Statistics vary but about 5-20% of patients will regain weight despite having gastric bypass surgery. This indicates that we still don’t fully understand the psychopathology of binge eating and its impact on gastric bypass surgery as one 2002 study of binge eating in gastric bypass patients concluded.

The two most common types of weight loss surgery are laparoscopic gastric banding and gastric bypass surgery with weight loss expected to be between 45-75% and 50-75% respectively. Gastric bypass surgery should be done by an experienced surgeon.

For more information about these types of surgery, UpToDate has an excellent patient handout on weight loss surgical options.

The study results were published in the British medical journal Lancet. The study followed for 10 years, people who had been diagnosed with impaired fasting glucose, otherwise known as “pre-diabetes”. The purpose of the DPPO was to study the long term effect of diet and exercise and the diabetes medication, metformin, on the delay of type 2 diabetes.

One group took metformin, a well known anti-diabetic medication, while the other group focused on life-style changes that included modest weight loss and increased physicial activity. A third group received a placebo instead of metformin.

Those in the life-style changes group delayed the onset of type 2 diabetes by 4 years compared with placebo, while those in the metformin group delayed the onset by 2 years according to Dr. David M. Nathan, one of the principal investigators of the study. He went on to say in a statement from the National Institue of Diabetes and Digestive and Kidney Diseases which funded the program, that “…people age 60 and older lowered their rate of developing type 2 diabetes in the next 10 years by about half.”

This is good news for anyone diagnosed with pre-diabetes showing that simple changes in your activity level to promote weight loss really does work.

Interval training increases endurance, increases fat burn, and as Gibala et al concluded in their study at McGill University, decreases the amount of  work out time. “Given the markedly lower training volume in the SIT group, our results suggest that intense interval training is indeed a time-efficient strategy to induce rapid muscle and performance adaptations comparable to traditional endurance training.”

Interval training is quite easy. If you normally work out on the treadmill for 50 minutes at 4 mph, try shortening your work out to 25 minutes. Every 5 minutes, spend 30 seconds going as fast as you can, then resume your previous pace of 4 mph. This will give you 5 intense work out sessions lasting 30 seconds each – in other words 2 1/2 minutes of intense work out time. (Be sure to include a 5 minute warm-down period. Abruptly stopping  your work out can cause dizziness and blood pooling in the lower extremities.)

As always, consult your health care provider if you are new to any exercise program. Once you’re cleared, give interval training a try. You’ll be surprised by how quickly you can lose weight.

In the November 2009 newsletter, the “right stuff” column featured broccolini. According to the newsletter, broccolini is rich in Vitamin C (130% of a day’s worth) and Vitamin A (30%). Eight stalks are only 35 calories. I like to add a bunch, trimmed (including the stalks) in soup.

Nutrition Action also suggests tossing them with a little olive oil and roasting them in the oven on 450 degrees for 12-15 seconds then sprinkling them with a little Parmesan cheese.

Feel free to submit your own favorite way of preparing broccolini.

The articles specifically write about the human side of drug trials by following five patients who entered the trial as the last resort, chronicling their miraculous remissions and the struggles involved in bringing these kinds of drugs to market. PLX 4032, developed by Roche for treating melanoma, was in the first phase. New drugs must undergo 4 stages in testing which are outlined below:

Dr. Keith Flaherty, the lead oncologist from the University of Pennsylvania, in charge of the Phase 1 trials, was investigating ways in which certain genetic mutations that cause melanoma could be turned off. To qualify for entry into the trial, patients had to have the genetic mutation that stimulated the cancer. And the results for PLX 4032 were nothing short of astonishing: tumors disappeared.

The articles detail the frustrations dealt with by patients, families and doctors when trying to push for combination drug therapy or when trying to speed up drug approval by the Food and Drug Administration (FDA). In addition, drug companies do not necessarily cooperate with each other as Dr. Flaherty finds out when he urges several companies to combine their drugs in one trial in order to target several different pathways in much the same way that HIV patients receive a “cocktail” of medications that slow replication of the HIV virus.

The articles make compelling reading. Here are the links:

Target Cancer: A Roller Coaster Chase for a Cure

Target Cancer: After Long Fight, Drug Gives Sudden Reprieve

Target Cancer: Recovery, Relapse, Reinvention

If you or someone you know is interested in participating in clinical trials (not necessarily this one) you can research all the trials available by going to clincialtrials.gov . There you can search a large database of federally and privately funded trials available in the U.S. and around the world.

Anthem mainly provides health insurance for people who are unable to get it through their employer. This means that the full burden of the rate increase is paid for by the individual.  Families already stretched thin will be forced to drop their health care coverage (and end up in Emergency Rooms when there’s a problem).

I checked the rates for family coverage using the following scenario: Male 39 yo, Female 37 with one 9 year old boy and 7 year old girl. The most expensive monthly rate was $299 BUT there was a $10,000 annual deductible plus an annual out-of-pocket expense not to exceed an additional $5,000. On some plans, the deductible is waived for certain services such as Well-Child and adult office visits. Ummmm, it’s not clear to me why someone would opt to pay an additional $116/month more for such poor coverage anyway. A $10,000 annual family deductible amounts to $833/month in medical expenses that would be incurred by the family for a year before their health care expenses would be paid for. Essentially, this policy is for catastrophic coverage only.

Whether or not the coverage provided by Anthem is adequate, this rate increase is being reviewed by the State Department of Insurance to see if it is justified by law. The president of Anthem, Leslie Margolin, argues that the anger directed against Anthem is misplaced. “This debate and this inquiry cannot and should not be just about the insurance industry or the delivery system or regulators or legislators or customers or brokers,” Margolin said.

“We have wasted precious time and precious resources doing battle with each other,” she added. “We must come together collaboratively and strategically to address the distressing symptoms of our troubled system — rising premiums, for example — and to address the fundamental underlying causes of our collective failure.”

The rate hikes are on hold until an outside actuary board can verify that Anthem spends 70% of its premiums on medical expenses, as mandated by California law. Anthem officials are confident that the rate increase will go ahead. Anthem officials say that their profit margin is on par with other health insurers and amounts to no more than 5%.

Sounds reasonable until it was declared during the Senate hearings 2/24/10 that Anthem made over $2.5 billion in profit last year (that excludes the profit it made on the sale of one of its businesses for another $2+ billion dollars). Anthem’s CEO testified yesterday that she made about $1.7 million dollars in salary, over $8 million in stock-options and another $74,000+ in bonus incentive pay last year.

By the way, Anthem last year (August 8, 2009) blasted the proposed health care reform bill and urged customers to help fight the bill. Clearly,  they are not urging customers to fight against this rate increase but while they continue to make profits, customers are forced to pay for it.

Regardless of whether Anthem is making excessive profits (it claims otherwise but you decide) the cost of health care is breaking employers and individuals alike. It’s time for a single-payer system.

There are some classic symptoms associated with appendicitis but that being said, the symptoms are fairly vague at first. The pain starts generally around the umbilicus (belly button) which then tends to radiate down to the right side of the abdomen. Loss of appetite (anorexia) and nausea almost always accompany the pain.

Now, many people complain of abdominal pain or discomfort with loss of appetite and nausea so the clinician looks for other symptoms that may help confirm the diagnosis. These are:

• guarding the abdomen voluntarily or involuntarily during the exam
• heart rate over 100
• slight temperature increase
• pain that is relieved with bending the right lower leg

Sometimes however, the symptoms are not so clear cut and can include:

• diarrhea, gas or indigestion
• general  malaise

Because symptoms can be vague especially at the onset, there is no one specific test used to diagnose appendicitis. Labs can be ordered to see if the white blood count is elevated or to rule out other causes of abdominal pain. CT scans and ultrasound testing can be useful when appendicitis is suspected but not clear. 

Even then, these radiologic exams can be less than clear. Case in point involved one patient of mine whose CT results were equivocal. The surgeon wanted to monitor her overnight to see if her symptoms worsened but she had had enough and decided she wanted to proceed with the surgery. Sure enough, the pathology report showed inflammation of the appendix.

Hopefully, a thorough history, physical and lab data can cinch the diagnosis - if not there are the radiologic tests previously mentioned. Otherwise, careful observation in a hospital setting may be required.

This informal survey by Reader’s Digest asked  ER nurses and docs about the kinds of things that patients do and say that don’t particularly endear them to the staff. Read the “7 Secrets of the Emergency Room” that appeared recently in the NY Times for a good chuckle.

The study followed 4857 American Indian children who were born between 1945 and 1984 for 23.9 years. Glucose intolerance (pre-diabetes) also increased the risk of early death by 73%. In addition, high blood pressure was strongly associated with premature death. 

Although the Pima Indians studied in this group had a higher rate of obesity and diabetes, the authors note that childhood prevalence of obesity in the 21st century among contemporary Hispanic and African-American children is similar to the group studied.  The authors write, “Thus, although we studied a population with high rates of obesity and diabetes, our findings may reflect the future burden of premature death among contemporary children from other ethnic groups and may be more generalizable than the findings in previous studies.”

We need to get behind the “Let’s Move” campaign to fight childhood obesity by offering healthy food in school cafeterias, and seriously considering the implementation of a sin tax on certain food/beverage items. Bringing back physical education in schools and making sure communities have sidewalks so that kids within walking distance can walk to school, would also help.

Yes, I understand how unpopular and costly some of these measures might be but consider the enormous economic impact obesity has on our health care system. When we start to see adult illnesses in children such as adult-onset diabetes, kidney failure secondary to diabetes, and coronary heart disease, then drastic measures may need to be taken.

Dr. James Eckner and colleagues of the University of Michigan Department of Physical Medicine and Rehabilitation in Ann Arbour, tested more than 200 Division 1 male and female athletes during the preseason physicals by measuring how long it took them to catch a weighted cylinder. Anyone who suffered a medically diagnosed concussion during the season took the test 3 days post-concussion.  Eight athletes suffered a concussion during the season and of those, seven had reaction times decreased by 15% from preseason trials.  

A more thorough test is currently used used to diagnose concussion that measures different aspects of cognitive function. Called the ImPACT test (Immediate Post-Concussion Assessment and Cognitive Testing), it measures visual memory, reaction time, processing speed and impulse control.  Generally, athletes take this test before the season begins and the results serve as the baseline test. If the player is injured during the season, repeat testing is then done and the two scores are compared.

However not all communities use this testing and there is no testing currently available for on-the-field use. This at least provides a cost-effective way to quickly evaluate a player suspected of head injury. A large scale clinical trial is expected to follow. The results of this small trial will be presented in April at the annual meeting of the American Academy of Neurology this year.

You can check out pictures of this weighted cylinder being tested.