Q: My sister-in-law is 55 and morbidly obese. She can't walk very well, so she had bariatric surgery and then later she's having a knee replacement. Is that double barrel surgery really necessary? - Belinda, K., Chattanooga, Tennessee
A: Having bariatric surgery before a knee or hip replacement is not uncommon for obese patients. In fact many times a surgeon will refuse to operate on a morbidly obese patient (with a BMI of 40 or more or 100 pounds or more overweight) until they lose substantial weight. That's because morbid obesity is associated with poor postoperative outcomes after total knee and total hip replacement.
Before joint replacement surgery, if movement is impaired because of severe joint pain and erosion, it's hard to exercise and shed pounds. That just compounds the health challenges associated with having obesity. After a joint replacement, obesity makes it difficult to do the post-op therapy needed to make the operation a success.
The bottom line is that bariatric surgery is a very effective way to lose weight before a knee or hip replacement. It can reduce post-joint replacement hospital stays and cut the risk of post-op complications, while improving overall patient health. In one recent study, researchers in the U.K. tracked 7,400 obese individuals who had bariatric surgery and found that it reduced their risk for a major adverse cardiovascular event by 59% compared with a control group.
The benefits don't stop there: Bariatric surgery also results in the remission of Type 2 diabetes because of enforced caloric restriction, enhanced insulin sensitivity and increased insulin secretion. Thirty percent of overweight people have Type 2. And obesity is thought to account for around 85% of cases of Type 2 diabetes.
So there you have it. Besides giving your sister-in-law the chance of a shorter and more effective rehab after her joint replacement, bariatric surgery can boost heart health and can result in remission of Type 2 diabetes.
Q: I went to the hospital because I had a sore throat and fever, and it felt like my chest was on fire. Luckily, my test for COVID-19 came back negative. I feel bad that I took somebody's spot in the emergency room. What should I have done differently? - Alex G., Portland, Oregon
A: This time of year, colds, flu, allergies, fevers, sore throats and coughs are common. Symptoms can overlap with those of COVID-19. So, if you have fever, chills, a sore throat, trouble breathing or digestive woes, your first step should be to call your doctor's office for a phone consult (don't go in). Then find out if your area has drive-thru COVID-19 testing stations (they may also test for flu and respiratory syncytial virus - RSV).
You should go to the ER or call 911 if you develop what the Centers for Disease Control and Prevention calls emergency warning signs:
- Trouble breathing.
- Persistent pain or pressure in the chest.
- New confusion or inability to arouse.
- Bluish lips or face.
If you don't have those symptoms but feel generally lousy, stay home and self-isolate. If you have had a test, wait for the results. Since the virus can be transmitted by someone who doesn't show any signs of infection, your family members should be strictly social distancing until they know if they're developing symptoms too. Symptoms may appear in two to 14 days after exposure.
The CDC says that if you have or highly suspect you had COVID-19, you can end your self-isolation when:
- You have had no fever for at least 72 hours (that is three full days of no fever without the use medicine that reduces fever); and
- other symptoms have improved (for example, your cough or shortness of breath have improved); and
- at least seven days have passed since your symptoms first appeared.
One caveat: A new study says patients treated for mild COVID-19 infection still have sheddable coronavirus for up to eight days after symptoms disappear, so stay tuned, if recommendations change.
Distributed by King Features Syndicate, Inc.
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