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Month: October 2014

Laboratory Blood Specimen Collection Change

October 30, 2014 5:20 pm

Older and Newer Blood Specimen Tubes

No one likes surprises at the lab when you are about to get your blood drawn. The picture above is of the older vacutainers blood specimen tubes and a new type of tube that is being introduced. There is currently a change over of blood specimen tubes in laboratories across the country.  Locally we are seeing the use of SARSTEDT tubes/syringes.  This change over is for several reasons. First and foremost is to reduce blood bourne pathogen exposure due to needle sticks and tube breakage. However, these blood specimen tubes offer some additional benefits, especially to people who frequently have lab draws. One of which is the ability to use aspiration of the specimen to decrease the incidence of hemolysis.  Hemolysis skews laboratory studies and damages the red blood cells in the collected specimen causing the need for repeated testing.  Aspiration is also easier on fragile veins due to the decrease pressure versus vacuum. The SARSTEDT tubes are versatile in that they can also be used as a vacuum tube if needed.

Hope this knowledge will alleviate at least some anxiety on your next trip to the lab for your blood draws.  Remember that follow up laboratory studies after weight loss surgery is a lifetime commitment that ensures your health and adjustment of vitamins and supplements.

Weight Loss before Weight Loss Surgery?

October 19, 2014 2:54 pm

I am frequently confronted by the question “Are you going to make me lose weight before I have weight loss surgery”? My answer is no, for several reasons, it makes little or no sense and there is scant scientific data to support it.

1-Anatomical and 2-psychological-behavior related variables have been suggested as the reasoning for the recommendations for diet before weight loss surgery.

Let’s see what the scientific evidence says about this.

1-Liver can be divided into two anatomical lobes. The tail end of the left lobe may extend all the way to the upper left side of the abdomen covering the upper 1/3 of the stomach,  the gastro-esophageal junction (GEJ) and the esophageal hiatus. It was suggested that the access to the GEJ could be made easier, if the left lobe of the liver was smaller.

“A decrease in the size of the liver by 18% was shown in patients who were subjected to a very low-energy diet for 12- weeks.”  This was published by Colles in a small study of 39 subjects.

It is important to appreciate that this reduction in liver size meant that a patient would have to tolerate an ultra low caloric diet (less than 500/day) for 12 weeks. The interesting observation was that even with this reduction in the size of the liver there was “… no difference shown in morbidity, mortality, hospital stay, and decrease in morbidity- associated diseases whether there is preoperative weight loss or not.”

2-Behavior modifications have been entertained as a necessary element to the success of adjustable gastric banding. Numerous studies have shown that there is no predictive value of preoperative weight loss in relation to the weight loss after surgery.


The overwhelming scientific data suggest that there is no value to subjecting a weight loss surgical patient to a pre-surgical ultra low caloric diet.
“The California Department of Managed Health Care recently conducted a review of weight loss prior to bariatric surgery and concluded that “there is no literature presented by any authority that mandated weight loss, once a patient has been identified as a candidate for bariatric surgery, is indicated. This comprehensive review states that mandated weight loss prior to indicated bariatric surgery is without evidence-based support, is not medically necessary, and that the risks of delaying bariatric surgery are real and measurable.” Published by the American Society for Metabolic and Bariatric Surgery in March 2011.


Dental Issues after Weight Loss Surgery

October 13, 2014 10:53 pm

Please click the link to view the webinar on Dental Issues after Weight Loss Surgery.  A special thank you to Armen Mardirossian, DDS, MS Diplomate for his contributions to this article. Update for Feb. 2017 Dental Resources here. Dental Issues after Weight Loss Surgery Webinar here.
Anatomy of a Tooth
Factors that contribute to Dental Issues
This is a review of data regarding weight loss surgery and dental health.  I am not a Dentist so please follow up with your Dental Health Care Providers if you are having any issues.  Always keep your health care providers informed of your overall health status.

Angular Cheilitis

October 04, 2014 2:35 am

Cracked corners of the lips is know as Angular Cheilitis (AC). This is a condition that is not uncommon. It has been contributed to a lowered immune state caused by multiple factors. The underlying lowered immune state may predispose a patient to an infection which can cause the AC. These infections can be caused by bacteria or fungus that is normally present in healthy individuals, but with any level stress placed on the immune system, they are able to spread. This condition can surface with minimal weakening of the immune system. Possible contributing factor of weakened immune system may be stress (physical and psychological), trauma, malnutrition, and extreme fatigue. Vitamin B and Iron deficiency was also suspected to be a cause of AC. The  Vitamin B or iron deficiency may be contributing factor of weakened immune state and not directly causing AC. It is however important to correct all possible contributing causes including Iron and vitamin B deficiency.