All Posts tagged VitalSigns

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.



Coming Soon: Trinity Medical Associates of Hardin Valley

I am pleased to announce that Trinity is in the final stages of developing a satellite office in Hardin Valley.  I plan on opening in January 2016 and will be staffing this clinic full time.  Being board certified in both Pediatrics and Internal Medicine, I’m excited to be able to provide a full spectrum of primary care services to all ages of the Hardin Valley community.

I have wanted to develop this office for many years.  Having grown up in Farragut and lived in Hardin Valley for a total of 11 years, I have longed desired to have a small community focused clinic that serves my neighbors.  The building is just a couple blocks down Hardin Valley Road from Trinity’s wellness center, VitalSigns.  I think this proximity will add to Trinity’s ability to focus on the patient as a whole person.  Caring for a person’s medical and spiritual needs as well as providing them the ability to learn better nutrition and physical fitness has become the hallmark of Trinity’s treatment paradigm.

This office will operate in a unique way that continues Trinity’s mission to break down the two barriers patients most often have to obtaining quality primary care: high cost and limited access.  Over the years, Trinity has innovated new ways to lower the cost of health care.  We’ve done this with individuals, within local corporations, and now, with the opening of our Hardin Valley office, for an entire community.

Additionally, Trinity has long held that patients should have easy access to their physicians and staff.  We’ve developed better ways over the years to allow more simple communication avenues.  Most recently, the patient portal allows patients to directly contact the clinical staff.  I want to innovate this access one step further.  A conversation about a patient’s concerns should be able to evolve using whatever means make sense: a phone call, an email, or an office visit as necessary.  Not all good care has to take place in an exam room and leave you with one less arm and leg on your way out.  I’ll explain more about this unique practice model in another post.

I know change can be hard and, unfortunately, this move will not be beneficial for all of my patients.  I know some patients will join me but many will not.  It’s the part I’ve dreaded for the three years I’ve been working on this project.  For those patients wishing to stay at the main office at Fort Sanders West we have a transition plan that should allow you to smoothly establish with one of our physicians without interruption in your care.  I don’t know of a better way to continue to seek the best possible medical care for my patients then to entrust them to my fellow physicians at Trinity.  They are to whom I entrust my own family’s care.

I’ll be posting more information about the new office as it becomes available as well as the unique model of practice I will employ.




Children aren’t little adults and adults shouldn’t be big children

During my training in medical school and residency I often heard well meaning friends and family members mention that the specialty of Pediatrics should be easy because, after all, children are just little adults.  The assumption was that kids and adults have the same set of problems.  In reality, kids have their own unique set of illnesses and health concerns.  They need their own unique approach to health.  Through my work in the ICU, the emergency room, and in outpatient clinics I have seen time and again that children are not just little adults.

The corollary to that statement is also true: adults should not be big children.  We are continually faced with a culture who tells us anything we choose is okay and anything we want can be ours.  Rarely do we hear the truth that our choices have consequences both natural and otherwise.  We cannot expect good outcomes from bad decisions.  We try to teach our children this but sometimes fail to grasp it ourselves.

I want to encourage my adult patients to stop saying things like “I can’t” or “I don’t like”.  We won’t accept our children telling us “I don’t like broccoli, being outside, taking my medicine, or going to bed on time” when we know that they need it for their own good.  We won’t allow our children to say “I can’t do my homework, go for a walk, or eat an apple.”  We tell them “You can and you will.”  Then we encourage them and teach them how to choose wisely.  We want our children to grow up and mature in order to make wise decisions for themselves.

Here at Trinity Medical Associates we aren’t going to accept those excuses either.  We are going to challenge you every time we hear you say “I don’t like” or “I can’t”.  We know you CAN be better than that and that you ARE better than that.  We aren’t going to just call you out and tell you to grow up.  We are going to encourage and teach you how to make those decisions.  We are going to walk with you through every step and hurdle.  We have built our wellness division, VitalSigns, to do just that.

Come talk to us about VitalSigns or go check it out on your own.  There is no other place in Knoxville that offers the community a chance to learn how eat and exercise in a way that truly cures disease.  We have Nutritional Counselors, Personal Trainers, an Exercise Physiologist, Nurses, and Physicians all working together to show you that “You can and You will!”



Free t-shirts and free exercise?!?!?

If you want a good reason to go exercise then here it is.

Come work out at VitalSigns 30 times in November and December and get a free t-shirt. If can make it 45 times in those two months we’ll pay for your January membership.

VitalSigns as a division of Trinity Medical Associates specializes in helping people get exercising without getting injured. Our ultimate goal is overall health and wellness so as to be good stewards of our bodies.

Come join the challenge!