We are getting this address turned into a real website in the coming weeks. Look forward to seeing you at our first information seminar on Tuesday October 26 - at the St Luke's Health Education Center at 3333 Squalicum Parkway in Bellingham, Wa (just a block west of PeaceHealth St Joseph Medical Center).
We will be doing at least two information sessions per month once we get the practice officially started on December 10th, so don't worry if you miss this first one - there will be more opportunities!
Our new contact and office location will be published in future newspaper ads (and here online), but until December 9th, I am still seeing patients at PeaceHealth Cordata General Surgery clinic - at 4545 Cordata Parkway - 360-738-2200.
Side note - I am getting a "comment" message from a postoperative patient who wants to see me, but don't have an email address to reply to - please call office, or email wmedlinmd@gmail.com - thanks!
Our online ad is in rotation this week at http://www.bellinghamherald.com/
Thursday, October 21, 2010
Saturday, October 16, 2010
More on medical weight management
This make some sense - much of what we do in behavioral counselling doesn't require a medical degree.
That doesn't mean you don't need a doc for your health, though!
TOPS article
Telephone counselling effective
That doesn't mean you don't need a doc for your health, though!
TOPS article
Telephone counselling effective
Sunday, October 10, 2010
Genetics and Obesity
Get ready for a lot more information like this in the next few years! True understanding is going to take decades to develop, though, and the complexity means that there will likely never be a single "magic pill"... Different people have different vulnerability (and different environments) - as well as different health effects from the same "disease"
Multicenter Genetic Study
Multicenter Genetic Study
Friday, October 08, 2010
Arthritis and Obesity - impact on productivity?
This is not surprising, but I don't see some employers recognizing the link, or the very significant impact on their most experienced workers. "Blue collar" industries are actually pretty far ahead on this issue, because they have experience with so many other work fitness issues (my best experience was a tour and interaction with the Bath Iron Works shipbuilding facility in Maine...)
Arthritis article
Arthritis article
Wednesday, September 22, 2010
UNDER CONSTRUCTION!!!!
THIS BLOG WILL BE TURNING INTO A FULL WEBSITE SOON
STARTING DECEMBER 10TH, I WILL BE OPENING A NEW PRACTICE IN BELLINGHAM, MOVING FROM PEACEHEALTH MEDICAL GROUP. UNTIL THAT TIME, I CONTINUE AT PHMG TO SEE PATIENTS IN CONSULTATION FOR ALL TYPES OF SURGERY, INCLUDING BARIATRIC SURGERY, AND TO PERFORM ALL TYPES OF BARIATRIC SURGERY EXCEPT DUODENAL SWITCH, WHICH I PLAN TO ADD IN 2011.
THE NEW PRACTICE WILL CONTINUE TO INCLUDE GENERAL SURGERY CARE, AND POSTOPERATIVE CARE OF PREVIOUS BARIATRIC PROCEDURES.
STAY TUNED FOR MORE!
STARTING DECEMBER 10TH, I WILL BE OPENING A NEW PRACTICE IN BELLINGHAM, MOVING FROM PEACEHEALTH MEDICAL GROUP. UNTIL THAT TIME, I CONTINUE AT PHMG TO SEE PATIENTS IN CONSULTATION FOR ALL TYPES OF SURGERY, INCLUDING BARIATRIC SURGERY, AND TO PERFORM ALL TYPES OF BARIATRIC SURGERY EXCEPT DUODENAL SWITCH, WHICH I PLAN TO ADD IN 2011.
THE NEW PRACTICE WILL CONTINUE TO INCLUDE GENERAL SURGERY CARE, AND POSTOPERATIVE CARE OF PREVIOUS BARIATRIC PROCEDURES.
STAY TUNED FOR MORE!
Friday, September 17, 2010
Irony from Ontario
Diabetes risks for pregnancy, baby in Ontario
The blind eye of policy as it relates to evidence. The quote at the end is just priceless - a glib pronouncement about prioritizing Diabetes prevention and treatment (as related to a very expensive study) in the same year that Ontario slashes the access of its patients to out of country care.
The real message is that millions are available to study and publish, but don't actually treat the greater population. Sorry for our Ontario peers - you are victims, but not alone in the world of policy hypocrisy.
Just to clarify - we need research, it just needs to translate into rational care. At some point, "we need more information" becomes a delaying tactic at the Governmental Level...
When your Minister of Health takes action based on evidence of Diabetes remission (hint hint) - I will eagerly highlight that here, too!
The blind eye of policy as it relates to evidence. The quote at the end is just priceless - a glib pronouncement about prioritizing Diabetes prevention and treatment (as related to a very expensive study) in the same year that Ontario slashes the access of its patients to out of country care.
The real message is that millions are available to study and publish, but don't actually treat the greater population. Sorry for our Ontario peers - you are victims, but not alone in the world of policy hypocrisy.
Just to clarify - we need research, it just needs to translate into rational care. At some point, "we need more information" becomes a delaying tactic at the Governmental Level...
When your Minister of Health takes action based on evidence of Diabetes remission (hint hint) - I will eagerly highlight that here, too!
Saturday, September 11, 2010
Canadian Diabetes Summit Article
Average 5 year wait for surgery
This is only counting patients in the queue, of course!
Estimates quoted here of major cost savings for treating diabetes with surgery in appropriate patients, also.
This is only counting patients in the queue, of course!
Estimates quoted here of major cost savings for treating diabetes with surgery in appropriate patients, also.
Wednesday, September 01, 2010
Not a good day for the Drug Industry (and later update)
Increase in nonfatal heart attacks and stroke with Meridia - and NO change in survival
Contrast with proven survival benefits with surgery - see previous posts and Vancouver Sun article for Diabetes remission (Archives of Surgery source)
UPDATE late October - (now that Meridia is withdrawn from the market)
Qnexa FDA rejection (2 drugs in one week - not much left in "pipeline"
Here's a quote from the end... of the article
"If there isn't any kind of path forward for this drug I think it is going to shut down all obesity drug development for a decade," said Dr. Tim Garvey of the University of Alabama. Garvey conducted two clinical trials of Qnexa and has consulted for Vivus.
"Why would a company put all that investment into developing a drug if the FDA signals they aren't willing to approve it," he said.
With U.S. obesity rates nearing 35 percent among adults, doctors and public health officials say new weight-loss therapies are desperately needed. And even a modestly effective drug could have blockbuster potential.
But the search for a drug that helps patients safely shed pounds has been largely unsuccessful. Two weeks ago Abbott Laboratories withdrew its pill Meridia from U.S. and Canadian markets after regulators said it increased the risk of heart attack and stroke.
The answer is that Phen-Fen had 18 MILLION prescriptions, and made a lot of people money, even if there was ultimately more harm than good out of it... The drug companies will keep trying, as they should, but there is no "silver bullet" - even surgery is not a cure, but a tool.
Contrast with proven survival benefits with surgery - see previous posts and Vancouver Sun article for Diabetes remission (Archives of Surgery source)
UPDATE late October - (now that Meridia is withdrawn from the market)
Qnexa FDA rejection (2 drugs in one week - not much left in "pipeline"
Here's a quote from the end... of the article
"If there isn't any kind of path forward for this drug I think it is going to shut down all obesity drug development for a decade," said Dr. Tim Garvey of the University of Alabama. Garvey conducted two clinical trials of Qnexa and has consulted for Vivus.
"Why would a company put all that investment into developing a drug if the FDA signals they aren't willing to approve it," he said.
With U.S. obesity rates nearing 35 percent among adults, doctors and public health officials say new weight-loss therapies are desperately needed. And even a modestly effective drug could have blockbuster potential.
But the search for a drug that helps patients safely shed pounds has been largely unsuccessful. Two weeks ago Abbott Laboratories withdrew its pill Meridia from U.S. and Canadian markets after regulators said it increased the risk of heart attack and stroke.
The answer is that Phen-Fen had 18 MILLION prescriptions, and made a lot of people money, even if there was ultimately more harm than good out of it... The drug companies will keep trying, as they should, but there is no "silver bullet" - even surgery is not a cure, but a tool.
Sunday, August 15, 2010
Saturday, August 14, 2010
Don't have to lift heavy weights at gym -Yay!
Lighter Weights are effective
One less barrier to getting in the gym - easier on the joints... also allows some variety!!!
One less barrier to getting in the gym - easier on the joints... also allows some variety!!!
Monday, August 09, 2010
Sunday, August 08, 2010
Evidence at Endocrinology conference - Gastric Bypass Superior
Bariatric Surgery in Diabetic Adults Improves Insulin Sensitivity Better Than Diet, Study Finds
And yet the last paragraph (see link) Dr Korner appears to have an attitude of "well, we will research this" rather that "we need to get THIS tool to the sick people who need it" Maybe I am overly sensitive, likely her statements are very selectively edited (ie., maybe it is the reporter's bias), but where is the call to action for the excellent tool we already have?
Are researchers only interested in supporting the pharmaceutical industry? I honestly don't think so, but you would be hard pressed to show evidence otherwise from this article.
If your endocrinologist, dietitian, insurer, or employer want to ignore evidence, you need to get this article to them by registered mail!
And yet the last paragraph (see link) Dr Korner appears to have an attitude of "well, we will research this" rather that "we need to get THIS tool to the sick people who need it" Maybe I am overly sensitive, likely her statements are very selectively edited (ie., maybe it is the reporter's bias), but where is the call to action for the excellent tool we already have?
Are researchers only interested in supporting the pharmaceutical industry? I honestly don't think so, but you would be hard pressed to show evidence otherwise from this article.
If your endocrinologist, dietitian, insurer, or employer want to ignore evidence, you need to get this article to them by registered mail!
Friday, August 06, 2010
More articles on epigenetics, life expectancy
Intrauterine environment important for later obesity risk
One of many studies showing that it's not just the DNA, but the womb that are important factors in predisposition to obesity.
(and another annoying "headless" photo - dehumanizing heavy people, and making the excuse of privacy)
Below are articles to bring to your HR director at work (especially the last one - shows them they are not just losing money having increased health costs...) Many seem to ignore the fact that newly treated WLS patients are often the most enthusiastic, loyal employees! Also, those who are the sickest are least likely to change jobs, due to worry about any new job not covering pre-existing conditions. Companies need to invest in treating this disease - but they need to be educated, and offered organized programs. To their credit, some insurers are actually working on this (I will deny saying most nice things about insurers, but they are not all bad)
Increasing Loss of Life to Obesity
Obese Employees Take More Sick Leave
Finally, I had a very nice visit tonight with a support group at Virginia Mason, and last night with the group here in Bellingham. Both groups are super impressive - both with good listening leaders, and great sharing, discussions, and real SUPPORT! I certainly felt supported as a patient - thanks!
One of many studies showing that it's not just the DNA, but the womb that are important factors in predisposition to obesity.
(and another annoying "headless" photo - dehumanizing heavy people, and making the excuse of privacy)
Below are articles to bring to your HR director at work (especially the last one - shows them they are not just losing money having increased health costs...) Many seem to ignore the fact that newly treated WLS patients are often the most enthusiastic, loyal employees! Also, those who are the sickest are least likely to change jobs, due to worry about any new job not covering pre-existing conditions. Companies need to invest in treating this disease - but they need to be educated, and offered organized programs. To their credit, some insurers are actually working on this (I will deny saying most nice things about insurers, but they are not all bad)
Increasing Loss of Life to Obesity
Obese Employees Take More Sick Leave
Finally, I had a very nice visit tonight with a support group at Virginia Mason, and last night with the group here in Bellingham. Both groups are super impressive - both with good listening leaders, and great sharing, discussions, and real SUPPORT! I certainly felt supported as a patient - thanks!
Wednesday, August 04, 2010
More evidence on individual vulnerability to obesity
link to report on Science Daily
Tell your skinny friends - we're not all wired the same! This doesn't mean we can stop worrying about lifestyle, food choices, etc - but hopefully will keep people from completely blaming themselves... (see at least 5 posts below for the theme of "taking responsibility without shame/blame"!!!)
Tell your skinny friends - we're not all wired the same! This doesn't mean we can stop worrying about lifestyle, food choices, etc - but hopefully will keep people from completely blaming themselves... (see at least 5 posts below for the theme of "taking responsibility without shame/blame"!!!)
Wednesday, June 30, 2010
SIMPLE Timer tools for Eating, Separating Fluids from Solid
I saw a great timer/ eating utensil set at ASMBS meeting last week - I think they are very useful looking, and sure to get even more refined. I look forward to getting feedback from users.
I haven't had too much problem eating too fast, but know that is a long term issue for patients. Actually, I think many eat so fast in 10 minutes that they can't finish a reasonable amount of food, then get "hungry" an hour later (or spend 20 minutes washing down food with immediate liquids) , then next thing you know, they are "grazers"!!!
This tool for the Treo/Palm platform helped me watch time go by over a 30 minute timer for meals. Kept me pacing my bites, then a followup 45 minute clock reminded me when I could drink after my last bite.
It is very easy to set up all sorts of custom timers - and tickles me that it is borrowed from the meditation world! This is mindfulness! Seriously, though, I do try to meditate, but exercise seems to be my main meditation.
Found a similarly reviewed product for those with an iPhone or iPod Touch - looks to be just as good. I can honestly say this type of tool may save people a lot of painful drift away from healthy habits.
Here are some comments on it
Finally - FOOD LOG, and EXERCISE LOG are critical for me - but I have NO fancy, or even basic software.... Just make an entry every day in my Calendar (on Palm, but will migrate to Google Calendar when get new smart phone..) and put my meal time and a basic description under the "note" attached to the "food Log" event. Super Easy, Super Fast - but totally on the record!
With exercise, I just enter it directly on the Calendar as an event - "Run 30*** Northshore Trail, Lift C/S/T (my abbreviation for Chest/Shoulder/Triceps)*** 6 sets, 15 minutes Weight ___ @ gym
I only put down my weight a couple times a week, but do get on the scale every day. My other "Lifts" are B/B for Back/Bicep, and L/A for Legs/Abdominals. For me, a three way breakdown keeps the lifting brief enough that I get it done in 15-30 minutes, so have very little excuse not to get it in at least 3 times per week. If I try to do it all at once, it gets overwhelming. That's where everyone has to figure out what works for their life and personality.
Keep it simple, but don't try to live totally unstructured!!! We all need SELF support first and foremost.
I haven't had too much problem eating too fast, but know that is a long term issue for patients. Actually, I think many eat so fast in 10 minutes that they can't finish a reasonable amount of food, then get "hungry" an hour later (or spend 20 minutes washing down food with immediate liquids) , then next thing you know, they are "grazers"!!!
This tool for the Treo/Palm platform helped me watch time go by over a 30 minute timer for meals. Kept me pacing my bites, then a followup 45 minute clock reminded me when I could drink after my last bite.
It is very easy to set up all sorts of custom timers - and tickles me that it is borrowed from the meditation world! This is mindfulness! Seriously, though, I do try to meditate, but exercise seems to be my main meditation.
Found a similarly reviewed product for those with an iPhone or iPod Touch - looks to be just as good. I can honestly say this type of tool may save people a lot of painful drift away from healthy habits.
Here are some comments on it
Finally - FOOD LOG, and EXERCISE LOG are critical for me - but I have NO fancy, or even basic software.... Just make an entry every day in my Calendar (on Palm, but will migrate to Google Calendar when get new smart phone..) and put my meal time and a basic description under the "note" attached to the "food Log" event. Super Easy, Super Fast - but totally on the record!
With exercise, I just enter it directly on the Calendar as an event - "Run 30*** Northshore Trail, Lift C/S/T (my abbreviation for Chest/Shoulder/Triceps)*** 6 sets, 15 minutes Weight ___ @ gym
I only put down my weight a couple times a week, but do get on the scale every day. My other "Lifts" are B/B for Back/Bicep, and L/A for Legs/Abdominals. For me, a three way breakdown keeps the lifting brief enough that I get it done in 15-30 minutes, so have very little excuse not to get it in at least 3 times per week. If I try to do it all at once, it gets overwhelming. That's where everyone has to figure out what works for their life and personality.
Keep it simple, but don't try to live totally unstructured!!! We all need SELF support first and foremost.
Monday, June 28, 2010
Infertility, Cardiac risks
Just a quick couple of links to come back to later - want to spend some time on the maternal issue from Quebec data showing improved obesity rates in children born after mom had Bariatric Surgery (duodenal switch in that clinic)
We just had a great lecture two weeks ago from a Seattle OB/Gyn whose clinic has stopped doing IVF in any patient over BMI 50 - looks like those in the article below have even tighter criteria.
In vitro fertilization failure rates in obese moms
Also, this issue is in the news today after a major Diabetes Conference just ended. 100,000 extra heart attacks, failure, strokes, deaths possible with this single drug - wow! It is very commonly used. I don't think we have enough respect for how complex the systems are that we manipulate. Surgery is certain to have risks, but they are not usually so insidious.
Avandia bad outcomes for 100,000 - Event rate more than 1 in 60?
We just had a great lecture two weeks ago from a Seattle OB/Gyn whose clinic has stopped doing IVF in any patient over BMI 50 - looks like those in the article below have even tighter criteria.
In vitro fertilization failure rates in obese moms
Also, this issue is in the news today after a major Diabetes Conference just ended. 100,000 extra heart attacks, failure, strokes, deaths possible with this single drug - wow! It is very commonly used. I don't think we have enough respect for how complex the systems are that we manipulate. Surgery is certain to have risks, but they are not usually so insidious.
Avandia bad outcomes for 100,000 - Event rate more than 1 in 60?
Thursday, May 27, 2010
Obesity Action Coalition - new campaign
I just got a paper copy of the magazine yesterday.
Your Weight Matters website
Not sure if it is replacing their regular magazine, or a separate publication, but it is very well written, and I think the campaign is admirable! We have to be empowered as a group, and this is how it happens!
There is a great article about Minorities - covering cultural and genetic issues. The Airline seat policy controversy is thoroughly addressed, and there are other great articles on advocacy, preop anxiety, and postop nutrition and mobility challenges.
I really commend OAC for taking on the controversies of Fattertainment and Childhood obesity also. Bigotry survives in our society by hiding in the shadows - those who struggled against all sorts of discrimination in decades and centuries past are very strong shoulders to stand on, but they have also shown that it requires real courage and active work!
Your Weight Matters website
Not sure if it is replacing their regular magazine, or a separate publication, but it is very well written, and I think the campaign is admirable! We have to be empowered as a group, and this is how it happens!
There is a great article about Minorities - covering cultural and genetic issues. The Airline seat policy controversy is thoroughly addressed, and there are other great articles on advocacy, preop anxiety, and postop nutrition and mobility challenges.
I really commend OAC for taking on the controversies of Fattertainment and Childhood obesity also. Bigotry survives in our society by hiding in the shadows - those who struggled against all sorts of discrimination in decades and centuries past are very strong shoulders to stand on, but they have also shown that it requires real courage and active work!
Data doesn't lie, but it can fail to tell the whole story
article about HealthGrades Bariatric report (includes link to report)
These ratings are based on "expected" outcomes, but I can tell you from experience that the heroic Docs who run our University and major referral hospitals are taking care of unmeasurable levels of complexity in some patients. That does not make them automatically the best, but it is worth taking into consideration BEYOND the data.
My own personal care will not be chosen simply on the "star system", but I think these databases will continue to be more useful every year.
These ratings are based on "expected" outcomes, but I can tell you from experience that the heroic Docs who run our University and major referral hospitals are taking care of unmeasurable levels of complexity in some patients. That does not make them automatically the best, but it is worth taking into consideration BEYOND the data.
My own personal care will not be chosen simply on the "star system", but I think these databases will continue to be more useful every year.
Excellent Blog Article from SCOAP
Return on Investment for Quality
This is really worth reading.
See previous post - SCOAP puts Washington State at the forefront of collaborative quality improvement.
This is really worth reading.
See previous post - SCOAP puts Washington State at the forefront of collaborative quality improvement.
Wednesday, May 26, 2010
Medications have risks, too
Liver Damage in 13 patients with Xenical/Alli
CBS link
This may or may not be the end of this story. We will only have to trust the FDA - Fen/Phen took a few years to have its major risks identified. 36 million people may have had prescriptions, but probably not 1 in 100 are taking it long term. How different would the data look if it ends up with 130, or even 1300 people injured out of 500,000 taking it more than a year? The benefit of taking this drug is not demonstrated to extend life expectancy (no non-surgical method has). What is the risk/benefit calculation if there is only minimal benefit???
I am not terribly worried about this drug, but the "next" med that actually has as much effect as Fen-Phen. Any new really effective med will sell like hotcakes (and be prescribed liberally). Any drug maker is in a huge rush to get to market for the BILLIIONS of dollars they will make with a winner. Just be careful with new things, whether operations or meds.
The sleeve gastrectomy only has a few large groups published more than 5 years out, but has been performed for more than 10 years... We have a lot to learn about exact techniques and effectiveness and patient selection, but the long-term issues seem to be limited to Reflux.
CBS link
This may or may not be the end of this story. We will only have to trust the FDA - Fen/Phen took a few years to have its major risks identified. 36 million people may have had prescriptions, but probably not 1 in 100 are taking it long term. How different would the data look if it ends up with 130, or even 1300 people injured out of 500,000 taking it more than a year? The benefit of taking this drug is not demonstrated to extend life expectancy (no non-surgical method has). What is the risk/benefit calculation if there is only minimal benefit???
I am not terribly worried about this drug, but the "next" med that actually has as much effect as Fen-Phen. Any new really effective med will sell like hotcakes (and be prescribed liberally). Any drug maker is in a huge rush to get to market for the BILLIIONS of dollars they will make with a winner. Just be careful with new things, whether operations or meds.
The sleeve gastrectomy only has a few large groups published more than 5 years out, but has been performed for more than 10 years... We have a lot to learn about exact techniques and effectiveness and patient selection, but the long-term issues seem to be limited to Reflux.
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