- We're at a critical stage here.
- Yeah.
You're gonna die.
Pretty soon.
- Today, we're watching Family by the Ton.
I'm not gonna lie, not a huge fan of the title
but let's see what the show has to offer
and learn something along in the process.
Let's get started.
- I would just eat until I'm dead, probably.
A normal day for me is wake up around 12,
figure out something I'm gonna eat immediately.
TV, video games, bed.
- So it's interesting that you see him drying himself
off with a towel of that specific way.
When you have excessive body weight
and you have excess skin, excess fat tissue,
you have to be really thorough about drying yourself
because it's really easy for a candida infection to begin.
And as a result, you can get really bad redness,
irritation of the skin.
It can then become a full on cellulitis
where bacterial infection sets in.
So it's really important to dry skin folds
in order to decrease the likelihood of this happening.
- I never would have thought at 34,
I'd be living with my father.
And I'd be, have no job,
have no real money and just be playing video games all day.
And eating.
- When you're trying to address someone's situation
where they're morbidly obese,
you have to look at the patient as a whole.
You have to look at what are the reasons
that contributed to this occurring.
What can you do in order to prevent it from recurring?
Look at triggers.
Look at mental health factors.
Look at sleep schedules.
Daily activities.
Like in general, I'm not against gaming.
I love gaming.
I consider myself a gamer, but there are times
when we can take something
that can be potentially beneficial
and make it into something that it's not.
And this can happen with anything.
I mean, it's really the dose decides the poison.
So having an unhealthy relationship with food, with gaming,
all of this can contribute
to this ultimate unhealthy lifestyle
which will ultimately decrease lifespan
and decreased quality of life.
And that quality of life is really what I like to focus on.
'Cause yes, we wanna extend life span.
We want patients to live a long life, but at the same time,
I want them to live that life comfortably.
I don't want them to be in pain.
I don't want them to be in mental anguish
because they don't feel like
they're connecting with the outside world.
And that's what a good doctor, nutritionist, or like I said
any other health professional looks at
when addressing these types of problems.
- Casey, I have your food. - Okay.
- I'm gonna tell him what to get him
and I'll come right back in a long time,
just in case he has too much food.
But I'll get it for him and bring it
to the house and put it right in front of him.
- [Casey] I don't wanna call him an enabler, but I mean,
sometimes it's really the way
like it seems that it is.
I'm not buying the groceries.
I'm not buying the frozen pizzas.
I'm not buying the chicken wings.
There's someone facilitating the food coming in.
And it's not me.
- I mean, there's partial truth in that.
I don't think that's a valid excuse for someone to make.
If my patient told me, hey, look, it's not about me.
I'm not the one doing the shopping.
At the end of the day, there's a level
of personal responsibility involved in all of this.
But to solely placed the blame
at the foot of others is not a healthy pattern.
Not because it's right or wrong
but because it takes away control from you.
And when you take away control from you,
you actually create more of a problem.
Where you feel like you're helpless,
you have to do it.
And there's nothing you can do to change it.
When that is not in fact reality.
There are things you can do to change it.
There are conversations to be had
with your 'enablers" because the foods
that are being consumed are A, unhealthy foods.
B, there's salt being added to already very salty foods.
The portion sizes are tremendous.
And I saw the father mentioned tea.
That tea has so much excess calories
from the added refined sugars.
Like that's even worse
than eating a huge amount of food
because at least when you eat the food,
you can feel satiated.
And there's some fiber and other nutrients in there.
But when you're just drinking sugar water,
which is essentially what a lot of these sweet teas are,
in mega amounts, you're just adding weight.
- So I bathe outside of this trough currently
because I cannot physically bathe
in a sit-down bathtub or stand up shower area.
Because I'm a bigger guy with like folds and flaps,
I have to move around, like almost like a pig in a way
and wallow and roll over to get like the back of my leg.
I have to lift up literal like pieces of skin.
It's just a super difficult process.
- There's a lot of adjustments that are needed
to be made in someone's home
when they are of this excessive weight.
There's also adjustments that need to be made
in the hospital.
I've had patients who are morbidly obese
who unfortunately did not fit
in our CAT scan machines and our MRI machines.
And then those scenarios,
A, you try and look at the facilities around you
if there's an option to transfer the patient
to someone does have a larger piece of equipment.
And then there's sometimes been situations
who we literally have to contact our local zoo
who have really large machinery
for some of their larger animals and we use those.
It's not a pleasant conversation to have with patients
but it goes to show how there's a lot that needs to be done
in order to make sure
that we're keeping folks like this healthy.
- This is our icebreaker.
We do have to take your weight first.
- This was coming.
When I weigh myself in my house, I do it butt naked.
Just use the bath in number one, number two.
And I've like tried to throw up the last meal I ate
so I can lose any pounds.
Now I'm there wearing clothes.
I'm kicking off my flip flops.
Anything I can get off of my body to lower the number.
'Cause I know it's gonna be shockingly big.
- [Woman] It's 711.8.
- Now I know bariatric offices that try
and save this step for later in the visit.
Reason being is whether this patient is approximately 500,
600, 700 pounds, we know that there's gonna be a benefit
to doing the procedure.
So we can already lead with that assumption.
A lot of times it's traumatic to step
on this scale and look at the number.
So we try and perhaps save it
for not the first first thing you do when you walk
into the office 'cause that alone
can cause people to not wanna come in
to see the doctor in the first place.
- We're at a critical stage here.
- Yeah.
- You're gonna die.
Pretty soon.
Unless something happens here.
- Now I know that's jarring to hear.
I understand why.
I agree with this approach.
I think this is the most successful approach
'cause it's honest.
Whether you have a patient who is morbidly obese
and is over 700 pounds or you're recommending
a do not resuscitate order for a family member.
Those are difficult conversations.
The truest, most honest, non-judgemental way
you could deliver that news
is gonna be the most successful way
you could deliver that news.
- With you, the route we're gonna go down towards
is a sleeve gastrectomy.
Okay, all right?
So this is your stomach.
All right.
What we're gonna do is we're gonna go in
and we're gonna remove this outer portion
of your stomach right here.
There'll be a metabolic switch that gets flipped
in your body when you have this surgery.
Your body will wanna lose weight.
- When Dr. Proctor was going over to surgery,
it was pretty scary only because I fear surgery in general.
- Understandable that he's apprehensive.
Surgery comes with legitimate, legitimate risks.
Even if it's bariatric surgery.
That being said, being 700 plus pounds
carries way more risks than the surgery.
And that's how we decide whether or not a procedure,
a medication, a treatment is good for a patient.
- Why don't you tell me what does a normal day
of eating look like for you
prior to when you saw Dr. Proctor?
- So like, we're waking up at like 12.
And then probably ordering food from the hot dog house.
- What do you usually order? - On like a normal day,
it might be like 20 wings or like 10 tenders.
And then it would be like a small order
of tater tots and a large sweet tea.
- This size cup?
- Yeah. - Okay.
So we're doing 32 ounces of sweet tea.
- My lunches were either a taco salad or like tacos.
But it was, you know, not a lot of sour cream.
And then the rest of it.
- Then what do you have in dinner?
- It could be anything
from like a big thing of fried chicken
or pizza we'd have like, not occasionally but sometimes.
- So Dr. Proctor wants you to lose 60 pounds
by the time he sees you next.
- The reason why all of these guidelines are in place
about having patients lose a certain amount of weight
before the surgery, having them see a psychologist,
running blood tests is you wanna set
the patient up for success.
If we just willy nilly did bariatric surgeries
on everybody who is obese, it would be problematic
because what happens is when you do the surgery,
there's very specific protocol you have to follow.
If you overeat with a smaller stomach,
you can actually cause surgical issues.
You can rupture your stomach.
You can cause vomiting.
It can cause mental havoc.
It can lead you to going into a dark depression.
We really try and select our patients
that we think are gonna have the best outcome
from the bariatric surgery
instead of just recommending it for all.
- So I've hired a personal trainer
for the first time in my life.
This is the first time I've been to the gym in a long time.
And I am a little bit nervous.
- Hey, what's up man?
- Casey, right?
- Yeah, yeah, Dex? - Yes, sir.
- When I watch programs like this on TLC,
my one issue that I have
is this is a lot of this is not reality for most Americans.
I don't want someone who is potentially wanting
to lose weight to look at this
and think that unless I have this, I can't lose weight.
It's not true.
You don't need the diesel personal trainer
in order to lose the weight.
Any kind of physical activity
when you're going from zero will help.
Also, being kind to yourself
and not pushing yourself too hard
in the beginning is also really important.
With someone who is 700 plus pounds,
you really wanna make sure that you're focusing
on injury prevention.
It's very easy to overload joints, to pull and hurt muscles.
And as a result, you can set someone back.
So it's really about starting slow
- Do you arm rotation.
- All right, gotcha.
- Good.
And we'll go back the opposite way.
I like Casey to move his own body weight
so he can establish a correlation
between what he's accomplished already
and when he can expect himself to do in the future.
- See, someone might look at that and say,
that's not exercise.
Yes, it is.
His heart rate's going up,
his breathing rate's going up.
This all automatically kicks up the metabolism,
helps them prepare to meet the challenge.
And he's been sedentary.
You can't push too hard, too fast.
You can put too much strain on the heart
and even cause a heart attack.
There's actually a type of heart attack
called the type II myocardial infarction.
That happens as a result of not a pure blockage,
but simply because there was so much strain
on the heart that there wasn't enough circulation going
that actual damage has occurred.
- It's been three months since my surgery and I feel good.
Little things are changing in me
that I didn't really expect to change so quickly.
As I accomplish more, my self-esteem is rising.
So I feel like I can do more.
So it's just a good feeling.
(crowd cheering and applauding)
I started this journey at 711 pounds
and today, I'm happy to say that I'm 545.
- I think it's great
when you start seeing your goals pan out
and that's how motivation happens.
It's seeing your hard work be paid off
and it might not happen off the first, second or third time.
But as you continue,
you keep seeing that you're making improvements.
Whether it's after a week, after a month or after a year.
And even for myself, I had a buddy
that was in the ICU recently
and had a lot of neurological deficits.
And as he was solely recovering,
he would call me each day upset the fact
that he wasn't making progress.
And I had to remind him.
Write down what your deficits are today.
Do it next week, do it the following week.
And then each time you're upset,
look back and see how much you've improved.
When you look in every hour by hour, day by day,
sometimes it's easy to lose sight
of how much you've accomplished.
But when you really spread it out and think in scale,
which we, as humans are not good at doing,
you get to see that accomplishment.
You get to feel motivated.
You get to see that you're making moves
in the right direction
even if it's three steps forward one step back.
- Well, I'm trying to get my license renewed.
- This is him now? - This was last month.
Because in my other license, I'm huge.
I'm a whale.
So there we go.
That's me.
I don't know if you can see that real well.
I don't know, but that's me.
It's really weird too, because like 2020 Corona
is like the worst year of some people's lives.
Like it's really been awful for people
but like, it's gonna go down in the record books.
It's like one of the best years of my life probably.
Life for me, is blossoming.
- What's he's experiencing right now
is almost like a form of post-traumatic growth.
It's looking back at your accomplishments.
There's nostalgia there.
And the fact that he's in fact reached his goal.
He's in fact, improved his quality of life.
It goes to show that everything that we discussed
at the beginning of this episode, where it comes
to extending life and improving quality of life,
he's a walking testimonial for, really proud of him.
Check out this video of me taking a career test.
Do you think I got doctor or something else?
As always, stay happy and healthy.
Compose or arrange music?
I have no creativity in my body.
So if you ask me to draw you something,
compose you something, it's gonna come out
looking like the trapped version of the happy birthday song.