Back to Back, One Month MD Podcast
Back to Back, One Month MD Podcast
Hosted by Dr. Mark Moran, this podcast dives into the fast-paced world of medicine, education, and personal growth. Each episode features insightful conversations with expert guests, sharing knowledge, experiences, and the mindset needed to excel in healthcare and beyond. Whether you're a medical professional, student, or lifelong learner, tune in for inspiring discussions that keep you moving forward—back to back.
Back to Back, One Month MD Podcast
Obesity and Low Back Pain: Causes, Prevention, and Solutions
Dr. Mark Moran and Dr. Umal Ssenkubuge, a Ugandan bariatric surgeon, explore the striking contrast between obesity rates in Uganda (2%) versus America (40%) while examining the direct connection between excess weight and back pain.
• Understanding how obesity causes low back pain through anterior pressure on the spine
• The importance of being "an active participant, not a passive recipient" in healthcare
• Setting realistic goals when addressing weight and pain issues
• Why consistency in health habits matters more than intensity
• Cultural differences in obesity causes – from convenience in America to status-seeking in Uganda
• The value of making small, sustainable lifestyle changes rather than seeking quick fixes
• How knowledge about your condition empowers better health decisions
• Why maintaining a relationship with one consistent healthcare provider improves outcomes
Visit onemonthmd.com to learn more about the causes, treatments, and prevention of low back pain.
Welcome to another episode of Back to Back. I am Dr Mark Moran and this is our special guest traveling all around the world, dr Umar Subagubigabi.
Speaker 2:I promise you, we practiced that five times. Senkubuge, that's what I said.
Speaker 1:Senkubuge, that's what you said, c'est un coup de bouquet.
Speaker 2:That's what you said. You're sure we can replay it over there.
Speaker 1:Have you ever seen the show Friends?
Speaker 2:Yeah.
Speaker 1:Okay. So remember when Joey was trying to learn French? Yes, phoebe was like Je m'appelle, and he was like Je m'appelle Joey and she's like.
Speaker 2:That is such a fun show.
Speaker 1:That is what I feel like when you're trying to teach me how to say your last name. Let's try it again. Ready Dr Umar Senkubuge. Is that pretty good?
Speaker 2:You did well.
Speaker 1:Do I basically speak Ugandese now? Is that the word Ugandese? Ugandese is a word.
Speaker 2:So Uganda has several tribes. The official language is English. Thank you very much, but that's Luganda that you're trying to speak.
Speaker 1:So I come from, so I'm basically fluent in Uganese Luganda. I'm going to call it Uganese.
Speaker 2:Well, they don't make you like us. This is the edition.
Speaker 1:That's the real thing. This is the AI.
Speaker 2:This. That's the real thing. This is the AI. Yeah, this is the AI.
Speaker 1:This is a trial version the beta.
Speaker 2:We're not going to get this thing done. I know Sooner or later.
Speaker 1:We'll get it, we'll get down to business. Okay, so anyway, dr Umar Sengubuge.
Speaker 2:Sengubuge, that's good Proud of you, man, I'm trying.
Speaker 1:He Proud of you, man, I'm trying. He's a bariatric surgeon in Uganda yes, right, and is actually blazing trails to try and establish an EMS system in Uganda, because you guys don't have one, right. So, consequently, he's over in the United States learning how to be EMS people and he's going to take all that knowledge back to Uganda and make the world a better place you couldn't have said it any better.
Speaker 2:That's such an intro I love it.
Speaker 1:Thank you, and I'm going to go ahead and award you best dressed guest of the night.
Speaker 2:I try, I walk up like this nice, I literally wore these to bed. These are my pajamas every day but honestly, this is my daily life back home you would never catch me back home dressed like this I avoid buttons, like everything I don't do buttons, it's impressions, first impressions. I'm trying to impress you, man, your first impression is really good, very good.
Speaker 1:So welcome to the show thank you very much.
Speaker 2:Today, we are going to talk about back pain.
Speaker 1:Of course we're going to talk about obesity your specialty, not you personally, but what you practice. Okay, right, and then we're going to see if we can teach the viewers a couple things, and we're going to have a couple laughs, and I'm going to be fluent in yuganese by the end of this podcast you're doing great so far so far I understand everything I'm saying listen.
Speaker 2:I'm excited to be here. I'm excited. I look forward to our conversation.
Speaker 1:Okay, so for our viewer, please tell us a couple things about you that we want to know.
Speaker 2:I am from Uganda. This is how they make us Six feet tall, all lean muscle. They just just just joking. My name is Umar. My friends call me.
Speaker 1:Do you need help pronouncing your last name? Because I can pronounce it for you.
Speaker 2:Seng Kubuge.
Speaker 1:Thank you very much Umar Seng, kubuge Seng.
Speaker 2:Kubuge Umar. I cut into people for a living, take away parts that they do not like and keep the good parts we give them shape. What we do is make people live happier, and Make people live happier and happier is very subjective. So we help people, prevent non-communicable disease progression. So if we catch you before you get sick, we'll help you. We'll walk that journey with you. I think helping is rather ambitious to say. So we will walk that journey with you to try and be your wellness partners. I think the best word is wellness.
Speaker 1:Wellness is a well good word. That's what my team loves to use. So, yeah, and so, on a typical day in Uganda, like how many surgeries are you doing or how many patients are you seeing?
Speaker 2:So that's a very other tricky question because where I come from, if you are a doctor you are pretty much everything because of the lack of specialties. That we, so you're a basketball player too if that qualifies as a medical profession, I would be rich are you an artist too?
Speaker 1:are you a rapper? Can you rap for us right now?
Speaker 2:since you do, I can't say I rap, but I can speak some words does that count for? Um, so yeah, we, we, we do, we do. We don't do surgeries every day, so we phase out. There's a process um which starts with consultations.
Speaker 2:So we look at, you come in just like a normal day. So we have days where we only do consultations, then we have days where we do pre-op, and then we have operational days where we get to do most procedures and then we have follow-up days. So it's a pretty busy, I would say, business practice. It's a pretty busy practice because with pop culture in the western world, people have learned that listen, this is how I was born and I don't have to put in so much work. If I can get the money, I can basically just go and buy a new body. Yeah, so it's, it's.
Speaker 1:It's such an interesting concept um, you guys don't have very much insurance over there, right?
Speaker 2:oh no, everything is paid out of pocket everything's paid out. Yeah, so insurance coverage in my country is about 0.5 percent, so roughly about 0.5 percent well, let's say 0.5% of 45 million people.
Speaker 1:Okay.
Speaker 2:So that is going to give you, give and take. If the math is right, you're going to be around 250, 300 people that are insured Somewhere or other. The rest of it is really paid out of pocket.
Speaker 1:I have a trivia question for you. Are you ready? Oh my God, this is a Uganda trivia question.
Speaker 2:Okay that I can do, because I just recently learned to play Jeopardy in class.
Speaker 1:Jeopardy. Okay, I just looked this up to figure out if I knew anything about Uganda.
Speaker 2:Let's go.
Speaker 1:You ready? Okay, what is the obesity rate in Uganda? Do you know the Jeopardy theme song? I will not know Take a guess, take a guess, take a guess. I'd rather you shoot and miss than never shoot at all. What's the obesity rate in Uganda?
Speaker 2:It's going to be very low.
Speaker 1:It is very low.
Speaker 2:It's going to even be less than 2%.
Speaker 1:It's about 2%.
Speaker 2:What is it though?
Speaker 1:It's about 2.3%, 2.3%, yeah.
Speaker 2:Yeah, I know that, because on my undergrad I did my first research in malnutrition. And the numbers are shocking.
Speaker 1:We have more malnourished people than we do have obese people. I'm sure, I'm sure, okay. So next question, follow-up question. So far you're doing very well. You have 100 on your grade. So far, yeah, on your grade so far.
Speaker 2:Yeah, okay, that's a fast. What's the obesity rate in America? I?
Speaker 1:would go 15%, 15%, it's higher 25?. Higher 30?. Higher 56%. It's actually about 40%.
Speaker 2:That makes sense.
Speaker 1:The obesity in america right now is about 40 percent of americans are obese. That's pretty bad that is.
Speaker 2:That's one of the other shocking things that I've seen, one of the culture shocks I've seen coming uh, into the united states. Of course I've always come in and out, but coming and studying and living in the united states, one of the most shocking things I've seen is how out of shape people are and it's really the social determinants of health. They are not as balanced, they are very. People are very comfortable here, for lack of a better word, and we can't really say comfort that's a sugarcoating word we use, but people have an abundancy of everything here.
Speaker 2:Whereas the scarcity that we have back home kind of prevents us from the extreme, so we both are living on the extremes. We need to find middle ground.
Speaker 1:Okay. Well, I'm going to give you a hint on this next question. How am I doing Middle ground? So far, you're doing pretty good.
Speaker 2:Okay.
Speaker 1:Okay, all right. What is the obesity rate for american kids age 6 to 19? So it was about two percent in uganda, it's about 40 for american adults. What's the rate roughly for kids in america between 6 and 19?
Speaker 2:well, that's gonna be even higher, higher.
Speaker 1:Maybe I'm waiting for your answer 35%. It's about 20% 20%.
Speaker 2:That's good, there's hope. That means there's hope.
Speaker 1:The way I see it is, one-fifth of kids are obese 20% 4 out of 10. Americans adults are obese. That's bad. That's not good, because we know there's all kinds of problems that come from obesity. I just read an article the other day about the leading cause of death in the united states.
Speaker 2:mortality is obesity it's cardiovascular disease which is secondary to obesity that's right.
Speaker 1:That's right. So cardiovascular death is still the biggest cause and there's many factors that go into cardiovascular death or risk or disease yeah, one of them, which is obesity. So as we start to tie all these numbers together between what your country is like two percent okay. Versus america, 40 of americans adults, are overweight.
Speaker 1:That's a problem that's a big problem then you think about the next generation, the kids 6 to 19. One-fifth of them are obese. That's a problem because we know from a medical perspective, too much or excessive weight puts all kinds of problems on your musculoskeletal system right. So I'm sure you understand that. Do you ever have talks with your patients about the consequences of obesity on musculoskeletal system or health as a general?
Speaker 2:Absolutely. I mean, let me just get back to what you just said earlier. I am thinking my head is going off right now, and it's going off in a good sense. You see how you're looking at obesity, causing the pressure that brings to the human body Right First, pose it right there, but then there's the pressure it brings to the economy. That's another conversation.
Speaker 1:Oh yeah.
Speaker 2:And I'm looking at it from the leading cause of death in America is cardiovascular diseases which is non-communicable diseases. The leading cause of deaths where I come from is infectious diseases, and this is what I keep telling people that one of the greatest innovations that America has given the world is the love for fast food.
Speaker 1:Because now on the rise.
Speaker 2:If you look on the graph on the rise, non-communicable diseases, specifically cardiovascular diseases, are on a rampage rise where we come from and we are seeing it basically because now fast foods have seen that there's a greater market where we come from.
Speaker 1:Now, where I come from, it's very prestigious for you to eat fast food I remember you telling me that for you to go to a prestigious, like elite people, that's, that's what the rich people go to. Fast food, where do they go to?
Speaker 2:well, they go to kfc, they go to all these drive-thrus because of convenience in now, whereas in america we see that as part of the biggest contributors because that's rather to the people that don't have as much. You know, that's what people that don't have as much you know to eat, because, man, groceries in the US are very expensive. Don't ask me how I know that. So when you get the two factors, the two baselines, and then pick up the common factor, it comes to lifestyle.
Speaker 1:Yeah.
Speaker 2:Isn't that interesting Very interesting, you're right.
Speaker 1:I mean americans certainly have a tendency to go towards convenience and they will pay for convenience right, they'll pay for people to deliver their food. They'll pay for delivery to people to uh have fast food ready for them. They'll pay for maid services. They'll pay for people to walk their dogs. They'll pay for all kinds of things because it's convenient and they're choosing to go do other things.
Speaker 2:The abundance you talked about there's there's just because, if you think about it, where I come from, I don't have money literally to live off later on to pay someone to walk my my dogs. I'm gonna use that, that example, to just, you know, put in some break a sweat, like I like to take my, tell my patients, or I'm not gonna pay someone to deliver fast food for me because of the status. I am going to drive, walk and drive and then get it. It's very interesting the different dynamics. But to come to the question, do I ever talk to my patients about obesity?
Speaker 2:That's basically what we do for a living. That's actually the core of what our practice is. It's helping someone move this journey, life journey together. We want to become your wellness partners. So we tell them about what you eat, how you eat it, when you eat it, what it's going to do to your body and then how do you reverse it if it's not too late to be reversed, if you can't reverse it, then that's when we come in to do interventions. But the first point is that's where we spend most of our time. I mean, like every first consultation is about one hour and that's basically what we are talking about to get to see what are your needs, what are your body needs and what do you give your body and we realize that people give their bodies more than what they need.
Speaker 1:So is this pre-surgery? This is pre-surgery, oh yeah this is because if a patient can do these lifestyle modifications and lose weight, they don't need surgery.
Speaker 2:That's the hard work, that that is hard.
Speaker 1:Work is very hard. I deal with the same thing about if people can exercise or increase the range of motion of their joints or eat healthy or Try to not be sedentary, they won't have as much pain. So it's very hard to get the patients to buy into what you're recommending.
Speaker 2:I totally understand that and so again, like we were talking and saying the other time, we just relate that to a car. If you drive a car and you go 200 miles, 200,000 miles, without servicing your car, the moment that car gets to break down, servicing is not going to help it. You have to change the engine, or the motor, like you guys call it. So that's the same analogy we use when you're talking to people about wellness and and the human body.
Speaker 1:we relate everything to the car, to the everyday life, and then we have an hours conversation about that I think that's a great analogy, because we do constantly tell our patients invest in yourselves, don't wait till the very end to start taking care of yourself. You got to invest yourself as you go through life and prevent the problems down the future. So I totally am on board with you on that, totally agree. So we're talking about obesity. What are some things or what are some causes of obesity?
Speaker 2:um, well, we will. Let's look at obesity this way. Let's look at it as one as which, what this, what people know? But this weight is in my, is in my family, the lineage, this is in my genes. And I argue with them and I tell them listen, I do not care what caused it or what it is, it can be reversed. So there are people that have genetic predisposition to it.
Speaker 2:That's certainly a possible cause but most, most of it is muscle people gain. You know what kind of medications you're on long term medications, mostly steroids are going to increase.
Speaker 1:Medications can cause obesity, so there is also lifestyle.
Speaker 2:The biggest is lifestyle. This is the biggest problem is what we talked about the convenience and regulating what you eat, how you eat it and when you eat it right.
Speaker 1:So inactivity, inactivity and poor diet and poor dieting Is causing obesity too. Also, interestingly, poor sleep is a cause of obesity.
Speaker 2:Absolutely.
Speaker 1:Right. So that's very important for our viewers to know that just not sleeping enough can cause obesity. I think it's because if you're awake You're usually just wasting time watching TV or not doing exercise, and then you start eating Just from habits of eating and watching TV.
Speaker 2:I'm just guessing on that, and people should also know that there's a difference between obesity on the scale and overweight, right? So, yeah, also rest. If you don't, you know there's a hormonal play that comes into your body, of course there's you know cortical, cortical levels going up high stress levels and then people.
Speaker 2:When people get pregnant mostly ladies there's there's a lot of hormones that come into play during post pregnancy and during pregnancy. But again, all that weight is reversible and we can't, we can't blame weight. You know people that gain weight as a result of opus pattern, weight gain to be obesity. That just doesn't count. Count right, it's going to be. Again. The biggest factor is going to be diet and inactivity, the refusal for people to modify those two perfect.
Speaker 1:So on that, what do you tell your patients? Is it better to just increase your activity and exercise, or is it better to have a healthier diet?
Speaker 2:it depends on which level we find them so where on the journey that we find them.
Speaker 2:In most cases, most of them come when you're pre-obese, when you just so, of course there's going to be a scale where there's no more accepted weight. Then there's going to be, of course there's underweight. That doesn't qualify to this conversation. There's underweight, there's no more weight, there's going to be overweight and then there's going to be obesity. Right Now, depending on where on this scale that we find you, the interventions are going to be different.
Speaker 2:If we find you in obesity, chances are how obese are you? There are people that are very obese and so that way, even lifestyle modifications are not going to help you Because, again, the outside is an indication of what is going on on the inside. So much as we want you to shed off the weight, there's also other things that are going on in your body, like cardiovascular diseases and diabetes, that we have to take control over. So in most cases, medications come into place and surgery, but in most cases, when we get into people's life, these are people that are very cognizant of their weight. Oh, I'm going out of shape. So those are the people that we love.
Speaker 2:I personally love to work with Because one they are willing, but because it's a pattern, it's a behavior. It is very hard for them to kind of get off that track to start. So we walk that journey with them and tell them hey, let's give them knowledge first of all. People will resist knowledge because now there's Google, there's AI, there's what my friend did, there's all this kind of I don't say misinformation. But what worked for Mark is definitely not going to work for me.
Speaker 1:It's just different information.
Speaker 2:There's different and streamlined information.
Speaker 1:And everything's kind of tailor-made to what you're searching for and your habits and everything. Certainly there's a bunch of misinformation along with good information. It's hard for the patients to weed through all that type of stuff.
Speaker 2:So what we do is we, we first of all get their needs assessment and then we walk that journey. At that point, hey, if you changed A, B, C, D and you're authentically and honestly changing it, because one of the things that we see in this practice is lying.
Speaker 1:Patients lie. Oh, trust me, trust me. You're saying patients lie.
Speaker 2:Yes, I know, patients lie, which is like I'm like listen, you're going to pay me anyway, so we could as well save you some money and time and do the right thing. So, yeah, we, we do that journey with them and then talk to them about how do you change the lifestyle. That is the most hardest thing to do because it takes a lot of unlearning and, as you might know, one of the hardest things to do is to unlearn right. So after the, if they are willing to unlearn, then in most cases they don't even progress to the medication and the surgical point. But then there are those that come into it hey, I have a wedding in two months. I am 200 pounds, I need to get back to 100 pounds. Okay, okay, there's nothing that is going to work unless let's go in and do surgery. And there's us when you come in with cosmetic surgery, and that's what you know, most people know us for and you know the practice that we run for. But in most cases it's the earlier that I talked about.
Speaker 1:It's very interesting. You say that patients need to buy in to what you're saying, because I have a lot of patients that are hesitant or resistant to my recommendations, and you mentioned that. Why are they going to pay you if they're not going to listen to what you say? I have that conversation many times with my patients because it really comes down to trust. The patients have got to buy in to trusting you 100%. If they're not going to trust you to do what's best for them, then they're going to slow down their progress.
Speaker 1:So imagine going to a financial advisor or somebody and say are you going to do what's best for our money? You have to trust what they're going to do. It. Advisor or somebody say are you going to do what's best for our money? You have to trust what they're going to do right. It's the same thing when you go to a doctor. You got to trust your doctors because they're trying to do what's best for you and make sure you find a good doctor, because unfortunately disclosure they're a bad doctor there are doctors that don't have patients absolutely first priority.
Speaker 1:So you got to find a good doctor and then, if you do trust them and listen to him or her when they say these are our recommendations, you can get to your goal as fast if you follow recommendations, or slower if you want to doubt me and not really jump into the ship and this is what we tell them.
Speaker 2:We tell them uh, your health is really a partnership right, and unfortunately, or the unfortunate thing is that you get to play as a much bigger part than I do, because you are living with yourself most of the time, and this is what I tell my patients. I'm like the right way to do fact checking is first hear the facts that I tell you don't, don't come to me with a, like a list of you know template that you downloaded. Someone like this is the fact. Then it ceases being the fact. Does that make sense? Sure, like, let me tell you then, go and check, as opposed to no, I want you to do this. Then you are becoming the doctor, and that's actually one of the the biggest problems that we face in our practice.
Speaker 1:So I'm going to give you a phrase that I want you to use in uganda okay so it'll be spreading through the world let's go I can say this is going viral across the world.
Speaker 1:I tell my patients we want you to be an active participant, not a passive recipient, in your health. So the patients come in and say what are you going to do for me, doc? I said nope, I'm not doing something for you. You are going to be actively involved with your health care and I'm going to help you be actively involved, but you're not going to be a passive recipient to what I'm telling you. You are going to be actively participating in your health care and your pain management. I'm telling you you are going to be actively participating in your healthcare and your pain management. So that's what I think we should tell the patients is be an active participant not a passive recipient of your healthcare.
Speaker 2:That is so powerful Now that you think about it. That is so powerful because often time, it's that passive passiveness that actually got us into this place, and this is what I always tell my patients as well. I'm like I wish you came to us earlier.
Speaker 1:Right.
Speaker 2:Yeah, but because you are passive about it, then this is where we, this is how we go, but hey, we'll be out of business if they didn't come, which would be great, which would be great, but you're right If people would come in earlier.
Speaker 1:it's already progressed. So if someone came to you when they're 50 pounds overweight, you're going to be a lot more successful, and they will too, instead of if they're 150 pounds overweight and they can't see you.
Speaker 2:It's the same thing with me.
Speaker 1:If patients come to me when they're 80 years old and they've had arthritis progressing for 50 years before they come see me, it's going to be a lot harder to get them better, versus if they come to me when they're 30 years old and it's just self-starting. We say you're fine, we have a lot of time to work with this. Be an active participant in your health, not a passive recipient, and you can, instead of going off this way, you can, start being a healthier person.
Speaker 2:And that also makes me remember one of the things that we do tell our patients is that if you do not act now, you're going to have to do three times the work tomorrow. Now, you're going to have to do three times the work tomorrow.
Speaker 2:And remember if you do not do it now, you're going to have to put an X3 tomorrow, right? So if we tell you, hey, come to us early, that feeling of pain that you feel could be something more than what you think, make a trip to the doctor, it will be way cheaper. We can catch it earlier, earlier than Google will catch it, because Google is going to just worry you and we could actually have some facts and work around it. So I like the idea of being an active participant, not a passive recipient.
Speaker 1:There you go, spreading across the world right now.
Speaker 2:It's gone viral. I love it.
Speaker 1:So we talked about some causes of obesity and the effects of that. Do you know some reasons or some ways to prevent obesity or things you can do to prevent obesity? It's very basic stuff.
Speaker 2:I think we just talked about that. First of all, be an active participant.
Speaker 1:Be an active participant.
Speaker 2:Break a sweat.
Speaker 1:Break a sweat Active lifestyle participant break a sweat. Break a sweat, active lifestyle, that's right. What else eat?
Speaker 2:eat healthy, eat healthy healthy lifestyle is very important, that is very important and and there's a there's a clear balance.
Speaker 2:I and I'm gonna ask you this about your practice there's a clear balance about so I keep telling people losing weight is not much of what you eat. Again, it's the, the modulation, because if you work out more than you eat, surprisingly you're going to gain weight. And you know this because when you see people go to the gym and I'll give you a clear example Someone goes to the gym, and I've seen this with most of our female patients. They will go to the gym at the start of the year, mark out on a calendar new goals, new me, let's go Change diet, da-da da. And then they start going to the gym.
Speaker 2:Well, they're seated behind their desk from 8 to 5, snacking in between, eating a heavy breakfast and doing all that kind of things, and then they go to the gym for two hours. They're on their phone for 30 minutes total. They're lifting weights. They are doing more burning of these calories that they accumulated during the day than they are actually. And then this is what their body thinks oh, we just depleted this amount of energy levels, because the body stores the energy that fuel, all the gas that runs your car. The body stores it as fat.
Speaker 2:So when you deprive your body of you know the stores that have that, either from glucose, and then you go to the fat, the body is going to think just like your savings account, would I have depleted this, let me fill it up. And that's how you gain more weight, not knowing. So. We tell them be very careful when you're active, because then it's going to increase your basal metabolic rate. You're going to eat more because your body demands are going to be more and in the process you're going to eat more because your body demands are going to be more and in the process you're going to be eating more frequently, and that's how you end up getting more weight. So it's a very important balance that we tell people hey, be very careful. And that's why it's important to go to a professional, because a professional will tell you what you eat and how you eat it and how you balance that with how much you can't just stop eating you can't just stop eating like you can't just keep eating and you can't just eat once a day.
Speaker 1:You got to balance it out, like you said yeah, it's a balance, so I agree with you. Another interesting thing I saw was have smaller plates right, yes, there's actually research that shows people that have smaller plates aren't as obese. So when you go to a restaurant or you go to a store, you buy plates at home, use smaller plates and you'll lose weight just from that mm-hmm the other thing you said you mentioned early was get a dog, because dogs can be walked by you, not a service right and the more you have to get up and walk your dog or go outside, then the more you're being active, the more you're back and again there is there is there is nothing like insufficient activity.
Speaker 2:you know the way the heart works is. You know the heart is one I'm sure you know this, but I want to make sure that our patients, or listeners, know this the heart is one of, it's actually the one of the organs in your body that do not depend on your glucose, on your glucose levels, right? So the normal primary source of fuel that your body that do not depend on your glucose, on your glucose levels, right? So the normal primary source of fuel that your body uses. The heart uses fat, and so I guess that's where the word cardio came from, when you tell people that, hey, I don't care if you walk, I don't care if you run, I don't care if you swim, we need you to move your body, just move.
Speaker 1:Get into the act of moving.
Speaker 2:And walking a dog or a pet is a very, very good way to move it.
Speaker 1:And my patients that say I can't start an exercise routine, I say don't think of it as a routine, Think of it as one day. Go 10 steps one day and then the next day go 11. And every day just increase it by one step, or five minutes, or one minute, but just start the activity of exercising and be consistent. You got to dedicate yourself to it.
Speaker 1:I'm not saying do it five hours a day. I'm not saying do it every day. I'm saying start the habit of going for a five minute walk. It's very simple two or three times a week and then, as the weather gets better, you start getting more energy because you'll build endurance, because you actually didn't go for a 10 minute walk right you slowly build up on your endurance and you'll see that it's a small effect.
Speaker 2:It's a small habit. You create a habit, you start on it, stay in it and then, before you know it, it gets on to you.
Speaker 1:That's very important.
Speaker 2:I love it. I think one of the things that we need to include onto, that is, one of the things that we tell you again patients back home, but also clients here is get into the habit of consistency around you.
Speaker 2:Wake up at a consistent time, do something, get into a routine kind of a routine and also get a doctor, get like someone that is going to know you. This business of hopping from this practitioner to this practitioner, to this practitioner, that's how you end up. You know getting all kinds of um. It's one thing if your doctor is not giving you results, or if your doctor is not giving you results or if your practitioner is not giving you results. It's the other thing if you stick in there and work with them Because, again, remember, this is a partnership that you've created.
Speaker 1:It's a relationship. It's a relationship.
Speaker 2:The longer you're in a relationship, the better off you feel, the more I know you or the more I know something about you, better service the mom going to understand your body. You've seen this where people that have worked with one practitioner for so long have seemingly better results. There's actual research People that have worked with one practitioner for so long if the practitioner is doing something right, they have way better results than people that do medical hoping from one person to another. So that's also very important with information.
Speaker 1:So patients just to reiterate should find a good doctor and stay with them and trust them and make them part of their family, because that's what they are. They're trying to help them out for global wellness and health for the rest of their lives, Because things are going to change.
Speaker 2:I mean, things are going to change in the way you eat. Things are going to change in the way you was 10 years ago.
Speaker 1:I'm sure you were not, gray. There's only one.
Speaker 2:Mark.
Speaker 1:Mark is constantly evolving. The only thing constant is change itself. The way I understand it correct me if I'm wrong is you work here via internet in Uganda from like 8pm to 4am yes, from about 6.30pm to 4am. So that's my yeah from 6.30pm.
Speaker 2:That's my resting time.
Speaker 1:6.30pm takes us to San Antonio time almost like 10, because then we are transitioning to like 7am back home so you work from here, 10 o'clock here, to four o'clock here over there through the internet and then you slack off and take two hours nap about three three, and then you get up, and then you go to your student job here to learn ems from eight to five, okay, and then you start all over again.
Speaker 2:Yes, so this is the balance part of it. Let me tell it my way. Mark is just messing it up.
Speaker 1:Just another story. Mark's messing up, that's fine.
Speaker 2:So because of the time difference, there's a huge time difference About a nine-hour time difference back home. So right now it's coming to 7 pm. Takes some time, so I would usually be asleep from like 5 pm up to like 10. All right, so five, six, seven, eight, nine, ten, that's about six so you're hating me right now?
Speaker 1:oh no, do you think this is a dream or a nightmare?
Speaker 2:ask me tomorrow, and then I get up at around 10. Guys are waking up back home and then we do that.
Speaker 1:So I do that mostly if I have consults the bariatric surgery.
Speaker 2:Well, smooth, consults, consults, and then I go to bed at around give and take, around 3.30, 4, depending on the day, and then I'll be up at 6. And then I start my day here, and then that goes on. So I I read just a good seven, seven, eight hours.
Speaker 1:It's just off the the normal cycle of the everyday because we learned earlier, sleep is very important. Oh I sleep.
Speaker 2:I sleep and I rest. I think so there's a difference between sleep and rest.
Speaker 1:Yeah, so really you're a full-time student and you're a full-time employee. That's a life baby-time employee.
Speaker 2:That's the life baby.
Speaker 1:Why do you slack off so much? I'm just wondering.
Speaker 2:You make me feel bad. But the tricky part is I think we talked about that it's a balance.
Speaker 1:Everything's a balance.
Speaker 2:You've got to learn that. One of the advantages of being in America is I'm very aware of what to eat and what not to eat. So I would regulate very much what I eat based on how non-very cheap things are here. I would regulate how I eat, so I would eat a certain kind of portion certain times of a week and then that's how I really catch up. Otherwise I would be non-looking the way I used to look 10 years ago.
Speaker 1:I remember you saying that food was very expensive here and you had to buy a lot less compared to back home. You could get a lot more. That would last you for weeks.
Speaker 2:Yeah, that's one of the privileges I think of being where I come from. The very many is that you get to, for example, 80 bucks. I would fill up an entire fridge full of fresh groceries. Well, I don't know how much 80 bucks would buy me here of fresh food. But I'm assuming that wouldn't be much. So see, that's the reason I'm telling you that I am very aware of what goes into the body.
Speaker 1:It definitely wouldn't fill a fridge, that's for sure.
Speaker 2:We certainly know it won't.
Speaker 1:But do you like Chick-fil-A French fries? I like chicken nuggets oh, I like the chicken. Yeah, oh yeah. But do you like their french fries? See, I have a problem with french people, uh-huh, and that so I would think you would like them, because you're frying them, right no, I love fries.
Speaker 2:I just don't eat my chicken with watermelon.
Speaker 1:Okay, so can we stay for our viewing audience? Two out of two doctors approve of Chick-fil-A French fries, and we're talking about obesity.
Speaker 2:We should get an endorsement from Chick-fil-A. They should watch this.
Speaker 1:We're talking about obesity, talking about French fries.
Speaker 2:That's okay, Anyway moving on.
Speaker 1:We're talking about obesity and we're going to move into low back pain.
Speaker 2:Yes, I know a little bit about that. Now can I take over the interview.
Speaker 1:Oh.
Speaker 2:Can I just hijack?
Speaker 1:Do we need to switch?
Speaker 2:seats. Can I just hijack?
Speaker 1:Do you want to switch seats?
Speaker 2:Because I really want to know this is one of the most complaints that people that are overweight complain.
Speaker 1:I do consulting in Uganda from about 2am to about 10am every morning. I feel as now.
Speaker 2:I would want to know from a specialist, from an expert, what the relationship, what the relationship is with mostly overweight and obesity and back pain. What is it that connects those two?
Speaker 1:Okay, that is such a good question. I'm so happy you asked and it all comes down to I am seriously asking. It all comes down to weight and gravity.
Speaker 2:Okay.
Speaker 1:So when someone is overweight, they have more weight pulling them forward and down with their lumbar spine. So instead of the spine being evilly stacked and distributed with the weight in the discs, it's pulling an anterior pressure towards their front which causes uh disc problems, which then consequently causes facetogenic problems because they're putting more stress on their back, because they're basically arching their back much more than they should be, because the weight is pulling them forward, which then causes arthritis.
Speaker 1:And it helps increase disc degeneration because they're compressing their spine much more than someone who isn't overweight. So someone who's overweight is compressing their spine so they have disc problems. They're pulling their spine forward like a hyper-arching back thing, so it puts more pressure on the back of their spine, where their joints are, which causes more arthritis or accelerated degeneration of the joints I have had.
Speaker 2:I have had patients ask me when you take away this fat, can you put it more in the back area than they have asked me to put it in the front area? Um, that is just a by the way, but no one has asked me. And and I keep asking could that be the reason that we don't tell our body where to deposit most of the fat? We don't really get to choose. It will deposit in the biggest cavity, and what is one of the biggest cavities that we have?
Speaker 1:Abdomen Usually abdomen for men, or thighs or breasts for women is where a lot of excess weight goes, and so it just causes anatomic changes with gravity and stresses on the spine, which leads to all these other back problems so if I'm overweight, should I?
Speaker 2:is it safe to say that I should walk with a stick, or do I just shed the weight? What do you recommend?
Speaker 1:I would say shed the weight, instead of keeping the weight and walking with a stick makes sense in the end, you want to be light and fast, so you want to maintain your ideal body weight. You want to maintain your joints by exercising and range of motion, and to do that you need to not have excessive weight. It's like carrying around two 50-pound dumbbells throughout your life. It's really really bad on your joints, so you can lose a lot of pain or problems with pain by just maintaining an ideal body weight and actually, in fact, obese people are 33% more likely to develop low back pain than people that aren't obese.
Speaker 2:That's why.
Speaker 1:So just obesity by itself will increase your chances of developing low back pain.
Speaker 2:So what would you like to tell someone out there that is obese with back problems and they're telling now I have arthritis problems or I have spondylitis problems and now I can't even exercise.
Speaker 1:Right Deal with that all the time. San Antonio has their fair share of obese people with diabetes and high blood pressure, but that's part of the situation we're in and we're here to help. So I tell them you have to be actively involved with your health care.
Speaker 1:You can't be a passive recipient of health. You have to decide to change your path. It's like you can keep on going in the direction you're going and things will get worse, or you can make a conscious effort to change the direction and change your habits. The example I give is if you are on 1604 and you never turn and you're trying to get to Austin, you're never going to get to Austin.
Speaker 2:It just doesn't go to Austin.
Speaker 1:So if you want to make a change in your path, you're going to have to change the way you're going and take a road that goes to Austin. If you get on i-10 trying to get to austin, it's never going to happen. So you got to make changes to your lifestyle and your habits to get to where you want to go. And if you do want to be in a position where you're not having lifelong pain or increased pain or suffering because you can't do things with your kids, your grandkids, because you, because you're in so much pain or the obesity is causing heart problems, or you're on all these medicines that treat high blood pressure and diabetes and all these other things, you're going to have to choose. That's not where I want to go. I want to go over here. So then make the change, because nothing is going to change unless you change.
Speaker 2:Well, doc, I have another question for you. Well, I am on all this kind of medication and my doctor told me I have to regulate the way I walk, how much exercises I do, because of my heart issues. And now, here you are telling me that I have to be active, and on top of that, I have a problem with my back. How do I go about that situation?
Speaker 1:Well, baby steps. I talked in the last podcast about make it first and 10, not first and 75 do you watch american football? Right, so they get the kickoff. They start on the 25 yard line, the goal's 75 yards away. They don't make it first and 75 right they take a big goal and they divide it up into much smaller, easily accomplished goals.
Speaker 1:First, intense I sell, just go first and 10, so we're gonna lose five pounds okay okay, let's see if we can do that and you can get into water and walk in water and exercise water, because the buoyancy will take a lot of stress off your spine and your joints to enable you to start building up an endurance so you can be active again right and as you start to lose weight, you can start being more active outside the water. The best pools, if you really want to know, are those pools that have the beach entrances. Do you know?
Speaker 2:what beach entrances are?
Speaker 1:Yes, so then as you're heavier, you can go deeper in the water and there's more buoyancy, and then, as you lose weight and you gain exercise, you can come to more shallow and you'll lose the buoyancy and put more stress on your joints. Lose the buoyancy and put more stress on your joints Makes so much sense.
Speaker 1:So then I say, okay, we're here for you, we're going to help you, we're not going to do it for you. We're going to help you and we're going to have small goals to get you to where you want to go.
Speaker 2:You didn't get like this overnight. You're not going to get out of this overnight.
Speaker 1:It took you years to get in this situation. So we're going to plan to do this, but we're going to keep on heading towards your goal. We're going to put you on I-35 to get to Austin instead of I-10. That's never going to get you to Austin.
Speaker 2:I really, really, really love. I love that. I think that most of the problems that we see I don't know about your practice, but most of the problems that we see is people have had this problem for 10, 15 years and then they come like, hey, I only have two months to fix this. So what advice would you give someone that is into the business of quick solutions, quick fixes?
Speaker 1:I would tell them that we can do as much as you want to do, but realize the shorter the duration you want to make changes, the harder it's going to be on you, which will increase your chance of failure. So you don't want to get a medical degree in one year.
Speaker 2:Yeah right.
Speaker 1:It's too much work, you will fail. You're setting yourself up for failure. So make it a reasonable goal and that's one of the things you do when you come up these not making it first and 75, but first and 10, you come up with a reasonable goal. Now I said lose five pounds. That's a reasonable first goal. That's not going to be your goal the whole time, because you know next month we're going to say OK, let's see if we can lose six pounds. Or if you can't lose any weight, let's see if we can make you walk twice as far, ok. Or if you can't walk, let's say see if you can get in a pool and stay walking in a pool for twice as long.
Speaker 1:So there's different ways to modify their health problems that they're dealing with, whether it's obesity or pain or whatever else, to try and get them to once again be actively involved with their health care. But the shorter the duration, then the harder it's going to be. One of my other favorite sayings is if you fail to prepare, prepare to fail. So if you're going to give yourself two months to lose 50 pounds and you've had years to try and prevent this, you're preparing to fail because you're failing to prepare so when I do talks or lectures or do anything else.
Speaker 1:I'm very adamant about preparing because I don't want to look like an idiot. I don't know what I'm talking about. So I go and I prepare. So I'm not failing to prepare, because then I would prepare to fail.
Speaker 2:So it takes, takes a little dedication it takes a little motivation.
Speaker 1:It takes us helping them. We're helping. We're not doing it for them like you do with your patient, but it's a team effort and they didn't get like this overnight. It's not going to go away overnight. It's going to take a change.
Speaker 2:And part of the team effort that I tell my patients is find an accountable partner.
Speaker 1:Absolutely.
Speaker 2:Find someone that is going to push you when you're slacking. Find someone that is going to get you back on track, because it's again like you said it's a journey.
Speaker 1:It's not going to happen over time you better have someone that is going to push you. Another thing we like to say is knowledge is power, knowledge is power. So the more you know about something, the more you can take control over that situation. And a lot of times patients have fear just because of ignorance Not to say they're stupid, but because they just don't have the knowledge of what goes on with that situation. So become an active participant and learn what the causes of obesity are, what the cure is for obesity are, or what you can do to minimize obesity, obesity, or what you can do to lose weight. So actively participate. Another thing is you can go to our website.
Speaker 1:It's one month MD dot com and you can learn about the causes and treatments and prevention of low back pain, and you could be an active participant in your health instead of a passive recipient.
Speaker 2:Look at that.
Speaker 1:All these things to help patients learn and use that knowledge as power to control their life and control the problems they're dealing with again it's, it's.
Speaker 2:It's one of those things that we say your body is a composition of different systems. Don't treat one in isolation, because here we are thinking well, obesity is just a more of a shape looking issue and it's giving you back issues. So you have to radiate, put you know coolant in your radiator, as much as you have to fuel up or gas up your car. Check on your tires, make sure that the body is doing when the electric system is doing good. Right.
Speaker 1:So I like, I like, I like that yeah, and an example I give many times, which my patients are probably sick of because they've heard it so many times, is a patient come in and they say you did a procedure and I'm still not better and I say okay, well, think about a car.
Speaker 1:If you had a car that didn't start and you took it to the mechanic and they said oh, you're out of gas, you have a bad alternator and your battery doesn't work. But I put gas in your car, your car is technically better, you can now have gas, but you still haven't addressed other things that prevent the car from starting.
Speaker 1:You still have a dead battery and you still have a bad alternator. So all those things will contribute to a symptom of the car isn't starting. But don't think it's one thing that needs to be fixed to solve the car from starting. It's multiple different things. So in the situation of dealing with weight loss or trying to eat healthy, it's multiple different things that are going to need to be done instead of just, oh, I'll take a pill and I'll lose the weight. No, you're going to change your lifestyle, but it takes multiple things to do to make lifelong changes.
Speaker 1:It'll take 60 days to make a change become a habit right, but then, after the habit is formed, then you continue to do it and you reap the benefits you couldn't have said hey, you heard from the expert.
Speaker 2:He could not have said it Very good.
Speaker 1:Did you have any other questions for me?
Speaker 2:I think I've earned my money's worth.
Speaker 1:Oh yeah, you definitely have. Are you going back to Uganda tonight, because you're done with all American doctors? Who's your favorite American pain doctor?
Speaker 2:I wouldn't say Mark, why are? You taking so long to answer that question? I wouldn't say Mark, why are you taking so long to answer that question? I?
Speaker 1:wouldn't say Mark, Like do you know any other American pain doctors?
Speaker 2:But there's a doctor that does back-to-back, that's the one.
Speaker 1:Well, I'm going to put on my podcast officially. You are my favorite Ugandan bariatric surgeon, dr Umar Slovanovich.
Speaker 2:That's Russian.
Speaker 1:How is it again?
Speaker 2:Yes, this is the only one thing. You don't have to be American about Sankubuge.
Speaker 1:Sankubuge. Si, I did say that, okay, thank you. Thank you, see. So Thank you very much For coming on. This has been Very educational. I hope you guys Learned something. I certainly learned a lot and I appreciate your time.
Speaker 2:I did learn so much From you, mark Good.
Speaker 1:Thank you very much For having me, and we wish you the best of luck With your schooling and back home, about starting something that will help out All Ugandan people.
Speaker 2:Absolutely, and maybe sometime we can get a pain management doctor in Uganda.
Speaker 1:I'm thinking about opening a satellite site just on Fridays.
Speaker 2:Friday is happening time. Ugandans don't do anything on Friday except for happening.
Speaker 1:Perfect, that's what I'm going. They just go dancing. No, that's what I'm going. That's how we deal with pain. I'll have a site there. I won't send any patients, I'll just go dancing. I hope you guys learned something. Please check back for our next podcast. We appreciate all your help. Always send any emails to us, because we want to answer your questions too. Thanks a lot.
Speaker 2:Thank you.
