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Bariatric Surgery: “Life Changing and Life Saving”

Thursday, 18 March 2010 04:39

wilbur_bw This month’s column is personal. I have a family member who I hope will consider bariatric surgery. I also work with a woman who had bariatric surgery three years ago. She is my nurse. She looks incredible, lost 90 pounds and considers it the best money she ever spent. She also is my patient and all of her medical conditions were “cured” by her procedure, and when she brings in “before” pictures, I have trouble recognizing her.

There are an estimated 61.3 million (30.5 percent) obese adults in the United States, and 9.6 million morbidly obese adults. Obesity, a leading cause of death worldwide, is a condition where excess body fat accumulates to the extent that it adversely affects health. In a doctor’s office, a number called the body mass index (BMI) is calculated to determine obesity levels. Healthy values range from 18.5 to 24.9. Anything above 30 is obese, while anything above 40 is morbidly obese.

Many common diseases are strongly associated with obesity. Life expectancy decreases by 20 years for a morbidly obese man and five years for a morbidly obese woman.

The primary treatment for obesity is dieting and physical exercise, and anti-obesity drugs may be tried. When these treatments fail, the last resort is surgical intervention or bariatric surgery.
To qualify for bariatric surgery an individual must meet specific criteria.

How does bariatric surgery work? Simple. The bariatric surgeon alters your digestive tract – the stomach and small intestine – making it impossible to eat much food in one sitting. There are two main types of surgery:

1. Restrictive Surgery (Lap band, stomach stapling or vertical banded gastroplasty). These procedures alter the size of the stomach to restrict calories. The size is reduced to the size of an egg using special staples or a silicone band. These are reversible and don’t fundamentally alter the anatomy of the digestive system

2. Malabsorptive Surgery (Roux-en Y). This is a two-part procedure. First, the surgeon reduces the size of the stomach, and second, the surgeon bypasses the first portion of the small intestine. This causes food to pass more rapidly through the digestive tract. So, even if the patient over-eats, fewer calories will be absorbed

The Success rate for bariatric surgery is very high. Also, high blood pressure is cured in 50 percent of patients, Type 2 Diabetes is cured in 80 percent, sleep apnea is cured in 75 percent, and shortness of breath is relieved in 80 percent.

The cost of the procedure can be substantial, and not all health insurance plans cover it.
There are risks to both procedures, but with experienced surgeons in an appropriate hospital, the risks are minimized. Memorial Regional Hospital in Hollywood has been designated as a “Center for Excellence” for bariatric surgery. There are free informational seminars offered on a regular basis for those considering the surgery. One group of surgeons I highly recommend has a very informative Web site at www.hollywoodbariatrics.com.

Obesity is an extremely common problem and a very serious health concern. It goes far beyond cosmetics. It is an excellent reason to visit your doctor and begin a discussion.

Richard J. Wilbur, M.D. is Board Certified in Internal Medicine. Dr. Wilbur practices at
Safecare Medical Center’s Hollywood office, located at 4050 D Sheridan St., Hollywood, FL 33021. For an appointment with Dr. Wilbur, contact his office at 954-989-7441 or online at www.safecare.com.

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Humane Society hosts low-cost vaccination clinics in early 2010

Thursday, 18 March 2010 04:39

The Humane Society of Broward County has scheduled two weekend vaccination clinics for early 2010. Here are the details you’ll need to know.

Saturday, Jan. 16:
7 a.m. to 9 a.m. is for CATS ONLY
Sunday, Jan. 17:
7 a.m. to 11 a.m. is for DOGS ONLY

Saturday, March 20:
7 a.m. to 9 a.m. is for CATS ONLY
Sunday, March 21:
7 a.m. to 11 a.m. is for DOGS ONLY

The clinic is held in the back parking lot of the shelter located at 2070 Griffin Road, just west of I-95. Appointments are not necessary.

Regular Service Dog Package
(dogs 4 months and up)
Cost is $35 if spayed or neutered; $50 if NOT spayed or neutered. Package includes: Rabies with Broward County tag*, 5 in 1 Booster and Bordetella.

Puppy Package (3 months and under)
Cost is $25. Package includes: 5 in 1 Booster, Bordetella and de-wormer

Cat Package
(4 months and older)
Cost is $25 if spayed or neutered; $40 if NOT spayed or neutered. Package includes: rabies with Broward County tag*, FVRCP and Revolution (1 dose).

Kitten Package (3 months and under)
Cost is $15. Package includes: FVRCP and de-wormer.

Vaccines and services sold individually:
• Micro Chip and Registration: $20                                                • Heartworm test: $20
• 5 in 1 Booster shot: $10                                                              • Bordetella shot: $10
• FVRCP (cat booster): $10                                                         • Droncit (de-wormer): $10
• Rabies with Broward County tag*
NOT spayed or neutered: $30
-Rabies: $10, with tag*: $15

*Tag is for Broward County Residences only.

The Humane Society of Broward County is a private, nonprofit organization supported by donations from companies and people who want to help us help the homeless animals. For more information call 954-989-3977 or visit its Web site at www.humanebroward.com to see pets available for adoption, make a donation or find out about upcoming events.

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New breast cancer research study conducted at Memorial Hospital

Thursday, 18 March 2010 04:39

breastcancer Nearly two decades after a human antibody was created that treats an aggressive form of breast cancer, it is now being used in a promising new clinical research study conducted in several countries and at 80 medical sites in the United States, including Memorial Healthcare System in Hollywood.

Herceptin, created in 1990 by leading biotech company Genentech, is the first humanized antibody approved for the treatment of HER2-positive metastatic breast cancer, an aggressive disease that responds poorly to chemotherapy. Designed to target and block the function of HER2, a protein produced by a specific gene with cancer-causing potential, Herceptin has been shown to improve patient response rates, disease-free survival and overall survival while maintaining the quality of life in HER2-positive breast cancer patients.

Breast cancer is the most common cancer among women worldwide and the second-leading cause of cancer death among women in the United States. According to the National Cancer Institute, approximately 15 to 30 percent of breast cancers are diagnosed as HER2-positive.

Characterized by increased quantities of the HER2 protein on the surface of the tumor cells that hasten their ability to grow and spread, HER2-positive breast cancer has a greater likelihood of recurrence and a lower chance of survival than HER2-negative breast cancer.

Since it was approved for breast cancer patients in 1998, Herceptin (trastuzumab) administered in combination with chemotherapy has become a commonly used treatment for women with HER2-positive metastatic breast cancer. Despite recent advances, however, additional treatment options are needed for patients with this aggressive form of the disease.

About 27 percent of women with metastatic breast cancer – in which the disease has spread to other parts of the body such as the lungs, bones, liver and brain – survive for five years. The average survival time is only about 24 months.

The purpose of the global clinical research trial that Memorial Healthcare System is participating in is to determine the safety and effectiveness of the investigational medicine pertuzumab, a humanized antibody designed to interfere with tumor growth, when given in combination with Herceptin and chemotherapy.

The new clinical trial, known as the CLEOPATRA (CLinical Evaluation Of Pertuzumab and TRAstuzumab) study, began recruiting patients in January 2008 and is underway in 18 countries worldwide. CLEOPATRA is a Phase III double-blind, placebo-controlled trial targeting patients with previously untreated HER2-positive metastatic breast cancer.

The Phase II clinical trial of pertuzumab and Herceptin targeted metastatic breast cancer patients whose disease had progressed on Herceptin-based therapy as their most recent treatment. To be eligible for participation in that trial, patients could not have received more than three lines of previous therapy, including Herceptin and chemotherapy.

In the Phase II study, half of the participants with advanced, HER2-positive metastatic breast cancer, whose disease had progressed during treatment with Herceptin, benefited from a combination of Herceptin and pertuzumab. Nearly one in four patients saw their tumors disappear or shrink, while another 25 percent of patients saw their cancer stabilize for at least six months.

The Phase II trial results released in 2008 represent “significant promise for women with breast cancer in the future,” said Dr. Jose Baselga of the Vall d’Hebron University Hospital in Barcelona, Spain, the trial’s lead investigator. “We are hopeful the combination of Herceptin and pertuzumab used with chemotherapy will be even more effective if used to treat women newly diagnosed with advanced cancer.”

Current goals of treatment for metastatic breast cancer include symptom relief, improved quality of life and increased overall survival and disease progression-free survival. If the CLEOPATRA study proves successful, the combination of Herceptin, pertuzumab and chemotherapy has the potential to become a new standard of care in HER2-positive metastatic breast cancer.

“Research into new treatments is vital to continue the progress being made against this deadly disease,” said Dr. Alejandra Perez, Director of Breast Cancer for the Memorial Healthcare System. “The CLEOPATRA study will tell us more about pertuzumab’s potential role in treating women in the future with HER2-positive metastatic breast cancer.”

To be eligible for the CLEOPATRA study, participants must be at least 18 years old and have HER2-positive metastatic breast cancer, and cannot have received treatment after the cancer has spread to other parts of the body.

For additional information on the CLEOPATRA study and its eligibility requirements, call 1-888-662-6728 or visit www.HER2study.com.

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Prominent interventional neuroradiologist joins Memorial Regional Hospital

Thursday, 18 March 2010 04:39

dr.-james-jaffe_bw James Jaffe, M.D., an interventional neuroradiologist, has joined Memorial Regional Hospital’s Division of Neuroscience.

In his new role, Dr. Jaffe will work with the hospital’s Brain Attack Team, which handles stroke intervention at the hospital’s Level 1 Trauma Center -- one of the few medical facilities statewide that is qualified to treat the most severe, life-threatening injuries.

Before joining Memorial Healthcare System, Dr. Jaffe was director of Interventional Radiology for Palm Beach Radiology Professionals in Atlantis, FL. Dr. Jaffe, who is board certified in Diagnostic Radiology with added qualifications in Vascular and Interventional Radiology, is a primary investigator on numerous studies on topics such as carotid stent trials, aneurysm embolization and thrombus retrieval for stroke.

Since 1987, he has published more than 20 articles on his neuroradiology research. The American Society of Interventional Radiology and Therapeutic Neuroradiology named him a senior member in 2004. He has also been an associate professor at the Miller School of Medicine at the University of Miami since 2006. Dedicated to cardiac health and awareness, he also served as Chairman of the American Heart Association’s Palm Beach County Heart Walk in 2008.

Dr. Jaffe holds both a bachelor’s of arts and a medical degree from Temple University in Philadelphia, PA.

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‘Tis the season for the sneezin’

Thursday, 18 March 2010 04:39

wilbur_bw The 2009-2010 flu season promises to be one of the worst in many years. On Saturday, Oct. 24, President Barack Obama declared the swine flu a national emergency, allowing hospitals and local governments to speedily set up alternate sites and procedures to handle any surge of patients. In Broward County, 11 deaths and 88 hospitalizations from swine flu have been reported as of Nov. 17.

The best way to prevent the flu is to be vaccinated. This year there are two separate vaccines administered. The first is the seasonal flu vaccine, which has been available since September. Many people have already received this vaccine either from their private physician or from retail outlets, such as Walgreens or CVS. It contains three strains of virus: two are identical to last year’s vaccine, and one has been changed to a slightly different strain of influenza B.

The second vaccine is for the 2009 H1N1, (swine flu), influenza virus. This is a new virus first detected in people in the United States in April 2009. Virtually all (98 percent) of the influenza cases reported so far in the United States have been caused by this new virus. Most people infected with this virus have a self-limited illness, but some require treatment, and deaths have occurred.

The vaccine for the 2009 H1N1 is being distributed through the local health departments. Initially there had been a shortage of vaccine but more is becoming available. As of Nov. 20, 54.1 million doses have been available in the U.S., an increase of 11 million doses since the previous week. It is available at public health facilities and some local physician offices. Providers administering vaccine are honor-bound to follow CDC guidelines.

Initially the vaccine will be made available to the following groups:
1)   6 months to 24 years of age
2)   Pregnant women
3)   Healthcare workers
4)   Patients with chronic illness (Asthma, diabetes, chronic respiratory illness or immunosuppressed or compromised) and household contacts of such people.

As vaccines become more available, the second group will be targeted: people 25 to 64 years of age.And finally, when the vaccine is plentiful: people 65 and older.

The reason for this is that the H1N1 influenza seems to be more serious in younger individuals, perhaps because older people have a partial immunity from exposure to a similar virus when they were younger.

The vaccine for H1N1 is made in the same way as the seasonal flu vaccine, which has an excellent safety record. People should not avoid the vaccination out of fear. The real risk from H1N1 far outweighs any theoretical worry of vaccine-related problems. So far, the most common side effect is a little discomfort at the vaccination site.

Remember to take simple measures to stay healthy:
1)   Cover your nose and mouth with a tissue when you sneeze or cough.
2)   Wash your hands often with soap and water.
3)   Avoid touching your eyes, nose and mouth.
4)   Stay home if you get sick, and limit contact with others to keep from infecting them.

If you feel you have the flu and are seriously ill, your doctor may prescribe one of the antiviral agents, such as Tamiflu or Relenza. These are most effective if started within two or three days of symptoms. As always, if you have any individual or specific health-related questions, the best source of information is your own personal physician.

Richard J. Wilbur, M.D. is Board Certified in Internal Medicine. Dr. Wilbur practices at
Safecare Medical Center’s Hollywood office, located at 4050 D Sheridan St., Hollywood, FL 33021. For an appointment with Dr. Wilbur, contact his office at 954-989-7441 or
online at www.safecare.com.

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