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Kevin E. Wasco, M.D.
<< Surgical Staff
Interviewer: Tell me about your work at Midwest Bariatric Solutions.

Dr. Wasco: One of the reasons we really like it, is because of the challenge - bariatric surgery is one of the more challenging surgeries there is. They are also a challenging group of patients.

The results speak for themselves. It is extremely satisfying to see people lose weight and also treat the co-morbidities. We have had people on 30 medications no longer need to take meds. Seeing people lose a tremendous amount of weight is great, but even more impressive is to see the co-morbidities - the sleep apnea, the diabetes, the hypertension - effectively dealt with.

Interviewer: Tell me what you enjoy most about working with bariatric patients.

Dr. Wasco: Obesity is the second leading cause of preventable death, soon to be the number one cause of preventable death in the next few years, even ahead of smoking, so there is definitely a need for it. We treat a lot of the co-morbidities associated with morbid obesity in a lot of our other surgeries - the ravages of diabetes, the purphovascular disease and many other problems.

Without weight loss, it's just impossible to successfully treat these, except at a late phase when you're not actually able to cure anything.

When you have a surgery that has shown to be a tool, not only for losing weight, but for curing many of these other co-morbidities, it only makes sense to use it.

The Roux-en-Y gastric bypass and Lap-Band surgeries are challenging for us to perform, but they work. And that's the important thing: that they work.

We enjoy working with the patients. It's fun. But, sometimes it's hard to recognize who they are after they lose so much weight!

Interviewer: You're also a trauma surgeon at Theda Clark. How do you balance your many responsibilities?

Dr. Wasco: It's sometimes challenging. These patients are some of the sickest patients there are. So, our background in critical care and trauma helps when we do one of these cases, because we're not really surprised by anything that happens in the OR. Nothing really surprises us. So, it's a natural. These people need our surgical knowledge. Some people also need critical care afterwards, just due to the critical nature of their illnesses.

Interviewer: Tell me why you decided to focus on bariatric surgery.

Dr. Wasco: We focus specifically on Lap-Band and Roux-en-Y gastric bypass, either laparoscopic or open because these are the two surgeries that are effective in treating the morbid obesity and treating the co-morbidities.

The surgery is something that we enjoy doing and it's a population that we enjoy dealing with. And, most importantly, it works. The way that we do it, it can be done safely. That's a good formula.

Interviewer: What are the differences in taking care of morbidly obese patients compared to your other surgical patients?

Dr. Wasco: Going into the surgery, they're often much sicker, or they have the potential to be much sicker. Many of them have been diagnosed with diabetes, sleep apnea or hypertension.

Many of the co-morbidities associated with morbid obesity have actually been picked up more as part of the pre-operative testing work done for Roux-en-Y gastric bypass. These patients often have so many co-morbidities and so many other risk factors. They have risk with their lungs, risk with their heart, increased risk of blood clotting, increased risk of cancer and increased risk of many other problems.

During the time of surgery, they're much more difficult to take care of, both from an anesthesia perspective and a surgery perspective because of their size. From the anesthesia side, you have to manage the effect on the lungs and how they wake up.

They also have a larger potential for wound infections.

A lot of times, if they have a leak or another problem, they don't act like another patient who might declare it earlier. You really have to be hyper-vigilant in taking care of them.

They're a challenging group of patients.

Interviewer: What is the most rewarding part of your job?

Dr. Wasco: The rewards are our patients. It's so rewarding to see them after they are at their ideal body weight. But, at the same time, it's more than just the final stages. I think it's more the whole process. It can be challenging at the beginning, but even that's not so bad because you know in the back of your mind, where they're going to be six months from now, and it's going to be a lot better.

It's good to be involved with a patient from start to finish. From when they come in for the informational seminar, actually undergo the surgery and then to see them at the end. The progression is extremely rewarding.

Interviewer: Where do you see morbid obesity trends heading in the future?

Dr. Wasco: It's only getting worse if you look at the epidemic proportions, particularly in the western hemisphere. And, with the adolescent population - it's growing astronomically.

It's going to be the number one cause of preventable death within 3 to 4 years.

I'm not sure who once said this, but we're living in a modern society with all of the ease of access to food, but we still have the caveman's genes and so we don't have a high metabolism for all of these "easy to get" calories and decreased amount of exercise that we have in today's society. I think it's only going to get worse.

Interviewer: What are the trends in bariatric surgery?

Dr. Wasco:
1. Surgeries performed laparoscopically
2. Lap-Band
3. Multi-disciplinary programs - that's the way it should be, but not everyone does it that way
 
There's also a trend towards exploring the timing of the bariatric surgery. What about people who are not quite morbidly obese? Maybe they don't have all of the co-morbidities, but do have some of them. Is it better to get to those people earlier? What about the adolescent population?

What about the people who aren't necessarily morbidly obese, but have a lot of those same problems? Will they be successfully treated that same way?

These are all questions that will need to be answered as we move forward in this field.
"We enjoy working with the patients. It's fun. But, sometimes it's hard to recognize who they are after they lose so much weight!"
"The surgery is something that we enjoy doing and it's a population that we enjoy dealing with. And, most importantly, it works."
"It's good to be involved with a patient from start to finish. …The progression is extremely rewarding."
 
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