More Than Medicine | How St. Mary's Cares At The Highest Level

The bariatric surgery program here at St. Mary's of northeast Georgia is comprehensive and everyone takes a team approach in giving you the best health journey possible. Julie Richardson, our Bariatric Program Coordinator, joins us on the show as she and our host Brooke Marshall discuss our patient support approach, how we use multidisciplinary care to acheive the best outcomes for patients, and innovations the team is working on. We know you have many questions regarding bariatric surgery (also called weight loss surgery), and we are here to answer them!

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This podcast is produced by Rooster High, a content marketing agency: https://roosterhigh.com

  • (00:00) - Better Bariatric Surgery through Safety and Innovation
  • (00:14) - Introduction
  • (00:59) - Overview of St. Mary's Bariatric Program
  • (01:43) - Why Choose St. Mary's Bariatric Program?
  • (03:10) - Building a Successful Bariatric Program
  • (03:32) - Patient Selection Criteria and Pathways
  • (04:22) - Criteria for Bariatric Surgery
  • (06:29) - Surgical Procedures Explained
  • (08:47) - Patient Resources and Support
  • (11:32) - Team Roles in the Bariatric Program
  • (12:21) - Day in the Life of a Bariatric Program Coordinator
  • (13:03) - Communication and Coordinated Care at St. Mary's Bariatric
  • (14:25) - Post-Surgery Support and Follow-Up
  • (15:28) - Patient Success Stories
  • (16:41) - Wellness Center and Community Support
  • (18:03) - Future Goals and Initiatives
  • (20:36) - The Future of Bariatric Surgery
  • (22:51) - Conclusion and Next Steps

Creators and Guests

Host
Brooke Marshall
Director of Marketing & Communications at St. Mary's
Guest
Julie Richardson
Bariatric Program Coordinator at St. Mary's

What is More Than Medicine | How St. Mary's Cares At The Highest Level?

At St. Mary’s Health Care System in Athens and northeast Georgia, we are dedicated to our mission to serve together in the spirit of the Gospel to be a compassionate and transforming healing presence in the communities we serve. This podcast is your window into the people, values, and innovation which have been at your service for more than 116 years.

On our show you'll hear interviews with physicians and staff about how we're serving you with new procedures, innovative technologies, and above all: high-level care, and higher-level caring. We hope you'll take this opportunity to get to know the folks serving at St. Mary's, who live, work, and serve alongside you here in our home of Athens and northeast Georgia.

St. Mary’s is much more than a hospital, this podcast is more than a show, and our mission really does include more than medicine. We are a not-for-profit Catholic health care ministry that cares for all of you: mind, body and spirit. St. Mary’s includes three hospitals, emergency services, numerous physician practices, a family birth center, our region’s first medical residency program, home health and hospice services, a retirement community, extensive outpatient services, and much more. We are proud to offer the region’s leading stroke program, leading-edge robotic surgery capabilities, advanced cardiac care, and a nationally recognized rehabilitation center.

Inspired by our Mission and Core Values, our vision is to be the best place to work, practice medicine and receive care in Northeast Georgia. We want to be your trusted health care partner for life.

[00:00:00]

Introduction
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Brooke Marshall: Well, thank you listeners for joining us today for our podcast. Um, my name is Brooke Marshall, the regional marketing director at St. Mary's Healthcare System, uh, here in Athens. We also have a location in. Good Samaritan in Greensboro, Georgia, and then Sacred Heart and Lavonia.

Brooke Marshall: And today we're joined by Julie Richardson, our bariatric program coordinator at St. Mary's Healthcare System. Julie has played a key role in building our comprehensive bariatric surgery program, guiding patients through every step of their weight loss journey. We'll talk about what it takes to develop a program like this, the incredible team that makes it all possible, and the important work they've been doing to support lasting healthy change for our patients.

Brooke Marshall: So welcome, Julie.

Julie Richardson: Thanks for having me.

Brooke Marshall: So let's jump right in, um, to talk about the bariatric program here at St. Mary's.

Overview of St. Mary's Bariatric Program
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Brooke Marshall: Can you [00:01:00] start by giving us an overview of St. Mary's Bariatric Program and what makes it comprehensive?

Julie Richardson: So, St. Mary's was actually doing bariatric surgery back in 2020, um, and they brought me on board in 2023 when they really committed to improving the program, increasing patient safety and making it a comprehensive program and working towards accreditation, what a comprehensive program is, is a program that is multidisciplinary. We have a whole bunch of different healthcare people who come together led by a physician that really work on improving quality and safety for our patients so we can get the best health outcomes, not just weight loss, but improvement in those weight related comorbidities as well.

Why Choose St. Mary's Bariatric Program?
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Brooke Marshall: So for a patient that's considering, uh, this procedure, what makes St. Mary's healthcare system stand out with a bariatric program?

Julie Richardson: Um, I think one of the things that we do really well is support all of those pillars for weight loss. We have wonderful [00:02:00] bariatric dieticians. Um, you can see Emily, virtually Julia is now in Dr. Carr's office. I think that's one of the things I've been most excited about with St. Mary's is they saw the value in nutrition. And as a dietician, this is something I really appreciate, is they saw that value in the dietician and brought one on board for the medical group. Um, Julia works out of the endocrinology office and the surgeon's office. I'm seeing our bariatric surgery patients and other GI patients.

Brooke Marshall: So you mentioned that virtually about Emily, the dietician. Patients don't have to be local to have surgery. Y'all see patients from all over Georgia possibly another state. Um, so y'all, it's access to care for anybody interested in this procedure?

Julie Richardson: Yes. And if you are closer to any of St. Mary's sister hospitals, the one in Livonia or the one in Greensboro, we can do a lot of your care around your local hospital.

Julie Richardson: The only thing is your surgery has to be done at the St. Mary's Hospital in Athens.

Brooke Marshall: In Athens. Can you tell us about the medical director of the program and who leads this program?

Julie Richardson: [00:03:00] Yes.

Julie Richardson: Dr. Carr is our medical director. Um, right now he's our primary bariatric surgeon, but we are looking at bringing a couple more on board in the next two years.

Brooke Marshall: Awesome.

Building a Successful Bariatric Program
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Brooke Marshall: So, building the program. Um, what is involved in building a successful bariatric program from the ground up?

Julie Richardson: Really, the first thing I did when I started was just to look and see what was already being done. I wanted to look at any policies, any pathways. I wanted to look at educational materials that they were using, and I really wanted to look at the outcomes data. So everything was data driven.

Patient Selection Criteria and Pathways
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Brooke Marshall: So you talk about creating a pathway. Why was this such a critical first step in the program?

Julie Richardson: So yeah, the patient criteria pathway was definitely one of the first things I looked at. It's one of the MBSAQIP requirements and MBSAQIP is the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Quite a mouthful, but they're the ones that accredit bariatric surgery programs.

Julie Richardson: Um, and they want you to lay out your standards for who you choose to do bariatric surgery [00:04:00] on. Um, what, so you make sure that your equipment is able to meet the patient's needs, that your staff are trained to meet the needs of those patients, and you can do the surgery safely. Uh, we needed to define those criteria so we then knew who we could count towards our volumes.

Brooke Marshall: We talk about patients as they're getting ready for, um, the bariatric program.

Criteria for Bariatric Surgery
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Brooke Marshall: If I'm a patient, what's the criteria that y'all are looking for for a patient?

Julie Richardson: Traditionally we follow the National Institute of Health, the NIH criteria, which would be any adult age 18 to 65. Um, we will take patients older than 65 if they're really healthy.

Julie Richardson: Uh, we just make them kind of screen them out a little more closely. Uh, they need to have a BMI of 35 or greater, and BMI is body Mass Index and it's just a ratio of your weight to your height. Um, so 35 or greater with comorbidities, which are those health related conditions such as reflux, diabetes, heart [00:05:00] disease, um, obstructive sleep apnea, and then 40 or greater without those weight related conditions.

Julie Richardson: Though a lot of the newer recommendations from like the American Diabetes Association and the American, um, society for Metabolic and Bariatric Surgery now recommend actually make using lower criteria 30 or greater with comorbidities are 35 or greater without. Um, and interestingly, insurance companies are actually falling in line, so we will do some lower BMIs.

Julie Richardson: If insurance approves it. Uh, and then the top end of the BMI scale would be a BMI of 60. Uh, we will take people into the program if their BMI is over 60. We just really work with them intensively to bring their BMI down. They just can't have surgery until we get to 60.

Brooke Marshall: So you talk about these co comorbidities. So a patient has the bariatric surgery. Do you see a lot of these comorbidities go down? Do you see patients come off of [00:06:00] prescriptions they were on prior to leave, lead a healthier life?

Julie Richardson: Definitely. And that's one of the things we track long term. The two procedures that we do at the hospital, the Roux-en-Y gastric bypass and the gastric sleeve are able to bring down about 60 to 95% of the most common comorbidities.

Julie Richardson: Um, and even if they don't completely resolve them, they usually improve them. So patients are able to decrease their number of hypertension medications.

Brooke Marshall: So you talk about the two different procedures that y'all offer.

Surgical Procedures Explained
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Brooke Marshall: Is it up to the patient to decide which procedure do y'all work with the patient to decide?

Brooke Marshall: Or how does you know one, know which one to do?

Julie Richardson: That is always the question patients ask, and it's a great question, and really it's a collaboration between the physician and the patient. We do an individualized risk calculator, uh, for each patient based on their age, their gender, their race, their comorbidities, their current weight, and that helps guide the conversation because it'll tell us the risk for certain complications based on [00:07:00] all of those criteria and which surgical procedure they're having.

Julie Richardson: But really it's about how much weight they wanna lose. You can lose more rate weight with the Roux-en-Y than you can the gastric sleeve, what comorbidities they have. For example, the Roux-en-Y is great at resolving diabetes and reflux where the sleeve can actually cause reflux. Um, but some of the complications with the Roux-en-Y such as marginal ulcers are more likely if you need long-term steroids or you smoke.

Julie Richardson: Um, so patients uh, who you do those things may not be candidates for those procedures.

Brooke Marshall: So for a non-clinical person and for just a patient looking up research, can you give just a very brief. You know what the two procedures are, the different in 'em or what they each entail?

Julie Richardson: So the gastric sleeve, um, removes the greater curvature of the stomach and staples along, so you're left with a [00:08:00] very narrow, stomach kind of picture a banana.

Brooke Marshall: Mm-hmm.

Julie Richardson: Uh, left behind. So that's considered a restrictive procedure 'cause you can't eat as much. Um, that's why you don't lose as much weight, but you don't run as many risk of complications, especially micronutrient deficiencies. Um, then the ruin, why gastric bypass makes an itty bitty little stomach.

Julie Richardson: You can kind of picture it about the size of an egg and then it reroutes your intestines, so you bypass a section of it. Um, the stomach that you no longer use actually still remains in there, and it kind of makes the shape of a y, which is called why it's called the Roux-en-Y.

Brooke Marshall: Yeah, Wonderful. Um, so the steps or milestones are some of the most important in getting to where the program is today. Can you tell us where the program started and where y'all are today?

Patient Resources and Support
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Julie Richardson: We really just started with very minimal educational material that was just a packet handed out to patients.

Julie Richardson: Each case was handled on a [00:09:00] patient by patient basis. And what we have done is build more pathways so there's more uniformed care. Our patients come in, they get a risk calculator that's tailored to towards them. We created this wonderful binder, um, it's a, we call it our bariatric surgery toolkit. That's like everything they'd ever wanna know about bariatric surgery and more.

Julie Richardson: We have created classes such as our surgical weight loss 101, which kind of just tells you the pros and cons of surgery, talks you through the different surgical procedures so you can really make an informed decision. Uh, we also have our nutrition class that we started, so you really understand the pre-op diet, the post-op diet, what supplements you need to take, what your nutritional risks are.

Julie Richardson: Um, we really built on our support group and started one of those. Um, other things we've done is really look at our outcomes data and we really wanna be a very data-driven program and try to find ways that we can improve to keep our patients happier and [00:10:00] healthier and safer during their surgery.

Brooke Marshall: Wonderful. So you mentioned a robust toolkit in classes. How have the patients responded to having these resources while they're doing the program?

Julie Richardson: Oh, our patients have loved the toolkit. Some of them even refer to them as their bariatric bibles. They carry them around with them to their appointments so they can put in extra notes.

Julie Richardson: Anything they get during support groups or any of the nutrition classes, they can add to it. They have sticky notes in them. Um, and it's just a great way for them to always have that resource with them to review. 'cause there's a lot of information that we give our patients. We want them to have every tool that they need to have the best outcome possible.

Julie Richardson: But it can be a lot, it can be really, really overwhelming. Um, so the fact that they can go reference it, they know that they can bring it with them to ask questions at any point really helps.

Brooke Marshall: So as you talk about those groups, the virtual classes, even Facebook, um, why is this kind of wraparound support so important for a bariatric patient?

Julie Richardson: Um, support is crucial [00:11:00] for a bariatric patient because it's a journey. It's everything from diet to exercise to emotional wellbeing, and if they don't have that tribe and that support with them. Um, then they aren't going to succeed, is what the research shows. And family and friends can be supportive, but having people who've been through what you're going through makes a huge difference.

Julie Richardson: Makes a huge difference.

Brooke Marshall: it takes a team of key staff members to run this program.

Team Roles in the Bariatric Program
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Brooke Marshall: Who makes up the bariatric program, and what roles do they play in supporting patients through their journey?

Julie Richardson: Great question. We have a huge team of people to support our program.

Julie Richardson: Our program is run by our medical director, Dr. Aaron Carr. Um, I'm the coordinator, so I'm kind of like a jack of all trades. Whatever needs to get done, I'll just make sure it happens. Um, we also have all of the office staff we have PAs, nurse practitioners and nurses who will see our [00:12:00] patients both in the office and in the hospital.

Julie Richardson: We have office staff who will help with insurance approval, getting them scheduled, getting them scheduled for surgery. We also have some bariatric dieticians that we're really excited about, so we can either see patients virtually or, or in Dr. Carr's office.

Brooke Marshall: Awesome. So you describe yourself as a jack of all trades.

Day in the Life of a Bariatric Program Coordinator
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Brooke Marshall: What does a typical day for you look like?

Julie Richardson: It really depends on what projects I'm working on. Some days I'm very education focused, working on putting together handouts and PowerPoint presentations for support groups. Other days I'm working on designing billboards and doing marketing things. Um, other days I am in data.

Julie Richardson: Doing statistics and seeing where the anomalies are and doing quality improvement and ways to help improve. where we're lacking.

Brooke Marshall: So it sounds like y'all have that full continuum of care with the team. Um, they're very collaborative. [00:13:00] How does that communication impact patient care?

Communication and Coordinated Care at St. Mary's Bariatric
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Julie Richardson: We communicate great as a team. We probably send out text messages, emails, phone calls on a daily basis. Our patients can reach out to us. Any of those ways as well as via MyChart. Um, we also get together every other week as a team just to talk about upcoming projects, review the data, can express concerns and discuss upcoming patients so we're all on the same page.

Julie Richardson: So if you tell one person, one thing, know that it's gonna get to the whole team.

Brooke Marshall: So speaking of that communication through the team, how does that team work together? Provide coordinated care before, during, and after surgery for a bariatric patient?

Julie Richardson: It helps us anticipate your needs. So we know that if you have difficulty moving around before surgery, that we need to make sure we get physical therapy involved in the hospital, get you to that wellness center earlier and get maybe some physical therapy even to build you up before surgery. Um, that if you don't [00:14:00] have a great support system at home, maybe you need some home healthcare going forward. Um, if you are home after surgery and you're struggling, we can get you those resources, whether it be some additional IV fluids as an outpatient or you need to come back and see the dietician.

Julie Richardson: Um, we are there to support. Every step of the way. And the best way to do that is to communicate as a team.

Brooke Marshall: So you talk about support in every step of the way.

Post-Surgery Support and Follow-Up
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Brooke Marshall: How do you help patients beyond surgery? So after, you know, they've come in, they've done all their work, leading to the surgery, they have the surgery, and then they go home, you know?

Brooke Marshall: Could you elaborate more on the nutrition counseling, the support groups, or follow up care that they receive?

Julie Richardson: Yeah. Most people think bariatric surgery is the end of the road. And it's not, it's like the halfway mark. Uh, follow-up care is really so important. We will see the patient typically at two weeks after surgery, one month after surgery.

Julie Richardson: Three months, occasionally, six months, one year. And then we [00:15:00] really wanna follow them yearly thereafter to make sure that they're losing the appropriate amount of weight. Not too much, not too little, that we wanna make sure that they're not deficient in any of their micronutrients. We wanna see how their comorbidities are resolving.

Julie Richardson: Um. And really we want them to stay engaged. Research shows that if they can go to like five support groups a year after surgery, they're gonna get better results, better weight loss, and better quality of life.

Patient Success Stories
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Brooke Marshall: Can you share a moment or story that's really stuck with you, where the team has made a difference in someone's journey?

Julie Richardson: Um, yeah. We have a patient, uh, who is probably just one of our bigger patients um, to begin with and has some issues with mobility due to some hip issues, not related to his weight. Um, and was only really able to walk five or six steps before surgery. Um, and really we were able to get him engaged with the [00:16:00] Wellness Center.

Julie Richardson: We have a great partnership with them. Our patients get a free day pass, they get discounted pricing and he really made the commitment after surgery to engage with them. He started out in the physical therapy program that's right across the hall. Um, and once he kind of graduated out of there, continued on with the wellness center and is now able to walk hundreds of steps is at the gym several hours a day.

Brooke Marshall: So just really changed his quality...

Julie Richardson: Joined us for our, our last support group and really just shared how grateful he is, how much he appreciated the surgery, and how it truly did change his

Brooke Marshall: Are really feel good moments for y'all's team.

Julie Richardson: Yeah, yeah.

Brooke Marshall: Wonderful.

Wellness Center and Community Support
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Brooke Marshall: Can you tell us a little bit more about the Wellness Center? Um, it is a part of St. Mary's healthcare system.

Julie Richardson: Mm-hmm.

Brooke Marshall: And I guess what it has to offer, it's not just for bariatric patients, it can be for people in the community as well.

Julie Richardson: Yeah. They do a lot of, um. Like cardiac rehab and other things through this. The Wellness [00:17:00] Center is kind of like a gym, but it's not a gym in the traditional sense.

Julie Richardson: It has all of the equipment, it has the trainers, but people are there to get healthier and not necessarily to get buff. Right. So even that patient we just talked about was saying how inviting it is and how he doesn't feel uncomfortable or judged in that environment, that he's just there with everyone else trying to live his healthiest and best

Brooke Marshall: And that makes a huge difference. 'cause I know the gym can be intimidating for people who've never been. So you, you take a bariatric patient who's been unhealthy, who's been overweight...

Julie Richardson: mm-hmm.

Brooke Marshall: ...then they lose this weight, you know, they're probably not comfortable walking into the gym.

Brooke Marshall: So I guess it's more inviting, having that sense of community, um, and people there who will support you through

Julie Richardson: Yes. And I know they've also mentioned that they kind of do a exercise prescription. The first time you go in the door, they'll give you a tour, but then they'll work with you and set up an exercise plan with their equipment specifically tailored to you.

Brooke Marshall: I'm sure that makes a difference for the [00:18:00] aftercare, for the bariatric

Julie Richardson: Yeah. That makes the biggest difference.

Future Goals and Initiatives
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Brooke Marshall: So recent work in initiatives, what have you and your team been focusing on recently to improve and expand the program?

Julie Richardson: We have a couple of things that we're really excited about this year. We're working on an ERAS protocol for bariatric surgery and ERAS stands for Enhanced Recovery After Surgery.

Julie Richardson: It's kind of a, an initiative between the surgeon and anesthesia and nutrition and nursing, and it really just focuses on getting patients, eating sooner, getting 'em up, moving as quickly as possible, which has been shown to decrease complications and decrease how long they need to be in the hospital.

Brooke Marshall: So it's getting them back to doing what they were doing prior, quicker with less downtime.

Brooke Marshall: What kind of feedback have you heard from patients on having that partnership with Wellness Center?

Julie Richardson: That it's an environment that they're super comfortable working out in, in a place they never thought they'd be comfortable.

Brooke Marshall: Wonderful. So looking ahead, where [00:19:00] do you see the program headed in the next year or two?

Julie Richardson: Yeah, I'm really excited about the next couple of years. Right now we have one bariatric surgeon, but we already have two lined up. Um, hopefully within the next six months we'll start. With our second bariatric surgeon, Dr. Yancy. Um, and then we'll bring Dr. Mercier in after that.

Brooke Marshall: And those are both two surgeons that are already part of St. Mary's.

Brooke Marshall: Correct?

Julie Richardson: Yes. They're a part of Athens General and colorectal surgeons. Um, we've already brought them in for team meetings. And they have provided great resources and knowledge. Um, so we're really excited to have them be part of our team.

Julie Richardson: We're also working towards MBSAQIP accreditation and like we've talked about, they're the accrediting body for bariatric surgery. And it really just shows that we've made that commitment to keeping our patients safe and having the best outcomes possible.

Brooke Marshall: Yeah, so adding the new surgeons, getting the accreditation, those are really big goals for the program. What will that mean for the program and the community?

Julie Richardson: It'll mean that we [00:20:00] have a local place where you can go for safe bariatric surgery that you can feel confident in. Right now, there isn't anything in our area. There aren't any surgeons that are MBSAQIP certified, so it really shows that St. Mary's is dedicated to their health and wellbeing

Brooke Marshall: Not just doing bariatric surgery on the fly?

Julie Richardson: No, no. That we really have put the thought into it, that we've really focused on all of those pillars, nutrition, physical activity, emotional wellbeing, and the medical side. Both medication and surgery.

The Future of Bariatric Surgery
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Brooke Marshall: So how do you envision bariatric surgery evolving in terms of patient care and outcomes? You know, you mentioned the future of bariatric care, including medications and broader eligibility. How is St. Mary's preparing for that change?

Julie Richardson: I actually think we're a little bit ahead of the change. Um, medications have really, especially the new GLP ones, have really made an effect on bariatric surgery [00:21:00] programs.

Julie Richardson: And a lot of surgeons shy away from using them. It's, you know, that's for their primary care doctor to handle. Once the medications fail, then you can try surgery. But really, it's not an either or scenario. And that's one thing that I really appreciate about Dr. Carr is his willingness to incorporate all those things. The physical activity, the nutrition and medications with bariatric surgery, his patients will be on medications before and after surgery. Um, we just feel like we need to equip our patients with all the tools

Brooke Marshall: And there's no one fit for every

Julie Richardson: No, there is no each patient, no one size fits all to bariatric surgery or weight loss.

Julie Richardson: Um, it really is. Uh, here are your options. Let's figure out what plan works best for you, what got you here, and how can we help?

Brooke Marshall: Gotcha. So it's clear that the program is more than just about surgery. You know, it's about transformation. Transformation from start to finish for the patient. [00:22:00] What's the one thing you hope listeners take away from this?

Julie Richardson: That, that weight loss surgery isn't about the pounds you lose or the way you look that it really is about. Improving your quality of life, decreasing your health conditions, and really letting you live the best, healthiest life possible.

Brooke Marshall: So somebody who is interested in taking the next steps, what would you recommend that they do?

Julie Richardson: I would recommend going to the St. Mary's Hospital website. Um, we have a great bariatric surgery page. We're working on putting up our surgical weight loss 101 class as a video, so you can really learn the pros and cons of surgery. But a lot of that information is already on the website. Um, once you review it, review the team. If that's something that you're interested in, you can go request an initial consult right from that website.

Brooke Marshall: Wonderful.

Conclusion and Next Steps
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Brooke Marshall: So Julie, thank you for sharing your insight and giving us a behind the scenes look at the bariatric program here at St. Mary's. It's clear that the combination of skilled [00:23:00] surgeons, dedicated support staff, and a truly patient centered approach is helping people transform their health and their lives and our community.

Brooke Marshall: We're excited to see how the program continues to grow and the positive impact that it'll have on our community. So thank you for joining us today.

Julie Richardson: Thanks for having me.

Speaker: Thanks for joining us on this episode of More Than Medicine. We'll be back soon. And in the meantime you can find more information in the episode description and on our website at st mary's dash help.org. That's St mary's dash help.org.