Episode 7: Barriers & Advocacy with Dr. Renee Hilton-Rowe

In this episode, Dr. Renee Hilton-Rowe steps in with a story that's as inspiring as it is impactful. Having witnessed the dire need for accessible bariatric care firsthand, she's turned personal challenges into a crusade for change. This episode is a journey into the heart of advocacy where you'll hear how Dr. Hilton-Rowe's unwavering dedication has paved the way for transformative policy reform, affecting over half a million individuals.

Dr. Hilton-Rowe, a surgeon and mother, intertwines the narratives of those she's encountered with her own, painting a vivid picture of the lives touched by metabolic surgery. Her reflections on the role of empathy and the importance of self-forgiveness in healthcare will leave you moved, while her insights on preventative medicine underscore the transformative nature of her work.

Lastly, we zoom in on the full spectrum of care that follows bariatric surgery, a testament to the power of comprehensive support networks. Dr. Hilton-Rowe shares the often-overlooked aspects of post-operative life, from the necessity of follow-up appointments to the psychological impact of dealing with excess skin. It's a deep appreciation for the medical professionals who go the extra mile, ensuring their patients are not only treated but truly supported on their journey to wellness. Join us for an episode that's not just informative, but a compelling narrative of compassion, resilience, and hope in the face of obesity and its related health challenges.

Transcript

Speaker 1: 0:00

Welcome to Core Bariatrics podcast hosted by Bariatric surgeon Dr Maria Iliakova and TMA LaCoste, bariatric coordinator and a patient herself. Our goal is building and elevating our community. The Core Bariatric podcast does not offer medical advice, diagnosis or treatment. On this podcast, we aim to share stories, support and insight into the world beyond the clinic.

Speaker 2: 0:24

Let's get into it. Today we have with us the director of the Center of Obesity and Metabolism at Augusta University Medical Center. She also leads the Access to Care Committee of ASMBS, which is the American Society for Metabolic and Bariatric Surgery. She demonstrates a longstanding commitment to patients having great access to the best quality of bariatric care. Ladies and gentlemen, please help me welcome Dr Renee Hilton-Row.

Speaker 3: 0:48

Thank you. Thank you so much for having me today, guys. I'm very excited to join you on your podcast. I've been listening to it and it's some amazing content for patients, surgeons, integrated health members really everyone. So thank you for having me.

Speaker 1: 1:02

Oh, that makes me so happy. Thank you for being here.

Speaker 2: 1:05

So, just to get started right off the bat, you have a really big demonstrated passion in making sure that people have access to bariatric care. What drives you there? Where did that drive for that come from?

Speaker 3: 1:18

Probably where I come from. So I grew up on a very small farm in South Georgia, a cotton and peanut farm and pretty remote the nearest hospitals 35 mile drive to a town and I grew up seeing that people maybe didn't have the best access to healthcare or all of healthcare where I was from. And then I say a lot of times your circumstance, maybe you're just in the right place at the right time. But I love a quote that I heard one time is you have to be the right person in the right place at the right time. And really why I think access has become my career or such a big part of my career, is that when I moved back to Georgia I left Yale and Connecticut which I think arguably Connecticut is one of the most progressive advanced states in terms of access for patients with obesity and when I got to Georgia there was a profound gap and huge access issues, most notably with our state health employee benefit plan. There was no access to obesity treatment and that's the largest employer in the state of Georgia. So I started this access journey because I had no idea what I was doing. I went to the access session at ASMBS and heard John Scott at the time give a talk about how to become an access person and joined that committee, became the state access to care representative for Georgia and really over the next few years, just pounded the pavement and did grassroots knock on doors in the capital advocacy. A group of us revitalized our Georgia State chapter and I think having a robust state chapter with minded individuals around you is just infinitely important for access and your ability to make change. And once we revitalized the chapter, we made it our mission to get this benefit back in the plan and it took years but we were able to do that and I think once I saw the benefits that I could have through pin strokes and policy change, this affected over half a million Georgians overnight. I will never operate on that many people, maria and Tammy, like I could try to, but I don't. I just don't know that. It's certainly possible for me to operate on half a million people, but through using my knowledge about this disease and my passion for advocating for patients, I affected that many people and to me. That is why access is so powerful for the surgeon, for anyone in health care, for patients to advocate for themselves is you're not just affecting yourself, your center, it's so much bigger than just me. And then, I think, after the success that we had in Georgia, I was asked to co-chair, along with Mickey Seeger, the Access to Care Committee, and this past year I became chair of the committee, which is a big job and it's a lot of responsibility, and I'm very excited to be in that role, because now I'm looking I'm not just looking at Georgia, I'm looking at all 50 states, which is very exciting on a day to day basis.

Speaker 1: 4:10

And so what does perfect look like for you? Obviously, maria said in a separate episode sometimes we can't do perfect, and that's something I struggle with, because I do want to give our patients perfect, but if, or perfect clinic perfect, what would that look like to you?

Speaker 3: 4:28

So, in terms of access, what I think is perfect is if I could take our new guidelines endorsed by the ASMBS and, if so, and take those to every insurer in the US and say here are guidelines that are evidence-based, that are supported by the two largest surgical societies looking at obesity. To me, that is where you go with surgery. That's what's perfect. You take evidence and you get rid of a lot of the barriers for patients trying to get this care. You get rid of all these mandatory preoperative obscene windows of time 12 months where you have to exercise and diet, six months even. I think that every patient's journey is different and that should be a decision made between that patient and her or his health care team when the registered dieticians are seeing positive change and when the surgeon is seeing positive change. Because I am one of the surgeons I do believe in lifestyle commitment. I do think you have to make this change pre-op and be educated. I think that's a much safer way to have surgery. But perfect for me, for our patients, is every human being has access to every way to treat obesity, not just medicine, psychiatric care, therapy medications, all of the new AOMs. It is almost impossible for me right now to provide my patients with medical therapy. I have better access to surgery in the state of Georgia than medications. As someone who's advocating for patients, I'm advocating across all of the aisles for every means to treat patients. I think it's really unfair to ask us, as metabolic surgeons, to just use surgery to treat a disease. Our surgical oncology colleagues are not asked to do that. If you have cancer, you get neo-adjuvant and adjuvant therapy, you get medication, you get chemo, you get radiation. They have all of these tools at their disposal. I think that patients who struggle with obesity deserve to have everything that we know can treat this disease in the hands of their healthcare providers. To do that, that includes a lot of different things, not just metabolic surgery. To me, that's what's perfect Every patient, every way to treat obesity, all the time, no boobs.

Speaker 1: 6:37

I just got chills. Amen, yes, yes.

Speaker 2: 6:41

Amen. I do have a question for you, though, because you said you had done a lot of grassroots and boots on ground kind of activism and I see that from you on this committee to access to care. You are constantly asking what's going on in this state, what's going on here? What are people working on? Including people, inviting people, encouraging people? What are some of the barriers that you're seeing? Can you tell us a little bit more about how it varies state to state?

Speaker 3: 7:05

So I think definitely the way that our country is structured, the politics are. It's a little weird, right? Everyone thinks that if something's passed at a federal level, all the states have to do it, and that is not true. I think that for the average surgeon, we're not taught how to be politicians. We're not. All of us are not MBAs or business-minded or lawyers. You have to learn the language a little bit. The first time I went to Atlanta, to the Capitol, I went with a very seasoned, 25-plus year experienced lobbyist who walked me around and told me who to talk to and what not to say and what issues not to bring up. Having that inside connection, I think was incredibly important and she really guided me and shepherded me through that first day. And I think that is the challenge that a lot of people face is they don't know where to start. It can be a very ominous thing to sit in your office as a healthcare provider or as a patient. They may not even have a background in healthcare, but you just want to advocate for obesity treatment. Like, where do I start? That's where I think organizations like the ASNBS and like the OAC, the Obesity Action Coalition, ochan all of these organizations are fantastic for this because you can get paired with a mentor, you can join a committee so that the first time you go to the Hill whether it's in your state or federally you're going with a group of people that can give you a little bit of training and you can learn from experts, people like Joe Naglowski and Chris Gallagher, who this is their world, this is what they do every day. I'm just participating in it as a passionate surgeon who wants to get good care for her patients. I think that's the biggest thing is, you would never go into the OAR Maria and just start doing sleeves and bypasses right, that's crazy. But no, no one's going to let you operate on them. So I don't think the right way to do this is just to drive up to the Hill tomorrow and walk into Senator Representative's office and say let me tell you about this, because I do think a little bit of coaching is needed. Now again, these organizations make it so easy. The OAC has so many ways that, even as a patient, you can click on their postcard download and they'll do the work for you. They'll help you, send it in to your insurance company and tell them hey, there's an access issue here. I have obesity and type 2 diabetes and hypertension and OSA. You're paying for all of these other comorbidities that I have. Why won't you pay for my surgery? The OAC can help patients with the language needed to get that attention, also connect them to other like-minded individuals. They bring patients with us when we go to lobby. I will tell you guys, I've been doing this for a while now. There is nothing more powerful than hearing a patient stand up and talk about there before and after being treated with obesity and letting those members of Congress, governors, whoever insurance comes, whoever you're in front of, let them see that you're a person. This is numbers on a spreadsheet. This is a real-life human being that, because an insurance company invested in them, they now have such better quality of life. It's not about the weight. I tell people that all the time, the least important thing that I measure as a medical researcher. I don't care. I want you to feel that. I want you to look good and be confident in your body. I really love treating and curing diabetes. I know people will disagree with me on that word, but I'm sorry If you're in remission. For 20 years I have cured your diabetes with a bypass. I don't think you're no longer. That is what made me so passionate about metabolic surgery is I love preventative medicine. This is preventative curative, it's just all things wrapped into one. I think the patients do a really good job showing people on the hill what that looks like with their stories. Stories are powerful. Real human life stories totally make the difference for us.

Speaker 1: 10:57

All right, take me in. I'm in. Oh Renee, I love that. Oh my goodness, why does it matter so much to you? Why are you so passionate about it?

Speaker 3: 11:06

I think for me one. I've always, since being an adult, probably struggled a little bit with my weight. I think most women after you start having kids especially and it's not always rated to kids, but for me it certainly was. I had two babies and under two years, and it took a toll. For years I had been seeing all of these women in my clinic and telling them oh, it's okay, let's do this and this, and not realizing that when I'm telling a mom of two to cook at home every night and not eat out, and like some of the expectations that you yourself give your patients, if you've never struggled with this disease, it may be hard to understand. And I do think that by being a woman and being a mom and talking to some of my patients, becoming a mom has definitely given me a whole new level of empathy. There are nights where my kids are getting Chick-fil-A on the way home. There are options there, but my kids don't want to help the options. They're wanting the mac and cheese and the chicken nuggets. So I'm trying to balance that with the reality that I'm a surgeon and I'm a surgeon mom and I'm very busy. You don't have to be perfect. There is no perfect. You ask what would be perfect, man, it would be great if we could get that, but we're never going to be perfect. I think having a lot of compassion, a lot of empathy and really a lot of forgiveness and telling patients forgive yourself, we're our own worst judge, but I think for me that is when I first saw metabolic surgery being performed. I was actually in the OR with Dr Ernestor at Delacris. Munoz down in Miami is one of my mentors, and the first time I saw him do a bypass I was just like wow, like that's the technically most amazing thing I think I've ever seen in an operating room. I want to do it. And then I started seeing his patients and how great they were doing, and so my dad actually asked me the question why do you want to do this? I thought you wanted to operate on hearts or cut out cancer, and I said no, I want to prevent people from getting cancer and prevent people from needing their hearts to be operated on, and that, for me, is why metabolic surgery is. I have drank the Kool-Aid. I truly believe in everything that we do. That's published in all the papers. I think this surgery, it changes lives and I've seen that with so many patients. Now we have a women's health initiative here and we've had women with stage one endometrial cancer go into complete regression with bariatric surgery and IUDs. So we're doing some really cutting edge research here, looking at endometrial cancer and endometrial hyperplasia and what that looks like in women with obesity and how metabolic surgery can even help cure cancer. So it's just such an exciting time to be in our field because I feel like the opportunities for research and making a difference through that and advocacy are just endless.

Speaker 2: 13:47

So you bring up a really interesting point. There's been some evidence that these kinds of surgeries, in this kind of care, can prevent cancer, which is, I think, astonishing. There's not a lot of surgeries that can prevent cancer or really have an impact on that. Can you talk a little bit more about what could be causing that and what you're seeing in the research that you're doing?

Speaker 3: 14:05

Yes. So we've even now seen endometrial hyperplasia in one of our adolescent patients at the age of 16, which, when we look through the literature, I think it's probably going to be the youngest case reported. We've seen stage one endometrial cancer and a 25-year-old. These are young women that are getting cancer and it's due to the unopposed estrogen, the high levels of estrogen that we see in women with obesity. Women who have obesity are way more likely to get endometrial cancer and have worse outcomes than women who don't have obesity. And then when we look at how women do, they get bariatric surgery. It decreases their risk of developing the cancer, it can help put the cancer in regression if they already have it, and it actually leads to better outcomes in women with cancer just by treating their obesity. I tell them there's no such thing as too late. Even if you've had this, your chances of recurrence can be lower by having metabolic surgery. And again, these are powerful tools to use when you're advocating for your patients, because there are metabolic surgeons that don't know this. There are general surgeons that don't know this, and I'll tell you I read a survey that totally changed the way that I practice as a metabolic surgeon. I was preparing for a talk and, as always, I did a deep dive in the literature, maria, when you get ready to give these talks, and I found the survey that I've read. That's right. And so I found the survey and it said that something like 19% of general surgeons actually asked about menstrual history and did a really good review of women's health when they actually were seeing patients. And that astonished me and I was like why are we not doing that? So I made that a part of my practice. We ask every single woman who comes in. We talk about age-appropriate screening, pap spear, mammogram, colonoscopy. We go into a deep dive talking about their menstrual history, if they have any abnormal bleeding, and we actually have partnered with our OBGYN group and I have an OBGYN who comes into our clinic twice a month and provides all of the women's health care for our metabolic patients. If you have not seen a GYN in years at our intake, we talk about all of that and if I identify, especially if you have abnormal bleeding, I set you up with her. We do the metriol ultrasound biopsy, pap smear, everything right there in the bariatric clinic Patients are amazing.

Speaker 1: 16:19

Oh my gosh, that is so amazing, especially as a busy mom, if I'm going to my appointment for my bariatric surgery and you can help me with those things, because I'm not, I'm going to be honest Haven't had my checkup stuff after my.

Speaker 3: 16:32

Yeah, he's two and a half, almost three, sorry, but life gets busy, and so I think one of the things that we tell our patients when they come in is this is about your whole body, head to toe, and we want to make sure you're completely healthy. And we talked to our adolescent patients especially about all things women's health. A lot of them have never seen an OBGYN and they might be 18. And we talk about everything from wearing their seat belt to safe sex, safe drive in the car, safe sex. Everything is on the table. And again, I think that again, this is really outside of the box, right, like most people probably are not doing this, but I think that's the way that you progress our field and you do the best for our patients. It truly is patient centered. We bring everything to our patients and again, I have a man, I have a great team and I love the OBGYN that I work with. Our patients say all the time this is the first time I've ever been to a doctor outside this clinic that didn't harple my weight the whole time. Not one can have the team say you need to lose weight. That's what's causing all of this. They know that patients are in our clinic because they know they need to treat their disease. So I think that this has been a really novel partnership. We're publishing on it so you can read about the things that we're doing, but it's been a really fun part.

Speaker 2: 17:42

We're here first, we're here first. It's FYI. Honestly, I really want to applaud you for that, because that kind of comprehensive approach I think is pretty novel and it's not what everyone is doing. But to be honest, you're right, these conversations that you get to have for patients, it's sometimes the only time that we're talking about screening for colonoscopies and that we're really looking at the whole picture. And even in our small program we also had diagnosed breast cancer and chligalopathy and things that just don't necessarily come up, because partially what you're saying is, when a person comes into a provider's office, oftentimes the obesity is blamed for everything. If they're overweight, that's the biggest elephant in the room and some other things are maybe getting missed.

Speaker 3: 18:22

Yes.

Speaker 2: 18:23

Do you see that? Do you see that as part of the care and the reason that you're providing some of the care you do?

Speaker 3: 18:28

Absolutely. I think that for so many of our patients they cry Like the first intake. I have tissues in the drawer of every single one of my bariatric rooms because either me or the patient someone's going to cry at some point. I feel like sometimes I cry with them because their stories are just so moving. But people don't want to be in our office. No one wakes up and says man, I am so excited I get to go talk to a bariatric surgeon today. No one ever. When people come to see us, a lot of times they're broken, they're desperate. This is their last straw, their last resort, and they know they need help. And they're really embarrassed and I think as healthcare providers, our job is to make them understand this is a disease just like other diseases and to suggest all of that stigma, all of that bias should be dropped at a door when you walk into an office. But again, a lot of times that's what they hear at every visit they go to, and I think some of our patients even start to feel ostracized by the healthcare community because they're tired of being blamed for their other problems. We wouldn't be diabetic if you'd lose weight. You wouldn't have hypertension if you'd lose weight. Clearly, if losing weight were that easy, we would all be doing it. Every one of us would be out there losing weight. But there's a reason. There's a bazillion dollar industry around fitness because it's hard. So I think that's one of the things that we do really well at first visit is tell them we're here with you, we're going to support you and this is not your fault. This is there's a multifactorial disease. There's so many reasons why you might have obesity, and I think we come at this from a really holistic approach and make the patient feel like they're a member of the team in their health.

Speaker 2: 20:03

So what would you recommend to patients, especially who are wanting to get involved in some of this grassroots campaigning or advocacy? I know you mentioned OAC, which is the Obesity Coalition, and OCAN and others. Where would you recommend people get started?

Speaker 3: 20:19

I would say the OAC. I think the OAC has such a patient friendly website, patient facing website, if you will, and there are great man. I have met just some of the most amazing patients through the OAC. When I went to the capital early in the I went in November we had a really nice roundtable discussion on Capitol Hill. The ADA, assbs was there, the OAC was there and I met some really amazing people from the OAC that told great stories. I think there's good mentorship in that organization. Again, there's so many organizations. I don't just want to sound like I'm like an ambassador for the OAC I'm not but I think Joe McGlowsky does such an amazing job with that organization him and the other leaders there really getting people involved, patients involved. I personally I think I would start with the OAC if I were a patient that wanted to do advocacy, because they have again, they have grassroot stuff. You don't have to go to DC. They need people right where you live doing that local movement.

Speaker 2: 21:20

You're right. Yeah, because what comes up all the time? In Iowa the care is different and the insurance companies are different in what they cover versus Florida, versus Georgia, versus Texas, and there's kind of states that seem to get it more than others, if you will, in terms of what coverage is promoted and what isn't. Do you know if there's any chance for a national kind of approach? Is that just totally fantasy or is that something you think could be possible down the road?

Speaker 3: 21:45

We absolutely are and I think now in my current role I feel sometimes like I'm neglecting Georgia because I'm so focused federally. We did that last year so we had, with our CMS response that we got from Access to Care and other organizations as well. So even bypass were on the potential removal from the IPO list and that would have been a very big national change and we advocated as an organization and we kept those procedures on the inpatient list, which I do think is very important for safety for patients. Troa the Treat Reduce Ability Act been around for years. We think this year is our year. So the reason that the leadership of ASNBS myself, chris Gallagher, jenna Glawski, a lot of people are going to the Hill on March 4th we are not just meeting with the representatives that are from our states, but that's at the federal level. So, yes, I'm going to go meet with representatives and senators from Georgia, but we're doing this in Washington at the federal level because TroA man, if we could ever get TroA past it. Just there's so many amazing things in that bill Again for kind of that perfect approach where we're treating obesity with all of our resources. I think that is really the holy grail nationally for us. But, yeah, anything that can affect the Essential Health Benefit Plan, cms, our Medicare, medicaid policies, our federal employee plans, like there are a lot of plans, the VA, there's a lot of things that we can affect at the national level, absolutely.

Speaker 2: 23:14

Yeah, so something that came up recently in some of my reading was that patients, or people on average, stay with their insurance companies less than three years and a lot of the benefit from bariatric surgery is seen in that 18 to 36 month period afterwards. Do you think that the fact that people are switching plans and they're employee based and they are all different is that having playing a role in the kind of coverage that insurance offers for bariatric surgery and other bariatric care?

Speaker 3: 23:41

So potentially, when I went, one of the things that I think stuck with me in Georgia is when I was presenting coverage of metabolic surgery in the governor's office, we started talking about money and I encourage people that are advocating never leave with that, like we shouldn't have to prove that we are a good ROI. Right, we're a return on investment. No one else in medicine has to prove that they're cost effective. It's not cost effective to treat cancer sometimes, but we do it because the right thing to do is patient. So I hate that we do have to prove that, but we are cost effective. We really are. It's a great return on investment and when we discuss that in the governor's office in Georgia, the comment made at the time was this is the best ROI that I've seen in this office this year and it's coming in healthcare and that's because it is a great return on investment. If you're treating diabetes as an insurer in Georgia at that time the cost of treating a diabetic on insulin was $17,000 per year. So they would read their investment and really I think some of the literature that I've read says you recuperate the investment less than 25 months In terms of the return on investment from just a dollar sign. It's hard to calculate that because our healthcare costs are so convoluted in the US, but I do think it's a great return on investment. But what people don't focus on is, yes, people stay for three years in the job, but when you look at the federal plan, people stay federal. Their kids are more likely to stay federal. There are some plans that people are lifers. It makes sense and I think the current it's very less. Why you see the federal, the federal employees are. They have access to medications. So I think they're seeing the bigger picture and I will tell you most of the conversations that I'm having now around access and around utilization have nothing to do with what I was talking about 10 years ago. 10 years ago, I was telling everyone what we were. I was walking into an office and telling them that obesity was a disease. Metabolic surgery is great for weight loss and it treats comorbidities. I'm not having to have that conversation in DC anymore. We're walking into a room and people are educated. They know what a sleeve is, they know what a bypass is, they know obesity is a disease and that it is an ever-growing pandemic that needs addressing. No one is arguing that All of the conversations now are we get it? We get that you guys work. We know that the GLP ones work. How do we pay for it? And I had a very interesting conversation, senator, one time that made the comment is you may really want something, but if you don't have the money in your checkbook, you can't buy it. And he said the federal government, state of Georgia, it's no different. We have a budget, and so I think that when you now start talking about access to care, it's bigger than just even talking about insurers covering it. It's taking on big pharma and talking about how we drive the cost of medication in this country and how we can have reform at an advocacy or access level to really control for cost. So I don't want to take us too far down that rabbit hole because I could do a whole another like two hour podcast on what's wrong with the cost of medication in this country.

Speaker 1: 26:47

I just want to say you're talking about medications. I invite you. Yeah, I'm talking about medications and I just had to bring this up because this is pinned on your Twitter or X account and January 18th of 2019. You said what if I told you I had a pill that could treat your hypertension, diabetes and heart disease, prevent cancer, lower your cholesterol, improve your sex life and treat obesity? I have that pill. It's called bariatric surgery. I got I just got chills reading it, but I Maria's, we need to interview this woman and she wants to interview everyone. But I saw that and I'm like yep, totally on board, 100%. You're so right there. I wish that was the beginning. That was the first step.

Speaker 3: 27:34

I'm smiling from ear to ear for people who can't see me, because I pinned that. Because when I said it at the time, I was just ticked off because I'd had another denial and I was tweeting at insurance companies and I ended up pinning that tweet because so many people loved it and I joked that I'm gonna put up billboards around town that say I can treat your reptile dysfunction, I can make your sex life better. I'm just gonna go crazy billboards out there so that people will. It'll get there and be like whoa, because people don't associate a lot of these comorbidities with obesity and with being treated by bariatric surgery. And we tell our patients it's not a magic pill, it's not a magic tool, despite that pinned tweet, but it is pretty close to magic if you use it the right way. And I joked, though, that if I could do it in appeal the results that I get from metabolic surgery, it just I would have aligned so far around my clinic building. I wouldn't be able to see everyone. Surgery is scary. It scares patients, but I like to tell anyone who's struggling with obesity go in, schedule a consultation at a center of obesity metabolism with people who do this every day and go talk to them, hear your options. Maybe surgery is not right for you. Maybe medications right for you. Maybe you know there are lots of ways to treat obesity. But don't be scared of surgery. There's a great paper that just came out and it compared safety outcomes of metabolic and bariatric surgery to other commonly performed laparoscopic procedures like hysterectomy, gallbladder hernia. We are just as safe. We're actually safer than a lot of these procedures and I tell patients that if you would and I tell providers that if you would send your patient to get their gallbladder out or get the hernia fixed, or if you're patient, you would have surgery for this. Don't not treat your obesity with surgery because you're scared. That is dangerous. I love to bust myth. That's your grandmama's bariatric surgery. We've made so many changes. We have safety nets in place. We use nbsa, qip. There's so many quality metrics that have been put into place with our specialty. That's why we're so safe. When I look at my SAR, I'm upset if I have a complication rate this 2% of what I do. When, again, hundreds of procedures and you have to bleeds after an operation that are treated with a blood transfusion, I feel like most surgeons would be like I'm the best surgeon alive, whereas with us we're super hard on ourselves, are tracking that we're like I should have had none. So I feel like this is incredibly safe because our organizations, our leaders, that the college everyone has been all of this effort and these resources into focusing not just on quantity but quality, and that's why I think being a metabolic surgeon today is totally different than even 10 years ago. I love what I do. I put that as actually a disclaimer on talks that I get. My real disclaimer is that I'm one of those people when I say I love my job, I'm like nauseating to talk to you because I really love my job. Like I come in every day and I tell the residents I have the best job in the world. You should all be bariatric surgeons. So I love my patients. I love this job. I cannot imagine if there's any students listening, medical students or residents. I cannot imagine having chosen a better field to dedicate my life to, because there are just so many opportunities to interact with wonderful people. So I hope that I've inspired someone today to at least check into access and advocacy can be a whole lot of fun and you can make a tremendous impact now.

Speaker 1: 31:06

I know we're running a little longer than usual and you said that I think we have a little bit more time, but I do want to touch base, especially from a patient perspective, here. Yes, there is a lot of good things when it comes to bariatric surgery, but after bariatric surgery that's what actually got me to ask Maria to start doing this is there's also some not so great things, like mental health sometimes is a little and heightened. All of that do you feel like your patients? I feel like your patients almost have the most resources that I've heard of so far. So what about post-op like mental health? And even I am so much more confident, like you said. I like the way I look. But also plastic surgery is. I'm really wanting it. It's a mental thing, though. Right, my body is great. It's doing what it's supposed to do so much better than it did a year and a half ago, but it's hard to look at it even more now. So do you have how do you battle the not so great things after surgery and do you think patients have enough resources for those not so great things?

Speaker 3: 32:09

so the most important thing after metabolic and bariatric surgery for patients I'm going to slow down, I'm going to say it emphatically so that every patient that listens to this can hear it it's follow up. It's making your follow up appointments with your surgical team. See our patients at two weeks, six weeks via zoom, three months, six months, 12 months and then annually for the rest of their life if they want to. What I tell them is if I don't know you're struggling, if I don't know you have depression, if I don't know you're unhappy with your body image, I can't help you. But if they're coming into their post-op visits, one it's accountability you're going to get everyone's going to talk to. We're going to check your vitamins. You're going to get on a scale. We're going to look at all of the metrics and the goals that you set for yourself. But for us that's meant to be a time of celebration, like we want to celebrate that with you. And if you're struggling, we want to help you get back on track, and we don't care if you're our patient or if you've moved here from California all the way to Georgia will take you. You set up a consultation. You come in if you've fallen completely off the bandwagon, that those are the patients that are hard to get back in the lost. All this way you've regained it all back and you feel I hear patients tell me I'm such a failure. That's not true. Again, chronic disease we know it is. We have a back on track program that we can roll patients into and give them all the support they need. I think support groups with other patients is such a valuable resource, whether it's online through big national groups. We, of course, run a Facebook support group. We do a lot of Facebook live sessions for our patients. I get on there from time to time and have to ask your surgeon session so they can ask me anything they want. And then I also think setting expectations is one of the most important things. I tell all of my patients you cannot lose 100 pounds and not have excess skin. It is impossible. You are going to have some skin that may require plastic surgery. Some people may not care, it may not ever bother them, and if that's you, that's great. But if you want that, tell me and I can refer you in consultation and we can talk about what that would look like and even how to get it covered by your insurance.

Speaker 1: 34:15

But I think so that's probably a whole nother episode in itself is getting it covered by insurance. We were just talking about this last night because Maria is here in Iowa. We wanted to get some of our friends past patients together and it was so good. It was so good and they all talked about some of them are like years out. Some of them are only like two months post-op. And that two month post-op is asking all the questions Like is this normal? Is this normal? Cause, unfortunately, like the support that she has is not as good. But so that's for. Yeah, getting together is huge.

Speaker 3: 34:50

My RD. I have a coordinator who's an RD. She's also a bariatric patient and I think sometimes bariatric patients make the best coordinators and RD's Cause, again, they've been there, they've done it and she actually gets people to come from a variety of different specialties, even to do support groups for our patients. So one a year is done by a psychologist who talks about all sorts of disordered eating. We have an REI expert who comes and talks about fertility and the right time to get pregnant. We have a. We have protein shake sampling, like tasting sessions, where everyone brings in their favorite protein shake recipe. We try to make the support groups fun. Again, I think that I don't want to underestimate or undervalue the importance of the support group. Have your support, do your follow up, go see your surgeon in that group and make sure that you're not missing out, cause there's probably a lot of resources that are there and you just don't know they're there.

Speaker 1: 35:42

And that's why I wanted to do this podcast is cause some places do not have that support group Like it. You know it's there, it's mandatory, but it's like sometimes it's like another job that person doesn't want to do because they have to do it. So actually, yeah, you said that bariatric coordinators tend to be the best if they're bariatric patients. I'm actually a respiratory therapist and Maria went oh, she went balls to the wall getting me hired because they're like no, it needs to be an RN or a RD and she's no, it needs to be a licensed healthcare provider. And I've gotten a lot of compliments of the job I've done and it's a lot because I've been through it and I know what I need. So I want to give that to our patients. Yeah, so support is you're so right.

Speaker 2: 36:31

Dr Hilton Rowe, I'm so grateful that you came and shared all of your expertise, your stories, and also helped us understand that there are surgeons out there who rock and who will move the world in order to get people the care they need and they deserve, and I'm just really grateful that you've served as a really great mentor to me personally and to many people out there. You are just a completely guiding light in this field, so thank you for all of the work that you do.

Speaker 1: 36:55

Yeah, thank you, because I had to share the world with, or Maria with the world, because she is a lot like you and people need bariatric surgeons like you guys, and it's not an in and out that you're actually like family right Absolutely.

Speaker 3: 37:11

And again, thank you guys. Thank you so much for having me and thank you for doing this podcast. I think it's an incredible resource, certainly going to be telling my patients about it. I told the access to care committee about it last night, so hopefully this can get broadly disseminated and surgeons, patients everyone alike will have access to it, because I think you guys are doing a great job. Thank you for having me.

Speaker 1: 37:30

Thank you so much. You have a good rest of your day and we will have you on again, because I loved this so much.

Speaker 2: 37:37

Thanks.

Speaker 1: 37:37

Everybody that's listening. Don't forget to follow us. Renee Hilton is on Twitter. As I said, she is just such a good advocate, but, yeah, don't forget to follow us Head over to Instagram. If you have any questions concerns, send us a message, but we'll see you all next time. Thank you, Bye.