Surgeon Dr. Erik Lough and Dr. Mistry Discuss Heartburn and Bariatric Surgery
Dr. Mistry: Welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host here with my well-coiffed cohost.
Donna Lee: Oh, that’s me.
Dr. Mistry: That’s right, Donna Lee.
Donna Lee: I haven’t been coiffed in a while. I had to get a new haircut, so you would notice me sitting here in the corner in the studio…waving at you.
Dr. Mistry: Oh my Lord.
Donna Lee: Look at me, look at me!
Dr. Mistry: Oh my Lord. You know, I recently looked back at a critical email that we got from a listener and I realized he actually loves me. It was you.
Donna Lee: It was me?
Dr. Mistry: Yeah, it was your part.
Donna Lee: Yeah, he didn’t like that. I said, penis? Testicals?
Dr. Mistry: No, no, no.
Donna Lee: He didn’t like that I said…
Dr. Mistry: Well yes, that’s right. Because now we’re on Saturday.
Donna Lee: He said, I got my jollies on saying certain words, but I’m saying body parts.
Dr. Mistry: That’s right. And maybe he doesn’t know that you were voted the seventh funniest mom in America by Nick at Night.
Donna Lee: We can say that together now, that’s awesome!
Dr. Mistry: And I cannot wait. I cannot wait until you let me put those YouTube videos online.
Donna Lee: No, no. Even, my children can’t watch it. So there you go.
Dr. Mistry: Well, we really appreciate everybody’s support and input to our show. It is an absolute pleasure to be able to share, you know our urologic and men’s health knowledge with the community. And we love the questions every week.
Donna Lee: And I love that we’re getting the followups. “Thank you so much. I got in to be seen.” “Dr. Mistry was awesome!” Or Dr. Ong, or Dr. Yang, and Dr. Jacomides.
Dr. Mistry: Yeah, we’re really lucky to have such a wonderful crew of people to see and take care of you. We have space, we have time, and we have a commitment to making sure that your urologic and men’s health needs are taken care of. And you know what urologist love is to grow.
Donna Lee: Oh, hey, that was awesome.
Dr. Mistry: Yes. And today we’re very lucky. I’m joined by a great friend of the practice and an awesome surgeon. You know, I love surgeons.
Donna Lee: I know you do. Yes. You love it when they save your ass, too.
Dr. Mistry: That’s right. I have Dr. Erik Lough with Capital Surgeons Group. Thanks a lot for joining us, Erik.
Dr. Lough: You’re welcome. Thank you.
Dr. Mistry: Hey, where did you go to medical school?
Dr. Lough: West Virginia University. West-by God-Virginia.
Dr. Mistry: And where’d you do your residency?
Dr. Lough: Same West Virginia university in Charleston, West Virginia.
Donna Lee: What words are you going to share here?
Dr. Mistry: Nothing. If it was another Texas school, I would talk to them. But my wife recently told me that when I make fun of other people’s medical school, it is unprofessional.
Donna Lee: It’s not nice, but it’s so funny.
Dr. Lough: The problem for me came when West Virginia joined the Big 12, and then I went to UT for undergraduate.
Dr. Mistry: Yes. So now there’s like a rivalry.
Dr. Lough: What do I do? Do I, I mean, of course I’ll still go with UT, but it was a little tough cause we still had a Big 12 head to head competition.
Dr. Mistry: Yes. Yes. Well, the good news is neither of you guys are in any danger of winning a lot of games, so you don’t really have to worry about…
Donna Lee: The danger is gone.
Dr. Mistry: The danger is gone. Erik, I think a lot of people may not know the total breadth of what general surgery gets to do. You guys train in a way that allow you to treat problems from the top of the head to the bottom of the foot. But most people would probably know you guys as dealing with problems in the abdomen, right?
Dr. Lough: Correct.
Dr. Mistry: Heartburn has been a fascinating disease just in our lifetime. How it’s changed, right?
Dr. Lough: Sure.
Dr. Mistry: When we were youngin’s, it was because we had stress in our life. Just how that has changed the opinion of heartburn, how dangerous it can be, all that stuff has just been like remarkable change.
Dr. Lough: We learned about surgeries in my residency that were basically now considered historical operations that we would, you know, people would get ulcers from excess acid and you’d have to do an operation to stop their ulcer.
Dr. Mistry: …from bleeding.
Dr. Lough: …or perforating, and then their stomach contents leaks out into their belly and they’re sick as a dog after that.
Dr. Mistry: And that was just 10 years ago. And we’re just in a different era.
Dr. Lough: You know, now that people have acid blocking medicines, the ulcers are very easy to treat. There’s billions of dollars pharmaceutical costs that just go to purely antacids and antireflux medicines and histamines blockers.
Dr. Mistry: You know, if you have had heartburn for a long time, you may be stuck in an old way of thinking about heartburn. You may still think that ulcers are brought on by stress, or you may think that acid excess is what causes the ulcer as opposed to a bacteria, you know, that we can treat.
Dr. Lough: Or if you just stop eating spicy food, or chocolate, or you know, no more jalapenos, you’ll, you know, your acid reflux will go away.
Dr. Mistry: And I just think, I also think that the fact that a lot of these medicines were available over the counter now made people bypass doctors when it, when it comes to that condition. And so they don’t get like the information. And so one of the things I love about doing this show for many listeners out there, this the most time they’re going to get with a doctor to discuss an issue that they may not have sought out for.
Dr. Lough: Yeah, maybe.
Dr. Mistry: So give me your spiel. I’m coming to you. Tell me, I’m having heartburn. Tell me what I would be feeling or doing to let you know that it’s pretty bad heartburn.
Dr. Lough: So I always start with asking people how long have you taking any medicine for acid reflux, whether it’s an antacid like Tums or whether it’s a Zantac or Pepcid or you’re getting over the counter Prilosec, and you are seeing a doctor that’s actually prescribing that for you, ’cause you need a next stronger level. So first things first, if you’re taking a medicine and it’s working to control your heartburn and it’s a low dose, you’re probably actually doing pretty good. The problem comes when you start to double your dose or take it twice a day or take one kind of medicine in the morning and a different kind of medicine at night. Then, you know, you go on vacation and you forget to bring it and it’s the most miserable day of your life. You know, you’re just trying to find the pharmacy. So that person has now sort of graduated beyond your typical medical management case of heartburn. That’s where surgery comes in and that’s why you know, someone like me, a general surgeon, can do surgery to stop your acid reflux. The goal of surgery to stop acid reflux is to number one, stop it, like we just said, keep the acid from going up into your esophagus; but two is to stop having to take medications. So we call that freedom from PPI, proton pump inhibitors, or freedom from acid blockers.
Dr. Mistry: A lot of people–I’m going to relate this to the prostate problems in men. A lot of people think that this is simply a lifestyle issue. I’m taking the pill so I don’t have pain, or I’m taking the pill so I can pee better. And they’re forgetting that there really is an underlying medical concern when you have these conditions. So maybe you could scare some people out there and tell them what are we scared of when somebody has reflex?
Dr. Lough: We’re scared of damaging our esophagus. The esophagus is just the muscular tube beyond our throats that just gets food from once we swallow it, passing it down into our stomach. Your stomach is actually what makes the acid and the acid is there to digest the food that you ate, but that should be leaving your stomach and going into your intestines. When you have acid reflux, the acid is going backwards up into your esophagus where it has no business being located. The esophagus starts to get irritated, eroded, damage to the lining of your esophagus.
Dr. Mistry: You can get cancers, difficulty swallowing…
Dr. Lough: It can cause, it leads to motility, problems with swallowing. It leads to risk factors for esophageal cancer and it leads to other things like where people lay down in their bed at night and the acid starts traveling upwards into their mouth and they start to choke on the acid or cough, have other problems with breathing.
Dr. Mistry: And I’m not going to say general surgeons are scared of much. One thing they’re scared about is things that go wrong with the esophagus. It’s very hard to fix it, right?
Dr. Lough: If you can’t swallow, you’re a miserable person. It’s, you want to, you know, we drink to stay hydrated and we eat to stay nourished. And if you can’t do that, you’re just, you know, forcing…
Donna Lee: I feel like we’re talking to me.
Dr. Mistry: Yes we are because we all know that you cannot swallow…and you don’t get your endoscopy…
Dr. Lough: Let me get you my phone number.
Dr. Mistry: …and you keep getting your medicines…
Donna Lee: …and when I hurl a little bit, it’s all acid. I do need to take care of that.
Dr. Mistry: Maybe you could describe some of the most common surgeries that you do for acid reflux.
Dr. Lough: The main things that I do, I say when I’m telling people kind of what kind of job I have, is I do hernia and reflux and obesity surgery. Sometimes the hernia, that’s the problem with reflux is actually something called a hiatal hernia, which is a hernia in the diaphragm. When you get a hernia in the diaphragm, part of your stomach will go backwards up into the opening in the diaphragm. And that actually makes it much harder to stop acid reflux with just pills. One of the first surgeries that we do is a robotic surgery, which is, a way to do laparoscopy, very delicately and with good vision and good instruments, which is to repair the hiatal hernia, bring the stomach back into the abdomen where it belongs from the chest, and then close that too big of a hole in the diaphragm.
Dr. Mistry: With a piece of mesh sometimes.
Dr. Lough: With suturing, number one, and sometimes with mesh. And that’s sort of part one of the procedure, if you have a hiatal hernia. The next thing you got to do is re-establish a higher pressure zone at the junction between your esophagus and your stomach because that’s sort of like the sphincter muscle that prevents the acid from going backwards. If it’s low pressure, it can’t hold the acid back in your stomach. If it’s losing its pressure, we got to increase it.
Dr. Mistry: And that’s when you’re going to wrap the stomach around.
Dr. Lough: We do a wrap of the stomach around that high pressure zone, or we put a linx implant, which is a magnetic device that helps to keep that area higher pressure that can open and close whenever you swallow food.
Dr. Mistry: That is one of the coolest things that I…
Dr. Lough: …it’s brilliant. I really wish it was my idea.
Dr. Mistry: …that the food that’s pushed through this magnetic ring is enough to break the magnet…
Dr. Lough: Yeah, there’s a magnetic bond that’s there between the beads on this ring that, at rest, nobody’s doing anything, they’re bonded. And so it’s keeping that high pressure. They’re keeping the acid out of the esophagus. It doesn’t take very much pressure to push those magnets apart from each other. Just enough to swallow food is enough to push it out. And then as soon as the food drops in the stomach, they close right back. Some reflux surgeries out there, a wrap can make it harder for people to belch or to vomit. So they get gas trapped in their stomach. But the pressure of a belch or the pressure of vomiting is actually strong enough also to separate those beads. So that’s the one benefit of that procedure compared to a wrap.
Dr. Mistry: But Dr. Lough, I think the message here is that…
Donna Lee: …I need surgery.
Dr. Mistry: Yeah, Donna Lee probably needs surgery. And that reflux may not be a benign condition. If you have always avoided seeing a doctor or have recently avoided seeing a doctor, you may be missing out on kind of the newest thoughts on reflux. So thank you so much for joining us today. How do people get ahold of you? What is the number for your office?
Dr. Lough: We have a couple offices in Austin. The office that I’m at in North Austin is (512) 498-4860 and we have a website, capitolsurgeons.com.
Dr. Mistry: And Donna Lee, you’re going to tell people how to get ahold of us.
Donna Lee: (512) 238-0762.
Dr. Mistry: No, our website to, come on…
Donna Lee: firstname.lastname@example.org is our email and armormenshealth.com I’m so sorry, KLBJ, we’ll be right back.
Speaker 2: Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.
Dr. Mistry: Hello and welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your ever a gracious and grateful host here with my…
Donna Lee: You’re complimenting yourself.
Dr. Mistry: I was trying. And my awesome cohost and practice manager here at NAU Urology Specialists, Donna Lee.
Donna Lee: That’s right. Welcome everybody. Happy Saturday. It’s a great day in the studio, with KLBJ.
Dr. Mistry: Really honored to be able to provide this show and this information to you. We have a great variety of men’s health topics that we talk about, most of which are related to urologic conditions. We love to have guests. I love to have surgeon guests. I love to talk about topics that are oftentimes on people’s minds, but they don’t either have the knowledge of how to get information on it, and today is a great opportunity to do that.
Donna Lee: Right, and all these KLBJ guys that are sitting around in their cars and in their houses being unhealthy, they need to tune in.
Dr. Mistry: That’s right.
Donna Lee: …figure out how to be healthy.
Dr. Mistry: And learn, or catch us the podcast, right? The Armor Men’s Health Hour podcast.
Donna Lee: Wherever you listen to podcasts, they are free.
Dr. Mistry: So our guest today is Dr. Erik Lough with the Capitol Surgeons Group. Hello, Dr. Lough.
Dr. Lough: Hello.
Dr. Mistry: Thanks a lot for joining us. Recently you were named the bariatric head there at North Austin Medical Center. Is that right?
Dr. Lough: Yeah, I’m the bariatric medical director.
Donna Lee: Wait, what was the hero analogy again?
Dr. Mistry: No, we’re not talking about…he’s not funny.
Donna Lee: He’s a “hero,” and it stands for…
Dr. Mistry: Tell us what a “hero” is when you’re a general surgeon.
Dr. Lough: Oh, “hero” is hernia, reflux, and obesity surgeon. HRO.
Dr. Mistry: That’s right. Dr. Lough is my hero.
Donna Lee: What’s your acronym?
Dr. Mistry: Dr. Lough really is my hero. Whenever I get in trouble in the operating room…
Dr. Lough: You have a “mapa.” That’s your acronym.
Dr. Mistry: That’s right, but people don’t like “Make America pee again.”
Donna Lee: Yeah, we did get a complaint on that particular man, the same person, that didn’t like me, and he thought that was disgusting, that we are trying to help American pee again.
Dr. Mistry: In urology, weight and being overweight plays a big role in so much of what we do. It makes people not great candidates for surgery, diet poor diet puts them at increased risk for prostate cancer. It lowers their testosterone. It has a number of impacts just during our lifetime in medicine. The idea of doing surgery to help people lose weight has, you know, really exploded. I thought for those of our listeners that don’t know bariatrics is what?
Dr. Lough: It’s weight loss surgery.
Dr. Mistry: It’s something that you specifically trained in.
Dr. Lough: Correct.
Dr. Mistry: It’s often done laparoscopically. And I thought it would be a good opportunity to talk about what is the process that people go through psychologically as they’re approaching whether or not to try to lose weight surgically.
Dr. Lough: Yeah. It’s actually sort of a longer process than most people would think. The surgical society that I’m involved in did a study nationally, looked at how long it actually takes a person from the moment they even have the conception of the idea, “Maybe I want to do weight loss surgery,” until they actually walk into a surgeon’s office to do a consultation for weight loss surgery. And it’s somewhere between 12 to 18 months. So that’s a lot of consideration. It’s different than something like, you know, people get pain in their belly and they find out they have gallstones–they get their gallbladder out two days later, you know they’re ready to go. Whereas this takes a longer process of people thinking about things.
Dr. Mistry: Do you think that many people wait until they have a medical condition? They know they’re overweight. They didn’t figure that one out 12 months ago.
Dr. Lough: That’s correct.
Dr. Mistry: They know they’re overweight. Is it a number of failed diets? Is it that now they can’t walk? Is it now that they’re not allowed to have a surgery? I mean, what do you think is the, is the common or a more common impetus for people to choose surgery for weight loss?
Dr. Lough: One of the very common ones you mentioned exactly is that they’ve developed a health problem that they otherwise didn’t recognize before and it’s directly because of their obesity. So that is going to be something like type two diabetes or high blood pressure or sleep apnea or high cholesterol. Now that they have an illness, whereas they didn’t consider their obesity as an illness, but now they have an illness. The reason they have it is because they’re obese. Joint pain is very common, difficulty breathing, and then what starts to happen is a lack of participation in activities. They used to run around with their kids and now they don’t really do that much anymore. Or they used to ride amusement park rides or they used to travel on an airplane and the stress of having to try to sit down in an airline seat or ask for the extender on a seatbelt, that’s what does it. Some people, you know, it’s just, they don’t like the way they look at themselves in the mirror. They know that they used to have a different appearance and the appearance is bothersome. And then, you know, people go through a lot of diets and they lose weight and then they might gain that weight back. And so they look at weight loss surgery as it’s just going to be yet another failed attempt at weight loss. What people come to learn, and which is the beautiful thing about weight loss surgery, is that it is such a different result compared to a standard nonsurgical weight loss.
Dr. Mistry: You know, in my practice I bring up the idea of weight loss surgery very often to patients. And it’s surprising to them. And what’s surprising to me is that another doctor didn’t bring it up already. I’m like, “Your doctor didn’t tell you that being 200 pounds overweight is probably the cause of your diabetes and high blood pressure and didn’t send you to a bariatric surgeon?” Like, and I talk about it very openly and honestly because I feel like people view weight loss surgery as a “giving up” as opposed to…
Dr. Lough: Like an easy way out…
Dr. Mistry: A giving up, instead of starting. And then I think a lot of people, you know, this is called a confirmation bias, is that when you only remember the stories that confirm your previously held belief. I think that when…and for me it was the gastric band because so many people got gastric bands and then they lost weight and they gained weight. So people pick the gastric band because it was quote unquote easy and quick and then they thought they weren’t doing that much and then it failed, so now they’ve kind of poo-pooed the whole idea of weight loss surgery. So, maybe you could talk about this concept of treating weight loss surgery like a personal failure.
Dr. Lough: Yeah, well it’s not a personal failure for one, but I do think that people have been told to lose weight at least. So if they see a doctor and they have diabetes, I’m sure that their family doctor or their primary care physician has said “You need to lose weight.” I don’t know if people have ever been directly told, “Your degree of obesity is going to be very difficult to lose with just diet and exercise alone. You would do better with weight loss surgery.” There’s a, you can go online on your phone or somewhere and just look up any old BMI calculator, body mass index calculator, and you just plug in your height and your weight and it’ll tell you what your BMI is. If your BMI is 40 or higher, you are considered morbidly obese or severely obese. A person whose BMI is 40 or higher has an average shorter life span by seven years than a person whose BMI is normal. If you go up to a BMI of 55, your average lifespan is 14 years shorter.
Donna Lee: Wow.
Dr. Lough: So it is definitely a chronic and I would say in general, a longterm life-threatening process. People that have heard of a few myths about weight loss surgery before, may be trying to avoid it. Probably the most common myth is that there’s too many complications because of weight loss surgery. They’ve heard a story or they know someone who had a complication and everybody in their mind who gets bariatric surgery gets a complication. The complication rate is by far less than 5%, overall. The mortality rate is one in 500, which is 0.2%. And that is actually less, believe it or not, if you look at the mortality rate for cholecystectomy, which is getting your gallbladder removed, for hip replacement surgery, or for hysterectomy…
Dr. Mistry: …which are very common surgeries.
Dr. Lough: Which are very common surgeries.
Dr. Mistry: …that people are not afraid of.
Dr. Lough: And so with the advent of laparoscopy and robotic bariatric surgery, which I perform on a daily basis, very commonly now, a person can get a sleeve gastrectomy or a gastric bypass. The surgeries take anywhere from an hour to just under two hours. You can go home the same day as surgery for most sleeve gastrectomies, and it’s just a one night stay in the hospital. Again, with the low complication rates that I mentioned before. So 2020 weight loss surgery is not 1995 weight loss surgery, it’s a whole different type of surgery that’s very safe.
Dr. Mistry: That’s amazing. And I think that, you know, as someone who tries to encourage preventative behavior in patients, I would love for people to use that BMI consideration as well as their prior history of how successful have they been with diet and then look at their physical activity. Could you get into a physical activity regimen to lose weight? And if you have severe doubts, you know, consider something a little bit more radical before you get diabetes and high blood pressure because although a lot of those will get eradicated with surgery, right?
Dr. Lough: Absolutely.
Dr. Mistry: You know, you’d rather not have already gone through that point.
Dr. Lough: You don’t want to get that far for sure.
Dr. Mistry: Because even if your diabetes goes away, your insulin metabolism has been altered, you know, for your life.
Dr. Lough: Your metabolism changes, you get a higher set point where your body feels natural at a certain weight. You know, a year after a sleeve surgery, people can lose somewhere between 80 to 100 pounds in a year after a gastric bypass, it can be as high as 150 pounds. So I challenge people to think of any diet that they’ve ever done where they lost a hundred pounds in one year.
Dr. Mistry: That’s amazing information. Well, if people have questions for us, how do people get a hold of us?
Donna Lee: They’re going to call us during the week at (512) 238-0762 they can send us emails to Dr. Mistry or Dr. Lough at email@example.com our website is armormenshealth.com and we will be right back after these messages.
: The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at firstname.lastname@example.org.