Explaining kidney health, disease and treatment; what weight-loss surgery is like; test-kit precautions: Upstate Medical University's HealthLink on Air for Sunday, April 3, 2022
Nephrology chief Michael Lioudis, MD, provides an overview of kidney health, including ways to reduce risk. Surgeon Lauren Rabach, MD, explains what to expect from weight-loss surgery. And Vincent Calleo, MD, medical director of the Upstate New York Poison Center, shares some precautions about the at-home Covid-19 test kits.
Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," millions of people have kidney disease but don't know it.Upstate's chief of nephrology talks about symptoms, treatment and reducing risk factors:
Michael Lioudis, MD: ...Our kidneys, which are about the size of our fist overall, well, they're filled with just a very delicate capillary, just this vasculature network there of blood vessels....
Host Amber Smith: A bariatric surgeon gives an overview of what to expect from weight-loss surgery:
Lauren Rabach, MD: ...Education is a very, very big component to what we do, more so than the surgery. The surgery is just a very small piece to the puzzle for them to be successful....
Host Amber Smith: And the medical director of the Upstate New York Poison Center shares some precautions about the at-home COVID-19 test kits:
Vincent Calleo, MD: ...There are risks that can go along with these test kits, if there's an accidental exposure to some of the contents...."
Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.
This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll get an overview of weight-loss surgery from a bariatric surgeon. Then the medical director for the Upstate New York Poison Center has a warning about at-home COVID-19 test kits. But first, a nephrologist gives an overview of what you need to know about kidney health and how to reduce your risk of kidney disease.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." One in three Americans are at risk for kidney disease, and many of them do not know it. Today, I'm talking about this with Dr. Michael Lioudis. He's an assistant professor of medicine and chief of nephrology at Upstate.
Welcome to "HealthLink on Air," Dr. Lioudis.
Michael Lioudis, MD: Well, thank you so much, Amber. I'm delighted to be here today.
Host Amber Smith: Now, the kidneys are responsible for filtering wastes from our blood. In someone who has kidney disease, what happens to the wastes that need to be filtered?
Michael Lioudis, MD: Well, it depends on the type of kidney disease that somebody has, but what happens is, for the most part, we see a gradual buildup of these wastes, and over time, these wastes can actually lead to other medical problems that are kind of subtle until they really culminate to something that is much more overt.
Host Amber Smith: You said it depends on the type of kidney disease. And I guess I hadn't realized that there's more than one. It's not just kidney "disease." There are a variety of kidney "diseases." Is that right?
Michael Lioudis, MD: As we think about kidneys, and most of us have two kidneys, there are multiple different ways that things can get affected and cause kidney disease. And so the two most common types of problems that affect kidneys are diabetes and hypertension. In fact, those two combined are about 75% of the leading causes of kidney disease. But there's other things, too.
Medications can cause kidney disease, different exposures to toxins can cause kidney disease,different things that can happen along the course of a normal, everyday life, so sometimes it's subtle, which is why I'm glad that I'm here today to talk about kidney disease and what we can do to hopefully prevent it and decrease it.
Host Amber Smith: Are there genes that predict a person may be at risk for kidney disease?
Michael Lioudis, MD: So that it actually is our really our 21st-century question mark So we've identified many different types of genes that can lead to kidney disease. For instance, polycystic kidney disease: We know that two genes that are really the primary issues. We've also identified other genes that can cause disease, but that actually is really unlocking how we can hopefully identify, maybe in the future, who is going to be susceptible to kidney disease. And more importantly, if we can find that person that is susceptible, how can we help that person?
And would there even be some gene therapies that could come up?
But that's still far enough in the future that we're still not quite there yet, to be able to kind of put those two together and really prevent the onset of kidney disease.
Host Amber Smith: How do people usually learn that they have kidney disease?
Michael Lioudis, MD: There are so many people that have kidney disease, and yet don't really know that they have a disease. In fact, two out of five adults just in the States alone, don't know that they have severe kidney disease, and that's very, very troubling.
So what happens is, kidney disease is very subtle. And because we're born typically with a lot of extra kidney function, which is why we have many people in the United States and all around the world that can even donate a kidney to a loved one. And so they can still have a wonderful, long life with a single kidney. So when we think about it, it has to be some severe decrease in kidney function before somebody realizes that they have kidney disease, and it can be so subtle that, in fact, it could be just with weight loss, nausea, itchy skin, appetite loss -- it could be a lot of subtle things, that we could perhaps say, gosh, well, that was something that I ate the other day.
You can probably explain it away until you have so many of those symptoms happening all at once that if you have not had routine care, then you may not know about it until your kidney disease is far, far along and very severe.
Host Amber Smith: Is it typical for a person's primary care provider to just stumble upon a kidney disease diagnosis?
Michael Lioudis, MD: Well, in an ideal setting, Amber, people that are going on in for regular preventative care or yearly physicals, get a battery of tests that are usually done. That's in addition to your physical exam that you also get blood work and typically a urine test, too. And so for those patients, one of our early identifying markers for kidney disease really is a simple blood test.
And that is a simple blood test that's usually done at your well visit. And usually also a urine dipstick test, too, that's, again, done typically at your yearly visit. And so those are the first level screenings that can indicate that a person may have kidney disease. Now, what's also interesting is I have had referrals to my office from people that have gone into employee health fairs, they've gone on in for simple blood pressure checks, and all of a sudden, they find that they have very high blood pressure.
And they're told you have to go see your doctor. And that then leads to ultimately a referral to a nephrologist. So there's a number of different ways that somebody could be identified as having kidney disease, but ultimately it is going on in and having a checkup before.
Host Amber Smith: When a person is told that they likely, because they've had the urine tests and other things, when they're told that they have kidney disease, is it staged, like when you're told you have cancer, and they go through and give you a lot more detail?
Michael Lioudis, MD: I'd like to think about those two aspects as kind of separate, so we're not talking cancer at all, but I understand where you're coming from. So I want to make sure that for our audience out there that's listening to us, well, kidney disease is not necessarily cancer, that's for sure.
But what we have there is there's five different levels of kidney disease. And then after that is a kind of a subset, the way that I think about it, that's called end-stage kidney disease, which typically means dialysis or the absolute need to get a kidney transplant, if that's available.
Host Amber Smith: So can kidney disease potentially be reversed, or once you have it, is it destined to become a chronic condition?
Michael Lioudis, MD: Really, we need to think about, what is it that has affected our kidneys? So if we think about it just separately, if we're thinking that wow, if we have uncontrolled diabetes, and we get that under control, can we help to decrease further damage?
The answer is yes, we expect that that is the case, if we could get that under control. Think about blood pressure, high blood pressure affecting the kidneys. I think about it as a jackhammer to the kidneys. Now that doesn't only affect the kidneys, it affects the heart, it affects blood vessels, the brain -- it affects the entire body.
And as we think about it with kidneys, it means if we can decrease that hypertension, get it under control, then we minimize additional damages. If we're taking over-the-counter medications, you group this one specific class called NSAIDs. Let me explain what that is. It stands for this thing called nonsteroidal anti-inflammatory drugs.
Think about it as Motrin, ibuprofen, Advil, Aleve, naproxen. These are drugs that are very common.Athletes take them, if you have a hard day at the gym, you had an injury, you're taking these things. If you have osteoarthritis, it really helps to decrease pain and inflammation. And they work. They work very well, but they're not designed for long-term use.
And so the problem ultimately is that when people are taking these things that are over the counter, and sometimes these over-the-counter medications or supplements are deemed, well, perhaps safer than something that's prescribed, but maybe they're not. Because in those cases, those medications can actually lead to direct kidney injury.
And so again, stopping those medications can sometimes actually decrease, reverse, help to improve kidney function. So it really is about understanding what goes into our bodies. What else is affecting our bodies? And then what things can we modify about our bodies to help our kidneys to be better?
Host Amber Smith: I'd like to understand a little bit more about the different levels of kidney disease.
So can you tell me what life is like for someone who has kidney damage and a mild loss of function, compared with someone who has more of a severe loss of function?
Michael Lioudis, MD: So, let's kind of think about that as three separate steps. So I typically think of mild as being stage one or stage two. And in fact, in those cases, it may have been an injury, it could have been an accident, could have been a bunch of different things, but quite frankly, that should not have an effect on a person's ability to exercise, live a wonderful, normal, long, healthy life. However, what it is, is it's just a reminder that all right, maybe you're not at 100% kidney function, but you may be very close to it. And so it's just an emphasis about making sure that you're doing the lifestyle changes to prevent it from moving from stage one or two to stage three, stage four, to stage five.
Now, typically that threshold where I think about things starting to change is right around that stage three. Now at that stage three, if you think about it, we have five stages of any disease and then dialysis, well, that stage three is right in the middle. And so that makes you perhaps more vulnerable. And so really increases the stakes that we need to emphasize.
What are the factors that got you to stage three? If it's diabetes, let's get that under control. If it's high blood pressure, let's get that under control. If it's the two of them, boy, I think about diabetes and high blood pressure as the Bonnie and Clyde on the 21st century, because those two things just rob you.
And you're not even aware that they're robbing until you have progressed to a point where I may not be able to reverse or stabilize, so that stage three is that that really that zone that a person, if they're in it that really we need to put a lot of emphasis and a lot of attention towards making sure that we have correct follow-ups thinking about good blood pressure control, cholesterol control, exercise, all the things that we think about as we think about leading a healthy lifestyle and really bringing it all to the table, especially at stage three. We should do it at any stage, but especially when we're thinking about that first one, two, and then three stages.
Because when we get the stage four and stage five, then the concern is that that person may be more susceptible towards progressing to the end stage, which is what we don't want.
Host Amber Smith: Upstate's "HealthLink on Air" is taking a short break, but stay with us to hear more about kidney health with Dr. Michael Lioudis.
You're listening to Upstate's "HealthLink on Air." I'm your host, Amber Smith. I'm talking with Dr. Michael Lioudis, who's Upstate's chief of nephrology, and our subject today is kidney health. Regarding kidney health, there are some terms that may be confusing. What is GFR?
Michael Lioudis, MD: Oh, that is a confusing one, because what you'll see is on typical lab tests that come on out and very routine lab tests, Amber, you'll see that you'll have your sodium, your potassium. You'll have your electrolytes listed there, and you'll have something called the creatinine. And then you'll see right underneath there, it'll have GFR, but it'll have specifically EGFR. So let's talk about GFR and EGFR. So that stands for glomerular filtration rate.
Think about it as the efficiency of your car engine, but in this case, the efficiency of your kidneys, and so the higher, the GFR, well, the more efficient your kidneys are. It's not a percent, so I don't want our audience to really think about a GFR as well, if I can have 100 for my GFR, well, I'm at 100%, but if I have 50 at my GFR, I'm failing.
No, that's not quite how it works. It's kind of like a rate, but it is across a spectrum, and it gives really an indication to the ordering physician or advanced practice provider, an indication about how efficient are your kidneys. And it also helps out to think about, well, dosing medications, too. So, what do I mean by that?
When we take medications in our body, they get metabolized. Sometimes our liver metabolizes them. Sometimes our lungs metabolize them. But a lot of medications get metabolized by our kidneys. Basically that means they get utilized. Sometimes we take a medication once a day, twice a day, four times a day, depending on the medication, because how quickly it gets utilized in our body.
Michael Lioudis, MD: So if we have a medication that is otherwise metabolized by our kidneys, and our kidneys aren't as efficient, we may need to dose it a little differently so that we don't overwhelm the actual levels of this medication in the body. So it helps us to identify somebody whose kidneys aren't as efficient and helps us to go ahead and think about medication dosing.
And it also helps us to see about over a period of time what's happening to a person's kidneys, and are therapies that we're actually going ahead and implementing, are they working?
Host Amber Smith: So if someone had their GFR at a certain number and then six months later, or a year later, that number is lower. Is that something to be alarmed about or does that maybe naturally fluctuate?
Michael Lioudis, MD: Well, our level can fluctuate a bit and it can fluctuate a bit by our diet. It can fluctuate a bit by how we keep up with our hydration. But, when we have a change in that GFR, the question is, is it so-called transient? Which means not "is it temporary?" Is it just that, Hey, when we checked that at that point in time, it was just a little bit different, and then when we recheck it again, let's say it's right back to where it was before. Well, that's OK. But if we see it, that it's gone down a little bit, well, then it's, again, an indication is that durable or not of a change? Is it a beginning of a change that will continue to go down? And so what we need to do is, therefore, follow it over time, and that's really it. It's kind of thinking about our bodies over time.
When I look at a picture of myself from five years ago, I'm a lot different than I was, and so our kidneys will change, too, much like the rest of our bodies. But the question really is, is that a significant enough change that will impact how long we live, how we live and what we need to do in order to keep ourselves healthy over the spectrum of a lifetime.
Host Amber Smith: If somebody's physician has told them they're concerned about kidney disease, at what point should that person find a nephrologist like yourself to follow their care?
Michael Lioudis, MD: When somebody gets labeled as having kidney disease, that's a tough label. It is something that sometimes you just can't shake it off, and so it has implications for a person's life, how they think about themselves and how they move along and what kind of care do they then need afterwards? So that's a conversation that typically starts with their primary care physician or advanced practice provider, which identifies that level of kidney disease.
Now there's a lot of different factors that will then really push whether or not a patient needs to see a kidney specialist. So a lot of those factors depend upon how severe is this change or identification number in that spectrum of those five stages of kidney disease that we were talking about. And is there a family history where we've had other individuals, whether they're parents, grandparents, siblings that have progressed to end-stage kidney disease?
So there's other factors that would really make us push to see a kidney specialist sooner rather than later. So that's, again, the conversation that usually starts with the person that first identifies if there's a problem. And then that's where you really want to have just a free flow of information, so that your primary care doctor or advanced practice provider knows everything about you so that they can really help to guide you through what can be a wilderness of all these different options and things.
Host Amber Smith: If chronic kidney disease affects more than 37 million people in the United States, how are these people being treated in general? Are there medications that will help the kidneys function better?
Michael Lioudis, MD: Well, there are, and it really, once again, depends upon why is that person having or being identified as having the disease? Now, the one thing that I kind of think about, again, is if a person is diabetic, well, getting on the proper medications for diabetes control will be key.
Measuring your hemoglobin A1C. People that have diabetes, know what I'm talking about with that hemoglobin A1C, which is a factor of kind of glycemic control, sugar control, over a period of months. If it's high blood pressure, being on anti-hypertensive medications, getting that down, getting that better controlled.
If it's other things that are causing it, well, then that's where usually you really get into seeing a nephrologist or an immune specialist.
Host Amber Smith: What percent of those 37 million people are liable to end up on dialysis and what percent are going to need a kidney transplant?
Michael Lioudis, MD: Well, we have 37 million people that have been identified as having kidney disease, but we only have roughly about 800,000 people that have progressed to the point where they either require dialysis or a kidney transplant.
So of those 800,000, a little more than 500,000 are on some form of dialysis. Now, you can say, wow, that's a big difference, 37 million to 800,000 that have gotten to a point where they've needed a transplant or be on dialysis. Well, there's a lot of people that move into different categories. We identify the issue, they get stabilized, they never progress down. Some people may pass away, along with age and other factors, but you know, fortunately not everybody, if you have kidney disease, will you get to the point where you need dialysis or kidney transplant.
Host Amber Smith: Is there progress on the creation of artificial kidneys that you're aware of?
Michael Lioudis, MD: There is, and actually, I was involved with the artificial kidney project at the Cleveland Clinic, where I came from, was there for over a decade. And so we were looking to go ahead and really figure out how to make an artificial kidney and give people more freedom, more hope.
We don't want to see anybody on dialysis in this country or anywhere. And being able to come up with an artificial organ that works well and is efficient, well, that's really our key hope, but we're not quite there yet. So we have still issues with miniaturization of the artificial kidney, being able to efficiently plant it -- what we're seeing is perhaps more optimism with xenografts, well, basically it is transplants from animals into humans that may not cause our immune systems to overreact. We recently had a patient that had a heart transplant that survived for a period of time and did well. And we're hoping that that's just the beginning for the future for transplantation, but we're not where we want to be with either one. Our goal is to keep original equipment, and that's what we really want to do. We want to keep people with their kidneys, to be healthy and to keep those kidneys healthy.
Host Amber Smith: Well, in terms of that, you've mentioned risk factors, but I do want to ask you a little bit more about risk factors for kidney disease. Do both Type 1 and Type 2 diabetes increase the risk for kidney disease?
Michael Lioudis, MD: They do, and especially if they are uncontrolled. Now it's really not only that if they're uncontrolled, but it's also the length of time that somebody has been uncontrolled with their diabetes. Typically our patients that are Type 1 diabetics, they tend to be diagnosed earlier, uh, and may have had diabetes for a number of years, and with variable control. Our patients, though, with Type 2 diabetes may have a number of years of having sub- clinical diabetes, where it hasn't quite evolved into full, uncontrolled diabetes. Both are problematic, uh, but it is the length of time, and it is also the amount of uncontrolled time that a person's had diabetes.
Host Amber Smith: So is it the same with high blood pressure? If it's under control, does that mitigate the risk at all?
Michael Lioudis, MD: It does, Amber. So we need to think about blood pressure. It's a unique thing as we think about blood pressure control, because there's so many factors that influence our blood pressure -- whether or not we're active, what our salt intake is, what our weight is -- there's many different things -- our family history. Now odds are if mom or dad had high blood pressure and especially if they both had high blood pressure, we probably will also have a tendency towards having higher blood pressure. And so the question really is, well, if we can get that blood pressure under control with both lifestyle modifications and the proper medications?
Well, the answer is, yeah, I think we can mitigate those risk factors over time. And that's what's really important, is just being able to identify. And so that's one, again, another aspect of our bodies where we can have very high blood pressures and absolutely feel normal and not think that anything is going on or there's a problem. So to me, that's also another reason for going on in, having yearly physicals or going to health fairs or even going to your local EMS or firehouse. And they typically will check your blood pressure for free, or even some of our pharmacies, they'll have blood pressure cuffs -- you can go on in and get your blood pressure checked.
If you find that it is high, you can certainly go ahead and seek some medical attention. Let's find out why.
Host Amber Smith: What connection does heart disease have to kidney disease? Because I don't think of the hearts and the kidneys being connected.
Michael Lioudis, MD: I think of our bodies as one big domino set.
So if my heart's not doing well, my kidneys may not. My kidneys aren't doing well, well, my heart may not. My liver is not doing well. Well, my kidneys may not do well, so you can see where I'm going with this. We're one big domino set. So if we think about heart disease or atherosclerosis -- well, that's hardening of the arteries.
It tends to happen over time, we think about higher cholesterol. But our kidneys, which are about the size of our fist overall, well, they're filled with just a very delicate capillary, just this vasculature network there of blood vessels. And so really what happens to the heart from an atherosclerosis can actually happen to the delicate vessel network in our kidneys, too. So they're tied together, and we're all tied together, inside of ourselves. And so good heart health will equal good kidney health and vice versa. Good kidney health will also equal good heart health. So those are how I think about them very simply and how we're all tied together.
Host Amber Smith: What about someone who has kidney stones or repeated urinary tract infections? Does that increase your risk of kidney disease?
Michael Lioudis, MD: It sure can. So we need to think about both of those a little bit separately. So when I think about kidney stones, kidney stones cause more than a billion dollars in lost work revenue, you name it. People are in pain, ER visits. They are awful, awful things that people go through. And for reasons that I don't have a scientific explanation for it, they happen in the middle of the night on a Sunday. So it always happens at inopportune times. Kidney stones, what they do is, in addition to pain, local inflammation, well, they can actually, as they move, they can also cause obstruction, which basically means they can plug up the outlet, which is that ureter that comes off the kidney. It helps to drain urine. And so what happens is, when they plug out that outlet, then you can get a buildup of urine and pressure with pain that can cause very significant damage over time. Now, in addition to doing all that, as these kidney stones move -- and causing internal destruction, like a boulder crashing down on a mountain -- it just pulls a lot of other things with it. It can actually increase the risk for infection, so it can cause a localized infection with impacted stone that leads to significant pain, loss of kidney function over time, even, in fact, loss of the very kidney where that stone is causing those issues.
Now, when I think about urinary tract infections, well, they're really separate. So urinary tract infections can be caused from a multitude of different things. Now, urinary tract infections, typically a lower urinary tract infection, in women tend to be more susceptible than men for lower urinary tract infections.
Now that doesn't mean you also have something called a kidney infection. So we think about our kidneys, they tend to be higher than our bladder and you have tubes that connect down to the bladder and then their bladder drains on now through another tube called the urethra. Now the lower urinary tract infection really is a bladder infection, and it's just lower than the kidneys. But if that infection goes and travels on up, let's call it a pyelonephritis, or a kidney infection, and people that have recurrent episodes of pyelonephritis, (it) causes inflammation, scarring to the kidneys that can cause a loss of overall filter function. And so over time, that can certainly lead to overt kidney disease and loss of function.
Host Amber Smith: I'd like to ask you about some concrete things that people can do to lower their risk.
Where are the best places to live and work to reduce risk of kidney disease?
Michael Lioudis, MD: That is a tough question to answer because it's not necessarily about where you live or work. We have people that have wonderful, long lives; they live near the Arctic. We have people that have wonderful, long lives and live near the Sahara Desert.
And so our kidneys are designed to be able to be efficient and allow us to function well in both of those environments, as long as we're keeping up our hydration, avoiding exposure to sun, dehydration, or in another way that we think about it in the kidney world, volume depletion. So we want to think about keeping ourselves in balance and keeping ourselves environmentally sound. We don't want to get ourselves sunburned, but we can certainly enjoy the sun. Again, it's the combination of lifestyle modifications, eating well, exercising. So, you can work on an assembly line, you can work on a road crew, you can be anywhere that is a safe area, but making sure that again, you're treating yourself well, hydrating.
Host Amber Smith: Aside from water, what foods make up a diet that is good for the kidneys?
Michael Lioudis, MD: Well, when we think about that, water is really my go-to, I must say. It's the best low-calorie drink in the entire world. So, there really isn't a substitute for water. But once again, if you feel that you'd like to put lemon in your water, to get hydration in a different way, or seltzer, those are all very useful, but when we're looking at a diet, we're really looking for a heart-healthy diet. If you're diabetic, it would be a diabetic diet. If I keep my heart healthy, it's going to keep my kidneys healthy. If I keep my diabetes under better control, because I'm really avoiding those sugary, refined sugar kind of diets, drinks, candies, ultimately, it's going to increase my ability to keep my kidneys healthier. So it's a heart-healthy or diabetic-healthy diet that will ultimately keep your kidneys
Host Amber Smith: Well, Dr. Lioudis, I really appreciate you making time for this interview.
Michael Lioudis, MD: Oh, it has been my pleasure, Amber, thank you so much.
Host Amber Smith: My guest has been Dr. Michael Lioudis. He's the chief of nephrology at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."
Are you considering weight-loss surgery? Next on Upstate's "HealthLink on Air."
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." If you are someone who has struggled to lose a significant amount of weight, you may have wondered whether surgery was an option. I'm talking with Dr. Lauren Rabach, from the metabolic and bariatric surgery program at Upstate, and we'll be covering who qualifies and what he or she can expect from weight-loss surgery.
Dr. Rabach, thank you for taking time to talk about this with "HealthLink on Air."
Lauren Rabach, MD: Thank you for having me.
Host Amber Smith: Now, who is the ideal candidate for weight-loss surgery?
Lauren Rabach, MD: So, the ideal candidate for weight-loss and bariatric surgery is one that's motivated. One that wants to really make a difference and an impact in their current lifestyle, whether that is getting off of certain medications, not wanting to take any further insulin or be on a CPAP machine for sleep apnea. So those are patients that we would recommend looking further into bariatric surgery.
Patients who qualify have to have a certain BMI cutoff or body mass index, and that is a BMI greater than 40 if you don't have any other related medical conditions or a BMI of 35 with those medical conditions associated with obesity. And that can be anything from high blood pressure to type 2 diabetes to osteoarthritis and joint pain, high cholesterol, sleep apnea. There's about 15 associated diagnoses that qualify, and actually the Society of Metabolic and Bariatric Surgery have correlated almost 40 disease processes that are directly associated with obesity.
Host Amber Smith: Are there any issues that might disqualify someone from weight-loss surgery?
Lauren Rabach, MD: It's very individualized. We take a look at the whole patient, what other medical conditions they have, what prior surgeries and current medication list that they'll need to take moving forward with their medical problems, so I'd say there aren't any true, hard contraindications, but we do have a multidisciplinary team to look at the patient as a whole, so from all organ systems, from a mental health standpoint, are they safe and optimized to undergo that surgery?
And that's really the goal before offering them a date (to undergo surgery).
Host Amber Smith: Is weight-loss surgery an option for someone who wants to treat their diabetes?
Lauren Rabach, MD: Yes, it is. Weight-loss surgery is probably the best tool we have for treatment of diabetes. We've looked at this in large studies. The Swedish obesity study is probably the biggest one to date, and it compares bariatric surgery to just diet and exercise alone in terms of the percent of resolution at one year, five years, 10 years down the road. And you're looking at a much higher rate of resolution, over three times as high, in patients with bariatric surgery, and especially with the gastric bypass.
Host Amber Smith: So, someone who has diabetes, do they have to be obese also in order to have this same procedure?
Lauren Rabach, MD: They do. They need to have a BMI of greater than 35, a body mass index, at present time based on what the requirements are for their particular insurance.
Host Amber Smith: So once somebody is thinking about surgery and has come to see someone like yourself, what else happens? What else do patients need to do before they have the operation?
Lauren Rabach, MD: I think first talking to their primary care doctors or providers that they feel very close with to kind of have a conversation, with their goals, with losing weight and getting healthier.
I think a good support system from family, from friends, is important. And then from there, what they can expect is a full examination, not only their heart and lungs, but also mental health. So we have them evaluated by our psychologists, our dietitians, their primary care providers, as well as myself and the other surgeons in the group to see, are they healthy and ready for a big bariatric surgery, such as a Roux-en-Y gastric bypass or sleeve.
So, they meet with a support group at least one time. And this support group is really run by our coordinators, but also a big role in this support group is prior patients who have had successes or patients that are going through the pipeline.
And so this is a good group for more information and more resources that come from other people, such as our coordinator, our nurses and other people who have experienced the surgery. We also would like to see some demonstration of weight loss, but again, that's very individualized, and oftentimes we don't give the patients preoperatively a number that they have to hit.
It's more the small changes that they're making to their lifestyle, to their activity, to their diet. So then afterwards, they're the most successful with their weight loss. Education is a big component to what we do to what we offer to these patients. More so than the surgery. The surgery is just a very small piece to the puzzle for them to be successful.
Host Amber Smith: This is Upstate's "HealthLink on Air." I'm your host, Amber Smith, speaking with Dr. Lauren Rabach, from the metabolic and bariatric surgery program at Upstate, which has a robust web presence at upstate.edu/bariatric. We've covered who qualifies for weight-loss surgery. And now we're going to look more closely at the types of surgery available and what patients can expect. So, Dr. Rabach, can you describe the different types of surgery?
Lauren Rabach, MD: The sleeve gastrectomy is where we remove about 80% to 85% of the patient's stomach. And this works in a couple ways, so you are going to have that restrictive effect in which you can't eat as many calories or consume as much as you would have prior to the surgery.
But we think, more importantly, what really drives weight loss after this is what we call the metabolic effect. So you have changes in your hormones that interact between your stomach and that interact between your brain that are altered after this surgery. We think this is really important for driving weight loss and really promoting, like I said, the metabolic effect in those appetite hormones being very suppressed.
The second common surgery that we do is called the Roux-en-Y gastric bypass. Now both of these surgeries that I'm talking about are performed in the minimally invasive approach, so small incisions. Patients tend to go home about a day after that surgery. With the gastric bypass, it's similar in that you're creating a smaller pouch from their normal size stomach, but you're also bringing up a piece of their small intestine. In that way, food is traveling in a different orientation than where it was before, so it will bypass and that's where we get the word gastric bypass, the first portion of your small intestine, called your duodenum. And this is very important also for the metabolic effect, which is similar to the sleeve gastrectomy, but what's even more important about it is the ability to bypass that first portion of the small bowel really makes a huge difference in terms of the ability to increase the amount of insulin that we're secreting, but also decreasing our insulin resistance, which helps with diabetes long term.
And there's a direct effect on glycemic control, and like I mentioned before, the appetite hormones. So, we know about ghrelin and incretin, and we also know about GLP-1, and these hormones are directly altered after these surgeries. So that's the biggest difference when you compare these two surgeries that we perform, and you look at that with diet and exercise.
Host Amber Smith: So, looking at the gastric sleeve and the gastric bypass, I'm curious which one is the safer option, which one lasts longer, and how do you go about helping a patient decide which one is the right one for them?
Lauren Rabach, MD: It really comes down to looking at the patient as a whole, and I bring that up time and time again, because everyone's an individual and comes with different medical conditions and a different background. So we kind of see what their prior history was with surgeries, with medical history.
We also look at what medications they're going to need to be on long term, and so that will play a role into which surgery is best for who. Now, after we go through the process of making sure you're ready for surgery, the necessary lab work and testing, we then meet as a team.
And that team is the patient, myself, our dietitians, because this really is a team decision. And at the end of that, we decide on what operation is best for that individual. Now comparing risks associated with the sleeve and the bypass, they're actually very similar. They have very low risks of complications and side effects.
We've really done a lot of advancements as far as lowering our complication rates and getting patients out safely at that one day post-op mark and getting them back to doing their normal activities by about seven to 10 days. So low complication rates, similar complication rates between the surgeries that we offer, and patients tend to stay a similar length of time, about a day after surgery.
The amount of time it takes to perform the surgery is very similar. Their postoperative diet is also very similar in their recovery, so, patients tend to do well with both of them. Both the sleeve and the bypass have excellent long-term weight-loss results, excellent results in resolving patient's comorbid conditions, like high blood pressure, diabetes, high cholesterol, and these are high rates. I'm talking like 80%, 90% for a lot of these conditions. So it's quite significant and quite amazing that we're able to do this with such low risk to the patient.
Host Amber Smith: Eighty to 90% of success that it stays for the long term, you mean?
Lauren Rabach, MD: And we're able to resolve certain conditions. So we've looked at patients who've had both a sleeve and bypass and looked at how their success was at even five years after surgery, and patients who've had a sleeve or a bypass,their chance of getting off those medications, not needing their CPAP machine anymore for their sleep apnea is very high, and that's where I'm talking about 80%, 90%, sometimes 95% resolution rates, especially when you're looking at diabetes, high blood pressure, high cholesterol, we've really have excellent results with getting patients off of those medications for good.
It's not uncommon that the day after surgery, we're already taking them off their medications, high blood pressure medications. We're lowering their dosages of their insulin or their oral diabetes medications, even 24 hours after their surgery. And it continues, even weeks, months down the road, us trying to reduce their dosages or taking them off their medications in general.
Host Amber Smith: Once the patient has a surgery date on the calendar, how do you tell them to prepare for that?
Lauren Rabach, MD: By the time they have their surgery date, they're already very well prepared. So they've met with me or one of the surgical providers, they've met with our dietitians on a pretty consistent basis, at least once a month, where we talk about the educational component, which is very key. So the diet to expect, activity level that we'll want them to participate in as soon as they're done, the vitamins that they're going to have to start taking shortly after the surgery.
All of these things we've talked about, and the patients have their expectations very clear by the time that surgery date rolls around. And then after that, it's really just about implementing those small changes, so that they're very successful with their weight loss long term, making sure that they're really hitting their goals, that they're getting the necessary lab work and meeting with the necessary providers to make sure that they're on track.
Host Amber Smith: So, it sounds like, even before the operation, the patient kind of starts living the life they're going to be living after the operation. They have to be prepared for that and used to it so that it's not like they come into the hospital and have the operation, and it's a whole different world when they leave. They're already accustomed to what they're going to have to eat and how they're going to have to behave.
Lauren Rabach, MD: Exactly. It's a very powerful tool that we have, but at the end of the day, it's a long journey, and they're going to have ups and downs, and so having all of that education before the surgery makes it an easier transition for them.
Host Amber Smith: Thank you for taking time out of your schedule to help explain all of this to us. My guest has been Dr. Lauren Rabach. She's a surgeon from the metabolic and bariatric surgery program at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."
Here's some expert advice from Dr. Vincent Calleo, medical director of the Upstate New York Poison Center. What's important to know about the COVID-19 at-home test kits?
Vincent Calleo, MD: There are a number of really important things to know about these test kits. First, we're very happy that we're seeing a larger number of these kits out in the community so that the population can safely test and know if they or their family members are sick and help to quarantine to help try to get this pandemic under control. But with that being said, I think it's important to know that there are risks that can go along with these test kits, if there's an accidental exposure to some of the contents.
Now within these test kits, there are small liquid vials that contain one of the ingredients to essentially use in the test to figure out if a person is positive or negative when it comes to COVID-19. Fortunately these bottles are usually very small, and the amount of liquid contained in them is pretty trivial. But it's important to remember that even small amounts can potentially cause symptoms, especially because there are a number of different test kits, and some test kits have more dangerous chemicals in them than others.
So, a few things that we think about with these exposures are remembering A. What type of a test kit it is. B. How much of the chemical the person may have been exposed to. And C. What type of chemicals are within the individual kit. That's all really important information for people to know as they're trying to figure out how sick a person may become. Now in terms of what we've been seeing at the poison center, there have been an uptick in the number of cases that we've seen. And over the last few weeks, our poison center alone has received over a dozen calls for accidental exposures to these COVID-19 test kits.
So it's important to remember that if someone is exposed to the substance, remember to stay calm. That's always going to be the first step. Next, you want to go ahead and give us a call at the poison center (1-800-222-1222) and we'd be more than happy to help walk you through what symptoms you may develop or whether or not you should seek immediate health care evaluation. Some of the symptoms that are more common can include things like nausea and vomiting, as well as stomach upset, but there are a number of different other ones out there, particularly depending on how much you were exposed to and what chemicals were within the test kit themselves.
So some things that families can do to help decrease the likelihood of an accidental exposure are going to be things like keeping these test kits out of sight and out of reach for children and pets. That's one of the first steps you can do. The next thing is reading the instructions and knowing how to perform the test properly. And after the test is performed, making sure that it's safely disposed of. These are a few simple steps that families can do at home to help to decrease the likelihood that anyone within that home may be exposed unintentionally or accidentally to any of the chemicals within that test kit.
And just remember, whether or not someone is exposed and has symptoms, or if they're asymptomatic, we are always here at the poison center to help provide guidance as to what someone should do after an exposure occurs. We're here 24/7. 365 at 1-800-222-1222. And we're always happy to help answer any questions we can.
Host Amber Smith: You've been listening to Dr. Vincent Calleo, medical director of the Upstate New York Poison Center.
And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.
Deirdre Neilen, PhD: Sometimes people think poets must be such serious souls, working endlessly to craft the perfect line, no time for fun, but Syracuse poet Joan Cofrancesco, who has recently retired, shows us the exuberance and the delight that can come from following the poetic muse. Here is "The Poem That I Will be Remembered For":
My best poem will have ocean
right in the middle of it, ocean so cold and deep
with life my friend will leave behind
his scuba outfit and tell me, "Wear this when you
go in." My best poem
will have night in it, too, and all the stars
in the Eastern sky, and this immense body
of water shining for miles under a new moon.
My best poem will have a jacuzzi
and a shower for itself, skylights,
a phone by the faucet,
a soapdish made from a clamshell
picked from the beach an hour before breakfast.
There will be waves breaking in my best poem;
and a beach where ocean-soaked
shellfish will rise up, consuming one another.
Oh, my best poem will throw tides!
But there won't be any waterglasses in my best poem.
I'll take up drinking from the bottle.
Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air": how COVID affects those with compromised immune systems. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thinking you for listening.