Impact Of Childhood Obesity

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I just read an article by Madison Park updated on February 15, 2012 on www.CNN.com which is the third in a series on childhood obesity in the United States.  It stated that because of the increasing number of children who are overweight and obese, schools need to get larger desks to accommodate them.  This is done not only to enable them to fit in a desk, but also to try to lessen their embarrassment.  This just validates the findings from the Centers for Disease Control and Prevention that a third of the children in the USA are overweight or obese and seventeen percent are obese.  It impacts the effectiveness of children’s car safety seats as well.  I urge you to read the article, “Obese children outgrowing kids’ clothing and furniture.”

What do you think?  Historically, has this always been a problem for some children and was just ignored until recently?  For those of you who were overweight during childhood, how were you treated by your classmates & how did you react?  Please share your comments and experiences.

For Your Health – Dr. Bob

Part 4 – Get The Best Care When You Need Elective Surgery!

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When you need elective surgery, make sure you evaluate your treatment options.

This includes not only how you will be treated, but also where you will receive the treatment and by whom.  Here’s how I viewed my situation – In my case with my multinodular thyroid with an especially large nodule on the right, I was given the option of just having the right side of the thyroid removed.  In that case there was a good possibility I would not have to take daily thyroid hormone replacement, but there was also a small possibility that there might be a cancer in the remaining thyroid.  However, most thyroid cancers are very slow growing.  If I kept the left half of my thyroid, I’d need periodic thyroid ultrasounds and follow-up.  At some point in the future I might need the left side to be removed as well.  Realistically with my cardiac history and advancing age I figured that my risk for surgery will only get worse as time goes by, so I chose to have the whole gland removed.  This way, I will know definitively if this is any cancer in any of the thyroid.  The only downside is that I now have to take thyroid medicine every day, but, since I already take daily medications for my blood pressure, that didn’t seem like such a negative.  Your potential treating physician should be able to help you understand the pros and cons of your treatment options.

Just as important, especially if you are having surgery is how much experience has your surgeon had with the procedure as well as the outcomes of the hospital for that kind of procedure.  I was initially evaluated by specialists at a local community hospital about 20 minutes away from my home.  I considered having my surgery there until I learned that the surgeon does only about 25 of these procedures a year and the hospital had a higher mortality with this kind of surgery than average.  Fortunately I live only 30 minutes away from a national center which also participates in my health insurance network.  Their mortality is better than average, and I had surgery by the chair of the department who does 300 of these a year.  Often your health plan will have some quality information about the hospitals and physicians in their network.  I used the information compiled on www.health.usnews.com to help me make my decision.

I hope these last four posts will prove useful if you are faced with new symptoms that might require surgery.  Please share your experiences with us!

For Your Health – Dr. Bob

Part 3 – When You Need Elective Surgery – Think Ahead!

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When you go to your doctor for some new symptom, realize that there will be a clinical process for your workup that could involve many steps, so think ahead!

I’m not suggesting that you will know exactly what tests will be necessary to evaluate your condition, but you can still think ahead.  In many instances, your PCP will have a pretty good idea what kind of treatment your symptoms will require.  In most cases, the tests he orders are done to confirm his suspicions.  With that in mind, if surgery is a strong possibility and you have a history of a chronic condition such as diabetes or heart disease, you may wish to schedule a pre-op evaluation by the specialist who cares for you for that condition.  Why?  Because these doctors are often very busy and you may have a long delay to get such an appointment.  At the very least check with the receptionist how quickly you can be seen if you need clearance before surgery.  In my case because of my heart history I knew I needed to be cleared by my cardiologist.  I also knew because I hadn’t had a recent stress test, he would probably want me to have that done prior to his giving me clearance. I was correct & getting these done added about two weeks to the process.

Next time I’ll discuss evaluating your treatment options to make sure you get the best care you can!

For Your Health – Dr. Bob

Part 2 – When You Need Surgery – Be Proactive!

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As you seek treatment for your problem, you will need to advocate on behalf of yourself on several levels:

  1. Make sure you know and comply with your health insurance rules and procedures – Do you need to get tests, referrals or procedures (even if they are outpatient procedures) preauthorized or precertified?
  2. Make sure you see physicians and use facilities that are in your health insurance provider’s Preferred Network.  Otherwise, your share of payments may be larger than if you “stayed in network.”
  3. Try to move things along as quickly as possible.  The people scheduling the tests & appointments are going to try to fit you in to the schedule where space allows.  If the test can be done at more than one location, you may want to ask whether it can be done sooner at a different location.  Similarly, some doctors practice at more than one office.
  4. If the appointment gets scheduled further out than you’d like, ask to be put on a waiting list.  That’s how I was able to get my thyroid removed 3 months earlier than it was originally scheduled.  Someone canceled a week before their operation & the surgeon’s office called me to see if I would like to take their place.  I had to scramble to get a few tests done, but I was able to do it and forego three months of anxiety while waiting for the original date.  I can relax.

Another non-medical reason to try to move things along could have to do with where in your insurance policy year you are and where you stand in regard to your deductible.  If you have already met your deductible for the year, your insurer will usually be paying a greater share of your health care expenses for the balance of the year.  Therefore, it may be financially to your benefit to get your surgery within this year rather than waiting until the following year. A full explanation is beyond the scope of this blog and really depends upon individual circumstances and health insurance coverage.  Next time we’ll talk about planning ahead!

Happy New Year!!

For Your Health – Dr. Bob

Part 1 – Know When To Seek Care & Act!

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About two weeks ago on December 9, I had my thyroid removed because it had enlarged and was pressing on my windpipe.  Though I am still waiting for the final pathology report, the results of the outpatient biopsy and the surgeon’s impressions were that this is not a cancer.  I first noted symptoms at the end of September 2011 and the workup took a little over 2 months.  Over that period of time I had 12 appointments for either testing or physician consultations. I think some aspects of my experience may be useful to help people in similar circumstances understand how best to use the healthcare system.

1. Pay attention to your body.

My symptoms were quite mild actually.  I started feeling a pressure against my throat as if someone was lightly pushing against my windpipe.  It wasn’t painful.  It was just different. My voice was also a little bit hoarse.

2. Understand the potential urgency of certain symptoms

As a doctor I naturally thought of all the things it could be, going from bad to worse.  Because it could start to affect my breathing, I set up an appointment with my PCP early the next week.

As a medical student, I was taught that about 80% of the reasons a person visits a primary care physician get better on their own.  But when you are having symptoms that can affect your breathing, heart beat, consciousness, or are causing an excessive amount of pain or a loss in how your body functions, you need to see a physician sooner rather than later.  For more on this topic check out this previous post, When To Get Care.

3. Get beyond the fear of the worst

The sooner a potentially lethal condition such as a cancer is diagnosed, the better are your chances for remission and potentially cure.  Ignoring symptoms does not treat the condition.  If it is a cancer, the delay gives it a chance to grow locally and spread throughout the body.  I know that this seems to be a very cold, scientific response to a situation that can be filled with emotions.  Everyone needs to work through these issues on their own.  But at this point, where a diagnosis has yet to be made, let your good sense take the lead and get a diagnosis.

In the next post I’ll share more about my recent experience and give you some things to consider if you ever are faced with a similar situation.  Meanwhile, please add your comments and experiences!

For Your Health – Dr. Bob