Lisa Kohler, MD - AkronCantonMDNews

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RateMDs.com: Physicians Beware By Corbin Moore The internet is a valuable tool for physicians both for research and communication. However, recently it has become dangerous ground. This is because the trend of anonymous consumer ratings has finally spread to healthcare. The reputations of all physicians are now vulnerable to damage by anonymous postings on internet sites. One of the most popular of these sites is www. RateMDs.com. RateMDs encourage patients to anonymously evaluate their doctors and post whatever they choose about their experience. The lack of checks or any kind of authenticity requirements mean that essentially, anyone can write anything about any physician. Angry patients, competitors, and others who would seek to harm your reputation now have a free and easy global platform in which to do so. A company out of North Carolina founded to protect physicians from frivolous lawsuits has been conducting research on RateMDs.com and other sites and what they have discovered is unsettling to say the least. Until now, there has been little that physicians could do about libel on the internet. However, there is at least one organization which is gearing up to combat web defamation (see www.medicaljustice.com). They have crafted a proactive, innovative solution that can help you prevent unwanted comments and take action if and when you find them. We encourage all physicians to look themselves up on www.RateMDs.com, www.healthgrades.com, and other sites. It is also a good idea to “Google” yourself and your practice regularly to see what’s out there on websites and blogs. Corbin Moore is president of Sirak-Moore Insurance Agency in Canton and Akron. ■ 1 0 | GREATER AKRON/CANTON M.D. NEWS JANUARY-FEBRUARY 2008
surgery feature Bariatric Surgery and Type 2 Diabetes A Treatment? A Cure? By Philip R. Schauer, MD; Bipan Chand, MD; Stacy A. Brethauer, MD; Tomasz Rogula, MD, PhD Bariatric surgery cases, involving Roux-en-Y gastric bypass, gastric banding, and biliopancreatic diversion, have increased dramatically in the United States over the last decade from approximately 10,000 cases per year to 200,000 annually in 2007. (See illustrations on next page.) This increase coincides with a dramatic increase in the incidence of obesity, as well as patient demand for surgery. The majority of bariatric procedures today are being performed with less invasive laparoscopic techniques, which have reduced complications, recovery time, and pain from the surgery, making it much more desirable for patients. Patients tend to lose anywhere from 40% of their excess body weight to 75-80% of their excess body weight. Many studies demonstrate that the majority of the weight lost from bariatric operations is maintained up to and beyond 10 years, indicating a very durable effect. The major benefits of bariatric operations are primarily, but PHOTOS COURTESY OF CLEVELAND CLINIC not exclusively, derived from the amount of weight loss. Many medical conditions, including the following, have been shown to be dramatically improved or reduced after surgery: type 2 diabetes, hypertension, hyperlipidemia, osteo arthritis, gastro esophageal reflux, sleep apnea, fatty liver disease, urinary incontinence, coronary artery disease. All of these have been shown to dramatically improve or resolve following bariatric operations. (See illustration on third story page.) BENEFITS OF BARIATRIC SURGERY TO PATIENTS WITH TYPE 2 DIABETES Of all the benefits of bariatric surgery, the most dramatic appear to be related to type 2 diabetes. Type 2 diabetes is defined as severe insulin resistance leading to a chronic state of hyperglycemia. Until recently, therapy for type 2 diabetes has been restricted either to insulin or oral hypoglycemic agents, in addition to lifestyle changes and dietary therapy. In the early 1990s, reports regarding the effect of bariatric operations on type 2 diabetes began to appear in the medical literature. In five published studies examining a total of 3,568 people undergoing Roux-en-Y gastric bypass, diabetes was in complete remission in most cases. The majority of studies showed remission in approximately 83% of cases. Remission in diabetes means that patients are able to discontinue all diabetic medications, and have a normal fasting blood sugar and a hemoglobin A1C (HA1c) of 6.0 or less. However, one study found the remission rate to be as high as 98%. 12345 Moreover, bariatric surgery may help prevent diabetes altogether. In a 5.5 year longitudinal study of obese people with impaired glucose tolerance, those who underwent bariatric surgery had a 30-fold lower risk of developing diabetes. 6 Lowering the risk of diabetes and its long-term health effects clearly saves lives. Given the close association between obesity and diabetes, it is not surprising that in one 2004 observational study, Christou et al found that the 5-year mortality rate in patients who had undergone bariatric surgery was 0.68% compared with 16.2% in the medically managed patients— an 89% relative risk reduction. 7 That same year, Flum and Dellinger reported the findings of a retrospective study of mortality in morbidly obese patients who had undergone gastric bypass. They found a 27% lower mortality rate over 15 years in the patient population as opposed to obese patients who had not had surgery. 8 GREATER AKRON/CANTON M.D. NEWS JANUARY-FEBRUARY 2008 | 11
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Page 6 and 7: cover story Lisa Kohler, MD Dealing
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