The Lap Band.... A good solution?

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Ask your medical question here. : MD STAT is an educational service. We do not prescribe medication. We do not enter into a doctor-patient relationship with you. We explain, educate, clarify, and suggest possible solutions to your medical questions. Thank you for your interest.

I am an obese woman, 45 years old, who has tried a variety of diets and I'm considering the lap-band procedure. I am 5'3" and weigh 260 pounds. The best I ever did in the last ten years was on weight watchers and I got to 190 over 6 months but I put it all back on over the next year. I am strongly considering the procedure. Do you have any opinion on this for me?
Gender: Female
How old are you?: 45
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Psychiatric

Describe associated symptoms not listed above: I am depressed about the way I look.

I am "borderline diabetic" but otherwise quite active and healthy.
 

Check all conditions present in your immediate family... :
Cardiac Disease
Diabetes

Please list any medication allergies that you have : : None
Please list any medications you are currently taking (and dosage if known) :: None
When was your last menstrual cycle?: 3 weeks ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Occasionally  

 

Summary:

 

What is the reality of the long term success with the lap band? Will I stop the yo-yo cycle? Are there any risks associated with the surgery aside from the normal surgical risks?

Does Air Travel Make You Sick?

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I see you have a doctor who knows about medicine and flying and how they interact and there's a question I just have to ask. Seems like every time I go on a cross-country plane ride I get sick. A cold or a sinus deal. Then I see this stuff called 'airborne', sold in stores.... It's some kind of herbal remedy invented by a teacher (?) who was tired of getting sick on airplane flights. Anyway, why do people tend to get sick when they fly and does this 'airborne' stuff have anything to recommend it?

Gender: Male
How old are you?: 40
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Ear/ Nose / Throat
Describe associated symptoms not listed above: You may also use this area to further explain symptoms checked above.

Just seems to take a few days to recover from an Jet flight.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!):

no major issues

Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Weekly


1. Is there something to the statement that it's easy to catch a bug or virus on a plane?
2. Why do I always feel bad after a flight?
3. Is there anything to do to remedy this, specifically, does that 'Airborne' stuff really work?

________________________________________________________

Our intrepid Space Doc will weigh-in shortly.

As to airline travel, realize this.... even though modern airliners are pressurized, they are pressurized to about 8000 ft AGL (above ground level), so, going up in a commercial jet is putting you, assuming you are a flatlander, in a relatively hypoxic environment for a few hours and much of what you are feeling may be due to Acute Mountain Sickness, which you can read about by clicking the link.

As to the "Airborne" herbal remedy, well, it won't do you any harm... PROBABLY. And if I lined up 100 people and gave them sugar water and told them all they were getting a powerful sleep medicine about 33 of them would go to sleep. This goes for all the 'supplement' market.... We simply have no scientific evidence to validate any of the claims made by these manufacturers, and the FDA is NOT regulating them, so the operative phrases here are 'caveat emptor' and 'placebo effect'.

Thanks for your question and stay tuned....

MDSTAT ER DOC 1

________________________________________________________________

 Dear air traveller:

There have been some studies that have shown a slight increase in sinus and cold symptoms during airplane trips, but this would probably be the same if you were confined in a crowded room anywhere.

As Doc 1 mentioned most planes are pressured to an altitude around 8000 ft which most people can tolerate, although some individuals can have altitude sickness symptoms of fatigue, nausea, headache, and shortness of breath as low as 5000 ft. altitude

I totally agree with Doc 1 that there have been no studies to inddicate the Airborne medication prevents any colds, sinusitis, or bacterial infections, and they have had to settle 2 or 3 lawsuits for false advertising.

However, I have been taking both vit. C (2000mg.) and Vit. E (400-800 i.u.) daily and haven't had a cold or sinusitis in over 10 years. The usual Airborne dose has 1000 mg of vit. C so it would probably be safest to take around 3 doses a day (rather than every 3 hrs) to avoid any possible kidney irritations.

Some people swear by the Airborne so it would probably be worth a try, but there are certainly no guarantees' I also have had a number of patients who have had good luck taking Sinutabs before a flight to keep the sinuses clear

Good Luck! Keep us posted.

Space Doc.

"Heartburn?"

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The email to which we should send notification of your answer: xxxxxxxxxxxx

About once every 60 - 90 days I get heartburn. It is very painful.  I take Target Brand "Antacid tablets" (750mg Calc Carb). But they essentially do nothing. So I take more than the reccomended dosage 1.5 - 2 times the amount (the bottle says 2-4 pills as symptoms occur) I will take 6 - 8 initially.  But because it doesnt do anything I am always tempted to take more if the pain intensifiys.  I usually dont keep track.  I just groan in pain and grab the bottle as quickly as I can and take another tablet.


The bottle says no more than 10 tablets in 24 hrs.


So I have 2 questions.  What happens if you "overdose" on Calcium Carbonate.  (Do you get constipated, do you die, or something in between).  Also, I figure that dosages listed on bottles sold to the general public have to be very conservative, so for a healthy male in his early 40s you could probably double the amount to be entering the risk zone - I am I being a complete idiot? (I know you have to be very careful about what you say in this public forum, but please dont give me the legal answer that I should do just what the manufacturer reccomends, give me the medical one.  If you cant give me a straight answer please just recuse yourself and tell me you feel it would be imprudent to answer). One last thing, assuming I cant down awhole bottle, what else can I do? Some things I have done in the past are sip water to keep acid down, sip milk to keep acid down and neutralize it a bit, eat bread to absorb the acid, writhe around on the floor.

Gender: Male
How old are you?: 41
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Abdominal Pain
Describe associated symptoms not listed above: None
What have you done so far to remedy this condition? Please include tests and relevant studies here.
: Nothing
Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): Lacerations (kidding - none really)
Check all that apply to you or your immediate family (parents, siblings, grandparents):
None of these
Please list any medication allergies that you have : : None
Please list any medications you are currently taking (and dosage if known) :: None
When was your last menstrual cycle?: I'm a man, baby!
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Never


So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response. You will likely get more than you ask for, but we wish to understand your priorities.
: The effects of levels of overdose are the top priority, 2nd would be what else I can do do stop the pain, 3rd priority is what is the dosage that would cause a "real" overdose (vs what the label says) is an overdose).

Blood in the Toilet

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Ask your medical question here. : My mother has just been to the bathroom and it is bright red blood. It is as if she is on her cycle. Her belly has not been hurting or has this ever happened before. What could it be?

Gender: Female

How old are you?: 49

How long has this been going on?: A few days

Check all symptoms you are currently experiencing:
Diarrhea

Describe associated symptoms. Her belly has not been hurting or has this ever happened before. What could it be?

Describe associated symptoms not listed above: just went to the bathroom today and that is when it started. Has happened two times already. back to back

What have you done so far to remedy this condition? Please include tests and relevant studies here.
: nothing

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): High blood pressure diabeties high chol

Check all that apply to you or your immediate family (parents, siblings, grandparents):
Diabetes
Hypertension

Please list any medication allergies that you have : : Please do not list any medicines you merely dislike. True allergies produce hives and other symptoms. An upset stomach is not an allergy to a medicine. Thanks!

Please list any medications you are currently taking (and dosage if known) :: Also, please tell us if there is medicine you are supposed to be taking but are not. Thanks!

When was your last menstrual cycle?: 2 weeks ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Never

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: Within 8 hours
So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response. You will likely get more than you ask for, but we wish to understand your priorities.
: possible causes, what it is, and how to prevent it

Devic's Disease and It's Relation to Multiple Sclerosis

8 minutes ago

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The email to which we should send notification of your answer *	XXXXXXXXXXXXXXXX
Ask your medical question here. *	how simalar is Devics disease compaired to MS? I know the treatment is somewhat different. My sister has been dx maybe 2 years.
Gender	Male
How old are you? *	41
How long has this been going on? *	More than a year
Check all symptoms you are currently experiencing	Eye
Describe associated symptoms not listed above	the only symptom she is having now is reoccuring optic neuritis.
What have you done so far to remedy this condition? Please include tests and relevant studies here.	Results of blood tests and Xrays can go here. Results of consultations with specialists as well.
Please list any medication allergies that you have : *	Please do not list any medicines you merely dislike. True allergies produce hives and other symptoms. An upset stomach is not an allergy to a medicine. Thanks!
Please list any medications you are currently taking (and dosage if known) :	Also, please tell us if there is medicine you are supposed to be taking but are not. Thanks!
When was your last menstrual cycle? *	Now
Are you currently using or do you have a history of tobacco use?	No
Are you currently using or do you have a history of illegal drug use?	No
HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED? *	Within the next few days
So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response. You will likely get more than you ask for, but we wish to understand your priorities. *	difference in the two diseases and life expectancy.

Neurological Issue?

Ask your medical question here. *
I keep getting "twitches" in various parts of my body. I mean tiny flutters of muscle contractions. No real pain or even discomfort and they last about 1 - 3 seconds, with intervals of anywhere from 2 minutes to 2 hours. Then I may go a few days with nothing. But it has been going on for months and it seems to be moving around my body. Upper lip for 2 weeks, inner ear for 3 days (most annoying it it like someone doing a soft drum-roll in your ear), eyelash for a day, scalp for 1 week, a different part of the scalp for another week, right hand for 5 days, etc. Just kinda weird. What is it? Anything to be concerned about? Especially since it seems to cover my whole body, but just 1 location at a time.
Gender *	Male
How old are you? *	27
WHEN DID THIS PROBLEM START? *	Wednesday, June 1, 2011
Check all symptoms you are currently experiencing *	Neurological
Describe associated symptoms not listed above	You may also use this area to further explain symptoms checked above.
What have you done so far to remedy this condition? Please include tests and relevant studies here.	Nothing
Check all that apply to you or your immediate family (parents, siblings, grandparents)	Cancer History of Back Pain Psychiatric Disorders
Please list any medication allergies that you have : *	Please do not list any medicines you merely dislike. True allergies produce hives and other symptoms. An upset stomach is not an allergy to a medicine. Thanks!
Please list any medications you are currently taking (and dosage if known) :	Also, please tell us if there is medicine you are supposed to be taking but are not. Thanks!
When was your last menstrual cycle? *	I'm a man, baby!
Are you currently using or do you have a history of tobacco use?	No
Are you currently using or do you have a history of illegal drug use?	No
Please describe your alcohol consumption :	Rarely
HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED? *	Within the next few days
So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response. You will likely get more than you ask for, but we wish to understand your priorities. ---------------------------------------------------------------------------------- Well, pardon the strange format here but we are working on a new way to answer questions and we will figure it out.  Sir, the condition you are talking about is most likely MYOCLONUS, and you can read about by clicking on the link preceding.   As you can see, this condition, if I am correct about what you have based on this history alone, is almost always benign and rarely is a sign of a central neurological disorder.  Multpile sclerosis can have different neurological symptoms over time but muscle twitching and jerking, especially the very short acting bouts you seem to be having, is NOT typical for Multiple sclerosis.  However, if your symptoms persists or worsen over the period of the next few months getting in with a Neurologist would be a good idea. I don't think you need to do that now. The rest of your history, your age, and your problem do not lead me to think of any dread diagnosis. Thanks for your question and please come back anytime.	Do I have some whole body problem, disguised as local tremors? Is this something I need to worry about now? Is this some thing that will get worse over time

A Multi-part Surgical Question

Dear Doctor,

For about 6 months I have had shooting pain down my left leg - it happens about 5 times a day but it REALLY hurts.  An xray or mri or something like that showed one of my lower vertabaes is somewhat shifted, the word the surgeon used was something like "sponge hello less he says". Any way we tried a spinal injection to block the pain and i wore a Boston brace for a while. Now the doctor is recommending surgery to fuse my spine.  I hate the idea of surgery, it seems so life threatening. So I have a question.

Is there any way to find out the historical risks of surgery - including the risks from  a specific doctor?  I mean can I find actual statistics about  1) Surgery in general, 2) different types of surgeries (these must be in some database somewhere right)? AND 3) Statistics about a specific hosptial or doctors track record (at least how many people have died during his surgieries)?  Are these records even kept, and if they are are they kept secret by hospitals?

Oh 1 more question, if that is ok.  If I DONT get surgery, and decide that the pain is better than the risk, am I doing damage - so that the pain will just get worse and worse?

Thank so much for the blog

Gary

___________________________________________________________

ANSWER TO FOLLOW SHORTLY  DOC1


Okay, Gary,

I will be answering this in parts as I am torn between the yard that needs to be cleaned up, the NCAA football on tv all day, and my desire to help you.

First, "sponge hello less he says".... This can only be something called SPONDYLOLISTHESIS.... if you click on the link you can read all about it from the NIH,  but it is as you describe, a slipping forward on one vertebra on the one below. It is usually a result of trauma but can also be something you were born with. Either way, instability in the supporting elements of the spine allow for the slippage, and if the slip becomes big enough many more problems occur.

I am not surprised that the shots did not help. They are a temporizing measure at best, in other words, they can buy you some time in advance of surgery with some amount of pain relief, but they are not curative.

And for the moment I am going to end with this to return to your more complicated questions in a bit.... Not to make light of your situation but the surgery for this is routinely performed, and, in fact, you happen to be talking with someone who has actually HAD the surgery, usually a fusion procedure. And, perhaps if you could email me your specific concerns about the surgery being life-threatening then I could address them, but with the state of the science of anesthesia and the techniques now employed by spine surgeons I would not look at this surgery as any more risky than an appendix surgery.

I have much more to ad but hopefully this is a good start for you. Back in a bit.

Doc1

Good morning Gary. I thought the above image would be instructive. As you can see, the defect that allows for the slippage of the vertebrae is in the posterior portion of the spine.

Spine surgeon have a grading system for this defect but it is less important than the symptoms and pain you are having. That alone does indicate that the surgery is probably the way to go, and, as you can see from the reference above, fusion surgery provides great results and relief of pain in 95% of patients. I am in that 95%.

As to your question regarding the historical risks of surgery, again, I would ask for some clarification. If we are going to include surgery performed back in the early part of the 20th century to our database then we will get a decidedly different result than if we use, say, the last ten years. This being said, I'm not sure if these statistics are available, though I will certainly check.

And I have now checked! The thought struck me to search for 'intraoperative mortality in the United States'. The bottom line is this... by far and away the most common cause of death in the operating room is cardiac arrrest.... heart attack, and so while I could not find statistics for TOTAL intraoperative mortality, I did find it for cardiac arrest, and you can view it here. The number is about 4 in Ten-thousand surgeries. I hope that is reassuring to you, and if you are healthy going into the surgery your risks are much lower than this.

As to your question regarding specific surgeons there IS a way to find out what patients think about their doctors and surgeons, I just don't know how accurate and valuable the information is. There are websites like Health Grades.com where you can search for particular doctors or surgeons, or search for a particular TYPE of physician or surgeon in your area.

And for the moment, the one thing I DO know you can do regarding malpractice claims, inquiries to the Medical Board in the state where you physician practices will not get you information about specific problems with specific surgeries, but WILL get you information on your surgeon's track record regarding malpractice.

Gary, I am going to try to finish this up a little later, hopefully this has been helpful so far.

Doc1

Smiling Bob

Hey Docs, 

I'm pretty sure I know the answer to this, but is therre any evidence at all that the 'male enhancement' products on the market work at all to increase penis size?

Sheepish in Virginia

______________________________________________________________________

Dear Sheepish,

No need to be sheepish, but you are correct. "Enzyte", "Longinexx" (love that name) and the like are complete scams and the amazing thing is that people actually pay for them. But don't take my word for it, let's check in with the Mayo Clinic. And think of it this way, if they did work, then all of us would have large penises. That WOULD be interesting because we would then actually learn if size matters, but we are as God made us.

Best,

Doc1

Cat Bite

Hey Docs,

I was at a friends and got but by her cat. I ended up in the ER the next day with a bad infection and they took an X Ray of my hand. I didn't say anything at the time but now I'm wondering if I got ripped off? Why do an X Ray?

Just Curious,
Ben in Portland, ME


Hey Ben,

Great question. Cat bites, as you discovered, are very dirty bites and often get infected. One of the WORST things that can happen is for the cat to break a tooth off under your skin. This is why they did the X Ray... To look for a cat tooth in the wound. Evidently you didn't have one or they would have had to get it out and that can be an unholy mess, but you DID NOT get ripped off. You got good care.

Hope you have fully recovered.

Doc1

Weight Loss Question

Hello Docs,

I am having trouble losing weight. I tend to yo-yo on the weight thing. I have tried Weight-Watchers and Nutri Systems, but I get so hungry I eventually binge and end up back where I started. What are options for me besides surgery? I am female and 40 years old. I am 5' 4'' and weigh 260 pounds. I have no other medical problems. I have had a recent complete physical including a thyroid check. I'm healthy but fat! What to do?

Thanks,

Cynthia

Dear Cynthia,

Thanks Cynthia for your question. There are as many ways to approach weight loss these days as there are people trying to lose weight. Weight Watchers and Nutri-System are great programs, but when it comes down to the essentials it takes two things to lose weight: good diet and regular exercise. The reason that most diets fail is because there is (believe it or not) too much self-reliance or (worse) reliance on friends to be a support structure for continued success.
You've done a good job by getting a primary physician to see you and get some routine lab work. However, the usual amount of time your primary provider has to devote to you (especially if you are an established patient) is going to be about 15 minutes. In my practice, I have found that it takes about 30-45minutes of time just to get a good history from the patient to make a plan about any further diagnostic testing or a treatment plan.
If you are ok physically, then you need to get a strong team together to help you succeed. A physician or other provider can often be a good source for accountability by following up at regular intervals. A dietitian can help you get on the right track instead of trying to wade through a sea of diet books and philosophies. Lastly, a good personal trainer can often be your best cheerleader. You might even consider a psychologist or psychiatrist if you think that there are issues that may be hindering your success.
Sometimes weight loss medication can help get you from the bad habits to the good habits. I often tell my patients that weight loss medication can help you lose weight even if you sit on the cough, but they are BETTER used as a means of helping you make a transition to a healthier lifestyle. Otherwise, they will be a miserable failure.
I would recommend that you seek the guidance of a physician who practices "bariatric medicine" (notice that I didn't say "bariatric surgeon"). If you look on the website for the American Society of Bariatric Medicine for a listing of physicians in your area that specialize in this expertise, then you may find the perfect partner in your weight loss goal. The website is www.asbp.org. Good luck to you!!! _DOC2