March 5th, 2008 by Dr. Val Jones in Health Tips, Opinion
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I’ve wrestled with this question for many years: “When is weight loss surgery an appropriate option?” I used to do weight loss research prior to working at Revolution Health. My studies focused on using “natural” methods to reverse type 2 diabetes – in other words, weight loss via diet and exercise. My study subjects were all obese, and most had struggled with weight for decades.
At some point during the trial, people would often ask: “Can’t I just have surgery for this and not have to struggle so much?” And I would gently remind them that surgery was no picnic, and to try diet and exercise first. “But it’s so hard!” they would say. I would acknowledge their difficulties and offer lots of empathy, and firmly encourage them to stick with their diet. In the end I found that only half of my study subjects could manage to stay on the diet for months at a time. So what should the other half do? Give up and let their diabetes ravage their bodies?
My friend and colleague Dr. Charlie Smith rightly points out that weight loss surgery can dramatically improve the health of people who have been unsuccessful at losing weight through diet and exercise. Heart disease, diabetes, and cancer rates were dramatically improved for morbidly obese people after weight loss surgery. So there is a clear benefit for some people to have the procedure.
However, the caveats should not be overlooked. First of all, weight loss surgery does not guarantee long term weight loss. It’s possible to gain back all the weight lost if eating behaviors are not changed. The human stomach is amazingly stretchy, and even if it’s surgically reduced in size, with repeated overeating it can eventually stretch to accommodate large meals again. Secondly, some types of weight loss surgery (like gastric bypass) can affect the body’s ability to absorb critical vitamins. Without enough of these nutrients, one can end up severely anemic, and osteoporotic just to name a few serious side-effects. And finally, the surgery itself is quite dangerous, carrying with it a potential risk of death as high as 1 in 200!
So weight loss surgery can be life-threatening, and is not a quick fix for a long term problem. However, morbid obesity itself is so dangerous (with the increased risk of heart disease, diabetes, and cancer) that it may require this extreme intervention to actually save lives. For people who have more than 100 pounds to lose, and have sincerely tried diet and exercise without success for a prolonged period, then weight loss surgery may be an appropriate option. For those whose lives are not at risk because of severe obesity, it doesn’t make sense to undergo such a risky procedure.
Are some people successful at losing a large amount of weight and keeping it off without surgery? Yes! The National Weight Control Registry keeps a list of thousands of Americans who have lost at least 30 pounds and kept them off for at least 6 years. What’s their secret? You guessed it – regular exercise and a calorie controlled diet. Some other things that these “successful losers” have in common: 1) they eat breakfast 2) they have a cardio machine at home 3) they weigh themselves regularly.
If you’d like to meet a group of people who are working towards long-term weight loss success, feel free to join my weight loss support group. We have weekly challenges, tools and trackers, a vibrant discussion group, and free medical insights to help you along your way. Weight loss is really hard to achieve by yourself. It takes encouragement, support, and a community of like-minded folks who are determined to make a difference. You can do it!… and I’d be honored to support you along the way.
P.S. There’s a special group forming at Revolution Health for folks who need to lose 100 or more pounds. It’s called “Overweight But Not Giving Up.” Check it out.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 29th, 2008 by Dr. Val Jones in Uncategorized
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Happy leap year everyone! The Revolution Health experts have been blogging away furiously, and I haven’t done a Revolution Rounds in a few weeks (naughty) so without further ado – here’s a nice round up of the best of the Revolution Health blogs…
Health tips
Most vitamins and supplements are not necessary if you’re eating a healthy diet. Dr. Joe Scherger summarizes Harvard’s Men’s Health Watch and concludes that only Vitamin D supplements may be warranted for the general population.
Relationships require pruning. Mira Kirshenbaum suggests that if you’re in an unhealthy relationship, it’s best to get up the courage to cut it off.
Ever wonder which arthritis treatments work best? Dr. Jim Herndon has distilled the latest research.
Children need to be vaccinated against the measles. Dr. Stacy Stryer explains that measles can be deadly in 20-30% of the people who get it.
Calcium can strengthen your bones, but may clog your heart? Dr. Vivian Dickerson cautions women about taking too much of this vitamin.
Did you know?
Only one in four people recognize the symptoms of a heart attack. Dr. Joe Scherger describes how you can tell if you’re having one.
Restless legs syndrome might increase your risk of a heart attack. Dr. Steve Poceta explains why.
Stem cell research could be the key to unlocking the mysteries of how cancer develops. Dr. Heinz-Josef Lenz describes some promising new research.
Pit viper venom might be useful in reversing strokes. Dr. Olajide Williams explains that the venom can dissolve blood clots in the brain.
There is a real mind-body connection in health and disease. Dr. Joe Scherger explains how it impacts men with erectile dysfunction.
Nighttime anxiety might convey a survival advantage. Dr. Steve Poceta wonders if we worry more at night because the ancestors who did so, lived to procreate.
A hospital is being sued for denying a surgical procedure to a transgender female. Dr. Cole Brown is not sure that this is fair, since the procedure was not emergent.
Orthopedics Corner
Dr. Jim Herndon is a faithful friend and blogger. He has had a particularly fine week – so many of his posts are great that I thought I’d give you a little summary of them all in one place…
Americans spend as much on back and neck pain treatments as they do on cancer treatment. Jim discusses the incredible financial burden of back and neck pain and the disappointing efficacy rates of treatments.
Neck pain is fairly common and particularly resistant to treatment. Jim describes the prevalence of this condition.
Glucosamine does not seem to improve hip arthritis. Jim discusses the mounting evidence that the benefits of glucosamine are very limited if they exist at all.
Patients with spinal stenosis (narrowing of the canal that contains the spinal cord) may benefit from surgery.
About 10% of total hip and knee replacements require revisions. Before you have yours, be sure that your surgeon is experienced with revisions.
Kiddie corner
Dr. Stacy Stryer is also a faithful friend and excellent pediatrician and blogger. Her sound advice and empathic tone is a key to her success. Here’s what she has to say this week:
First of all, Dr. Stacy reports on the strange practice of a nursing mom on America’s Next Top Model TV show: she’s drinking her own breast milk. Yuck!
Studies show that parents spend more time with their first child. Stacy wonders if she’s been a neglectful parent of her younger child.
Measles is a fatal illness for up to 30% of children who get it. Sadly, measles is on the rise because parents have opted out of the MMR vaccine due to unsubstantiated fears of vaccine harm.
Depression in a parent might be a risk factor for poor health among their children. Dr. Stacy takes a fresh look at how to keep America’s children healthy.
Dr. Jim Hill explains why children who don’t exercise regularly may perform worse on academic tests.
And my final post of Revolution Rounds is from a couple of neurologists who relay a compelling story: they saved a woman’s arm from a mistake made by an orthopedist in Serbia!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 21st, 2008 by Dr. Val Jones in Uncategorized
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Health tips
Are you struggling with depression? Mira Kirshenbaum suggests that talk therapy may be more effective than medications.
Does your child have mono? Dr. Stacy Stryer explains that mono has very different symptoms depending on a child’s age.
Be careful of vitamins and supplements – some of them may negatively affect your other medications. Dr. Julie Silver offers a list of the most common supplements that interact with medications.
If you see flashing lights or floating objects in your visual fields, see an ophthalmologist right away. Dr. Jackie Griffiths explains why the symptoms of retinal detachment can be quite ominous.
Are you about to have surgery? Dr. Jim Herndon suggests some questions to ask your surgeon before and after the operation.
Don’t be shy about asking for help when you have cancer. Dr. Heinz-Josef Lenz highlights some great advice from the Colon Cancer Alliance.
Looking for ways to enhance your sex life? Mira Kirshenbaum has some creative suggestions.
Do you have diabetes? Exercise might be the most important “treatment” for type 2 diabetes. Dr. Jim Hill explains.
Did you know?
Fertility decreases by 5% for every 1 point increment in BMI over 29. That means that getting pregnant becomes more and more difficult as you gain weight! Dr. Mark Perloe explains.
Men can suffer from post-vasectomy pain. Dr. Joe Scherger describes this problem and what to do about it.
Could having children increase a man’s risk for prostate cancer? Dr. Mike Glode reviews the evidence.
Your brain needs sleep to recharge its neurotransmitters. Dr. Steve Poceta explains the exact reasons why sleep is so important for the health of the human brain.
Approximately 1 in 25 children will have at least one febrile seizure in their lifetime. Dr. Olajide Williams explains that a seizure that occurs during a time of fever does not mean a child has epilepsy.
Siestas and/or power naps could reduce your risk of heart disease. Dr. Joe Scherger highly recommends this regular form of stress reduction.
There are fat zip codes and skinny zip codes. Dr. Jim Hill explains why thinner people congregate in certain places. Think upper east side, Manhattan!
A recent study suggests that calcium supplements may put older women at higher risk for heart attacks. Dr. Jim Herndon explains why he’s skeptical of this potential link.
Medicare will not pay for in-hospital complications believed to be due to errors. Kelly Close wonders how they know for sure that an adverse outcome is related to an actual error or not.
Do you know someone who engages in repetitive, jerky movements? Dr. Olajide Williams is a neurologist who explains what “tics” are and what can be done about them.
Around the globe
China: How many autism experts are there in China? About 30 for 1.3 billion people. Robin Morris describes how bleak the prospects are for parents of children with autism.
United States: In an outrageous court ruling, a physician was held responsible for the death of a young boy who was run over by a patient (while driving his car) on blood pressure medicines. Dr. Cole Brown wonders how much of a patients’ actions can be blamed on his physician?
Africa: “River blindness” is caused by a parasitic invasion of the eye. These parasites can be killed with a medicine called ivermectin, but apparently the wily larvae have developed a genetic mutation that renders them resistant to the only known medicine that can kill them. Dr. Jackie Griffiths reminds us all how tenuous our antibiotic victory over microbes and parasites really is.
Personal perspectives
Some people use diet coke in their CPAP machines! Dr. Steve Poceta tells the story of how one of his patients preferred this type of humidified air. Not sure what that will do to your lungs…
Ever wonder how to weigh the pro’s and con’s of chemotherapy in a terminally ill patient? Dr. Mike Rabow describes how he advises patients about this difficult decision.
Dr. Rabow describes some tear jerking true stories from a hospice in Florida.
From the blogosphere at large: this week’s grand rounds is hosted by Alvaro Fernandez at SharpBrains.com. The theme is: briefing the next US president on healthcare. Some really important information in there folks, so go ahead and have a good read!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 2nd, 2007 by Dr. Val Jones in Opinion
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I recently had the chance to observe a breast augmentation procedure performed by a surgeon friend of mine. The patient was a tall, attractive woman in her late thirties. Her husband was in the room, quietly listening to my friend’s explanation of the procedure and what should be expected. The patient was friendly and enthusiastic – the breast augmentation procedure was her birthday gift to herself. This was her second procedure, as she had already increased her cup size from an A to a C a few years prior. This time she wanted D or larger.
I felt mixed emotions as I observed the surgery. On the one hand the patient’s breasts looked fine the way they were (in my humble opinion) and it seemed wrong to further distort her natural body type. Yet on the other hand, I think that patients have the right to look the way they want to, and my personal beauty ideal shouldn’t be projected on to them. I asked my friend how she dealt with this sort of conflict.
“Well,” she said, looking at me with her surgical mask and blue hair net, “if a woman wants a green dress, it’s not the store clerk’s business to try to pressure her into buying a red one. I just try to give the patients what they want, and not impose my opinions on them.”
And so I watched as my friend carefully sutured the wounds around the new implants. She checked the movement of the saline-filled sacs inside the chest. She pushed the breasts together to check the cleavage.
“But the breasts don’t touch each other when you push them to the center,” I said, head tilted sideways.
“Her sternum is too wide for that. This is one of the limitations of implants of this size on her body. She just doesn’t have enough tissue to make that kind of cleavage.”
“Is that ok with her?” I asked, glancing down my own scrub top.
“It’s a give and take – she knows that going larger will not give her a natural look, but she’s ok with that. This is what she wants.”
And so the anesthesiologist woke the patient up, extubated her, and the nursing staff slid her over to the stretcher that would carry her to the recovery area. My friend escaped her sterile gown and gloves and prepared her post-op note at the nursing station desk. I smiled at the nurses who assisted in the surgery, and we shrugged at each other and went on our separate ways. I hope the patient is pleased with the outcome, though most of all I hope she feels content with how she looks, no matter what the bra cup size.
What do you think about breast augmentation?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 13th, 2007 by Dr. Val Jones in Expert Interviews, News
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Sadly, four transplant patients in the Chicago area recently discovered that their new organs were infected with HIV and hepatitis C. This is the first case of infected organ donation in the past 20 years, with over 400,000 successful, healthy transplants completed in that time period.
I’m actually a little surprised that this is the only known case of infected organ transplants in the past two decades, since the tests to rule out HIV and hepatitis C rely on antibodies. It takes the body at least three weeks to produce antibodies to these viruses, and so people who are infected with HIV and hepatitis C have false negative tests for the first few weeks. So there is always the risk that an organ donor could have contracted these viruses within 3 weeks prior to his or her death.
I asked Dr. David Goldberg, an infectious disease specialist in Scarsdale, NY, to weigh in:
Are there any tests available now that can detect the viruses themselves, or only antibodies? How early after infection could we detect them?
Traditional serologies measure antibodies against the viruses which take weeks or months to develop, whereas there is a more rapid test, called “PCR,” that is a direct measure of the number of viruses in the blood.
HIV reproduces rapidly, so the virus can usually be detected in the bloodstream within 8 days of infection. By contrast, hepatitis C virus replicates more slowly, so the virus may not be detectable until as long as 8 weeks after exposure. So the use of the HIV PCR test in addition to antibody tests would pick up almost all cases of HIV, but the hepatitis C PCR might still miss a number of early infections.
How can we protect future organ recipients from such a tragic event?
PCR is not generally performed because the test is time-consuming and many organ donors are trauma victims, which leaves little time for testing. However, PCR testing could theoretically reduce the number of HIV infected organs that are transplanted (from recently infected individuals), but would not improve the odds in hepatitis C because of the slow growing nature of the virus. In the end there’s no perfect test or 100% guarantee that organ donors don’t have HIV or hepatitis C.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
