00:00they can eat almost immediately after surgery they shouldn't have any pain they should be
00:05ambulating out of the bed almost immediately the next day sometimes when we do the surgery in the
00:10morning by evening they have to already walk right all right so these are the recovery that we
00:16targeted from them in our practice because we practice a holistic approach in the management
00:22of our overweight and obese patient we have to put the patient through several phases
00:29have four phases phase one phase two three and four phase one is what we call as clinic and
00:35counseling so we teach the patient we counsel the patient and we coach them everything about healthy
00:43lifestyle diet modification most important thing the barriers and limitation they have they have
00:51experienced before so we do not want to repeat all those mistakes before and we also teach them what
00:58are the drivers of weight gain and weight loss okay and this is very important and this is done in
01:04in combination with our other disciplines like the dietitian the physiotherapist as well as the
01:11counselor right physiotherapy as well exactly and we coach them in the gym oh we coach them in the gym
01:18because sometimes you see sometimes when when when you when you have diabetes hypertension you went to
01:25clinical setan for example the doctor will tell you uh you can exercise you can jaga makan but how
01:31they don't yeah yes exactly all right so we teach them simple basic steps okay that incorporate both
01:39aerobic as well as a resistant exercise which can be done by almost everyone correct and can be done at home also
01:46can be done at home it has to be done at home and for those patients who have some physical limitation
01:52we will do some modification and and hopefully during this phase one usually we give them about one
01:58to two months they have to have a target of five to ten percent fat loss right we do not look at the
02:04weight okay okay because everyone it could be muscle loss exactly exactly and we do not want muscle loss
02:10okay okay so we we are targeting the fat and specifically the visceral fat
02:16my kiss and loss
02:19but you can always regain your muscle you can regain your muscle okay post-operative you have to regain your muscle right
02:25right now once they have targeted this uh they have achieved this targeted five to ten percent
02:30uh fat reduction then they will go to phase two which is the uh surgery and and this will take about two weeks all right
02:37where we put them on meat replacement therapy so meat replacement therapy is just that we give them low
02:43calorie diet why we do why do we replace their normal meal to a formula or what we call
02:50kalau orang melayu cakap susu lah it is not actually susu it's a specialized formula a medical formula so
02:58that we can accurately calculate the calorie but at the same time we are giving them adequate protein okay so this has to
03:06be done about two weeks are they 200 calories pesashi i think uh it depends on the product it depends on
03:12the product some product comes in sachet some product comes in the can some product come in uh ready to
03:18drink bottle right so it depends all right so we will work together with our dietitian in in giving the
03:25the advice to our patient so when this is done uh we will also incorporate further intensive exercise the
03:32exercises that we have actually taught them before we add more intensive exercise and uh in phase two
03:39they have to lose another five to ten percent of their visceral fat so this actually help them to
03:45actually improve their cardiac cardiac response to the stress uh during the surgery and for those
03:52patients who have sleep apnea micro sleep all those issues with uh you know hypo ventilation they have to be
03:59put on cpac machine okay so this is the preparation on second phase and on the third phase they will
04:05definitely go for surgery and nowadays we call uh what we do to all our major uh cases uh going for
04:13major surgery is that uh enhanced recovery after surgery right okay meaning that they can eat almost
04:20immediately after surgery they shouldn't have any pain they should be ambulating out of the bed almost
04:25immediately the next day sometimes when we do the surgery in the morning but evening they have to
04:31already walk right all right so these are the recovery that we targeted from them and they need
04:38to be counseled and understand the the flow right and in phase four is a long-term follow-up
Comments