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Study shows dramatic health benefit from obesity surgery

Thursday, August 23, 2007

The big article in today’s New England Journal is on weight loss surgery. It saves lives. In fact, the benefit is quite dramatic.

The authors studied 9,949 patients who had undergone weight loss surgery, and compared them to a control group of 9,628 severely obese individuals who did not have the surgery.

The findings:

  • Overall mortality decreased by 40% in the patients who had surgery.
  • There were 56% fewer deaths due to coronary disease,
  • 96% fewer deaths due to diabetes
  • and 60% fewer deaths due to cancer.

Long Term Mortality After Gastric Bypass Surgery.pdf

The accompanying editorial warns:

The lowest surgical mortality is seen among surgeons who have performed more than 50 operations and preferably more than 100 operations.

We know that obesity is an increasing epidemic in this country, and we know it’s killing people. The lives saved by obesity surgery is one measure of the mortality attributable to obesity.

Clinically, I would have to say that this study shows bariatric surgery is a good option for morbidly and perhaps even moderately obese individuals. An article in the Voice of San Diego observes that the study:

…should put to rest uncertainties about the benefits and risks of weight-loss surgery and may cause governments and insurers to rethink who should qualify for the procedure, some doctors said.

“It’s going to dispel the notion that bariatric surgery is cosmetic surgery and support the notion that it saves lives,” said Dr. Philip Schauer, director of bariatric surgery at the Cleveland Clinic in Ohio, who had no role in the research.

On a broader level, though, this is a social problem and a preventive health issue. We are grossly overfed in this country. Food processing, distribution and marketing has made food overabundant, cheap, and highly gratifying to consume. We have learned to eat for pleasure rather than for nourishment.

I try to counsel my patients to change their attitudes toward food. We need far less to run our bodies than what we actually eat.

I have started giving as much attention to dietary counseling as I do to tobacco cessation. Obesity causes as many deaths now as smoking.

One good online resource for patients looking for info on healthy eating and weight loss is the National Heart, Lung and Blood Institute Obesity Initiative. You can calculate your body mass index and your risk of weight-related diseases. The site also has information on diet plans, menus and exercise.

If you really want to get serious about healthy eating, you could buy Mark Hyman’s book, “Ultra-metabolism”. Another terrific resource for understanding and shedding the habit of over-consumption is “Hooked! Buddhist writings on greed, desire and the urge to consume”, by Stephanie Kaza.

In the Berkshires, if you are interested in the possibility of weight loss surgery, the guy to see is Andrew Lederman. The program is relatively new, but the patients I’ve sent to him so far are satisfied.

Filed in Obesity | | Comments (2)

Monoclonal Antibody Effective for Bird Flu

Tuesday, May 29, 2007

Here’s a bit of good news on Avian Influenza. Researchers at the Hospital for Tropical Diseases, in Ho Chi Minh City, Viet Nam, have isolated antibodies from the cells of human survivors of H5N1 influenza (bird flu). These antibodies were found to be protective against the virus in mice, though they have not yet been tested in humans.

The article is available in PLOS Medicine, an open access journal published by the Public Library of Science.

In the 1918 Spanish Flu pandemic, blood (actually, plasma, which is the portion of the blood that contains antibodies) from survivors was administered to newly infected patients and cut the death rate in half.

Now the method is more sophisticated. Instead of transfusing plasma, we can isolate the antibody that is effective, produce it in cell culture, and administer it in purified form. This is called a monoclonal antibody, and that’s what the mice in the Vietnamese study received.

This is much safer than a plasma transfusion. Also, monoclonal antibodies can be mass produced.

For those who have not been following the Bird Flu topic – H5N1 is a new strain of influenza that is spreading among birds, and to a limited extent from birds to humans. The human population has no immunity to this strain, so it has the potential to cause a worldwide epidemic (a pandemic) with fairly high mortality.

At present, bird flu cannot cause a pandemic because it is not yet transmitted from person to person. Based on the history of other flu viruses, however, this is expected to happen eventually. Scientists are watching bird flu very closely for any signs of mutation to a more transmissible form.

If bird flu does mutate and cause a pandemic, monoclonal antibodies may be a form of early, lifesaving treatment for those infected.

Filed in Avian Influenza, Infectious Disease, Medical Topics | | Comments (0)

Lenox Internal Medicine is Go

Thursday, August 31, 2006

Just a quick update – I can’t quite believe it, but we’re in our second week.

Our first few days were complete chaos. They moved the furniture in on Thursday morning and we opened Thursday afternoon, with unpacked boxes in the hallways, no equipment, no printer, copier or office supplies.

A sensible person would surely have waited until Monday, but the truth is I had a lot of patients who really needed to be seen and I did not want to put them off another four days… (Continued)

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Site Looks Funny with Internet Explorer

Thursday, August 31, 2006

Thanks to Liz Pertzoff, for notifying me that this site looks odd when viewed with Internet Explorer. I will fix that as soon as I get a chance.

I use Firefox as my browser, and if you have not checked it out, I recommend it. It’s free, it’s extremely easy to download and install (just click the button and it installs). It’s perfectly safe – in fact, better virus-protection than Internet Explorer.

And stuff just looks better.

You can download Firefox here if you like.

But I promise I will fix the site for IE.

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We Open Tomorrow

Thursday, August 17, 2006

Well here I am, in the new office. The painters are done – the last bit of construction before we could open. The Fire Department just signed off on the Certificate of Occupancy. Our medical supplies are sitting in boxes in a back room. Rebecca and I just came back from Staples with a file cabinet, pens and paper, a shredder and, of course, a wireless router.

It looks like Lenox Internal Medicine is really going to happen.

In fact, it’s going to happen tomorrow. We have our first patient coming in at 9 am.

It will be our “petit opening” – I scheduled a few patients for Thursday and Friday, who couldn’t wait until next week.

The office looks beautiful. A week ago, the foreman threw up his hands and said “You have twelve different colors of paint!” (Rebecca, who chose the colors, looked innocently at the doorframe next to her). The painting threw us behind schedule a bit – but I wouldn’t change a hue.

We had a great architect, Dana Bixby. She’s based in West Stockbridge. If you live in this area – or anywhere, for that matter – and need an architect, you won’t find one better than Dana. A sixteen-hundred square-foot doctor’s office is not exactly an architect’s dream project, but Dana put thought and imagination into every detail and it really shows. The space is warm and welcoming, attractive, and easy to work in.

John Salvini of T & J Contractors was the builder. I really did not believe it could be done in six weeks but, lo and behold, here we are. We were on site a lot during the construction and I know that all the builders put care and craft into their work. I am so grateful for their efforts.

There are many other people to thank – Ross Kuntzman, our landlord, who owns Berkshire Lighting, who didn’t mind having three exam tables on his showroom floor for weeks; Beverly, who let us use Bellissimo Dolce in downtown Pittsfield as a substitute office while we were waiting for this one to open; Josh and Kathy Yurfest for convincing us it was possible; my patients, for believing in me.

Of course, without Rebecca, it really couldn’t have happened. She’s given so much to making this practice a reality. I am very fortunate to have her as my wife.

Right now I’m awfully tired. I’ll head home and get some sleep.

Wish us luck. And stop by to take a look at the place. We’d love visitors.

More soon.

Filed in About The Practice | | Comments (3)

Site Design in Progress

Monday, July 10, 2006

If you’re looking at this site right now, you might notice it looks a bit funny. I’m working on the site design. Once I’m done, I’ll put up info on how to find the practice, physician bio, etc.

For now, though, if you’re looking for Lenox Internal Medicine: we’ll be opening in the middle of August, at 450 Pittsfield Road, in Lenox. That’s at the intersection of Route 7/20 and Holmes Road, right in between Berkshire Lighting and Subway, across the street from Essentials Day Spa. I’ve added a handy map, here.

We’ll provide all primary care services – office visits, hospital care, general physicals, urgent visits, etc. I’m board certified in Internal Medicine and have admitting privileges at Berkshire Medical Center. I have ten years of experience in Internal Medicine. I have been practicing for the past four years at Dalton Medical Associates.

We will take Medicare, Mass Health and most private insurances and HMOs.

For more information, or to schedule an appointment for after August 15, please call 413 637-1976.

If you are my patient and trying to reach me, or if you need an urgent appointment, you can leave a message for me at the above number, or at Dalton Medical Associates – 413 684-2110. I will stop in there to check my messages once a day through August 14.

Thanks for your interest, and check back here soon for more information.

Filed in About The Practice | | Comments (1)

Quitting Smoking Without Gaining Weight – a Role for Topiramate?

Friday, July 7, 2006

So, in addition to information about the practice, I thought I would post medical news and notices on this site. Basically, it will be a medical weblog as well as a practice home page. Let me know if you like the idea (for practice news, scroll down).

I see on the UPI wire that the ongoing Lung Health Study at the University of Minnesota has finally proven what a lot of my patients have been telling me for years: you gain a lot of weight when you quit smoking…

(Continued)

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