Friday, March 23, 2007
Footing the bill for gastric bypass
Anne Durand weighed 287 pounds in 2006
When Anne Durand greeted me at the door, I thought she might be her sister. Certainly this woman wearing a size 2 suit was not Anne, who in 2006 weighed 287 pounds. But it was Anne, and she was ready to talk about her gastric bypass surgery. (Watch Video)

It seems Anne was always an active person. As a hot-shot consultant, she liked to travel both for work and pleasure. But as the years went by, she began to have a lot of pain in her joints and was eventually found to have an autoimmune disease. She stopped exercising, went on medication and began to gain weight, lots of it. She became so heavy that she had to use a motorized scooter to get around. She couldn't take walks with her husband. She wasn't enjoying her life. She was desperate. Her doctor finally suggested she think about bariatric surgery to rid herself of the weight. She had the procedure and within months became mobile and her illness went into remission.

Anne Durand is not alone. According to the American Society of Bariatric Surgery, more than 177,000 patients had gastric bypass or stomach banding procedures last year. Intended to help people who are considered severely obese or suffer from complications because of their weight, the surgeries can be expensive as well as dangerous. And those are two things insurance companies don't like to hear. Susan Pisano, a spokesperson for America's Health Insurance Plans says insurers want patients to understand that bariatric surgery is not a quick fix and that there are other alternatives.

Now, some insurance groups are insisting on more then just a doctor's opinion and a patent's desire before they'll agree to pay for these procedures. Beginning this month, Tufts Health Plan in Massachusetts is requiring some obese patients to enter a yearlong diet and counseling program before undergoing bariatric surgery. Tufts' hope is to have patients lose their weight naturally, without surgery. But some doctors feel the policy just postpones the inevitable. According to NIH research, only about 5 percent of patients, once they are morbidly obese, are able to lose weight by willpower alone. And other surgeons believe it's none of the insurance companies' business to tell people what surgeries they can or cannot have.

But Tufts Health Plan is not alone; many insurance companies say it is their business to oversee their clients' health. They insist that many patients who seek these surgeries can lose weight without going under the knife. They also stress that these procedures are risky and it's a safer tactic to wait out the surgery for a year, than to jump into an operation that many patients don't understand.

Had Anne Durand waited a year to have her surgery, chances are she would have not been able to walk. She cringes when she thinks about it. But insurers say that she's an exception and that many of those who have bariatric surgery could look to better nutrition and exercise as a solution to their obesity.

What do you think?

For more on bariatric surgery, watch House Call with Dr. Sanjay Gupta Saturday and Sunday at 8:30 a.m. ET
Thursday, March 22, 2007
Can TV make you a better doctor?
I sleep well when I go to bed on Sunday nights. I close my eyes knowing I will be in the operating room on Monday morning. The O.R. at Grady Memorial Hospital in Atlanta, Georgia, is where I feel at home, content and focused. I know the patients need me to bring my "A-game." I know the residents in neurosurgery need me to teach, demonstrate, explain and encourage. I am confident that I will deliver on both.

My day begins with orange juice and a scrambled egg - vitamin C and protein - no caffeine. Never any caffeine on Mondays. It is early, very early and during my 10-minute commute to the hospital, there is no one else on the road. It is surgeon time. From the car, I call my chief resident. This month it is Lou Tumialan. He's already at the hospital and gives me the latest updates on the patient who will be our first case.

At the hospital, it may appear that Lou and I are joined at the hip, in a never-ending, quiet, unemotional conversation. We run through scenarios, we discuss options and possible outcomes for the patient. We hope for the best and we are prepared for just about anything. We emerge from the doctor's locker room energized, unshaven, and dressed in our uniforms of green. A small wooden box containing our magnifying glasses is tucked like a football in our right hands. We scrub in together, both up to our elbows in the harsh yellow iodine soap and we become quieter, more inwardly focused. It's almost as if I can actually feel every cell in my body working to bring years of information, education and experience to the starting blocks of my mind. I am ready for the race. I feel fully prepared to start the case.

Today, I get to return function to a broken and damaged body. On the very best days, I get to save a life. A resident doesn't have that same sense of confidence and calm. I tell my residents it's fine to have butterflies, just make sure they're flying in formation. There may be surprises, there is certainly a sense of urgency, but chaos is not an option. It is never an option.

Maybe I feel so comfortable at this particular hospital because, like me, it has a history of combining health care and journalism. Henry W. Grady, editor of the Atlanta Constitution newspaper in the 1800s, worried that Atlanta's poor couldn't get good medical care. His dream of providing quality basic health care for Atlanta's less fortunate came true when Grady hospital opened in 1892. Although he chose journalism as a career, he felt drawn to health care. I, on the other hand, chose medicine as my career, but felt drawn by the power of journalism. Now, six years into a life with dueling careers, I have a clear appreciation for both. Each job makes me better at the other.

Today, because of what I've learned from being a journalist, I will not only try to educate Lou on a particularly complicated maneuver to correct a spinal injury, but I also will explain what can be gained from getting to know the patient's story. Accuracy, the cornerstone of good journalism, is also critical to the neurosurgeon, as Lou will learn during today's intense six-hour procedure.

As more than a dozen medical professionals move around a music-filled operating room, negotiating sharp instruments, multimillion dollar machines and lifesaving, yet dangerous, chemicals, the residents will also hear my lesson on clear communication. These lessons are as important for a doctor as they are for a journalist. It's my hope that my experiences as a journalist will allow me to more fully prepare and equip our next generation of doctors.

So far, so good.

To learn more about Dr. Sanjay Gupta's work at Grady Memorial Hospital, watch "Grady's Anatomy" on CNN this weekend. It airs Saturday and Sunday at 8 p.m. and 11 p.m. ET.
Wednesday, March 21, 2007
Creating a "culture of prevention"
On CNN's American Morning today I talked about the latest news regarding heart disease. It's pretty sobering. Already heart disease is the biggest killer of men and women in most developed nations in the world. Unless we do more, the situation may become much, much worse.

A study published in one of the big medical journals is titled, "The International Pandemic of Chronic Cardiovascular Disease," and that really says it all. Researchers examined data of almost 70,000 people from 44 countries who had some confirmed evidence of heart disease or a combination of risk factors such as smoking, hypertension and excess weight. Most alarming was that one out of every seven had a catastrophic event within just one year. They either had a heart attack, a stroke or they died. (Full Story)

Certainly, we are better than ever at treating heart disease, but we are still not a society that practices a culture of prevention. We can unclog blood vessels with angioplasty, even bypass them with open-heart surgery. We can use medications to stop plaque from forming and sometimes reverse its growth. The problem is that too many people are waiting too long. Too many people never get a chance to prevent the diseases that eventually rob them of their lives and their well being.

One of my great passions is to try and create this "culture of prevention." It makes sense medically, morally and financially. People will live healthier and more functional lives without spending countless days in intensive care units and assisted-living facilities. Still, we are in constant firefighter mode, rushing to the scenes of disasters, instead of preventing the fires in the first place. I would love to hear your thoughts on how to work toward a culture of prevention.
Tuesday, March 20, 2007
To prescribe or not to prescribe?
To prescribe antibiotics, or not to prescribe antibiotics? That is a question thousands of doctors ask themselves every day. It's a common scenario: A patient comes into the office complaining of what is almost certainly a viral infection. The doctor knows the infection will probably clear up on its own in a few days, but the patient asks, "What about a Z-Pak or another antibiotic?" The patient tells the doctor it always works and a previous doctor prescribed it all the time. Many doctors cave. I have sometimes caved.

The truth is the infection probably would have improved without antibiotics. Usually by the time, someone sees his or her doctor, the viral infection is already starting to go away. Right around the time the antibiotics dose of five to seven days is complete, presto: The patients feel better. Of course, they attribute that to a $70 antibiotic, instead of plain old natural history.

There are many things one can do to deal with viral sinusitis, besides antibiotics. A good decongestant, such as Sudafed, will be very helpful, as would a saline flush through the nose. It's not the most pleasant, but people who use it swear it works well. Still, researchers at the University of Nebraska Medical Center in Omaha found that antibiotics are prescribed 82 percent of the time for patients with acute sinus infections. (Full Story)


That is too often. As a result, extremely antibiotic resistant bacteria, such as the flesh-eating bacteria, are developing. So, why are doctors so willing to dole out a prescription?

I have found that patients like to walk out of the office with something in hand, so they feel like they accomplished something on their visit. If you don't give them an antibiotic, they feel like you have not treated them.

How should doctors deal with patients who demand antibiotics? What are your suggestions on how to handle this?
Monday, March 19, 2007
Daily supplement for war?
Four years ago today, we watched the U.S.-led coalition forces invade Iraq. To be honest, I can't remember where I was. The events of that date aren't etched in my mind as are those of September 11, 2001, or even the day Saddam's statue fell. What I do remember clearly are the reports from U.S. officials citing evidence that Iraq was planning to use chemical weapons against U.S. forces, Iraqi citizens and consequently the embedded journalists on the front.

At the beginning of this war, health and medical reporters were focused on the unknown terror of biological and chemical weapons. We prepared ourselves for attacks of botulism, smallpox, anthrax. We studied the difference between nerve agents such as sarin and blistering agents such as mustard gas. Four years ago, if you had asked me the size of a danger zone in a nuclear or biochemical attack with the wind blowing 20 miles to the west and sunny conditions, I could spit out the calculation as if it were a multiplication table.

Today, the conditions are much different for medical journalists. When it comes to the war in Iraq, our headlines focus on how the military has dealt with caring for its own for the past few years. I've interviewed young soldiers returning home who say they just aren't the same emotionally or physically. From combat medic training, to post-traumatic stress disorder to amputations to what's been called the signature injury of this war - traumatic brain injury, I've had the privilege of interviewing young servicemen and servicewomen both before and after their deployment.

In a broader sense, war has always been a time for incredible medical advances. By necessity, doctors are forced to innovate in the battlefield. They need to be more nimble and get the injured to care faster and more effectively. In many cases, trauma medicine feels the greatest impact of the war.

But just recently, a new Department of Defense-funded study focused on quercetin, a powerful anti-oxidant commonly found in apples, onions and black tea. The researchers found that quercetin could possibly help soldiers on the battlefield. The major findings found that after extreme exercise mimicking physical conditions in the field, quercetin could help fight off the common cold and could help improve mental vigilance. The study looked at 1,000 mg compared with the 25-50 mg eaten daily in the average American diet. The findings are promising, and more studies will be done before it will be recommended as a supplement to soldiers or civilians.

The study was funded under the Peak Soldier Performance Program. It's just one arm of the DOD's Defense Advanced Research Projects Agency. The goal of many of its projects is to help soldiers fight better, stronger and longer.

Four years later, what do you think about the medical advances learned during the Iraq war? What do you think of government research dollars targeting improved soldier performance? In medical terms, what do you think is unique to this war?
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