Archive for June 2016

Is surgery really the best option to treat obese diabetics?

In 1993, MTV’s new hit reality show The Real World: Los Angeles was in its second season.  During that season Tami Akbar Roman famously had her jaw wired shut in an attempt to lose weight.  From her perspective it was a simple enough idea, if she can’t eat food, then she should lose weight, right?  It was one of the first of a long line of reality show TV stunts that are all too familiar today.  Twenty three years later, I’m sad to say that a panel of international experts on diabetes has recommended something very similar as their preferred treatment for obesity in diabetics.  They go on to extend these surgical recommendations all the way down the line to diabetics with class I obesity (BMI of >30kg/m2) who have poor glycemic control.  That means a 222lb man standing 6 ft tall with poor blood sugar control on medications should consider bariatric surgery as his next best option.

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

Even in 1993, long before I started my medical training, I understood that physically preventing food from entering the body was a poor way to lose weight and become healthier.  It must start with a change of heart and an improvement in understanding.  A point that Tami was happy to prove for me as she attempted to take all her normal foods and puree them through a blender.  I seem to remember a cheeseburger slurry showing up during one of the episodes.

That’s the story with so many patients who undergo surgical weight loss.  Without the change of heart and change of understanding, the recidivism rate is quite high.  Lest you think I’m pointing a finger, let me explain that I understand their dilemma all too well.  I teach nutrition.  I treat diabetes.  I see the heartache and pain associated with blindness, kidney failure, amputation, and neuropathic foot pain and yet I still really like Double Stuf Oreos. “Like” is too soft a word.  I long for Double Stuf Oreos.  Every summer I’m tempted mightily by these wonderful little chocolate promises of happiness.

Don’t give up what you want most for what you want now

What are we to do?  How do we change?  How can we go from surgically altering our bodies in an attempt to irrevocably force limited food consumption to choosing life-giving options that promote our wholeness physically, emotionally, and spiritually?

For me, I believe it starts with a change of my heart and a change of my understanding.  I’ve learned more about nutrition in the last 15 years then any other medical topic.  My understanding has been refined through trial and error in my own life as well as when I work with patients through their struggle.  This self-education was fostered by friends as early on as medical school and continues to this day as my fellow Trinity physicians and clinicians challenge me with new research.  I love being part of a practice culture that works so hard with individual patients in their understanding of how nutrition shapes health.  The continual education and re-education of nutrition has been the easy part for me.

Love… faithfulness, and self-control

As Paul fought against Jesus’ calling in his life so too does my heart still kick against the goads of my soul.  I am coming to believe more that for us to truly change our behavior in nutrition, among many other areas of lives, we must first change our heart’s desire.  I recently heard it said that you “Don’t give up what you want most for what you want now”.  Similarly, in Galatians 5:22-23 Paul pens the fruit of the Spirit as love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control.  I believe that if my love is rightly fix on something worthy of that love, if what I want most in my life is the growth of that love relationship, then the natural outcome will be the fruit of the Spirit including faithfulness and self-control.  Faithfulness in choosing well when someone else’s interests are at stake (ie, how I parent, how I practice medicine, how I treat my neighbor, etc…) and self-control in choosing well when only my own interest’s are at stake (ie, what I eat, how I exercise, my personal time, etc…).  (Notice that fruit is singular not plural.  That’s important because the fruit comes as a single unit not multiple fruits from which we get to pick and choose those that taste good while avoiding those that are unpleasant to us.  We produce these traits as a collective whole.)

So that begs the question, “What should I love?”  If the direction of my heart’s affection changes the choices I make and how I live my life, then what should be my heart’s desire?  There is only one thing worthy of your love and worship.  It isn’t health, or your family, or your self-image, or even the promise of less pain in your life.  It isn’t the hope of a cured cancer or the re-opening of clogged arteries that is worthy of our utmost desire.  Only God is able to receive worship properly.  Paul writes to the Corinthian church, “whether you eat or drink, or whatever you do,  do all for the glory of God.”  When our first thought at every intersection of our lives is “how do I glorify God in this situation?”, then we fundamentally start changing the things we do.  Our choices are now informed by a true and perfect set of guidelines that lead to our ultimate good.  They very often lead to our physical good, a healthier or more functional body, but that isn’t their goal.  The goal of our actions is to glorify God.  In that power, we can choose well the foods we eat or avoid.

Biblical counseling is nutritional counseling is Biblical counseling.

However, the fruit of the Spirit isn’t the fruit of my spirit but the fruit of THE Spirit.  It is God’s Spirit dwelling in me to grow in faith and love of God Himself.  It is much deeper than following a 12 step program of reform.  It is much more fundamental than even just adhering to the 10 commandments of scripture as though they are highway guard rails that keep us pointed in the right direction hopeful that we might finish the race before we screw up too badly.  Instead, we are to be driven by the hope within us in Christ’s finished accomplishment.  As God works in our lives, His fruit is produced.

Trinity’s Biblical counseling program was built on this foundation so that we can help our patients understand what their heart’s desire should be.  We saw the need to help our patients understand the hard moments of their lives in the light of God’s worthiness to receive worship.  It was only natural for us with this counseling mindset to extend our help for patients into the area of nutrition and exercise with our VitalSigns program.

I urge you as we all walk together through your life to reach out to us and begin to understand the choices that will truly fulfill you.  Please call us at 539-0270 to set up an appointment with your physician or clinician to begin this discussion.  Call and set up an appointment our Biblical Counselors or our Medical Nutrition Management clinicians to start addressing the fundamental issues that shape our lives.  Don’t let another set of superficial, hollow medical guidelines lead you further away from the truth.

-mbm

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Direct Primary Care hates reading…

…in the waiting room because the doctor is running late (again)!

In the DPC model of care, I get to spend more time with each patient.  I don’t have to try and polish my skills at polite interruption because I have other patients waiting.  Instead, each visit is long enough to cover the majority of concerns a patient my have.  If not, we can easily prioritize which concerns to cover and schedule a follow up visit (again, with no per visit fee) to address the rest.  That means I can stay on time virtually all of the time.  Many of my DPC patients don’t even have the chance to sit down in the waiting room before being shown to their room and I’m ready to walk in as soon as they are settled.  I love this model of care and I think my patients do too.  I do feel sad for all the leisure reading my patients will miss out on while waiting in my lobby.

If you’re interested in learning more about Trinity’s Direct Primary Care program, then send me an email at mbmccoll@secure.trinitymedical.net or call my DPC coordinator, Mel Moss, at 244-1800.  We’d love to talk to you more about the program and explain how it can benefit you and your family.  When you’re ready to experience the Direct Primary Care program you can sign up at Trinity Direct Primary Care Sign Up.

mbm

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Direct Primary Care June Newsletter

Direct Primary Care News

There are lots of important happenings this summer for Trinity’s Direct Primary Care!

  • Tennessee’s Health Care Empowerment Act goes into effect July 1st.  We’re very excited to be able to offer Direct Primary Care to all Tennesseans this year.  With this Act, patients covered by Medicaid or TennCare will now be able to take advantage of DPC programs.  Previously, TennCare refused coverage for any services or prescriptions written by a non-contracted physician.  Patients seeking care from a DPC physician would not be eligible to use any of their TennCare insurance benefits.  This law allows for these patients to have TennCare approve and cover orders, prescriptions, and services for which they are already eligible in the normal fashion instead of denying care.  More care equals a healthier Tennessee.

Out of the office dates:  Converting to DPC has been a tremendous challenge but has yielded so many rewards.  One of them is the ability to spend more time with our families free from the burden of bureaucratic paperwork.  Here are the dates we’ll be out of the office this month.

  • Dr. Hone is out the office June 6th through 10th.  Her nurse practitioner, Sherrie Corgan, FNP, will be covering all of the Maryville DPC patients that week.  Dr. McColl will also be available in the Knoxville office if needed.  Dr. Hone will not be checking email while she is out.  Please contact the Maryville office at 982-0835 for any patient needs.
  • Dr. McColl is out of the office June 20th through 24th.  Dr. McColl’s DPC patients may utilize Trinity’s Walk In Clinic that week for urgent needs with visits and services being covered under the same terms as their membership.  Office visits will carry no per visit fee with labs and procedures billed at the usual DPC rate.  Dr. Hone will be available in the Maryville office if needed.  Please contact the main office at 539-0270 for any clinical needs.  Dr. McColl will not be checking email while he is out.
  • As always, DPC patients can contact Mel Moss, DPC coordinator, at 244-1800 for any administrative or billing questions.

Moving on up!  Both DPC offices are hard at work renovating their new office spaces to better serve  DPC patients.

  • Trinity Direct Medical Care, the official name of the new Maryville office, has plans to open the new office during the week of June 13th!  The new location is right down the hill from their other office and is located at 1515 E. Lamar Alexander Parkway.  Patients with appointments scheduled that week will be notified at their appointment reminder of the location change.  Once they are open for business, they will be publishing their new phone and fax numbers.  Until otherwise notified, please continue to use the current number, 982-0835, for any patient needs.
  • Trinity Medical Associates of Hardin Valley is in the home stretch of renovations.  For the next couple of weeks, there will be a flurry of activity on site including exterior painting and stone work, concrete driveway pouring, and even the installation of a new fire hydrant as they look towards opening in July.  For those who haven’t seen the new location please feel free to drive by.  It is located at 10437 Hardin Valley Rd and is 0.5 miles east of the Pellissippi Parkway intersection.  They will be keeping the main DPC number of 244-1800 as the new office number
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