What You Need to Know About Bariatric Surgery-Lap Band of Louisville

What You Need to Know About Bariatric Surgery-Lap Band of Louisville

– Welcome to our surgical
weight loss seminar. I’m Doctor Vincent Lusco and along with Doctor John Olsofka, we’ll be presenting
information about obesity, the lap band procedure and
our program’s philosophy and after care program. I developed a strong passion
for weight loss surgery back in 2001 when I helped assist on the first lap band in Kentucky. It was at that time that I realized there was a much simpler
and safer alternative to the more radical stapling procedures that were available at that time. Doctor Olsofka and myself, we began this program in 2003 at Saint Mary’s and Elizabeth Hospital and since that time, we’ve performed 4,000 lap band procedures. We’ve been recognized as
a Center of Excellence and also have received numerous distinctions and recognitions. More importantly though, we’ve helped transform the
lives of over 4,000 patients in helping them lose weight
and become healthier. So what is obesity? We hear that term all the time. As physicians, we look at that as a chronic, life-threatening disease. When you hear the word bariatric surgery all we’re referring to at that
time is weight loss surgery. When we look at the causes of obesity it’s a multi-factorial process. It’s not just one or two things. We look at a person’s
metabolism and their genetics. We also look at environmental
and cultural processes and there’s also numerous
side effects from medications that people take that cause weight gain. In the old days, you had
these little tiny Coke bottles and now there’s ballooned up to these gigantic 16, 24 ounce bottles and you even see the 64
ounces at the gas stations. Additionally, in the old days
when you went to the movies, you had a little popcorn box. Now, it’s ballooned up to this giant tub that has free refills. So the new definition of normal
has changed in our society. The other issues is that as
we mentioned just previously is a person’s metabolism. And the problem with the metabolism is that you can have two kids that grow up kind of
in similar environments and eat the same things and one will grow up and be tall and lean and the other will grow
up to be overweight. This is the BMI charts that we use to determine how obese or
overweight somebody is. And it’s typically below this black line where someone is a candidate
for weight loss surgery, although there’s been
some new FDA guidelines that allow people with BMIs of 30 to 35 to be candidates for this as well. But this is simply calculated
by taking one’s height and their weight and
punching it into a formula. As this slide shows, the
different categories of BMIs. A normal BMI is defined
as between 18 and 25. In the category of a BMI of 30 and above, you see the categories
of obese, severe obesity and morbid obesity. These are the patients
that typically benefit from weight loss surgery and when you see that word morbid obesity, that has a connotation of a
decrease in life expectancy. So as we’ve seen in our society, obesity has become an epidemic. Recent studies have found
that one in three people in the United States is obese. And in the past 20 years,
these numbers have doubled. When we began givin’ these
talks over 10 years ago, it was 20% of the United
States were overweight. We’re also seeing an
alarming number of children that are becoming overweight and this is mostly due to decreased time for physical activity and worsening food
choices in the cafeteria. But unfortunately, about
75% of these obese children go on to become morbidly obese adults. Also to put this epidemic in perspective, there were 400,000
premature deaths last year noted due to obesity. And what we’re seeing is
that the number of deaths from smoking last year was 400,000, which is the same amount as the number of deaths from obesity and that number seems to be going down since fewer people are smoking. And to put that in perspective with the two most common
cancers that we see, both colon and breast, there were 90,000 deaths
from that last year. As this slide shows, there
are many health problems associated with obesity. Some of the common ones we hear about are diabetes and high blood pressure, as well as reflux, sleep apnea, and problems with mobility,
such as arthritis. The other issues that we encounter is fertility issues in women
as well as certain cancers such as colon cancer, breast
cancer and uterine cancer. Most patients who are at the point of considering weight loss surgery have tried multiple attempts
at weight loss in the past and these have mostly
included diet and exercise, working with their physicians, taking appetite suppressants and some more extreme measures such as hypnosis and jaw wiring. This cartoon I think reflects some of the frustration
that our patients will have when they come into
their physician’s office and they get told to
just try the Atkins diet or to exercise more, but this is a cartoon that one of my patients gave me. “It’s a very simple diet. “you can eat anything you want “as long as you chew
each bite 3,000 times.” The problem is are that most
diet and weight loss aids rarely work in helping us reach the goal of long-term weight loss. So why would someone consider surgery? Well, only three to 5% of
people who attempt weight loss are successful long-term. Additionally, the National
Institutes of Health states that surgery’s the most
effective and the only method which results in significant
weight loss long-term. And here recently, the
American Diabetes Association which is an association mostly
of family practitioners, endocrinologists and internists, these are not surgeons, but they’ve recommended that anybody with a BMI of over 35
and type two diabetes should be evaluated for
bariatric consultation. For the next series of slides, I’d like to discuss
different treatment options that involve surgery to
help people lose weight. And in the old days, there were some purely
malabsorptive procedures, which we’re not gonna get into, but they basically bypass the majority of the intestinal tract. Then, back in the 80s, there
was a restrictive procedure that was fairly commonly done called a vertical-banded gastroplasty and that was the beginning of
the restrictive procedures. And that basically
reduced the amount of food that you could eat at one time. And then, with the advent of
the gastric bypass procedure, that was both a combined procedure that provided both
restriction and malabsorption. So next, we’re gonna discuss
some of the current treatments for obesity that involve surgery. On this slide, you see the lap
band and the gastric sleeve. We’re not gonna spend much time talking about the gastric bypass because it’s not commonly done. The gastric sleeve we’ll mention here involves amputation of
about 85% of your stomach. So with the gastric sleeve, it’s becoming a very common procedure across the United States. We’re trained to perform this procedure, however, we have some
concerns about the safety and long-term outcomes
that we’ve seen so far. First of all, there’s not much debate that a well done sleeve provides
good initial weight loss, almost as much as a gastric bypass. The major issue is that over time that small tunnel of
stomach that’s created can stretch back out and that leads to
patients becoming hungrier and being able to eat
more food at one setting. A lot of the five year data shows that a lotta these patients have gained most of their weight back. This operation was initially designed to be part of a two stage operation, where the sleeve is done inititally, but then once a patient
started to gain weight, there was an intestinal bypass procedure recommended afterwards. Unfortunately, that’s not how this procedure’s
promoted these days. My other concern with the sleeve is that there are risks from leaks from the long staple line, which can lead to lengthy ICU stays and require multiple re-operations. Other issues include worsening
reflux after the sleeve requiring extra acid medications. The rest of the talk
we’ll spend discussing the lap band system. It has multiple advantages over the other stapling procedures. It’s by far the least invasive approach. It doesn’t require any
stomach stapling or cutting or intestinal re-routing. It’s also completely adjustable, which I’ll discuss more in a moment. It also has the lowest
operative complication rate and a very low mortality rate and a very low malnutrition risk. And as you can see from this video, there’s a soft silicone band that’s put around the very
top part of the stomach and it creates a pouch about
the size of a golf ball and the balloon that’s on
the inner portion of the band allows us to control how
quickly that pouch empties. The tighter the band is, the slower the pouch is going to empty and the more open it is, the
faster it’s going to empty. Some of the disadvantages
with the lap band are that the weight loss
is not quite as fast as with the gastric bypass
or with the gastric sleeve and to some people, they
look at that as a negative. I’ve always taken a different approach. I think that most of the time, patients didn’t gain this weight overnight and it’s really not safe to
lose it overnight either. Also, with a more gradual weight loss like we see with the lap band, there’s fewer plastic surgery procedures that are probably gonna
be necessary later on ’cause there’s not as
much loose or saggy skin that you see sometimes
with the bypass procedures. Also the other thing that’s
super critical with the lap band is that patients have to
follow up after the procedure. They can’t just have this done and not follow up and get adjustments or it just won’t work. So in summary, there is a band placed around the very top part of the stomach that creates a small
pouch that holds less food than what your normal stomach does. This is the part of the
stomach that tells your brain to stop eating, that you’re full and that’s the mechanism
by how this works. The adjustments are fairly simple. They’re procedures that take place in the office and take
just a couple minutes. We’ll talk to the patients every time they come back to the office to determine if they need to
have an adjustment or not. One of the things that’s special about our after care program is that we do the adjustments ourselves and when I say we, I mean Doctor Olsofka, myself, or Doctor Theuer. We’ll visit with the patients
every time they come back. If the patient’s eating
more food than expected and their weight has plateaued then we decide to do an
adjustment at that time. If they’re eating small amounts and losing weight on a consistent basis, that patient typically
doesn’t need an adjustment. Most patients take about
two to three adjustments to get the band just right and they’ll take somewhere
around five or six adjustments over the lifetime of the band. So they’re not gonna need an adjustment every time they come back to the office. So up to this point, we’ve
spent most of our time discussing the actual surgery, but really the important part is after the surgery and the follow up. And the most important
thing about our program is the after care. And I think that’s where
patients are gonna find that’s why we have such great
results with the lap band. When the patients come back, they’re gonna meet with the
physician who did their surgery and I think that that’s really important. You’re not farmed out to a
Nurse Practitioner or to a PA. When we meet with those patients, we sit down and we talk with them about their dietary habits,
and what they’re eating and how much and how
much weight they’ve lost, because that’s an important factor with the conversation as well. But the thing that’s important
about the adjustments is that we don’t follow
a cookie cutter algorithm on how much fluid to put in the band. A lotta programs will put
the same amount of fluid in each patient, each time they come back. The way we do our adjustments is that they are very customized and tailored for each patient. The way it works is
when we see the patients back in the office we’ll talk to ’em. If we decide that they’re eating too much and their weight’s plateaued, then we do the adjustment
right there at that time. It takes just a couple minutes. We clean the skin off with
a little bita alcohol. We access the port. There’s really no discomfort with that. We then have the patient sit up and we give ’em a glass of water. The band is then over-tightened to where it’s basically closed off and we have the patient
take several drinks of water and after about the third or fourth drink they’ll feel the water pass through. At that point, we know that that’s the
sweet spot on the band. We then confirm it with
another couple drinks and if the water’s goin’ down easy, we know that’s right
where they need to be. Most patients will take about
two to three adjustments to get their band just right and most patients will take
about five to six adjustments over the lifetime of the band, so they’re not in the office every couple weeks getting a fill. This is really important to get the band tightened just right because if you don’t follow
up and don’t get an adjustment it’s not going to work. Along with these other visits, we’re not only assessing them for how much food they’re eating, but we’re also tryin’ to give them tips and advice to make other
healthy lifestyle changes so that they can be successful long-term. – So my name is Doctor John Olsofka and I’m gonna finish the second half of the seminar on the lap band. I may reiterate some of the
things that Doctor Lusco said, but I hope that you
recognize the passion we have with the lap band surgery
and with our program. We talked about how weight loss surgery can change your life. You had better believe it. This is not about a cosmetic procedure. We look at health
problems such as diabetes, hypertension, gastroesophageal
reflux, sleep apnea, all of these things are
intimately associated with being overweight. With the lap band, we are able to decrease
all of these comorbidities. You look at someone who loses
weight with the lap band and 100% of them will improve
in their type two diabetes. In fact, it’s been shown that
with long-term weight loss, almost 80% will get off
medication completely. If you think about what
this change is long-term, this can be dramatic as far as
your healthcare is concerned. We look at a couple patients that we have before surgery and current. You can certainly tell
with this young lady her life has been changed long-term. The timeframe with this is
about four or five years, but you can see that her
whole lifestyle has changed. Her weight’s down, her
comorbidities are improved, she’s dyed her hair,
she’s having more fun, she’s got a new attitude. It is a complete lifestyle change. Look at our next lady here. Basically, she’s on multiple medications for some of the things that we mentioned. Diabetes, hypertension, heartburn, all of these things that are
associated with morbid obesity. But more importantly, her co-payment with these
monthly medicines is almost $300. Now, I hate to tell ya, but you’re not gonna get a phone call or an email or letter from
your insurance company that says, “We’ve got great news. “We’re gonna lower your co-payment.” It’s not gonna happen but when you look at this lady’s results, this is only six months later. She is no longer diabetic. She is no longer hypertensive. She no longer has reflux disease. She has a co-payment of $25. The only medication she’s
still on is Allopurinol and that’s for gout. So we don’t do real well with gout, but all of these other things are radically changed
with long-term weight loss and the lap band. Well let’s look at some
history of the lap band. It was developed in Belgium in 1993. It was improved the United States in 2001. What is that delay? Well as you know, there is a long process for getting anything approved
in the United States. If you look at the heartburn
medicines Omeprazole, these were out in Europe 20 years before we got them in the United States, so this isn’t a surprise that it took so long to be approved. We’ve done hundreds of thousands of these procedures worldwide and it continues to grow. As Doctor Lusco had mentioned, it is purely a restrictive procedure and I think what’s important about that is that when you take in food, you also absorb everything
that you take in. In United States, our
food is highly fortified with vitamins and minerals, so we do not see issues with malnutrition. We do not see issues with
malabsorption and diarrhea. If you eat it, it’s absorbed and therefore it’s a healthier diet plan, a healthier plan for weight loss. This is also a reversible procedure. It takes about 10 minutes
to take the band out. Now with that bein’ said, it’s meant to be a
permanent procedure also. This is not a training device. This is a behavior modification and a lifelong change. But heaven forbid there
was some difficulty, whether you developed a
problem that you needed to have increasing
nutrition in your lifetime, we could take this out
in an outpatient basis in like I said, about 10 minutes. Well, what is life like
with a well adjusted band? We expect you to lose
one to two pounds a week. Now, that may not sound like much, but if someone came up to you and said, “Hey, you’re gonna lose 50
to 100 pounds this year.” That’s a significant weight loss, and as Doctor Lusco had mentioned, the difference with
the stapling procedures are often that there’s a
rapid weight loss early with a gastric sleeve or a bypass. We’ve seen those patients. They kinda look gaunty and they look ill. They’ve lost their weight, but they tend to not look as
healthy as you would think. With one to two pounds weight loss, that is a healthier way to lose weight and also we look at that as long-term. When you come in to the office and we look at your weight loss curve, if you’re not on that profile of one pound or two pounds a week, then it’s our job to make an intervention. That intervention may consist
of an adjustment as mentioned, or we may just have a counseling session and teach you how to use
your band more properly, make some food choice changes. You’re able to eat most solid foods. You’ll get on the internet,
you’ll see people that say, “I can’t eat bread or I can’t eat meat.” But you gotta recognize that the pouch with the gastric band, the part of the stomach that tells your brain that you’re full is only about the size of a golf ball. Now, how much bread fills up a golf ball? How much meat fills up a golf ball? What we have to do is
define your new normal. You’re not gonna go out and
eat a Big Mac at McDonald’s, but you can go out and eat a
small sandwich from McDonald’s. You can eat normal food like normal people but not very much and that is the goal of
a well adjusted band. If you hear someone with a band or you hear or read it
on the internet or so that they’re vomiting after every meal, that’s not what they’re
supposed to be doing. Their band is too tight, they
need to see their physician and that’s the importance
of our after care program. We stay in contact and
we train our patients how to make the maximum of their tool. There’s no limitations of liquids. We do not want you to drink
liquids with your meal or high caloric liquids, but generally between meals
we want you to stay hydrated. You can drink pretty
much what you want to, as I mentioned, except
high calorie liquids. You will see satisfied with
a small amount of food. You’re gonna go out to eat,
have a small amount of food and be happy with that. The adjustments with the band allow that food to empty at a slow pace so that the next time that
you’re actually hungry, the next time that you’re
looking for a meal, it’s time to eat anyway. It’s the next meal time. We’re tryin’ to do two
things with the lap band. We’re tryin’ to limit caloric
intake with each meal, but we’re also tryin’ to
eliminate that grazing behavior or that snacking between meals and it’s with those two
types of calorie restriction that we’re able to see success
and long-term weight loss. You can still enjoy meals and goin’ out to eat with your friends, but I’m afraid they’re
gonna be awfully jealous ’cause number one you’re
gonna have a tiny bill compared to theirs and they’re
gonna look at you sometime, especially the ones that are overweight and they’re gonna say, “You know, you can’t survive “on this small amount of food. “You need more.” And usually we call that projection. They want what you have. And you’re gonna look up with them with the knowledge of
our after care program and say, “You know what,
I’m just fine with this.” And that’s gonna become, as
we mentioned, your new normal. From time to time, your
band has to be adjusted. We talked about and Doctor Lusco mentioned on these adjustments, that there’s a sweet spot that we get to and that usually takes about
two to three adjustments. But we’re on top of it. We’re aggressive. We’re individualizing these
adjustments for our patients. One thing that’s hard to appreciate and it is relatively unique nationwide is that we have done
every single adjustment on every single patient
since we started that. Now we mentioned we’ve done
up to 4,000 patients to date. So that’s 4,000 patients
times multiple adjustments. Doctor Lusco and I do about
40 adjustments per week each. The reason that that’s important is when you come in with a question, and you wondered, “Am I too tight? “Does this need tightened?” We can generally answer that
question with confidence and get you back on track
or maximize your success. We make it simple. We find that our patients,
over their entire lifetime, have worried about what’s
good and what’s bad for them. About calories and carbs and overeating and making good choices. We want good choices, but
we wanna simplify that. We’re gonna teach you the difference between solids and liquids. We’re gonna have you eat
good food, nutritious food, but we’re gonna get
away from number systems and things that really just overhwlem you as far as long-term care. Remember, this is a behavior change. It’s gonna become normal for you to go out and eat a small amount of food, regardless of what that is, as long as it’s solid and have the confidence that
using your tool correctly is gonna offer you long-term success. We basically redefined your norm. That one slide was so powerful that talked about why people
gain their weight back and that was basically
that when you go on a diet, when you go to Weight Watchers or when you engage in some
modality of weight loss, often you go back to that old normal. You go back to that large popcorn. You go back to that large Coke. What we’re changing is what’s normal. And I tell my patients it’s amazing. We see stages in the lap band. We see the learning stage and often that takes about
three months or more. And then we see kind of the stable stage, where they’re workin’ with their band and they’re seein’ the results. But finally they get to a
special stage we call acceptance, and that’s where they look in the mirror and our patients say, “I
am different with food “than other people and I have a lap band. “I don’t eat very much and that’s okay.” And when it becomes okay, then
you stop feeling resentful, you stop feeling deprived. It just is what it is and you don’t have to
think about this anymore. I gotta tell a funny
story here real quick. I had a patient the other
day, in fact, I had a couple. And generally when people come
back to see us in our office if they’re doin’ fairly well, we’re spreadin’ out their visits and they were on their
sixth month rotation. We were seein’ ’em every sixth month and like I said, this was a couple and they were doin’ very well. And so I asked ’em as
I do all my patients, “So what have you been up to? “What’s been goin’ on in your life?” And they said, “We just got
back from a 10 day cruise.” Now you gotta recognize that
when people come in our office, we ask them to keep
their weights once a week and record that and then
we put that in a graft. And I picked up their
graft and I looked at it and I didn’t see a single week where they had gained a pound. And I looked at ’em, I
said, “You went on a cruise. “You mean to tell me you
went on a 10 day cruise “and lost a pound?” And they looked at each
other and they looked at me and they said, “Absolutely.” I said, “How did you do that?” And I knew how they did that. But I wanted to hear them say it. They said, “We just do what we been doin’. “We just do the same thing we’re used to.” That had become their new norm. They said they were the ones that had fun because you generally hang
around with people just like you. They went with a lotta larger people that would have a huge meal and they called ’em up and said, “We’re not gonna make it out tonight. “We’re exhausted.” And this couple said they went on a cruise and did everything. And that to me, like
Doctor Lusco had mentioned, we became interested in this. We see the patient successes
and it just spurs us on to continue to help people. Well, not everything’s
perfect as we mentioned. We do look at complications
with any surgical procedure, but as Doctor Lusco had mentioned again, this is a very, very safe procedure. The procedure itself takes
about a half hour to 45 minutes. They’re all done outpatient and the complication rate is minimal. If you look at this chart, we talk about a leak rate. Now leak rate is when
you have a staple line or stapling procedure
and that breaks down. Then that can be a real problem. The leak rate for a lap band is zero. The PE or the DVT, the
blood clots to the lungs are minimal, it’s less than 1% and that is decreasing. Because basically our folks come in, they have a 20 minute operation, they’re up walking within an hour and they’re going home. You don’t have time to get a blood cut. Wound infections minimal. Incisional hernias. People have gynecological surgeries, gall bladder surgeries
and they get hernias. This is only done laparoscopic. We do not do this as an open procedure, therefore, we have minimal hernias. Mortality. In our program, that is zero. Nationwide, that is less
than .05% and decreasing. The reason there was a mortality early on is that these operations, when they first came to United States, took about three or four hours. And we did see complications
with PEs or DVTs. That is now eliminated. What we see for our complications is that remember we’re creating that pouch and that pouch the size of a golf ball. You can have a slip with
the stomach slipping up underneath that band and
creating a larger pouch. Now usually this is
somethin’ that Doctor Lusco or Doctor Theuer and I pick up. It is not a dramatic event. You’re not gonna be out
eating with your friends and stand up and grab your chest and say, “Oh, I think my band slipped.” It just doesn’t work that way. What happens is it’s a gradual
process and people come in and they’re just not sensing that restriction the way they used to. We would do a swallow study. We would recognize this
and we would fix this. If you have a slip and you
come in to our practice, then we are gonna take you back to surgery and in a half hour, your band is gonna be just like it was when we put it in. That’s very important to understand because that’s probably the most common long-term thing we see
and we can deal with that. Erosions, very rare. This is where the band actually
erodes into the stomach. This is a reason that we
would have to remove the band. Now fortunately that’s very
rare and we have had folks that have come back six months later and we’ve replaced their
bands after an erosion. Once again, this is usually
not a dramatic event. It’s somethin’ that we pick up and fortunately it’s very rare. We have some port malfunctions
and some port infections but once again, that is also very uncommon and can be dealt with
on an outpatient basis. I think the key here to recognize is once again out of 4,000 patients our mortality is still zero. Now who gets a lap band? Well, you have to be 18 years old or older and you have to have a
BMI of 30 or greater. The reason we do 18 years or older is because generally, you have to be wanting
to do the procedure. You have to have made
that conscious decision that you wanna do somethin’ different and we don’t see that in a teenager. They can’t make a decision over anything. And so we do have some folks come in, their parents bring ’em in and say, “Can you do somethin’ for my son? “He needs to lose weight.” And if he looks at me and
says, “I don’t think so,” then the lap band’s not gonna help him. Neither is anything else for that matter. But it certainly would be safer and could be done at a younger age. You have to have a history
of bein’ overweight and you have to be
prepared to make a change. When I see people come
into office, our office, they’re ready and I think
that’s really the key is to ask yourself,
“Are you sick and tired “of bein’ sick and tired?” If you wanna make a change, then the lap band is easily the safest and one of the most successful
things that you can do. So I think one thing to note also is it’s not necessarily
related to dietary habits on who can have a band. And the reason I mention that is that some people come in and they eat very large meals frequently and then there are other
people that come in and they have a lot of sweets
or a grazing type behavior and if you go to a different facility that offers multiple procedures sometimes they try to
shuttle different groups into different procedures. We’ve found that with the lap band that it really does work across the board because in conjunction with that tool, we’re able to modify those habits into something that’s conducive
with long-term weight loss. Now, insurance approval
for the lap band system. The good news is that most carriers are now accepting lap band. So if you talk to a friend
and asked ’em about lap band and they say, “I don’t think
my isnurance covers that,” then they’re not ready for the band yet. They haven’t looked into it
because it’s awfully rare that we find someone that won’t approve the lap band these days. The bad news is there are some
policies that have exclusions and if you have an
exclusion in your policy, that’s basically a contract and we can write a thousand letters, but it’s often difficult to override that. Now the other thing that we’re seeing is that some carriers
require a three to six month physician supervised diet. And what that really is, the way we look at that is a de- motivation factor. You go in, you’re ready
to buy the new car, you walk out, you’re
fired up and they say, “Whynt you wait six months
for makin’ that decision.” That’s not a good plan. They’re tryin’ to dissuade you. Our program is set up to help you work with your physician
to meet those criteria or work within our program internally to meet the criteria to
get the insurance approval. We also partnered with
multiple lending organizations that can help with not only financing if your insurance doesn’t pay for it, but also the co-payments and the deductibles that you may have. And this is somethin’
that’s pretty new out there in the medical field now, with lookin’ at the higher deductibles and co-payments that
we’re starting to see. What if my insurance doesn’t cover this? Well you have to ask
yourself, “What am I spending “on my habits already?” Think about all the
money that’s been put in to different weight loss programs. The medications that are
out there to treat this. You go through Super America or Thorntons and they got this whole
thing of weight loss pills that people spend actual real money on. Think about the medications that you’re on and the co-payments that we mentioned. And also, the food that you’re eating. There’s a real thing to say about the amount of food that you’re taking in on a daily basis versus having a lap band
and the smaller amounts. We have a lotta people in
our program that plate share. We do bands on couples and on families and they’ll go out and they’ll
go out to eat together. In fact, a story that’s a true story. We did a band on a husband,
wife, and their child. The child was obviously 18 or 19 years old and they go out to eat. And of course the plate’s delivered and they bow their heads to pray and they say, “Thank you
Lord for this chicken leg. “May it serve our needs.” And this is reality. They’re gonna split this plate and this small amount
but most importantly, they’re gonna be happy about it. And that’s really the key with this. So why choose us? You decided after this seminar that you’re interested in lap band. Why not go somewhere else? Well I think there’s
a whole buncha reasons and I just wanna sorta reiterate those. We do consider ourselves
the lap band specialists. One thing that we didn’t mention is that we’re also a training center for other lap band surgeons, for other programs that come down and see how have you been successful. And they’re able to go through and walk through with us
on our after care program. We have a program that’s
specifically designed for the lap band. We have support groups and when you go to a support group, everyone in that support
group has had a lap band. It is comparing apples to apples and that’s very important
because at other places someone may have had a sleeve,
someone may a had a bypass, someone may a had a band and so we really do offer
that support network. We have an extensive support network as mentioned both in our office and with our coordinators at the hospital. The surgeons do all the adjustments. This is so critical. You bring in the issue, we resolve it, we do an adjustment and
we get you back on track. And the nice thing about this
also is that like I said, it’s a tool and you can be away
from the program for awhile and come back two years later and we welcome you with open arms and we can sit down and we
will be very sympathetic and say, “Welcome back. “Welcome back to the program. “Let’s get back on track.” And that’s the beauty about
this tool, that it’s down there. It’s waiting for you to engage
with it and be successful. We have an efficient office system. If you have an adjustment and you feel a couple weeks out that you’re not getting
that restriction you need call us up, we’ll work ya in. Other programs it’s six to eight weeks to get an office appointment. We generally can work
people in within one week. And there’s always a
bariatric surgeon in town. We always have someone that’s available if there’s any complications. We’re not gonna check your care out to a surgeon that doesn’t have
the experience that we have. And we are local. We’re not advertising and goin’ all over the country or so tryin’ to promote the band. We’re gonna be here and we really enjoy this area and we want you to be
engaged in our program. One of the other reasons is
that we have been recognized by multiple insurance companies as being Centers of Excellence. We are a Blue Distinction
for Blue Cross Blue Shield. We are an Aetna Institute of Quality and we’ve also been
recognized in the community as some of the top docs
in Louisville Magazine in the bariatric field. We are proud of these accomplishments and we feel that these
accomplishments and recognitions are useful in promoting your success. The last thing is there’s two surgeons involved in every procedure. They say two heads is better than one and I believe that. And so Doctor Lusco and
I and Doctor Theuer, when we do these procedures, there’s two of us involved. And that really does improve safety and that improves decision
making and outcomes. You have two separate
encounters with your surgeon. You’re gonna see us early on when you’re thinkin’ about
havin’ this procedure. We’re gonna answer your questions. You’re then gonna go through
our bariatric program and further training and one week before
you have your procedure you’re gonna sit down with you’re surgeon and we’re gonna answer
every question you have. I will tell you that it is
such a comprehensive program that you are gonna know
more about the lap band and more about the expectations than most primary care doctors in town. And the most common question
or most common answer I get at the visit right before
surgery when I ask, “Do you have any questions?” The answer is, “Nope, I am ready to go.” And we are proud of that preparation. We continue to provide access. We have a nutritionist involved. We have exercise physiotherapy involved. We have counseling. We have psychiatric
treatment if we need it. We provide the access,
both to our department and to the surgeons individually. So last couple things I’ll say are I get a question occasionally, “What if this doesn’t work for me?” And I can tell you and I
think Doctor Lusco agrees that I can look you in the eye and I can tell you that if you do your job and I do my job, it
works across the board. If you’re engaged in this program, then you’re gonna do well. If you go off and don’t
have the adjustments or go off and do it at your own pace it’s just not gonna work and that’s where it really comes into play that you’re ready to
make a lifestyle change. “Surgery’s the easy part,” we tell people. That takes about 30 minutes and technically it’s not very difficult. It’s that one to one interaction. We want you to lose one to two
pounds a week consistently. If you don’t, we get you
back in and talk to you. Sometimes your band’ll
need to be adjusted, but sometimes the brain’ll
need to be adjusted. But one of those two things we can do to keep you on track. The last thing is you’re gonna have fun. I know that sounds crazy, but you’re gonna like
the people you work with. You’re gonna like our staff. Hopefully you’ll work
well with the doctors but you’re gonna lose weight
at a consistent basis. And when you lose your weight, what do you do with those clothes? You get rid of ’em, you give ’em away. You don’t put ’em in the closet. You don’t put ’em in a box and that’s very rewarding,
very motivating. The last couple slides is this
is a picture of your band. Actually, this is not a band,
this is a hammer obviously, but it’s exactly what the band does. It’s a simple tool. There is no magic. This is a ring of silicone. This is a very simple tool, a hammer. If you give this simple
tool to a five year old and let him run loose,
he’s gonna wreak havoc. But if you take this same tool and give it to a carpenter, he’s gonna build you a deck and that is our goal. We wanna take this simple tool, teach you how to use it so that you can build that deck
and have long-term success. The good news is about this is that when you become the carpenter you don’t go back to
bein’ the five year old. Well, this is a lifelong
decision as we mentioned. This is a permanent device. Our program is dedicated
to the lap band system and our team is committed
to the total care package. And that’s it, are you
ready to get started? Thank you for this opportunity to share our successes in our program. I think you can tell
that Doctor Lusco and I and Doctor Theuer are very
dedicate in what we do. We want your long-term success. If you have other questions, there’s areas on our website for frequently asked questions that can go into some
of these in more detail. But if you’re ready to get
involved with our program then give us a call ’cause
we’re ready to take care of you.

One comment

  1. It seems like everyone is discouraging me from getting the Gastric band, even my Gastric doctor who suggested bypass. I'm in the process of preparing for Gastric surgery come August 2017 and I'm undecided about getting the band or sleeve. It seems in America that the sleeve have become unpopular and its shunned. I wish I can come to lap band of Louisville Kentucky! This video have given me hope that the gastric band can work and work great if you have Great Physicians/ Specialist…

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