we're at a critical stage here you're gonna die pretty soon today we're watching family by the time 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 was just eating till 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 you see him drying himself off with the towel in that specific way when you have excess of 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 uh 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 to 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 decrease quality of life and that quality of life is really what i like to focus on because yes we want to extend lifespan 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 okay he'll tell me what to get him and i'll come right back a lot of times in case that's too much food but i'll get it for him and bring it to the house and put it right in front of him i don't want to call him an enabler but i mean sometimes that'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 it's not i'm not the one doing the shopping at the end of the day there's a level of personal responsibility involved in all this but to solely place the blame at the foot of others is not a healthy pattern not because it's right or wrong but because it 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 quote unquote 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 i saw the father mention 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 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 made it outside 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 and 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 in our mri machines and the nose scenarios a you try and look at the facilities around you if there's an option to transfer the patient that someone does have a larger piece of equipment and then there's sometimes been situations where 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 the icebreaker we do have to take your weight first this is coming when i wear myself in my house i do it butt naked just use the bathroom 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 because i know it's going to be shockingly big it's 711.8 now i know some 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 going to 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 because that alone can cause people to not want to come in to see the doctor in the first place we're at a critical stage here you're gonna die pretty soon unless something happens here now i know that's jarring to here i understand why i agree with this approach i think this is the most successful approach because it's honest whether you have a patient who's 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-judgmental 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 you got you all right what we're going to do is we're going to go in and we're going to remove this outer portion of your stomach right here there will be a metabolic switch that gets flipped in your body when you have this surgery your body will want to 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 doctor proctor like we're waking up at like 12 okay um 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 yeah yeah okay so we're doing 32 ounces of sweet tea my lunches were either taco salad or like tacos but it was you know not a lot of sour cream and then were you having 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 want to 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 over eat 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 going to 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 how you doing 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 want to 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 gonna do your arm rotation all right you got you good then we go back the opposite way all right i had casey move his own body weight so he can establish a correlation between what he's accomplished already and what he can expect himself to do in the future see like 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 him 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 a type two 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 [Music] [Applause] i feeling this journey at 711 pounds and today i'm happy to say that i'm 525. 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 slowly 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 and scale which we as humans are not good at doing you get to see the 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 removed this is him now because on 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 is 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 in the beginning of this episode when 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