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.