Dive Into The World of Bariatrics with WLSA Bariatric Surgeon, Dr. Reza Adib

Dive Into The World of Bariatrics with WLSA Bariatric Surgeon, Dr. Reza Adib

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hello i'm felicity cohen i'm so excited to introduce you to my wellness warriors podcast for over 20 years i've been a passionate advocate for helping thousands of australians find solutions to treating obesity and health related complications through surgical intervention and holistic managed care my podcast is dedicated to all the people past present and future who have helped shape my journey and continue to inspire me to work consistently to achieve a healthier australia in both adults and future generations i hope you enjoy it so far i've been talking to lots of patients and doctors and all sorts of other health professionals and today it's my absolute pleasure to introduce you to dr reza adib reza i've known for many years in fact i first met him in 1998 when he was a surgical registrar at the royal brisbane hospital and i think it's really important to understand when we're talking about the journey for a bariatric patient the critical component obviously is having someone who's a master of their craft and there couldn't be someone who's more in tune with the needs of a bariatric patient and who's more proficient experienced and highly skilled than dr ojib so it's going to be great to have a chat to him today about his journey as a bariatric surgeon welcome thank you very much for having me felicity thanks for coming on the podcast pleasure to be here so i'd like to actually start by going back a little bit in time and talking about your your training and at what point in time were you exposed to bariatric surgery and when did you think it might be an area that would interest you i trained in rural brisbane as you mentioned between 1994 and 1999 and i then was sent to an international fellowship in edinburgh infirmary where i was exposed to higher end of gastroesophageal surgery surgery of the stomach and the upper part of the gastrointestinal tract at that stage it was mostly for cancer but as i was looking and reading into the future of our supply and demand in our society in australia towards the second part of my fellowship in between years of 2001 2 and 3 i started introducing myself to uh and getting training in a bariatric surgery which was starting to become an important uh subspecialty of upper gastrointestinal surgery and it wasn't for wrong reasons because by the time i came back and set up my practice in australia i realized that the cancer part of upper gastrointestinal surgery is going to make 10 of my gi work and 90 will be people who are seeking uh the correct um uh surgical decision for management of mobility in australia and which is just a supply and demand of australian population and i'm very happy that i did that training in france in austria and mostly in scotland and eventually came back to australia in 2004 and set up my private practice and it's and it has been a pleasure working with you in the last eight years it has been an absolute pleasure and that your drive into uh finding the right patient for the uh right treatment program and for me to lead the surgical side of their treatment it i think it has been a good workmanship and good match one of the things that i notice about the change over the last 20 years and i think there's really three pillars there's the cultural implications and change in perception of bariatric intervention there's the political climate and what does that look like and what's changed and there's the technological change and if we look at the advancement in medical technology and what's happened over the last 20 years the change is it's phenomenal isn't it you know when you look at what has happened 20 years ago at the start of my career and at the start of your bariatric career we only did gastric bands for patients that was all we could offer and the landscape's changed so much but so has perception and understanding and one of the things that really strikes me is interesting and i'm really interested to hear what you have to say the gp perception and doctor's view around how we treat a bariatric patient accepting that this is a chronic disease that needs to be treated and managed for the future benefit of our whole society i remember doing a category one workshop for gps when the attitude was so poor and the understanding around management of a bariatric patient was not well understood what do you think's changed in terms of that perception firstly amongst the medical community i think um the medical community has has uh seen obesity uh as a disease that was what needed to be changed uh at the outset once that happened and once they accepted that obesity is a chronic disease the rest slowly is falling into into its place and don't forget 20 years ago when we were offering bariatric surgery to these patients uh the majority of patients were hiding it from public it was it was something to be um it was it was a family secret whereas now i mean look at your own work thanks to your yourself uh involving social media correctly in the management of this disease has created a situation where nowadays when patients come to see us they know they know a lot about their disease they know a lot about their uh co-morbidities they know a lot about what is the correct option for them because they've chatted and this usage of social media educating the gps as you mentioned educating the patients it is all what we have achieved in the last 12 years so the last 20 years because as years have gone by people are not ashamed of what they're doing anyway they actually say well i have a disease and this is the cure i have type 2 diabetes i'm going to have this operation that's going to get get rid of my type 2 diabetes on top of my type 2 diabetes i have high blood pressure high cholesterol like i snore i have sleep apnea i have all these comorbidities and these are the solutions so they look at it as disease and solution they talk between themselves they question they get answers from you know centers like weight loss solutions australia they and the abundance of knowledge that this creates around itself and the connections that it creates it is phenomenal we did not have this 20 years ago it was just a one-off small you know you offer a lap band that was the only thing around and people come for their follow-ups and nowadays it's just there's a sea of knowledge and it just makes me so proud when the patient turns up for their consultation and and they start telling you oh yes doctor and and i have a bit of a reflux as well and my reflux i need to take medication every day and you know what i know you're not going to give me the sleeve gastrectomy because i'm a better candidate for a bypass a few years ago i couldn't broach the subject or bypass to some of these patients and now they tell me they need to have this bypass so i am proud of where we are and it is thanks to hard work again thanks to us um sticking to the guidelines and doing the right operation for the right patients we did not create the situation where this is seen as an operation that causes bad mobility bad complications we have got good results we have got good people at the helm of our institute institutions where including yourself all credit because you have propagated the right word in the right community in the right patient setting where they can talk to each other they can ask you questions they can ask us questions and this freedom an abundance of information has gained a the result that is good good good patient outcome good patient outcome creates good conversation between themselves good conversation brings more people who need that help into our circle and this circle is just getting bigger and bigger and in australia as you are aware in australia currently there is one million people with bmi more than 40 who are eligible and ready to have operations but every year not more than 20 000 bariatric surgery gets done so out of every 50 people 49 of them are still missing are still somewhere there i think the thing about that as well is that those numbers are continuing to escalate and the projections for 2025 which is not that far away are that our morbid obesity statistics continue to grow so that's a shame that we're not actually offering treatment to 50 at least of that population who's requiring requiring intervention right now i think you're right you know that perception amongst the medical community has changed a lot and it's changed because of results and outcomes and they can see reduction in the medical comorbidities they see reduced medications and they see happy patients so i think that's really powerful that the patients have actually driven back to the the gps and to other health professionals their results have spoken such volumes to teach and educate the medical profession that yes this is an acceptable pathway to take so i think that huge shift 20 years ago this is taboo surgery and perhaps that image of the surgeon being a bit of a rogue surgeon offering bariatric intervention that perception has absolutely shifted and i think we should be very grateful for that change in education and perception and i think also the same thing amongst the patient population you know a couple of years ago you'd talk to someone who had no clue whether their next door neighbor had had surgery now everybody knows someone who's been there done that in their inner circle and i think that helps a lot when we're having these conversations and talking to patients who need to learn more so yes our population size and magnitude of the problem is definitely something that's growing all the time what for you has been the greatest i guess technological change and invention that has helped you to actually achieve better results it's technological uh technology-wise um the improvement in energy sources improved where we when we operate on the gastrointestinal tract all these organs have got blood supply we need energy sources that to safely seal these vessels around the organs improvement in technology of energy sources has been crucial improvement in technology of staplers and stapling technology has been absolutely crucial and important in the outcome that we are that we are seeing and the operation rooms themselves are different the operation tables are different and they to create a team around that environment and tr train this team to work in a more efficient manner and and in in a more um [Music] both technology efficient time efficient all of this creates uh an absolute uh road to better results and i'm a firm believer that it only gets done in cent centers that do a lot of it that's why recently we achieved the center of excellence queensland's only center of excellence for bariatric and metabolic surgery uh which was uh basically observed and studied by american society of metabolic and bariatric surgery and a team came to our hospital and they they went through our results they went through our equipment they went through our sensitivity of our staff sensitivity to our nurses where the patients sleep what kind of transfer they have what kind of wheelchairs they have what kind of everything and we became queensland's only center of excellence for bariatric and metabolic surgery and that is coming a long way that is coming a long way and and leadership in in in a system like this is not just about doing a better operation it's a it's it's everything together it's about staff who know their job it's about from the moment you walk into weight loss solutions australia you meet that person who's sitting on the desk they haven't dealt with hundreds of different types of diseases they deal with obesity they deal every patient they seek to get the right treatment for their obesity they know that they know the patients they're sensitive toward the patient they understand the patient care to the dietitians to the nurses to the exercise physiologists to the psychologists to the general practitioners sitting there to the research assistant sitting at so all of these that we have in our team every one of them is a cog in this big wheel that the end result of the big this big wheel is that we get their outcome i am very sure if i show you the report from bariatric surgical registry and by the way we are the highest contributors to bariatric surgical registry in australia and when i show you the two year three or four year follow-up on our patients we are setting about 10 11 better weight loss and better results and less complications less liquid than the rest of the country and it and it doesn't say anything out of the more we do the better we get in what we do the better patient education better patients educate between themselves the staff educate these people and we are going further and further away from the rest of our bariatric community towards better patient care so i'm very proud of it i'm very proud of it also and i'm a massive advocate for having a multi-disciplinary team support patients throughout the journey i personally see the surgeon as being front and center and pivotal obviously to making the best decision for the patient around which intervention but then having successful pre-operative care post-operative care that's consistent that's dedicated and ongoing for the patient especially over that first 12 months is driving those outcomes not just at 12 months but has a vision of where is that patient going to be 5 10 and 30 years out because at the end of the day we hope that it's going to be one operation one solution and that we've controlled and managed that patient literally for the rest of their lives and for me i guess the ultimate hope is that our patients never end up in nursing homes that we keep them away from the cardiologists the endocrinologists and everybody else that could potentially be the pathway for that patient should they not choose bariatric surgery first so i feel that the multi-disciplinary team approach as well as having that multi-tiered hospital environment where everybody has had the education and the sensitivity to deal with bariatrics in the hospital setting they're kind of complementary and integrated and both equally important to our patients so i think we've done a really good job on driving that kind of model so i really am a great believer in that model you know we over 20 years we still continue to learn to improve refine and change how we work because we always want to be better and one step ahead and i think we're probably at least 10 steps ahead but that's a good thing i completely agree with you and to give the patient reassurance that in their during the follow-ups there is no limit to the number of times they can ask questions there is no limit to the number of time there's no there's no hidden costs or hidden charges if if they want to get be educated more on the dietetic side of it there's dietitians sitting there in weight loss solutions australia if they want to if they're worried about the psychology of what they're eating and you know they they then the loss of their uh their their uh eagerness uh at any stage during the course we have we have psychologists sitting there and waiting for them all over the phone they can just pick up the phone talk to them we have physiologists we have uh everybody who's there nurses surgeon we are there to troubleshoot and we want to give this culture to the patients that once they're once they're treated by wetland solutions australia we are there for the rest of their life absolutely and they have to understand that we are not going away we're not going anywhere this institution is there for the rest of their life for a better life if there's any time they need to ask any question any hiccups any any problems in future they could just pick minimum they could pick up the phone if not walk in we always welcome them so let's just talk a little bit about how you walk the talk so first of all one of the things that i know you're really great at is keeping yourself healthy and fit and capable of working at such a high intensity and incredible you know productivity um you've competed in the noosa triathlon over how many years i'm not sure now for the last few years last few years it's a huge event to train for um is that is keeping yourself healthy and well is that important to you well absolutely i think i think this is what the patient sees is when they walk into a bariatric unit they want to see that the pain that the surgeon sitting there is he is himself or herself a a picture of what they would envisage themselves in the years to be you know they they look healthy they they they um they um practice what they preach and yeah so i am i am very pleased to be involved in a few team sports i still play basketball a couple of times a week i i train for uh triathlons with swimming cycling at least i took my two kids who are eight and ten yesterday for the first river loop in brisbane which is a loop of 40 kilometers of uh cycling both of them completed it quite well at the age of eight and ten wow so we start from you know for a while they were they were thinking that uh they're lost you know they asked me are we lost because they were not used to dr riding in those suburbs and no i'm very pleased that we keep this health uh all of us and i know for sure that in weight loss solutions australia we have uh boot camps for the staff boot camps for the patients uh uh cook ups for the you know healthy cook ups for the for the patients and staff getting getting involved in their uh different health health programs we have competed as you know for the last few years uh with the team in weight loss solutions in australia in um the gold coast half marathon gold coast marathon gold coast 10k and i myself led a team from wesley hospital in brisbane to gold coast bike ride last year so i it is quite an exciting thing to be a part of so i think keeping healthy and being a symbol for your patient it is uh it's paramount to the um to the good outcome and making the patient believe in you if a patient goes to a doctor it does not seem to be that healthy a patient goes to a doctor that i don't know he can smell nicotine on them or it it starts from the wrong belief in that in that surgery so no i'm very happy to be advocating good health to our patients and i think they have been happy too they're groups and groups of our patients every now and then they and you know it from them sending their own colleagues them sending their own family family members friends you know when they come and say oh you operated on such and such my my my cousin or you operated on my sister or my wife and you know now i think i've seen the journey i want to follow this on and you know and to be able to offer them the same thing to what they need it it's been quite a pleasure it's one of the things that uh drives me um on a day-to-day basis and it's a and it's quite a pleasure to be a part of this team it's really rewarding and i actually love the fact that we had a hundred people compete in the gold coast marathon last year so i'm hoping to repeat that all over again i think it's great if we can educate and get patients involved in fitness physical activity mobility whatever it looks like for them at their level um but it is going to be life-changing and often we see patients who have really poor functional fitness their mobility is compromised they've got plantar fasciitis they've got sore hips sore knees sore back all of those things are going to change and if we can get to get them to the point where we're also helping to get them motivated and learning about how to move better um it's going to make you know creates change in our society so the change and the transformation through our patients that we're creating across a multi-tiered level of health issues is quite significant apart from the fact that you know i think we're saving our government a fortune by having patients invest in their own health um choosing and prioritizing to to invest in themselves now um at whatever that takes is saving our um our government billions long term um and i think that's a really important story to tell as well that we're creating such impact on our health system and we need to educate those in the position of power making those decisions that this is effective it works and it's changing the health of our nation i completely agree with you if you if you look at the number of patients on our database and can this would actually be a great project if you go back and have a look at the number of uh productive years that we've added to someone's career after bariatric surgery you know with less comorbidities and less days lost from work and we could add them all up they you know less days off of taken off sick from the comorbidities more years in the production line in in being productive life and all of that it would be a great project just to look at how much uh uh this has changed our working uh community and and you know more productive community you know i have zero doubt and that's why we are in a um fortunate era where we can actually argue this discuss this with the people you know who run the uh society and government to be able to justify the procedures it is unfortunate that the procedure is not that available in our public system but then again it's fortunate that we have found ways to convincing these people who are making those decisions to allow people as an example access their superannuation for an operation that is not readily available in in a public system to to add to their working life to take less days off sick leave to have have a better greater future of uh work life balance healthier family happier families and less premature death so there is no doubt that all of us together has helped people have a better life and quality of life oh it's amazing it took me about 10 years to learn from our patients that they were improving their financial health and wellbeing at the same rate as their health and wellbeing and that financial equation i think is really interesting because patients started to come to me and say i've now got the self-confidence to go for the job promotion that i would never have put myself up for or i'm actually employable because we see patients who actually are out of the workforce and they cannot re-enter the workforce because their weight is holding them back on so many different levels so seeing that financial health equation change as well over time i think is really powerful as well and something that's so interesting in our story of what we're seeing in our patient population every day so um you've got two kids an eight-year-old and a ten-year-old how has working in this field contributed or changed what how you raise your children has it impacted your life as a parent oh it does um i again work life balance i truly believe in the work-life balance i um it's interesting that um um our kids they they they sort of they have a different taste in what food to pick and what food not to pick and although they have they have a very active and healthy lifestyle they i can just see that around me they what goes in a shopping trolley and what goes you know on the on the dinner table and all of that has sort of a without us knowing it it's it's a a picture of what we are reflecting on our patients and what we what we suggest to our patients it somehow transcribes itself in what actually goes on a table and our lifestyle if if we get up in the morning on a sunday like yesterday and the weather started looks like he wanted to have a few drops of rain and and i see the kids are around the computer games say come on chop chop let's go let's go for a bike ride and they never say no let's go for a bike ride let's throw the frisbee in the park let's let's let's do something that makes us go for a bit of a um kick around a a a park or you know could do something so the kids completely subconsciously our kids follow our uh lifestyle and i try to make sure that there is a balance between my work and my uh life and the kids see enough of me that you know it's good for their education it's good for the day-to-day living and and and all of that i think the the new generation of surgeons as you know they're they they don't take pride in saying i i've never seen my kids uh before they've gone to bed and and we take pride in being there with the kids and doing their homeworks with them and you know be a part of the the household so no i am i'm quite happy with the live uh work balance however in the meantime people are wondering how do we get through those numbers and it is thanks to teamwork it's thanks to people like yourself and your staff and uh our team that by the time the patients are coming for those operations they're educated they are educated by the time they make it to the hospital they are in a hospital that does about 1 800 operations a year it's a center of excellence so from the person who greets them at the door till the person introduces them to day surgery operation day of operation surgery puts them on the on the chair waiting for the operation to the person that gets them inside to the anesthesiologist who puts them under the anesthetic they're all so well trained so well exercised that by the time they just see it is like it is almost i have surgeons coming to uh visit me in some of our master classes that we have for surgeons interested they sometimes they say to me it's like a orchestra everyone's playing their instrument and no one talks to anyone you can you can talk about other things because no one needs to talk about everything just gets done like a well rehearsed orchestra so and i'm very proud it's not just me it's it's the people around us including our team that makes us look good and makes the results and the patient look good and and we are blessed we are going i have never been so and every now and then i stop take a step back i said god i am so blessed look at this there are days that we have to do nine operations in a row and at the beginning of the day i just said oh god this is going to be a big deal halfway through the day i just said we are so blessed this is like poetry just goes on for itself so no i am very very happy with people around us uh with our team weight loss solutions australia with everybody who works so hard there educate patients education it is the key when a patient comes to the operation theater knowing everything that's going to happen to them what's going to happen to me on the day of admission what's going to happen to me the the evening of the operation how am i going to press that you know control energies here then the next morning how am i going to have that that x-ray how am i going to get up how am i going to do this my breathing exercises this has been rehearsed so much that by the time they come to the hospital they know it they just go through the motion and good result is not is not good surgery surgeon only not at all it is good education it is good education it's good staff around you and it's everybody that puts like i said everyone is a cog in this big wheel that the end result is good patient outcome so last year if so we saw the um the chapter on the one anastomosis gastric bypass chapter was launched that was quite a new addition to the suite of bariatric intervention and how surgeons have that dialogue around best procedure and is this appropriate and what are we going to do next and we see all these other new operations coming to the forefront of discussion being the sadie the sassy the endoscopic sleeve gastroplasty as you know we're dedicated to research in that area but also dedicated to research across the board with our work that we do in bariatrics what's your vision for the future what do you think and what do you see is going to be the future direction of bariatrics let's look 10 years from now oh look if you asked 10 years ago about where slave how sleeve took up in in the last 10 years in in the united states um the rouen why gastric bypass traditionally was the operation of choice it was a safe a safe procedure and it continued to stay a safe procedure and it wasn't for the fact that they did not look at one another's gastric bypass initially due to some difficulty they had in publishing their data at the moment it is showing a lot of promise for people with diabetes with severe morbid obesity without reflux because there's always a worry about reflux around sleeve gastrectomy and around one hand some of the gastric bypass but i mean it's showing a lot of promise long bypasses like um single anastomosis do the alias uh switch which is a sadie procedure they have gained a lot of popularity in particular with their super obesity and you know morbidity as a one stage or two stage procedure we we run a balance of that against our cohort of patient balancing it against the the uh risk of um malnutrition and elemental um vitamin and mineral deficiency so and a good balance is the key to good judgment there is no not a single cure for every um condition and if to match every patient to their uh um to the operation that's suitable for them would be the best thing with an open mind you can't have a clinic that just uh offers roanoke gastric bypass or a clinic that just offers single and a stomach's gastric bypass but what we're doing is uh and what our results are a reflection of our judgment because we are having less than 1 in 300 mobility and complication where as the rest of australia accepts 1 in 100 is a accepted complication rate or leak rate we are having at least two three times better results probably by better matching patients to what the best operation for them is and and not taking unnecessary risk in in cases where the risk of malnutrition or risk of malabsorption is higher the patient lives remotely we choose an operation that does not need as much um tight follow-up in terms of vitamins and minerals but still gives a good weight loss so we have been fairly conservative but that's that's why we got the results that we had so far but i mean we we are offering we probably one of the uh only clinics in australia that just about offering every modality of weight loss surgery that is there i mean i've just been during this weekend i've been asked to talk about intra-gastric balloons in our next scientific congress in melbourne on 14th of may and it's interesting because they had everything else covered but we now have done more intra-gastric balloons in queensland than any other cent centers with good results and uh and um i've been asked uh to give two talks one about a single stage revision of a lap band into a room by gastric bypass which is one of the operations that we do regularly now saves the operation saves the patients one step which is a two-stage operation we just do it in one stage and the second talk that i've been asked to give is about new horizons in non-surgical treatment including um intra-gastric balloon so yeah thank you so much for sharing all of your vision with me today and look i think you know what you've achieved so far in your career is absolutely noteworthy and amazing and quite exceptional and i think obviously we're very lucky and fortunate to have talented gifted surgeons because it's absolutely critical and key so i've got one last question first of all you need to keep yourself fit and healthy and well because we've got a long way to go ahead of us haven't we oh i think so yeah yeah we definitely whatever anger i look at it i think that are our um our um teamwork relies on a surgeon who can do the right operation for the right patient for the and the the staff that you um run with harmony and with such uh professional balance that um make uh doing that procedures so easy for me because i am very proud of the amount of educations that you give your our team gives uh to the patients before they make it to the them to the operation table to the point that when i when i see them in the clinic they know everything about the operation we go through the we just go through nitty-gritty of surgery and it's and it's potential calm because they've already been educated so well when we do the operation they have a very very thorough follow-up and i'm i am i am extremely pleased with how our um our combination works and i'm looking forward to the next many years to even educate and train more staff and surgeons and more dietitians and more psychologists to do to do this clinic we could potentially even do this in every state but um let's leave it for another chapter absolutely and it's an exciting adventure that we have to look forward to my final question so the podcast is called wellness warriors what do you think wellness means to you or how would you describe that for you in your daily life wellness for you is i think it's an ease there it's an ease when you're at ease with yourself when you're at ease with who you are is wellness when you're at ease with what you are who you are your goals your achievements when you when you're at ease with yourself and wellness warrior it's a great law it's a it's a great topic you might not reach your wellness yet but you are a warrior you are absolutely punching your way to you see your wellness and where you want to be and you are getting yourself as close to that stage in life which is state of satisfaction with yourself with your health with your diet with your family with people around you and if a small part of it is to cut down your comorbidities cut down your the number of conditions that you have with the help of us so let us be a very small part of your your warrior-ness towards your wellness and i really hope that we can add a very very small part uh to our uh wellness warriors thank you that's a beautiful description thank you very much for joining me on the podcast it is a pleasure to work with you that's great having dr deb with us as part of the team thank you so much it is a pleasure to be here thank you for joining the wellness warriors podcast it's been a pleasure to have you online with us if you enjoyed the series please leave your review subscribe and follow and we look forward to sharing many more stories with you in the future

2021-03-10 20:20

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