The surgical lipo-industry - Forum

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Re: The surgical lipo-industry - Ärzteforum

Post#11 »

I doubt you would get many neurosurgeons interested, when I was working in
neuro my boss used to tell me he went into neuro because it was the one
surgical speciality you didn't have to operate through fat!


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A Doctor

Re: The surgical lipo-industry - Ärzteforum

Post#12 »

In all of the discussions about morbid obesity, I was struck by the
underlying theme of prejudice against the obese.While the statements may
have varied, it was clearly stated over and over again. Of course,
everyone will deny such prejudice, or rationalize it, or joke about it.
It has all been done before for race or creed. Now with this particular
patient population, it is being done for medical reasons. If anyone on
this list is overweight, or really obese, I wonder if any of the
comments hurt? Could such feelings on the part of surgeons obscure
their objectivity?

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StSt

Re: The surgical lipo-industry - Ärzteforum

Post#13 »

I think we are all a bit prejudiced against patients when their bad habits,
in which they persist, cause them problems (out of which we then are
expected to try to extricate them). People eat too much, drink too much,
smoke too much, sleep around too much - prevention is better than cure and
to spend much time and money treating the consequences of bad habits when
patients persist in those bad habits is not the best use of scarce health
resources. Inevitably however we spend much of our time doing just that.

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StSt

Re: The surgical lipo-industry - Ärzteforum

Post#14 »

I am fat! I was not when arriving in this country a while ago but New
York's delicious food has it's side effects.

Please do not worry about us- we do not hurt as we have thick skin-or
subcutaneous tissue.

Grandpa Phil

Re: The surgical lipo-industry - Ärzteforum

Post#15 »

Not much of response to a poll.
While in residency, I have witnessed a degradation of our bariatric surgery
program from almost weekly VBGs, through a rare monthly gastric bypass into
none bariatric cases. I have participated in the care of the obese patients
and have done both types of procedures. My observations:
1) despite the fact that all the patients were referred from a
special multidisciplinary group which included endocrinologist,
psychiatrist, psychologist and after a certian period of diet trials, most
of the patients were non-copliant, non-cooperative and very difficult to
take care of both in the ICU and on the floor.
2) I can't recall even a single patient whose postop period was
uncomplicated.
3) Bariatric operations create new problems which sometime
difficult to address. We had a 40 yo lady 12 years s/p VBG who developped a
duodenal ulcer which eventually perforated and was diagnosed with it almost
a week later when presented with a large Rt gutter abscess. There is no way
to visualize duodenum using conventional EGD or upper GI in a patient s/p
VBG or gastric bypass.
4) Whan I was consenting an obese patient for a bariatric procedure
I told him/her that he/she was not going to normally eat and/or enjoy the
food for the rest of the life, that they would be able to drink or eat very
small meals and so on and so forth. I was very uneasy, and I thought that
would scare them. And I still think that this scare may actually push some
of the obese people to start some other programs instaed of going to the OR.
5) Somebody said: You can't treat supratentorial problems with
infratentorial procedures. I agree.

Of note. A very close friend of mine was asking advise regarding her
obesity. Somebody recommended her bariatric surgery. I warned her not to
rush with it. Simple diet and graet determination helped her to get rid of
125 pounds. Now, she is keeping me busy in finding a good plastic surgeon
to reduce her pannus and do some face lifting. I'm glad to help her.

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A Doctor

Re: The surgical lipo-industry - Ärzteforum

Post#16 »

So much for the post last week saying"medical weight loss regimens NEVER
work"...is the author of that post reading this--any comments?

John Dissector

Re: The surgical lipo-industry - Ärzteforum

Post#17 »

I try to be very careful with words NEVER and ALWAYS, especially regarding
the results of different treatment regimens. Endocrinology and internal
medicine literature have some proof (wether it is scientific or not - this
is another question) that there are effective weight loss medical
programs. Before it was condemned at removed from the market, Pheh-phen
containing regimen was very popular and seemed to be effective in certain
groups of patients.

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Billroth

Re: The surgical lipo-industry - Ärzteforum

Post#18 »

Noone ever claimed that with a strict diet and determination weightloss
cannot be achieved. There is no question that without food size will come
down. Fat does not form out of air, and as a son of Nazi concentration
camp survivors I permit myslef to point out that there were no
morbidly obese prisoners there.

However the data presented at the NIH concensus panel on bariatric surgery
showed quite conclusively that operations were more effective in the long
run than any medical treatment, in attaining persistant weight loss. (I
believe the figures were 60% vs 20%) This patient is among the 20% who
succeed on medical management- no big deal.

Let me underscore that I don't do these operations. I assist on occasion,
however, and I don't believe all who do them do so for monetary gains. In
our system the surgeon is not paid for most of these. It is true that once
they aquire a reputation they can get an occasional private paying
patient, but these are not done at the hospital here. I would be
surprized if any of these guys gets a private patient like this more than
once or twice a quarter.

I do refer patients for this operation when they meet the NIH concensus
guidelines.

John Dissector

Re: The surgical lipo-industry - Ärzteforum

Post#19 »

Yes--believe it or not someone did post that very thing on this net last
week--I didnt mention the name, but am just waiting for that person to
acknowledge

John Dissector

Re: The surgical lipo-industry - Ärzteforum

Post#20 »

Those guidelines did not come from any Class I evidence, as there are no
PRCT's
to support this position--you must qualify assertions like this with the value
of the data used--and at best this can only be from Class 3 data

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