- "My 600-lb Life". I'm curious how it compares to the other show that we've
watched, "Family by the Ton." Hate the names of these shows, but let's see what it's got. Huge thank you to ZipRecruiter for sponsoring this video, bewoop. - One, two, one, two, three. (gentle music) - Repositioning is of utmost importance, especially when you're
overweight to this degree because you start putting pressure on certain areas of your skin,
your muscles, your bones. You could develop pressure ulcers. Those can get infected, becomes very, very complicated to treat. - I have no life. My legs can't even hold my weight anymore. - That's why it's so important when we talk about someone
being obese or being overweight, we talk about their quality of life being equally as important
as their state of health and their risks that they face. - My weight has condemned me to this bed. I can't do anything. I can't even bathe myself. - It's really important that you clean within the skin folds as well 'cause bacteria can get trapped there. It's a dark, moist
environment most of the time, and as a result, fungi thrive
in that type of environment. So not only do you have to wash it well, but you have to dry it well as well. - I have arthritis, gout,
lymphedema, diabetes. - I wouldn't be surprised if this is all a result
of metabolic syndrome, which can develop from being
overweight to this degree. You know, a lot of people, when I even talked about bariatric surgery on some of my past videos were quite critical of me for saying that, that bariatric surgery can
be an option for somebody. But for somebody like this who
is struggling to move around because of arthritis, because of legitimate medical conditions, she's unable to take care
of herself on her own. So yes, bariatric surgery
can be a life changer, a life saver in many cases. While I don't think it's
appropriate in all cases, far from all cases, I think you need to be
open-minded that in medicine, the selection for the treatment depends on the individual
patient in front of you, and this patient for now, at least it makes sense. (somber music) - As a kid, I was never overweight. (somber music) It wasn't until my early 20s that my weight started to be a problem. (somber music) I tried to break up with
my boyfriend at the time. He lost it, and he took me hostage. (somber music) He held me a gun point and I thought I was gonna die. - A lot of folks rush to judge people. Many feel like fat shaming is appropriate because they view someone
who is obese as lazy. People have true problems, medically related and
psychologically related. This person dealt with
a traumatic situation and perhaps that is the cause of the start of this condition. So to judge someone unfairly just by simply writing
them off as lazy is unfair, and that's why we're against
fat shaming on this channel. - I was too scared to leave the house, and I lived in constant fear, and I just ate. I'm a junk food junkie. - A lot of times when you
eat those types of foods, they can increase temporarily some neurotransmitters in your brain that help you feel good. So it almost becomes a
type of self medication when you start binging foods like that, especially the junk foods. - If she don't lose the weight, I'm afraid this shall pass. - It's a very reasonable concern to have when someone is of that size 'cause you're putting tremendous strain on your every organ in your body, and it's an unnatural strain as well. - We're expecting
arrival of Marla McCants. From what I understand, she may be close to 800 pounds. If she's that big, and she should have
used bariatric ambulance with medical care to go with her. She should not have come
to Houston on her own. She should have waited for a safer option. - Yeah, I agree, but at the same time that safer option may be
unaffordable to most people. That's why, as a doctor, you can't just make recommendations. You have to make recommendations
with the patient in mind. Do they wanna do this? Can they afford to do this? Is this service even available to them? - I can already see that she is in one of the worst condition
health-wise I ever seen. - For a prolonged trip like
that with lack of mobility, her chance of developing a blood
clot goes through the roof, and why is that dangerous? Because a blood clot is
more likely to happen in the lower extremities, and if that clot travels
in the circulation back to the heart and then to the lungs, and gets stuck there, you develop a pulmonary embolism which cuts off blood supply to the lung, and essentially, that part
of the lung starts dying. You could see how that
could quickly become fatal. - I can't move my legs. - Your leg hurt? (Marla groans) (somber music) Look, it got that a
little bit swelling, huh? - Well, that swelling could
be as a result of the DVT, that clot we just talked about, or it could be her lymphedema acting up. - We're gonna run some tests to find out what maybe going on with you. - The test that they're usually
running in these situations would be a Doppler ultrasound
of the lower extremities, which is an ultrasound
to check for blood flow in the lower extremities to
see if everything's opened, if all the blood vessels are open, and then also a D-dimer test. And sometimes if they suspect that the clot is already
traveled to the lungs, we can do a special type of CAT scan. Back to the show in just a second, but first, I want to talk
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and rate your candidates and then lets you contact them directly with a personal message so you can get the right person to fill that job opening in no time. Try ZipRecruiter for free by visiting ziprecruiter.com/doctormike. Remember, doctor is spelled out. All right, let's get back to the show. (somber music) Okay, so that could potentially mean that one, obviously, the pulmonary
embolism we just talked about, but also a lot of stress on her heart. Something could have happened there, congestive heart failure-wise, but also patients that are of her size do develop sleep apnea
where they stop breathing for periods of time, but usually it's not to the point where their heart stops as well. - She put her body to limit for years and the car ride down was just
too much for her to handle. We need to get her to surgery immediately to put the filter in her. - So what he's talking
about here is an IVC filter, which is an inferior vena cava filter, which is meant to be put into the vein in order to catch and act like a net for clots that could
potentially leave the lower body and come up to the lungs, so prevents them from reaching the lungs. Now, usually we do this
only as a secondary resort, because in patients who have blood clots, we usually put them on
blood thinning agents unless there is a true contraindication for starting the blood thinners, or that they scan her legs and they see so many clots there that they don't even think
that they can dissolve them. In this case, I'm not sure why they decided to go with the IVC filter
instead of blood thinning agents, but they could be doing
both at the same time. That's also been done in the past as well. - And I'm currently placing
the filter in the vena cava. This is a delicate operation so we have to do this very carefully, but it will help save Marla's life. - It's important to point out, 'cause I don't think Dr. Now
is making this very clear. This isn't the treatment to save her life, this is a treatment to prevent
another clot from happening and dislodging and going to the lungs, and also it's not 100% effective. (somber music) That's a very aggressive diet. I don't know if she needed
that aggressive of a diet right off the bat. Even eating 2,000 calories a
day would cause weight loss. I don't think you needed
it to be so extreme. - Outside of having to
adjust to a controlled diet, they've been trying to get me up to walk. I feel like they're pushing me too hard. - So one of the orders
that we almost always put in for patients that are hospitalized for extended period of time
is ambulate with assistance. Ambulate at least from
out of bed to chair, because that allows the patient to decrease the likelihood
of developing clots. It helps facilitate the recovery, starts working the cardiovascular system. Because a patient who's so deconditioned, meaning not used to moving around, needs to gradually work their
way up in order to return to be able to have some
level of independence. (suspenseful music) - Hi.
- Hi. - When someone become immobile, they get used to others
doing everything for them. That can be a tough dynamic to change. - You ready?
- Yeah. - Okay, I'm gonna bring this one first. - [Dr. Nowzaradan] But we are
gonna do what we can to try. - Are you ready, al right. - The rest will be up to Marla. - Push. (Marla groans) - I'm falling, please!
- It's okay, we got you. - If Marla won't get up
then we can't treat her. - Yeah, being able to move
and carry your own body weight is very important in order for her to have success of any surgery, 'cause, again, you need to have your heart strong enough to be able to do that. Part of my risk stratification
for preoperative screening is finding out what a patient's
activity levels are like. What are they able to do? For example, if a patient
actively exercises, they're automatically a lower risk versus a patient who's
sedentary, doesn't exercise, gets winded just by walking a block. That patient automatically
becomes higher risk. When I say higher risk, I mean higher risk for
their heart stopping, like that's the risk I'm talking about. (suspenseful music) - I'm going to go ahead and
perform weight loss surgery because outside of this, she has no hope. Gastric bypass surgery
reduce size of stomach and also bypass part of the intestine. The stomach is big as a watermelon, but this operation, we're
gonna reduce size of stomach to the size of a small orange. - This sounds and looks
barbaric because it is, but it's an extreme measure to potentially save a person's life. This is why we don't
recommend bariatric surgery from someone who's only
somewhat overweight. Every treatment has risks. In fact, if a treatment
doesn't have risks, it likely, in the beginning never had any potential benefit anyway. - Marla is demonstrating
very poor attitude and very poor response. This is a very dysfunctional behavior. She stumble like that, if she act like a kid,
you treated like a kid. - It's a very controversial
way to be a physician. I find that I've had success with other motivational techniques, making a healthier
connection with your patient, using motivational
interviewing techniques. Granted it doesn't work all the time. Patient needs to know there's consequences for their actions. You could tell the Dr. Now is getting a little bit offended, getting a little irritated. Pulling yourself outta that
situation is probably ideal because now, while you're
using this old school like hardened type of mentality, doesn't work for all people and can actually have the
patient turn against you. - [Dr. Nowzaradan] I'm
hoping that sending her home will be a wake up call. (somber music) - But I wonder why they
need Dr. Now for this. Dr. Now is not a
rehabilitation specialist. Maybe getting her in with
a mental health specialist would've probably been
the best thing here. And while Dr. Now could be
a great bariatric surgeon, he's clearly not a
mental health specialist. He's clearly not a rehab specialist, and while all of his advice
medically makes sense, he's clearly not being effective in communicating that message and getting the patient to
take care of her best interest. Getting another team member here would go a long way in helping her perhaps find her inner
motivation to wanna stand up. (upbeat music) - Here we go, all right. Keep pushing your weight off. (Marla groans) - All right.
- Okay. - Good job, Marla. - Yeah, I didn't think I could get up. - You wanna try it again? - Yeah, we can. - This is the time and tested true method, time tested true, true time tested method of motivation doesn't come first. It's doing the action and
then the motivation follows, like her saying, "I wanna do it again." - There you go.
- Keep going, keep going. - Keep going, you're almost there. - Keep going, you're almost there. - [Nurse] All right.
- [Doctor] There you go. - Wow, wow, that's great weight loss. (nurses cheering) - [Nurse] Good job. - I'm so proud of myself. Makes me feel like I can do anything. - But 300 pound less, huh? Can you tell the difference? - Yeah. - Breathing is probably easier for her. Because your lungs cannot fully expand against all of that excess skin, weight, and as a result, parts of
your lungs actually die off through a process called atelectasis. - So when can I get seen in surgery? - From what I can tell, you're not making much
effort to get better. - That's your opinion. I don't think I have a very
good understanding with you and you don't have one with me. - I think that's a very fair assessment. He's jumping to conclusions
it seems like all the time. As a doctor you need to
be doing this as a team, like a collaborative approach. Not just with you and the patient, but you, the patient,
the physical therapist, you have to be getting the reports. If the reports were coming in
from the physical therapist, "That patient's not
interested in doing this," that's one thing. But my suspicion is
he's making assumptions based on her weight or lack of progress. Now, you need to be investigating
this lack of progress, where it's coming from. You can't just make assumptions. - In the 5,000 patient in past 40 years, I don't remember I've seen
anybody six months after surgery that hadn't been able to walk. - You're putting me group. - My opinion is based on my experience. - You can't put me with nobody else. - You got the bad attitude. - And why do I have a bad attitude? - Time out, Dr. Now, separate yourself. You can have this same exact
conversation, same theme, same message that he's
trying to get across without ever getting mad. You are literally doing the opposite of de-escalating the situation. - I feel you don't treat me fair or right. - Marla, I can't do anymore for you. - Okay. - See your primary doctor, ask him tomorrow to find another surgeon because we are dismissing
you from our care. - The patient makes a statement. - I feel you don't treat me fair or right. - [Dr. Now.] Marla. - You need to explore that as a physician. What do you mean by that? Patient will say, "I
want this skin surgery and you're not giving this to me." I can then say to the patient, "I would love to give
you the skin surgery, but I know that if we do it
before you start walking, ultimately, it's gonna harm you. My goal here is to treat
you not to treat your skin. It's to make you as healthy
as a person as possible and not put you into negative situations or dangerous situation. Isn't that what you want
for yourself as well?" You see how we just all
got on the same page? That might not work the first time. That might have to take multiple things, but that's where you gotta be patient. You gotta be patient with your patients. - I finally found the
clinic here in Nashville to help me keep making
progress with my weight loss. I hope I made it below 400 pounds. - Wow. - 364. - And she's standing. - Ms. McCants.
- How you doing? - Nice to see you. Well, you have made a standing progress, and if you can lose that next 100 pounds then you can have all
the extra skin taken off. - Yes. - If you do the skin
surgery also too early, you then still lose more weight. You'll need more surgery, means more scars, more complications. You also have to be understanding
that having excess skin makes it challenging to
mobilize and move around. Be understanding and say, "I understand that this is terrible, but we're gonna have to
keep moving through this. So what ways can I help you?" Maybe you can get them
outfit recommendations, compression stockings, whatever it is to try and help your
patient achieve their goals. - [Marla] Once I get this skin off of me and nothing's holding me back anymore, I'm gonna travel and see the world. - Genuinely, her life has changed. Her opportunities have expanded greatly. And I'm not talking about her opportunities to travel
the world, that's cool, but her ability to move to the kitchen, her ability to prepare food for herself. That if one of her kids get sick, she could still care for her daily needs. Imagine that if one of
her kids can't come, she would have to not be able to shower and potentially get infections
then get hospitalized. It's not a quality of
life that is reasonable. So that's why bariatric surgery
absolutely needs to exist, at least for now. We need to be open-minded to its risks and be aware of its risks and
not overuse it as a treatment. - We can't wait to show
you how she looks now. Please welcome, Miss Marla McCants. (women cheering) - Wow. - You're not alone. You can overcome your struggles and fears. You can overcome. You can do it, I did it, you can do it. - Post traumatic growth right there. Someone went through a terrible situation, both, initially, with her partner, but now also a traumatic
situation with her weight, and now she's a role model for people. She's using that trauma to
grow from to help others grow. Yay, I'm team Marla. Actually, not too long ago, I was accused of being
fat phobic on Reddit. Click here for that video where I sort of explained my stance. I think it's a worthwhile watch, and again, huge thank you to ZipRecruiter for sponsoring this video. As always stay happy and healthy. (upbeat music)
