When does one undergo a malabsorptive procedure for weight loss? Part 1

-->  The first thing you should know is that all malabsorptive procedures are second choice. You should never ever undergo this procedure as the first surgery for weight loss. These procedures are complex, take a long time and fraught with serious complications. They also cost a lot more than the routine lap band or the sleeve gastrectomy.
 

Malabsorptive procedures alter and divert the digestion process, thus causing food to be poorly digested, incompletely absorbed and the majority is excreted in the stool. Malabsorptive procedure were performed widely 30 years ago but discontinued because of severe complications. The majority of patients did not even live long from the complications. Over the years, surgery has become refined and better instruments are available to perform this surgery. There are several versions of malabsorptive procedures created to prevent absorption of food. The stomach is not removed but simply bypassed using various surgical techniques.

Malabsorptive surgery for weight loss: part 2

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When does one undergo a malabsorptive procedure for weight loss? Part 2

Malabsorptive procedures do cause a profound loss in weight and are very effective in reversing the health complications of severe obesity. One can lose anywhere from 50-100 lbs in 1-2 years. The weight loss can continue for 1-2 years and then plateau.

The current malabsorptive procedures are much safer but the potential for complications is always present. However, unlike laparoscopic banding, malabsorptive procedures are much more technically difficult and can cause severe complications. In both cases, the consumer should select their surgeon well ahead of time. And since the consumer is paying for the surgery, if in doubt, go elsewhere. 

In general, malabsorptive procedures are done when the surgeon has F..ked up the lap band or sleeve gastrectomy big time or the sleeve did not help induce weight loss. I think all patients who are thinking of undergoing a malabsorptive procedure should first see a psychiatrist to ensure that they comprehend what the surgery is all about. This is not some mickey mouse procedure like removing the appendix, but one that can seriously affect your health and life. While many advances have been made in surgery, the one thing that has not changed is the quality of surgeons. While there are some great bariatric surgeons, there are many more who SUCK. So choosing your provider is the most important step.

Should I undergo weight loss surgery?

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I have been recommended a restrictive procedure for weight loss. Any suggestions?

Restrictive procedures have been developed to make the stomach much smaller. The small stomach then creates a sensation of being full anytime food is eaten. Even small amounts of food will give a sensation of being full immediately. Restrictive stomach procedures are not new and have been around for decades.

The only significant difference today is that these procedures are done with a minimally invasive technique. That means placing small holes, using a camera and fine instruments to perform the surgery. The lap band has been an abysmal failure and if this is recommended to you, you should run from this surgeon and leave town. Sleeve gastrectomy is widely done but most patients end up with more complications than any benefit. 

Basically, in medicine when one procedure is revised many times and touted to be a cure for something, one has to be careful. Either the procedure was never effective in the first place or there is more money to be made. My advice to all patients has been the same- if you want to lose weight, eat less and walk more. This is safe, works and only requires motivation. It is also complication free unless you are texting while walking and run into a bus.

How does one get a fungus infection of the nails?

How does one acquire a fungal infection of the nails?

Fungus infections of the nails usually develop when the nails are continuously exposed to warm moist environments such as bathroom floors, gym areas, sweaty sneakers or exercise rooms. The fungus that affects the nails is very distinct from athlete’s foot virus. The athlete's foot virus will not infect nails.  Even though fungal nail infection can be recognized very easily, it is quite difficult to treat.

 Fungi that cause infections of the nails are very durable organisms. They do not require a lot of nutrients or sunlight to survive. The fungus has only one preference- the environment is moist and humid. Such environments are present in your dirty constrictive shoes, swimming pools shower rooms gyms. The fungi usually enter the skin through small cracks on the skin alongside the nail. In the majority of cases, the fungi simply die if one maintains good hygiene and nail care. However, if one continues to provide a warm and humid environment, the fungi will start to grow.

Nail fungus can affect either the hand toes nails or the foot toe nails. But because the feet are always covered with shoes and exposed to more humid environment, the fungi usually are commonly seen on the toenails. It is also believed that fungi also thrive in conditions where blood supply is less. And this is more commonly seen in the feet as compared to the hands.

How do I know if I have a fungal infection of my nails?

In general, if you develop a fungal infection of the nails, initially you will not have any symptoms. Fungi grow slowly and it takes them time to damage the nail. However, within 3-6 weeks, you will see the following changes

-  The nails will become unevenly thick. The thickness is very unsightly

-  Even the slightest trauma will cause the nails to crumble. the nails often are brittle and easily crack

-  The shape of the nails is uneven and the texture is very rough

-  The nails will appear dark, lifeless and not polished

-  The nails will start to darken with time

In some cases, the entire nail may separate from the nail bed. Pain is also a common complaint in individuals who have a fungal infection.  The pain is constant but not intense. As the infection progresses, there may be a foul smell associated.

In short, the cosmesis of your nails will SUCK. Most people either cover the nail with nailpolish or apply all types of crap thinking that this is a cosmetic problem, which delays treatment.

Lost sex toy in my anus

Last night while playing with myself I accidentally lost my home made sex toy in the anus. It is the shape of my lipstick container. Do I need to go to the doctor?

 

Yes you do. I know this is embarrassing but you have little choice. The sex toy can lodge into the rectum and can even perforate the bowel-which can be very serious. Just go to the ER and tell them that you have a foreign body in the rectum and would like to have it removed. Just tell the nurses that you can only provide a history to the doctor. Keep the conversation to a minimum. You will most likely undergo a rectal exam but in most cases, the sex toy is too deep to be removed with fingers. Hence, you will undergo an X-ray and then a surgeon or a GI doctor will be called. They will use a small fiberoptic scope that has a snare. It will take less than 10 mins and you may not even need anesthesia. You can ask for the sex toy back if you wish. My best advice, buy a sex toy with flanges at the base so this prevents it from slipping in the anus. This is not an unusual problem, but with human creativity and spontaneity this is not a common problem seen in the ED. Losing large sex toys (huge dildos) in the anus somehow appears to be more common in men, whereas women tend to insert tiny objects. Good luck.

Oxygen for cluster headaches

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Does oxygen work for cluster headaches?

Yes, it is an excellent way to stop an acute attack. It has been shown in a number of studies that briefly inhaling oxygen (60%-100%) either through a mask or a nasal cannula can rapidly relieve cluster headaches. Oxygen treatment is deemed safe, relatively cheap and works immediately. The only drawback is that one has to have a container of oxygen around when the attack happens. It is also highly recommended that the individual not smoke during this therapy. Many companies market portable oxygen units that can be transported in back pack. These lightweight canisters can easily be carried almost anywhere.

Some individuals find that that oxygen only decreases intensity and not the duration of headache. Others find that with time, oxygen fails to work for acute headaches but does help prevent further attacks from coming on.

Once oxygen is inhaled, the relief from pain occurs in a few minutes. The majority of individuals who have used oxygen indicate that it does help initially. However, with recurrent attacks oxygen often fails to reduce the intensity of headaches. Nevertheless, oxygen should always be the first therapy for cluster headaches. Current studies indicate that oxygen can abort at least 70-85 percent of cluster headaches.

Should I get the shingles vaccine?

All consumers should know that one cannot get shingles unless one has first developed chicken pox. In North America, more than 90% of adults and children have had chicken pox and current estimates indicate that about 30% (or one in three) will get shingles in their lifetime. The vaccine decreases the risk of developing shingles by only 50 percent. This is a very low effective rate for something that costs a lot of money. 

The other factor to consider is age. The vaccine is at present approved for people over the age of 60 because the chances of developing shingles is higher with age. However, there is a downfall- as one gets older the vaccine also becomes less effective against shingles. Actually the best benefit of the shingles vaccine is that it prevents the development of the painful post-herpetic neuralgia in 70% of cases.

The other question regarding the vaccine is –“Should everyone over 60 get it?” the answer is no. If one has already got a definite case of shingles early on in life, the chances of getting another one is very unlikely. Therefore, for those who know they had shingles once, discuss with your physician about what to do next.  Personally I would not recommend the vaccine in such a scenario.

Cost

The pharmaceutical company Merck is out to make money. The company charges $150 for the one shot vaccine. Moreover, if you think that is outrageous, the doctors are charging close to $300 to administer the vaccine. In contrast, the standard flu vaccine only costs $10-$20. One would think vaccines play a vital role in preventive medicine but unfortunately the health care professional value your money more than your health.
In some cases, the cost of the shingles vaccine may not be covered by Medicare or insurance. Know as Zostavax, please check with your insurance plan or Medicare if they do cover it

Laser for varicose veins

Will my varicose veins disappear after laser treatment?

When you have the laser treatment, the majority of varicose veins in the upper leg (thigh area) will disappear for a short time. However, laser is not used to treat varicose veins in the lower leg. Even after treatment, the majority of people develop recurrence. Laser does not cure varicose veins; it simply removes them temporarily. Lasers have been hyped as a panacea for many medical disorders but in fact are over used and misused. Almost every doctor nowadays has a laser device in the office which he/she uses to zap patients. 

In the majority of cases, the laser is abused only to make money from gullible patients and scam insurance organizations.  

 If you have the money, you can have the laser treatment and it will get rid of the varicose vein in the thigh area. To prevent varicose vein recurrence you will need to wear compressions stockings for the rest of your life. If you do not have money for laser, wear compression stockings. Laser for varicose veins will cost anywhere from $400-$600 per leg. 

Remember, in many cases, the laser treatment is done by healthcare providers who have very little or no training in surgery and do not know anything about the anatomy of the leg. In fact, to make money, many doctors now have vein clinic and let junior doctors, physician assistants or nurses do part of the procedure. I have already reviewed many cases of severe injuries with laser used to treat varicose veins. My advice- seek a surgeon rather than a general doctor.

Testing for dementia

Recently my doctor suggested a dementia test for my dad. Is this worth it?

No it is bullshit, absolute nonsense. Doctors have now added testing for dementia as another way to scam patients. Every single test for dementia only brings more money for the doctor and is of no benefit to the patient. If you were told you were getting forgetful, then ask yourself, so WHAT? There is no treatment for dementia and the diagnosis is not going to change anything. If your dad has dementia, the medications we have at present are far more toxic than the dementia itself. Today, doctors order a variety of brain scans and MRI and then tell you if you have dementia or not. It is all academic and of no clinical relevance. Screening patients for dementia is nothing more than a scam designed to take away your hard earned money. You do not need a test to tell you that you are forgetful. Even if this forgetfulness is diagnosed early, there is no treatment for it. The best treatment for dementia is a loving family and supportive care. I would definitely recommend you change this doctor as he/she is a scam artist. WTF!

Lemon juice to dissolve kidney stone

I have a kidney stone and the pain is excruciating. I have heard that lemon juice may help. Is this true?

Kidney stones are extremely painful. I do not think there are many medical disorders that can cause such intensity of pain. You will first need to take prescription strength pain pills and drink ample water if you want to get rid of the pain and the stone. Some alternative health practitioners often recommend drinking a variety of juices to help dissolve kidney stones. Many juices have been recommended and most anecdotal reports suggest that lemon juice works the best. You need to drink nearly 2 ounces of lemon juice mixed with water. Some people also add cider vinegar to this combination. Others may add orange juice, grapefruit juice or even lime juice.

Now to the facts- I am unable to find any scientific study that shows lemon juice or any other juice works for kidney stones. Alternative healthcare practitioners are not real doctors; nor do they have any bona fide training in the basic sciences. Most cannot differentiate the mouth from the arse. A kidney stone is like a hard crystal. You know the cement that is used to build your home, some kidney stones are just as hard. Do you really believe some darn juice is going to dissolve your home? If you do, you and the alternative healthcare practitioner are both in need of some serious mental care.

My advice is simple; you are free to try and drink any juice you want, you can even add your piss in the combo. If it works, good for you but my feeling is that you will need to see a real doctor and get some pain pills, drink lots of water and wait it out. If the stone is large, it may need to be removed with a variety of devices.