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Obesity Surgery: Is It for You?

Every doctor can tell you their names — the patients who change their diet, begin exercising, and lose 40, 50, even 100 pounds. Along the way, those patients also lose something else: medical problems like diabetes, high blood pressure, high cholesterol, and sleep apnea. And their back pain and arthritis stop bothering them. They go from taking a half dozen medications to taking none.

The reason that doctors can tell you their names is that every physician has one or two such success stories — but only one or two. Many people are overweight, and most cannot lose it. The medical consequences include not just the diseases mentioned above, but also heart attacks, heart failure, cancers, and stroke.

Sad to say, surgery is the only proven treatment that leads to long-term “significant” weight loss. Not surprisingly, as the Baby Boomers age and gain weight, and as the operations themselves get more sophisticated, the number of operations performed has gone up about fivefold in the last years.

And an ever-increasing number of hospitals are now advertising their weight-loss centers, driven in part because these operations can help the hospitals fill beds and stay afloat financially.

Thus, the questions facing many people are, should they should have surgery, and, if so, where?

The current U.S. guidelines suggest that surgery be considered for people with a body mass index of 40 or more. If you have existing obesity-associated conditions such as diabetes, cardiovascular disease, or sleep apnea, then a body mass index of 35 can be used as the threshold for considering surgery.

Just as the risks of having such a high BMI are considerable, the health benefits of dramatic weight loss for very overweight people can be huge. In a study of the New England Journal of Medicine, Swedish researchers described long-term follow-up on a large group of patients with obesity. At the 10-year follow-up, the weight of patients who had undergone surgery was 16% lower, while weight had increased 2% in comparable patients who did not have an operation. More than one-third of patients who had undergone surgery had recovered from diabetes, which is usually a lifelong condition. A wide variety of other health measures had also improved dramatically.

The problem is that the risks of obesity surgery are also considerable. In the Swedish study, significant complications occurred to 13% of those who had surgery, and the mortality rate was 0.25%. These rates are actually better than those at many hospitals — presumably because centers that are more experienced with these operations have better outcomes.

If you decide to undergo surgery for obesity, you should strongly consider choosing a surgeon and a hospital that meet the criteria recently developed by the Betsy Lehman Center for Patient Safety and Medical Error Reduction. These guidelines recommend that the procedures be performed by surgeons who do 50 to 100 cases or more per year and at hospitals where more than 100 cases are performed annually. There should also be designated teams at the hospital (anesthesia, operating room) focused on weight-loss surgery, and round-the-clock attending physicians on-site to cover patients who have these operations.

The bottom line: First, do your best to avoid obesity, and to help those in your family do the same. Try to lose weight in the old-fashioned ways. But if you are very overweight, surgery can be a solution. The risks of surgery are not trivial, however, and you should do your best to pick a surgeon and a hospital that minimize the chances that you will have complications.

During your fight to avoid obesity, some alternative medicine therapy may help you, for example, acupuncture is proven to be able to reduce stress and anxiety, factors that increase impulsive eating, visit AB Acupuncture for more information about how acupuncture works.

Ginkgo Biloba: A Smart Drug?

I figure there are three kinds of herbs: those that are helpful, those that are hype, and those that are hyped a lot but happen to be helpful as well. Ginkgo biloba, in my opinion, falls into the third category although I’m not sure that what it’s hyped for is exactly what it’s helpful for.

My first questions are, “how can it do that?” and “shouldn’t we all be taking it?”. The advertising is fairly vague as to how it is supposed to work so, naturally, I had to look elsewhere for the answers. I think that once you understand how the herb works, it’s a lot easier to decide when to use it and for what purposes.

The most available research on Ginkgo biloba indicates that it is helpful only in those conditions in which impaired circulation is a factor. Substances in Ginkgo biloba inhibit Platelet Activating Factor (PAF) in the blood and therefore make blood less sticky. Slippery blood flows better through arteries that might be partially clogged with cholesterol deposits. There also seems to be a regulatory effect on the muscle tone of blood vessels by the herb so that the blood has more room in which to flow. It makes sense that if something gets more circulation, it will work better.

In claudication (a condition involving poor circulation to the legs), Ginkgo biloba was found to significantly improve the pain-free walking distance in those sufferers who took it. Similarly, memory loss due to poor blood flow to the brain might improve through the use of Ginkgo. In fact, there are clinical studies on dementia patients which showed modest improvement in memory in those who took Ginkgo. The problem is, not all dementia is related to poor circulation.

So, if my brain is slow but the circulation to my brain is fine, will Ginkgo help me? Only if you believe that football players who wear those silly breathing strips on their noses really perform better than those who don’t.

Seriously, though, I think Ginkgo biloba has a valid place in the treatment of circulatory disorders. Patients with claudication, impotence, memory loss, or other manifestations of microvascular (small vessel) disease stand a good chance of seeing improvement with Ginkgo at a far more reasonable price than the pharmaceutical drugs we have available today.

The recommended dose of Ginkgo is 120 milligrams daily, usually taken in divided doses. Look for standardized Ginkgo biloba extract with at least 24% ginkgo flavone glycosides. It comes in several forms and is available at your local pharmacy.

Check with your healthcare provider or pharmacist before taking Ginkgo biloba. There is some evidence that it can contribute to bleeding complications if taken with other medications or herbs that also “thin” the blood.

And if you’re interested in learning more about the curative effects of eastern medicine and treatments, consider booking an acupuncture appointment with AB Acupuncture.

A Sample of Self-Acupressure for Neck and Shoulders

Acupressure points in the neck and shoulder area affect the circulation of Qi, or life force, throughout the body. Ancient texts say where the Qi goes, the blood, or circulation, follows. When we are under stress, we tend to hold energy in the neck and shoulders, either through focus on mental activity or through the unconscious protective muscular tightening that "covers the neck." You can work these specific points through self-acupressure or book an appointment with an experienced acupuncturist.

Simple Neck and Shoulder Self-Acupressure

You can work most of the important acupoints in this area by simply searching them out with your fingers. As you press into these areas, you are looking, feeling, asking for the most tender or tense areas to reveal themselves. When you find them, squeeze or press gently but firmly in the area until you feel a change in the sensitivity, then move on. To begin, it is best to lie on the floor or lean your head against the back of a chair or sofa though you can do these techniques in almost any position. Close your eyes, take a deep relaxing breath and use your thumbs to press gently and firmly into the muscles all along the base of the skull. Begin behind the ears and move toward the spine, exploring the area with your fingers. Still breathing deeply, return to the most tense or sensitive points, press and hold until you feel the muscle soften or the tension ease. Now find the most tense places in the back of the neck by rubbing across the muscles, one hand on either side of the spine, beginning under the skull and moving down to the shoulder. Find the most tense places there. Continuing to breathe deeply, press and hold. Moving down, cross one arm over the chest and squeeze all along the big muscle (trapezius) across the top of the opposite shoulder. Again, use your fingers to feel for the tensest or most sensitive point and breathing deeply, press and hold until you feel a release. Repeat on the opposite side. Now drop both arms to your sides, breathe, and imagine your skull is as heavy as a bowling ball, and is completely cradled by the surface on which it rests. Remind your neck and shoulder muscles that the head is supported for the moment so they can take a break and let go!! If you are returning to activity, imagine your head as light as a balloon, move your neck and shoulders, and lift off!

Neck Release with Specific Points

Holding two points at the same time enhances the body wisdom of allowing flow of Qi between the points, which we experience as relaxation. The method is usually to hold a point in a tense area: a "local point", with another point along the same flow which influences movement of Qi: a "distal point." Or you may begin by holding the same local points on both the left and right sides and adding distal points to help more blocked locals release. Working on yourself, you may hold the local point with the hand on the same side of the body and hold the distal point with the opposite hand. There are several important points in the JSD #21 area. (See chart) You may just use your fingers to find the most sensitive point and hold it with a "joker": a point that may be held with many locals, or you may try holding the distal for the specific point that you think you have found.

Holding two points at the same time enhances the body wisdom of allowing flow of Qi between the points, which we experience as relaxation. The method is usually to hold a point in a tense area: a "local point", with another point along the same flow which influences movement of Qi: a "distal point." Or you may begin by holding the same local points on both the left and right sides and adding distal points to help more blocked locals release. Working on yourself, you may hold the local point with the hand on the same side of the body and hold the distal point with the opposite hand. There are several important points in the JSD #21 area. (See chart) You may just use your fingers to find the most sensitive point and hold it with a "joker": a point that may be held with many locals, or you may try holding the distal for the specific point that you think you have found.



See also Point Locations on charts below


(NOTE: A "Tsun" is the width of the second knuckle of the thumb)

#1 - In the hollow 1 tsun above the eyebrow, up from the pupil of the.

#2 - Below the cheekbone, directly down from the pupil of the eye and pressing up towards the cheekbone.

#19 - In a hollow above the inner tip of the shoulder blade (scapula), 1 tsun lower than and inside of #20.

#20 - On the trapezius muscle directly up from the nipple line.

#21 - Below #22, outside the junction of the third and fourth cervical vertebrae.

#21: LI: At the level of the Adam's apple, in the body of the sternocleidomastoid (SCM) muscle.

#21: BL Inside and down from #22 about a tsun each direction.

#21: SI: Behind and slightly lower than the #21:LI, in the "stringy" muscles of the neck.

#21: TW: At the level of the chin, on the back edge of the sternocleidomastoid muscle.

#22 - Between the trapezius and sternocleidomastoid muscles, just below the skull (occipital bone). Press toward the opposite #1.

#23 - On the back of the shoulder joint, about 1 tsun below the bony ridge (acromion) and pressing up towards it.

#24 - At the lower end of the deltoid muscle, pressing directly in towards the upper arm bone (humerus).

#26 - 2 tsun above the outer arm wrist crease, between the bones of the forearm (radius and ulna) , where a little muscular knot can often be felt.

#35 - ("hoku") - In the webbing between the thumb and index finger, at the end of the crease formed when they are pressed together. Press toward the index finger bone. FORBIDDEN FOR PREGNANT WOMEN.

#37 - Just inside and above the inner corner (canthus) of the eye. Press toward the bridge of the nose.

"EAR LOBE Point" - Behind the earlobe, between the jaw and the base of the skull, pressing toward the jaw.

"Jaw" Point - In the masseter muscle, which forms a bulge when the teeth are clamped shut, and a hollow when they are parted.

"NOSTRIL Point" - At the side of the nose, on the bottom edge of the cheekbone.

"TRAGUS Point" - In front of the tragus (flap of cartilage) of the ear.

Crohn’s Disease

What Is It?

Crohn's disease is a long-term (chronic) condition in which inflammation causes injury to the intestines. It typically begins in young adulthood, most often between ages 15 and 40.

No one knows for sure what triggers the initial intestinal inflammation at the start of Crohn's disease. Many experts think that a virus or a bacterial infection might start the process by activating the immune system and that the body's immune system stays active and creates inflammation in the intestine even after the infection goes away. Family members may share genes that make Crohn's disease more likely to develop if the right trigger occurs. Ten percent to 25% of people who have Crohn's disease have at least one relative with Crohn's disease or a similar disease called ulcerative colitis. Crohnύs disease is more common in people of Jewish heritage, relative to non-Jews.

Once Crohn's disease begins, it can cause lifelong symptoms that come and go. The inside lining and deeper layers of the intestine wall become inflamed. The lining of the intestine becomes irritated and can thicken or wear away in spots. This creates ulcers, cracks, and fissures. Inflammation can allow an abscess (a pocket of pus) to develop.

A unique complication of Crohn's disease is called a “fistula”. A fistula is an abnormal connection between organs in the digestive tract, usually a connection between one piece of the intestine and another. A fistula can be created after inflammation becomes severe. To understand how a fistula is created, consider the way the intestine attempts to heal. Between attacks of inflammation, the intestine recoats itself with a new lining. When the inflammation has been severe, the intestine can lose its ability to distinguish the inside of one piece of intestine from the outside of another piece. As a result, it can mistakenly build a lining along the edges of an ulcer that has worn through the whole wall of the intestine, forming a fistula.

The section of the small intestine called the ileum (in the right lower abdomen) is especially prone to damage from Crohn's disease. However, ulcers and inflammation can occur in all areas of the digestive tract, from the mouth all the way to the rectum. A few other parts of the body, such as the eyes and joints, also can be affected in people with Crohn's disease.


Some people with Crohn's disease have only occasional cramps, or diarrhea that is so mild they do not seek medical attention. However, most people who have Crohn's disease experience long stretches of time with no symptoms interrupted by bursts of symptoms, called an exacerbation, when inflammation returns. During an exacerbation, or during the initial appearance of Crohn's disease, you might experience the following symptoms:


It may require months for your doctor to diagnose Crohn's disease with certainty. Your doctor will look for evidence of intestinal inflammation and try to distinguish it from other causes of intestinal problems, such as infection or ulcerative colitis, a related disease that also causes intestinal inflammation. If you have Crohn's disease, your symptoms and the results of various tests will fit a pattern over time that is best explained by this condition.

Tests that can indicate inflammation and show evidence of Crohn's disease include:

Expected Duration

Crohn's disease is a lifelong condition, but it is not continuously active. Following a flare-up, symptoms can stay with you for weeks or months. Often these flare-ups are separated by months or years of good health without any symptoms.


There is no way to prevent Crohn's disease, but you can keep the condition from taking a heavy toll on your body by maintaining a well-balanced, nutritious diet. By storing up vitamins and nutrients between episodes or flare-ups, you can decrease complications from poor nutrition, such as weight loss or anemia. Your doctor will monitor your blood for complications of poor nutrient absorption.

Crohn's disease can cause a higher risk of colon cancer, particularly if it affects a large portion of the colon or rectum. It is important to have your colon checked regularly for early signs of cancer or for changes that can precede a new cancer. If you have had Crohn's disease affecting the colon or rectum for eight years or more, it is time for you to start getting regular testing to look for cancer. One good strategy is to have a colonoscopy exam every one to two years once you start regular testing.


Medications are very effective at improving the symptoms of Crohn's disease. Most of the drugs work by preventing inflammation in the intestines.

The medication commonly used first is a group of anti-inflammatory drugs called aminosalicylates. They are chemically related to aspirin and suppress inflammation in the intestine and joints. They are given either by mouth (pills) or by rectum, as an enema. Some drugs in this group include sulfasalazine (Azulfidine), mesalamine (Asacol, Pentasa, Canasa, Rowasa), and olsalazine (Dipentum).

Certain antibiotic drugs, particularly metronidazole (Flagyl) and ciprofloxacin (Cipro), help by decreasing the bacterial growth in irritated areas of the bowel. They may have a side benefit of decreasing inflammation, too. If you still have diarrhea, but there is no infection, antidiarrheal medications, such as loperamide (Lomotil) may be helpful.

Other more powerful anti-inflammatory drugs may be helpful, but they can also suppress your immune system so that you have an increased risk of infections. For this reason, they are not often used on a long-term basis. These drugs include prednisone (Deltasone, Prednisolone, Orasone) and methylprednisolone (Medrol, Solu-Medrol), budesonide (Entocort), azathioprine (Imuran), 6-mercaptopurine (Purinethol), cyclosporine (Neoral, Sandimmune), and methotrexate (Rheumatrex, Folex).

A new drug, infliximab (Remicade) has been used in recent years for severe Crohn's disease, particularly when a fistula has formed that does not respond to other treatments. This medication blocks the effect of a chemical called "tumor necrosis factor" that may be responsible for causing inflammation in the intestine.

Surgery is another possible treatment. In general, surgery to remove a section of the bowel is recommended only if a person has bowel obstruction, persistent symptoms despite medical therapy, or a non-healing fistula. Up to 50 percent of people who have Crohn's disease will end up having at least one operation during the course of their disease.

When To Call A Professional

New or changing symptoms often mean that additional treatment is needed to keep Crohn's disease under control. For this reason, people who have Crohn's disease should be in frequent contact with a doctor. One serious complication, bowel obstruction, causes vomiting or severe abdominal pain and requires emergency treatment. This occurs when the inside of the intestine becomes narrowed so that the digestive contents cannot pass through. Other symptoms that require a doctor's immediate attention are fever (which could indicate infection), heavy bleeding from the rectum, or black paste-like stools (this is how blood looks after traveling a long distance through the intestine).


Crohn's disease can affect people very differently. Many people have only mild symptoms and do not require continuous treatment with medication. Others require multiple medications and develop complications. Crohn's disease improves with treatment and is not a fatal illness, but it cannot be cured. Crohn's requires people to pay special attention to their health needs and to seek frequent medical care, but it does not prevent most people from having normal jobs and productive family lives. As is the case for any chronic illness, it can be helpful for a newly diagnosed person to seek advice from a support group of other people with the disease.

What is Diabetes?

It is important for everyone at risk of type 2 diabetes to understand the causes of the disorder because it is by treating the causes early - and effectively - that we can prevent or minimize the severity of the complications associated with this disease.

Below you will find answers to some of the questions frequently asked by people learning about diabetes. We hope this information helps you better understand what diabetes is.

What is diabetes?

Diabetes mellitus (diabetes) is a condition characterized by high levels of blood glucose (the simple sugar that "fuels" the cells of the human body). Diabetes develops when the body can't produce or effectively use a hormone called insulin that helps to remove excess glucose from the blood.

The most common type of diabetes is type 2 diabetes, which is caused by the body's failure to make enough insulin or to be able to use it properly. The second most common type of diabetes is type 1 diabetes, which happens when the body can no longer make this vital hormone.

Type 1 Diabetes

Type 1 diabetes develops when the body can no longer make insulin, the hormone that helps to remove excess glucose (the simple sugar that "fuels" the cells of the human body) from the blood. People with type 1 diabetes must be treated with injections of supplemental insulin. Type 1 diabetes accounts for 10-15% of all diabetes and occurs most frequently in children and adolescents.

Type 2 Diabetes

Type 2 diabetes, which occurs mainly in adults, is much more common than type 1 diabetes and accounts for roughly 85-95% of all cases diagnosed. Patients with type 2 cannot produce or effectively use a hormone called insulin that helps to remove excess glucose from the blood. Type 2 diabetes has different causes and can develop and go undetected for years in people at risk. Decades can pass before it begins to show any signs, which is why type 2 diabetes is usually detected first in the middle-aged or elderly, long after damage to the body has already started.

It’s worth noting that diabetes and obesity are conditions that commonly come hand-in-hand. Consider seeking diagnosis and treatment at IES Medical Group if you would like to undergo a procedure to assist in weight loss.

The World Health Organization (WHO) estimates that 135 million people worldwide are affected by type 2 diabetes, and it is probable that even more will have developed this condition by the year 2025 -- from 200 to 300 million1.

What are the symptoms of diabetes?

Diabetes type 2 is symptomatic only when blood glucose levels are above normal. Common symptoms of high blood sugar in diabetes include being very thirsty, frequent urination, weight loss, lethargy, blurred vision, and recurrent infections. On the other hand, many people do not have any symptoms at all and therefore early detection is very important. The main sign of diabetes is too much glucose in your blood, something your doctor can detect.

What causes type 2 diabetes?

Sedentary lifestyle, obesity, smoking, high cholesterol levels, high blood pressure, and age accelerate the development of the disease in susceptible individuals. The factors that determine whether an individual develops type 2 diabetes or not are mainly genetic (i.e., in the family).

What is Insulin?

The primary "tool" used by the body to keep blood sugar levels under control is a hormone called Insulin. Insulin is made by special cells (called beta cells) found in the pancreas. When a person who does not have diabetes eats something, the body releases insulin to the pancreas as part of the process that converts food into fuel. Insulin helps cells in various organs to take in the glucose (sugar) that they need as fuel and also helps remove high levels of glucose from the bloodstream. In this way, post mealtime glucose spikes (high blood sugar levels after meals) are turned into normal blood sugar levels. Someone who cannot make insulin or one who cannot make proper, effective use of the insulin produced, ends up "starving" the cells of insulin and leaving blood sugar levels higher than they should be.

The Challenges to the Caregiver When Dealing With End-Stage Dementia

End stage dementia is the last of the three stages of dementia. The challenges of this stage are dramatically different for the earlier stages. Many family caregivers are exhausted and often burned out from providing care at home when they get to this level of care.

The caregiving skills needed are dramatically different than the previous stages. At this stage of the disease, the former personality or the person that once was is no longer there. The mental capacities have remarkably deteriorated. The majority of brain cells in all areas of the brain have disintegrated. The death of these brain cells has a profound negative effect on the body and its organs.

Most problems in the early stages of the disease were mental, especially in terms of memory. Now, at end-stage dementia, it will be the physical decline that will take most of the caregivers' time. Negative and disruptive behaviors will decrease or be eliminated. At this stage, the body and mind are deteriorating and starting to fail. The individual affected by dementia can no longer control many bodily functions and requires total care.

The mental and emotional characteristics that were once the focus on care will now take a back seat. The challenges of providing physical care are now the priority. By this time, many family members decide placement outside the home is necessary. Some family members feel that they want to continue to provide the care at home. Studies show that there is a better quality of care provided in the home setting. While it is possible to provide home care for someone at this late stage of dementia, it is really important that family caregivers understand that they will need added support. This support may come from family members, home health providers, and palliative and hospice care services.

More on caregivers and the challenges of dealing with end-stage dementia at home Late-stage dementia symptoms and problems can be a real challenge for caregivers. Arming yourself with knowledge about what to expect during any of the dementia stages will bring you some comfort and help you provide better care. Individuals at this stage become startled easily by noises or even a person entering the room. Take time to introduce yourself every time you approach them and let them know who you are.

Maintaining weight is difficult at this stage. Swallowing difficulties may arise and there is an increase in the possibility of aspiration pneumonia. It is a good time to have a swallowing and feeding evaluation preformed to become educated on feeding techniques to decrease the potential for this to occur. This is a time when getting them to eat anything for the calories are important. Often time, sweet things such as custards, puddings, and ice cream are good choices.

There are new behaviors that may appear, such as holding onto something and not letting go of it. Unless this object will cause them harm, do not try and remove it. They lose the ability to control movements and may even develop habits of patting something repeatedly.

Many individuals develop a sensitivity to touch and may respond when touched by moaning or crying out loud. The response is an exaggerated response that they no longer have control over.

Skin care at his stage is very important, as there is a decrease in nutrition, fluid intake, and activity. At the end-stage of dementia, the individual is mostly confined to bed, so complications such as infections, pneumonia, and pressure sores can occur. Support services such as non-medical home health care and palliative and hospice services are needed at this time. Many questions if hospice will hasten death. It does not. Hospice will allow you to provide the best quality of care and make them as comfortable as possible. These services support the caregivers as they come to the end of their caregiving journey.

The challenges of providing care to those with end-stage dementia at home are possible to overcome. It is also important for a family caregiver to realize that they are not a failure if a placement is necessary. The most important thing is that the individual with dementia receives the best care. It is difficult for many family caregivers to change from their full-time caregiving role to that of an advocate. Many caregivers fail to realize advocating for quality care is just as important as being able to provide the care.

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