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Resistance Exercise BandsExclusive Member Content

July 19, 2017 12:47 pm

Exercise Benefits & Events

August 09, 2016 2:25 pm

Exercise and it’s benefits for body, mind and weight loss can’t be over emphasized. Everyone can benefit from some form of exercise whether it be a brisk walk, chair exercises, exercise bands, aquatics, running, hiking or biking. As a family we try to exercise often and attempt to participate in at least one event a month or so. These types of events tend to keep us more accountable and motivated. The group atmosphere, energy and vibe only add to the experience. Listed below are some of our favorite exercise events. We will update this list and add to it.

Physical Benefits:

Weight loss and maintenance can be a benefit of exercise. It also improves muscle function and strength.
Improves Type 2 Diabetes and Metabolic Syndrome
Reduces some Cancer Risk
Improved Cardiovascular Health
Improved “Good” cholesterol
Strengthens and improves Bone Health
Living longer
Improved Sleep

Mental Health Benefits:

Reduce Stress
Boosts Endorphins
Helps with Anxiety
Improved Self Confidence
Being in the Great Outdoors and Sunlight (increases Vitamin D)
Prevent Cognitive Decline
Sharpen Memory and Cognitive Function
Help with Addiction
Increase Relaxation

One important key note is to pay close attention to hydration with exercise, not only with fluids but electrolytes as well. Exercise increases fluid loss due to sweat and increase circulation to muscle. You need to increase fluid intake to compensate for these losses.

Exercise events by the month:

June

The Los Angels River Ride is one of our families favorites. Great ride for a great cause.

August

Luau 5K walk and fun run This is a fun family activity as they have a kids run and lots of activities. It is also in Griffith Park which is a beautiful and treasured location.

September

The Prudential 401K Run is to promote saving for retirement and is a FREE event at the beautiful Rose Bowl

October

The Aloha Run brings a little Hawaiian feel to the fall.

JDRF One Walk fighting Type I Diabetes

November

City of Hope’s Walk for Hope

December

Santa to the Sea (must bring a gift for a child)

Varying months depending on location:

Race for The Rescues

Walk from Obesity

Step Out Diabetes Walk

Get your Rear in Gear to fight Colon Cancer

CicLAvia a Los Angeles area quarterly biking event.

Sunshine, Water, Rest, Air, Exercise and Diet

May 23, 2014 4:10 pm

Sunshine, Water, Rest, Air, Exercise and Diet

Of course this is over simplified, but we can’t forget the importance of the basics in our general well being. Weight loss surgery and especially Duodenal Switch have distinctive supplement requirements that need to be individualized based on your individual needs.

Sunshine is essential to life. It provides the light that wakes us and helps to regulate wake/sleep cycles and provides us with a feeling of well being. Sunlight is not only the basis of all living things but crucial in boosting the bodies Vitamin D supply. Most Vitamin D deficiencies in the general public are caused by lack of sun exposure. It is important to note that our bodies can not accomplish Vitamin D metabolism if we are wearing sunscreen. Without adequate Vitamin D stores bones will not form properly, muscle strength is impaired and osteoporosis. Vitamin D 1,25(OH) accumulates in cell nuclei of the intestine, where it enhances calcium and phosphorus absorption, controlling the flow of calcium into and out of bones to regulate bone-calcium metabolism. However, after weight loss surgery this mechanism can be impaired. Addition supplementation of Vitamin D is usually required based on laboratory studies following weight loss surgery. Duodenal Switch patients should take a dry “water miscible” type of Vitamin D3 daily.

Water comprises 50-60% of our adult bodies. Water is essential in cell life. It aids in transporting vitamins, nutrients and minerals to our cells. Chemical and Metabolic reactions rely on water to remove waste products including toxins that the organs’ cells reject and removes them through urine and feces. Our body temperature is regulated by sweating and the evaporation of water on the skin. Also, effectively Lubricating our joints and acting as a shock absorber for our brain, eyes, and spinal cord. Decreased stomach size, after weight loss surgery, limits the amount of water a person can drink at one time. It is imperative that patients ingest enough waters and fluids after surgery. We like to see our patients consume a minimum of 64 ounces of fluids a day, more on warmer days.

Rest is something we can all use more of. Lack of sleep can cause a whole host of health issues ranging from altered levels of hormones involved in metabolism, appetite regulation, stress response to cardiovascular health, insulin resistance, immune function and most importantly post-operatively tissue repair, muscle growth and protein synthesis. It’s easy to take rest for granted but do not underestimate the power of sleep.

Air is an obvious essential of life. It is important in about every function of our cells. After surgery it is important to lung health and tissue repair. Be aware of the type of air you are breathing. Pollution and contaminants in the air can impair lung function. After surgery your breathing and breathing exercises will prevent complications such as pneumonia and atelectasis. Long term air contaminants can cause asthma and long term lung health. In addition, post surgical patients will need to use their incentive spirometers to combat lung complications.

Exercise’s health benefits can not be denied. Exercise combat health conditions and disease such as stroke, metabolic syndrome, diabetes and cardiovascular disease. It also improves emotional outlook and mood. Physical activity stimulates the brain to release chemicals that involve increasing memory function. Exercise helps maintain healthy weight, improves energy, promotes better sleep, lowers stress and anxiety. Needless, to say after surgery exercise is extremely important for all the above reasons but also to ward off complications such as pulmonary embolism and deep vein thrombosis.

Diet is last but definitely not least. Balance along with moderation and eating whole unprocessed foods are best ways to ensure your health. We derive most our building blocks for cell growth from the nutrients we consume. The quality of the food we put into our bodies is important in lowering health risks such as cardiovascular disease, cancer, and weight control. Protein is crucial in muscle growth, hemoglobin, cell structure and enzymes formation. It is extremely important after weight loss surgery to remain diligent about protein intake throughout your lifetime.

It is interesting to see how all these elements are so intertwined in their synergy to maintain health. Most are easily found or done in nature. When engaging in one of these elements, many of the others are needed or benefited by the doing the first. Exercise requires that you stay hydrated, deep breath, possibly out in the sunlight and therefore you will rest better. Always follow your surgeon’s orders and recommendations based on your individual health status and laboratory studies.

Fat Loss Through ExerciseExclusive Member Content

June 03, 2008 12:14 am

EXERCISE AND CALORIESExclusive Member Content

July 26, 2000 7:49 am

Elective Surgery and Anesthesia for Patients after COVID-19 Infection

January 23, 2022 6:03 pm

ASA and APSF Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection is also available for download (PDF)

Since hospitals are able to continue to perform elective surgeries while the COVID-19 pandemic continues, determining the optimal timing of procedures for patients who have recovered from COVID-19 infection and the appropriate level of preoperative evaluation are challenging given the current lack of evidence or precedent. The following guidance is intended to aid hospitals, surgeons, anesthesiologists, and proceduralists in evaluating and scheduling these patients. It is subject to change as new evidence emerges.

In general, all non-urgent procedures should be delayed until the patient has met criteria for discontinuing isolation and COVID-19 transmission precautions and has entered the recovery phase. Elective surgeries should be performed for patients who have recovered from COVID-19 infection only when the anesthesiologist and surgeon or proceduralist agree jointly to proceed.

What determines when a patient confirmed to have COVID-19 is no longer infectious?

The Centers for Disease Control and Prevention (CDC) provides guidance for physicians to decide when transmission-based precautions (e.g., isolation, use of personal protective equipment and engineering controls) may be discontinued for hospitalized patients or home isolation may be discontinued for outpatients.

Patients infected with SARS-CoV-2, as confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) testing of respiratory secretions, may be asymptomatic or symptomatic. Symptomatic patients may be further sub-classified into two groups depending upon symptom severity. Table 1 provides definitions of these COVID-related illness levels of severity.

Patients with mild to moderate symptoms* (generally those without viral pneumonia or oxygen saturation below 94 percent)
Patients who experienced severe or critical illness** due to COVID-19 (e.g., pneumonia, hypoxemic respiratory failure, septic shock).

Severely immunocompromised patients***, whether suffering from asymptomatic or symptomatic COVID-19, are considered separately.

Current data indicate that, in patients with mild to moderate COVID-19, repeat RT-PCR testing may detect SARS-CoV-2 RNA for a prolonged period after symptoms first appear. However, in these patients, replication-competent virus has not been recovered after 10 days have elapsed following symptom onset. Considering this information, the CDC recommends that physicians use a time- and symptom-based strategy to decide when patients with COVID-19 are no longer infectious.

For patients with confirmed COVID-19 infection who are not severely immunocompromised and experience mild to moderate symptoms*, the CDC recommends discontinuing isolation and other transmission-based precautions when:

At least 10 days have passed since symptoms first appeared.
At least 24 hours have passed since last fever without the use of fever-reducing medications.
Symptoms (e.g., cough, shortness of breath) have improved.

For patients who are not severely immunocompromised and have been asymptomatic throughout their infection, isolation and other transmission-based precautions may be discontinued when at least 10 days have passed since the date of their first positive viral diagnostic test.

In approximately 95 percent of severely or critically ill patients (including some with severe immunocompromise), replication-competent virus was not present after 15 days following the onset of symptoms. Replication-competent virus was not detected in any severely or critically ill patient beyond 20 days after symptom onset.

Therefore, in patients with severe to critical illness** or who are severely immunocompromised***, the CDC recommends discontinuing isolation and other transmission-based precautions when:

At least 10 days and up to 20 days have passed since symptoms first appeared.
At least 24 hours have passed since the last fever without the use of fever-reducing medications.
Symptoms (e.g., cough, shortness of breath) have improved.

Consultation with infection control experts is strongly advised prior to discontinuing precautions for this group of patients. Clinical judgment ultimately prevails when deciding whether a patient remains infectious. Maintaining transmission-based precautions and repeat RT-PCR testing may be appropriate if clinical suspicion of ongoing infection exists. The utility of repeat RT-PCR testing after improvement in symptoms is unknown as patients will frequently remain at least intermittently positive for weeks to months.

If a patient suspected of having SARS-CoV-2 infection is never tested, the decision to discontinue transmission-based precautions can be made using the symptom-based strategy described above.

Other factors, such as advanced age, diabetes mellitus, or end-stage renal disease, may pose a much lower degree of immunocompromise; their effect upon the duration of infectivity for a given patient is not known.

Ultimately, the degree of immunocompromise for the patient is determined by the treating provider, and preventive actions are tailored to each individual and situation.

What is the appropriate length of time between recovery from COVID-19 and surgery with respect to minimizing postoperative complications?

The preoperative evaluation of a surgical patient who is recovering from COVID-19 involves optimization of the patient’s medical conditions and physiologic status. Since COVID-19 can impact virtually all major organ systems, the timing of surgery after a COVID-19 diagnosis is important when considering the risk of postoperative complications.

There are limited data now that address timing of surgery after COVID-19 infection. One study found a significantly higher risk of pulmonary complications within the first four weeks after diagnosis ⁽¹⁾. An upper respiratory infection within the month preceding surgery has previously been found to be an independent risk factor for postoperative pulmonary complications ⁽²⁾. Patients with diabetes are more likely to have severe COVID-19 disease and are more likely to be hospitalized ^(3,4). Studies conducted during the 2009 influenza A H1N1 pandemic found that pulmonary function continues to recover up to three months after ARDS ⁽⁵⁾.

Given this current knowledge base, wait times before surgery can be reasonably extrapolated and are a suggested starting point in the preoperative evaluation of the COVID-19-recovered patient.

The timing of elective surgery after recovery from COVID-19 utilizes both symptom- and severity-based categories. Suggested wait times from the date of COVID-19 diagnosis to surgery are as follows:

Four weeks for an asymptomatic patient or recovery from only mild, non-respiratory symptoms.
Six weeks for a symptomatic patient (e.g., cough, dyspnea) who did not require hospitalization.
Eight to 10 weeks for a symptomatic patient who is diabetic, immunocompromised, or hospitalized.
Twelve weeks for a patient who was admitted to an intensive care unit due to COVID-19 infection.

These timelines should not be considered definitive; each patient’s preoperative risk assessment should be individualized, factoring in surgical intensity, patient co-morbidities, and the benefit/risk ratio of further delaying surgery.

Residual symptoms such as fatigue, shortness of breath, and chest pain are common in patients who have had COVID-19 ^(6,7). These symptoms can be present more than 60 days after diagnosis⁽⁷⁾. In addition, COVID-19 may have long term deleterious effects on myocardial anatomy and function ⁽⁸⁾. A more thorough preoperative evaluation, scheduled further in advance of surgery with special attention given to the cardiopulmonary systems, should be considered in patients who have recovered from COVID-19 and especially those with residual symptoms.

Is repeat SARS-CoV-2 testing needed?

At present, the CDC does not recommend re-testing for COVID-19 within 90 days of symptom onset ⁽⁹⁾. Repeat PCR testing in asymptomatic patients is strongly discouraged since persistent or recurrent positive PCR tests are common after recovery. However, if a patient presents within 90 days and has recurrence of symptoms, re-testing and consultation with an infectious disease expert can be considered.

Once the 90-day recovery period has ended, the patient should undergo one pre-operative nasopharyngeal PCR test ideally ≤ three days prior to the procedure.

References

COVIDSurg Collaborative. Delaying surgery for patients with a previous SARS‐CoV‐2 infection. BJS 2020; 107: e601–e602. https://doi.org/10.1002/bjs.12050
Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338. https://doi.org/10.1097/ALN.0b013e3181fc6e0a
Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: a nationwide analysis. Eur Respir J 2020. DOI: 10.1183/13993003.00547-2020
Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020;369:m1966 doi: https://doi.org/10.1136/bmj.m1966.
Hsieh M-J, Lee W-C, Cho H-Y, et al. Recovery of pulmonary functions, exercise capacity, and quality of life after pulmonary rehabilitation in survivors of ARDS due to severe influenza A (H1N1) pneumonitis. Influenza and other respiratory viruses. Apr 2018. https://doi.org/10.1111/irv.12566
Tenforde MW, Kim SS, Lindsell CJ., et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network – United States, March-June 2020. MMWR 2020 Jul 31;69(30):993-998. https://dx.doi.org/10.15585%2Fmmwr.mm6930e1
Carfi A, Bernabei R, Landi F., et al. Persistent Symptoms in Patients After Acute COVID-19. JAMA July 9, 2020. doi:10.1001/jama.2020.12603
Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(11):1265-1273. doi:10.1001/jamacardio.2020.3557
https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
Accessed Oct 28, 2020

Table 1: Definitions for Severity Levels of COVID-Related Illness
The studies used to inform the guidance in this joint statement do not clearly define “severe” or “critical” illness. The definitions in the National Institutes of Health (NIH) COVID-19 Treatment Guidelines (cited under references below) are suggested to categorize disease. The highest level of illness severity experienced by the patient at any point in their clinical course should be used.
* Mild Illness: Signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.
* Moderate Illness: Evidence of lower respiratory disease by clinical assessment or imaging and oxygen saturation (SpO2) ≥94 percent on room air at sea level.
** Severe Illness: Respiratory rate >30 breaths per minute, SpO2 <94 percent on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3 percent), a ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates involving >50 percent of the lung fields.
** Critical Illness: The presence of respiratory failure, septic shock, and/or multiple organ dysfunction.
*** The studies used to inform this guidance did not clearly define “severely immunocompromised.” For the purposes of this guidance, “severely immunocompromised” refers to patients:

- Currently undergoing chemotherapy for cancer.
- Within 1 year of receiving a hematopoietic stem cell or solid organ transplant.
- Having untreated HIV with a CD4 T lymphocyte count <200.
- Having a combined primary immunodeficiency disorder.
- Treated with prednisone >20mg/day for more than 14 days.

Reference sources from CDC and NIH websites as of 22 Sept 2020:
Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
Overview of testing
https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html
Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html
Duration of Isolation and Precautions for Adults with COVID-19
https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcommunity%2Fstrategy-discontinue-isolation.html
National Institutes of Health (NIH) COVID-19 Treatment Guidelines
https://www.covid19treatmentguidelines.nih.gov/whats-new/

A GUIDE TO COVID-19 TESTS FOR THE PUBLIC

January 23, 2022 5:38 pm

THE MAIN TESTS AVAILABLE FOR COVID-19

VIRUS STRUCTURE

To understand testing methods, it is helpful to understand the structure of the coronavirus SARS-CoV-2, which causes the disease COVID-19. The virus is composed of a core made up of nucleic acid (nucleic acids are what makes up the virus’s genetic code) in the form of RNA, surrounded by a coat called the envelope which contains various proteins. Spikes formed of a protein called the S (spike) protrude from the envelope. It is the S protein that attaches to cells of the human respiratory tract.

TESTING

The tests commonly available for SARS-CoV-2 can detect either:

the RNA − detected by the PCR test
the surrounding proteins − detected by the rapid lateral flow devices
the human body’s response to the virus – detected by antibody tests.

PCR TESTINGNUCLEIC ACIDS ARE WHAT MAKES UP THE VIRUS’S GENETIC CODE

PCR tests detect the virus’ RNA. These tests are normally carried out in a laboratory using a swab of the nose and/or throat. PCR tests can detect very tiny amounts of RNA, meaning they are extremely sensitive. They are the best test for current infection. Patients with COVID-19 usually start to become positive by PCR testing a day or two before symptoms start and will continue to test positive by PCR afterwards for some time. Repeat PCR once a diagnosis has been made is not necessary. The period the patient must isolate for is defined by time from the start of symptoms or, if there are no symptoms, from the first positive test. Current UK policy is that patients must self-isolate for ten days after this time.

WHEN SHOULD I HAVE A PCR TEST?

If you currently have symptoms that may indicate COVID-19, this is the test you should have to diagnose the infection.
If a lateral flow test is positive. The purpose of the PCR test is to confirm the diagnosis, since it is a more accurate test than the lateral flow test.

IS A PCR TEST ACCURATE?

PCR is the most accurate test available for current infection. In a person with symptoms, a positive PCR test is likely to accurately indicate infection. If a person has symptoms suggesting infection but a negative PCR test, doctors may decide to repeat the test if they still suspect infection (e.g. in hospitalised patients).

LATERAL FLOW TESTS

These are the rapid tests that are used in the community. They are convenient because they can give a result within 30 minutes and do not need a laboratory. They detect proteins from the virus, not RNA. They use a swab of the nose and/or throat and are carried out on a small flat plastic device like a pregnancy test. These tests are very different from PCR. They are not suitable for diagnosing individual patients who suspect they may be infected because they have symptoms. People with symptoms need a PCR test. Lateral flow tests are intended for picking up additional infected cases who would otherwise be missed because they don’t have any symptoms.

WHEN SHOULD I HAVE A LATERAL FLOW TEST?

You should only have this test if you don’t have any symptoms and have been invited to take one as part of an exercise to identify infected people without symptoms.

ARE LATERAL FLOW TESTS ACCURATE?

These tests are not as sensitive as PCR. They are simply a convenient way of picking up a proportion of undiagnosed people who have no symptoms. The way to look at these tests is that every additional positive case picked up is a bonus, preventing further unknown transmission of the virus. If a person tests positive with these tests, they need to confirm this by having a more accurate PCR. In the meantime, they must self-isolate. If these tests are negative, the person may or may not be infected and that person must continue to take the usual precautions such as hand washing, wearing a mask and social distancing. A negative lateral flow test should not be used to rule out infection or indicate that it is safe to do something such as visit relatives. You can read more about the accuracy of lateral flow tests here.

ANTIBODY TESTS

These tests detect the body’s response to a previous infection, by looking for antibodies that the body has produced. It takes some time after infection for the body to produce antibodies. So, antibody tests are not suitable for diagnosing people at the time they have symptoms. They are useful for finding out if someone has been infected in the past. This is useful, for example, for studying how many people in a population have been infected. It is not known for how long after infection antibody tests remain positive. Levels of antibody are likely to decline with time, over months or years.

WHEN SHOULD I HAVE AN ANTIBODY TEST?

You might be asked to have an antibody test as part of a study to see how many people have been infected in the past.
In future, if a doctor wanted to know if you had been infected in the past, they might perform an antibody test.

LAMP AND LAMPORE TESTING

Like RT-PCR, LAMP and LampORE tests detect the viral RNA. They have the advantage of being able to use saliva as a sample, as well as swabs. Recently LamPORE has been deployed for local community testing in some locations. This test can be carried out in mobile laboratories around the country. LamPORE tests have high accuracy. They can be used for people with or without symptoms, but they are currently being deployed in the UK to detect people without symptoms in the community. As these tests are more accurate than lateral flow tests, positive tests do not require a confirmation by PCR. Copied: Source https://www.rcpath.org/profession/coronavirus-resource-hub/guide-to-covid-19-tests-for-members-of-the-public.html

Sleeve Gastrectomy in Adolescent patients

September 23, 2020 5:44 am

The benefits of weight loss surgical procedures are undisputed. Over the last decades, as the incidence of obesity has increased, so has the need for effective long-term treatment options. It is no secret that diet and exercise plans are only short-term remedies since none of them provide realistic long-term alternatives. Let’s be clear that a healthy diet and activity level are critical to a healthy body and mind and to the long-term success of weight loss surgery. A frequent question: How young is too soon for weight loss surgery? We work with our patients to ensure that weight loss surgery will not affect the growth of an adolescent patient with regard to height, bone formation, and hormonal status. Specifically, there are concerns about a female patient’s ability to get pregnant and have children. All the scientific evidence points to the benefits of weight loss surgery and the improved ability to get pregnant and bear the pregnancy to completion. Weight loss positively impacts the ability to get and have a healthy pregnancy leading to a non obese child. An article recently published demonstrated the benefits of early intervention. Specifically, it showed the improved odds of resolution of diabetes in the younger patients (100% in adolescents, Vs. 75% in adults ) at 24 months post-op.

Sleep apnea resolved at the same rate. These early interventions can mean there may be lower long-term risk and associated conditions for these teens as they age. A recent article was written from several adolescent weight loss surgical patients’ perspectives: This included their feelings of hope for their futures and health.

Osteoporosis Medications, Action and Side Effects

May 25, 2019 3:40 pm

Recently I had a short live presentation on the subject of osteoporosis, osteoporosis medications, and the treatment options of this deteriorating bone condition. A patient who has had a bone scan may be diagnosed with Osteopenia and/or Osteoporosis. This information is usually conveyed by the forms of a Low T score. Both of these indicated demineralization of the bones, and the end result is worsening of the bone structure. This leads to weaker bones and higher chance of fracture due to stress or trauma.

Treatment options should be approached is a global and systemic fashion. It is critical that the nutritional status is at its best possible and optimized for important healthy bone vitamins and minerals. Low protein needs to be corrected. Special attention should be given to nutrients, minerals and vitamins. These include Protein, Calcium, Magnesium, Vitamin D, and Vitamin K1/K2to name a few.

Healthy bones require ongoing and routine force in the form of exercise to remain health. Just as exercise improves muscle strength, it also improves bone health. Exercise is also critical in improving bone structure and density. Ideally, exercise should be weight bearing and resistance. Examples include: hiking, walking, jogging, climbing stairs, playing tennis, and dancing. Resistance type exercise is weight lifting and resistance bands. These exercise work by creating a pull or force on the bone either by gravity, movement or weight. Always check with your physician before beginning an exercise routine, start slowly and building up to longer periods of time. The ideal goal would be at least 30 minutes a day, every day, if you are able.

We frequently see patients immediately started on osteoporosis medications without checking or improving some of the nutritional markers noted above or without looking at exercise history. In some case, the medication recommended are contraindicated due to nutritional status.

The medications can be grouped in to those that help with new bone formation (Anabolic agents) or those that help by suppressing the bone breakdown phase (Antiresorptive agents).

National Osteoporosis Foundation has an exhaustive list (below) of medications for treatment of Osteoporosis.

The table below outlines the side effects and mechanism of the actions of the common medications used for treatment of osteoporosis which was published by the University Health News Publication on August of 2014.

With all this information, the few points to remember is that the most important factors in healthy bone structure are the nutritional status Protein, Calcium, Magnesium, Vitamin D, and Vitamin K1 levels.

This is an animation of normal bone Metabolism. It shows how bone structures is taken down and rebuilt continuously. This allows for a healthy bone maintainence as we age. The key is the balance of breakdown (osteoclast) and the build up (osteoblast) activity is regulated. Osteoporosis develops when there is more breakdown that build up.

With permission of Dr. Susan Ott of University of Washington.

Additional information available on her site.

Past blogs on Bone Health.

Gastric Balloon

March 12, 2019 9:10 am

Here we go again…. There is a new cure for obesity, Gastric Balloon, with minimal to no risk, is an outpatient procedure and/or can be done in the surgeons office with no anesthesia. Have we not similar claimed like this before (Adjustable gastric band) ?

Randomized sham-controlled trial of the 6-month swallowable gas-filled intragastric balloon system for weight loss published in Surgery for Obesity and Related Diseases 14 (2018) 1876–1889, by Sullivan et. al reports

“Conclusions: Treatment with lifestyle therapy and the 6-month swallowable gas-filled intragastric balloon system was safe and resulted in twice as much weight loss compared with a sham control, with high weight loss maintenance at 48 weeks.”

This sound very promising, however is very vague and leaves out significant, critical, and pertinent information.

The outcome of weight loss at 24 weeks was reported in Total Body weight loss % (TBWL%), Excess weight % (EWL), weight loss, and BMI change. Of those, the last three were statistically significant changes.

The outcome the weight loss was reported to be at 7% TBWL% at 24 weeks with some weight regain, with the patient employing post REMOVAL life style changes.

It is stated that the Gastric Balloon is temporary device that needs to be removed in 6 months and should be considered in low BMI patients (<35kg/m2). It is is important for those patients who are considering this temporary expensive measure for minimal weight loss to entertain the alternative of the same temporary results that may be obtained by lifestyle changes. These results may be maintained by a healthy lifestyle, exercise, and eating without the need for a device.