How am I suppose to chose? Am I prepared to die on the operating table, NO. Do I want to die slowly by staying 362lbs, NO. So now what? I know most people think obese people should be able to just stop eating and the weight will come off, but it doesn’t work that way for everyone. Me being one of those people. I have a 12 yr old son that I want to live for. I want this surgery but how can I say, as I’m being wheeling into surgery “see you soon” knowing that he may never see me again..all because I want to be healthy. I’m so confused!

This eloquent paragraph defines the problem of obesity. You know that your weight is a major problem, yet cannot succeed with conventional methods.

Most physicians and readers do have difficulty understanding your situation. Peronally, I have succeed in modifying my diet and enhancing my exercise program. That must not work for you.

So what are you to do? No one can make this difficult decision for you. When does one risk everything (albeit a low probability) to gain everything? I can tell you that on average having surgery will benefit you. But averages work for populations, not for individuals. Talk to some surgeons who specialize in this surgery. Interview them, and they might help you with your decision making. Good luck – we all hope you make the right decision for yourself.

I’m not a doctor… my wife has Atrial Flutter. She feels much better in Sinus Rhythm. So isn’t it a good idea to have “rhythm” control just from a quality of life point of view?

And if she is in sinus, are the data clear that she should still be on warfarin? How about going back to warfarin if she should go into AF, but otherwise don’t take it. She’s been in sinus for several months now.

Thanks for this interesting question. Let me first describe the difference between atrial fibrillation and atrial flutter. Heart rhythm normal starts with the atria (the 2 smaller chambers) contracting, and very soon thereafter the ventricles (the larger chambers) contract. In normal hearts these contractions synchronize to maximize blood flow through the heart and out to the body.

Atrial fibrillation occurs when the atria no longer have coordinated contractions, rather they fibrillate (fibrillate refers to the act of fibrillation – muscular twitching involving individual muscle fibers acting without coordination). Thus, the atria “quiver” but do not send coordinated impulses to the ventricles. The ventricles receive irregular signals to contract. Thus, the rhythm becomes irregularly irregular.

One danger of atrial fibrillation comes from the “quivering” in the atria. Since they do not contract properly, the blood tends to pool, allowing coagulation to occur. (oops another medical term – coagulation means that clots can form). The clots are the problem. They can grow to a large enough size that they cause problems when they “break loose” from the atria. Thus, the risk of stroke in untreated atrial fibrillation.

Atrial flutter is a different rhythm. In this rhythm the atria do have coordinated contractions – usually at a very fast rate (think around 300 times per minute). This atrial rapid rate is usually modified by the electrical connection to the ventricles (what we call the AV node). The AV node handles the electrical impulses from the atria – passing on a signal to the ventricles to contract. A rate of 300 is too fast to pass on to the ventricles. Usually every other or every third signal gets through.

Because atrial flutter usually causes symptoms immediately, most patients receive treatment to restore sinus rhythm. The unusual patient with chronic atrial flutter does have some risk for thrombi and emboli (blood clot terms – thrombi when they form – emboli when they break off and flow elsewhere and cause problems).

When atrial flutter is succesfully treated, anticoagulation is generally not needed. If it became intermittent one might anticoagulate (especially if the patient alternated between atrial flutter and atrial fibrillation).

I hope this complex answer helps.

I just started taking Zetia after a muscle bout with Lipitor. What side effects will I have with Zetia? Hope to hear from you.

Having not yet treated any patients with Zetia, I have to look this one up. The FDA says stomach pain and tiredness can occur. FDA information on Zetia. I hope that helps.

Will the vaccine prevent other hpv like common warts and also when will it be available?

Great question, which I cannot answer! I suspect that the vaccine will prevent some warts – but will probably only work against a small subset of HPV strains (those which most commonly cause cervical cancer). I have no idea on the timetable for this vaccine.

Well, maybe. Services are services. But what about the consumer? I am facing 4 or 5 hours of work to sort out insurance problems caused either by the insurance company or by the doc’s office. I’ve got a dentist who has filed 4 times for the same services (and was paid fully), and an internal medicine practice that just billed the insurance co. for services 8 months ago. Straightening this out will cost me 3 or 4 hours of weekend time. And no reimbursement!  I have to go through this two or three times a year.

First, thanks for the comment, and I do understand your frustration. The object of your frustration is the insurance companies not the health care professionals. Why should we charge you for filling out forms? Because we are running a business and time is money! The forms that I imply are extra forms. Another comment states it well –

I am all for it. (Speaking as an MD.) Doctors spend huge amounts of time filling out these forms. I’m sure I don’t have to convince *you*, but here is a partial list:
– Disability forms
– Jury duty forms
– health clearances for school, work, prospective adoptive parents
– Life insurance forms (death claims)
– Letters to health clubs allowing patients to get out of their memberships

It’s unbelievable. It adds a significant amount of time to the time spent in the office. I think it’s time to start charging.

And that is the point of the rant.

And is use of hormones also a placebo for those of us who have had hysterectomies with oophorectomies, or those twenty-somethings in premature menopause? Since we are lumped in with all other women and all conceivable forms of hormones are now too dangerous to use (and goodness knows there are no side effects or risks in the antidepressants, bone-density enhancers, statins, antihypertensives, false teeth, dried-up-eyeballs, and, let me not forget, copious helpings of KY to “treat” that vag atrophy that we’ll be switching to), I can only guess not.

Gee, if hormones are that evil, maybe women should ALL have oophorectomies before menarche. Think of all the problems that would prevent!

Premature menopause and oophorectomies represent a totally different situation than the studies address. One difficulty in medicine is the balance between belief and data. I prefer data. We must criticize studies carefully, but then understand what they tell us. I would prescribe hormonal therapy to patients with oophorectomy or premature menopause until around 50 years.

With specific reference to vaginal atrophy, I understand that vaginal estrogen does help a great deal. Also, continued sexual activity seems to retard atrophy.

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Thanks for the many excellent comments and questions. I hope some of these answers are helpful. And thanks for reading!!