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Tackling a Head-to-Toe Disease

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BARDSTOWN Board-certified surgeon, Robert Farrell, MD, FACS, leads the Weight Loss Surgery program at Flaget Memorial Hospital in Bardstown, Kentucky, a part of CHI Saint Joseph Health. As the clinic’s surgeon and medical director, Farrell has managed the clinic while caring for patients in Nelson County and surrounding areas since 2010. He is joined by a caring, exceptional staff, including bariatric nurse coordinator Anna Culver, BSN, RN, and physician assistant Hannah Moore, MSPAS, PA-C.

Farrell majored in biology and pre-med at Thomas More College in Northern Kentucky before attending the University of Louisville School of Medicine to obtain his medical degree. Later, he completed his residency and fellowship at the St. Louis University and Carolinas Medical Center, respectively, graduating in 2010.

Throughout his coursework, he continued to be fascinated by bariatric surgery, starting his intensive training at the forefront of minimally invasive procedures. Farrell, also a general surgeon, finds his bariatric surgery work fulfilling because of the far-reaching effect that weight loss procedures have on the body. “One of the reasons I love this field: I can’t think of anything else you could do to a person that can correct so many conditions simultaneously.”

He continues: “Obesity is a head-to-toe disease. There’s not a single body system that isn’t affected.” In many cases, surgery and maintained weight reduction decrease the risks of certain cancers and liver diseases, along with what Farrell calls the “Big Three” comorbidities: diabetes, sleep apnea, and hypertension.

Patient Population

Patients must be at least 18 years old to seek care in the Weight Loss Surgery clinic, and Farrell says that he’s seen plenty of patients in their seventies.

“When patients come to us, they’re patients for life.”— Robert Farrell, MD, FACS

“Age is just a number to me. I look more closely at physical factors, such as overall health, coexisting conditions, and fat percentages.” Although Farrell noted that while patients have trended female for many years, increasing numbers of male patients seek a surgical option now.

A Difficult Decision

Due to a persistent medical myth, patients seeking surgery have been wrongly criticized for being somehow undisciplined or complacent. “That couldn’t be further from the truth,” Moore says. “Surgery is a difficult choice to make after nothing else has worked.”

Moore grew up in Morganfield, Kentucky, and graduated from the University of Kentucky PA program. Motivated by her combined love of technical skill and patient care, she started working at Flaget Memorial four years ago. “It’s the amount of work patients put in after surgery that really determines their results. Weight is lost the same way it’s gained — one pound at a time,” she says.

Not a Quick Fix

Weight loss surgery serves as a stepping stone for sustainable health, not a turnkey solution. All clinic providers at Flaget Memorial must set realistic expectations. Culver explains that the support group she leads promotes the necessary lifestyle changes that occur after surgery. Not surprisingly, support group participants lose significantly more weight and enjoy longer-term results than non-participants.

Culver, a native Kentuckian who attended McKendree College, has worked on the Flaget Memorial staff since 2005, where she previously served as an operating room nurse. Now, she guides patient education programs, empowering people with all the tools they need for healthier living. Culver sees how wellness and exercise change patients and enjoys encouraging them as they take strides, literally and figuratively, to reach their goals. The clinic gives their patients reduced-calorie, protein-packed recipes following surgery, as well as a step goal of around 10,000 steps per day, the equivalent of nearly five miles.

Chronic Disease. Patients for Life.

Farrell believes more providers should understand the chronic nature of obesity, knowing this mindset shift would improve overall results. He explains, “Somehow obesity is treated as though the doctor is giving the patient their only shot at health by administering the surgery. If the patient gains weight later, providers shouldn’t act as though it’s because the patient didn’t care or wasn’t committed enough.” He understands that when patients internalize that blame, they struggle to share their vulnerabilities with the provider. Farrell manages patients from a chronic disease perspective, understanding the ongoing challenges of obesity and meeting them with much-needed compassion.

“When patients come to us,” says Farrell, “they’re patients for life.” In the early years of bariatric surgery, it garnered a poor reputation because doctors weren’t committed to patients’ long-term success. For example, physicians failed to provide instructions for what and when patients should eat, how to take care of themselves post-operation, or how to start an exercise program.

In contrast, Farrell believes in a total care framework at every stage, pre-operation, operation, and post-operation. Moore oversees these critical periods by setting expectations before surgery, assisting Farrell with the procedure, and guiding patient success afterward. The clinic schedules several follow-up meetings to evaluate healing, fluid intake, medication dosage, and more — followed by annual meetings to encourage weight maintenance.

Though patients lose significant amounts of weight after the surgery, Moore explains that the body re-regulates a few months later, possibly leading to a plateau. Patients need the most motivation during this trying period, where support could wane and unhealthy habits reappear.

Center for Weight Loss Surgery at Saint Joseph East

LEXINGTON Bariatric surgery is also performed in Lexington at the Center for Weight Loss Surgery at Saint Joseph East, part of CHI Saint Joseph Health. Board certified bariatric surgeons Thomas H. Greenlee, MD, FACS, Joshua P. Steiner, MD, FACS, and Alberto Zarak, MD, have seen thousands of patients since the Center opened in 2002.

The laparoscopic procedures offered include Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

Bariatric Program Director Karen Hillenmeyer, PA-C, leads a team of weight loss providers including exercise physiologist Billi Benson, BA, Med, bariatric dieticians Stephane Anklan, RD, LD, and Amanda Nighbert, RD, LD, and bariatric nurses Lillie Harris, RN, CBN, and Leslie Hughes, RN CBN.

The clinic measures more than weight and BMI, since factors like fat percentage, muscle mass, and measurements also reveal how often the patient has been exercising and if they’re gaining muscle or losing fat. Aiming to kick-start sustainable results, practitioners focus on specific, measurable, and attainable objectives with their patients.

“This program is special because of Dr. Farrell and our team,” says Moore. “He fearlessly advocates for each patient and holds high standards for their care. Every person at the clinic takes part in patient success, as we walk with them through every success and challenge.”