit there another day, because it's just one more day that you're going to feel horrible and not be able to do the things you want to do. Right. And by sitting there your life could be shortened just by that. Exactly. The number one comment from our patients is that they wish they did this years ago. I would say probably 90 percent of patients say that at some point in time to me. Okay. So this is a health intervention that could be life saving and certainly life lengthening versus the track you've been on now over many years. Don't feel like a failure. There is help. We're going to take another short break. We'll be right back with some final comments about weight loss surgery when we continue on Patient Power. 16

17 If you want to get a hold of Dr. McMahon, Ross McMahon, bariatric surgeon, specialist for surgery for weight loss, whether it's the Roux-en-Y, did I get it right? Yep. Or the Lap-Band surgery, here are some phone numbers to call That's for the surgical weight loss program at Swedish. You can always call SWEDISH and they'll get you there. Or you can go to their website, which is swedish.org and then a forward slash, wls for weight loss surgery. Okay? Swedish.org/wls. I want to mention next week we're going to switch gears, talk about surgical and nonsurgical options for people who are out there training hard in sports, and we're going to have some orthopedic rehabilitation experts from the University of Washington. And it's going to be treating musculoskeletal issues, what happens when you push the body too far. My 18-year-old son, he's a cross-country runner, and we've been talking about that. What does he need to be a good athlete? Anyway, this has been a very informative discussion, and I want to leave it on a very positive note. And I think Dr. McMahon was talking about the cost of not getting the treatment you need for weight loss. So sure you want to do all you can. Sunday morning a lot of people are out there walking, biking, running, rock climbing, good for you. And that's good for anyone, whatever your weight is. But what if you're just putting on the pounds. Many people do it after pregnancy. Robin, I know it was tough for you. So, Dr. McMahon, you have a lot of work to do but hopefully people have listened. But it must be gratifying to you the people you've helped. Oh, yeah, hearing a story like Robin's, knowing that you had something to do that is always very, very, very satisfying. There's no question about that. All the best to you with your program. Thank you for coming to the Pacific Northwest. And, Robin, all the best to you. Thank you for sharing your story and good luck with your new life. Will I see you snowboarding this winter? You might. You just might. 17

18 Okay. And you'll look great. I know you will. Thank you. Thank you for being here and sharing your story, and a lot of people are afraid to speak out about it. You are no longer invisible, Robin, so all the best to you. This is what we do on Patient Power week after week, talk about significant medical issues, and we're not selling anything. We just want you and your family to be as healthy as you can. All the replays are on patientpower.info, so take a look at that, and we'll have the replay for this probably by Wednesday, okay? And if you can join us for all those live webcasts starting tomorrow morning at nine, lupus, and then fertility issues on patientpower.info. Have a great Sunday. Remember, knowledge can be the best medicine of all. I'm Andrew Schorr. We'll see you next week. Please remember the opinions expressed on Patient Power are not necessarily the views of Swedish Medical Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That s how you ll get care that s most appropriate for you. 18