University Health System Blog

Dr. Shawn Tsuda answers the question: “Can you be considered obese if you have a normal body weight?”

If you are what is considered an ideal body weight, according to the Metropolitan Life Insurance tables from the 1940s, you will generally not be considered overweight or obese.

The Centers for Disease Control (CDC) defines being overweight and obese by a body mass index (BMI). BMI is a person’s weight in kilograms divided by their height in meters squared.

BMI is a better value for measuring a person’s weight compared to actual weight in pounds. This is because a 210 pound man who is 6 feet 6 inches tall is probably more lean than a 210 pound man who is 5 feet 6 inches tall.

The CDC defines a normal weight as a body mass index between 18.5 and 24.9. Overweight is between 25 and 29.9. Obesity is defined as a BMI greater than 30 and morbid obesity a BMI greater than 40.

The problem with body mass index is that it does not directly measure fat content.

However, it is still a valuable tool because for most people other than very muscular body builders or athletes, a BMI suggesting overweight or obesity means that medical problems and a shortened life expentancy comes along with it.

A diet and exercise plan and in some cases, surgical treatment for morbid obesity, can resolve medical problems, improve quality of life and avoid premature death.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Kate Martin answers the question: “What’s the significance of the spread between systolic and diastolic blood pressure readings?”

Blood pressure is measured through systolic and diastolic readings. An example of a normal value is 120 mmHg and 80 mmHg, often said as 120 over 80 and written as 120/80.

The numerator, which is the systolic value, is the peak arterial pressure reached when the heart muscle contracts.

The diastolic pressure, the denominator, is the residual amount of pressure in the arteries when the heart muscle relaxes.

The difference between the systolic and diastolic pressures is known as the pulse pressure.

The average person has a resting pulse pressure of 40 mmHg. This can become transiently elevated with exercise due to increased demands on the heart and blood vessels but returns to normal about ten minutes afterwards.

Persistently high or low pulse pressure can have serious health implications, however.

Most often encountered in situations of trauma to the chest or abdomen, a low or narrow pulse pressure usually indicates there has been a significant amount of blood loss. Other situations that can also cause low pulse pressure include congestive heart failure and aortic stenosis, in which there is a narrowing of blood flow through one of the major heart valves. In these circumstances, pulse pressure is often as low as 25 mmHg.

A common cause of consistently elevated pulse pressure is stiffness of one of the major arteries, such as the aorta. This may be the result of fatty deposits along walls of the arteries, known as arteriosclerosis, or a leaky heart valve. Other conditions that may cause this include hyperthyroidism, anemia and abnormal connections of arteries with veins called arteriovenous malformations. In general, a pulse pressure greater than 60 mmHg is considered abnormally elevated or widened.

Recent research has indicated high pulse pressure is a risk factor for the development of heart disease and arrhythmias. Treating high blood pressure usually helps reduce pulse pressure as well.

Kate Martin, M.D. is an assistant professor of family and community medicine at the University of Nevada School of Medicine in Las Vegas. She practices at the Family Medicine Clinic.

Have a health question? University Health System doctors answer select questions from readers like you.

KVVU-FOX 5 poses the question: Is the economy to blame for a recent rash of murder-suicides in Las Vegas? The city has witnessed four cases of murder-suicides in only two weeks. FOX 5 News turns to Ole J. Thienhaus, M.D., dean of the University of Nevada School of Medicine and a practicing psychiatrist, for his perspective.

Watch the video

(Original air date: Sept. 18, 2009)

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, please contact him by email or call 702-671-2230.

Have a health question? University Health System doctors answer select questions from readers like you.

From KNPR’s State of Nevada website: The health care debate has created ugly rhetoric about the government creating death panels about who should live and die. But how are those end of life decisions made now? Who makes the decision? What issues do doctors focus on in telling the patient and his or her family when further medical intervention is pointless? And what options are there to ease the pain or even speed up an inevitable death? We ask those questions of Dr. Misti Song of the University of Nevada School of Medicine.

Tune in to the radio program on Monday, Sept. 21 at 9am.

You can call in during the live radio show at 702-258-3552 or statewide toll-free 877-ASK-KNPR (877-275-5677) from 9-11am. You can also send an email with your question, comment or idea during the first hour. Include your first name and the city you’re writing from.

Listen to audio (available after live air date of Sept. 21)

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, please contact him by email or call 702-671-2230.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “What happens if I regain the weight I lose after gastric bypass surgery? Can the surgery be redone?”

Weight re-gain following bariatric surgery remains a concern for many patients who have had, or are considering, surgery for weight loss.

While weight-loss procedures – whether the gastric bypass, adjustable gastric band, or the sleeve gastrectomy – remain the best option for durable weight loss in patients with morbid obesity, regain of most or all of one’s preoperative weight is possible.

While the primary cause of weight re-gain can be from a gastric pouch that is stretched, a gradual re-connection between the remant stomach and “new” stomach, or a band that is too loose or malfunctioning, the most common reasons are poor behavioral choices.

Grazing for food, snacking, eating too close to bed time, lack of exercise, and lack of portion control are the common culprits.

This emphasizes the importance of having weight loss surgery-when indicated-in the context of a comprehensive program that has support groups, personal follow-up with the surgeon, and a committment to life-long care.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Kami Larsen answers the question: “I’ve heard fruit juice is bad for kids because it contributes to obesity. But it’s a good source of vitamins. What should I do?”

The amount of fruit juice consumed by children is definitely a contributing factor in our battle against childhood obesity. While in some cases it may be a good source of vitamins, typically the carbohydrate (sugar) content is far too high.

If parents want to ensure their children get vitamins in the diet, they should be focused on whole fruits and vegetables, not solely on juice.

In moderation (four to six ounces per day), juice can be acceptable, even helpful.

Parents should check the label to look at vitamin content and go for those that offer the most bang for the buck. Simply pumping 32 ounces a day of apple juice into a child is typically just giving them empty calories.

Kami Larsen, M.D. is a pediatrician at University Health System in Las Vegas, Nevada. Dr. Larsen is assistant professor of pediatrics at the University of Nevada School of Medicine and medical director of Kids Healthcare Clinic.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Gregory P. Brown answers the question: “What’s the difference between normal worrying and an anxiety disorder?”

Transient worry and concern over stressful situations is a normal response to life. When anxiety symptoms or worry begin to impair daily functioning, it’s possible that the normal experience of episodic worry may have progressed into an anxiety disorder.

Panic attacks, repetitive checking behavior, recurrent nightmares of trauma, or obsessive guilt, may indicate a more severe problem and should be assessed by a physician or therapist.

Gregory P. Brown, M.D. is an associate professor of psychiatry at the University of Nevada School of Medicine in Las Vegas. Dr. Brown is board certified in general psychiatry and forensic psychiatry, American Board of Psychiatry and Neurology.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Kami Larsen answers the question: “As a parent, what should I know about child immunizations?”

In my practice as a pediatrician, I encounter concerned parents every day. Many times their concerns are about common illnesses, diet and sleep patterns. Lately however the same question keeps recurring—How safe are my child’s vaccinations?

It’s a question I hear over and over and typically I can spend 30 minutes or more informing families about this. The truth is that in recent years the Web has made it easier for families to find information about vaccinations. The problem however is that not all of this information online is complete, accurate or up-to-date and some information can even be harmful to your child’s safety.

Most parents want to do what’s right for their child, and so do most pediatricians. In recent decades, vaccines have played an unbelievable role in decreasing the number of serious illnesses, hospitalizations and deaths in children. Without childhood vaccinations, thousands of kids each year would die from illnesses like measles, chicken pox and whooping cough. Due to this dramatic decline, many people believe that these illnesses that pediatricians vaccinate against have been wiped off the face of the earth. Unfortunately this simply isn’t true. We still have outbreaks of measles, pertussis (or whooping cough) and other vaccine preventable diseases. Just this winter (2007), Clark County (or metropolitan Las Vegas) faced an outbreak of mumps.

As parents we tend to have a false sense of security and assume that the miracles of modern medicine will keep our children out of harm’s way. For our parents and grandparents the reality of infectious disease is only a memory away. Before immunizations 20,000 cases of paralytic polio were reported each year. These epidemics left thousands of children in braces, wheelchairs and iron lungs.

Before measles immunization was available, now part of the MMR vaccine, nearly everyone in the U.S. got measles. What we tend to forget is that about 450 children each year died from the infection. Up to 20 percent of those infected with the virus are hospitalized and encephalitis with concurrent brain damage may result. Many of the cases we see today are a result of travelers visiting the U.S. and carrying the infection with them. In a city like Las Vegas, the number of visitors is large and outbreaks among residents who aren’t immunized are common.

Pediatricians also commonly see outbreaks of whooping cough, another serious illness. Unfortunately the most serious complications of this infection are in children. According to the Centers for Disease Control and Prevention, between 1990-96, 57 people died from pertussis—49 were babies (less than six months old). The coughing fits associated with the illness are so severe that many children can’t eat, drink or sleep. They may end up with pneumonia, seizures and even brain damage.

This is just the beginning of the story. Today our children are fortunate enough to have vaccines that prevent against several forms of meningitis, hepatitis, tetanus, chicken pox and other life-threatening infectious diseases. Many of these illnesses are viral and can’t be treated with antibiotics. I can’t count the number of times I’ve heard a parent say to me, “We all had chicken pox and survived.” The truth is not everyone who’s had chicken pox has survived. Disease that once were common aren’t today. That is the benefit of immunizations.

Despite this many parents recently have decided against vaccinating their children for multiple reasons. However more often bad information is behind these decisions.

There’s a misconception that vaccinations cause autism. It’s important to note that there has never been a scientific link between autism and childhood vaccinations. Many proponents of this theory blame thimerosal, a preservative commonly used in the past. In 2001 a recommendation to remove thimerosal from immunizations was passed. The only immunization currently in use containing thimerosal is the inactivated influenza vaccine.

Any medication has the risk of side effects and this holds true for vaccines. However, in general, the risks are minimal and the risk of a serious side effect are rare. Concurrently the risks associated with acquiring the illnesses I mentioned above outweigh those of immunizations.

It’s important that parents get accurate information and facts. Helpful information is easily accessed online at the American Academy of Pediatrics or from your child’s pediatrician.

As a mother of two, I’m faced with the same decisions as any other parent. Each day I fight to protect my children and help nurture them into happy and healthy adults. Don’t gamble with your child’s health. Talk about immunization with your child’s pediatrician today.

Kami Larsen, M.D. is a pediatrician at University Health System in Las Vegas, Nevada. Dr. Larsen is assistant professor of pediatrics at the University of Nevada School of Medicine and medical director of Kids Healthcare Clinic.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Jay Coates answers the question: “What can I expect before and after surgery?”

Few events in life create as much anxiety as having to undergo surgery. To help allay some of your anxieties with ‘going under the knife’ I’d like to offer some general guidelines for undergoing surgery with general anesthesia.

Consent

First of all, before surgery, you must have informed consent. Sounds obvious but some patients may feel too intimidated to ask their surgeon basic questions. What procedure is being preformed? Why is it necessary? Who will be doing it? What are the risks and complications associated with this surgical procedure? Surgery should not be taken lightly. Every surgical procedure has potential risks and complications. Among the most common are bleeding, infection and problems with general anesthesia. Your surgeon and you should review these risks and you should fully understand these risks before undergoing the procedure.

Pre-op clearance

The pre-op clearance answers the surgeon’s basic question of whether the patient is healthy enough to tolerate the surgery. If you’re young and in good general health the surgeon may clear you through with a physical exam. If you’re older or have health problems, your surgeon may want medical clearance from your internist or cardiologist. Your doctor will submit a medical report to your surgeon that indicates what risks, if any, you may encounter while undergoing the physical stress of surgery. If the risks are high your surgeon will discuss these with you and decide whether surgery should still be preformed or if an alternative treatment is a better option.

The night before

No food or drink after midnight the night before the day of the surgery. Patients often wonder why they can’t eat anything past midnight. The answer’s simple actually.

If you’re receiving general anesthesia, you’ll be intubated, meaning you’ll have a breathing tube placed during surgery. The medications that you’ll be given and the intubation procedure itself, could cause you to reflux what you ate the night before. If this happens you can experience aspiration while you’re under, meaning food or liquid from your stomach can come up and then go down the wrong pipe (trachea) and into your airways, possibly causing aspiration pneumonia. The risk of getting aspiration pneumonia is greatly reduced by having your stomach empty. You may have to take pre-operative antibiotics the night before or morning of surgery and perhaps even for a day or so after. These help reduce the chance of infection. There may also be some medications that you’re currently on which you must stop taking from the night before to two weeks before surgery. For instance, you shouldn’t take aspirin 10 days before surgery as it interferes with platelet function, as platelets help your blood clot.

Checking-in

The day of surgery you’ll need to check into the pre-op area of your hospital or surgical center. The nurses will have you change into a gown, place an ID bracelet on you, review any general questions you may have and check your informed consent document and medical clearance. You should be interviewed by your anesthesiologist, who will place you under general anesthesia and intubating you. You’ll repeat a lot of the same information to many different people but this repetition helps to eliminate mistakes. Your surgeon will usually see you before you go to the operating room. If you’re having a procedure like a breast biopsy or hernia repair, you may be asked several times by different people what side of your body the surgery is being done. Again this repetition helps cut down on medical error.

Regardless of the surgical procedure, you should feel confidence in your surgeon and have all your questions answered before surgery. The most common source of conflict between a patient and a doctor is lack of communication. If you don’t feel confident in your surgeon or your questions aren’t being answered, you should look for a second medical opinion and find a surgeon who will take the time to help you understand.

Jay Coates, D.O. is an assistant professor of surgery at the University of Nevada School of Medicine and vice chair of trauma surgery at University Medical Center in Las Vegas.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Laparoscopic gastric bypass versus the laparoscopic adjustable gastric band: Is one or the other better for long term weight loss results?”

The number of weight loss procedures performed over the past ten years has increased by more than a ten-fold in the U.S., exceeding 200,000 operations in 2006. The laparoscopic Roux-en-Y gastric bypass, which provides both restriction and malabsorption of food intake, is still considered the gold standard operation for long-term weight loss.

However, the laparoscopic adjustable gastric band, which uses one of two FDA approved devices for primary restriction of food into the gastrointestinal tract, is the second most commonly performed procedure and is quickly gaining in popularity. There is an abundance of data that supports both the gastric bypass and laparoscopic adjustable gastric band as safe (but not risk-free) procedures with sustainable weight loss and a positive impact on obesity-related diseases such as diabetes mellitus, hypertension and obstructive sleep apnea. (Learn more about weight loss surgery procedures from the U.S. National Library of Medicine).

The amount of weight loss that can be expected on average for the gastric bypass ranges between 60 and 80 percent of excess weight loss, or loss of weight beyond a calculated ideal body weight. The laparoscopic adjustable gastric band has a wider spectrum of success, ranging between 30 and 70 percent of excess weight loss.

Both operations are endorsed by most professional medical societies as acceptable treatments for the severely obese. The choice of operation depends on the patient’s preference, along with his or her surgeon’s counseling on any specific contraindications to either of the operations. An informed decision is essential to undergoing any weight loss procedure.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.