New video link

Diabetes Video postop Billings Clinic

Physician empathy and engagement - new study Yale

Well I am doing a lot more Twitter and Facebook lately, but would like to share more here.

There is so much that is of temporary interest, and I want to be more durable on the blog.

This NYT blog about physician empathy and engagement is a keeper!


http://well.blogs.nytimes.com/2013/04/29/overweight-patients-face-bias/?smid=pl-share

Many thanks to Dr Bobby Bhasker-Rao and his team in Palm Springs for excellent case observation on the da Vinci surgical robot today.  The gastric bypass procedure is excellent with current techniques.

Thanks also to my local Billings and onsite Palm Springs Intuitive reps for so much work to make the trip happen!

Sounds like my surgeon and friend in Grand Rapids, Michigan did his first robotic Sleeve Gastrectomy today, too.  Congrats Dr Jamie Foote!!!

First Sleeve Gastrectomy Operations at Billings Clinic!

Thanks so much to the dedicated OR and surgical floor teams that made yesterday's cases go so nicely! People are really pitching in to make things go smoothly - from the RN team lead who came in on her day off, to our Physician Assistant who stayed to back up Dr Murray, and did such a great job driving the laparoscope, to our great questions from nursing staff, and the equipment vendors who are making real cutting edge tools available to us here!

Thanks also to our patients for being extra patient with new processes and materials, and for giving us great feedback!

We have an information session tonight - always a treat!

Why not put in a picture just for fun - this will remind me to do more in the future.
Say Hi to my pill organizers!  One is for AM, the other for afternoon/evening.
I have been reading "The Power of Habit" and realize that a lot of our suggestions are to make easy to follow new habits...  This is the only way I can be even 80% compliant with meds/vitamins (and Devrom!)

Telemedicine - the future is here, Rules need to catch up!

Wow- I am at a great Eastern Montana Telemedicine Network annual Facilitator retreat.

Great talks so far from Jonathan Linkous, the CEO of American Telemedicine Association and Paula Guy RN CEO of Georgia Partnership for Telehealth - THANKS SO MUCH!


Brace yourself for a 4G revolution!

First Billings Clinic Gastric Bypass - thanks to TEAM!

I want to send a major note of gratitude to the many people who made today's case a success.

There have been so many dedicated workers giving their best to Metabolic Care - inpatient, outpatient, support services.  Many run-throughs, pathways, new materials, etc.

This is how great care is delivered - thank you all!  We are just getting started...

Thanks to Billings-Montana Dietetic Association, and Montana Osteopathic Medical Association!

We had the opportunity to present to both groups in the past week.   What a great time to meet providers in multiple areas of practice!

Metabolic Disease and Obesity touch so many - and it's just a pleasure to share care as a team.  Medicine is going through difficult but necessary changes as we meet the challenge of incredibly complex care, and learn to do it more efficiently and effectively.

My hope is that we will build tools that keep the patient in the Driver's Seat...  Expect a lot of bumps in the road as that happens, but stay engaged - it really makes a difference.

Duodenal Switch, Surgical Robotics

My day yesterday was "activating" for two important areas that I have been circling for several years.

I first sat at the console of a daVinci robot in Spring 2003 while doing "Top Gun" advance laparoscopy training with Dr Butch Rosser in NYC. It was very promising, but surgeons weren't ready yet with fully evolved techniques to use the tool.

As of 2012, that is no longer the case.

I got a chance to hear several great lectures and see operative video of Robotic surgery - the tool is useful in ways that have evolved. Got a chance to test drive the SI model that Billings Clinic owns, and plan to move forward with Advanced training.


Our new focus on metabolism has brought the Duodenal Switch operation back toward the mainstream of thought in our society. Many leaders are proceeding into this procedure with care - but more will be offering this. Also, as we see limitations with Sleeve Gastrectomy, and even with Gastric Bypass, alternatives are necessary, and backup options require that we be masters of all approaches.

Much more to come on these subjects - ask if you want more on a particular topic!


INTUITIVE SURGICAL ROBOTIC SURGERY

Duodenal Switch Interest Group Homepage

Progress is not always exciting... But still takes effort

Here at the big meeting - we seem to cover a lot of the same subjects, but every year things move forward.

The sharing and mutual education from around the world, the involvement of more specialties and Allied Health professionals will make best patient care and outcomes.

I am learning so much about successes and challenges of colleagues. Very excited about more minimally invasive approaches, new tools, new thinking.

It's how we improve exponentially faster than by experience alone - instead, it's "experience together"!!

At the Annual ASMBS meeting - San Diego

It is always a treat to run into friends from training, and to see those people who we follow virtually on emails, phone calls, etc.  The first part of the week is dedicated to Allied Health Professionals - and the work they do to keep programs on track is impressive.  Change happens with deliberate effort.  This is a group with passion, focused on delivering high value, high quality care.

The new quality initiative with American College of Surgeons (MBSAQIP) is the next step in making progress for the care we all aspire to.

I wish patients and administrators could see this stuff happen, but the results will speak for themselves!  Data is not easy to obtain for long term care, or for complex disease and treatment.  This new project makes it more affordable, less cumbersome, more useful.

Making progress with Regional Chapter ASMBS ND, SD, WY, MT

Last week (the Saturday of Memorial Day weekend)  Dr Lloyd Stegemann of ASMBS and Joe Nadglowski, President of Obesity Action Coalition gave up time with their families to help Surgeons and Allied Health Practitioners from Colorado, South Dakota, North Dakota, Wyoming, and Montana start Chapters of ASMBS.

Colorado is populous enough to do its own Chapter, but the rest of us are coordinating to form a Dakota/Yellowstone Region chapter.  One surgeon drove through the early morning hours after being on call the night before - from South Dakota!  That is commitment, and I am very proud to be associated with such devoted caregivers.  More to come on this after our national meeting in a couple of weeks!

MOST IMPORTANTLY!!!  The influence we can all have together - our competition is not other towns, surgeons, or hospitals - it is limited access to care...

I am excited to help lots of people in our region join OAC, and to make a difference in the health of so many.  If we are able, we will partner with employers, insurers, hospitals, equipment makers, and legislators to eliminate the institutional bias that keeps people from evidence based care!

Please take some time to explore the links over on the right side of the Blog.  I am learning WordPress, and will be making this more dynamic, but the basics are not hard to find.

Thank you for caring, thank you MORE for signing up for OAC, and making your voice count!

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.



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