March 24, 2013
The deadlift has been called the “King of Exercises.” I love that title. The deadlift used to be called the “health lift,” because with this one lift, you are exercising all of the major muscle groups in your body. Obviously, everything from the mid-back down is firing on all cylinders during a properly performed deadlift, but the upper body benefits are often overlooked. The shoulders, chest, upper arms and forearms are all supporting the weight making it great for the upper body as well. While the debate will continue as to which lift is “king,” everyone agrees that a properly executed deadlift is a great exercise.
Allow me to show a brief video that introduces the deadlift to those of you who may be unfamiliar with this foundational movement.
If you paid attention to the narration from Coach Glassman during the above video, he points out something that most people never appreciate, “the deadlift is nothing more than the biomechanically sound approach [to picking] things up off the ground.” You may want to ponder that for a minute.
I have had many patients tell me that can’t do something because of a bad back, bad knees, bad hips, or bad whatever. A deadlift merely teaches you the proper way to pick your shoe, your keys, your child, your pencil up off the ground. I would suggest that if your back is so bad that you can’t pick up an object off the floor, you are bad off. Virtually no one, from cradle to grave, is immune from that need. So the point is, don’t avoid the deadlift…learn to do it properly. Now, for your viewing enjoyment, a video designed to make you cringe.
Holy ruptured disk Batman!! Don’t do that…ever! That’s a great way to end up in traction at your local ICU. Please compare that to the proper deadlift form.
Now that you know how to (and how not to) perform a deadlift, all you have to do is start. If you have never done it before, start with low weights and go slow. Start without weight if necessary. You may want to enlist the help of a personal trainer or a strength and conditioning coach. Work on your form first. Once you know your form is great, start moving some weight.
Lifting heavy (defined as > 75% of your maximum lift) with compound movement exercises- such as the deadlift- has significant benefits. Testosterone and growth hormone are best stimulated under these conditions. This is good for both men and women. Stabilizing muscles that are often overlooked during routine training are stressed by the deadlift. Grip strength is increased. Core muscles are improved. The spinal muscles are strengthened resulting in improved posture. There is an immediate functional improvement to your life since everyone performs deadlifts multiple times daily. Even the cardiovascular system is tapped during a properly structured deadlift workout.
Overall, the deadlift is an exercise that should be performed- often and heavy. First, get proper training in order to prevent injury. Then, get started on the “King of Exercises.”
March 1, 2013
It was with great fanfare that the Journal of the American Medical Association (JAMA) released an article in January of 2013 that stated that you are less likely to die if you are obese! Well, that’s not exactly what the research said, but that didn’t prevent the popular press, such as The New York Times, from latching onto that headline and splashing it all over the internet.
The article itself was very scholarly. It was a meta-analysis* that examined BMI and the relative mortality risk. It analyzed 97 individual studies that included almost 3 million patients and 270,000 deaths. So the study itself was huge and well put together.
BMI categories were broken into the typical ranges: normal weight (BMI 18-25), overweight (BMI 25-30), Grade I obesity (BMI 30-35), Grade II and higher (BMI > 35). From there, they looked at mortality rates from all causes to arrive at their conclusions.
The conclusions of the study were that the overweight individuals (BMI 25-30) had a lower mortality rate than normal weight individuals (BMI 18-25). Those with Grade I obesity (BMI 30-35) had a similar mortality rate when compared to the normal weight individual. Grade II and higher (BMI > 35) was associated with an increased mortality rate when compared to the normal weight individual.
From these conclusions, all sorts non-sensical extrapolations appeared in the lay press and popular blogs. My favorite…maybe we should all gain more weight in order to decrease our relative mortality. Obviously, this is ridiculous, but people were saying things that the researchers weren’t saying and that the research couldn’t support. Allow me to point out two major problems (and a few minor problems) with taking this paper to that illogical end point.
First, the researchers used BMI as their measurement. At best, BMI is a crude tool. It does not measure health or fitness levels. BMI does not measure longevity or quality of life. In my opinion, BMI is useful as a physical descriptor, and it is useful when it correlates with the findings of a thorough history, physical, and lab work. It isn’t of much more use than that.
There are many people who are considered “overweight” by BMI standards but are actually incredibly fit and healthy. Even though the charts may say they are overweight or obese, they are actually at a good weight for them. Athletes with increased muscle mass are notorious for throwing off the BMI measurements.
Second, as the great philosopher George Strait would say, there’s a difference in living and living well. Just because you are alive doesn’t mean you have a good quality of life. As the saying goes, give me life to my years rather than years to my life. Most of us would rather have good health and full lives to the end. When my time comes, let me say my good-byes, and I’ll make a quick exit stage right. Languishing in bed for a decade is not the way most people would choose to go.
This research, while excellent research, did not measure quality of life- only mortality. We can’t make the assumption that just because one group lived longer that’s a good thing.
Other potential confounding factors for this research is that it addresses only all-cause mortality and not cause-specific mortality. It can’t take into account body fat distribution. Age was difficult to derive from the studies. And there is always the possibility of a publication bias (the tendency to publish only positive studies that support an idea instead of studies that are negative or inconclusive about an idea).
The take-home message for this manuscript is not to gain weight if you are at a normal BMI. Please don’t use this as an excuse to ignore your health. The appropriate conclusion is simple- don’t use BMI as your sole source of measuring your health. Don’t hyperventilate over the extra BMI points f you are otherwise healthy.
It’s been know for several years that there is a lower mortality among the overweight and moderately obese populations. The “why” is more difficult. Do these people seek medical care more often and more quickly? Does a little fat provide a significant cardioprotective effect? Do these patients have more “stored energy” that helps during illnesses and injuries? Until we have a better grasp on the “why,” it is difficult to make educated recommendations. Until researchers can make better recommendations the old recommendations still stand- follow a sensible diet, have a lifestyle of reasonably strenuous exercise, and have appropriate medical evaluations to head off trouble.
It’s always amazing to me how quickly the popular press picks up on research and then sensationalizes the headlines. This is a good example why you should read your newspaper, or the internet, with a skeptical eye.
* A meta-analysis is a way of combining several studies into a single huge study. It increases the power and accuracy of the individual studies and decreases the risk for biases in the research. A well-performed meta-analysis is considered one of the highest levels of evidence.
January 31, 2013
Author: S. Bledsoe, M.D.
No time to get to a gym? Out of town? Embarrassed to work out in front of people? All of these are excuses I have heard for why people can’t work out. I posted the above video to show that an extremely vigorous workout can be performed using only body weight exercises.
Watching the entire video, you will note a couple things. First, the only pieces of equipment used were a pull-up bar and a stability ball. Second, some of these body weight exercises can be done by an extremely sedentary person. Third, some of these body weight exercises require incredible strength and are mainly for the fitness elite.
May I insert a little common sense, make sure before you start a vigorous exercise regiment, even just body weight exercises, you get cleared by your doctor. One more thing. If you can’t do a pull-up, don’t attempt the “clapping pull-up” unless you have an excellent disability policy.
Anyway, I hope you found the video both challenging and motivating. As for me, I’m going to keep perfecting my “backflip burpee.”
January 28, 2013
Author: S. Bledsoe, M.D.
“I never thought it could happen so quickly!” After 9 years of struggling with infertility, Susan was now 9 weeks out from her sleeve gastrectomy and 8 weeks pregnant. Her 10 year wedding anniversary happened to fall a week after her procedure, and…well…you get the idea. She thought there was no way pregnancy after weight loss surgery could occur so quickly. She was wrong!
In my preoperative counseling, Susan had discussed her goal of pregnancy after weight loss surgery. I told her that the safest thing would be for her to wait until her weight loss stabilized before attempting to become pregnant. This usually takes 18-24 months but waiting at least a year would be the minimum. I even told her that after surgery she would become a “Fertile Myrtle,” so she needed to be extra careful. She just didn’t think it could happen to her. What could I do at that point but congratulate her and encourage her?
There is a good reason to wait for a period of time before becoming pregnant. After weight loss surgery, your body is undergoing some dramatic changes. Some of these changes are stressful both physically and psychologically. Throw on top of these stresses a new pregnancy that has its own dramatic changes taking place, and you can see how this could be a very difficult few months.
Why bariatric surgery increases the chances of pregnancy is a question we will look at in later posts. I will look at two things right now: timing of pregnancy after weight loss surgery and safety of pregnancy after weight loss surgery.
When it comes to timing, the important thing is to wait until your weight loss has stabilized. That means wait at least a year. Even better would be to wait 18-24 months. This will ensure that your body has time to adjust and normalize after the stressor of major surgery prior to taking on a second stressor of pregnancy.
For women of childbearing years, this means to make sure you take appropriate precautions after surgery. While the oral contraceptive is probably adequate, there are no studies that prove the effectiveness of “the pill” after a weight loss procedure. If possible, use two methods of birth control, including a barrier method.
That’s easy enough, but I am often asked about the safety of pregnancy after weight loss surgery. For that person I would say, pregnancy is often safer after weight loss surgery for both mother and child. One of the primary reasons for this is the improved glycemic control after bariatric surgery.
One patient of mine was know to have had gestational diabetes with a previous pregnancy. After a gastric bypass, she became pregnant. To the surprise of her Obstetrician, her blood sugars were normal throughout the pregnancy. This anecdotal story is similar to what is found in large studies such as the one that came out in 2010 in the Journal of the American College of Surgeons. This manuscript documented lower incidences of gestational diabetes and Caesarean section for obese people who had weight loss surgery versus obese people who did not have weight loss surgery.
Another article out of Santa Monica, California in 2008 noted that when compared to patients without surgery, the surgical weight loss patient has nutritional deficiencies are rare, pregnancy outcomes are acceptable, complication rates are equivalent, Ceasarean section rates are identical and there is likely some protection for the post-surgical patient against gestational diabetes, preeclampsia, and pregnancy induced hypertension.
Conversely, obesity is problematic for both the mother and the child. A 2010 manuscript appeared in the Journal of Obstetrics and Gynaecology Canada entitled “Obesity in Pregnancy.” The authors summarize the major findings associated with obese mothers bearing children and made recommendations for the practitioner. As the mother enters pregnancy, her pre-pregnancy BMI should be below 30. Those mothers that are obese when entering pregnancy are at a higher risk for several, some severe, medical issues including cardiopulmonary disease, gestational hypertension, gestational diabetes, and obstructive sleep apnea. The child is at increased risk for congenital abnormalities. Obese mothers also have a higher rate of Caesarean section. Although the paper did not make the connection, I would point out that all of these recommendations and observations are addressed with weight loss surgery.
In my own practice, I have had several patients become pregnant after surgery, some far too early in the process. However, all of them had far easier pregnancies and safer pregnancies than expected. I am happy to report that all mothers and all children are doing well. As for Susan, at the time of this writing, she is approximately half-way through her pregnancy with both mother and child doing well.
A bariatric procedure should always be a carefully considered decision. This is especially true of women who are interested in pregnancy after weight loss surgery, because timing is the key to having a safer pregnancy and healthier child.
January 5, 2013
In the health and fitness industry, there are few areas that contain more misinformation that the topic of women and weight lifting. I hear this all the time from my female patients, “I don’t want to get big and bulky.” I have a news flash for you…you won’t!
I want to thank my friends at Whole9 for calling my attention to the above video that simply perpetuates the insanity associated with women and weight lifting. At one point in the video, this “celebrity trainer” (whatever that is) says this, “No women should lift more than 3 pounds.” That ruined the whole piece for me and damaged the credibility of this trainer in my opinion. There were other things that raised my blood pressure, but let’s focus on this BIG one.
Ladies, how often do you have to lift more than 3 pounds? The answer is probably hourly, if not constantly. At the Sam’s Wholesale, you have to lift heavy, awkward boxes filed with jars of peanut butter. At home, you put heavy toys on the top shelf of the closet. You drag the vacuum cleaner up the stairs. Even Ms. Paltrow in the video says that she has to carry around her 30 pound child. Just the effort of standing up from a chair or performing a push-up requires more than 3 pounds of exertion.
The point of your exercise regiment is improve your health, decrease your chances for injury, and prepare you to meet life’s physical challenges. Looking better in that dress is a fringe benefit. If you have never trained your muscles to lift more than 3 pounds, what will happen when you need to move that 40 pound bag of dog food from the grocery cart to the trunk of your car? You will either be unsuccessful or risk injuring yourself because your muscles have never learned to lift heavy objects.
So not only will life often demand that you lift more than 3 pounds, but research also directly contradicts this assertion. I know of no scientific data that would back up the idea of women never lifting more than three pounds. I do know of a lot of data that reveals the importance of women and weight lifting. Here are a few reasons why you ladies should lift weights and lift heavy weights at that.
Weight lifting burns body fat efficiently. A 2002 study from the University of Alabama documented a significant decrease in both intra-abdominal fat and subcutaneous fat in women who underwent a 25-week resistance training program. In fact, the results for the women were even better than the men in the study. This suggests that women may have more to gain than men by lifting weights.
Weight lifting helps prevent osteoporosis. A study out of Tucson, Arizona revealed a significant regional increase in bone mineral density in premenopausal women who were participating in resistance training. This study would argue that resistance training may have a protective effect against osteoporosis.
Weight lifting builds useful strength. The Journal of Strength and Conditioning Research published a manuscript in 2011 that revealed significant increases in strength in women who participated in a 12-week resistance training program. These women saw their strength increase by almost 40% over the training regiment which was more than the men in the study. Again, perhaps women have more to gain than men from weight training.
Weight lifting is fun. Alright, I don’t have any scientific research that confirms the “fun-ness” of weight lifting. I will tell you that, because weight lifting is very objective (i.e. you added 10 pounds to your deadlift compared to last month) goal-oriented people tend to really enjoy their efforts. If you can join a community of other females that enjoy weight lifting, such as can be found in my home gym Alexandria Crossfit, your enjoyment will be even greater.
In the field of fitness and nutrition, there can be conflicting answers to the same question with “experts” all claiming they know the truth. This is certainly true when it comes to women and weight lifting. Ladies, based on current scientific research, I have three bits of advice for you when it comes to weight training. Do it…often…and heavy.
December 31, 2012
One of the most common concerns that I hear from people who are about to undergo weight loss surgery is the excess skin that can accompany significant weight loss. There is no speculation about the source of the excess skin. If you have the weight equivalent of an extra adult human hanging off you in the form of fat, the skin has been stretched beyond the point where it can spring back into its original position. The most common question I get about excess skin is who will have this condition after surgery. More pointedly, “Will I have excess skin?” The short answer is I don’t know, but we do know that there are things that will increase your risk for having excess skin.
One, what do you look like before your weight loss? If you have a large, pendulous abdomen, you are very likely to develop loose skin after a significant weight loss. People with excess or disproportionate amounts of fat in certain areas seem to struggle more. Many women after childbirth already have some excess skin in the lower abdominal region due to diastasis or scarring from Cesarean sections. They commonly have lower abdominal issues after weight loss surgery.
Two, how much weight do you lose? Obviously, the more weight you lose the more likely you are to have excess skin. Someone who loses 200 pounds will have more problems than someone who loses 70 pounds. That just stands to reason.
Three, how quickly do you lose your weight? If the weight loss is rapid and extreme, the skin has little time to adjust. If the weight loss is slow and steady, the skin has a bit more time to adjust. Patients can at times have little control over the rapidity of the weight loss, but some things are within their control. Follow your surgeons directions as it relates to diet and exercise. No crash dieting or excessively brutal exercise regiments. Slow and steady wins the race
Four, how much collagen do you have? Collagen is what gives your skin the youthful, elastic, “springy,” quality to it that will allow for the skin to rebound after being stretched. Men naturally have more collagen than women. Younger people have more collagen than older people. So a 22 year-old man would be expected to have less trouble with excess skin than a 65 year-old female, all other things being equal. The “magic age” seems to be around 50. That is the time when collagen content begins to diminish more rapidly, especially in post-menopausal women.
The second question I hear a lot is, “Is there something I can do to prevent excess skin?” Yes, but very little. Some factors you have no control over- your age and gender. Some things are in your control but in the past- how much weight you have to lose. And some things are in your control, but I you may not want to control it just to limit excess skin- speed of weight loss. However, there are a few additional things that might help, but probably won’t prevent, redundant skin.
First, stay well hydrated. Water is critical to the health of your skin. How much you drink is well within your control. After your weight loss procedure, drink a minimum of 64 ounces of fluid per day. This will help keep your skin healthy and put it in a good position to respond. There are several ways to ensure you are well-hydrated. The best is to simply check your urine. I was taught in medical school that a single functional kidney is smarter than a room full of nephrologists (no insult intended towards my nephrology colleagues). If your urine is dark amber and malodorous, you need to drink more fluid. If your urine is clear, you are probably doing well. Another simple, but imperfect, test is a “pinch test.” Simply pinch the back of your hand. The speed that this returns to normal is an indication of hydration status.
Second, maintain proper nutrition. What’s good for your overall health is good for your skin’s health. Specifically, take in at least 60 grams of protein daily. Protein is critical to your body’s ability to heal itself and maintain a healthy body. Your diet should support good health and consist mainly of lean meats, vegetables, fruits, and nuts. I recommend my patients follow a diet similar to the Paleo diet. I have written about this a lot and believe it to be the healthiest diet especially for a post-op patient.
Third, make sure that you have adequate micronutrition. Take a multivitamin specifically manufactured for a surgical weight loss patient like Bariatric Fuel. Many experts recommend extra supplementation for Vitamin D, Vitamin C, and Biotin for skin health. Some also suggest that Omega 3 Fatty Acid supplementation in form of fish oil can also help.
Fourth, don’t self-sabatoge. Smoking is not only a disgusting habit and contributes to cancers and vascular disease, but also damages the collagen in your skin. Just put down the cigarettes. Excessive sun exposure also damages your skin. Some sun exposure is good for you and is critical for your body to manufacture Vitamin D. But too much sun ages the skin rapidly and increases your risk for certain kinds of skin cancer.
Lastly, proper exercise, including resistance training, is necessary. Strong muscles fill out your skin and help support the tissue. The obvious and well-documented health benefits that are associated with exercise also make you a generally healthier person that can be visably seen.
If the above fails and you have significant trouble with excess skin after your weight loss procedure, a surgeon can assist you with certain procedures that are designed to shrink the skin or remove the excess skin. New advances in laser liposuction, such as SmartLipo, will allow for skin shrinkage. But the limits of what the laser can reasonably be expected to achieve can be quickly surpassed by what occurs after weight loss surgery. Talk to someone experienced in SmartLipo techniques in order to see if you qualify.
If you clearly need a surgical procedure, be sure to speak to someone experienced in body contouring after weight loss surgery. Although I am trained to perform Corset Trunkoplasties and Abdominoplasties, I feel that these are better performed by a reconstructive surgeon. I recently visited, Dr. Alexander Moya of Geisinger’s Center for Aesthetics and Cosmetic Surgery, to see newer techniques in body contouring. He was extremely knowledgeable and proficient with these procedures. You would do well to choose someone like him for your procedure.
In closing, I would encourage you to keep things in perspective. While the excess skin is unsightly, consider it a sign of successful weight loss. Not to minimize the psychological impact of excess skin, but your improved health and improved quality of life are the most important things. I wish you continued success in your road to better health!
November 20, 2012
For the past 7 years, the Cleveland Clinic has chosen 10 medical innovations that they feel will change the medical landscape in the coming year. Over 110 experts make their nominations which are then examined by a committee that will chooses the winners. As you can imagine, the selection process is stringent. So what medical innovation received the top spot in this year’s voting? Bariatric surgery for diabetes control took home top honors!*
Although it has been known for years that bariatric surgery can resolve diabetes and result in significantly reduced medication requirements, recent research has been able to directly compare the incredible success of weight loss surgery against intensive medical therapies. A head-to-head comparison that unequivocally confirms the superiority of weight loss surgery over medical management in the diabetic patient is the missing link that bariatric surgeons have been awaiting.
It is probably no coincidence that one of the recent ground-breaking research manuscripts originated in the Cleveland Clinic itself. Dr. Philip Schauer published his work in the New England Journal of Medicine documenting his success. If you would like to read more about this research, follow this link.
This vote of confidence is incredibly gratifying to those of us in this field. Hopefully, this will cause more physicians to consider the viability of weight loss surgery and more diabetics to insist on surgical treatment. Of all the patients that enter my office, the diabetics are the ones I get the most excited about. We have an opportunity to improve their immediate and long-term health. The results can be swift and dramatic. Oftentimes, normal blood sugars can be obtained in the hospital immediately after surgery!
If you are suffering from diabetes, you owe it to yourself to talk with a bariatric surgeon about your options. It could be life changing.
* These were the Top 10 Medical Innovations for 2013 as decided by the Cleveland Clinic:
1. Bariatric surgery for diabetes control
2. Neuromodulation therapy
3. Mass spectrometry for rapid bacterial identification
4. A handheld imaging device
5. Five new cancer drugs
6. Femtosecond laser cataract surgery
7. A lung washing system
8. A new aneurysm technology
9. Breast tomosynthesis
10. The Medicare Better Health Rewards Program Act of 2012
November 13, 2012
Author: S. Bledsoe, M.D.
In 1513, Spanish conquistador Juan Ponce de Leon went searching for the Fountain of Youth. He never found the legendary fountain, but his expeditions did earn him a poisoned arrow in the thigh. He later died of his wounds at the age of 46- just a little shy of his goal of eternal youth. Although Ponce de Leon was searching for a legend, there have been a number of cultural pockets that seem to have found a way to increase their longevity. One such culture is on the little island of Ikaria
Ikaria is a 100 square mile Greek island located in the Aegean Sea. The island is named after Icarus in Greek mythology who fell into the sea near the island. It had been a part of the Ottoman Empire for centuries until 1912 when the little island expelled the Turks and joined with Greece. It has been known for many things- thermal springs, red wine, and the slow pace of life. Recently, it is known for the longevity of its roughly 8000 permanent residents.
“The Island Where People Forget to Die” appeared in the New York Times recently. In analyzing their lifestyles, there were several things that were identified as reasons why the Ikarians live longer than you and me.
Diet was identified as a big variable. This should come as no surprise to anyone who hasn’t been living under a rock. Beans, vegetables, olive oil, coffee, and goat’s milk were all staples in the Ikarian diet. Most of the people grow their own vegetables and even herd their own goats. I tried to find out if there was a McDonald’s on the island. I was unable to confirm the presence of the Golden Arches in Ikaria. If this information makes it back to McDonald’s HQ, I have no doubt that silly clown will be traipsing all over the island ruining the culture. The local beverages of “mountain tea” and red wine also figured prominently into the narrative. Both drinks are locally made. It is interesting to see the number of healthy cultures that drink herbal teas and moderate amount of red wine.
Possibly the thing I found most interesting was that the Ikarians love an afternoon nap. When I was a kid, I would have preferred being water-boarded than to take an afternoon nap. Fast-forward to today, my Sunday afternoon is incomplete if I can’t catch at least 30 extra minutes of sleep. I would love to have an afternoon siesta, but it seems that the American lifestyle, my job, and napping are antithetical. Of historical interest, there are many famous men who insisted on afternoon naps- Winston Churchill, John F. Kennedy, Napolean Bonaparte, Thomas Edison, and Stonewall Jackson. In 2007, The Archives of Internal Medicine published an article that demonstrated that afternoon naps were associated with 37% fewer cardiac deaths in men. So next time you’re caught sleeping on the job, tell your boss you are trying to decrease your likelihood of dying from a cardiac event. Let me know how it goes.
In contrast to most of us, the Ikarians are not slaves to the clock like Americans. No one wears a watch there. A lunch date could take place somewhere between 11:00 and 4:00. The pace of life here is just a fraction of what it is elsewhere. This reminded me a little of Hawaii where the islanders were on “island time.” Meaning, a scheduled time was more of a range than an actual point in time. The pace in Ikaria is at a snails-pace when compared to the frenetic lifestyles of most Americans.
Lastly, the people of Ikaria have strong social ties to their community. They enjoy getting together and passing the time by telling stories and drinking the local teas and red wine. Every holiday and religious event is an excuse to get together as a community and celebrate. These strong familial ties and friendships certainly add to their longevity. In his book “The Survivors Club,” Ben Sherwood documents that one the “X-factors” that helps people survive serious physical traumas is close relationships with family and friends. There is something that can’t be quantified that positively effects our well-being when we have close relationships. As Mr. Sherwood states, “there is something powerful about family and friendships.”
All of these things add up to a single common denominator- less stress. It has been known for a long time that excessive stress wasn’t good, but only recently, we have been discovering just how detrimental excessive stress can be for your health. Excess stress can decrease immunity, increase rates of atherosclerosis, encourage insulin resistance and obesity, diminish HDL cholesterol, cause depression, manifest as sleep disorders and chronic pain, and contribute to overall poor health. What do experts suggest doing to alleviate stress? Slow down, eat well, and spend time with family and friends are all good suggestions. Sounds like the Ikarians have nailed it!
We Americans could take some cues from the long-living Ikarians. A healthy diet, a little extra rest, a less rigidly scheduled life, and strong relationships are things we could strive for on a daily basis. Even if these things don’t improve your longevity, your life would likely be more enjoyable and a lot less stressful.
October 29, 2012
Weight loss surgery can cure diabetes. You read that correctly! Weight loss surgery can cure diabetes.
Over the past 20 or so years, bariatric surgeons have noticed the profound effects that weight loss surgery has had on glycemic control. Hundreds of studies on many thousands of patients confirm what surgeons and patients already knew. This information has been slow to be accepted by the medical community, because it was felt that diabetes was a medical problem at large. What was missing from the bariatric literature was a controlled, head-to-head comparison between bariatric surgery and intensive medical therapy…until now.
Dr. Phillip Schauer from the Cleveland Clinic documented the superiority of bariatric surgery in a 2012 article that appeared in the New England Journal of Medicine. He discusses his findings in the above video. This confirms the superiority of surgery over medical therapies for a qualified patient with diabetes.
The effects that surgery exerts on diabetes is complicated, and it goes far beyond simple weight loss. Often, diabetes is resolved immediately following the surgery before they lose any weight at all! More and more, diabetes is now being viewed as potentially a surgical issue in the right patient.
Remember only a bariatric surgeon can determine if you qualify for bariatric surgery, but if you are a diabetic and your BMI is greater than 35, you owe it to yourself to consider weight loss surgery. You may find what thousands of patients have found our for themselves, that weight loss surgery can cure diabetes.
October 21, 2012
If you’ve been keeping track of the rollout of Obamacare, you know that Oct. 1, 2012 had serious repercussions for many hospitals- about 2,200 hospitals nationwide to be exact. These hospitals have been identified as having a 30-day readmission rate that is considered too high. The government’s answer to this problem is penalize these hospitals by decreasing their Medicare reimbursement by 1%. This will gradually increase to 3% over time. It is estimated that this will cost the hospitals almost $300 millions over the next year. This represents around 0.3% of the total amount that Medicare pays hospitals. This adds up to trouble for the patient.
If I were to grade this idea, I’d give it an “A” for good intentions and an “F” for implementation. My major problem with this misguided attempt is that all patients are not the same. The vast majority of patients are engaged in their health care. They want to get better, and they want to return to their normal lives. But some people are what we call “non-compliant.” They will not take care of themselves. They will not follow the doctors instructions. They will not follow-up appropriately. This begs the question, why would a patient not follow their doctors instructions? Let me give you a few reasons.
Some people purposefully abuse the medical system. When I was in training, we had a patient “Ms. Smith” who was in our hospital every 3-4 weeks with the same complaint of abdominal pain. She had the million-dollar work-up, including exploratory surgeries, but she was always back for more. As my training continued, I began to cover two additional hospitals. Imagine my surprise when I found that “Ms. Smith” was admitted to one of these hospitals. A little research uncovered that she basically had a little circuit of hospitals in town that she would go too. She would get discharged from one, go home for a day or two, get readmitted to a different hospital, and repeat the cycle. She basically lived at one hospital or another most of the year.
Some people purposefully self-sabatoge. I’ve had prisoners swallow safety razors 5 or 6 times, so they could get out of prison. I’ve had people stuff foreign bodies or even stool in their wounds, because they like the attention they were getting when they were sick. If they left the hospital, they wouldn’t be sick and no more attention. I’ve had people in the middle of an active stroke walk out of the hospital and not return, because we didn’t want them to go outside and smoke while they were on a medication drip.
Some people, surprisingly enough, just can’t seem to make rational decisions. Consider that 6% of people think the moon landings are a complete hoax. 7% of people believe that Elvis is still alive. If you can’t be convinced that Elvis is dead, how can I convince you to take this little pill and see me again in 2 weeks?
Substance abuse will cause people to ignore or not remember their doctors instructions. 7.4% of Americans meet criteria for alcoholism. Around 1,000,000 Americans are considered “hard-core” heroin users. Almost 9% of the U.S population currently uses some form of illegal drug. Over 6 million people abuse prescription medications. Certainly, these numbers represent a lot of overlap (heroin users are also likely to abuse prescription drugs and alcohol), but suffice it to say, substance abuse is a real problem in America.
Psychiatric disease can also play a role in being “non-compliant.” Psychiatric diseases can range from mild to disabling. Schizophrenia is present in around 1% of our total population. Antisocial personality disorder occurs about 1% of the time. Major depressive disorder is the leading cause of disability for Americans aged 15-44 and occurs in 6.7% of the population. The National Institute of Mental Health has a list of the most common mental disorders in the United States. Mental disease is real, disabling, and problematic for medical care.
Finally, dementia, often undiagnosed, can play a role in a patients ability to follow their doctors instructions. About 1 person in 7 over the age of 71 has some type of dementia. It’s scary to learn that ½ to 2/3 of all dementia is currently undiagnosed, including almost 80% of mild dementia flying under the medical radar. I can tell you that dementia can be very subtle. I have had many, what I thought were, normal conversations with elderly patients only to find out the next day that they couldn’t remember any of the conversation. I like giving instructions to both the patient and a family member, no matter what the age of the patient, in order to ensure that there is no confusion. Regardless, confusion can occur, and dementia can play a role.
I’m guessing here, but I would estimate that 10-20% of all patients nationwide have a medical diagnosis, substance abuse problem, ulterior motive, personality quirk, or decision making capacity that puts them at a high risk for ignoring or not following their doctors direct instructions. To ignore this and put the responsibility totally on a hospital system is ludicrous.
Just so there is no misunderstanding, treating difficult people is something that every physician, nurse, and hospital is ready and able to do. We all recognize that we will run into drug addicts, psych patients, dementia, personality disturbances, and, occasionally, homicidal patients. Everybody deserves a chance at life and improved health, and we work tirelessly to bring improvement to everyone. This isn’t a complaint that we have to care for them. This is an expression of concern that reimbursements for hospitals are tied to things well outside of their ability to control.
Why should you care about this? Who cares if a hospital gets a cut in payment? In a single word…access. Hospitals are already financially strapped. Rural and inner city hospitals are in particularly difficult financial straits. I know from personal experience that hospitals can go bankrupt. That situation is bad for the employees and the community that is served. I fear that diminished payments will result in more hospital closings. This can result in serious access issues for patients who have to drive longer and longer distances to hospitals that are drowning under the new influx of patients.
I think that while the people who dreamed this up had noble intentions, the cure is worse than the disease. I can only hope that either I am wrong or this error is corrected before serious damage is done to our hospital systems.