by Cori Smelker
photos by Ivan Ramirez
Much has been made in the media lately about the fiscal cliff that our nation has to
face. But there is another cliff, one that has not been mentioned often, but one that Dr. Manish Singh is intensely concerned about. That is our health and wellness cliff, and more specifically the issue of type-2 diabetes.
Dr. Singh, who is the Medical Director at Doctors Hospital at Renaissance Bariatric and Metabolic Institute (BMI), makes no bones about what causes type-2 diabetes. “You are not born with it,” he explains. “It is caused by obesity and bad eating habits.” Type-1 diabetes is genetic, and people are born with it; but type-2 is linked directly to obesity. According to the American Medical Association, anyone with a BMI (Body Mass Index) of greater than 30 is considered obese.
It gets worse. According to Dr. Singh, the national average for type 2 diabetes is close to seven or eight percent. Doctors already consider that high, and definitely far higher than it was even 10 or 15 years ago. The worst countries in the world see type-2 diabetes in nine to ten percent of the population. “Valley Endocrinologists put our statistics at 30 to 40 percent. That is three or four times higher than the worst coun- tries in the world. That is not an epidemic, that is an emergency.” Dr. Singh exclaims.
But all is not doom and gloom. There are some very positive steps that can be taken, and Renaissance BMI is here to help. Two studies conducted earlier in 2011 and 2012 by the Cleveland Clinic, one of the largest research facilities in the country, prove conclusively that with surgery and medical therapies, type-2 diabetes can be reversed. Bariatric surgery is surgery that reduces the size of the stomach with gastric banding, or by re-routing the small intestines to a small stomach pouch (gastric bypass surgery) or through use of a gastric sleeve.
This is where the expertise of doctors like Dr. Belinda Jordan come into play, ac- cording to Dr. Singh. “Dr. Jordan is a board certified bariatrician. She has a unique perspective that really helps patients, as she underwent bariatric surgery in 2005.” She provides medical weight loss services as well as the preoperative and post-operative care for the bariatric surgery patient.
“You see, the biggest problem for patients has been poor outcomes after surgery, or weight regain,” Dr. Singh says. “We personally feel that there has not been proper follow up. It is not a case of just having the surgery and one week later you are done. You need a long term follow up. So at Renaissance BMI, we have devised a 5-year program or contract that we have with our patients. We follow up with the patient for at least 5 years after surgery.”
In the first year, the patient comes in four or times and sees not only the sur- geon, but also the bariatrician, the dieti- cian, and the exercise physiologist. They can join support groups too. The follow up plans are designed around the needs of each patient. In the second year, they are seen three times, and then on an annual basis thereafter. As a result of this, the success rate should be about 75 percent.
Why are the doctors and especially Dr. Singh so invested in this? The answer, for them is simple. The rise in type-2 diabetes in patients as young as 15 is alarming. The larg- est population of type-2 diabetes patients is between the ages of 20-40. “These are the most productive members of our commu- nity. If they have complications from diabe- tes, such as kidney failure, blindness, or even amputation – the productivity of the whole community, of society goes down. It has a di- rect impact on the community’s growth. Tak- ing care of diabetes through bariatric surgery means we are increasing productivity.”
Dr. Singh recalls a specific event from November 2011. He came to the Valley as a surgeon, and one of his early cases was a limb amputation on a 29-year old man. He had been a type-2 diabetic for 12 to 15 years. Due to not taking care of his diabetes, he now faced amputation. Dr. Singh clearly remembers his feeling of horror. “It was
shocking to me that someone so young would now be on disability. Instead of be- ing a productive member of society, and contributing to the system, he is now on government aid and a strain on the system.”
Then he realized there were so many other young people in the same boat. “There are these young people, and they should be work- ing, playing, getting an education, but they are hooked up to a dialysis machine, or have an amputation, or are blind to a certain degree. Or they are injecting insulin, which means the disease is so advanced, simple medications are not enough for them any longer.”
Rather than just throw up his hands in frustration, he and other doctors rolled up their proverbial sleeves and got to work. “I know from experience that metabolic surgery can impact people positively. It is great to see someone who is on several medications, or in- sulin dependent to come off all their medication,” he states happily. One success story is a 50-year old man who was on 370 units of insu- lin a day (most patients can average about 20- 50 units a day), and who underwent bariatric surgery. In 6 months he lost 100 pounds. But the best part is he is completely off all insulin. All he takes is a daily vitamin pill!
When asked whether the problem is daunting, Dr. Singh acknowledges it is mon- umental. But he is quick to add that surgery and intense follow up will benefit patients. However, national averages show that only 1% of likely candidates get surgery. In the Valley the number is even lower. The main reason cited is no money, or no insurance. But if a patient does have medical insur- ance, whether state or private, the surgery is often covered, if the primary care doctor informs them that the surgery is medically necessary. Most insurance companies re- quire a letter of medical necessity from the weight loss surgeon and the primary care physician before approving the procedure.
Even if a patient does not have health in- surance, Renaissance BMI is able to help.
For more information, contact the Bar- iatric and Metabolic Institute at 956.362. LOSE / 956.362.5673