Video Blog about Obesity Action Coalition (OAC) and advocacy!

Bullying - the role of weight bias

Joe Nadglowski commentary about weight bias and bullying

Thanks for another great piece of writing! The OAC continues to lead...

Sleeve coverage great link. And I am a man of mystery!

I am more active on my Twitter feed of late - will get more active here soon!

This link is the official ASMBS, SAGES, Obesity Society, and ASBP response to Centers for Medicare and Medicaid Services regarding Access to Care for Sleeve Gastrectomy.

asmbs.org/2012/04/asmbs-…

The link to comment has a button at the top of the page to select the comment period.  If you commented lately, you will need to "reset" to the more recent group to find yourself.  Apparently, I am not allowed to reference myself as a patient, so some of my comment was "redacted"!

Wow!  I feel like a spy!

Call to Action: irresponsible Medicare denial of Sleeve coverage

Ok - I have been neglectful of this blog!  Have been retweeting a lot of the interesting stuff I see online, instead of posting links here.  Some good stuff on @bonuslife

I will post again soon with report from trip to DC for advocacy, but want to call URGENT ATTENTION to all about Medicare's unbelievable rejection of coverage for Sleeve Gastrectomy just yesterday.

HERE IS THE LINK FOR YOU TO COMMENT (may have to copy and paste to browser)

Many thanks to the leadership of ASMBS for their call to action.

The entire text of the decisions can be found here:  http://go.cms.gov/Hel9dT

You can comment easily - just use the button on the top right of the page.


Here is my public comment - but please post your own - every person counts (and it can be short!)

Subject: Public Comment for Bariatric Surgery for the Treatment of Morbid Obesity

This is a notification that CMS has received your comment, as stated below, for the subject topic.
First Name: Walter
Last Name: Medlin MD
Email: --------

Comment: As a metabolic surgeon, and sleeve gastrectomy patient myself, I am distressed at the number of avoidable deaths this policy will cause. I have many Medicare patients who are waiting for this coverage for various reasons. 


Many are poor candidates for the adjustable gastric band due to large hiatal hernias or fear of the variable outcomes with bands. Some of these also have had celiac or inflammatory bowel disease, or nephrolithiasis, or extensive small bowel adhesions that greatly increase the risk of gastric bypass. 


This policy forces our seniors into a bad choice, and I speak from personal experience. This rightfully will be construed as an economic and discriminatory decision, setting the bar unnecessarily higher than for other disease treatments. 


While I agree that study of all our treatments should continue, it is frankly outrageous that this well studied, widely adopted intervention is rationed from our most worthy citizens. 


Unfortunately, I will have to bring obituaries to my Senators and Representative. This is a dangerous, harmful decision. I respectfully request that you immediately provide full coverage in line with STAMPEDE trial criteria.

Address #1: 2800 10th Avenue North
Address #2: 
City: Billings
State: Montana
Zip: 59107
Phone: 4062382500
Fax: 
Organization: Billings Clinic












Here is my letter to our Montana Senators.  Many thanks to their team for wonderful visit last week!  I didn't think it would be this soon that we had a crisis to discuss!








Dear Senators Tester and Baucus,

It was very nice to meet with you and your staff last week.  

I hope you will ask Medicare officials to listen carefully and respond to comments on their decision to deny coverage to millions of Americans for Sleeve Gastrectomy.

As a surgeon with the means to pay, I went into my own pocket to receive this care, but most of my patients do not have that option.  It really is terrible to see them suffer needlessly when we have effective, durable, evidence proven treatments that are life saving and life altering.

My blog and Twitter posts may be a bit too passionate, but I hope your team might review the links to the cooler heads at ASMBS, and stop this policy that hides bias between the lines of "we need more studies".  That sounded hollow coming from the tobacco industry, and from opponents of safety systems in cars.  It sounds no better coming from our Medicare administrators.

Thanks!

Walt Medlin MD

Billings, MT

blog - www.bonuslife.net

Twitter @Bonuslife 

Below is the email I am sending out to Bellingham PeaceHealth St Joseph Medical Center Physicians and Allied Health Practitioners today...

Dear Colleagues,

It has been an honor to work with you all these last 2 ½ years. Though I have consulted on over 200 patients for obesity and metabolic issues, we have only been able to take 12 to surgery here locally, because of a variety of factors beyond my control. My practice closes this Friday. Dr. Bachman has agreed to take over my charts for clerical continuity, with the understanding that specialty Bariatric care is appropriately referred to regional providers. I include a partial list below, and encourage you to use these providers for your own liability protection when patients are complex.

I have been asked to start a Bariatric Surgical program at Billings Clinic in Montana, to complement their World-Class Endocrinology service. I will still get to do Trauma and General surgery as well, so will be fully engaged and supported in a tertiary center.

My only regret is knowing that many will continue to suffer and die needlessly without treatment here in Bellingham. Many just do not have the resources to travel. Most patients now do have excellent coverage – it simply is a matter of finding the location that accepts it.

I hope to keep making my blog a valuable place to send patients to explore links and resources www.bonuslife.net
And my Twitter is @bonuslife

Again, many thanks for being so supportive. Please continue to speak up for this group that is so stigmatized and unfairly marginalized by society and industry. Your compassion alone makes a difference, your timely referral saves lives!

To quote Goethe – “Knowing is not enough, we must apply. Willing is not enough, we must do”
Or to paraphrase - Actions speak louder than words!!!
Sincerely, gratefully,
Walt Medlin


REFERENCE FOR REGIONAL RESOURCES------

University of Washington – has 4 world class surgeons who I know well. They are the best of the best.
800-326-5300 for Medicon, or 206-598-2274 for the clinic.
(http://uwmedicine.washington.edu/Patient-Care/Our-Services/Medical-Services/Bariatric-Surgery/Pages/default.aspx)

www.pugetsoundbariatrics.com based in Edmonds, with office also in Barkley area.
Drs Landerholm, Billing, and Crouthamel are excellent, though a bit controversial with same-day surgery for sleeve gastrectomy.
I do not believe they take Medicare, but do have preferred provider status with PeaceHealth. 800-558-6514

www.NorthStarMedicalSpecialists.com our local Medical program with Dr Tony Burden (at Lakeway entrance to I-5 N) 676-1696
Dr David Lauter comes up from Bellevue, and does take Medicare with his Center of Excellence at Overlake

www.nwwls.com in Everett has until recently been only Lap-Band (which is falling out of favor). Drs Michaelson, Chock, and Montgomery are now adding full spectrum care, including Sleeve Gastrectomy and Gastric Bypass. They are a great clinic, and nearest actual OR facility. 800-350-2263

www.ghc.org Group Health covers many of our Whatcom County neighbors, and does a great job, though the out-of-pocket expense is >$1,400

Swedish, Virginia Mason, Evergreen and Northwest Hospitals all have excellent programs as well, with Center of Excellence certification.

Madigan Army Medical Center is actually a national leader. I highly recommend them for your patients with Veteran’s benefits (and spouses)
http://www.mamc.amedd.army.mil/gensurg/referrals.htm



Dietitian Support - Rachel Akins RD at South Campus has extensive experience with the Group Health Program.

www.accomplishbariatric.com is a Seattle based telephone Dietitian counseling service that I have used with great results. They are very cost effective, though not usually covered by insurance (4 sessions are less than $300 though!)


Psychological Support – Marlene Sexton LMFT has been our local professional, and runs a highly regarded support group as well.

Free support group (which all post op patients should attend at least a few times each year) is 7PM the first Wednesday each month at the HEC.

Shame on you KIRO-TV!

This is the most frequent comment after the article/video - and that about sums it up...

Join the Obesity Action Coalition - we need to fight ignorance with education. Stigma is being used here to fuel sensationalism, but we can use this as a starting point for engagement. If KIRO has integrity, they will follow this up with a series of the VALUE of care for Metabolic and Obesity related conditions and mortality.

KIRO-TV Seattle piece that will raise your blood pressure!

I grew up with this sort of loaded language around gender and racial discrimination being widespread. Now those are reduced a bit, or hidden under deeper "coded" language in the media, or hidden from the public view. Discrimination with weight is still open, raw and ugly... and allowed because it is still a commonly held view.

The worst thing about this is the sexism - the hissing voiceover that implies spoiled lazy women, and reeks of the old "welfare queen" name calling. Our country is defended by WHOLE FAMILIES who make sacrifices, and they deserve to be treated with dignity.

I have been interviewed several times for TV and print. It is obvious that those interviewed here were given the impression that this was going to be a fair piece. I dare KIRO to release the full unedited interview tapes, so we can see how this trap was set. Investigative journalism should not be cowardly.

Very Sad - Meds have risks, too

This is not to minimize risks of surgery....

I have had several patients with increased Blood Pressure as a side effect of Phentermine.


Death of Bubba Smith - coroner report on E Online

Hormonal impact on dieters regain - more evidence

Australian Study of long term hunger hormone changes after Diet

"Our study has provided clues as to why obese people who have lost weight often relapse. The relapse has a strong physiological basis and is not simply the result of the voluntary resumption of old habits," he said.
Dr Proietto said although health promotion campaigns recommended obese people adopt lifestyle changes such as to be more active, they were unlikely to lead to reversal of the obesity epidemic.

Caregivers are slowly getting the word - but ingrained opinions will still be shaping (distorting) medical practice for some time... Institutions have to help change practice with guidelines and with appropriate coverage. Hopefully Secretary Sebelius of HHS will show leadership!

Stigma allows Georgia to Discriminate against Obese

It is hard to believe a State could get away with cutting access to care across the board to any other disease.


CNN Video - thanks to ASMBS for spreading



"Sorry, we no longer can afford chemo, we won't pay"

"You made a decision to become pregnant, we won't pay"

"You crashed your car while over the speed limit, we won't pay"

"Cardiac stents have a rate of restenosis and failure, we won't pay"


We will look back at this years from now with the same disbelief that we have now for other forms of institutionalized discrimination.



.

Adjusted or Maladjusted?

Appetite is so much more than just hunger. Stress creates a desire for food in my life that is recognizably different from sustenance. Luckily, I get to have a front row seat to the struggles of others - sort of a built in support group. Life is always going to be a challenge, but the self image we take forward has a lot of influence.

My attitude will never be sunny all the time, but if I can trust myself to listen, the down days won't spiral out of control. Unrealistic expectations get me in trouble, but happen less as experience finally gives me perspective. Those with innate maturity are lucky!

Anyhow, hope this helps if you are having that sense of being overwhelmed...

What it means for me in practical terms is relieving stress (mostly with exercise) and using Mindfulness to recognize the opportunity here and now to simply be with the situation, without struggling - even if just for one breath (and it's always one breath!)

Risks of meds - new data

Pancreatitis and pancreatic cancer risk with newer Diabetes Meds

Recent articles Bariatric/Obesity care and access

Hypertension

STOP Obesity Alliance Director Christine Ferguson, J.D.

Importance of Acceptance vs Rejection

Obesity in Pregnancy - Infection Risks

Mild Obesity much more Risky in South Asians...

This is one of the primary reasons I relocated to Bellingham. This article confirms in Canada what the research in India and China have been saying for several years.

McMaster University research for increased susceptibility in South Asians with mild obesity

Unfortunately, the epidemic of Diabetes and Metabolic Syndrome seems to be ignored by the politicians and public health officials in British Columbia. Other provinces recognize the role of surgery in effective treatment, and the need for large scale, coordinated efforts to combat this. Maybe it is latent racism against immigrants, because the medical leaders in Vancouver are certainly fighting the good fight to make the facts known in the halls of power.

What needs to happen is for the community to speak out - and be heard "loud and clear"...

"Many Canadians of South Asian descent -- as well as those of Aboriginal, African and Chinese descent -- are experiencing historic levels of risk for heart disease and stroke. It is only through research like this that we can learn how better to treat and prevent these diseases, so lives are not cut short," said Mary Lewis, vice-president, research, advocacy and health promotion of the Heart and Stroke Foundation of Ontario. "The Heart and Stroke Foundation of Ontario is proud to support such important work."
Dr. Arya Sharma, director of the Canadian Obesity Network and a co-author of the study said: "This study helps explain why South Asians experience weight-related health problems at lower BMI levels than Caucasians. For the clinician, this also means that individuals of South Asian heritage need to be screened for the presence of heart disease and diabetes at lower BMIs."

Indeed - screening and research are important - but deploying known effective tools should not be delayed. Lives are being lost unneccesarily - every day. Why doesn't BC allow 5,000 operations per year, instead of 50?

We are killing ourselves with inactivity and obesity related diseases

Importance of muscle mass in insulin resistance

GET TO THE GYM, OR DIG A DITCH!!!! Anything to build muscle...


Declining US life expectancy from middle aged inactivity and obesity

Gastric Bypass food preference changes?

Study from UK for fat intake

Lots of people talk about how food tastes a bit different. I thought my cheese habit was high fat, but maybe it's still better than it used to be!

When will Obesity become a conservative hot button?

Conservatives should care about obesity for their own valid reasons

When they run the country "like a business" we had better make sure our employees (and wards) are cheap to keep, and very productive! It's not cost of health care that's a problem, it's lack of value.

We will get more "Bang for the Buck" from Evidence based medicine - and obesity care has the very best evidence! (thanks to Dr Dixon, as well as Dr Rubino, Cohen, Schauer, Morton, Shikora, Pories, Sugerman, Buchwald... too many to list on one screen!)

Looking forward to visiting ANYONE in DC willing to take leadership on access to care. Many thanks to Rep Edolphus Towns for giving us a great start on the Obamacare side. You sir, are a leader!

Dentists and Diabetes detection

Here is a nice article, with several older related articles on the sidebar.

Look back to older posts for the millions of undiagnosed diabetics in the literature.

Periodontal disease, and point of care Hemoglobin A1c testing

Incontinence treatments - not all benign

Careful of the implants...

I have seen too many women getting consultation for bariatric surgery who had unsuccessful bladder slings, when the intraabdominal pressure of obesity was a more likely cause.

Exercise, baby! No, really...

To fight obesity, even babies should exercise

I really like this... free range toddlers sounds a bit dangerous, but most of us were pretty wild and roamed free as kids. I definitely spent much more time in front of the TV with each year.

Caregiver shortages

This is only one factor leading to problems. Productivity and limited hours and aging population will have effects, too.

Health Reform leading to increasing shortages of Providers