October 21, 2012

Good Intentions Gone Bad- The Medicare Reimbursement Debate

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Written by S Bledsoe

Author: S. Bledsoe, M.D.

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.

October 14, 2012

8-Weeks and Done or 8-Weeks and Just Begun- The Genesis Experience

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Written by S Bledsoe

Author: J.Taylor

Perspective and motivation; these are two very powerful things; the kind of things that can either defeat you or drive you.

 

If you are meandering through life, day by day, with no particular aim, an 8-week Paleo/Crossfit challenge, known as The Genesis Experience, can knock you into a tailspin.  You can see the challenge as an enormous mountain blocking your path to “Nowheres-ville”, and you have no hope of scaling that seemingly impassable mountain.

“Fine.  Whatever.  I guess I’ll at least attempt to crossover the mountain so I can get back to normal, and resume my path to  ‘Nowheres-ville’.  I mean, if I at least make an attempt, I’ve alleviated my guilt, right?  I mean, I’m just proving to everyone that I really am stuck, and I’m just going to have to be this fat forever.  I tried, after all.  What more can people want?”

That’s one perspective.

Here’s another:

“The Genesis Experience.  Wow.  What exactly does that mean?  I’ve never even heard of it before.

Well, I talked to my doctor about my frustration with my weight-loss plateau.  I went to him, searching for answers that I didn’t have.  I’ve done the things that I think I should be doing, and I’ve hit a brick wall (or a mountain, as some say).  As a matter of fact, I keep hitting that same brick wall, with the same result again and again.  I suppose that means I need to get off my current path and find a way around this obstacle, or burst through it.

Great!  My doctor has given me this shiny, new ‘toolbox’ (called The Genesis Experience) full of tools to break down this brick wall.  I’m glad he listened to my concerns; I guess the next thing I need to do is explore this toolbox and figure out how to use these new tools.  It looks very intimidating, but going back and hitting that brick wall again is not an option for me.”

 

I’ve chosen the second perspective.  It’s a choice.  I’ve made that choice and set it in ink.

It’s a turning of a page.  I’m not going to read the book backward.  The page has been turned and I’m moving on to the rest of the story; and yes, there is a “rest of the story”; it doesn’t end here.

By choosing this perspective, it takes the monster of  lifetime weight issues and makes it just an obstacle – not an impassible mountain.  That, my friend, brings HOPE.

This choice also renews motivation.  “Oh, this is a nasty brick wall, but now I’ve been given tools to break the wall down, and guidance on how to use the tools effectively. LET’S DO THIS THING!”

In addition, this perspective does not put focus on the chatter of what other people think, say, or expect.  It puts the focus right where it needs to be; on me and the obstacle.  The chit-chat of what others may or may not think is peripheral junk, pebbles on the path; not worth my time or energy.

 

As of today, this 8-week challenge has come to its conclusion.  I’ve completed the task, and I’ve done what my doctor suggested.  I’ve worked extremely hard, and I’ve done a good job.  I’ve seen positive results:  greater strength, greater stamina and endurance, greater mobility, better and steady energy (not high-low energy spikes), greater mental focus….and by the way, I’ve dropped two dress sizes this 8-weeks.  Not too shabby, eh?

 

So here’s the question:  8-weeks and done?  Or, 8-weeks and I’ve just begun?

 

Pfff!  If you even THINK it’s 8-weeks and done, you know nothing about me.

October 7, 2012

Success After Weight Loss Surgery- Show Up

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Written by S Bledsoe

Author- S. Bledsoe, M.D.

“What can I do to improve my chances for success after my weight loss procedure?”  As a bariatric surgeon, I am often asked this question.  Of course, success is dependent on many factors, most of which are widely understood.  I don’t think anybody would argue with me that a sensible, protein-based diet plan is a major predictor for success.  Regular exercise would be high on any reasonable list of things to do post-procedure.  But I want to highlight two things that I think are critical to long-term success after weight loss surgery that don’t get a lot of press.  I can summarize both of them into two words- “show up.”

 

The first thing that you need to “show up” for would be your appointments with your bariatric surgeon.  During the honeymoon phase after your procedure, most people are very diligent about seeing their surgeon.  As time continues, the novelty wears off, your weight loss has stabilized, and the idea of waiting to see you doctor has lost what little appeal it had in the beginning.  Let me encourage you, regular follow-up with your physician is very important to your success and your long-term health.

 

Researchers from the University of Pennsylvania recently published an article in Obesity Surgery.  In their report, they analyzed 313 gastric bypass patients and demonstrated that weight loss was significantly increased with increasing numbers of clinical visits with their physician.  In fact, patients were almost 3 ½ times more likely at 12 months and almost 3 times more likely at 24 months to have lost more than 50% of their excess body weight as their attendance at follow-up appointments increased.

 

So, why are people more likely to lose weight if they follow-up with their physician?  It’s hard to say, but I suspect that part of the answer lies with accountability.   They know that when they walk in the door to see their doctor that they will be queried about their weight gain and applauded for their weight loss.  That’s the doctor’s job.  I have had patients tell me that they really start paying attention to what they are eating and start working out more as their appointments get closer.   That’s the power of accountability.

 

But, I think there’s another reason why people lose more weight if they go to their physician’s appointments.  Complications of all varieties are identified earlier.  Vitamin deficiencies will make you feel lethargic or sickly.  Who wants to work out when you feel exhausted?  Big problems are avoided, because they are found when they are irritations as opposed to emergencies.

 

Your doctor is there to head off problems and to be a resource to you.  They want you to succeed.  You are their walking billboard.  You should take advantage of their knowledge and expertise.  But, you should “show up” to one more thing in addition to your doctor’s appointment.

 

The second thing that you need to “show up” for would be your support group meeting.  Hopefully, you live in an area with a robust and stimulating support group.  If you don’t, consider starting one.  It is a great way to connect to others, find new friends, get new ideas, and achieve success after your bariatric surgery.  The idea of support groups for weight loss surgery patients has been around for years and is gaining in popularity, but we’ve known for decades that support groups help cancer patients.

 

Perhaps the most common cancer support groups are those for victims of breast cancer.  Breast cancer support groups began in the 1970’s and have become commonplace in most communities.  While support groups do not increase survival of women with breast cancer, support groups will improve the mood, improve the perception of pain, and decrease anxieties.  This improvement in mental well-being can be attested to by thousands of breast cancer survivors.  This improved quality of life extends to other cancer patients when they become involved in support groups, and there is no reason that bariatric patients should not capitalize on this to help them with their weight loss.

 

A 2011 systematic review from UCLA was released by Obesity Reviews.  They compiled 10 studies that included 735 patients to determine if attendance at support groups increased the likelihood of weight loss.  Let me quote the study itself.  “Support group attendance after bariatric surgery is associated with greater post-operative weight loss.”

 

Why do support group attenders lose more weight?  There is no doubt in my mind it’s because of the wealth of knowledge found in other patients.  As much as your doctor tries, they cannot identify with your struggles like another patient.  The person next to you may be able to give you exactly the advice that you need at exactly the right time.

 

That being said, one day you may be the beneficiary of the knowledge, and the next day you may be the dispenser of the knowledge.  No matter how far down the path you go, always be willing to help a fellow traveler.  You will benefit greatly from these interactions.

 

So, there you have it.  Just show up.  When you have a doctor’s appointment, show up.  When there is a support group meeting, show up.  If you will do just these two simple things, I have no doubt that the odds of your success will increase substantially.

September 27, 2012

Functional Goals After Weight Loss Surgery

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Written by S Bledsoe

Author- S. Bledsoe, M.D.

Linda (not her real name) was 14 months after her sleeve gastrectomy, and she was very concerned.  “I’ve stopped losing weight, and I’m not where I want to be yet.”  She had hit a weight loss plateau.  It happens to everybody, but for her, it happened too soon.

 

In her case, Linda was a success story in every sense.  Her diabetes was gone.  Her high blood pressure had resolved.  Before surgery, she couldn’t walk 50 yards before surgery without taking a break.  Now, she was competing in local 5K races.  She had lost 60% of her excess body weight, but she still had about 60-70 more pounds to go.  She was, understandably, happy with her progress but frustrated with her stall.

 

Perhaps you can identify with Linda.  You are doing what you are supposed to be doing.  You are watching what you are eating (cheating rarely).  You are exercising pretty well (OK, everyone could do more).  In spite of this, you are worried that you will never reach your weight loss goals after your bypass/sleeve/band.  What should you do?

 

After ensuring there are no glaring problems with your diet or exercise regiment, you should throw away your scale and set functional goals for yourself.  What do I mean by “functional goals”?  Set an attainable goal that is based running faster, lifting heavier, or performing more efficiently any movement or exercise.  Let me give you an example by using walking.  Let’s say you can walk 1 mile in 20 minutes.  A new functional goal for you would be to walk a mile in 18 minutes.  After you hit that milestone, your new functional goal might be to jog 1 minute out of every 4 minutes.  Perhaps you enjoy kettlebell swings.  A new functional goal might be to perform more repetitions within a given period of time, more total rounds, or a heavier weight.

 

By using functional goals, you will constantly be challenging yourself.  It will give you something new to focus on instead of staring at the scale until your eyes sweat.  And, the reality is that functional goals are more important than weight loss goals.  These are the things that make you feel like you are getting healthier and better able to be involved in your life.  Hitting these goals will mean you are able to play with your kids.  You can climb a flight of stairs.  You can tie your shoes without getting out of breath.  Your quality of life is directly tied to how well you function- not your weight.

 

Am I minimizing your weight loss goals?  Not at all!  Your weight loss goals are important and obtainable.  You just need to re-focus.  By focusing on functional goals, you will eventually hit your weight loss goals.   

September 25, 2012

Pondering the Paleo Diet- Seeing is Believing

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Written by S Bledsoe

Author- J. Taylor

As you well know by now, when I first heard about the Paleo diet, I immediately shut down and decided there was NO WAY I could do it.  There were so many foods on the “do not eat” list, and only the foods I liked the least were on the “eat me” list.

My favorite comfort food is my homemade, hearty oatmeal, and I distinctly remember the first informational meeting when I learned I would not be able to eat it.  I was completely shocked (everyone knows oatmeal is good for you!), and I felt this internal wall go up defending my right to eat this wholesome dish.  I felt like getting up and leaving the meeting right then and there.

I’m not going to lie, the first week or two were difficult, but I’m so very glad I pushed through the hard part and stayed on target.  I’ve learned so much in the past couple of months; but now it’s more than just academic knowledge.  I’ve seen the positive results for myself with my own body.  It’s like a light bulb has turned on and now I “get it”.

Even keeping the food journal, that I thought would be so tedious, was immensely helpful.  I could look back and see how my body reacted to certain foods, and also, by keeping the journal I stumbled upon juicing my veggies (which has been a big help to me).

My mental focus has greatly improved.  The fogginess that hung over me while I ate bad carbs has all gone away, and I’m vibrant and alert, now.

In addition to that, I no longer have spikes of energy followed by crashing.  I have a nice, steady energy that lasts all day long, with no spikes.  Wow!  What a blessing that is.

I’ve had some other unexpected, positive results from the Paleo diet.  My complexion has evened out, my psoriasis has vanished and my chronic neck pain is gone.  I was not anticipating any of these things, I was just trying to lose weight.

As this 8-week Paleo diet/Crossfit challenge comes to an end, I realize I don’t want it to.  As I look back to the beginning, it seemed so unattainable.  Now, at the end, I’m so proud of myself.  I’m stronger, more confident, and I have decided to continue on with this lifestyle.  Difficult?  Perhaps.  But much easier than it was 8 weeks ago.  And I feel sure that in another 8 weeks, it will be even more second-nature to me.

What about you?  Have you taken time to consider any of this?  Don’t let your fear hold you back.  You have nothing to lose (except weight, LOL) and so very much to gain.  Think about it, and let me know what you decide.  I want to hear your story.

September 20, 2012

Eat Your Peas and Keep a Food Journal

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Written by S Bledsoe

Author: J. Taylor

Discipline and routine – ick!  Some people make it look so easy, don’t they?  For me, it seems to be the bane of my existence.

How many times have I started a diet or a gym class, gotten about two or three weeks into it and given up?  Does this sound familiar to you?  Of course, that’s also some of the same behavior that put me more than 100 pounds overweight.

So, whine as I might, I had to face the facts.  I needed to put on my “big-girl” pants and deal with it.  I simply MUST change BOTH my diet AND my exercise.  In the past, I’ve done one or the other, but it seems I never had what it took to do both at once (at least not for an extended length of time).  I would need a mega-dose of the “D” word, “discipline”.  If I struggle with discipline, then how on earth do I attain it?  Doesn’t it first take discipline to attain discipline?

My first step to this goal has been to admit that I balk at routine and discipline.  Not just admit it to myself, but actually discuss it with others.  Then, the cat is out of the bag, and I actually have to deal with it.  No more ignoring the elephant in the room.

Secondly, I sought out help.  That is such an easy thing to type out into a sentence; but in reality, I’m notoriously self-sufficient and cringe at the thought of asking help from anyone.  (Pssst, this is also called “pride”, but if I don’t say it out loud, maybe it doesn’t really exist. Ya think?).  Nevertheless, it was obvious I wasn’t able to make the change on my own, so I searched for a healthy form of support.

As I mentioned in a previous blog, my doctor suggested the Paleolithic Diet & Crossfit challenge.  How could I refuse?  I’d asked for help; I’d searched for a path to better discipline, and bada-bing-bada-boom, here it was!  Besides, it was only 8-weeks.  I can do anything for 8-weeks.

As part of this challenge, I was required to keep a food journal, and to email it to the doc each week.  As much as I hate to admit it, the food journal turned out to be very beneficial.  I journaled  what I ate and drank, what time I ate it, and how I felt one hour later.  During the first few weeks, the doc could get a feel for my pattern of nutrient intake, and as a result, better advise me on my questions and my choices.

About the third or fourth day into the challenge, I began a horrible battle with carb withdrawal.  In the past, I may have dropped out, but I was determined to break through this wall.  I had to push on through, no matter what.  As a result of keeping a food journal, my doc could see that although my fruit intake was great, my veggie intake stunk.  So, he let me know, and I looked for a way to get more veggies into my diet.

I borrowed a juicer from a friend, and juiced a lot of my veggies, and kept track of it in the food journal.  As a result of doing this, the doctor and I could see a marked improvement in my energy and mental focus.

Okay, I admit it.  Discipline is good.  It may be difficult, but it’s very beneficial.  Are you ready to try?

September 17, 2012

Reset Button – The 6-Day Pouch Reset

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Written by S Bledsoe

Author- S. Dekeyzer-James

The Internet is like a massive alien bazaar — whatever you could possibly want is out there for you to look at, buy, sell, or trade. Whatever subject you’re interested in is out there — all you have to do is choose a search engine, type in what you’re looking for and press “enter”.

 

I’ve been researching, studying, and analyzing web sites on one subject for several years now: Weight Loss Surgery.  I’ve looked at hundreds maybe thousands of web sites, YouTube channels, FaceBook pages, and dozens of chat areas all on weight loss surgery. I’ve also been monitoring what’s being discussed in the weight loss surgery community; and I’ve learned quite a bit – some of it good; some of it — flim-flam.

 

About two months ago, my weight loss had just about come to a standstill.  So, I began delving back into the web sites, YouTube channels, FaceBook pages and chat areas again looking for some answers.  It was by accident that I was looking at a YouTube channel I subscribe to and I saw over in the right column where they post “suggested videos of interest” a video entitled: Pouch reset.

 

If you were to “Google” pouch reset you’d get one million nine hundred thousand “hits”.  That’s probably how many reactions you get about this subject too.  I found most folks split down the middle.  Some said it was “completely bogus” and others said “it works like a charm”.  After a good bit of actual Internet research and studying a good many web sites — filtering out the nonsense while I was at it — I offer  the *6-Day Pouch Reset Plan.

 

*Note: Since many of the web sites I looked at were selling rather pricey versions of the Pouch Reset plans – I offer the completely non-proprietary version below.  I urge you to do your own research to find a plan you’re comfortable with.

 

What is it?

Basically the “Pouch Reset” was putting you back in touch with your “tool” (i.e. your pouch). It condenses the approximate 6-weeks recovery period after surgery in to six days.  It was recommended that about ten to fifteen months post-op you could try the 6-Day Pouch Reset.

 

Okay, I thought, nothing ventured, nothing gained. I waited until the weekend end to begin. Here’s the plan I followed for six days:

 

The 6-Day Reset Plan:

 

Day 1 and Day 2:  Liquid protein — in the form of protein shakes, smoothies, you drink these for each of your meals and snack. The first day I was thinking I had it licked, but by day two; I was wavering…. but I stuck it out.

 

Day 3 and Day 4:  Measured Puréed foods — Two ounces of whatever you’ve decided to eat.  Fat free refried beans; sugar free jell-o and continue having the protein shakes – I usually had a shake for breakfast.  I continued with my exercise classes, but found that I fizzled out about 30 minutes into the class — but still I stuck it out. By the end of day 4 I was feeling pretty good!

 

Day 5 and Day 6: Semi-soft foods – I continued measuring my food, two ounces of refried beans with a cube of cheese melted in it. I added things like scrambled eggs, pan seared fish filets, and kept the protein shake for breakfast and if I felt hungry I had another protein shake for a snack.

 

The results:

I weigh myself every Saturday morning. I use Wii Fit Plus™ my daughter and I got for Christmas to keep track of everything.  So just like every Saturday, I powered up the Wii and stepped on the Wii Fit board and it measured me and lo and behold 6.2 pounds lost!

 

When I stepped on the scale at the weigh-in at the gym that Monday night, I had lost another pound for a total of 7.2 pounds!  The following Saturday, I’d lost another 4.4 pounds.

 

Bogus or Beneficial?

All the various Pouch Reset Plans do exactly what they claim they will do: make you aware again of the tool your bariatric surgeon gave you to work with.  I say it was beneficial – but you’ll have to decide for yourself if you give the Pouch Reset Plan a try.

September 15, 2012

Loner vs. Group Workouts

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Written by S Bledsoe

Author- J. Taylor

Which gives you a better workout?  Group class or loner style?

Up until I began my 8-week diet and exercise program called The Genesis Experience, I had never tried group workouts.  At times, I would hire a trainer to help me out; but it’s always been me versus me.

With this 8-week focus group I am participating in, it’s the first time I’ve experienced a workout in a class style with a trainer who is teaching us proper form, different moves, etc.  My class consists of five other people who are similar to me.  In other words, we are all well matched.  No one is light years better than me, nor am I the leader of the pack who is being slowed down by the rest of the group.

I’m finding out that this style of training works really well for me.  When it’s me versus me, my mind is so focused on my shortcomings, that I actually seem to become an enemy to myself, thwarting my own efforts; thus in the end, defeating myself and giving up.

With this group I’m training in, we have sort of a friendly competition amongst ourselves, yet at the same time, we root for and encourage one another.  For me, it is making a night and day difference.  Rather than me feeling as if everyone else is in a completely higher league than I’m in, I know that my classmates are in the same boat as me, with similar struggles, and trying to defeat the same “monsters” I’m working to overcome.

I know there are different strokes for different folks.  But, for me, I’ve discovered that a group style workout is far better than going loner style.  What about you?  What works best for you?

September 12, 2012

Weight Loss Surgery vs. The Biggest Loser

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Written by S Bledsoe

Author: S. Bledsoe, M.D.

I couldn’t believe my ears!!  I was speaking with a fellow general surgeon, and I had just quoted him a huge meta-analysis of over 22,000 patients that demonstrated the amazing successes with weight loss surgery.  His response was, “Well, I was watching on The Biggest Loser the other day…”   Was this educated man really equating a TV Show to a mammoth scientific meta-analysis?  I had to pause for a second to collect my thoughts.  The difference in the level of rigor between the peer-reviewed publication and The Biggest Loser is the difference between the Pope speaking ex cathedra and the local busybody passing gossip over the backyard fence.    Sigh…  Some people well never acknowledge the superiority of weight loss surgery.

 

This interaction was replayed in my mind when I read this article in the LATimes the other day.  I thought the article was fascinating.  Fascinating in a I-can’t-believe-what-I’m-reading kind of way.  Dr. Robert Huizenga is the medical director for NBC’s The Biggest Loser.  For those who are unaware, The Biggest Loser is a reality show that recruits obese individuals for a vigorous exercise regiment and strict diet.  Of course, an ultimate winner of the competition is crowned The Biggest Loser.  The diet is a low calorie, and the work-out regiment consists of 4 hours of exercise every day.  So far so good, but then Dr. Huizenga states that the changes he saw have “never been documented in the history of severe weight loss.”  Really?  It sounds like another day in the office to me.  He further draws the comparison between weight loss surgery and the TV show.

 

Weight loss surgery has been and always will be a last resort for a person in their weight los journey.  Before I will perform a weight loss procedure on anyone, they must have demonstrated that they have attempted diet, exercise and behavior modification without success.  I have sent people out of my office when they tell me they have never tried weight loss through the traditional methods.  I have monthly seminars for people interested in weight loss surgery.  One thing I always say, “If you can lose your weight through diet, exercise and behavior modification, that’s what you need to do!”   That does not mean that the weight loss crown is in danger of being passed from surgical intervention to NBC.

 

On the show, Dr. Huizenga documents the average contestant is a BMI of 40 with the majority having diabetes and high blood pressure.  This is a lighter patient that most bariatric surgeons work with.  A typical patient for a surgeon would be this article from the Annals of Surgery where the 379 patients had an average BMI of 46.  This range is much more typical from the bariatric surgeon.  A BMI of 40 or less is in the featherweight category for me.

 

Dr. Huizenga further describes the diet as being low-calorie, and I have no issue with the diet.  But the exercise regiment is impressive.  Four hours of training every day.  This includes one hour of resistance training, one hour of intense aerobic activity and two hours of moderate activity.  I thought to myself, “Who has time for this much exercise?”  The answer is obvious- a game show contestant.  There are few people in real life that are capable of this kind of time commitment.  In fact, Jillian Michaels (one of the original The Biggest Loser personalities) herself states that this much exercise is “not possible” and “not safe” in real life.   I was watching a similar show the other day where the contestant had to quit their fulltime job because of time constraints.  Fortunately, they had a supportive spouse who got a second job, so they could continue 4-6 hours of daily exercise.  This is just impossible for all but a few people.

 

I didn’t disagree with everything that Dr. Huizenga said in the article.  I agree that “what doctors call ‘aggressive medical therapy’ is laughable.”  I also agree that large weight loss results can be had safely.  And I also believe that people should go to great lengths to show themselves that diet and exercise isn’t working before attempting surgery.   Unfortunately, I can’t agree or disagree with his statements that his results are as good as weight loss surgery since the results are not yet published at the time I am writing this.

 

But the thing that got my blood pressure up was the following:

 

“In an interview, Huizenga said the “Biggest Loser” approach, which shocks a patient’s body to build muscle and bone while losing fat, may be intensive and costly. But he asserted it would probably be cheaper to treat obesity with such an intensive, short-term program than to treat a bariatric patient at a cost of $30,000 per surgery and the additional expense of treating complications.

“If someone like me could get half the amount that a bariatric surgeon gets to treat a single patient, you could see some amazing things,” Huizenga said.”

 

This ridiculous comment reminded me of Presidents Obama’s assertion  about a surgeon being compensated “$30,000, 40, $50,000” for a foot amputation.  People, please, if you don’t know something, don’t act like you do.  A surgeon who trained me used to say, “No information is better than bad information.”  No information will result in you tracking down what is correct.  Bad information will result in action based on an erroneous thought.

 

Here is the truth about the surgeon’s reimbursement for bariatric surgery.  That $30,000 figure is to cover the surgeon, the hospital, the hospital stay, the nurses, the anesthesiologist, the pathologist, the OR time, and any ancillary services required as well.  In my region, surgeons don’t get reimbursed even 10% of that figure under the best of circumstances.  In all cases, this price includes the follow-up for 3 months after the procedure in which we do not get compensated anything extra.

 

So, Dr. Huizenga is willing to personally supervise patients for a 24-week program of intensive dieting and grueling exercise for $1000 of total payment?  I think most insurance companies would be on board.  In fact, many patients would probably fork over one thousand dollars for 6 months of that kind of personal attention.  Obviously, the doctor is gaming for the $15,000 payout, because expecting him to do that for $1,000 is as unrealistic as getting most people to exercise for 4 hours a day!

September 10, 2012

My First Experience with the Paleo Diet

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Written by S Bledsoe

Author- J. Taylor

Paleo diet, Caveman diet, Adam & Eve diet – call it what you will, but it all means the same thing;  the only carbs you get on the Paleo diet come from fresh veggies and fruit.

 

Greek yogurt?  Nope.

Milk?  Nope.

Cheese? Nope.

Cereal? Nope.

Pasta?  Nope.

Ice cream?  Ummm, that’s a given “no-no” on any diet.

Okay, what about Pinto beans?  Those are good for you.  Nope.

Baked potatoes – they’re healthy?  Nope.

 

When I discovered that this was the Paleo diet my doctor prescribed for me, along with the 8-weeks of a Crossfit exercise regiment known as The Genesis Experience, I thought to myself, “this is impossible!  What have I agreed to, anyway????  That doctor has lost his marbles!”

The first week was rather rough, I admit.  I had to think of things I could actually tolerate eating.  In addition to that, I needed to do a lot more prep work for the food I actually did eat.  Plus, I had to think ahead for the entire day and pack food to bring with me to work, or bring a healthy snack if I were to be out in town for the day.

In addition to all of this, I had to deal with a “carb hangover”, or carb withdrawal symptoms, of lethargy and a general, overall yuckiness.

 

HOWEVER – After the initial couple of weeks, I noticed positive changes in my body.  I was determined not to give up just because it was difficult in the beginning.  After all, isn’t that what I’d been doing my entire life?  Isn’t that why I ended up having bariatric surgery?  Hmmmm?

As per the doctor’s requirement, I was keeping a food log of what I ate, and how I felt an hour after I ate it.  It became clear that I had no problem at all getting plenty of fruit in my diet, but veggies were sorely lacking.

So, in an effort to correct this imbalance, I borrowed a juicer machine from my friend, and gave it a try (it’s a “Jack Lalanne Classic” juicer, and it works great).

I juiced:  kale, spinach, chard, collard greens, etc.; which by themselves would’ve tasted awful.  But, I found that by including a lemon, or apple in along with them, it really helped cut the “green” taste for me.  Okay, it still didn’t taste terrific, but, I was getting all my nutrition in, and it only took a couple of gulps and I was finished.  Yep, that worked for me.

As a result of keeping the food log, my doc and I could see a pattern emerging.  Once I began juicing, my energy and overall sense of well-being significantly improved.

At present, I am half way through my 8-week Paleo diet/Crossfit challenge.  Some of the folks in the group began seeing and feeling positive results almost immediately.  But, for me, it has taken at least three weeks into this program to really start seeing and feeling positive results.

But, I’ve kept at it the whole time, even on days when I felt discouraged that I wasn’t seeing the results my classmates were.  I’m extremely glad I’ve kept with it.  I’m loving the results I’m seeing now and also those I’m feeling.  Perhaps ol’ doc hasn’t lost his marbles after all!

 
 
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