April 2018; 60:3 Pages 137–180 Bariatric surgery A nonsurgeon’s guide to bariatric surgery Bariatric surgical options and future directions Clinical assessment to determine suitability for surgery Prevention & management of complications after surgery ALSO IN THIS ISSUE Regional variations in access to orthopaedic care in BC www.bcmj.org 138 BC MEDICAL JOURNAL VOL. 60 NO. 3, APRIL 2018 bcmj.org April 2018 Volume 60 • Number 3 Pages 137–180 contents 141 Editorials Rain-birding, David R. Richardson, MD (141) My back pages, Timothy C. Rowe, MB (142) 143 President’s Comment The art and heart of medicine Trina Larsen Soles, MD 145 BC Centre for Disease Control Cyclospora infection: A tropical disease in our midst Eleni Galanis, MD, Linda Hoang, MD ON THE COVER Management of obesity requires Clinical Articles lifestyle modification counseling, diagnosis and treatment of psy- chological and eating disorders, THEME ISSUE: BARIATRIC SURGER teaching of coping mechanisms, medication use, and an assess- ment for bariatric surgery. When 146 Guest editorial: A nonsurgeon’s surgery is included in this ap- proach, patients can lose more guide to bariatric surgery than 70% of their excess weight. Sharadh Sampath, MD Theme issue articles begin on page 146. 148 Bariatric surgical options and future directions Ekua Yorke, MD 151 The BCMJ is published by Clinical assessment to determine a Doctors of BC. The journal patient’s suitability for bariatric surgery provides peer-reviewed clinical Ali Zentner, MD and review articles written primarily by BC physicians, for BC physicians, along with 156 debate on medicine and medical Prevention and management of politics in editorials, letters, and complications after bariatric surgery essays; BC medical news; career Jacqueline Chang, MD, Nam Nguyen, MD, Sharadh Sampath, MD, Nooshin and CME listings; physician profiles; and regular columns. Alizadeh-Pasdar, PhD Print: The BCMJ is distributed monthly, other than in January and August. 160 Regional variations in access to Web: Each issue is available at www.bcmj.org. orthopaedic care in BC Subscribe to print: Email Kevin Wing, MD, Alastair Younger, MD [email protected]. Single issue: $8.00 Canada per year: $60.00 Foreign (surface mail): $75.00 164 WorkSafeBC Subscribe to the TOC: Managing type-III acromioclavicular joint injuries To receive the table of contents Ben Jong, MD, Danny P. Goel, MD by email, visit www.bcmj.org and click on “Free e-subscription.” Prospective authors: Consult 166 Obituaries the “Guidelines for Authors” at Michael Moscovich, MD www.bcmj.org for submission Dr Charles Rally, requirements. BC MEDICAL JOURNAL VOL. 60 NO. 3, APRIL 2018 bcmj.org 139 contents BC Medical Journal 167 General Practice Services Committee Vancouver, Canada 604 638-2815 A mental health resource for all communities: The Salt Spring Island [email protected] Youth Suicide Intervention Toolkit www.bcmj.org Afsaneh Moradi 168 News Editor Facility Engagement: Relationships drive change, Sam Bugis, MD (168) David R. Richardson, MD PVD: It’s not in your head (168) Editorial Board Respect in the maternity ward, J. Stewart (169) Jeevyn Chahal, MD (169) David B. Chapman, MBChB Stories for Caregivers: Finding solace in a social platform Brian Day, MB Timothy C. Rowe, MB 170 Yvonne Sin, MD Council on Health Promotion Cynthia Verchere, MD Is current medical training preparing physicians to prescribe exercise Willem R. Vroom, MD to their patients? Managing Editor Kara Solmundson, MD Jay Draper Senior Editorial and Production Coordinator 171 CME Calendar Kashmira Suraliwalla Associate Editor Joanne Jablkowski 174 Billing Tips Copy Editor Audit red flag: Treating a family member or yourself, and billing for it Barbara Tomlin Lorne Verhulst, MD Proofreader Ruth Wilson Design and Production 175 College Library Scout Creative Finding clinical practice guidelines Cover Concept Karen MacDonell, PhD & Art Direction Jerry Wong Peaceful Warrior Arts 176 Classifieds Printing Mitchell Press Advertising 179 Club MD Kashmira Suraliwalla 604 638-2815 [email protected] ISSN: 0007-0556 Established 1959 Postage paid at Vancouver, BC. Advertisements and enclosures carry no endorsement of Doctors of BC or BCMJ. Canadian Publications Mail, Product Sales Agreement #40841036. © British Columbia Medical Journal, 2018. All rights reserved. No part of this journal may be reproduced, stored in a retrieval Return undeliverable copies to BC Medical Journal, system, or transmitted in any form or by any other means—electronic, mechanical, photocopying, recording, or otherwise—without 115–1665 West Broadway, Vancouver, BC V6J 5A4; prior permission in writing from the British Columbia Medical Journal. To seek permission to use BCMJ material in any form for tel: 604 638-2815; email: [email protected]. any purpose, send an email to [email protected] or call 604 638-2815. Statements and opinions expressed in the BCMJ reflect the opinions of the authors and not necessarily those of Doctors of BC or the institutions they may be associated with. Doctors of BC does not assume responsibility or liability for damages arising from errors or omissions, or from the use of information or advice contained in the BCMJ. The BCMJ reserves the right to refuse advertising. 140 BC MEDICAL JOURNAL VOL. 60 NO. 3, APRIL 2018 bcmj.org editorials Rain-birding y the time this editorial is to patients describe seasonal affec- matter the time of day or night. I re- published I will have surviv- tive disorder, I would think to myself, turn solar satiated but filled with dis- Bed another winter. Now, don’t nope, not me. I certainly don’t remem- gust and self-loathing of my gluttony. get me wrong, I love living in British ber lying around as a teenager (well, Looking for an alternative, I attended Columbia and particularly the Lower yes, I do, but that is just a side effect a cycling camp in sunny California Mainland. I have called it home since of being a teenager) thinking about the this past February. Daily guided rides preschool, and love the people and rain and hoping it would stop. offset the evening gorging and calorie beauty of our province. I can’t imag- fest so I at least returned home weight ine residing anywhere else. I have I intend to fine tune neutral but not without a few tender taken care of numerous retirees who my winter escape plan as areas. disappear around November only to I don’t think my late onset Moving forward I intend to fine reappear in my office the next April. tune my winter escape plan as I don’t seasonal affective problem These snowbirds escape winter by think my late onset seasonal affective fleeing to warmer destinations. I re- is likely to resolve. problem is likely to resolve. In fact, member thinking that if I were retired I anticipate some worsening as the I wouldn’t have a need to go south and So, what to do? I don’t feel my years go by. would spend my time enjoying all the symptoms merit medication, and Lastly, if you think about it, fabulous local activities. However, sitting in front of a light box would shouldn’t retirees who leave Vancou- over the years I find myself dreading detract from couch surfing and Net- ver from November to April really be the onset of another Vancouver winter. flix bingeing. Therefore, I decided called rain-birds? It’s not that I’m afraid of being wet or to build sun breaks into my winter —DRR cold (I realize we are waterproof and schedule. Thankfully, I have the fi- I can always put on more clothes) but nancial means to get on an airplane find the seemingly endless dreary, wet, and head to sunnier destinations. I am and grey days harder to tolerate with still working out the details, as all- each subsequent year. I become less inclusive vacations to places such as motivated and slightly irritable. My Mexico nurture my inner 300-pound energy plummets and I drag myself alcoholic who can’t seem to refuse around. Previously, when I listened any offered beverage or food item no DESIGN A SPACE THAT REPRESENTS YOUR PRACTICE THINK FUSION FIRST DISCOVER MORE AT GOFUSION.CA CALL US: 604 629 0469 BC MEDICAL JOURNAL VOL. 60 NO. 3, APRIL 2018 bcmj.org 141 editorials My back pages was a heckuva year, natal mortality rates in the province by EEG findings. Thinking back to 1971 as George W. Bush and pediatric bed utilization. The only those glory days, radio-immunoassays might have said. Justin Trudeau was article in 1971 that described a study had limited availability; steroid hor- born in 1971; so too were Elon Musk, with a prospective design was one re- mone assays were performed using Amy Poehler, and Pavel Bure. So, porting the effects of different forms colorimetry in large-volume urine too, was Greenpeace. As if that wasn’t of exercise on cardiac rehabilitation collections. Antibiotics had barely enough, 1971 was the year in which I in 14 men after myocardial infarction. reached a second generation. The graduated from medical school. That The authors noted that the average at- management of cancer was aggressive was 47 years ago, and medical prac- tendance of participants for the exer- and grim. How did we manage? tice was … different. cise programs was more than 95%, in Well, medical practice relied on In 1971, the BCMJ was already 12 contrast with the dropout rate of 50% a basis of theoretical knowledge fol- years old and had become an essen- in such programs elsewhere, and pro- lowed by an accumulation of clini- tial part of provincial medical life. The grammed exercise resulted in signifi- cal experience. The older you were, pages of the BCMJ at that time includ- cant improvements in physical work the more you had seen.