You could fly to New York and participate...
Can't wait for results!
We are very quickly headed toward individualized access to care, guided by disease and risk, rather than a BMI number...
Monday, February 28, 2011
Thursday, February 24, 2011
Role for Plication? Preop Weight for other procedures.
I think any program would more highly recommend gastric bypass, which has a proven track record, and durability. But, if the patient won't accept the best, we should still offer options.
These sisters have been in the news for their transplant - I didn't realize they had an obesity issue. Thanks to Dr Bachenberg for sending me the link!
Need to lose major weight to qualify for an operation
I have yet to see the research article this newspaper refers to, but it is not a surprise. Programs see this, and my recent visit to my old program in Duluth confirmed our experience there. Many Band patients are quite happy though, and I will continue to place them, with as much informed consent as humanly possible.
Gastric Bypass more effective than Band
These sisters have been in the news for their transplant - I didn't realize they had an obesity issue. Thanks to Dr Bachenberg for sending me the link!
Need to lose major weight to qualify for an operation
I have yet to see the research article this newspaper refers to, but it is not a surprise. Programs see this, and my recent visit to my old program in Duluth confirmed our experience there. Many Band patients are quite happy though, and I will continue to place them, with as much informed consent as humanly possible.
Gastric Bypass more effective than Band
Monday, February 21, 2011
Saturday, February 19, 2011
Great Jane Brody Advice
She has been writing sensibly about healthy living for a long time - I remember articles from my college days.
This one is just a great summary - so often things are made over-complicated.
New Government Guidelines
This one is just a great summary - so often things are made over-complicated.
New Government Guidelines
Bioenterics Intragastric Balloon Removal Video
We plan to offer removal for those who have had them inserted out of country.
Saturday, February 12, 2011
Why I had Weight Loss Surgery
Rising Rates of Stroke in Middle Age
It's not quite as dramatic a risk factor as Diabetes, but my Hypertension scared me to death. It's much better controlled now, so I'll probably get hit by a bus!
Seriously though, these risks are important. Real lives are destroyed. When we talk about "comparing the relative risk of surgery to that of non-surgery" keep articles like this one in mind.
Shout out to all who attended the benefit last night for Ali McCabe in Duluth - sorry to miss the party!
It's not quite as dramatic a risk factor as Diabetes, but my Hypertension scared me to death. It's much better controlled now, so I'll probably get hit by a bus!
Seriously though, these risks are important. Real lives are destroyed. When we talk about "comparing the relative risk of surgery to that of non-surgery" keep articles like this one in mind.
Shout out to all who attended the benefit last night for Ali McCabe in Duluth - sorry to miss the party!
Tuesday, February 01, 2011
Need for systematic disease management
The biggest problem here is a lack of an integrated health system that keeps the medical "to do" list prioritized based on evidence based impact. Instead we play "whack-a-mole" with whatever happens to stay on the patient's mind...
Gestational Diabetes and later risks
126 Million Americans with Diabetes or Glucose Intolerance
America does have awesome medical capability, we just don't deliver it where it's needed! This is where other systems get a lot more bang for the bucks they put in.
Gestational Diabetes and later risks
126 Million Americans with Diabetes or Glucose Intolerance
America does have awesome medical capability, we just don't deliver it where it's needed! This is where other systems get a lot more bang for the bucks they put in.
Monday, January 24, 2011
Economic Study of Obesity Cost
Very High cost of obesity to the Individual
Very sorry that this is not common knowledge....
So many patients don't think they are worth the investment, or that they will see benefit.
Paying for healthcare goes against the grain for many of us - but the hard truth in this economy is that help is NOT necessarily on the way from government, employers, or institutions (argh!)
What is to be done? We have to work in a community for advocacy, but not expect immediate results.
In the short term, my goal is to provide service as affordably as possible. This means keeping materials and handouts fairly basic, and depending on people to use online access to "extras" Every cost moderating decision we make helps keep us from having a "gold plated" price structure. We aim to be a bit like Costco - clean, friendly, value based. If you want posh surroundings, we can recommend a couple of really nice hotels!!!
Very sorry that this is not common knowledge....
So many patients don't think they are worth the investment, or that they will see benefit.
Paying for healthcare goes against the grain for many of us - but the hard truth in this economy is that help is NOT necessarily on the way from government, employers, or institutions (argh!)
What is to be done? We have to work in a community for advocacy, but not expect immediate results.
In the short term, my goal is to provide service as affordably as possible. This means keeping materials and handouts fairly basic, and depending on people to use online access to "extras" Every cost moderating decision we make helps keep us from having a "gold plated" price structure. We aim to be a bit like Costco - clean, friendly, value based. If you want posh surroundings, we can recommend a couple of really nice hotels!!!
Friday, January 21, 2011
Diabetes and Breast Cancer Survival
We are learning more every year about increased incidence, and increased lethality of many types of cancer with rising BMI, especially from younger ages.
link to article
There's a lot to be studied before making conclusions about what might be the cause, much less what might be an effective intervention. These articles always end with "keep good blood sugar control", but who knows if that will change anything. I certainly wouldn't endorse Bariatric Surgery in a particular disease finding, but we DO know that overall survival increases after surgical intervention from the Swedish Obese Subjects (SOS) trial, and from large studies by Dr Christou in Quebec and Dr Buchwald in Minnesota, among many others..
link to article
There's a lot to be studied before making conclusions about what might be the cause, much less what might be an effective intervention. These articles always end with "keep good blood sugar control", but who knows if that will change anything. I certainly wouldn't endorse Bariatric Surgery in a particular disease finding, but we DO know that overall survival increases after surgical intervention from the Swedish Obese Subjects (SOS) trial, and from large studies by Dr Christou in Quebec and Dr Buchwald in Minnesota, among many others..
Tuesday, January 18, 2011
Breakfast yes, maybe not breakfast feast!
It's so easy to go overboard...
I think we are metabolically more complex than the argument that all calories are treated exactly the same, but look out for anyone who is selling a diet based on some magic "combination" or timing that is going to let you consume twice as much!
Article on "Big" breakfast not being helpful for later reduction
I think we are metabolically more complex than the argument that all calories are treated exactly the same, but look out for anyone who is selling a diet based on some magic "combination" or timing that is going to let you consume twice as much!
Article on "Big" breakfast not being helpful for later reduction
Thursday, January 13, 2011
Treat Sitting Like Carbs?
sounds like a good idea - looking to see more studies to reinforce
article link
I had a "standing desk" in my office in Duluth, mainly to keep myself alert, but plan to build one to use in Bellingham (my accountant has a nice one)
article link
I had a "standing desk" in my office in Duluth, mainly to keep myself alert, but plan to build one to use in Bellingham (my accountant has a nice one)
Monday, January 10, 2011
Obesity Discrimination in Presidential Politics
Awareness coming to the media
As a professional, I have experienced hiring discrimination based on obesity, and it's probably even worse with working class jobs.
Governor Christie is a multi millionaire!
As a professional, I have experienced hiring discrimination based on obesity, and it's probably even worse with working class jobs.
Governor Christie is a multi millionaire!
Thursday, December 23, 2010
Nice synopsis of the limits of Sleeve
Just doing some reading of back issue links, and I think this article gives a good insight into the "art" of surgery and medicine that we physicians have to deal with when the data is not sufficient to give all answers.
I agree with the author though - the sleeve is a reasonable balance of risk vs benefit for a large number of patients, but they should each understand that there is a chance that it may require future revision. "Failure" of the operation does not mean that the patient, surgeon or the operation deserves any "blame" however. Unfortunately, it is usually the poor patient who blames him or herself - often unfairly.
No perfect operations, including sleeve!
I agree with the author though - the sleeve is a reasonable balance of risk vs benefit for a large number of patients, but they should each understand that there is a chance that it may require future revision. "Failure" of the operation does not mean that the patient, surgeon or the operation deserves any "blame" however. Unfortunately, it is usually the poor patient who blames him or herself - often unfairly.
No perfect operations, including sleeve!
Monday, December 20, 2010
"SLIMBRICATION" - Dr Dan Cottam Salt Lake City
Wow - what a great visit on Friday to see Dr Dan Cottam perform a laparoscopic gastric imbrication. This is a very exciting newer procedure that is probably the least invasive intervention yet. It will be some time before we have good medium and long term data though.
In the meantime, expect to see it offered in people who have a failed Lap Band, or who are reluctant to have the Gastric Bypass or Sleeve procedures.
Here is his great video - likely soon he will be performing a combination sleeve and imbrication - Slimbrication!
"> v
and here is the link to his YouTube Channel
I have also started a WMedlinMD YouTube Channel, though it currently has instructional lectures, not an updated information session. My old information session from 2007 is linked on the right side of this page, and here. Since it was on Google Video, I havent' figured out how to put it on YouTube yet...
CHAPTER 1 - INTRO / BMI
CHAPTER 2 - BAND & BYPASS OPERATIONS
CHAPTER 3 - LAPAROSCOPY
CHAPTER 4 - BENEFITS AND RISKS
CHAPTER 5 - SUCCESS HABITS
CHAPTER 6 - CHALLENGES
CHAPTER 7 - PROGRAM STEPS, SUMMARY
In the meantime, expect to see it offered in people who have a failed Lap Band, or who are reluctant to have the Gastric Bypass or Sleeve procedures.
Here is his great video - likely soon he will be performing a combination sleeve and imbrication - Slimbrication!
"> v
and here is the link to his YouTube Channel
I have also started a WMedlinMD YouTube Channel, though it currently has instructional lectures, not an updated information session. My old information session from 2007 is linked on the right side of this page, and here. Since it was on Google Video, I havent' figured out how to put it on YouTube yet...
CHAPTER 1 - INTRO / BMI
CHAPTER 2 - BAND & BYPASS OPERATIONS
CHAPTER 3 - LAPAROSCOPY
CHAPTER 4 - BENEFITS AND RISKS
CHAPTER 5 - SUCCESS HABITS
CHAPTER 6 - CHALLENGES
CHAPTER 7 - PROGRAM STEPS, SUMMARY
Doing some Canadian reading
I have been getting acquainted with Vancouver a bit over the last year. I have avoided making too many direct contacts for fear of the lack of control of my billing as an employee surgeon. Now that I am independent, we can set some reasonable prices for consultation and Lap Band fills, followup for Out-of-Country patients, etc (planning to offer Vertical Sleeve Gastrectomy and Gastric Imbrication for competitive prices)
Anyhow, I found Dr Yoni Freedhoff's blog through CTV... havent' contacted him yet, but he is absolutely on base regarding the loss of access to care for Ontario residents!
Shout out to my friends in Thunder Bay!
False savings in access-restricting "cost containment" measures by Ontario
DR YONI'S BLOG
Anyhow, I found Dr Yoni Freedhoff's blog through CTV... havent' contacted him yet, but he is absolutely on base regarding the loss of access to care for Ontario residents!
Shout out to my friends in Thunder Bay!
False savings in access-restricting "cost containment" measures by Ontario
DR YONI'S BLOG
Monday, December 06, 2010
Provocative topics
CNBC "Ban Obese Workers? video!!!
Subsidizing Obesity Video
"Downside of Downsizing"
I have mixed emotions about these opinions, and definitely think the first video is over the line...
Subsidizing Obesity Video
"Downside of Downsizing"
I have mixed emotions about these opinions, and definitely think the first video is over the line...
Friday, December 03, 2010
Thursday, December 02, 2010
Thursday, November 25, 2010
Sunday, November 21, 2010
Next Information Seminar Tues Nov 30, 6:00 PM
Same address - Health Education Center 3333 Squalicum Parkway, Bellingham
360-752-9888
Our NEW OFFICE PHONE is working, and appointments being taken
(if you need to be seen before Dec 9, call PeaceHealth Cordata 738-2200)
Here is a link to a Bloomberg story about Diabetes in India
Video Link India Diabetes
I have only watched it once.. didn't hear all the audio.
Note that the surgeon interviewed is listed as a "Metabolic Surgeon"!
360-752-9888
Our NEW OFFICE PHONE is working, and appointments being taken
(if you need to be seen before Dec 9, call PeaceHealth Cordata 738-2200)
Here is a link to a Bloomberg story about Diabetes in India
Video Link India Diabetes
I have only watched it once.. didn't hear all the audio.
Note that the surgeon interviewed is listed as a "Metabolic Surgeon"!
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