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Ask the Expert Articles

I'm obese, but when I lose weight, I gain it back and more. Why?

When is knee replacement worth it?

Why is skin cancer screening important?

Who needs a mammogram?

What should I expect with colonoscopy?

What screenings can't be skipped?

What is a PHR?

What is a Magnet hospital?

What is a hospitalist?

What are signs of stroke?

How is diabetes different?

How can I prevent flu?

Can't artery blockages be detected?

Can weight-loss surgery treat diabetes?

Can leg pain be serious?

Can children have gallbladder disease?

Are clinical trials safe?

 

I'm obese, but when I lose weight, I gain it back and more. Why?

Question:I’m obese, but when I lose weight, I gain it back and more. Why?

Answer:Obesity is strongly associated with type II diabetes, high blood pressure, coronary artery disease, obstructive sleep apnea, degenerative joint disease, infertility, fatty liver disease, cancer and chronic headaches. It is a disease that results from an unbalance in the nervous, endocrine and gastrointestinal systems, which communicate together to regulate your weight.

As part of this, certain hormones tell you when you’re hungry or full. This helps people survive starvation by slowing metabolism when weight is being lost and increasing hunger until that weight is regained.

It also explains why if you lose 20 pounds, your body changes these hormones until you gain that weight back, and sometimes more. To make matters more difficult, today’s typical diet (which is unnaturally high in salt, sugar and fat) also modulates these hormones and can trigger your brain’s reward system. The reward system is what regulates addiction to substances such as cigarettes, alcohol, and sometimes food.

Ideally, there would be a medication or therapy to help control the hormones that govern food intake and metabolism. Currently, bariatric or weight-loss surgery is the only known way to manipulate these hormones to provide long-term weight loss.

Utilizing laparoscopic, minimally invasive surgical techniques has significantly increased the safety of weight-loss procedures. In fact, studies have demonstrated that the risk of remaining obese is higher than the risk of surgery. This is due in part to the remission of obesity-related conditions such as type II diabetes after bariatric surgery.

Determining if weight-loss surgery is right for you begins with education about different bariatric procedures, the risks and reasoning behind it. There also is no substitute for a one-on-one consultation with an expert in bariatric surgery, as there are several factors to be considered when deciding if a weight-loss procedure would be beneficial for your overall health.

For more information, you may want to attend a free public seminar offered by Scottsdale Healthcare Bariatric Center, designated a Center of Excellence in Bariatric Surgery by the American Society for Metabolic and Bariatric Surgery. Details and seminar registration are at www.shc.org/bariatrics.

Jason Reynoso, MD is a bariatric surgeon at Scottsdale Healthcare Bariatric Center, 1020 N. 92nd St., Scottsdale. For more information, visit www.shc.orr/bariatrics or call 480-882-7460.

 

Knee replacement isn’t what it used to be 

Question: How can I tell if the pain in my knees is bad enough to warrant knee replacement surgery?

Answer: People usually decide it is time to replace their knee when the pain from knee arthritis limits their walking to a few blocks, they walk slowly or limp, their legs become crooked, or pain from knee arthritis disturbs their sleep. 

As an orthopedic surgeon, I can tell you that total knee replacement can dramatically improve a person’s quality of life. Time and time again, patients tell me they wish they would have undergone their replacement sooner. 

I also can tell you that total knee replacement isn’t what it used to be. Today, it’s one of the safest and most successful types of major surgery. In more than 90 percent of cases, there are no complications and it results in significant pain relief and restoration of mobility. 

Much of this has to do with technology. Implants have been developed that last longer and accommodate active lifestyles—which explains why we see younger and more active patients undergoing joint replacement earlier. 

Technology also has impacted knee replacement surgery itself. For example, a computer with a GPS-like device enables me to place a knee implant according to the patient’s individual anatomy. Importantly, this facilitates placing knee implants precisely and accurately, resulting in better-fitting and longer-lasting knee replacements. 

Computer-assisted knee replacement also uses minimally invasive surgical techniques. That means patients have smaller incisions and less hospital time, scarring, pain and recovery time. In fact, there’s no incision in the large muscle on the front of the thigh, as in traditional knee replacement surgery. 

Stefan Tarlow, MD, is an orthopedic surgeon at Scottsdale Healthcare. He practices at Advanced Knee Care, 20201 N. Scottsdale Healthcare Dr., Ste. 260, Scottsdale, 480-483-0393, www.tarlowknee.com.

 

Simple steps, screening protect against skin cancer 

Question: Why is it important to be screened for skin cancer and how can I protect myself? 

Answer: Skin cancers are the most common cancers diagnosed in the United States with approximately 1 million people affected annually. While skin cancer can occur at all ages and in all races, early diagnosis can minimize scarring and maximize cure rates. 

The American Academy of Dermatology and American Cancer Society endorse complete skin exams with periodic health examinations by a healthcare professional. A complete skin exam should include highly visible areas including the scalp, ears, buttocks, nails and feet. Gynecologists, dentists and opthamologists also play a role in detecting melanomas in more obscure areas. If you have a family history of melanoma in a first-degree relative, such as a parent or sibling, or you have several moles, you are at higher risk and should be examined annually. 

Like all cancers, skin cancer is caused by a combination of environmental factors, such as the Arizona sun, and genetics or skin type. We cannot alter our genetics, but we can change our exposure to UV radiation to lower our risk of skin cancer. 

  • Wear moisturizer with SPF 30 on the face, neck, chest and arms. 
  • Avoid the peak hours of 10 a.m. to 4 p.m. when possible and wear sun-protective clothing during those hours. 
  • When outdoors for an extended time, use waterproof sunscreen with SPF 30 or greater that offers UVB and UVA coverage. Reapply every two hours if swimming or sweating. 
  • UV light is important for our body’s production of Vitamin D. Consult a physician about the need for oral supplements when protecting yourself from ultraviolet radiation. 

Scottsdale Healthcare medical staff member Neel Patel, is a dermatologist who practices at Southwest Skin Specialists, 10200 N. 92nd St., Ste. 205, Scottsdale, 480-614-2447.

 

Mammogram recommended for all women over 40 

Question: Everyone is focused on pink ribbons and breast cancer during October. Who really needs to have a mammogram? And how often? 

Answer: Regular mammograms to screen for breast cancer are important for finding cancer early, when treatment is often easier and more effective, and the disease is possibly curable. 

All women over 40 should have screening mammograms annually, regardless of their family history because all women are at risk. Mammography is the only modality proven to reduce mortality or deaths from breast cancer. 

Unfortunately, many women put off this important screening because of the discomfort of having a mammogram. To help, Scottsdale Healthcare offers mammograms with the FDA-approved MammoPad®, a cushion that provides a warm, soft surface for the breast. This increased comfort can help patients relax and result in improved images for radiologists to read. 

To help women feel more comfortable, Scottsdale Healthcare also offers a dedicated BreastHealth Center, with a private, peaceful environment and a full range of advanced breast diagnostic services—all under one roof. 

This includes digital mammography, which is especially beneficial for detecting cancer in young women and women with dense breast tissue. 

Breast MRI services also are available. Screening breast MRI has been recommended by the American Cancer Society for women who are at high risk of breast cancer, including those with a strong family history of breast cancer or previous high-risk biopsies. 

Additionally, Scottsdale Healthcare’s BreastHealth Center offers breast biopsy, a procedure that can provide a definite diagnosis of cancer. 

All procedures at the BreastHealth Center are performed by female technologists, and the radiologists who interpret the studies are physicians who have specialized training and experience in all aspects of breast imaging examinations and procedures. 

Connie Jones, MD, is a radiologist at Scottsdale Healthcare’s BreastHealth Center, located at Scottsdale Healthcare Shea Medical Center. To schedule an appointment for a mammogram at the BreastHealth Center, call 480-882-4703.

 

Colonoscopy used to diagnose and treat at same time

Question: I’m over 50 and know I should have a colonoscopy. What should I expect and do I need a specialist? 

Answer: Kudos for recognizing the importance of this screening, which is recommended starting at age 50, or at age 40 if you have a family history of colorectal cancer or polyps. 

During a colonoscopy, a long, lighted scope is maneuvered through your colon. The scope allows physicians not only to see polyps, but also remove them. This makes colonoscopy an important procedure that can both diagnose and treat. 

Polyps are found in approximately 30 percent of people over age 50. While most polyps do not become cancerous, physicians can’t tell which will or will not lead to disease, so all are removed. 

As for needing a specialist, research shows that colonoscopy is 76 to 90 percent effective in reducing the risk of dying from colorectal cancer when performed by a well-trained gastroenterologist. This is because gastroenterologists are skilled at maneuvering the scope all the way to the end of the colon, better ensuring polyps are not missed. 

For any polyps to be spotted and removed, you’ll need to cleanse your bowels before your colonoscopy. The day prior, you’ll be on a liquid diet and be given a laxative. If you work, you may want to leave mid-day on the day prior to your colonoscopy, as well as take the day off for the test. 

During the procedure, there’s very little discomfort. Patients generally receive “twilight” rather than general anesthesia and feel or remember almost nothing. Some opt to watch the procedure. 

Complications are very uncommon. Colonoscopy—which is generally covered by insurance, including Medicare—only rarely results in perforation or bleeding of the bowel. 

On the other hand, colon cancer is very common. Excluding skin cancers, colorectal cancer is the third most commonly diagnosed cancer in the nation, according to the American Cancer Society. 

Certainly, the benefits of colonoscopy far outweigh the risks. 

Scottsdale Healthcare board-certified gastroenterologist Stuart Triester, MD, practices at Thompson Peak Gastroenterology & Hepatology, 20401 N. 73rd St., Ste. 275, Scottsdale, 480-945-2321.

 

Don’t let these 3 screenings slide 

Question: If I’m feeling fine, are there adult health screenings I can put off? 

Answer: Always talk openly with your doctor about what screenings you may or may not need. Even if you feel great, certain screenings can detect health problems in their early stages when they are most treatable. Mammograms are a perfect example. 

While many screenings are available, three should not be overlooked—colorectal cancer screening, cholesterol checks and blood pressure checks. 

Only about half of Americans screen for colorectal cancer by testing for blood in the stool or having a colonoscopy. The U.S. Preventive Services Task Force (USPSTF), which is affiliated with the U.S. Department of Health & Human Services and Agency for Healthcare Research & Quality, gives colorectal screening an “A” for adults ages 50 to 75. This means it is among the most highly recommended screenings on the USPSTF’s grading scale. 

Cholesterol and blood pressure checks are important in screening for cardiovascular disease. Your blood pressure should be checked at least annually. If you have healthy cholesterol levels, you can go five years between cholesterol checks. 

Other screenings can be vital in safeguarding your health. For example, pap smears to test for cervical cancer are important for women, while prostate cancer screening may be warranted for some men. You can even perform one key screening yourself. Standing on the scale is actually screening for being overweight or obese, which is associated with health issues such as heart disease and stroke. 

Although screenings are part of taking care of your health, your lifestyle is equally—or even more—important. As they say, “an ounce of prevention is worth a pound of cure.” A healthy lifestyle (which includes at least 30 minutes of physical activity daily, avoiding tobacco, and following a nutritious diet) can help protect you against cancer, heart attack, diabetes and more. 

M. Moe Bell, MD, MPH, is a family medicine physician and associate director of the Scottsdale Healthcare Family Medicine Residency Program. He practices at the Scottsdale Healthcare Heuser Family Medicine Center, 7301 E. 2nd St., Ste. 210, Scottsdale, AZ 85251, 480-882-4545.

 

Personal Health Records help organize medical information 

Question: What is a Personal Health Record and how would it benefit me? 

Answer: A Personal Health Record or PHR is an electronic tool for managing and organizing your health information. Simply put, it is a record of your health and medical information that you create online and are responsible for keeping up-to-date. 

A PHR provides a central place for recording details on your allergies, medications, health conditions, family health history, immunizations, surgeries, procedures and tests. You can create a PHR for yourself and your family members. For example, mothers can create records for themselves, their husbands, children and grandparents. 

As another benefit, a PHR puts your medical information at your fingertips. You can access your PHR anywhere and anytime you have a connection to the Internet. 

Say you get sick while away from home and go to a doctor who asks about a certain aspect of your medical history. All you need to provide an answer is Internet access. Or you may be able to print out your PHR and take it with you before you go. 

For some people, the accessibility of a PHR comes with concerns about the security of their personal and medical information. At Scottsdale Healthcare, our free PHR service is powered by RelayHealth, a trusted software developer used by doctors and hospitals across the United States. 

In addition to being secure, Scottsdale Healthcare’s PHR service enables you to link your PHR to Scottsdale Healthcare. By doing so, the information in your Personal Health Record will be readily available if you come to Scottsdale Healthcare Shea Medical Center, Scottsdale Healthcare Osborn Medical Center, Scottsdale Healthcare Thompson Peak or any other Scottsdale Healthcare facility for healthcare services. This eliminates having to remember medication and medical history details, which can be especially challenging during an emergency. 

Consider this scenario: You have an elderly parent who takes several medications. You suddenly have to take your parent to a Scottsdale Healthcare emergency room. If you’ve created a PHR for your parent, you can grant Scottsdale Healthcare permission to access the PHR. There’s no worrying about remembering the names of the medications or how much and how often they’re taken. You can remove Scottsdale Healthcare’s access permission at any time.

Contributed by Irv Rollingher, MD, Medical Director for Clinical Informatics at Scottsdale Healthcare.

 

Magnet designation an indicator of hospital quality 

Question: What is a Magnet hospital? 

Answer: It is a hospital awarded the top honor in nursing from the American Nurses Credentialing Center, which is affiliated with the American Nurses Association. 

Magnet status is the gold standard for excellence in nursing care. Only 3% of America’s hospitals have earned the Magnet designation. Two of the Valley’s four Magnet hospitals are in Scottsdale—Scottsdale Healthcare Shea Medical Center and Scottsdale Healthcare Osborn Medical Center. 

A benchmark for measuring quality of care, Magnet designation is important when choosing hospital services. Research shows that Magnet hospitals have better clinical outcomes, higher patient satisfaction rates and lower mortality rates. With this in mind, it’s no wonder U.S. News & World Report considers Magnet status when compiling its list of America’s Best Hospitals. 

To earn Magnet status, hospitals undergo a rigorous evaluation and must reapply every four years. They must focus on quality care and have programs and processes in place to facilitate that care. Rather than decisions being solely made by executives, nurses who work at the bedside must be involved and empowered to provide the best care for patients—and the best place to work. 

Not surprisingly, this enables Magnet hospitals to recruit and retain nurses, which translates into stability in patient care systems. Because doctors naturally want to work with outstanding nurses, Magnet hospitals also have an edge at attracting top-quality physicians and specialists. 

While the Magnet award represents nursing excellence, it reflects the entire hospital’s dedication to collaboration. At Scottsdale Healthcare, for example, we have “lift teams” comprised of non-nursing staff members who help nurses lift patients when needed. This not only prevents back injuries among nurses, but also gives them more time at the bedside. Why? Because nurses no longer have to pull other nurses away from patients when they need help lifting a patient. The organizational cooperation exhibited by our lift teams especially impressed reviewers during Scottsdale Healthcare’s successful Magnet evaluation in 2006. 

Opened in late 2007, Scottsdale Healthcare Thompson Peak Hospital will be reviewed for Magnet status next year, at the same time its sister hospitals are re-evaluated for the award. Our goal is to provide Scottsdale with its third Magnet hospital. 

Peggy Reiley, RN, PhD is senior vice president and chief clinical officer for Scottsdale Healthcare, and administrator of Scottsdale Healthcare Shea Medical Center, 9003 E. Shea Blvd., Scottsdale AZ 85260; 480-323-3000.

 

Hospitalists are qualified medical professionals 

Question: I recently was hospitalized and told that the physician caring for me was a hospitalist. What is a hospitalist? 

Answer: A hospitalist is a board-certified internal medicine or family medicine physician. However, instead of treating patients in an office or medical practice, a hospitalist only treats patients within a certain hospital. Their role is to coordinate your care in the hospital setting if your primary care provider does not come to the hospital. 

As onsite physicians, hospitalists provide and facilitate the care needed by hospitalized patients. This can mean everything from managing cardiac conditions to treating infections. They request consults, order testing, help with discharge planning and coordinate your care in the hospital. 

Although you are more familiar with your regular physician, hospitalists often have more expertise in caring for complicated hospitalized patients because they “practice medicine” in a hospital rather than a traditional medical practice. They also are very familiar with their hospital’s services and healthcare personnel—which can help expedite getting the care you need. 

Additionally, hospitalists can focus their attention on you during your hospital stay. Because they don’t maintain outside practices, they are more available to follow up on tests, answer nurses’ questions, react quickly to changes in your condition, and check on your progress. 

For example, if you are a patient at Scottsdale Healthcare Thompson Peak Hospital, our hospitalists typically will see you more than once a day to assure that care is going according to plan, explain test findings, and keep you and your loved ones informed about your treatment and discharge. 

You should expect your hospitalist to communicate with your primary care physician and gather the information needed to provide appropriate care. After you are discharged, the hospitalist should provide your physician with detailed information about your stay. That way, your regular doctor is prepared to continue providing your care, which is important because you will not see the hospitalist for follow-up visits after you are discharged. 

While no one looks forward to being in the hospital, you can rest assured knowing that the hospitalist caring for you is a qualified medical professional and a partner on your healthcare team. 

Contributed by Richard Silver, MD, Medical Director of Hospitalist Services, Scottsdale Healthcare Thompson Peak Hospital, 7400 E. Thompson Peak Parkway, Scottsdale, AZ 85255; 480-324-7000.

 

Stroke symptoms signal need to act fast 

Question: My mother is elderly and I’m worried about stroke. How can I tell if she’s having one? 

Answer: Stroke is the third leading cause of death in the United States, so it’s only natural that you’re concerned. 

Warning signs include sudden numbness or weakness of the arms, leg or face (especially on one side of the body); sudden difficulty in seeing, speaking or understanding; dizziness or sudden trouble walking; or a sudden severe headache for no apparent reason. 

A stroke occurs when a clot blocks a blood vessel to the brain. The blockage prevents the brain from receiving blood and oxygen, resulting in brain damage. That damage occurs within seconds of having a stroke. 

That’s why it’s important that you call 9-1-1 immediately if you or anyone else notices any of these symptoms. It’s vital that treatment begins as soon as possible to minimize brain damage. 

For example, if Tissue Plasminogen Activator (tPA) is given intravenously within three hours of having certain kinds of strokes, it can significantly reduce the chances of permanent disability. A powerful drug that dissolves stroke-causing clots, tPA can only be given if a neurologist determines it is appropriate for the patient. 

As a Primary Stroke Center certified by The Joint Commission, Scottsdale Healthcare Osborn Medical Center has specially trained physicians and neurologists, nurses, therapists and technicians available 24/7 to provide rapid diagnosis and treatment of stroke patients. The hospital’s Stroke Center also has coordinated communication between paramedics and hospital staff to ensure rapid treatment, as well as advanced neurological services and facilities. 

When it comes to stroke, all that can make the difference between life, death and disability. 

Gary Reese, MD, is a neurologist and medical director of the stroke program at Scottsdale Healthcare Osborn Medical Center. He practices at Neurological Physicians, 7331 E. Osborn Dr., #110, 480-947- 7671.

 

Type 2 diabetes is different than many diseases 

Question: How is Type 2 diabetes different than other diseases? 

Answer: Type 2 diabetes is a chronic disease that results when your body doesn’t properly use or make insulin, which helps store food in our cells for energy. Several aspects make it different than other diseases: 

  • You take over a non-functioning part of your body. With diabetes, you have to assume the job of your pancreas, which produces insulin. That means regularly poking your finger to check your blood sugar level and maintaining a proper diet, level of activity and medications to keep that level within target range. 
  • You are swimming against the tide of today’s society. Maintaining healthy blood sugar levels is tough when food is part of social events, portion sizes are huge, and we are too busy or tired to prepare nutritious meals or be active. 
  • You can have diabetes and not know it. The symptoms come on gradually and mimic other things. For example, you may be especially thirsty or tired and attribute it to being in the desert or being very busy. 
  • It can be prevented or delayed. The key to warding off Type 2 diabetes is a healthy lifestyle. 
  • It can be managed. While some diseases are debilitating, thousands of people with diabetes live happy, healthy lives by managing their disease through diet, exercise and/or medications. 

That’s not to say it’s easy. It can be difficult to maintain the right blood glucose level because it continually changes and is affected by variables such as diet, medication, activity and stress. 

At the Scottsdale Healthcare Diabetes Center, individuals with diabetes can gain accurate information, support and practical strategies for managing their disease. Certified diabetes educators offer individual consultations and classes as part of an educational program recognized by the American Diabetes Association. Services range from self-management training and meal planning to nutrition counseling and healthy cooking classes. 

In addition to Type 2 diabetes, education is available for Type 1 diabetes (which can’t be prevented and typically affects children and young adults), gestational diabetes, and prediabetes, which is when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes.  

Contributed by Mary Lee Lehrich, Certified Diabetes Nurse Educator at Scottsdale Healthcare’s Diabetes Center. For more information call the Scottsdale Healthcare Diabetes Center at 480- 323-4800.

 

Simple steps important in avoiding seasonal and swine flu 

Question: I’m worried about my family catching the flu or swine flu this year. How can I keep us safe? 

Answer: A few simple steps can go a long way in preventing both seasonal flu and H1N1 flu, which was originally called “swine flu.” 

  • Get your seasonal flu shot. This applies to both adults and children. A vaccine for H1N1 flu is not yet available, but you should check with your individual physician or county and state health agency Web sites for the latest information and guidance on the vaccine. 
  • Wash your hands. Frequent hand washing is one of the best ways to prevent catching or spreading germs. Always wash your hands after covering a cough, sneeze and blowing your nose. Scrub your hands with soap, for at least 15 seconds, or rub your hands together with an alcohol-based gel until it dries. 
  • Cover your mouth or nose. Flu viruses are primarily spread through droplets that are coughed or sneezed from an infected person. Try to cough or sneeze into a tissue, or cough into your sleeve. 
  • Avoid close contact. Avoid close contact with those who are sick. If you are sick, avoid contact with others. That means those who are ill should stay home from work, school and other activities. 
  • Try not to touch your nose, eyes, or mouth. If you touch something contaminated with the influenza virus then touch your eyes, nose or mouth before washing your hands, you can become infected. 
  • Adopt a healthy lifestyle. Keep your immune system strong by eating a healthy diet, getting plenty of sleep and exercise, staying hydrated and managing stress. 

With both seasonal flu and H1N1 flu expected to affect a large number of Arizonans this year, it’s important that we all take these steps to prevent its spread and protect our health. Scottsdale Healthcare experts will hold free talks on the flu Sept. 2 at Barnes & Noble, 10500 N. 90th St. and Sept. 8 at the Scottsdale Civic Center Library. Call 480-882-4636 to RSVP. 

Jack Applefeld, MD, is medical director of critical care at Scottsdale Healthcare.

 

Can't artery blockages be detected?

Question: Periodically, I read about celebrities such as journalist Tim Russert and pitchman Billy Mays, who suddenly die of heart problems. Couldn’t their illness have been detected and prevented? 

Answer: Blockages in the arteries of the heart—similar to what may have contributed to the deaths of Tim Russert and Billy Mays—can be hard to find. A type of plaque that builds up on the artery walls, called lipid core-containing plaque, cannot be detected by commonly used tests such as treadmill exams and coronary angiograms. 

Lipid-core-containing plaque is believed to be “vulnerable plaque” or fatty plaque that ruptures, forming dangerous blood clots. Vulnerable plaque is suspected of causing most sudden cardiac deaths, strokes and non-fatal heart attacks. 

Scottsdale Healthcare now has new infrared and fiber optic technology to detect lipid-core containing plaque. Thanks to philanthropic donations, we are first in the region to offer the LipiScan Coronary Imaging System, which works by placing a catheter equipped with a fiber-optic laser light into the artery. 

Specifically, the system shines near-infrared light through the blood to the artery wall and measures the light reflected back. The reflected wavelengths indicate how much fat and other substances are in the plaque in the illuminated portion of the wall. Knowing the composition of the plaque can help physicians provide appropriate treatment for managing the patient’s coronary artery disease. 

Cardiologist David Rizik, MD, is medical director of invasive cardiology at Scottsdale Healthcare. He practices at Scottsdale Heart Group, 10101 N. 92nd St., Scottsdale, 480-860-1919.

 

Bariatric surgery can benefit those struggling with diabetes and obesity 

Question: Is it true that gastric bypass surgery can be used to treat diabetes? 

Answer: Many people with Type II diabetes also are obese. Bariatric or weight-loss surgery can put Type II diabetes into remission, meaning individuals have normal blood sugar and no longer need insulin injections or diabetes medications. 

The American Diabetes Association recommends that bariatric surgery should be considered for adults who have Type II diabetes and a body mass index of 35 or more—especially if their disease is difficult to control through medications, exercise and proper eating habits. 

By putting diabetes into remission, bariatric surgery can prevent serious health problems, including heart disease, kidney failure, vascular disease and amputation, and blindness in extreme cases. It also may reduce or reverse obesity-related problems such as infertility, high blood pressure, high cholesterol and sleep apnea, as well as decrease the risk for heart disease and cancer. 

Gastric bypass, which involves creating a small pouch from the stomach, is the most effective type of bariatic surgery at impacting diabetes. Considered the gold standard of weight loss surgery, gastric bypass helps patients lose an average of 75-80 percent of their excess weight in the first year after surgery. 

Importantly, however, the remission of diabetes in obese patients who undergo gastric bypass is not just due to weight loss. It’s keenly related to a change in the anatomy of the intestine that affects the hormones secreted by the intestines. Because of this, many of these patients leave the hospital with normal blood sugar levels. There is an immediate effect even before they lose weight. 

If you are obese and have Type II diabetes, you may want to find out if bariatric surgery can set you free of insulin injections or medications—not to mention help you prevent serious health problems and improve your quality of life. 

Robin Blackstone, MD, is medical director of Scottsdale Healthcare’s Bariatric Center of Excellence. For more information, call 800-504-9567 or visit www.scottsdalebariatric.com.

 

Leg pain can be sign of serious condition 

Question: My legs hurt when I walk or exercise, but it disappears when I stop. Should I be concerned? 

Answer: Yes. What you describe could be a symptom of peripheral arterial disease or PAD—a serious condition that occurs when a fatty material called plaque builds up in the arteries that carry blood from your heart to your legs and arms. 

Other symptoms of PAD include: 

  • foot or toe pain that disrupts your sleep 
  • wounds on your lower legs or feet that heal slowly 
  • leg muscle fatigue, leg cramping, numbness or coldness in lower legs and feet 

According to the National Institutes of Health, between 8 and 12 million Americans have PAD. People with PAD also may have atherosclerosis (a hardening and narrowing of the arteries) involving the heart, brain and kidneys. This means they have an increased risk of heart attack, stroke, kidney failure and uncontrolled high blood pressure. 

In fact, the risk of heart attack or stroke is seven times greater for patients with PAD. If untreated, PAD also can lead to amputation. Sadly, half of patients who lost a limb never saw a vascular specialist. 

While PAD is a potentially life-threatening condition, it can be diagnosed and treated using techniques such as lasers and balloon angioplasty stenting to open up arteries. Fortunately, these are minimally invasive procedures that generally do not require an overnight hospital stay. 

Walid Alami, MD, is an interventional cardiologist at Scottsdale Healthcare. He practices at Heart, Arteries & Veins, 9445 E. Ironwood Square Dr., Scottsdale, 480-747-6532.

 

Gallbladder disease on rise in children 

Question: My young niece was diagnosed with gallstones. Isn’t that something just adults get? 

Answer: Pediatric surgeons have noted a dramatic increase in biliary disease in children during the last 10 years. There has always been an early onset of gallstones in certain populations, including Native Americans, but we are now seeing many different ages and types of children. A family history of gallbladder disease makes a child at higher risk for having problems. 

Gallstones can be present and not cause any symptoms. If, however, a child feels significant abdominal pain, nausea, vomiting or a variety of other more vague symptoms, an ultrasound may be ordered to look for the presence of gallstones. When a stone blocks the outflow of bile from the gallbladder, patients can have significant pain and nausea. The gallbladder even can become infected, making the symptoms even worse. 

When a child has these types of symptoms, a pediatrician should be contacted. It might be necessary to go to the emergency department where labs and x-rays, including an ultrasound, can be performed easily. If there are lab abnormalities, the patient may need some time in the hospital or some preoperative procedures to treat the problem. Pediatric surgeons usually remove the gallbladder before the child goes home. The surgery is done laparoscopically, so the incisions are small and the recovery time is relatively short. 

Children with gallbladder problems tend to be sicker than adults with the disease, prompting pediatricians and pediatric surgeons to act aggressively to treat the problem. Early removal of the gallbladder does not tend to create problems for children as they age. 

Kathleen Graziano, MD, is medical director of pediatric surgery at Scottsdale Healthcare. She practices with Pediatric Surgeons of Phoenix, which offers appointments at Kidz Klinic at Scottsdale Healthcare Shea Medical Center, 9003 E. Shea Blvd. For information, call 480-323-1200.

 

Participating in clinical trial can be worthwhile 

Question: I’ve been diagnosed with cancer and my doctor suggested that I sign up for a clinical trial. Could that help me? 

Answer: All clinical trials are regulated by the U.S. government and must follow strict guidelines designed to protect participants in the trials. Participants must qualify by meeting criteria such as your type of disease, current condition, medical history and age. 

Clinical trials are very important in the development of new medications and treatments for cancer, as well as the advancement of medical care and knowledge about cancer. Before new medicines or treatments can be made available to the public, they must undergo clinical trials to determine if they are both safe and effective. 

Participants have access to the latest drugs, procedures and therapies. While there is no guarantee that a new treatment will help you, studies have shown that patients who participate in clinical trials often benefit more than those who do not. 

Some people dismiss the idea of participating in clinical trials because they fear they may get a placebo. However, most cancer-related research studies do not involve the use of placebos because they are generally designed to compare the effectiveness of a new drug or treatment against the standard drug or treatment. 

While clinical trials are very closely monitored and carefully evaluated, there are some risks in participating. The new drugs or treatments being studied may not be more effective than the standard care, and they may have unexpected side effects. Keep in mind that you can quit the study at any time—and that your oncologist will be kept informed throughout your participation and work with the research team. 

Ramesh Ramanathan, MD, is medical director of Scottsdale Healthcare Research Institute in the Virginia G. Piper Cancer Center Scottsdale Healthcare. For information on participating in cancer clinical studies, contact Joyce Ingold at 480-323-1339 or jingold@shc.org.