Obesity: Prevention and Reversal

By: Robert A. Shaffer M.D., Gastroenterology Associates N.A.P.C. & Medical Director of Shaffer Weight Loss Center

            As gastroenterologists we treat people with a multitude of GI disorders, many of the disorders that we treat are related directly or indirectly to obesity or improper diet. Obesity is the second leading cause of preventable death in the United States due to consuming high energy, low nutrient diets, living a more sedentary lifestyle watching oversized flat screens and playing video games or many tiring work days with longer commutes compared to the1960’s.  In Alabama over 30% of the population is obese and over 60% of the United States is either overweight or obese. Overweight and obesity are both preventable and reversible with proper nutrition and exercise; our goal is to consistently educate people on how to become successful in reaching their long term health goals.

Overweight and obesity is described as having excess of adipose tissue causing a person to be at a high risk for certain diseases. A measurement of these risks can be taken by measuring an individual’s Body Mass Index or BMI. BMI consists of a formula that uses a person’s height and weight that will give an accurate estimate of disease risk. BMI of 25-29.9 is considered overweight, 30 and above is obese.

What does this mean for 60% of the population that is overweight or obese? It means that they will at some point begin to experience some type of health issues as a direct result of this unwanted excess adipose tissue: atherosclerosis, hypertension, diabetes mellitus, joint pain and degeneration, kidney stones, gallstones, cancers of the breast, uterus, and liver in women and cancer of the colon, rectum and prostate gland in men. Excess fat in the thoracic cavity impairs breathing leading to increased levels of carbon dioxide in the blood causing fatigue. These aliments require medications to help maintain homeostasis and can also cause unwanted side effects.

Reducing body fat by 8% - 10% could make an obese patient less dependent on medication. Overweight patients may not have health issues yet but if they were to begin a good nutrition and exercise plan they could greatly reduce the future risk for these health concerns. We have become a society that is addicted to bad foods, and bad habits and we help our patients to break out of the cycle of eating the wrong foods for the wrong reasons, and changing the attitudes towards exercise and fitness to take away the fear of starting that road to lifelong fitness by giving them the tools they need to get there.

We are now offering the Serotonin Plus Weight Loss Program® at our Saint Vincent’s East Location. This is a program that focuses on reducing carbohydrate cravings by using an oral supplement that does this very effectively in combination with a reasonable diet low in carbohydrates and starches. The dietary plan is based on real foods and educates patients on nutritious food selections and portion control along with regular exercise based on the individual’s tolerance for an average weight loss of 35 pounds in 12 weeks. With great success, 99% of or patients are able to achieve their weight loss goals and are feeling the benefits of maintaining a healthy lifestyle.

 

 For more information on our weight loss programs please contact:

 

Robert A. Shaffer Medical Director of Shaffer Weight Loss Center

Denise Biro Weight Loss Coordinator

Shaffer Weight Loss Center

100 Pilot Medical Drive

Suite 250

Birmingham AL 35235

(p) 205 397 1448

(w) gastrodocs.info

(e) weightloss@ganapc.net                                                                                

facebook.com/ shafferweightlosscenter.com

References & Resources:

http://www.cdc.gov/obesity/data/adult.html http://www.nhlbi.nih.gov/meetings/workshops/overweight/report.htm

www.mckinley.illinois.edu/Handouts/pdfs/​body_mass_index.pdf  http://www.mckinley.illinois.edu/interactive/bmi_calculator.htm)

www.spweightlossmd.com

Mobile Health and Innovation

By Kristen McManus, RD LD and Melanie Rubery, MS RD LD CLT

“There’s an app for that.” How often do we hear that catchy phrase on a weekly basis? It seems there is an app for just about everything, and it’s no question the convenience of smartphones has helped make the lives of busy Americans much easier.

Because we spend so much time on our phones, the smartphone platform is the perfect way to engage people in the field of health and wellness. Worldwide, chronic disease management has emerged as a area of particular interest and innovation. Research has shown that people who keep a food journal will reduce the amount of food they eat by about 10%, but most people do not have the time to keep a detailed, hand-written food and exercise journal. That’s where smartphone applications step in-- with the emerging technology of mobile fitness, tracking calories consumed and calories burned through exercise has never been so simple. With just the touch of a finger, people have the ability to document their entire day’s worth of calories and exercise. 

Based out of Birmingham AL, Healthy Life and Nutrition has developed a wellness program called Sensibalance. This innovative platform has taken mobile health to the professional level. In addition to providing services 100% online, each client has 24/7 access to a registered dietitian (RD) via email and web-based portal. Clients are placed on an individualized calorie level program and are given an allotted number of daily food bars for the 3 macronutrients:  carbohydrates, protein, and fat. A food bar is the equivalent of a serving size. Along with having an equal distribution of the macronutrients, clients are also able to track their water, fruit, vegetable, and fiber intake to ensure they are meeting their daily needs. Clients are able to record their food and exercise with an app compatible with the iPhone and Android.  All information syncs with their online profile. The greatest advantage of Sensibalance is clients are able to work with registered dietitians who are experts in the field of food and nutrition. They can actually learn what foods are good for them and why, instead of just trying to stay under a certain calorie limit for the day. It teaches individuals how to make healthful eating choices and facilitate an actual lifestyle change. Dietitians are also able to provide medical nutrition therapy for various nutrition-related diseases such as diabetes, hypertension, and high cholesterol.  With such tools and support, Sensibalance works as a program for individuals, corporate wellness, and physician referrals.

For More Information:

Website:  www.healthylifeandnutrition.com

Email:  melanie@healthylifeandnutrition.com

205-492-0404

                                     

Be Careful With Automatic Contract Renewals

By Debbie West, Practice Administrator with Birmingham Pediatric Associates and Owner of WestMed Disposal

It is so easy to overlook the fine print in contracts when they sit in a stack on your desk while administrators are putting out the day to day fires that arise in a medical practice. Often times they go from office desk to brief case to bedroom night stand in hopes of a quick glance before the 10:00 news. Those are the pieces of paper that end up in the "Scarlet" pile for tomorrow is another day.

Automatic contract renewals can come back to haunt you if the service provider is not providing adequate service and you have several years remaining on a contract. In some cases where companies have a monopoly in the industry, there is not much incentive to correct the issue. If there is no financial benefit to a long term contract, then keep it to a minimum or 1 to 2 years. Financial benefits such as price guarantee would be a separate issue.

It is very important to know expiration dates of contracts as many companies require 90 day notice in writing. I also suggest sending the letter certified with a return receipt request. Good documentation is critical when ending a contract that has an automatic renewal. When it comes down to providing documentation that the cancellation letter was sent, it can alleviate wasted time by having all your ducks in a row.

Allow yourself plenty of time to price shop. It is a very competitive market due to the economy so make sure to capitalize on this. 

Don't feel bad about asking for references. Also ask counterparts in other practices, round table groups, management organizations or specialty organizations for this information. Other managers are great resources so don't hesitate to utilize this valuable benefit.

The Controversy Over Prostate Cancer Screening

By The Physicians of Urology Centers of Alabama

Prostate cancer is the most commonly diagnosed non-skin cancer and the second leading cause of cancer death in American men. One in nine men will develop prostate cancer.

Contrary to common belief, prostate cancer iis not just a disease of the elderly. The disease affects one in 15 men from ages 60 to 69. Those with a family history and African Americans are at the greatest risk. Screening for prostate cancer consists of a simple blood test called a “PSA” and a rectal examination. Generally, men ages 40 to 75 are the candidates for screening.

Since the PSA test came into widespread use for early detection by the mid-1990s, the

death rate due to prostate cancer has fallen by almost 40 percent. Despite this, there is much controversy regarding screening for prostate cancer. The screening is not “perfect,” but no “screening” is, nor is intended to be. The success of prostate cancer screening is similar to that of screening mammography for breast cancer and colonoscopy for colorectal cancer.

Adding to this controversy is the recommendation by the U.S. Preventive Services Task

Force (USPSTF) against prostate-specific antigen (PSA) based screening for prostate

cancer released on May 21, 2012. The USPSTF is “an independent panel of non-Federal experts” funded by the US Department of Health and Human Services.

We believe that the above recommendation is substantially flawed and support this statement with the following facts:

· Since the PSA test came into widespread use for early detection by the mid-

1990s, the death rate due to prostate cancer has fallen by almost 40 percent.

· 90% of all prostate cancers are now confined to the prostate gland (likely curable)

at the time of diagnosis. Prior to PSA screening, only 30-40% of prostate cancers

were curable at discovery.

· This decision is coming from a “panel of experts” with no urologists, medical

oncologists or radiation oncologists, the physicians most familiar with prostate

cancer.

· One of the most influential studies cited by the USPSTF is the PLCO study

published in the New England Journal of Medicine in March 2009. Many flaws

were found with this study, including the fact that the median follow up of the

“unscreened” patients was 5.2 years (far too short to see many deaths from

untreated prostate cancer), 40% of the “unscreened” patients had actually had a

normal PSA prior to entry into the study (therefore they were actually “screened”)

and 33% of patients were lost to follow-up and not included in the data analysis.

· A second influential study from Europe, the European Randomized Study of

Screening for Prostate Cancer (ERSPC), also in the NEJM in March 2009,

showed “only” a 20% reduction in death rate in screened patients (median

follow-up was almost 7.5 years, long enough to start seeing an impact of

screening). Analyzing only these study patients with the longest follow-up (over

10 years), the decrease in death rate rose to 38%.

· The results of the Göteborg Randomized Population-based Prostate Cancer

Screening Trial, a 14 year Swedish study partially funded by the National Cancer

Institute (July 2010), showed a 44 percent decline in prostate cancer deaths as a

result of PSA testing.

· The USPSTF panel itself graded the studies used in drawing their conclusions as

either “good, fair or poor” regarding their underlying scientific methods. The

PLCO and ERSPC studies each graded “fair.” Of the 20 studies examined

regarding the benefits of screening for prostate cancer, one was graded “good,” 18

were graded “fair,” and one graded “poor.”

· The USPSTF bases their objections not on the risks of screening,

which are negligible, but the risks of diagnosis and treatment of cancer. This

is a scientific bait and switch of the worst order. Screening is not diagnosis,

nor is it treatment; it is a method to provide patients and their doctors with

information that is then used to determine the appropriateness of further

evaluation and/or treatment.

The task force’s recommendation is not binding, but as a government funded

initiative, the concern is that Medicare will stop paying for screening and, if so,

private insurance companies will follow suit. Every man has a right to make his

own decision about screening after reviewing the potential risks and benefits with

his own doctor. We cannot allow an unaccountable government entity to deny

patients access to tests that saves the lives of thousands of Americans every year.

The final recommendation by the USPSTF is a one size fits all philosophy that states that patients cannot be trusted to make informed decisions on their own. This same task force suggested mammograms were unnecessary for women ages 40 to 49 and has also recommended against teaching women breast self exams, both of which were retracted after massive public outcry. The USPSTF’s recommendation risks undoing 20 years of progress in patient education.

We, as practicing Urologists, have seen that early detection leads to better outcomes for

our patients. Ask any man whose life has been saved as a result of taking the PSA test.

They'll tell you early detection of prostate cancer is the real difference between life and

death. They’ll tell you the PSA test identifies cancer early, before it has spread.

We believe the decision on how best to test and treat for prostate cancer must be made

between a man and his doctor, not from a government funded panel that doesn’t even

include experts in the disease.

Critical Limb Ischemia in the Diabetic Population

By Brenton Quinney, MD of Birmingham Vascular Associates

Peripheral arterial disease is a common disease process treated by vascular surgeons.  From asymptomatic disease to claudication and critical limb ischemia, these patients present a challenging clinical problem for the vascular surgeon and primary care team. 

Critical limb ischemia is the reduction of arterial blood flow severe enough to warrant immediate intervention to prevent limb loss.  Hallmarks of critical limb ischemia are the symptoms of rest pain in the foot that tends to improve with positioning (e.g. hanging one’s foot off the side of the bed) and ulcerations to the feet. 

Critical limb ischemic patients pose significant problems due to systemic co-morbidities.  Atherosclerosis in other vascular beds (coronary and cerebrovascular) increases mortality in this group.  Outcomes of patients with critical limb ischemia six months after diagnosis are dismal with 20% mortality, 40% alive with amputation and 40% alive without amputation¹.  With the added burden of providing cost effective care, the challenge of these patients is formidable.

Diabetics with critical limb ischemia pose an even more difficult clinical scenario.  Peripheral arterial disease caused by smoking and hypertension have more proximal vascular lesions.  In contrast, diabetics with critical limb ischemia tend to have diffuse lesions in the distal tibio-peroneal vessels making revascularization more difficult. Additionally, the associated neuropathy can mask ulcerations that typically could be detected sooner in other patient populations. 

Developing a comprehensive treatment plan for diabetics with critical limb ischemia is best served by a variety of specialties that treat not only the arterial pathology, but the systemic co-morbidities as well.  Intensive risk factor modification and treatment of other associated atherosclerotic disease is critical.  Daily foot care and skin examinations are vital to identify ischemic ulcerations in their early stage.  Also, early consultation for appropriate non-invasive vascular studies can assist in the management of this complicated patient population. 

Further information for vascular surgery issues can be found at:

www.vascularweb.org

¹ Norgren L, Hiatt WR, Dormandy JA, et al.  TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45:S9A.

Lyme Disease

By Kelli Tapley of Birmingham Pediatric Associates

As summer approaches, primary care physicians’ ears perk up when our patients

present with “went on Boy/Girl Scout retreat a month ago and came back with a weird

rash. Now seems tired and complains of headache, joint pain and had a painless, nontender

swelling of the face before his/her face started to droop.” DING, DING, DING.

But most of us aren’t lucky enough to get such a gift from the gods of Textbook

Presentations for Lyme Disease. Rather, we are often faced with vague symptoms like

fever, abdominal pain, fatigue and headache with no mention of rash or camping trips,

much less tick exposure.

A recent report from the CDC’s Summary of Notifiable Diseases stated that cases of

Lyme Disease have increased 400% from 2005-2008. In light of the increased incidence

of Lyme Disease, as well as other tick-borne illnesses such as babesiosis and

anaplasmosis which are both transmitted via Ixodes scapularis, and the early arrival of

spring, it’s helpful to review the diagnostic and preventative measures. Although, there

is some controversy among Infectious Disease experts as to why there has been an

increase; climate change, better diagnostic assays, improved reporting and awareness

among physicians have all been suggested as potential reasons.

First, it’s important to counsel our patients and their parents that the sooner the tick is

removed, particularly if it’s noted and removed within 72 hours, the smaller the chance

of developing Lyme Disease. Suggest that parents have their children bathe or shower

immediately after being outdoors and frequently inspect for ticks. While the likelihood of

our patients wearing long sleeves and pants with pant legs tucked into socks in the

sweltering southern summers is somewhat unrealistic, a more practical solution would

be to recommend repellants with 10-30% DEET in children 2 months and older and

spraying pesticides around the perimeter of yards.

While it can take some time for the symptoms of Lyme Disease to manifest after a tick

bite, if they meet the criteria developed by the American College of Physicians (a recent

history of having resided or traveled to an endemic area for Lyme Disease and risk

factor for exposure to ticks and symptoms consistent with early disseminated disease or

late lyme disease) administering the ELISA before the Western Blot can eliminate the

likelihood of false positives. The guidelines for interpretation are available at

www.aafp.org.