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Category Archives: Medical Procedures

Info graphic with some medical history highlights

For a quick look at some of the highlights of medical history, check out this info graphic, which was sent along by and links back to their site:

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What you need to know about bariatric surgery

Bariatric surgery types

As many of you who’ve struggled to lose weight know, it isn’t easy (understatement of the year). People will at times lose a lot of weight, only to regain it plus some. It’s hard to stick with diets and exercise regimens week after week, month after month, year after year.

Bariatric surgery overview

An option that seems to hold out the promise of long-term success is bariatric surgery, aka weight loss surgery. There are several types of weight loss surgeries available today. The most invasive are the gastric bypass type surgeries, which typically result in the most weight loss, but potentially have the most complications, especially in the peri-operative period. On the other end of the spectrum is the “lap band” procedure in which an adjustable band is filled with various amount of fluid to make the opening to the stomach smaller. Typically, it has the fewest serious complications, but also results in less weight loss. However, it’s fully reversible. Somewhere in the middle are the gastric sleeve type procedures in which part of the stomach is resected.

Positive research on bariatric surgery?

A new study in the British Medical Journal compared several different outcome measures between people who had undergone bariatric surgeries to those who had undergone non-surgical weight loss over a two year period.

Compared to those in the non-surgical weight loss group, those who had undergone bariatric surgery lost significantly more weight (close to 60 pounds more on average), they had more remission of their diabetes and pre-diabetes, they had a higher quality of life, they needed fewer medications, their blood sugar was lower, their good cholesterol was better, and their triglyceride (blood fats) levels were lower. Other studies have also shown a reduction in mortality (presumably through fixing people’s diabetes, as well as other obesity related conditions such as sleep apnea).

On the other hand, people in this study also developed more iron deficiency anemia, and 8% of people needed further surgeries. Other studies (as well as my own clinical experience) have shown other nutritional deficiencies such as vitamin B12 deficiency.

But what’s the catch…

Great! Let’s forget the gym, the diets, the struggle.

Not so fast. Let’s discuss the flip side. We’ll start with the limitations of the above study, and at the same time, touch on other relevant issues. The above study only followed people for two years. It’s well known that many people gain much of the weight back as the years go on. This tends to occur much more with the lap band, but I’ve seen it with the bypass surgeries as well. I’ve even seen people end up heavier than before their surgery! Furthermore, this study wasn’t powered to tease out differences between the different types of weight loss surgeries. My feeling is that the bypass surgery, which is also the most invasive, also had the most impressive results.

There are also the day to day side effects. For example, people with the lap band who are banded too tightly also tend to vomit if they eat too much or the wrong types of food. I’ve seen people with the lap band subsist on cake and yogurt (or ice cream) because fruits, vegetables, chicken, and other healthy fare did not go down well due to the narrow opening leading to their stomach. People who have undergone the gastric sleeve may develop heartburn. And of course, as mentioned above, I have seen people end up in the operating room to fix complications (at times needing several procedures and numerous CAT scans to see what’s going on, which subjects the body to much damaging radiation).

Furthermore, all of the studies above were conducted in bariatric “centers of excellence” under perfect conditions, and all of the subjects had tried losing weight on their own before undergoing surgery. Thus, the results may not apply to people who use less expert surgeons/hospitals or who have never seriously tried to lose weight through diet and exercise.

Should you opt for surgery?

So, what’s the bottom line? Should an obese individual jump to surgery?

It depends.

If you’re young and otherwise healthy (no diabetes, heart disease, etc), and if you’ve never seriously tried to lose weight before, then there’s no convincing evidence that the surgery will improve any long term health outcomes, and the possible complications might be worse than the benefits. On the other hand, if you’ve struggled to lose weight, and have serious medical problems (especially diabetes requiring insulin, in which it’s especially difficult to lose weight), then weight loss surgery may be a reasonable option for you.

If you’re considering undergoing surgery, then definitely do your homework. Studies have shown superior outcomes with experienced surgeons and hospitals. Furthermore, it seems to me (based on what I’ve seen in my own clinical practice), that the people who are the most successful long term are those who use the surgery as a nice push in the right direction, and continue exercising and watching their dietary intake. Those who simply rely on the surgery do initially lose weight, but are the ones who seem to gain a lot of it back as the years go on.

There’s one final point that I wish to emphasize, which I alluded to earlier. If you do undergo the surgery, be on top of taking your vitamins and checking your levels. I’ve had a number of cases of permanent nerve damage from years of low vitamin b12 levels, and I’ve seen a number of other nutritional deficiencies causing a variety of symptoms and conditions (e.g. headaches, debilitating fatigue).

– Tamir

(Image source: National Bariatric Link.)


Can flu shots prevent heart attacks?

A few weeks ago, I mentioned the upcoming flu season and the importance of getting vaccinated, especially if you smoke.

Can flu shots prevent heart attacks?

One further benefit I neglected to mention was that flu shots can prevent heart attacks, according to some recent research. Yes, you read that correctly. Recent data suggests that in those who’ve suffered a previous heart attack, the flu shot can cut down on the chance of another heart attack by more than half.

How can flu shots prevent heart attacks?

There are different theories about why this may be true. Some believe that the strain that the flu places on the body leads to a heart attack in people who already have a weak heart. The strain can stem from the complications of the disease (e.g. pneumonia) or because people suffering the flu feel very ill, with their bodies struggling to fight off a nasty infection.

A second theory requires some quick background information. Heart attacks often occur in the following way. An individual will have plaque build up in his or her arteries, including the vessels that supply blood to the heart. Some plaques are unstable and rupture, releasing fatty material into the blood vessel which ends up causing a clot to form. This seals off the blood supply to the heart, resulting in a heart attack. Some theorize that the flu virus, through the tremendous inflammation it causes in the body, increases the chances that a plaque that’s otherwise stable will become unstable and ruptures, causing a heart attack.

(Some evidence also shows a link between flu shots and a reduction in strokes in susceptible individuals, probably through similar mechanisms.)

Lastly, here’s an interesting point that will reinforce how much of a risk factor the flu is for developing a heart attack. The CDC (a government agency that tracks outbreaks, etc), uses spikes in heart attack rates in different locations as an alert to a flu outbreak.

So, once again, anyone 6 months and older should get the flu vaccine. If you’re a high risk patient, especially if you have heart disease, then do yourself a favor and get immunized. It could end up saving your life.

– Tamir

(Image links to source: Bottomline publications.)


Don’t get your symptoms written off by a doctor

Doctors should hear you out

We’ve all heard horrible stories in which someone went to their doctor with a chronic symptom and was brushed off. “It’s nothing. Probably stress. It’s just some indigestion – take some Tums.”

And, of course, it ended up being cancer. Or a heart attack. Unfortunately, the medical system, for a variety of reasons (which are outside of the scope of this blog post), doesn’t always work as it should. Doctors and other health care providers find themselves having to see more and more patients. In many cases, there’s poor continuity of care. A patient will be part of a health clinic in which they see Dr. A one time, Dr. B another time, and Dr. C is on call. No one really knows the patient and the evolution of their symptoms.

Don’t get me wrong; most symptoms aren’t cancer or anything severe. I don’t want you to start panicking every time you have a headache or a cough. However, if you’re experiencing any symptom that isn’t going away after a week or two, or is severe, it’s definitely worth mentioning to your doctor. If you feel that your doctor is not taking you seriously, then persist. If still nothing is being done, then go for a second opinion. Trust your instincts. The doctor might see you for 15 minutes or so once or twice a year. You live with yourself every day. You know how your body feels on a regular basis. You’re aware when something feels off. I’ve never understood how a doctor can simply write off a patient’s legitimate concern as “just stress.” Or “all in your head.”

I’ve seen several mishaps in my own career, including a missed cancer diagnosis. I’ve seen patients being told that they’re crazy when in fact they had serious medical problems. Part of the problem is that doctors for the most part tend to see harmless conditions, especially in young, otherwise healthy people. When a doctor sees thousands of coughs, headaches, back pains, abdominal pains, episodes of fatigue or malaise that are due to benign conditions, then when someone actually has a common symptom, it’s very easy to chalk it up to being nothing too serious.

The best litmus test you can use to judge your doctor is whether they’re listening to you and giving you the benefit of the doubt as opposed to interrupting you after a few seconds, belittling you, and moving on. Stay away from such physicians.

Again, I want to emphasize that most symptoms aren’t anything to lose sleep about. I don’t want anyone becoming a hypochondriac after reading this. However, if something feels off to you – if you don’t feel right or have a new unexplained symptom, by all means pursue it until you’ve arrived at an answer – or at the very least excluded serious medical conditions. This is especially true if you smoke or have pre-existing medical problems that place you at higher risk.

– Tamir


Flu Season 2013-2014

Time to prepare for the flu season again. The government has a very nice, user-friendly website with information about the flu and the flu shots.

Flu Season Warning

Flu Prevention

As you may already be aware, people who smoke are at a higher risk for developing complications from the flu. However, it’s recommended for everyone over the age of 6 months to receive a flu vaccine every year. This is one of the best ways to protect yourself from catching the flu.

In addition, careful hand-washing, especially when touching things in public places such as door handles, shopping carts, other people’s hands, etc. is a good way to prevent catching the flu, as well as many other types of infections such as colds and stomach viruses. Many people are under the impression that flus and colds are transmitted by people sneezing or coughing on others. While this is true, in reality, it’s not that common for someone to actually sneeze on you. More commonly, a person will cough or sneeze into their hand, then proceed to touch something with that hand (e.g. open a door). A second person will then touch that same door, picking up the virus onto their hands. Subsequently, when people eat, smoke a cigarette, or otherwise put their now contaminated hand in their mouth or facial area, the virus can now enter their respiratory tract and cause infection.

A good investment is to carry a small bottle of antibacterial alcohol-based hand sanitizer (e.g. Purell) in your pocket or purse, and anytime before eating, smoking, or throughout the day, rub your hands with it. In addition, when people handle their cell phones, germs end up on them which again, can cause infection when the phone is put close to the mouth/face.

Flu shot formulations

Back to the flu shot… there are a few formulations available this year, broadly falling into two categories: shots and nose sprays. Anyone from the age of 6 months and up can get the shots. Most tolerate them quite well. A few people may feel some localized mild pain at the injection site. Rarely, someone may feel achy for a day and perhaps have a low grade fever. You can’t catch the flu from the flu shot since it doesn’t contain a live virus. Reactions from the flu shot are due to the immune system reacting to the vaccine, not to an actual infection.

The flu nasal spray is approved for healthy people between the ages of 2 and 49. It does contain a live virus, although one that’s weakened and thus unable to cause an infection in healthy people. It isn’t approved in pregnant women. I find it a good way to immunize children and others who loathe getting stuck with a needle.

You’ll be doing yourself a favor

Since the flu can arrive at any time, it’s always best to get vaccinated early as it may take a few weeks to achieve optimal protection from the vaccine. Although the vaccine isn’t 100% effective (and that’s why it’s a good idea to wash your hands, use Purell, etc. as discussed above), it’s still the best preventive measure that we have, and given its excellent safety profile, it seems foolish not to go for it. The government does do its best every year to include circulating flu strains; however, there are no absolute guarantees of a perfect match.

Lastly, if you do smoke, the flu is one more reason to quit. In addition to reducing your risk of catching the flu and developing complications such as pneumonia from it, quitting can help reduce the chances of you developing other respiratory infections. Regular exercise, a healthy diet, adequate sleep, stress reduction and making sure your vitamin D levels are optimal (which can be checked through a simple blood test at your doctor) are other ways to prevent the flu and other nasty winter bugs.

– Tamir


Get a flu shot – the flu can hit smokers extra hard

Medical experts recommend that EVERYONE from the age of 6 months and up receive a flu vaccine every year. This is especially true for those of you who smoke, since smokers often have worse complications from the flu.

Many areas around the country are already witnessing many cases of the flu, and unfortunately, one of the strains circulating is a more aggressive, dangerous type that killed many more people the last time it reared its ugly head. Fortunately, this year’s vaccine does cover that strain, as well as most of the other ones going around. Even if you received the flu shot last year, it’s still important to get vaccinated this year as well. Unlike many other diseases for which we are immunized, such as measles, diphtheria, and chicken pox, the flu virus mutates, and there are often different strains going around from year to year – therefore, last year’s vaccine is insufficient to protect you this year. In addition, it can take up to 2 or so weeks to achieve effective immunity from the vaccine, so the sooner you go get vaccinated the better.

– Tamir


Important medical tip about smoking and blood pressure


Although smoking doesn’t lead to the development of hypertension (high blood pressure) per se, smoking a cigarette can result in the transient elevation of the blood pressure and heart rate. Therefore, if you currently smoke cigarettes and have scheduled an appointment with your doctor, try your best not to smoke for an hour before that appointment. Doctors need accurate blood pressure and heart rate measurements to decide whether or not you suffer from high blood pressure. The last thing you want is to be started on a blood pressure medication that you don’t really need.

If you forgot and accidentally smoked a cigarette right before your visit, then definitely mention it. You can offer to hang around after the visit for half an hour or so (depending on how soon before the visit you smoked) and have the doctor or nurse recheck your blood pressure.

– Tamir