Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Dr. Ricks: Changing Lives One Surgery at a Time
Discover the inspiring journey of Dr. Matthew Ricks as he shares his path from rural roots to transforming lives through weight loss surgeries. In this episode, Dr. Ricks walks us through the intricacies of sleeve gastrectomy, gastric bypass, and duodenal switch, detailing how these procedures help patients achieve true satiety and effective weight loss. Learn about the strict criteria for candidates, including the pivotal roles of BMI and comorbidities such as diabetes and heart disease, and understand the profound impact these surgeries have on patients who have exhausted traditional methods.
Join us as we delve into Dr. Ricks' vast experience, performing over 5,000 surgeries alongside his esteemed colleague, Dr. Darren Minkin. We explore the robust support system they offer, featuring dieticians, psychologists, and nurses, as well as insights into the debated effectiveness of medications like Ozempic. Beyond the operating room, get a glimpse into Dr. Ricks' personal life, from his love of football and occasional golf to his devotion as a father of five. We also touch on the vibrant regional sports loyalties in Utah and the burgeoning community of St. George, underscoring the dedication of medical professionals in enhancing community health. Don't miss this heartfelt conversation highlighting the life-changing work of bariatric surgeons.
Hello, this is Dr Jason Edwards and I'm here for Doc Discussions. I have a special guest today. This is Dr Matthew Ricks. Matthew, welcome. Thank you, appreciate it, matt. Where are you from? I'm originally from Idaho. How about that Now? Where at in Idaho?
Speaker 2:I was born in the northeast kind of corner of the pan, the panhandle, on a small potato farm.
Speaker 1:How about that? That's a total stereotype. Right Potato farm in Idaho, that's right.
Speaker 2:Call me the Forrest Gump of potatoes.
Speaker 1:I can tell you how to make them Very good, very good. And so how does a guy from Idaho get to St Louis, missouri? Where'd you go to undergrad at?
Speaker 2:I went to BYU and then from medical school I went up to Kirksville. Sure and I did my residency down here in St Louis, and the rest is history.
Speaker 1:Very good, and so you're a bariatric surgeon, correct, that's right. And can you explain to folks what a bariatric surgeon does?
Speaker 2:Bariatrics is dealing with weight, so it's really manipulating the stomach and the small intestine to help maximize weight loss.
Speaker 1:And what kind of surgeries do you do specifically?
Speaker 2:So there's really three that we mainly focus on the sleeve gastrectomy, the gastric bypass and the duodenal switch. Those are the three that we focus on.
Speaker 1:Okay, so the sleeve gastrectomy, that's when you take like a man-made sleeve and place it around the stomach to constrict the stomach, or how does that work? So that's a band, you're talking about Okay, that's a band.
Speaker 2:The sleeve is we remove about 80% of the stomach and make it into a sleeve-like stomach.
Speaker 1:Okay, okay, and then can you explain, just in you know, in 30 seconds, the details of the other two procedures.
Speaker 2:So a gastric bypass. What we do is we divide the stomach. It's hard to say without pictures, but we divide the stomach and create about a 50cc pouch, so about a fourth a cup pouch.
Speaker 1:Okay.
Speaker 2:And then we run the small bowel and then we bring the small bowel up and tie it into it. So when you eat it quickly goes through that small pouch into the small bowel.
Speaker 1:Okay. So when patients I've had a few patients go through this procedure, and when they eat they become full, they're satiated very quickly.
Speaker 2:Right. So the whole purpose of the bypass, well, any bariatric surgery one is number one is to create satiety, so quick feeling. So with bariatric surgery, a lot of times the main cause is overeating, right? So if you can decrease the amount of calories they consume, they're going to lose weight. So that's the main purpose of the sleeve is to decrease how much you can eat. So you take a stomach for a sleeve. You take a stomach that holds almost two liters of fluid. Reduce it down to about a cup, cup and a half right.
Speaker 2:So that's about all they can eat at one. Standing is about a cup, cup and a half With a gastric bypass. It's different. The mechanism is different. You don't have the stretch you do with the sleeve and it actually starts filling the small bowel quickly. And the stretch of the small bowel gives you the sense of satiety, okay, okay, and so do patients do.
Speaker 1:they lose more weight with the bypass than the sleeve About two percentage more points with the bypass than the sleeve.
Speaker 2:Okay, so not a huge difference.
Speaker 1:Yeah, and what type of patients are candidates? There's some strict criteria for this, correct?
Speaker 2:So there is. So insurance rules our world, so they create our laws right, you bet. So any? If you look at what a BMI is, it's really a percentage or a number that's assigned to weight. Right, yeah, it's based upon height, it's based upon weight, and anybody over a BMI of 30 is considered obese. Okay, all right. And so for the ASMBS, which is our governing faction, it tells us that if you want to do bariatric surgery on someone, you have to have a BMI of 30, with an additional comorbidity.
Speaker 1:So the five comorbidities we look at is heart disease, high blood pressure, diabetes, osteoarthritis and sleep apnea.
Speaker 2:That has to be a significant percentage of the population that meets that criteria. There is a big percentage that does absolutely.
Speaker 1:Yeah, Without comorbidities. Is there a BMI standard?
Speaker 2:There is BMI of 40. Anything above 40.
Speaker 1:Okay, so that's a pretty big jump from 30 to 40. Right, and so patients come in and I would assume that the average patient would be somewhat motivated and excited to have the surgery done, although probably have kind of the normal trepidations, right? Is that accurate?
Speaker 2:By the time they come and see us, they've been through the ringer of diets. Some have been on 10, 15, 20 diets. Some have lost great weight, up to 100 pounds. But the problem is it becomes a cyclical issue, right? So they get on their diet, they lose their weight, they end their diet for whatever reason, and then they gain their weight back and then plus some, and then it becomes a cyclical pattern of gaining and losing, gaining more and losing less, until they get to really where we see them in the office. So by that point they're ready to have something a little more drastic done.
Speaker 1:Typically very motivated, right yeah, and from what I remember, patients typically lose about 100 pounds for the procedure.
Speaker 2:something like that it's based upon their preoperative weight, hundred pounds for the procedure, something like that. It's based upon their pre-operative weight. So if someone comes in that has a bmi of 40 and they're five foot one weigh 200 pounds, they're not going to lose 100 pounds, right? So it's based upon estimation of their ideal body weight subtracted from what they weigh now. If you put that together, it's usually about 60 to 80 percent of their excess body weight okay, okay and so so, just um.
Speaker 1:So I, although it's dependent on the patient, what's just the average weight?
Speaker 2:you would say that you see people lose probably between 100, I'd say 80 to 120 okay, yeah, yeah yeah, I actually had a patient we did a duano switch on that I actually saw yesterday and he's down 310. So it's amazing, what a victory.
Speaker 1:And and so how would you? I mean, I would imagine, if you're going through this boom and bust, the cyclical weight loss and weight gain and and, from my understanding, which is rudimentary, so tell me if I'm wrong but when people lose their, their bigger, and then they lose weight, the gain is typically that they're, they go higher than they were before the rebound's always greater.
Speaker 1:Yeah, yeah. And so I would imagine that most patients are kind of, from a psychological standpoint, except for the excitement for the surgery, probably not doing great because it's just been a long haul.
Speaker 2:You have your barrage. You have some that are on one end. You have some are completely on the different end yeah um, it is a very psychological battle when it comes to weight it really is, um, and part of our program.
Speaker 2:actually, we have several psychologists that we employ just to kind of get us where we need to get, because there are eating disorders that go along with it, there's binge eating that goes along with it, there's uh, um, they eat because they're nervous or because they're scared, because they're bored, and so there's sometimes a lot of working through that just to get them to where they want to be.
Speaker 1:You know, one of the things I like about this podcast is we like to talk about a lot of different things, and you know, you know what you do. There's so many disciplines that are involved in it, including psychology. That's great that you have psychologists there. Yeah, I mean there's social factors, there's societal factors. There's a lot of reasons why people are more obese than they used to be. I was watching a Chris Farley skit the other day and you know Chris Farley was comically obese in the late 90s and now, I mean, for better or worse, there's a lot of people walking around that big these days and and so I know you and your team are needed out there. And so what would? How would you describe patients like when you see them back in clinic and they've lost you know whatever percentage it is, but you know roughly 80 to 120 pounds. How are they?
Speaker 2:doing. It's amazing. It's a life change. There's a lady example that I saw actually Tuesday. She's been out about a year and a half and she's down about 110 pounds. She had the sleeve but her whole goal was she had a five-year-old kid right.
Speaker 1:Yeah.
Speaker 2:So she couldn't get on the rides with him at Six Flags.
Speaker 2:She couldn't get on the rides with him at six flags, she couldn't get on an airplane with him, she couldn't do all these things with her him, and so, because of that, one of her main goal was to be able to live life with her child yeah and so six months into it she was down 80 pounds and all of a sudden I get all these pictures of her 10, 15, 20 different trips to south america, to maine, to, to California, and she's like these are things that I never dreamed that I could ever do, and now I'm doing it.
Speaker 1:That's the you know. The one thing that you kind of, on the surface, you don't anticipate is the ripple effect of this. You know it's. It's made her child's life better.
Speaker 1:It's certainly made her quality of life better and probably increased her length of life or her probability of having a longer life. You know, I'm a cancer doctor and we know that excess weight and obesity are associated with several different types of cancers. Right and so that includes gastrointestinal cancers, uterine cancer, breast cancer. And that's because fat tissue secretes a lot of hormones. Right, especially estrogen, estrogen, mainly right. And then if you're obese it's because you're eating more and that creates more reactive oxygen species and that itself can create cancers. And aging it itself can create cancers and aging.
Speaker 1:Right, and so just by merely taking in actually taking in less calories is one of the few things that's been shown to increase life. I remember the first time they did it was with mice Right and it was like. I can't remember how much longer it extended the mice's life, but it was like almost double or substantially.
Speaker 2:I do Actually that study.
Speaker 1:I totally remember that study, yeah, and I don't know if it was double, but it was. It was a shocking amount that, if you thought about it like extrapolated out to humans which it probably doesn't work like that in humans, but I mean a significant amount more right, and there's there's very few things you can do as a human aside from like not smoking. That would really increase your length of life. You know that long, and they've never run a study with humans doing that, because humans live a long time and you know that would be a long study.
Speaker 2:But there's actually several studies out there that have gone 30 to 40 years, so they track these patients for 30 to 40 years is that right? They separated them into those who have had bariatric surgery and those who hadn't okay and actually what they found is substantial increase in cancer in those who didn't have surgery?
Speaker 1:Okay, that would make sense. Was that a perspective study or a case control study?
Speaker 2:To be honest with you, I can't remember.
Speaker 1:Yeah, but either way.
Speaker 2:Actually it was based out of Salt Lake Actually came out in January Of this year oh, of this year, how about that?
Speaker 1:Yeah. So it's always good when you have this kind of leads to the field of epistemology, like what is truth and when you have a study that shows the same thing in earthworms as the same thing in mice, as the same thing in human beings means that whatever biological mechanisms underlie this have been present for hundreds of thousands of years. You know, through evolution they've kind of sustained, which makes sense. That's incredible. So so patients, a decreased risk of cancer, likely longer lifespan.
Speaker 2:Dr Justin Marchegiani. Longer lifespan. The other thing that we really focus on is their comorbidities, right, All these patients come in highly diabetic on multiple anti-diabetic medications and your whole goal is to get them off everything. So with a diabetic, 80% of the patients will come off all their diabetic medications.
Speaker 1:How about that?
Speaker 2:Cardiovascular risk factors decrease by almost 50%. Pcos and the symptoms that go along with that decrease by like 70% and fertility actually increases. So these patients who have tried and tried and tried with that decreased by like 70 percent and fertility actually increases. Yeah, so these patients who have tried and tried and tried and never been able to conceive, you know almost 90 percent of those patients will be able to with after the first year and so their hormones are imbalanced.
Speaker 1:They have just less pure inflammation in their body I'm sure there's less. You know, the orthopedic guys hate this right. There's less, uh, joint replacement surgeries because of the weight. And so it's really making a dramatic difference in the two metrics that matter the most the length of life and quality of life for patients and not only for them, but for their family members too, and so that's got to be an uplifting specialty to be in. Is that what attracted you to it in the initial phase?
Speaker 2:It actually is one of the things absolutely when I was in my residency actually, we'd do clinic with some of the bariatric guys that were with us and I'd see these patients over and over who were successful. You know, not every patient's going to be successful. You know, usually we see about 5%. What we call failure late is not losing more than 20% of their excess body weight, and so you know, those patients usually have some of their components that you have to work through to get them where they need to be. But in case, majority do extremely well and are very happy with the end result of things.
Speaker 1:Yeah, I, my first year of training was in general surgery and I remember the same thing. It was a very uplifting clinic to be a part of. Most of the patients were very excited to do the procedure and then most of the patients in follow-up were doing very well the vast vast majority.
Speaker 2:The vast majority.
Speaker 1:You know, 95% success rate is a better way to frame it, and that's pretty good. That's excellent. Yeah, and so do you work solo in practice, or do you have?
Speaker 2:partners. I do have a partner, dr Darren Minkin. He's my partner. That's really. There's just two of us over there.
Speaker 1:Yeah, yeah, so yeah, but two bariatric surgeons is a pretty good practice. A lot of them are single single surgeon practice.
Speaker 2:So you guys got a pretty good operation going on. We do have a good operation. We've been together for 13 years yeah, and so you got a psychologist nutritionists we have dieticians, we have psychologists, we have our nurses that are kind of run the show. And then we have we're hooked up with bariatricians. So if we need a little additional support for appetite suppressants or some type of metabolic medication, we can hook them up with that too.
Speaker 1:Very good and just like a rough estimate of how many cases have you done in your career so far.
Speaker 2:Bariatric cases probably right around 5,000.
Speaker 1:5,000. How about that? Yeah, that's a busy practice.
Speaker 2:It's been fun.
Speaker 1:Yeah, and you guys have been well known over there for a long time. Even before St Luke's, chesterfield acquired St Luke's to pair, you know kind of in the community it was always known as a place to go for bariatric surgery.
Speaker 1:And so yeah, that's great. Dr Ricks, I got a question this these Ozempic and Ozempic-like medications are kind of all the rave and patients are taking this and my understanding of it is in the trials, you know, patients took these medications and it decreased their desire to eat more and so they lost weight. But the trial was not a you know, it wasn't a three-year trial. It was a relatively short term and my guess is patients gain that weight back once they get off of it. But what's your understanding of that or what's your take on?
Speaker 2:that. So what I've seen, you know we've seen these for a couple of years now. Most people do pretty good in the short term and the mechanism behind was actually gastric and small bowel emptying is significantly slown to the point where some people develop severe intestinal pseudo-obstruction and severe gastroparesis due to these. It's not everyone. Most people do extremely well, but once they stop the medication, all that restriction that they feel. In fact I had a lady that I talked to. It's probably been a month. She said when she started she's like now I know what skinny people feel like and eat like, because I just don't feel like they have to eat all the time. So I think it's a great drug. I definitely think there's a place for it.
Speaker 1:Yeah, it seems to be effective for short-term weight loss. But it's, you know, I'm suspicious by nature. But you know, and every good scientist should be suspicious I mean, that's you know, you should be skeptical of things. And so I'm interested to see how patients will do in the long run, because I don't think we have a lot of great data.
Speaker 2:We don't have great data. We have two-year data. Is about what we have. Yeah, it has been shown to be very effective, but once again, once people get off or the tolerance issues, the other thing people just can't tolerate it.
Speaker 1:Yeah, yeah. So it'll be interesting, it could be very, very good. And then you know, historically some of these things have medications have turned out to be not so good, have turned out to be not so good, and so we should kind of, as good scientists and good clinicians, kind of move forward with a close eye on it and not make too many decisions beyond what we objectively see.
Speaker 2:I agree with you 100%.
Speaker 1:Yeah, so what do you like to do with yourself when you're not doing surgery? That's a tough question for a surgeon, because surgeons just like to do surgery and they're not known for being on the golf course. That much contrary to popular belief.
Speaker 2:I do drive a mean golf course, but I cannot golf.
Speaker 1:Yeah, that's me. If you want to boost your confidence, give me a call and we'll go play that sounds good. I keep track of how many balls I lose.
Speaker 2:That's my score most of my free time revolves around my kids.
Speaker 1:I have five five kids, how about that two?
Speaker 2:are graduated, one's in idaho, one's in texas, and then I have a senior and then my two boys, so they pretty much control the rest of my life, yeah, so um, uh, so they're're in college, yeah. One's in Texas, one's in Idaho, actually called Rick's College. My great-great-grandfather founded it. You're kidding me, yeah?
Speaker 1:So I actually in the apartment I used to live in in Columbia Missouri when I was an undergrad. The car that parked next to me had a Rick's College.
Speaker 2:Really so that's the only reason I know about it. That's hilarious yeah.
Speaker 1:How about that? Yeah, good times. So are you a local celebrity back there? No, there's got to be plenty of Ricks.
Speaker 2:right, plenty of Ricks. Yeah, that's how it works out there, yep.
Speaker 1:Very good. And so you're a father and a surgeon and not much of a golfer. I'm not much for golfing. Yeah, I love football. Okay.
Speaker 2:There you go. Okay, and I'm sure you're a BYU fan they're okay, they're okay.
Speaker 1:I mean yes, yeah. And then what's the rivalry like between the Utes and the BYU? Byu Cougars Is that?
Speaker 2:right yeah, Growing up actually the rivalry was BYU and Utah State. Well, for my family, because my dad went to Utah State, All the kids went to BYU. So, we'd always go to those games. Byu and Utah are pretty big. It just matters what part of the country you're from. If you're from the Salt Lake area, then you're a Ute fan. If you're from everywhere else, you're a BYU fan.
Speaker 1:Utah State. Where's that at?
Speaker 2:BYU's uh utah state. Where's that at? By using provo, provo, right. By using provo, the?
Speaker 1:u is in salt lake. It's in logan utah, so northern utah, but but salt lake and provo and and it's all kind of right there, right kind of right there yeah and then, and then there's southern utah. There's a little bit going on down there yeah, not much, not much, not much.
Speaker 2:Yeah, uh, red rocks.
Speaker 1:Yeah, but, but. But St George is down there, right yeah. That's. I think that's a growing area.
Speaker 2:It is. It's exploding down there actually.
Speaker 1:Yeah, one of our neurosurgeons moved there. It's a. It's a. You've got a beautiful house and it's a beautiful area but um yeah, very good. All right, Matt. Um well, I, um I very much appreciate talking to you. It sounds like you've got a thriving practice and you're making a big difference in patients' length of life and quality of life, and it sounds like you and your partner are certainly a vital part of our medical community here and we appreciate you guys.
Speaker 2:Well, thanks, I appreciate the invitation. All right.
Speaker 1:Thanks, Matt.
Speaker 2:Yep.