Q&A: Weight Loss Surgery; Blood Pressure Medication; Tick Bites
Q. Can weight loss surgery help my osteoarthritis? I’m considered obese by BMI (body mass index) standards.
A. If you’re obese, you’re three to four times more likely to have knee osteoarthritis than people of normal weight. Excess weight adds stress to weight-bearing joints, such as hips and knees. Osteoarthritis develops when cartilage, the material that cushions the ends of bones at the joints, deteriorates, causing bone to rub against bone. In addition, it’s thought that obesity is an inflammatory condition; fat cells secrete cytokines, which produce inflammation. That inflammation can affect your joints, causing pain.
It’s known that losing weight relieves pressure on joints. If you cannot achieve weight loss through diet and exercise, bariatric (weight loss) surgery may provide relief and improved health for you. The surgery is usually considered for people with a body mass index greater than 35 (obese) who have a concurrent medical condition, such as diabetes, high blood pressure, sleep apnea, or arthritis.
There are several types of bariatric surgery, but two are more favored: gastric bypass surgery, in which the stomach is reduced by about 95 percent and the small intestine is reconnected to the now-smaller stomach pouch; and sleeve gastrectomy, in which the outer part of the stomach is removed, reducing it in size; bypass is unnecessary. Weight loss occurs because the stomach is smaller and appetite is less—hunger hormones in the stomach are reduced due to the smaller stomach. Both procedures are minimally invasive, with major complications low.
Q. At what point should a person start taking medications to control blood pressure?
A. There are more factors to consider than just the top (systolic) and bottom (diastolic) numbers that appear in your blood pressure reading. By American Heart Association standards, a healthy/normal blood pressure is less than 120/80 mm Hg; pre-hypertension is considered between 120 and 139 systolic and 80-89 diastolic; a reading of 140/90 mm Hg or higher is considered hypertension.
Some experts think that treating mild hypertension with medications has unclear benefits; another study shows that treating early hypertension (140-159 mm Hg/90-99 mm Hg) can reduce the short-term risk of dying from stroke or cardiovascular disease. And recently, changes in treatment guidelines recommend that older adults with a blood pressure reading up to 150/90 mm Hg may not benefit from aggressive medical treatment to reduce their blood pressure to a more healthy range. In addition, treatment comes with a risk of side effects, such as fatigue, leg cramps, hacking coughs or dizziness.
If you’re in the prehypertensive range, or just under the 150/90 level, consider non-pharmaceutical ways to lower your blood pressure. Following the DASH diet eating plan (Dietary Approaches to Stop Hypertension), which emphasizes fruits, vegetables, whole grains, lean proteins, and reduced sodium intake, along with daily exercise of 30 to 60 minutes, can go a long way toward weight loss and a healthier lifestyle, and maybe even preclude the need for blood pressure medication.
Q. A friend was recently bitten by a tick and has been having some cognitive problems and complications ever since. Can these symptoms be reversed?
A. A number of common infections can affect the brain, including Lyme disease (derived from an infected tick bite), encephalitis, meningitis, abcesses in the brain or spinal column, West Nile fever, and babesiosis. These infections can sometimes lead to permanent brain damage by causing pathological changes in brain tissue, or by triggering an immune response with inflammation that damages brain tissue, or promoting toxic levels of the neurotransmitter glutamate that leads to disruption and death of brain cells. However, medications such as antibiotics and anti-inflammatories, hydration, pneumonia prevention, and, sometimes, surgical drainage or scraping of infected tissue can relieve these problems and lower the risk of permanent damage. It’s important to be alert to the primary source of these infections, if possible, to aid treatment.
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