10/4/08
Last month, an article was published in the American Journal of Managed care which shows that bariatric surgery is very likely to pay for itself with 2-4 years from the surgery. To people suffering from obesity this just makes sense. The cost savings from cutting prescription drug requirements in half is part of the story, and bariatric surgical patients benefit from fewer doctor visits as well. The calculations presented in this paper don’t even take into account the benefits of lower weight in terms of better productivity and longer life.
But the question arises: even if bariatric surgery is cost effective, is it right to use that as a key factor in deciding on coverage? For other medical conditions (diabetes, heart disease, cancer, etc.) the question is whether the treatment is the most effective and whether it is cost effective in comparison to other treatment avaiable.
The key difference seems to be that obesity is not yet understood as a disease that deserves treatment, and it is hard to see how we can quickly influence key decision makers on this subject.
DoctorJP@hotmail.com
9/1/08
What about losing hair after massive weight loss? It is a very common concern for our patients after surgery; at 3-5 month post-op many of our patients are concerned to find volumes of hair coming out in the brush. What does it mean? Is it permanent? Are there ways to prevent hair loss?
The facts are: 1) About half of patients after bariatric surgery experience significant hair loss, and this is true whether they have a gastric bypass, or a gastric band, or a gastric sleeve operation (it appears the pace of weight loss is not a key factor). 2) The hair nearly always grows back to its former density (thickness). 3) No one has found any vitamin, supplement, or topical treatment that reduces the chance of hair loss.
Our best understanding is that the hair actually comes out as part of your body’s recovery process following the stress of surgery and the sudden reduction in calories. To read more, check our web page on side effects.
8/24/08
Last week, the FDA reported that Byetta, a relatively new drug commonly used to treat diabetes, has been associated with the onset of pancreatitis in a small but continuing subset of patients treated with the drug. Two of the recently reported patients died from complications of the pancreatitis. This report reminds us of an important part of the equation when we think about surgery for obesity: the fact that living with obesity and its associated diseases (without surgery) can be quite risky.
I am writing about this issue on our surgical website because people (most commonly those who are not suffering from obesity themselves) sometimes get caught up in the risk of surgery, wondering why any sane person would submit themselves to ANY risk for the sake of lower weight. The fact is that the risk of the weight is usually greater than the risk of surgery for properly selected patients - the Byetta report is just a reminder that carrying excess weight, and often diabetes, is itself a risky proposition.
DoctorJP@hotmail.com
7/11/08
Another research study finds that bariatric surgery (especially gastric bypass) leads to dramatic reduction in risk of many types of cancer. Dr. Nicolas Christou, from McGill University in Canada, has published results that confirm the finding of earlier studies and expand on the information available. Here are the risk reductions as found in Dr. Christou’s study:
Breast cancer - reduced by 85%
Colon cancer - reduced by 70%
marked reductions in skin cancer, pancreas cancer, esophagus cancer, and others
It appears that surgical weight loss does much to reverse the serious increase in cancer risk that one experiences from obesity. This information arrives on top of multiple research studies which show that bariatric surgery reduces rates of diabetes, high blood pressure, heart disease, GERD, joint failure and many other problems.
In other words, when bariatric surgery is done well in patients who are properly selected and properly prepared, it improves health and extends life. And yet, patients who have standard health insurance continue to have difficulty with coverage of this life-saving intervention. This is an unfortunate mystery.
4/15/08
A couple of days ago I received a message from a patient of mine, who is a moderator for an online support group in Dallas. The topic that was hot on her site was revision surgery: the when, how, who, why, (and even more so) WHY NOT?
She had written a very nice discussion about the need for patients to make the best of the pouch "tool" they carry before they fix on revision surgery as the solution, but it was not clear to the group why surgeons are mostly hesitant to take on revision surgery. Since this is a common question, I’ll use my first blog on our website to share the background on why surgeons (and well informed patients) try to stay away from revison surgery.
The main reason that revision surgery is WAY more risky has to do with the scar tissue that inevitably forms from the first surgery. This scar tissue is a natural result of any surgical manipulation, and it causes two significant problems:
1) The scar means that the stomach pouch is stuck densely to the surrounding organs, such as liver, spleen, pancreas. In order to "re-work" the stomach pouch it is necessary to separate out all that scar tissue (often very difficult) with the potential of tearing or perforating one of the delicate tissues that is stuck together.
2) Most revisions require re-stapling or cutting across some of the old scar tissue that is on the pouch itself. Cutting across the scar is not so hard, but then we need that scar to heal properly to avoid a leak. Because scar tissue does not heal as reliably as tissue that’s never been traumatized before, the leak rate from revision surgery is 10 times higher or more, in comparison to primary (first time around) surgery. Even if a leak is not lethal, it results in lots of anxiety, pain, and loss of time for the patient and the surgeon.
So bottom line is that revision surgery is very hard to do well, and even when it is done well it is a rather risky undertaking. This is why a lot of surgeons are hesitant to take that on.
Thanks for reading!
DoctorJP@hotmail.com
